7 ms·

I think it is more complicated than that. Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited

by 40four 6y ago

I think it is more complicated than that. Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals. Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serious financial trouble, despite the influx of Covid-19 patients. At a cursory level, I think most people would assume the hospital business is booming, but this assumption couldn't be more wrong. At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse. So it is not correct to imagine all hospitals are running at full capacity, and burning out their workers. In fact, many health care professionals are drawing unemployment at this point. I know this is doesn't make sense at the surface level, but it is something we all need to consider when continuing to advocate for lock-down or stay at home strategies. Our economy depends on movement of people/ goods/ services. That includes hospitals. I wish there was more serious discussion about this, and how we keep things moving as much as possible, while also protecting one another from spreading the virus. Lock-down alone is not an solution. If your areas hospitals are at risk of reaching capacity, for sure close it down. But almost nowhere in America outside of NY/NJ is there a risk of that right now. We've tried it for a while, but now we have more understanding. Now I want us to re-imagine how we can continue a life of movement, and also reduce risk of infection.

gvjddbnvdrbv 6y ago
Everything you wrote is weird and simply shows that you need a proper health care system over there.
- dannyw 6y ago
  America isn’t going to transform their healthcare market in the next several months. We can be ideological and let hospitals fail and doctors and nurses get laid off, or we can be pragmatic and focus on what creates the best outcome as we navigate the reality we are in.
  - dillonmckay 6y ago
    The US cannot even prevent its own law enforcement from maiming innocent citizens, so I would not hold my breath for any healthcare reform.
- ThomPete 6y ago
  Americas healthcare system has it's flaws but the benefits amongst others is that it keeps being able to afford to invest in new research and methods and to specialize. It's the advantage of being a profit center. This is much harder in universal healthcare systems that are cost centers and thus can't just decide to change to a newer better method. Furthermore, the universal healthcare system have to budget who gets what kind of medicine. So while all people gets treated the same way not all illnesses does. Everything have pros and cons. The US system is much better in some ways and have shortfalls in others and vice versa.
  - gvjddbnvdrbv 6y ago
    I recently had a successful experimental surgery in this countries nationalised health service. Interestingly the idea had come from a study where the surgery I had was a control group and the 'real' group had a stem cell therapy as well. My problem was resolved, the single payer system didn't waste $100,000 on stem cell therapy. Good result. In the privatised system that carried out the original study the additional stem cell therapy is being done. It seems like optimising for profit optimises for cost.
    - gambiting 6y ago
      I just wanted to add a story as well - my dad was diagnosed with a very rare type of stomach cancer called GIST about 15 years ago in Poland. At the time, he was one of ~6 other people in the entire country with this diagnosis, and the diagnosis was....bleak to say the least, I think the doctors were cautiously giving him 6-12 months max. However, company Novartis has just certified their "Glivec" drug specifically to use against GIST, since it targets the same cell pathways. Now, the problem - Poland does have nationalized healthcare, but Glivec was insanely expensive - basically a box of Glivec cost around as much as an annual pay for many people in Poland at the time....and my dad had to take two boxes per month. And no, because it hasn't been proven to work against GIST yet, it was not on the list of refunded drugs - so my dad was placed on a controlled trial conducted by the largest oncological hospital in Warsaw, where the study funded the drug for him. Long story short - the drug worked miracles, my dad not only recovered, he lived another decade after that(died of another cancer that sadly didn't have a miracle cure this time). But - other people in this study didn't get the drug. I don't know if they were given placebo or just something else instead. My point being - they didn't survive, my dad did. After the study was concluded, the drug is now paid for by the national health service and anyone who needs Glivec can get it. So why isn't this a critique of the nationalized system? Well, because the way I see it - in a private health care system, no one in this group would survive, because no one in Poland could ever afford this treatment. At least some of the people were still given a chance because the system has enough flexibility to at least try new and experimental treatments.
rsanek 6y ago
Actually, over half of US hospitals are not-for-profit and another quarter are public. Only a small minority are for-profit. See https://en.m.wikipedia.org/wiki/Non-profit_hospital https://en.m.wikipedia.org/wiki/Non-profit_hospital
- stickfigure 6y ago
  This fact is missing something essential; Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Also, it's something of a minor nit - nonprofit corporations need revenue too. My wife is a nurse for Dignity Health (another "nonprofit" hospital here in California) and has been effectively laid off for the last couple months. It's great that the ER is empty, but in the mean time nurses are struggling and people aren't getting their cancer screenings. If this goes on long enough, our healthcare system will fall apart from atrophy, not from overuse.
  - unishark 6y ago
    > This fact is missing something essential; Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Why is that? You don't think they lay people off in Canada or Japan when there's no patients? Even single-payer systems can have private hospitals. They are simply paid by the govt instead of (or really in addition to) by patients. They still need business and to balance the books. Canada has a similar mix of all kinds of hospitals like the US, though it may be more slanted in some way.
  - hcknwscommenter 6y ago
    >Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Huh? It is exactly what I think of when I use the term non-profit in the context of a healthcare maintenance organization. I truly have no idea what you mean by your quoted statement.
    - rscho 6y ago
      He/she means: KP generates a lot of money for some important people, and their marketing and management strategy is as aggressive as for-profit institutions
akiselev 6y ago
> At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse. Nitpick: Over half of US hospitals are nonprofits or government owned [1] though I believe hospitals are vastly outnumbered by private clinics and independent practices. Doesn't change your overall point - even the hospitals run by governments, the Catholic church, and other institutions have budgets and are watching their main incomes disappear without much hope for the near future. [1] https://www.aha.org/statistics/fast-facts-us-hospitals https://www.aha.org/statistics/fast-facts-us-hospitals
- m0zg 6y ago
  While factually true, this does not defeat the point: those non-profit and public hospitals rely on paid procedures to pay their employees. And yes, those employees are furloughed and laid off en masse.
- 40four 6y ago
  Thanks, I see now that I overstated the number of for profit hospitals. You are right, though. They all depend on us using them.
- Spooky23 6y ago
  Government owned or Non-profit isn't as meaningful as you might think. End of the day, hospitals live on Medicare admissions for cash flow (ie. old people) and surgery for profit. Old people are staying home, people aren't hurting themselves on the couch, etc. Government owned is only meaningful with the Federal government, which has unlimited resources.
jariel 6y ago
"I know this is doesn't make sense at the surface level," No it makes perfect sense, and it doesn't matter if it's 'nonprofit or for-profit' - the inefficient use of resources is just the same. Hospitals are the most expensive places in the world to run, with very highly trained personnel, gear, etc.. In a socialized system, if they are not used, it's a massive inefficiency. Now imagine a system where 10's of millions of people are in economic pain - but they still have to foot the bill for unused medical services via taxes. It's just shifting around deck chairs with respect to where the pain will be borne.
- rscho 6y ago
  When a system is socialized, funding is also shifted so that the poorer taxpayers contribute less than the richer ones. So no, it's not just shifting around deck chairs. There's a balance to strike.
- pjc50 6y ago
  In a centralised system in an emergency, there shouldn't be idle capacity!
skybrian 6y ago
It seems like the root financial problem isn't for-profit versus non-profit, it's pay-per-procedure? This is like paying the fire department based on how many fires they put out. Medicare seems no better. (I would guess that Kaiser might be doing somewhat better since they're paid monthly but their finances aren't easy to find.)
- Spooky23 6y ago
  There are four scenarios at a very high level. It an uber complex system and the amount of time and money wasted in optimizing and managing revenue cycles is almost incalculable. If you compare it to any complex large scale system it's sickening to look at the waste -- even the military looks like an efficient machine in comparison. (In some ways) Medicare pays on a set scale for performance. If you have a heart attack, they pay a fee for the surgery and x days of hospitalization and x days of rehab. If the hospital gets you home in x-3 days, they make money. If the hospital fucks up and you get an infection and stay for x+10 days, they eat it. Medicaid is a PPO that pays on a per procedure basis. Their rates suck, but they don't care about quality for the most part. There's a billing optimization process to maximize revenue for poor old people. (Some things are better billed to Medicare, others to Medicaid) Private insurance pays for whatever they cover at a rate of y+z% over the Medicare rate. The patient gets the bill for whatever else happens. Uninsured get whatever treatment is legally necessary. They patch you up, take a loss, kick you out and do it again when you come back.
distant_hat 6y ago
Lest someone think this is a US thing, this is true in India as well which has a fairly different medical system. Hospitals are struggling to stay afloat and many nurses and ancillary staff have been laid off. Doctors in India are typically independent contractors and not employed by hospitals. Not only are no non-essential activities happening, many essential ones are also being pushed back and people are dying as a result. There are multiple stories of people not being able to go for dialysis because hospitals insist on a negative COViD test to admit you and authorities don't allow you to get tested if you are not showing COViD symptoms. It is a catch-22 that can be resolved only if you are well-connected or rich. Also, in knock-on effects, immunization programs are severely impacted, and many infectious diseases are likely to make a huge comeback with the monsoon season since typical mitigating measures for those were put on hold. The non-COViD death toll will be massively above typical years.
- geekybiz 6y ago
  Am from India & agree on this. Lockdowns helped slow the spread but aren't the perpetual answer. And the side-effects of lock-down (like essential services being pushed back) are taking lives. When evaluating lock-down's pros & cons, it always isn't life vs economy. It often also is Covid fatalities vs other fatalities. Atleast in India, that's happening.
  - Spooky23 6y ago
    Agreed. People on the prudent/cautious camp are missing that lockdowns are really last-resort, expensive controls at the bottom of the pyramid, used when better controls fail. We can't just netflix and chill for the next two years. But we can't just pretend nothing is wrong either!
m4rtink 6y ago
Well, that's pretty screwed up. For comparison Czech hospitals also scrapped anything non essential during the worst part of the local outbreak, both to have capacity for treating coronavirus patients and to reduce the chance of infection spreading through hospitals. At the same time a strong lockdown was done country wide. This was apparently effective with cases limited to a few clusters at the moment & most of the lockdown restrictions removed by now. Were the hospitals affected ? They did report funding shortfals right after the lockdown due to all the cancelled elective procedures, so the ministry of health simply gave them extra money to cover the lockdown loses. And at the moment most hospitals are back to normal workflow. Also, the people involved in directly handling the infection got bonuses as a thank you for doing the needed but dangerous work.
Spooky23 6y ago
It's weird that this isn't more widely known. Alot of my friends are in the medical field, and they are taking a beating personally. Stuff like long term 15-20% pay reductions and furloughs in addition to layoffs. Not only are hospitals for profit, but their part of cartel-like health networks. For some jobs, its hard to jump because 80% of the work is affiliated with two companies regionally.

by 40four 6y ago

gvjddbnvdrbv 6y ago

Everything you wrote is weird and simply shows that you need a proper health care system over there.

dannyw 6y ago
America isn’t going to transform their healthcare market in the next several months. We can be ideological and let hospitals fail and doctors and nurses get laid off, or we can be pragmatic and focus on what creates the best outcome as we navigate the reality we are in.
- dillonmckay 6y ago
  The US cannot even prevent its own law enforcement from maiming innocent citizens, so I would not hold my breath for any healthcare reform.
ThomPete 6y ago
Americas healthcare system has it's flaws but the benefits amongst others is that it keeps being able to afford to invest in new research and methods and to specialize. It's the advantage of being a profit center. This is much harder in universal healthcare systems that are cost centers and thus can't just decide to change to a newer better method. Furthermore, the universal healthcare system have to budget who gets what kind of medicine. So while all people gets treated the same way not all illnesses does. Everything have pros and cons. The US system is much better in some ways and have shortfalls in others and vice versa.
- gvjddbnvdrbv 6y ago
  I recently had a successful experimental surgery in this countries nationalised health service. Interestingly the idea had come from a study where the surgery I had was a control group and the 'real' group had a stem cell therapy as well. My problem was resolved, the single payer system didn't waste $100,000 on stem cell therapy. Good result. In the privatised system that carried out the original study the additional stem cell therapy is being done. It seems like optimising for profit optimises for cost.
  - gambiting 6y ago
    I just wanted to add a story as well - my dad was diagnosed with a very rare type of stomach cancer called GIST about 15 years ago in Poland. At the time, he was one of ~6 other people in the entire country with this diagnosis, and the diagnosis was....bleak to say the least, I think the doctors were cautiously giving him 6-12 months max. However, company Novartis has just certified their "Glivec" drug specifically to use against GIST, since it targets the same cell pathways. Now, the problem - Poland does have nationalized healthcare, but Glivec was insanely expensive - basically a box of Glivec cost around as much as an annual pay for many people in Poland at the time....and my dad had to take two boxes per month. And no, because it hasn't been proven to work against GIST yet, it was not on the list of refunded drugs - so my dad was placed on a controlled trial conducted by the largest oncological hospital in Warsaw, where the study funded the drug for him. Long story short - the drug worked miracles, my dad not only recovered, he lived another decade after that(died of another cancer that sadly didn't have a miracle cure this time). But - other people in this study didn't get the drug. I don't know if they were given placebo or just something else instead. My point being - they didn't survive, my dad did. After the study was concluded, the drug is now paid for by the national health service and anyone who needs Glivec can get it. So why isn't this a critique of the nationalized system? Well, because the way I see it - in a private health care system, no one in this group would survive, because no one in Poland could ever afford this treatment. At least some of the people were still given a chance because the system has enough flexibility to at least try new and experimental treatments.

rsanek 6y ago

Actually, over half of US hospitals are not-for-profit and another quarter are public. Only a small minority are for-profit. See https://en.m.wikipedia.org/wiki/Non-profit_hospital https://en.m.wikipedia.org/wiki/Non-profit_hospital

stickfigure 6y ago
This fact is missing something essential; Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Also, it's something of a minor nit - nonprofit corporations need revenue too. My wife is a nurse for Dignity Health (another "nonprofit" hospital here in California) and has been effectively laid off for the last couple months. It's great that the ER is empty, but in the mean time nurses are struggling and people aren't getting their cancer screenings. If this goes on long enough, our healthcare system will fall apart from atrophy, not from overuse.
- unishark 6y ago
  > This fact is missing something essential; Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Why is that? You don't think they lay people off in Canada or Japan when there's no patients? Even single-payer systems can have private hospitals. They are simply paid by the govt instead of (or really in addition to) by patients. They still need business and to balance the books. Canada has a similar mix of all kinds of hospitals like the US, though it may be more slanted in some way.
- hcknwscommenter 6y ago
  >Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Huh? It is exactly what I think of when I use the term non-profit in the context of a healthcare maintenance organization. I truly have no idea what you mean by your quoted statement.
  - rscho 6y ago
    He/she means: KP generates a lot of money for some important people, and their marketing and management strategy is as aggressive as for-profit institutions

akiselev 6y ago

> At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse. Nitpick: Over half of US hospitals are nonprofits or government owned [1] though I believe hospitals are vastly outnumbered by private clinics and independent practices. Doesn't change your overall point - even the hospitals run by governments, the Catholic church, and other institutions have budgets and are watching their main incomes disappear without much hope for the near future. [1] https://www.aha.org/statistics/fast-facts-us-hospitals https://www.aha.org/statistics/fast-facts-us-hospitals

m0zg 6y ago
While factually true, this does not defeat the point: those non-profit and public hospitals rely on paid procedures to pay their employees. And yes, those employees are furloughed and laid off en masse.
40four 6y ago
Thanks, I see now that I overstated the number of for profit hospitals. You are right, though. They all depend on us using them.
Spooky23 6y ago
Government owned or Non-profit isn't as meaningful as you might think. End of the day, hospitals live on Medicare admissions for cash flow (ie. old people) and surgery for profit. Old people are staying home, people aren't hurting themselves on the couch, etc. Government owned is only meaningful with the Federal government, which has unlimited resources.

jariel 6y ago

"I know this is doesn't make sense at the surface level," No it makes perfect sense, and it doesn't matter if it's 'nonprofit or for-profit' - the inefficient use of resources is just the same. Hospitals are the most expensive places in the world to run, with very highly trained personnel, gear, etc.. In a socialized system, if they are not used, it's a massive inefficiency. Now imagine a system where 10's of millions of people are in economic pain - but they still have to foot the bill for unused medical services via taxes. It's just shifting around deck chairs with respect to where the pain will be borne.

rscho 6y ago
When a system is socialized, funding is also shifted so that the poorer taxpayers contribute less than the richer ones. So no, it's not just shifting around deck chairs. There's a balance to strike.
pjc50 6y ago
In a centralised system in an emergency, there shouldn't be idle capacity!

skybrian 6y ago

It seems like the root financial problem isn't for-profit versus non-profit, it's pay-per-procedure? This is like paying the fire department based on how many fires they put out. Medicare seems no better. (I would guess that Kaiser might be doing somewhat better since they're paid monthly but their finances aren't easy to find.)

Spooky23 6y ago
There are four scenarios at a very high level. It an uber complex system and the amount of time and money wasted in optimizing and managing revenue cycles is almost incalculable. If you compare it to any complex large scale system it's sickening to look at the waste -- even the military looks like an efficient machine in comparison. (In some ways) Medicare pays on a set scale for performance. If you have a heart attack, they pay a fee for the surgery and x days of hospitalization and x days of rehab. If the hospital gets you home in x-3 days, they make money. If the hospital fucks up and you get an infection and stay for x+10 days, they eat it. Medicaid is a PPO that pays on a per procedure basis. Their rates suck, but they don't care about quality for the most part. There's a billing optimization process to maximize revenue for poor old people. (Some things are better billed to Medicare, others to Medicaid) Private insurance pays for whatever they cover at a rate of y+z% over the Medicare rate. The patient gets the bill for whatever else happens. Uninsured get whatever treatment is legally necessary. They patch you up, take a loss, kick you out and do it again when you come back.

distant_hat 6y ago

Lest someone think this is a US thing, this is true in India as well which has a fairly different medical system. Hospitals are struggling to stay afloat and many nurses and ancillary staff have been laid off. Doctors in India are typically independent contractors and not employed by hospitals. Not only are no non-essential activities happening, many essential ones are also being pushed back and people are dying as a result. There are multiple stories of people not being able to go for dialysis because hospitals insist on a negative COViD test to admit you and authorities don't allow you to get tested if you are not showing COViD symptoms. It is a catch-22 that can be resolved only if you are well-connected or rich. Also, in knock-on effects, immunization programs are severely impacted, and many infectious diseases are likely to make a huge comeback with the monsoon season since typical mitigating measures for those were put on hold. The non-COViD death toll will be massively above typical years.

geekybiz 6y ago
Am from India & agree on this. Lockdowns helped slow the spread but aren't the perpetual answer. And the side-effects of lock-down (like essential services being pushed back) are taking lives. When evaluating lock-down's pros & cons, it always isn't life vs economy. It often also is Covid fatalities vs other fatalities. Atleast in India, that's happening.
- Spooky23 6y ago
  Agreed. People on the prudent/cautious camp are missing that lockdowns are really last-resort, expensive controls at the bottom of the pyramid, used when better controls fail. We can't just netflix and chill for the next two years. But we can't just pretend nothing is wrong either!

m4rtink 6y ago

Well, that's pretty screwed up. For comparison Czech hospitals also scrapped anything non essential during the worst part of the local outbreak, both to have capacity for treating coronavirus patients and to reduce the chance of infection spreading through hospitals. At the same time a strong lockdown was done country wide. This was apparently effective with cases limited to a few clusters at the moment & most of the lockdown restrictions removed by now. Were the hospitals affected ? They did report funding shortfals right after the lockdown due to all the cancelled elective procedures, so the ministry of health simply gave them extra money to cover the lockdown loses. And at the moment most hospitals are back to normal workflow. Also, the people involved in directly handling the infection got bonuses as a thank you for doing the needed but dangerous work.

Spooky23 6y ago

It's weird that this isn't more widely known. Alot of my friends are in the medical field, and they are taking a beating personally. Stuff like long term 15-20% pay reductions and furloughs in addition to layoffs. Not only are hospitals for profit, but their part of cartel-like health networks. For some jobs, its hard to jump because 80% of the work is affiliated with two companies regionally.