yeah, it's crazy fucked. i have/have been on "good" US insurance plans for over a decade and my previous employer was also the hospital (a ranked university teaching hospital) and even being on the good insurance there, it takes several months to get an appointment after a referral for something that is generally regarded as serious/debilitating. the insurance and employer are always finding weird little ways to negotiate the insurance down and claiming to be cash strapped, but have constantly rotating fine art displays, a grand piano in the lobby with a professional musician during several of the working hours, and the finest recruitment displays, entire floors dedicated to billing/account specialists chasing payments, and god tier outsourced/fee based catering/food services. not to mention all the exec level people of this non-profit make absolutely unjustifiably huge salaries. also, no one could ever, ever tell you how much something was going to cost. it was always a mystery. i remember going through every hoop i could find to get prior authorization for oral surgery my in-network/in-house dentist said i needed. i spent days getting various offices to email things to each other and eventually the biller said the insurance company finally agreed to cover everything after my $75 outpatient surgical co-pay. what that means was, after i paid by $75 and got the surgery, months down the line i had to pay a bill for about $300. i called the surgery office and apparently that was a totally different fee that insurance never covers that nobody told me about. i complained to some friends and they all said that i got off easy and i must have really bothered them, because their "after action" bill was like $500-600 for the same surgery.

i bet if i hired a lawyer and sent threatening letters i could have gotten that taken off, but who the fuck has time, energy, and money for that? and what if the in-network provider/billing system decided to boot me because i engaged in legal action against them, then i'd really be fucked for everything else healthcare related.

i remember a friend of mine fucked his ankle up on the job and with this good insurance going through all the protocols, it took months to get his ankle imaged for a diagnosis. and THEN, the imagery was digitally sent to an outsource firm in south east asia (where M.D. labor is cheaper per hour) to get the diagnosis, which was then typed up and returned to the US where someone read it to him over the phone and scheduled treatment.

it would probably take 1000+ pages to identify all the ways in which any specific hospital in the US has been completely hollowed out from actually generating the value of public health and reoriented to the administrative bloat surrounding the pursuit of revenue streams.