> The patient load hadn't grown. The number of nurses has gone up, not down.

Healthcare utilization, number of unique patients, amount of care per patient has all gone up.

American has a massive overutilization problem driving cost but is unwilling to be honest with itself about it.

AKA the "Be your own advocate and demand more testing!" crowd.

Although Kaiser tends to repel such patients (they'll happy say "No" and tell you to find some other provider). The bulk of complaints I've heard about KP in California boil down to "They wouldn't give me a referral to a specialist".