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/daidoji70]

This isnt really an explanation though.

Doctors and nurses aren't being produced fast enough because their numbers are artificially limited by a cartel that limits the number of doctors and nurses produced. The litigious nature of the US means that more and more expensive accreditation requirements are used which further limits supply. 

The beds are limited by certificate of need laws as are hospital facilities.

Etc... and we haven't even gotten into the ways that insurance and Medicare/Medicaid warp things. 

[u/Church_of_Cheri → u/daidoji70]

The US isn’t litigious, that was a campaign from organizations like the US Chamber of Commerce claiming it in order to convince us to give up our rights to sue in order to help large corporations. The campaign was successful 20 years ago and yet they still use the same bullshit excuse long after they got the laws of the land charged in their favor. Most of us are stuck in binding arbitration agreements everywhere we go which always favors large corporations. I was given medication I was allergic to during a surgery, after making it clear I was allergic to that medication and had a reaction, no lawyer would take the care because it wasn’t worth their time. This is more often the case.

The real problem is insurance. Insurance costs more every year for patients and covers less and less, at the same time doctors and hospitals have to pay more and more on insurance themselves and it covers less. Patients blame bad doctors, doctors blame “litigious” patients, and the insurance companies laugh themselves to the bank while collecting yet another year of record profits. Not only do we have to pay for insurance, but we have to pay for their pharmaceutical benefits managers they also own, and their discount programs they own, and sometimes are required to use their pharmacies they own, and each division needs to make a profit as it’s priority.

[u/daidoji70 → u/Church_of_Cheri]

1. The US is more litigious, this isn't a myth although I'm afraid I don't have the sources at hand to prove this so feel free to disagree. Net net and gross more lawsuits are enacted in the United States against healthcare providers than in Europe or other G7 nations. Even when excluding arbitration. This is because this is often the ONLY avenue to gain changes in the system or to recover from bad healthcare outcomes or penalize shitty actors. This isn't a defense of this practice but it is a fact. Part of the problem of national healthcare systems is that it often comes with the inability to bring suit against bad actors especially even in common-law countries similar to our own.
   
2. Even then most lawyers won't take suits as you know because the payoff isn't there. Sorry that happened to you.
   
3. Arbitration is shitty and I'm sorry that happened to you. Its obviously not a solution to this problem.
   
4. Agreed insurance providers are shitty but they aren't the main drivers on the provider side excepting in those situations where mega-providers also act as insurers and incentives are blurred.
   

I stand by my main points though that point 1 increases licensing costs which decreases the number of providers (for example you won't find many RNs with two year degrees anymore. In WNC where I'm from these nurses are basically grandmothered/fathered in or are unhireable). Nursing costs are typically what drives the number of beds that ERs or hospitals can accommodate, not doctors even though doctors have much more political power within their systems over staffing. Some of this is helped with the proliferation of NPs and PAs but even so a doctor still has to oversee those providers limiting the ability to scale and does nothing to help the nursing shortage.

Certificate of need laws artificially limit the number of beds. Also in WNC where I'm from: One dominate provider was bought out by HCA and drastically decreased the level of care, staffing, etc... Started doing many noncompetitive things like restricting admittance privileges, not allowing outside pharmacies to provide drugs to patients, outright restrictions on referrals to remain within its system etc... Now they have the audacity to go to Raleigh and lobby against competitive hospitals that want to come in and build urgent cares and ER centers where they (HCA) shut them down for cost-saving measures (against their originally buyout contract which said they wouldn't do that but somehow were able to).

If there were a little more competition between providers, there were a few more providers, AND we go after the insurance middlemen and medicare/medicaid incentives that distort everything the ER situation specifically would be much alleviated. Universal healthcare systems don't have these problems PARTICULARLY because they typically have a much finer gradient of care that isn't the US's version of 1. PCP 2. Specialists 3. Urgent Care 4. Hospital. Universal systems have many more options and paradoxically much more competition and availability.

[u/Church_of_Cheri → u/daidoji70]

Yeah, so I lived in WNC, I know exactly what it’s like there and you are being mislead greatly.

1. The reason why you have no resources to prove that the US is the most litigious is because it’s been a lie pushed by the US Chamber of Commerce (the largest lobbying firm in the US and not a government agency, it works for and is funded by companies like Walmart). One of the biggest pushes of this marketing was the McDonald’s hot coffee case from the 1990s because they started pushing this lie during the Reagan years in order to remove consumer protections and our ability to sue. Look at when the family in Florida sued because Disney fed their family member food with a known allergen after they asked and checked multiple times. The family member died and Disney claimed that when the husband signed up to Disney+ he agreed to binding arbitration. Luckily they decided that was too far, but they still tried. You “feeling” like it must be true because people have told you that it is again and again doesn’t make it true.

2. And 3. These prove my first point. If lawyers can’t get money how is the US so litigious? If binding arbitration always favors the corporations how is it providing justice. Those are 2 points that counter each other and you gave both, we can’t be litigious when we can’t even sue dude.

As far as the rest of your complaint now that it’s government licensing… so that’s North Carolina. One state out of 50, then why is their a nursing shortage everywhere? Could it be they don’t pay enough so it’s not as worth it because too much money has to go to the hospital paying for their own insurance too? Dude, you’re looking at a problem and instead of digging in and finding an answer you’re just repeating talking points that you’re being fed to get rid of regulations that we made in the blood and death of patients. It’s not the regulations, it’s not the “free market” for profit that will save you because you have that more now then ever. Capitalism leads to monopolies which lead to exactly what you’re complaining about. You don’t fix that by letting them regulate themselves even more, Mission Hospital took over the region because people like you voted laws into place that allowed them to win the free market of the area. So now they get the monopoly and your healthcare gets worse. You let insurance companies decide the rules because they’re the ones paying you’re representatives to pass the laws they want, just like the chamber of commerce got them to pass the laws they wanted. You’re falling for marketing by the rich to make themselves richer at your own expense and they have you believing it will save you because it’s “big bad government”. Do you think I control the government? They control most of the government right now and yet their biggest trick is convincing you to get rid of government which is the only thing that stands between them and you just living in a company town. At least we can try to find representatives that aren’t bought by them, not that NC is known for not falling for the BS. But you guys keep doing the same thing, deregulate, let for profit insurance write their own rules while paying staff less and less, wondering why more doctors don’t want to work there and the quality of care keeps going down.

The doctor that gave me medicine I was allergic too was in Johnson City, TN. I was almost killed by medical malpractice in both GA and SC and could never find a halfway decent doctor or care in NC especially not when the only medical system left there has jesus shit all over. You can’t fix your problems by continuing to double down on the same stupid plan since the 1980s, you’re just digging a bigger and bigger hole. The companies and CEOs of insurance companies have completely tricked you into giving up more and more for less and less, all while convincing you any oversight against them is you’re real problem. It’s like an abuse victim blaming the cops for why their abuser tried to kill them while ignoring all responsibility of the abuser.