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Not to undermine your dramatic point[1], but: Most hospitals run at profit margins well below 10%. Median operating margins are in the vicinity of 2% (https://

Not to undermine your dramatic point[1], but: Most hospitals run at profit margins well below 10%. Median operating margins are in the vicinity of 2% (https://www.modernhealthcare.com/providers/operating-margins-stabilize-not-profit-hospitals-still-vulnerable https://www.modernhealthcare.com/providers/operating-margins...) And for the last few years, expenses have been growing faster than revenues (though the rate of growth of expenses has slowed.) Whatever you imagine they're bringing in, they're not. Nor is their job to maintain the long-term health of the country. That's literally the government's job. [1] Those numbers have a historical reason behind them, which people are either ignorant of or choose to ignore. The short version is: hospital prices are set as a part of the negotiations with insurers. Insurers account for the vast, vast majority of dollars going into hospitals, so their business operations are built completely and entirely around insurance dollars. Uninsured patients register as barely more than a rounding error. So while, yes, being uninsured in this context sucks, hospitals aren't gleefully rubbing their hands and going "muahaha, $5K for stitches!" They don't expect to see that 5K, they don't rely on that 5K, and they're not trying to gouge that uninsured person who's almost certainly not good for that 5K. That person has just fallen into the crack(s) in our healthcare system, which are more complicated than "evil greedy hospital", or "evil greedy insurer."

pdonis 7y ago
> Nor is their job to maintain the long-term health of the country. That's literally the government's job. No, it isn't. It's everybody's job. The government is a tool we use to delegate certain aspects of that job--and often it's a very bad tool to use and we should be relying on it less, not more. The idea that "it's the government's job" to do things causes all kinds of problems, because people think they can just let the government take care of it and not have to worry about it any more. You can't do that. Ultimately it is we, the people, who are responsible.
- chimprich 7y ago
  > Ultimately it is we, the people, who are responsible. What a bizarre position. This distributed approach to the emergency health of nations hasn't worked out well in the current situation. I can't see how it would suddenly start working better in the future under our current economic system either. Everything is set up under economic pressures such that inefficiencies are ruthlessly exposed and eliminated. This maybe works out OK for creating new generations of electronic gizmos but it is catastrophically fragile for things like PPE as described in the article. To avoid something like this in the future, the only options I can see are more government control or rethink how economic systems work.
  - pdonis 7y ago
    > What a bizarre position. I don't see how it's bizarre to recognize what the US Constitution says. > This distributed approach to the emergency health of nations hasn't worked out well in the current situation. In the US at least, what hasn't worked is waiting for centralized authorities to tell people what to do, instead of just doing obvious common sense things like social distancing and wearing masks. Not to mention allowing the FDA to prevent state and local health authorities from taking obvious common sense measures to develop tests, either on their own or in cooperation with private labs, when it was clear that the FDA and CDC didn't have tests ready. > more government control Would be a bad idea, since the more centralized authority controls things, the worse the consequences are when the centralized authority makes a mistake. > rethink how economic systems work What you call the "catastrophically fragile" economic system is a product of government control. So again more government control seems like a bad idea.
deathanatos 7y ago
I have a hard time believing and reconciling that against the cost of treatments. E.g., I had my vocal cords looked at; took only ~1/2 hour of an ENTs time, and is a (somewhat) common and non-risky procedure. $4,000. I have no way to justify that price — I highly doubt the ENT is making $8k/hr! It was one of the big reasons that drove me away from PPOs in general: completely opaque, expensive, retroactive billing. Going to the doctors puts you on the hook for near unlimited liability. Now, Kaiser was a nice contrast; I had the opportunity to get my wrist operated on for RSI. Somewhat invasive, would require weeks of healing, not guaranteed to be successful (it had a ~50% success rate!): $300, priced out before the operation. (Sadly, I'm no longer with Kaiser, as they were west-coast and the rent was too high.)
- WillPostForFood 7y ago
  Only 25% of hospitals in the US are for profit. 56% are non profits, and the rest are run by the government. https://www.kff.org/other/state-indicator/hospitals-by-ownership/ https://www.kff.org/other/state-indicator/hospitals-by-owner...
  - grok22 7y ago
    NYTimes article, so may be pay-walled; but it sorta seems like non-profit hospitals in many places really do make money: https://www.nytimes.com/2020/02/20/opinion/nonprofit-hospitals.html https://www.nytimes.com/2020/02/20/opinion/nonprofit-hospita...
    - kube-system 7y ago
      I see this confusion come up in just about every discussion about non-profits. “Profit” and “income” are two entirely different things. All businesses, whether for-profit or non-profit, aim to generate income (i.e make money) so they can further their goals. Profit is when you take that income and distribute it to shareholders. The main difference between for-profit and non-profit companies is that non-profits cannot do this. The distinction of “non-profit” means a lot less than most people assume it does.
craftinator 7y ago
It's really, really easy to be broke with a six figure salary. All you have to do is spend 99.9% of it every year. Have you seen the lavishness of the modern US hospital? The art pieces, high vaulted ceilings on every floor, solariums, gardens, decorative architecture... These things are not free. They are very, very expensive! And at the same time, they are fucking worthless in regards to making people healthy. I pay my insurance because I want to be healthy, not so the hospital I go to looks pretty. They are marketing machines that live outside their means, and I should not owe them $5k for stitches. It's fucking insane, and it's greed to use those massive markups on people who are in life or death situations. It's equivalent to wartime profiteering.
- jimmaswell 7y ago
  The artwork and everything has been found to improve patient outcomes. Gardens and paintings aren't that expensive compared to other costs at a hospital.
vl 7y ago
Oh, please, have you been to the hospital? This is typical visit: check-in with security, wait in line, check-in with receptionist, wait, talk to the nurse assistant (wtf? I kid you not, now nurses have assistants!), wait, repeat exact same thing you said to assistant to the nurse, wait, see doctor for 5 minutes and repeat exact same thing again! How the fuck is it supposed to be efficient?
- Red_Leaves_Flyy 7y ago
  Why don't you go to urgent care instead? If you define why think you need a doctor you'll probably be fine at urgent care. If urgent care won't take you then you'll probably be seen quickly at a hospital.
  - vl 7y ago
    Because it wasn’t an ER visit, it was an appointment.
- evgen 7y ago
  It is actually rather efficient, you just lack the wisdom to understand anything beyond your own narrow point of view. Check-in with security: Yes, because this is 'Merica and it has actually become necessary to do a preliminary screen to make sure you are not a raving nutjob. Check-in with receptionist: Enter you into the system, until this point is hit you are not even at the hospital as far as the system is concerned. Talk to nurse assistant: No, this is not just an assistant for a nurse, but rather a term used to describe someone who has a particular level of training and commensurate duties. A CNA can take vitals, ensure that they have the proper records for you (e.g. records say vi is a 45 year-old white male and we have a 60 year-old Latina, maybe we need to double-check things.) This is also the first real step in the triage process where someone with medical background can make a quick decision as to whether or not you need to be seen quickly or can wait. Talk to nurse: Ok, now we actually start doing more fine-grained examination and diagnosis. Chances are this is where the real diagnosis and treatment was decided, but you don't need to know this. Talk to doctor: Now someone who is very busy will take a few moments to examine you and make a decision. The nurse you talked to earlier put markup on your chart indicating what she noticed and found as well as possible standard treatments for same so the doctor was able to confirm that it was horses and not zebras and then sign off on the treatment. In a hospital all of that process you think of as inefficient does not give a shit about you or your time, it is trying to maximize the value and impact of the time that really matters in a hospital: the attention of doctors and RNs. The process may have been inconvenient for you, but it means that the people who matter at that hospital only spend their time where it is needed and trivial tasks or downtime are handled elsewhere in the process.
Aeolun 7y ago
> more complicated than "evil greedy hospital", or "evil greedy insurer." Evil greedy medical industrial complex? I think most of the issues in the US medical situation come from everyone trying to profit as much as possible.

pdonis 7y ago

> Nor is their job to maintain the long-term health of the country. That's literally the government's job. No, it isn't. It's everybody's job. The government is a tool we use to delegate certain aspects of that job--and often it's a very bad tool to use and we should be relying on it less, not more. The idea that "it's the government's job" to do things causes all kinds of problems, because people think they can just let the government take care of it and not have to worry about it any more. You can't do that. Ultimately it is we, the people, who are responsible.

chimprich 7y ago
> Ultimately it is we, the people, who are responsible. What a bizarre position. This distributed approach to the emergency health of nations hasn't worked out well in the current situation. I can't see how it would suddenly start working better in the future under our current economic system either. Everything is set up under economic pressures such that inefficiencies are ruthlessly exposed and eliminated. This maybe works out OK for creating new generations of electronic gizmos but it is catastrophically fragile for things like PPE as described in the article. To avoid something like this in the future, the only options I can see are more government control or rethink how economic systems work.
- pdonis 7y ago
  > What a bizarre position. I don't see how it's bizarre to recognize what the US Constitution says. > This distributed approach to the emergency health of nations hasn't worked out well in the current situation. In the US at least, what hasn't worked is waiting for centralized authorities to tell people what to do, instead of just doing obvious common sense things like social distancing and wearing masks. Not to mention allowing the FDA to prevent state and local health authorities from taking obvious common sense measures to develop tests, either on their own or in cooperation with private labs, when it was clear that the FDA and CDC didn't have tests ready. > more government control Would be a bad idea, since the more centralized authority controls things, the worse the consequences are when the centralized authority makes a mistake. > rethink how economic systems work What you call the "catastrophically fragile" economic system is a product of government control. So again more government control seems like a bad idea.

deathanatos 7y ago

I have a hard time believing and reconciling that against the cost of treatments. E.g., I had my vocal cords looked at; took only ~1/2 hour of an ENTs time, and is a (somewhat) common and non-risky procedure. $4,000. I have no way to justify that price — I highly doubt the ENT is making $8k/hr! It was one of the big reasons that drove me away from PPOs in general: completely opaque, expensive, retroactive billing. Going to the doctors puts you on the hook for near unlimited liability. Now, Kaiser was a nice contrast; I had the opportunity to get my wrist operated on for RSI. Somewhat invasive, would require weeks of healing, not guaranteed to be successful (it had a ~50% success rate!): $300, priced out before the operation. (Sadly, I'm no longer with Kaiser, as they were west-coast and the rent was too high.)

WillPostForFood 7y ago
Only 25% of hospitals in the US are for profit. 56% are non profits, and the rest are run by the government. https://www.kff.org/other/state-indicator/hospitals-by-ownership/ https://www.kff.org/other/state-indicator/hospitals-by-owner...
- grok22 7y ago
  NYTimes article, so may be pay-walled; but it sorta seems like non-profit hospitals in many places really do make money: https://www.nytimes.com/2020/02/20/opinion/nonprofit-hospitals.html https://www.nytimes.com/2020/02/20/opinion/nonprofit-hospita...
  - kube-system 7y ago
    I see this confusion come up in just about every discussion about non-profits. “Profit” and “income” are two entirely different things. All businesses, whether for-profit or non-profit, aim to generate income (i.e make money) so they can further their goals. Profit is when you take that income and distribute it to shareholders. The main difference between for-profit and non-profit companies is that non-profits cannot do this. The distinction of “non-profit” means a lot less than most people assume it does.

craftinator 7y ago

It's really, really easy to be broke with a six figure salary. All you have to do is spend 99.9% of it every year. Have you seen the lavishness of the modern US hospital? The art pieces, high vaulted ceilings on every floor, solariums, gardens, decorative architecture... These things are not free. They are very, very expensive! And at the same time, they are fucking worthless in regards to making people healthy. I pay my insurance because I want to be healthy, not so the hospital I go to looks pretty. They are marketing machines that live outside their means, and I should not owe them $5k for stitches. It's fucking insane, and it's greed to use those massive markups on people who are in life or death situations. It's equivalent to wartime profiteering.

jimmaswell 7y ago
The artwork and everything has been found to improve patient outcomes. Gardens and paintings aren't that expensive compared to other costs at a hospital.

vl 7y ago

Oh, please, have you been to the hospital? This is typical visit: check-in with security, wait in line, check-in with receptionist, wait, talk to the nurse assistant (wtf? I kid you not, now nurses have assistants!), wait, repeat exact same thing you said to assistant to the nurse, wait, see doctor for 5 minutes and repeat exact same thing again! How the fuck is it supposed to be efficient?

Red_Leaves_Flyy 7y ago
Why don't you go to urgent care instead? If you define why think you need a doctor you'll probably be fine at urgent care. If urgent care won't take you then you'll probably be seen quickly at a hospital.
- vl 7y ago
  Because it wasn’t an ER visit, it was an appointment.
evgen 7y ago
It is actually rather efficient, you just lack the wisdom to understand anything beyond your own narrow point of view. Check-in with security: Yes, because this is 'Merica and it has actually become necessary to do a preliminary screen to make sure you are not a raving nutjob. Check-in with receptionist: Enter you into the system, until this point is hit you are not even at the hospital as far as the system is concerned. Talk to nurse assistant: No, this is not just an assistant for a nurse, but rather a term used to describe someone who has a particular level of training and commensurate duties. A CNA can take vitals, ensure that they have the proper records for you (e.g. records say vi is a 45 year-old white male and we have a 60 year-old Latina, maybe we need to double-check things.) This is also the first real step in the triage process where someone with medical background can make a quick decision as to whether or not you need to be seen quickly or can wait. Talk to nurse: Ok, now we actually start doing more fine-grained examination and diagnosis. Chances are this is where the real diagnosis and treatment was decided, but you don't need to know this. Talk to doctor: Now someone who is very busy will take a few moments to examine you and make a decision. The nurse you talked to earlier put markup on your chart indicating what she noticed and found as well as possible standard treatments for same so the doctor was able to confirm that it was horses and not zebras and then sign off on the treatment. In a hospital all of that process you think of as inefficient does not give a shit about you or your time, it is trying to maximize the value and impact of the time that really matters in a hospital: the attention of doctors and RNs. The process may have been inconvenient for you, but it means that the people who matter at that hospital only spend their time where it is needed and trivial tasks or downtime are handled elsewhere in the process.

Aeolun 7y ago

> more complicated than "evil greedy hospital", or "evil greedy insurer." Evil greedy medical industrial complex? I think most of the issues in the US medical situation come from everyone trying to profit as much as possible.