@dynamitemoth My unconscious came up with a perhaps less controversial parallel overnight. The American healthcare system is full of hard working, caring people who are truly doing their best. Yet we still spend twice as much as other rich countries while covering less people. The system is structured that often the best option is the emergency room, which is also the most expensive option. Insurance is so complex that patients need to make sure that the doctors treating them are on their plan even when the hospital is.1
A personal example: I was in the psychiatric ward of a well respected and good hospital. However, a private company had recently bought it and was cutting the budget to increase profitably. One weekend there were simply not enough staff. Those who were there were incredibly compassionate and good at their jobs, but there weren’t enough of them and patients ended up taking care of other patients. Which of course triggered us creating a shit show cascade of trauma.
There were no evil or incompetent people, yet the situation was terrible. At one of the best hospitals specializing in a specific area of mental health. When the system is broken, the intentions of those inside are not the important part. Structural factors are.
- Or that the specific illness is. When I shop for insurance, I make sure specific hospitals are covered. In case I have to go to the psychiatric ward, I want to make sure that my psychiatrist knows the doctors there. One year I bought insurance that covered the right hospital. Except that they subcontracted out their mental health coverage to Value Options. Which didn’t cover that hospital. I had looked pretty hard when choosing insurance, yet I could find nothing on their website indicating the difference. I didn’t think to ask if the hospitals they listed as in network were actually in network for my needs. ↩
- The Carceral State and Good People