I grew up in a medical family, primary care. I’ve worked in the medical field for 40 years, from the front office to the back, lab to radiology. I’ve been a registered nurse for 33 years and a family nurse practitioner for 30 years. I have worked in hospitals, private practices, federally qualified health centers (FQHC), hospice, and corporate health. I am deeply passionate about my calling—caring and advocating for my patients, my family, my colleagues—trying to help them navigate our complex, overburdened system of care. Patients are frustrated, confused, in debt. Health care workers are being shot, stabbed, beaten, both physically and mentally broken in all settings. Health care workers account for 73 percent of all cases of workplace violence. We are overworked, undervalued, clicking boxes, burned out. So, what has gone wrong?
Patients have trouble accessing care. They face “ghost lists” that insurances provide them of in-network providers that often lead to nowhere. Many new patients on Medicare and Medicaid are turned away because reimbursement is now 30 percent lower than in 2001. Chronic diseases and obesity surge due to sedentary lifestyles, poor food quality, ultra-processed foods, and harmful additives, preservatives, and pesticides—many of these banned in other countries. More patients are seeking care than ever, but fewer caregivers are available. Health insurance denies necessary tests and medications daily, increasing our workload and stress. Many of us work 40–100 hours weekly, buried in complex patient care and administrative tasks. Doctors and dentists face the highest suicide rate of any profession in the U.S. We are exhausted and disillusioned. How did we get here?
Health care wasn’t always like this. There was a time when care was simpler, both providers and patients happier. There was price transparency—no co-pays, no referrals, no prior authorizations. Ninety-five cents of every medical dollar went to patient care. Then came the pivotal shift around 1990. The Stark Law prevented doctors from referring patients to facilities that they had a financial interest in. However, this law did not prevent large corporations from buying up hospitals, practices, imaging facilities, and self-referring between them all. Blue Cross, once a nonprofit and our biggest insurer, became a for-profit, joining Aetna and Cigna and introducing complex referrals and prior authorizations. Practices hired more staff to navigate these new, time-consuming forms trying to get our patients care. When we waived co-pays for poor patients, we were threatened with $10,000 fines—”a violation of their patient contract.” Malpractice premiums soared, driving neurosurgeons out of states such as West Virginia. Head traumas had to be med-flighted to neighboring states for care. In-office services like casting became unaffordable due to high premiums placed on these special patient services. Lawsuits became commonplace. Medicine shifted from prioritizing care to maximizing profit for big corporations, pharmaceutical companies, health and malpractice insurance carriers, and lawyers.
Price transparency vanished as insurance companies cut reimbursements, forcing providers to increase prices simply to recover costs. Patients ended up paying more while insurance claimed to be “saving them money.” We had to learn the game to survive.
Drug prices spiraled. Guaifenesin and colchicine, once penny-cheap generics, became expensive Mucinex and Colcrys after pharmaceutical companies exploited loopholes in FDA regulations. Direct-to-consumer advertising bypassed provider expertise, pressuring patients to demand specific medications. Due to new internet accessibility, suddenly everyone was an expert in their care. Patients began losing trust in their providers. Pharmacists were tasked with performing routine vaccinations and point-of-care testing in addition to their responsibility of dispensing medications, educating patients, and being a resource to providers on the intricate nuances of pharmaceuticals—all for big corporate profits.
Independent practices and hospitals struggled to manage complicated insurance contracts, billing issues, complex coding, and HEDIS measures. Extra staff were hired to meet these demands. Private equity groups and large corporations began buying hospitals and nursing homes, sometimes to help a struggling practice, but always for profit. Providers, now employees, face pressure to see more patients and provide more services to increase profit. In 2024, 128 physicians and staff from the University of Virginia issued a “No Confidence” letter, citing management’s pressure to inflate billing codes. This puts doctors’ livelihoods and licenses at risk and places patients and insurers on the hook for these inflated bills.
Cheaper medical supplies replaced higher-quality materials as companies cut costs to increase profits. Parts break, fall off, and don’t connect smoothly. Yet providers are ultimately responsible for patient outcomes. We pay high fees for multiple licenses, annual CME, and training—often on our own dime and PTO. We sacrifice family time. Many providers and staff are salaried, working extra patients in, using cancellation lists, trying to meet patient needs and demands.
I’ve worked in FQHCs that provide essential medical care for the uninsured and underinsured. Grants covered labs, patient assistance programs covered expensive insulins and medications. When the Affordable Care Act (ACA) passed in 2010, patients were required to buy insurance through the marketplace or face penalties. They had coverage now, but also monthly premiums, co-pays, high deductibles, and expensive medication costs. We became experts at the Walmart $4 list, but insulin and many necessary medications weren’t included. Drug coupons and pharmaceutical assistance programs were no longer accessible to government-insured patients. Patients canceled their visits and stopped or stretched out their medications. “Noncompliance” was often a decision between health care, housing, and food.
Medical expenses became the leading cause of bankruptcy in the U.S. There were no winners.
In 2014, the Hospital Acquired Condition (HAC) Reduction Program by CMS penalized hospitals for patient infections, hematomas, surgical complications, and falls, even when unavoidable. Reduced reimbursement forced hospitals to increase outpatient service costs to survive.
Medicare Advantage plans exploit fine details in Medicare. Private insurers hire providers to see enrollees at home under the guise of “closing care gaps.” Insurance then links patient diagnoses to form inflated diagnoses, increasing annual reimbursements by thousands of dollars, even when no additional care is performed.
In 2024, the pharmaceuticals and health product industries spent $293.7 million lobbying lawmakers. Health insurances spent $117.14 million. Hospitals and nursing homes spent $131.6 million. This money directly influences legislation that protects corporate profits at the expense of patients and providers. Health insurance CEOs make $20–30 million annually. Our elected officials, with a salary of $174,000 annually, are multimillionaires. Yet, our health care system continues to collapse, our colleagues leave, and our patients delay expensive care.
I work with an incredible company that provides in-house primary care, labs, and prescriptions for employers, bypassing insurance entirely. This has kept me from leaving medicine, as many of my colleagues have already done. Businesses and local governments with self-funded insurance experience savings and increased employee satisfaction and retention. Hospice is my other passion. Patients deserve to live and die with dignity and respect, without the constraints of insurance. Even here, CMS creates barriers. End-of-life dialysis patients must stop dialysis to access hospice, forcing them to choose between life-extending treatment or comfort care.
Do you see the game we have been forced into? We work with patients in life and death. But we are not just managing health, illness, and disease—every day, we are fighting a system that profits greatly from this. The system would fail without us, and the future is not looking bright. Health care workers should be able to make a good living providing care—this is our world. We should not be funneling wealth upwards to insurance executives, big corporations, and private equity groups.
Health care is precious, fragile, a critically vital aspect of society. It should be fiercely protected from corporate and political interests. If our health care system is to survive, those profiting from our expertise, our sacrifices, and our patients’ suffering must make their profits elsewhere. They have no skin in the game.
Bettina Reed has been a practicing family nurse practitioner for 30 years and a registered nurse for 33 years, working in private practice, federally qualified health centers (FQHC), hospice, and hospitals. Her core values are God, family, country, truth, compassion, kindness, equality, hard work, and peace.
Her father made house calls and saw patients on their farm as well as in his practice. He taught them that everyone puts their pants on one leg at a time and that every person matters. Her mother is a German immigrant, a war child, who taught her that there are many sides to a story. Watching her German Oma and Opa age and die showed her that socialized medicine is not the answer. Her German cousin, who has been a physician for many years, taught her the rest of that broken system.
She has been married for 33 years, living on the farm with her horses, donkey, dogs, cats, koi, fruit trees, and flower and vegetable gardens. Her family raises cattle and hay. Her recreational passions include her animals, gardening, reading, fishing, swimming, beaches, and wide-open spaces.
She is a strong advocate for both patients and health care workers. She is curious, loves to learn, and asks a lot of “whys.”
