I can't write an overarching big picture argument so I am just going to focus on things I have noticed. We have a gentleman on our service who has suffered several strokes. All the diagnostic workup and treatment is done; what he needs now is rehabilitation. His insurance (Medi-Cal) won't pay for him to go to an acute rehab facility so he stays in the hospital. The hospital costs a lot more than an acute rehab facility would and it will lead to poorer outcomes for the patient (since rehabilitation is more effective early and hospital acquired infections are common). There's nothing we can do so he is indefinitely on our service without a significant hope of recovery even though a cheaper and more effective alternative exists.
The clinic is overbooked so that multiple patients are scheduled for the same 15 minute slot. Patients wait hours after their appointment time in order to be seen by a doctor.
A "stat" CT is ordered for a patient with a life-threatening stroke as a result of domestic violence. It takes four days for her to get the scan even with medical students harassing the radiology techs.
The emergency department overflowing such that I found my patient not in a room, but in "Hallway C, Bed 2."
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