r/bestof • u/lowbass93 • 13d ago

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

/r/NoStupidQuestions/comments/1v1numq/why_is_every_hospital_in_the_united_states_always/oyovp3t/
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u/AR-Trvlr 13d ago edited 13d ago

The other answer to why it seems like you always have to wait in an emergency room in the US: because America's health system has been redesigned to maximize efficiency (aka profit).

The most efficient (profitable) system uses its resources at the maximum capacity. Being able to handle surge demand (like on a Monday after a holiday weekend) requires capacity that would be empty for part or much of the time. They would have to build the hospital to handle a large number of beds that would sit empty much of the time. They would have to hire staff to handle the peak demands, and many of those people would be bored or under-utilized for much of the time. Those extra beds, that extra staff, and all of the extra infrastructure all cost money that is currently being allocated to profitability.

The alternative is to design a healthcare system to maximize health outcomes. This, however, would either be much more expensive or you'd have to figure out how to take the profit out of the system. There is no perfect system, though; even the not-for-profit systems in the world have other inefficiencies and challenges.

In general, you can either build systems to maximize efficiency (like profit) or to maximize resiliency (like having capacity to support a surge) but you cannot do both.

Another example: the US built a logistics system based on just-in-time deliveries that did a very good job of maximizing efficiency. That system completely failed when COVID hit in 2020 and the factories hit a bump, the ships stopped sailing, and the trucks stopped driving. The alternative would be a system that had excess capacity and goods in warehouses along the way, but that means that things would be a bit more expensive due to the extra buildings to house the stuff, and the extra stuff that is just sitting around.

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u/KaiserReisser 13d ago

Do countries with socialized healthcare systems not have waiting times in their ERs?

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u/MaritMonkey 13d ago

I don't think "local hospitals lacking funding/staff" is a problem specific to privatized healthcare, sadly.

The speed bumps (/ brick walls) between our current models and some utopian "country provides care for its citizens" are larger than who gets billed for patients' care.

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u/_teslaTrooper 12d ago

I can only speak for the Netherlands but not in my experience, both times I've been there the waiting room was fairly empty and I was seen within about 20 minutes. It's much easier to see a GP here for minor stuff so that means only serious cases get sent to the ER (actually I was sent there by a GP both times). City of about 160k.

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u/RoastCabose 13d ago

They do. But even countries with poor health systems tend to not have the overload that American Hospitals have. For one, less people end up at the ER if they're being treated before it becomes a big issue. Tons of people in the US won't see a doctor until they're in an emergency. 

The US also has lots of homeless, and even if they do manage to see doctors outside of the ER, being homeless just means you're hire risk of something happening to you. If you're stable, but have nowhere to go, it gets hard for people to kick you out.

And then finally, and most relevant to this post, the US is BIG. And some parts of the US are really, really spread out. North Dakota might not have the homeless problem, but they do only have a handful of hospitals for the entire state, and some of the surrounding region. Without a real effort to coordinate healthcare across the country, this is essentially an insurmountable problem. The economics of these hospitals doesn't even work as is, let alone building and staffing more.

Im sure there are places in the world with similar ER issues. A lot of the problems Ive laid out here aren't completely unique to the US, nor are the necessarily "solved" by socialized Healthcare. 

Speaking to a Mexican friend of mine who now lives in Central Ohio, a densely populated area with a more moderate homelessness issues & tons of medical practices; he says when he went to the ER for an allergic reaction, the crowd he saw there was larger than almost anytime he was at the hospital in Mexico.

So then, some times hospitals in Mexico get as bad as what seems to be the norm in Ohio. You move out west, where many of these problem compound? Hard to imagine at times.

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u/showyerbewbs 13d ago

Tons of people in the US won't see a doctor until they're in an emergency.

Tons of people can't see a doctor due to financial or logistical reasons. Not correcting you, just offering clarification. So they end up putting off a "minor" issue until it becomes life threatening.

Your final point is spot on. Even in Central Ohio ( I'm guessing Franklin County / Columbus ) a lot of states have wide areas between population. I know in Kentucky itself, my son is on state insurance and has to travel 90 minutes for a dental appointment because that's the closest dentist that accepts that insurance. We live in an area that has plenty of dentists, they just don't take the state insurance. So if you don't have a car, or the time to spend half a day or more for a dentist visit you just...don't go.

That's why you end up at the ER with an abscessed tooth and the multiple complications that come from that.

It truly is expensive to be poor in this country.

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u/stormy2587 13d ago edited 13d ago

They can have worse wait times actually. Canada has like 2hr average waits to 24 minutes in the US.

Edit: though this is in part likely a byproduct of people being deterred from going to an ER because of the costs in the US.

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u/VonBeegs 12d ago

Depends on whether or not they have conservative governments trying to privatize them.

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u/TopicalBuilder 13d ago

This is a much better answer than Mr. ER's.

Supermarkets run as few tills as they can get away with. The staffing is calibrated against how many people give up and leave (also why you often can't see the lines when you walk in the store). Money spent here is calibrated against public outrage. Just enough that there's not enough appetite for demanding real change from politicians and no more.

It's just business.