Patients lack access to affordable care.

The results of the ACA subsidy fight won’t change that.

The ACA subsidy fight is political theater.

Everyone’s yelling about funding while patients can’t get basic care.

I used to think the healthcare debate mattered. Then I started practicing in the ER and saw the truth nobody wants to admit.

Patients already lack access to affordable care.

Being sick sucks. But navigating the healthcare system? That’s 1000x worse.

And I’m talking about the best circumstances here.

I’ve worked at excellent hospitals. Focused teams. Hardworking people. Empathetic doctors and nurses who genuinely care.

Yet patients remain intensely frustrated:

• They wait way longer than they should

• They can’t get follow-up appointments after leaving the hospital

• Their prescriptions never arrive or insurance won’t cover them

The system is collapsing right in front of us.

Customer service? Nonexistent.

Follow-up care? A joke.

Everyone feels it. Clinicians. Nurses. And especially patients.

Here’s what blew my mind when I started working in the ER:

Before practicing emergency medicine, I always wondered why people came to the ER instead of seeing their primary care doctor. Less money. Less time. More personal attention.

Made total sense, right?

Wrong.

Getting medical care is extremely frustrating - perhaps more frustrating when you’re “covered” for too much money under a subsidized, confusing, restrictive insurance plan that promises the world and delivers nothing.

The reality is harsh. Patients show up to the ER because they literally have no other option.

In my region (DC/MD) there’s a 4-6 month wait just to establish care with a regular doctor. Four to six months! And that’s at most offices, except the direct care practices that take cash and have transparent pricing.

Once you finally get “established,” you’ll wait 1-2 weeks for a sick visit.

If they can see you at all.

This has nothing to do with whether you have insurance or not.

Let that sink in.

You pay 25K a year in premiums and still end up in the ER for a bladder infection.

The prescription problem is even worse. Patients struggle daily with backordered medications, electronic prescriptions that vanish into thin air, and insurance formularies that won’t cover the med their doctor prescribed.

They’re stuck calling pharmacies. Waiting on hold. Getting transferred. Being told to call their doctor. Their doctor tells them to call insurance. Insurance tells them to call the pharmacy.

It’s an endless loop of frustration.

Patients are opting out of the system until they have no choice. And who can blame them?

The narrative being pushed is fundamentally flawed.

Politicians say we’re one funding bill away from solving healthcare. That’s a damn lie.

Patients weren’t getting adequate or affordable care before. Returning to the status quo changes nothing.

We need systemic overhaul, not more of the same.

The question we should be asking ourselves is this:

“What are we going to do about it?”

Because complaining won’t fix anything. More subsidies won’t fix anything. Going back to how things were definitely won’t fix anything.

The system needs to be remodeled from the ground up.

Patients (and employers) have the power to choose differently and better- right now.

Direct care models work. Transparent pricing works. Cash-based practices work.

But we keep pretending that shuffling money around in a broken system will somehow make it less broken.

It won’t.

What’s your answer?

Because the current system isn’t working for anyone except the people profiting from the chaos.

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Want to fix healthcare? It starts with admitting the truth about what’s broken.

Until next week,

Tiffany