A low level example of how complicated medical stuff is in the USA.

I have Medicare.
I pay $130 a month. My income is below poverty by any measure.
I pay for drugs insurance.
I have an annual deductible.
Medicare negotiates costs of services at an incomprehensible formula.

I grow a keretosis (sp?) on my hand. What can I say, I'm Irish. We are specialists at this.
It keeps growing and looks awful.
My friend Gretchen, who is an aestetician tells me to have it looked at when it gets red from being bumped and grows big. She says it is a keretosis, but large.
I make a doctor's appointment and walk to the medical building near the hospital.
The doctor looks at it and says it is a keretosis. It is big. It should fall off.
I go home.
A flurry of bills and statements come. I am not sure whether I owe anything.
A month passes and it is really ugly.
New appointment with the doc.
He tells me to make an appointment to have it frozen off.
I do so.
He freezes it and says it should be fine in a few weeks.
It is worse.
He looks at it again and says it should be surgically removed. He can do it, but it would be better to go to a dermatologist.
He gives me a referral but says it could take a long time because we don't have enough dermatologists in the Valley. The dermatologist will call and make an appointment when they get the referral.
I wait three weeks.
Nothing happens.
I call the doctors office and they say that the procedure has changed and I need to call the dermatologist.
I call and the first new patient appointment is months out.
I call the doctor and make an appointment for him to cut it off. He will be on vacation for three weeks.
Doctor's office cancels the appointment three weeks later. Doctor's wife is sick.
Thing is growing and looking angrier every day. Gretchen is freaking out.
I went and had the thing cut off.
I had to go back the next day to have it redressed.
I went back again a week later to have the stitches out.
It looks OK.
No report back from the lab yet, 10 days later.

The bills and statements will be flying for months.

Now, I understand that this is a very minor deal, but what is wrong here? I am a 69 year old woman walking to the office again and again. All these people are involved in cutting off this minor thing. All the appointments are charged to Medicare. It felt crazy.

In Nicaragua, I had a cyst on my shoulder that started growing after many years. I went to Dr. Blanco and waltzed in and he said he should remove it. I said, "How much?" he said "$30" I said "fine". He cut it off, did a beautiful job, barely any scar. I handed the receptionist $30 and went home. Twenty minutes max. No phone calls. The receptionist put the money in a drawer and went on chatting with her friend.

I live in a crazy country and am soooooooooooo grateful that I haven't encountered a big problem yet.