I work in a busy emergency room. I had left ten years ago and just returned last May. At first I was amazed at how much sicker the patients were and how heavy the work had become. This weekend I realized that we do a lot more for the patients. It seems that almost everyone who comes in with anything more serious than a twisted ankle gets blood work and an EKG. It doesn't seem like a lot until you multiply it by hundreds of patients every day. When you have a very elderly person and/or a very sick patient, they amount of care they receive skyrockets unbelievably, even if that person isn't expected to live much longer. For example, I had a 90 year old woman with an extensive cancer history come in with difficulty breathing. Probably she had inhaled some food because she couldn't really feed herself any longer and developed pneumonia. Her family had made her a DNR (Do Not Resuscitate), so that if her heart stopped we wouldn't do CPR or stick a breathing tube in her mouth. But other than those caveats, she got numerous, costly tests and possibly will spend the remaining weeks of her life in a hospital, undergoing daily blood tests and CT scans and god knows what else.
Now, this isn't really news to me, as a nurse, that the US spends more on health care and has poorer outcomes than any other rich country. But it did occur to me that we might be at the peak of what we can provide. We take care of more and more baby boomers as they're getting older and they are not as healthy as the generation before them. Fifteen years ago I'd take care of a lot of 80 year olds who had never been really sick, had never taken any medication other than aspirin and had never been in a hospital. Now, I'm seeing 60 year olds with all kinds of health problems and we haven't even got to the baby boom bubble yet. I can't imagine that we're going to have enough staff, resources or even space to take care of these people in another ten years.
It's important to remember that the American medical system is predatory. Doctors and nurses may be trying to help people, but the system as a whole is just trying to suck as much money as possible into the giant black hole of private capital around which the whole economy orbits. This means that any procedure a hospital can bill insurance for, it will do, and it's very difficult for patients to refuse. Meanwhile insurance companies will raise rates, and governments will pretend to do good by throwing more money down the hole while cutting more valuable services.
My guess is that rich people will continue to get more medical care than is good for them, and middle class people will also get more care than is good for them while going deep in debt. This will drop most of them into the lower classes, who are already getting much less care than they need. It is not possible for medical providers to cut back services to what is actually helpful; it is only possible for them to cut back to what is profitable. Of all the issues facing us, health care is the only one where I can't see any non-catastrophic path to a better world. If you have comments, here's a subreddit link. I'll be spending today in the kitchen and tomorrow on the bus.