8 ms·

> If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they? As a non-Ameri

> If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they? As a non-American (UK and Australia citizen) it bewilders me that this is considered a possibility. Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US?

kevin_thibedeau 9y ago
1) Properly healing people reduces your customer base. 2) Yes (with some exceptions). The other aggravating factor is that most mutual insurance companies have also converted to a for profit model that reinforces the incestuous coupling between pharma and medical providers. There is no voice left who has an interest in lowering costs.
thaumaturgy 9y ago
> Are they for-profit in the US? Yes, with few exceptions. Here's how this goes: "But if they weren't for-profit, then it would be more like Canada's or England's health care, and I've heard you have to wait months for anything over there. Also it would mean they wouldn't have as much money for innovation, and, y'know, the US has the best health care technology in the world. Oh, sure, only the rich can afford it, but if you're poor you can still go to a hospital and they won't turn you away." There, that's every single defense of our system, in one paragraph. I don't think I missed anything. Now, pardon me, I need to go throw up.
- lostlogin 9y ago
  One issue with the above. > England You mean Britain. It wouldn’t be HN without a rant correction.
  - tonyedgecombe 9y ago
    > You mean Britain. At the moment.
  - matthewmacleod 9y ago
    Not to get excessively meta-pedantic, but the constituent countries of the UK each run their own independent health services. The difference in wait times is currently quite a hot topic of discussion! If anything, a comparison with England is probably more appropriate :)
  - kgwgk 9y ago
    If you want to go down that road, probably you mean the United Kingdom. And you may not be aware but “Each of the UK's health service systems operates independently, and is politically accountable to the relevant government: the Scottish Government; Welsh Government; Northern Ireland Executive; and the UK Government, responsible for England's NHS.”
dragonwriter 9y ago
> Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US? Contrary to sibling comments, no, they generally are not. Most (58.5%) US hospitals are private nonprofits, and another 20.2% are public. Only 21.3% are private, for-profit. [0] [0] https://www.beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-the-hospital-industry-2017.html https://www.beckershospitalreview.com/hospital-management-ad...
- thaumaturgy 9y ago
  Contrary to your comment, yes, they generally are; they're just using Hollywood accounting and referring to their profits as "excess earnings". "A study published in the May issue of Health Affairs revealed that in 2013, seven of the top ten most profitable hospitals in the United States were nonprofit hospitals, with each earning over $163 million in profits from patient care." https://www.forbes.com/sites/brucelee/2016/05/08/very-profitable-nonprofit-hospitals-but-where-are-the-profits-going/ https://www.forbes.com/sites/brucelee/2016/05/08/very-profit... (Forbes, yuck, I know. This Washington Post link covers the same story: https://www.washingtonpost.com/news/to-your-health/wp/2016/05/02/these-hospitals-make-the-most-money-off-patients-and-theyre-mostly-nonprofits/ https://www.washingtonpost.com/news/to-your-health/wp/2016/0...) That article links to a CBS "investigation" into the University of Pittsburgh Medical Center, which claims to be a nonprofit but made $948 million from 2011 to 2012, pays its CEO $6 million a year, gets a private chef, chauffeur, and a jet for additional compensation, and has a dozen other administrators each making over a million dollars a year. https://www.youtube.com/watch?v=zikgppxCFnA https://www.youtube.com/watch?v=zikgppxCFnA Claiming themselves to be a nonprofit saves them about $200 million in state and federal taxes. So, they're just an "accidentally profitable" nonprofit. But yeah, sure, let's just keep taking the health care industry at its word when it says it's not profitable. edit: more, because why use a scalpel when a hammer will work just as well? "Many nonprofit hospitals calculate their charitable care by using something known as “charge master” pricing; exorbitant, non-negotiated prices which are inflated many times higher than what private insurance or Medicare would pay. This allows facilities to overstate their provision of “charity care,” calculated as revenue loss by the hospital in exchange for their lucrative tax exemptions. In a patient evaluated with chest pain, the allowable for Medicare is $3600; however, in an uninsured patient, the hospital may “write-off” an inflated $25,600 in uncompensated costs, which is 8 times higher than actual cost of care provided." http://thehealthcareblog.com/blog/2017/04/25/the-fairy-tale-of-a-non-profit-hospital/ http://thehealthcareblog.com/blog/2017/04/25/the-fairy-tale-... "But even many hospitals that showed losses on patient care had positive margins overall. The study found that median net income per adjusted discharge from all activities—including investments, charitable contributions and space rental—was $353 for all hospitals and $178 for hospitals with 50 or fewer beds." http://www.modernhealthcare.com/article/20160502/NEWS/160509991 http://www.modernhealthcare.com/article/20160502/NEWS/160509... "Non-profit is instead simply a tax status, and specifically, it exempts hospitals from paying real estate and other taxes in exchange for contributing a fixed portion of their revenues to ‘community benefit’ rather than paying dividends to shareholders. ... Cleveland Clinic, one of the largest health systems in the country, was held up as an example of a wildly profitable non-profit in a recent article in Politico." https://www.acsh.org/news/2017/07/19/non-profit-hospitals-can-be-extremely-profitable-11572 https://www.acsh.org/news/2017/07/19/non-profit-hospitals-ca... (read that one, it's a good breakdown of the accounting that hospitals use to maintain their nonprofit status while behaving in every other way like any other for-profit business.)
thousandautumns 9y ago
American hospitals do offer the best care possible to patients. Thats actually the problem. Much has been made recently of the tendency of hospitals (in the US) to overdiagnose/overtreat patients, which is driving up the overall cost of healthcare. In other countries like the UK, I think that there is more caution regarding prescribing costly, unnecessary procedures. The result is that, yes, the actual healthcare is probably better than anywhere in the world, but the additional quality compared to countries like the UK or Australia is marginal considering the added cost, which for anyone with bad/no insurance, is insurmountable.

kevin_thibedeau 9y ago

1) Properly healing people reduces your customer base. 2) Yes (with some exceptions). The other aggravating factor is that most mutual insurance companies have also converted to a for profit model that reinforces the incestuous coupling between pharma and medical providers. There is no voice left who has an interest in lowering costs.

thaumaturgy 9y ago

> Are they for-profit in the US? Yes, with few exceptions. Here's how this goes: "But if they weren't for-profit, then it would be more like Canada's or England's health care, and I've heard you have to wait months for anything over there. Also it would mean they wouldn't have as much money for innovation, and, y'know, the US has the best health care technology in the world. Oh, sure, only the rich can afford it, but if you're poor you can still go to a hospital and they won't turn you away." There, that's every single defense of our system, in one paragraph. I don't think I missed anything. Now, pardon me, I need to go throw up.

lostlogin 9y ago
One issue with the above. > England You mean Britain. It wouldn’t be HN without a rant correction.
- tonyedgecombe 9y ago
  > You mean Britain. At the moment.
- matthewmacleod 9y ago
  Not to get excessively meta-pedantic, but the constituent countries of the UK each run their own independent health services. The difference in wait times is currently quite a hot topic of discussion! If anything, a comparison with England is probably more appropriate :)
- kgwgk 9y ago
  If you want to go down that road, probably you mean the United Kingdom. And you may not be aware but “Each of the UK's health service systems operates independently, and is politically accountable to the relevant government: the Scottish Government; Welsh Government; Northern Ireland Executive; and the UK Government, responsible for England's NHS.”

dragonwriter 9y ago

> Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US? Contrary to sibling comments, no, they generally are not. Most (58.5%) US hospitals are private nonprofits, and another 20.2% are public. Only 21.3% are private, for-profit. [0] [0] https://www.beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-the-hospital-industry-2017.html https://www.beckershospitalreview.com/hospital-management-ad...

thaumaturgy 9y ago
Contrary to your comment, yes, they generally are; they're just using Hollywood accounting and referring to their profits as "excess earnings". "A study published in the May issue of Health Affairs revealed that in 2013, seven of the top ten most profitable hospitals in the United States were nonprofit hospitals, with each earning over $163 million in profits from patient care." https://www.forbes.com/sites/brucelee/2016/05/08/very-profitable-nonprofit-hospitals-but-where-are-the-profits-going/ https://www.forbes.com/sites/brucelee/2016/05/08/very-profit... (Forbes, yuck, I know. This Washington Post link covers the same story: https://www.washingtonpost.com/news/to-your-health/wp/2016/05/02/these-hospitals-make-the-most-money-off-patients-and-theyre-mostly-nonprofits/ https://www.washingtonpost.com/news/to-your-health/wp/2016/0...) That article links to a CBS "investigation" into the University of Pittsburgh Medical Center, which claims to be a nonprofit but made $948 million from 2011 to 2012, pays its CEO $6 million a year, gets a private chef, chauffeur, and a jet for additional compensation, and has a dozen other administrators each making over a million dollars a year. https://www.youtube.com/watch?v=zikgppxCFnA https://www.youtube.com/watch?v=zikgppxCFnA Claiming themselves to be a nonprofit saves them about $200 million in state and federal taxes. So, they're just an "accidentally profitable" nonprofit. But yeah, sure, let's just keep taking the health care industry at its word when it says it's not profitable. edit: more, because why use a scalpel when a hammer will work just as well? "Many nonprofit hospitals calculate their charitable care by using something known as “charge master” pricing; exorbitant, non-negotiated prices which are inflated many times higher than what private insurance or Medicare would pay. This allows facilities to overstate their provision of “charity care,” calculated as revenue loss by the hospital in exchange for their lucrative tax exemptions. In a patient evaluated with chest pain, the allowable for Medicare is $3600; however, in an uninsured patient, the hospital may “write-off” an inflated $25,600 in uncompensated costs, which is 8 times higher than actual cost of care provided." http://thehealthcareblog.com/blog/2017/04/25/the-fairy-tale-of-a-non-profit-hospital/ http://thehealthcareblog.com/blog/2017/04/25/the-fairy-tale-... "But even many hospitals that showed losses on patient care had positive margins overall. The study found that median net income per adjusted discharge from all activities—including investments, charitable contributions and space rental—was $353 for all hospitals and $178 for hospitals with 50 or fewer beds." http://www.modernhealthcare.com/article/20160502/NEWS/160509991 http://www.modernhealthcare.com/article/20160502/NEWS/160509... "Non-profit is instead simply a tax status, and specifically, it exempts hospitals from paying real estate and other taxes in exchange for contributing a fixed portion of their revenues to ‘community benefit’ rather than paying dividends to shareholders. ... Cleveland Clinic, one of the largest health systems in the country, was held up as an example of a wildly profitable non-profit in a recent article in Politico." https://www.acsh.org/news/2017/07/19/non-profit-hospitals-can-be-extremely-profitable-11572 https://www.acsh.org/news/2017/07/19/non-profit-hospitals-ca... (read that one, it's a good breakdown of the accounting that hospitals use to maintain their nonprofit status while behaving in every other way like any other for-profit business.)

thousandautumns 9y ago

American hospitals do offer the best care possible to patients. Thats actually the problem. Much has been made recently of the tendency of hospitals (in the US) to overdiagnose/overtreat patients, which is driving up the overall cost of healthcare. In other countries like the UK, I think that there is more caution regarding prescribing costly, unnecessary procedures. The result is that, yes, the actual healthcare is probably better than anywhere in the world, but the additional quality compared to countries like the UK or Australia is marginal considering the added cost, which for anyone with bad/no insurance, is insurmountable.