One of the challenges of moving is establishing care with a variety of providers. After living in Rapid City for 25 years we had a family doctor who we knew and trusted and a dentist who had provided care for our family for years. We were seen regularly by a dermatologist and we knew who to call when we needed care. Susan had a trusted electrophysiologist who read and interpreted the signals from her heart monitor. When we moved, we needed to establish care with new providers. Then we moved again, making some of those providers nearly an hour away. Furthermore, although we had figured out where to go for our immediate needs, we haven’t established strong relationships with care providers. We are still seeking new providers and establishing new relationships.

I drove back to Mount Vernon last week to see the dentist, but that isn’t a long-term solution. I don’t want to have a long commute to get my teeth cleaned.

Added to the complexity of establishing care is the pandemic. Health Care providers are overwhelmed with people seeking care. Because Covid symptoms mean that providers and their staff need to quarantine, many are short staffed. Appointments need to be rescheduled because there aren’t enough people to respond to the demand.

Susan had an appointment to establish care with a family practice physician. However, she has a cold. We have been very healthy since our mood and have avoided illness. We’ve been more isolated and have followed the protocols of wearing masks and keeping our distance. That means we’ve avoided some of the usual winter colds and other viruses going around. It also means that our immune systems haven’t gotten their usual workout and we may be a bit more vulnerable to viruses. In this case we know our granddaughter had cold symptoms a while ago and suspect that Susan’s cold was from that virus.

I need to add that we have been provided with Self-Test Covid-19 Antigen Rapid Test kits by our employer, and have tested negative for Covid, so we know that the symptoms are not from the Omicron variant.

However, being responsible, Susan reported her cold symptoms to the doctor’s office over the phone. They asked her to reschedule. The next available appointment was a couple of months away. When she reported the conversation to me, we noted the irony of being told that you can only be seen by a doctor if you are well. If you have any actual symptoms, they don’t want you to come to the doctor’s office.

It isn’t difficult to see why urgent care and hospital emergency rooms are overwhelmed. A couple of years ago, a cough or congestion usually meant a trip to the doctor’s office, a quick examination and a treatment plan. Now, there advice is to self-care unless things become critical.

We’re pretty good at self care and we have good health insurance. That means that we have access to telemedicine provided by our health insurance company. It wouldn’t involve seeing a local doctor, but we could obtain a prescription, should we need an antibiotic or other care that is beyond what we usually are able to provide at home.

Both our access to telemedicine and our access to Covid-19 home tests are luxuries that most people don’t have. Our community is filled with people who are doing their best with self care because they simply don’t have access to doctors and paramedics and nurses. As a result, very little preventive medicine is being practiced. We know that people consume less health care and health care costs are lowered when they receive preventive care. But our current situation demands that people wait for care and that any preventive measures be undertaken at home without consulting health care professionals.

Media reports make it seem like the breakdown of the health care system in the United States is the result of the pandemic, but the reports I have read recently fail to mention that the health care system was failing to provide care for many people before the pandemic struck. The US system of for-profit providers has resulted in a tiered health care system with luxury care at one end of the spectrum and virtually no care at the other end. We have had a system of medical “haves” and “have nots” for decades in our country. We spend way more per capita than any other country on health care and have way worse results overall. Our health care system is failing us.

Anti competitive strategies, such as limiting the number of admissions to medical colleges and controlling the number of physicians have created shortages. The shortage of skilled nurses has resulted in a system of unfair wage structures that mean that traveling nurses often earn much higher wages than those who serve faithfully in their home communities. Wage discrepancies create morale problems in most health care institutions. For-profit insurance means that there is pressure to provide less care while premiums rise to increase profits. Despite paperless medical record systems, the burden or record-keeping overwhelms medical practices.

I have an appointment next month to establish care and receive my annual wellness check with a family care practice. Since it will be my first visit, I had to fill out 12 pages of medical history and other information prior to my visit. This despite having authorized the transfer of my medical records from my previous health care providers. Those 12 pages of paper forms will be entered into a computer by a staff person, a process that often involves errors that have to later be corrected. In the last transfer of records, the dosage of one medicine I take was doubled and I didn’t discover the error until I filled a prescription and received a 180 day supply of the medicine. The cost of prescription medicine is drive up by over consumption.

There has to be a better way. Perhaps one of the side effects of the pandemic is that it is revealing just how broken our health care system really is. A large overhaul is in order. In the meantime, take care of yourself. You need to stay healthy enough to be able to see your doctor.