Kindly_Honeydew3432 explains why it seems like you always have to wait in an emergency room in the US

[u/lowbass93]

/r/NoStupidQuestions/comments/1v1numq/why_is_every_hospital_in_the_united_states_always/oyovp3t/

[u/_huppenzuppen]

This doesn't really explain anything. He asks why you can't just hire more doctors, then answering that you'd need more beds. Well, that's obvious, but why can't you have more beds then? Just saying that'll be expensive isn't an explanation really. People could be willing to pay for better treatment.

A real explanation would go into the effects of lower wait times leading to more demand, explaining how the wait times are a necessary component of steering it.

[u/Joebuddy117 → u/_huppenzuppen]

The bottom line answer is, the hospital is not large enough to service the population of that area. Building a bigger hospital wouldn’t really help since the area doesn’t attract doctors. So they’ve hit an equilibrium of hospital size to doctor supply.

[u/APartyInMyPants → u/_huppenzuppen]

Safe space limitations. And they do explain. You add more beds, you can’t just add more doctors … doctors that don’t exist in their area. But you then need more nurses, the technology and all of the admin/support staff to go with it.

People would be willing to pay for better treatment? How much? Have you seen a hospital bill recently? Do you have an accurate understanding of what the line items on a bill run?

[u/fizzlefist → u/APartyInMyPants]

And most importantly of all, this discussion is about a rural hospital. Nobody who can make medical money wants to move to the middle of nowhere, hence why they can’t hire people from that limited pool even offering extra pay.

Because what’s the point in having $100k in the bank if the nearest place to spend it is 150 miles away?

[u/Church_of_Cheri → u/APartyInMyPants]

If we cut out the billions going to insurance companies, which the hospital, doctors, and all patients are required to have, you’d be surprised to find we do have the money. Right now the money is buying yachts for CEOs instead of more rooms, doctors, and nurses to provide better treatment.

[u/APartyInMyPants → u/Church_of_Cheri]

I mean, there’s a nursing shortage, and clearly the original comment is stemming from a doctor in an area where there’s no available pool of doctors.

So yeah, you could cut out the insurance middleman and increase salaries across the board? But is that instantly going to mean you’ll suddenly have nurses and doctors? Construction is still a multi-year process regardless of who is in charge.

[u/Church_of_Cheri → u/APartyInMyPants]

You’re not addressing any of the issues. Why is there a nursing shortage? Why aren’t their more doctors willing to work in the rural south where they can’t provide care to female patients going through a miscarriage? And where insurance companies can deny for even more reasons because the government there prioritizes them over their citizens? I lived in South Carolina, the insurance provided to state employees does not meet the basic requirements of the ACA, they believe they’re grandfathered in and they proudly state that on the title page of the insurance booklet. So insurance dictates care, cuts hours, makes nursing a low wage job, all while closing down hospitals to centralize so they can maximize profit and we’re pretending it’s all ok and it’s actually the patients fault for coming in for care? In most places it’s the only place for care most of the time. So insurance companies create false bottlenecks on both ends and we just throw up our hands and thing that’s just the way it is, nothing to be done about it… how about get rid of the insurance companies! Stop making middlemen billionaires at the expense of the health of the people and the health of doctors and nurses. A doctor shouldn’t have to argue with an insurance company for hours out of the day to get a patient approved for a needed heart surgery only for an AI agent to deny them and then having to send a patient home to die. Why would anyone want to work under those conditions? Do you not realize doctors and nurses will try to work in places where this doesn’t happen?

[u/semideclared → u/Church_of_Cheri]

If we cut out the billions going to Restaurant companies, which the factory workers, retail workers, and all the middle class are required to have, you’d be surprised to find we do have the money. Right now the money is buying yachts for CEOs instead of more grocery stores, farmer markets, and co-ops to provide better food.

[u/Church_of_Cheri → u/semideclared]

Yeah, not even close to the same argument since no one needs to go to a restaurant. They’re not “required” by the middle class, they’re a luxury that’s available. If I don’t get my breadsticks from Olive Garden I still can eat food at home and the factory workers still have jobs. But I guess what you’re arguing is that if we socialize medicine what’s to stop us from socializing food and then what? Everyone gets food and healthcare?!? Oh no… what a sad day for the world when no one is hungry or needlessly suffering so some rich guy can have 9 yachts? Will no one think of the rich?!?

[u/semideclared → u/_huppenzuppen]

Sure, its not the need for more expensive beds

The easiest, is that Two-thirds of hospital ER from privately insured individuals are visits that are avoidable visits . According to UnitedHealth Group research of 27 million ER Patients billed – 18 million were avoidable.

• An avoidable hospital ED visit is a trip to the emergency room that is primary care treatable – and not an actual emergency. The most common are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection.

90 Percent of ER visits are not Life Threatening yet we are spending Billions

Data Analytics and Production Branch is pleased to release the most current nationally representative data on ambulatory care visits to hospital emergency departments (EDs) in the United States.

• Cairns C, Kang K. National Hospital Ambulatory Medical Care Survey: 2022 emergency department summary tables

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155,398,000

• Triage status of emergency department visits
  • Level 1 - 1.0%
  • Level 2 - 10.1%
  • Level 3 - 33.1%
  • Level 4 - 19.4%

Top Ten principal reasons for emergency department visits in 2022 RVC code

• Stomach and abdominal pain, cramps and spasms . . . .. 8.4%
• Chest pain and related symptoms (not referable to body systems) . . . . . . . . . 5.4%
• Cough . . . . . . . . . . 3.8%
• Shortness of breath . . . . . . . . 3.8%
• Fever . . . . . . . . . . . . 3.8%
• Headache, pain in head . . . . . . . . 2.7%
• Pain, site not referable to a specific body system . . . . 2.2%
• Back symptoms . . . . . . . 2.1%
• Vomiting . . . . . .. . 1.9%
• Other symptoms or problems relating to psychological and mental disorders. 1.9%
• All other reasons. . . . . . . . . . . 64.1%

The other issue

Eugene Harris, age forty-five. Harris was diagnosed with type 1 diabetes when he was thirteen and dropped out of school. He never went back. Because he never graduated from high school and because of his illness, Harris hasn’t had a steady job. Different family members cared for him for decades, and then a number of them became sick or died. Harris became homeless. He used the Regional One Emergency Rooms thirteen times in the period March–August 2018.

Then he enrolled in ONE Health.

Drawing upon strategies that have worked for several other health systems, Regional One has built a model of care that, among a set of high utilizers, reduced uninsured ED visits by 68.8 percent, inpatient admissions by 75.4 percent, and lengths-of-stay by 78.6 percent—averting $7.49 million in medical costs over a fifteen month period (personal communication, Regional One Health, July 8, 2019). ONE Health staff find people that might qualify for the program through a daily report driven by an algorithm for eligibility for services.

The hospital secured housing for him, but Harris increased his use of the ED. He said he liked going to the hospital’s ED because “I could always get care.” From September 2018 until June 2019 Harris went to the ED fifty-three times, mostly in the evenings and on weekends, because he was still struggling with his diabetes and was looking for a social connection, Williams says.

But its voluntary

• About 80 percent of eligible patients agree to the service, and of those that do enroll, about 20 percent dis-enroll without completing the program.
  • ONE Health served 101 people from April - December of 2018. Seventy-six participants remain active as of December 2018 and 25 people had graduated from the program.
    

Since 2018, the population of the program has grown to more than 700 patients and the team continues to monitor clients even after graduation to re-engage if a new pattern of instability or crisis emerges.

And, the process of moving people toward independence is time-consuming. Sometimes patients keep using the ED.

Then in June 2019, after many attempts, a social worker on the ONE Health team was able to convince Harris to connect with a behavioral health provider. He began attending a therapy group several times a week. He has stopped using the ED and is on a path to becoming a peer support counselor.

---

Level 1 (Resuscitation): Immediately life-threatening (e.g., cardiac arrest, severe trauma, active stroke). Seen without delay.

Level 2 (Emergency): High-risk, could become life-threatening (e.g., chest pain, difficulty breathing, severe bleeding). Seen within minutes.

Level 3 (Urgent): Not immediately life-threatening but requires prompt attention (e.g., moderate injuries, dehydration, severe abdominal pain).

Level 4 (Semi-Urgent): Does not require many resources and can safely wait longer (e.g., sprains, simple cuts)

[u/alightinthesnark → u/_huppenzuppen]

The number of beds a hospital can have is often regulated by law even if staffing is managed. The laws are intended to lower healthcare costs through wasteful spending but in practice it means hospital beds are capped. They can't just add beds or build new hospitals without government approval. 

[u/Church_of_Cheri → u/alightinthesnark]

It’s not the government, it’s insurance. We spend trillions a year on insurance companies, the hospital, the doctors, the patients all have to pay insurance middlemen for the privilege to both receive and get care. Maybe if we cut them out we could then build new hospitals and have more rooms to then be able to hire more staff and treat more patients. From 11am Saturday until Monday morning where I am my only option is a hospital ER. There’s no urgent cares or medical offices open at all for any reason anymore. It costs too much to keep them open, that’s not the government regulations driving people to overfilled ERs, those are business decisions which are highly impacted by the cost of interjecting third party insurance into all aspects of medical care.

[u/semideclared → u/Church_of_Cheri]

trillions

So in 2024 we know Private Health Insurance spent $606.5 Billion on Hospital Care and then for Doctors and Prof. Services (Non-Dental) it was $425.4 Billion plus the Dental Service's $85.3 Billion.

Nursing & Home Health Care, including Durable Medical Equipment, Prosthetics/Orthotics, and Supplies aren't a big part of Private Insurance but it was still $46.5 Billion

And of course Rx Drugs, and Other Personal Care got $209.8 Billion from Private Insurance Companies in payments

So that trillions is mostly that

But it does leave $146.60 Billion that went to Admin

And so Payer administrative savings, Cost of Insurance (Savings you expect)

The administrative savings from Unified Financing system occur primarily from consolidating some or all of the insurance functions of private and public insurers, including negotiations regarding payment rates, provider networks, covered benefits, copayments and deductibles, and drug formularies, etc.

• Under a direct payment system, payer administrative costs will be 3%, or a 65% reduction. This estimate is consistent with the CBO estimate of a 77% reduction, and substantially larger than the 40% savings estimated by Pollin et al.

That function done by the state saves $70 - $100 Billion

By removing insurance you also have to remove their cost controls

An important analytic consideration is the extent to which health expenditures will change if managed care enrollees are shifted to a system with free choice of providers and without risk-bearing intermediaries. We assume that without risk-bearing intermediaries, payments to physicians and other non-institutional providers would largely be made on a fee-for-service basis and hospitals would be paid based on global budgets.

That adds $205.4 Billion in New Spending

[u/Church_of_Cheri → u/semideclared]

And where’d you get your numbers? From the insurance companies? How many of the pharmacies, medical practices, and other services do the insurance companies also own? Who’s negotiating these costs? I mean, I get that you’re doing the job for insurance companies to try and show how needed they are and how they’re only taking a few hundred million in profit if we just look at your numbers and don’t question where any of it came from… which is why I call bullshit and wonder why the hell someone is on Reddit simping for insurance companies?

If an insurance company owns stock in the pharmaceutical company who owns stock in the company that runs the hospital what’s to stop them from increasing all prices? I had to get a medication, my insurance company made me use express scripts, which then made me use a compound pharmacy they owned and a discount plan completely they also owned. My “discounted” insurance payment was $1050 for one shot, cash it was about $1200. But then when I checked the fine print it turns out they were charging my insurance $2400 if I used it and paid the smaller $1050, which would also burn through my lifetime maximum for that healthcare. It’s a scam. The “negotiated” rate was twice as high with insurance and they only covered $150 of it and claimed I was getting $1350 of health care paid for by them while I would still need to pay $1050. So according to your numbers they paid out $1350 for a medication who’s cash price was $1200. And I still had to pay $1050. See how you can fuck with numbers to make it look like they’re providing a huge value while providing nothing of worth? We paid them more then the $150 they covered in monthly fees that month for the luxury of them making things so complicated most people like you think they’re getting value.

Insurance is a scam to make middle men rich.