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I have a close relation that works for one of the oldest pediatric hospitals in the country. It was recently revealed that they will be shuttering almost all pe
by germinalphrase 5y ago
I have a close relation that works for one of the oldest pediatric hospitals in the country. It was recently revealed that they will be shuttering almost all pediatric services in the next year because they can 10x their profits by only serving elderly clients. The entire purpose of this organization was to provide pediatric healthcare, and it wasn’t losing money…
Sometimes, it feels like we’re min-maxing ourselves to death over here.
- dontbeevil1992 5y ago[flagged]
- LewisVerstappen 5y agoThe healthcare system in the US clearly has nothing to do with free markets considering how unbelievably opaque and regulated everything is.
- jerry1979 5y ago[flagged]
- marcusverus 5y agoBy that line of reasoning, capitalism produced Social Security and communism produced Alibaba.
- LewisVerstappen 5y agoSure, but that's like blaming "humanity" for all the woes of the health care system. It's humans who produced the health care system in the US after all. You have to be more precise as there are clearly aspects of capitalism that have resulted in tremendous improvements in quality of life (look at North Korea vs. South Korea). Regulatory capture is one of the issues & revolving door politics. Especially a big problem in the healthcare & finance industries (the current head of the SEC spent his career at Goldman Sachs for ex.)
- whatshisface 5y agoI don't even think Marx would agree with that. He thought capitalism produced a stage of history that wasn't exactly capitalist, which then would inevitably produce communism through socialism.
- frgtpsswrdlame 5y agoI doubt Marx could have thought of something more capitalist than $THC or $HCA.
- whatshisface 5y agoHe could have and did: factories and craftspeople from Adam Smith's world are the epitypes of capitalist activity. Giant corporations that half-merge with the government are Marx's final, dying and barely capitalist stage of capitalism, that hardly involves markets at all. He thought capitalism (factories and craftspeople) would reach the end of its lifespan and give birth to $THC or $HCA.
- orwin 5y agoIt is what he called late stage capitalism. He might have been wrong on the solutions, but he nailed the problem quite well.
- marcusverus 5y agoBy that line of reasoning, capitalism produced Social Security and communism is produced Alibaba.
- whimsicalism 5y agoI don't think the US can be summed up with a single word. Can I hire my friend who is a medical student to perform surgery on me legally? No?
- wcfields 5y ago> I don't think the US can be summed up with a single word. I think it can, I've been thinking about this and it's "scam". Like, think how often everything in our country is a straight up scam. Healthcare, parking tickets, basically anything you buy. It's almost all snake-oil flim-flam every which way and as a 'consumer' you have to wade through the mire every single day to get scammed as little as possible.
- yoyohello13 5y agoSo true! Everywhere I turn it's just people trying to extract the maximum amount of money from me for the minimum amount of value in return. It can't be good for our psyche.
- yhoneycomb 5y agoActually, that’s exactly how unfettered “free market” capitalism operates. The end game is big companies end up controlling everything, including the regulations in order to tip the scales in their favor.
- LewisVerstappen 5y agoRegulatory capture is the issue that needs to be solved. Not free markets. Free markets are the most efficient way for information to be transferred throughout the system. Stricter campaign finance laws, ending revolving-door politics, etc. But putting the blame on free markets seems like a mistake.
- thomasahle 5y agoMonopolization and regulatory capture are standard features of free markets, if you leaving them running long enough.
- thedataslinger 5y agoWait, wait, wait--you're saying that we need to solve issues like regulatory capture through legislation... so that we can have a market without governmental interference (aka a "free market")? Huh? You can't on the one hand tout the "free market", while on the other complain that we don't have the "right" kind of governmental interference. Even if you could square that circle, it still sounds disingenuous to argue that we could have the most efficient system if only we were to eliminate _thing that said system actively encourages_. The failure is baked into the game, my friend.
- Cederfjard 5y agoI don’t think that reasoning is necessarily unsound. For there to be regulatory capture, there needs to be regulation. The legislation proposed could be to remove or minimize that regulation, and thus limit the ”hooks” whereby to capture it with. Replacing ”governmental interference” with ”less governmental interference”, not ”different governmental interference”. I don’t take such a libertarian view myself, by the way. Just pointing out that I don’t think you can pick apart the argument of the person you replied to in that way.
- cowpig 5y agoThere's no such thing as a "free market" for healthcare. The ability for consumers to exit a market is one of the prerequisites for the invisible hand effect. You can't exit the healthcare market.
- throwawayboise 5y agoSure you can. You can decide that you are not going to enrich an industry that basically does nothing for you in the long run. Everyone ends up dead, and I for one do not plan to spend my final years under constant care from a industry that is designed to drain every last dollar I have before I pass on.
- jewayne 5y agoI think the majority of people say something to that effect at some point in their life. But the only real alternative is suicide of some kind, and how many people actually follow through with suicide?
- marcusverus 5y agoYou can't exit the food market, either, and yet there is clearly a thriving free market for food. How does your theory account for this?
- jewayne 5y ago45 million Americans are on the SNAP (food stamp) program. Does your definition of "thriving free market" account for this?
- wcfields 5y agoI think you're being purposefully obtuse, but here's why: - SNAP / EBT / Foodstamps for people making so little money. Add onto that, Food banks. - Farm subsidies for many cheap foodstuffs (Corn) causing massive cheap, albeit junk food that can sustain. - I can literally grow food in the ground for "free", put it in mason jars and save my food for a year. I can't open a fresh can of broken-arm at the fixed cost. - Food is fungible, if I'm hungry, I can wait 2, 3, 8+ hours to eat, or have a quick snack until meal time. It's not like I need a Big Mac infusion in the next 10 seconds or else I'll die from lack of special sauce. - You have many options of food. You can eat Soylent, rice&beans, or steak for every meal at various price points. You don't really get an ala carte when it comes to Chemotherapy. - You can always eat monkey pellets [1] [1] https://www.reddit.com/r/moreplatesmoredates/comments/qbfkfl/4chan_user_eats_diet_of_monkey_chow_is_absolutely/ https://www.reddit.com/r/moreplatesmoredates/comments/qbfkfl...
- callmeal 5y ago>The healthcare system in the US clearly has nothing to do with free markets Ahem. Regulatory capture would like a word.
- dnissley 5y agoHow has regulatory capture helped create the US healthcare system?
- ren_engineer 5y agocapitalism is the reason for hospitals choosing to serve patients covered by Medicare which will give them a blank check with tax payer money?
- thedataslinger 5y agoIt's not because Medicare offers a "blank check"; after all--the amount of revenue that the hospital can generate will always be hard-capped by the number of beds+/physicians+/resources available. They go with Medicare because the pay-out rate (i.e. "collect-ability") for billable services is much higher--and much more predictable--than if they attempted to collect/negotiate with non-governmental providers. A LOT of money is lost by hospital systems due to unpaid patient responsibility (e.g. insurance deductibles), which they can minimize by offering only services already guaranteed to be covered by Medicare.
- Clubber 5y ago>Medicare ... will give them a blank check with tax payer money? Whoever gave you that idea, you should stop listening to them. Medicare payments are subject to a medicare fee schedule, which is typically much lower than a traditional private enterprise's fee schedule. What that means is medicare gets billed a lot less than a regular patient with insurance. https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/ https://www.kff.org/medicare/issue-brief/how-much-more-than-... "Private insurers paid nearly double Medicare rates for all hospital services (199% of Medicare rates, on average), ranging from 141% to 259% of Medicare rates across the reviewed studies." "The difference between private and Medicare rates was greater for outpatient than inpatient hospital services, which averaged 264% and 189% of Medicare rates overall, respectively." "For physician services, private insurance paid 143% of Medicare rates, on average, ranging from 118% to 179% of Medicare rates across studies."
- gen220 5y agoMedicare is not a blank check. It's a standard check (see sibling comment on fee schedules), and each check tends to actually be quite low of an amount. The magnitude of "standard" and "low" are both demonstrated by the fact that when private insurers negotiate pricing contracts (basically, a one-off fee schedule) with hospital groups, they express prices in terms of "medicare multiples". For example, the insurer will pay up to 13x of what Medicare pays for an fMRI administered under non-emergent circumstances with medically-justifiable cause. Pretty much every multiple is >1x, many are far more than 10x. And medicare is arguably more expensive to provide, since the probability of confounding issues from disability or age is higher than in the general insured population. Medicare is very consistent with paying, especially in comparison to private insurance, but the a la carte fees are quite "low" by relatively-freer-market definitions (I say relatively, because the reality is that private insurers negotiating with hospital groups is the antithesis of a free market, in most conceivable dimensions). --- The main reason medical groups lobby against "medicare for all" is that they will lose lucrative "20xM" payouts from private insurers, and it's difficult to see how their ballooning administrative costs can survive on such a lean diet. Of course, this line of thinking is deliberately ignorant of the thought that medicare fee schedules can be renegotiated to reflect the population of patients "medicare for all" would incorporate. But nobody's interested in thinking two turns ahead, let alone advancing the game state, when their pockets are nicely-lined on turn zero.
- hedora 5y agoWe’re facing some massive generational crises at this point, and it feels like the only solution is to wait for the current leadership to die off, and hope the gen x’ers fix it. The WWII generation fixed the ozone hole, but their kids didn’t lift a finger for global warming. Subsequent generations are scrambling to pick up the pieces for our kids, while crap like this, and our rapidly collapsing democracy keep sabotaging our efforts. Heck, in California, we’re actively causing psychological harm to an entire generation of kids (with masks) because of a tiny minority of anti-vaxxer school teachers. Of course, progressive boomers exist, as do idiotic younger people. However, the current generation of leadership in the US has completely failed us. Anyway, it’s not surprising to me that that crowd decided to shunt healthcare resources away from their (great) grandkids and into elder care.
- ISL 5y agoThe WWII generation may have worked to fix the ozone hole, but they also unknowingly created it: https://en.wikipedia.org/wiki/Chlorofluorocarbon#History https://en.wikipedia.org/wiki/Chlorofluorocarbon#History
- karmelapple 5y agoAnd all of the generations helped create climate change, yet we're not doing all that much to comprehensively combat it at a government level.
- bsedlm 5y ago> We’re facing some massive generational crises at this point, and it feels like the only solution is to wait for the current leadership to die off, and hope the gen x’ers fix it. oh man, I choose to laugh so I don't start crying hahaha. I want to turn this into an argument of why age-reversal and other longevity research is such a bad idea (personally, I think it's kind of evil; but maybe I've seen too many villanous cartoon characters throwing everything under the bus so the can live forever).
- wardedVibe 5y ago
- black_puppydog 5y agoYeah if they're only after profits, why not become a hedge fund?
- 93po 5y agoMany are owned by hedge funds: https://www.nbcnews.com/health/health-care/private-equity-firms-now-control-many-hospitals-ers-nursing-homes-n1203161 https://www.nbcnews.com/health/health-care/private-equity-fi...
- whimsicalism 5y agoBecoming a hedge fund is actually a bad idea if you are only after profits because it is unclear that over long-time horizon this is actually a very profitable activity. We only remember the winners.
- Kranar 5y agoThe majority of hedge funds fail within 3 years, having never reached profitability.
- lupire 5y agoHedgefunds don't get to perpetrate $Billion Medicare fraud and then get elected to the Governor and Senate. (HCA / Rick Scott).
- RayVR 5y agoBeing a hedge fund that makes money is significantly more difficult than you think
- Aperocky 5y ago> they can 10x their profits by only serving elderly clients. I knew of certain defunct malls that decided to get rid of things that doesn't make money and only keep the high profit inventories. Soon people stopped coming and they went under..
- throwawaygh 5y ago>> they can 10x their profits by only serving elderly clients. > Soon people stopped coming Ah, yes. Why didn't we think of this before? By increasing the cost of (geriatric) healthcare, we can destroy demand. That's how supply/demand curves work right? In this way the invisible hand delivers unto us a fountain of youth ;)
- Aperocky 5y agoThey may 10x their profit by serving elderly clients but that is assuming x more elderly clients would want to suddenly come. But why? Are elderly clients underserved in that area? Are they going to ditch their original care provider and all come here?
- throwawaygh 5y ago> But why? Old people in the USA are EXTREMELY wealthy in terms of healthcare purchasing power. All retired people have medicare. Many retired people have additional healthcare coverage from their former employers (doesn't exist anymore -- disappeared along with pensions -- but this benefit used to be common). Many retired people have significant savings in addition to medicare and private health insurance. Most new parents have little to no government assistance, do not have significant expendable income, and have little to no accumulated wealth. Children, of course, are even poorer than their deadbeat parents.
- germinalphrase 5y agoWhat I was told is that elderly people need more and more frequent care. Additionally, reimbursements tend to be higher for the procedures elderly people need vs children.
- anonporridge 5y agoCronus devouring his children.
- whimsicalism 5y ago> The entire purpose of this organization was to provide pediatric healthcare, and it wasn’t losing money… If it's entire purpose was to provide pediatric healthcare it should probably have registered itself as a not-for-profit.
- germinalphrase 5y agoWhy register as a not-for-profit when you’re profitable?
- dragonwriter 5y ago> Why register as a not-for-profit when you’re profitable? If your purpose isn't to return a profit to stakeholders, but to serve some social purpose eligible for charity nonprofit status plus like “pediatric healthcare”, registering as a nonprofit gives you more surplus revenue because of tax exemption and the ability to accept donations that are tax deductible for the donors. It’s also often good PR.
- stevehawk 5y agonothing about being not-for-profit means you can't make a profit. it just means you don't return those earnings to the shareholders and thus find yourself governed by those shareholders.
- archon810 5y agoCan you share the hospital name?
- milkcircle 5y agoIt's probably Tufts. https://www.boston.com/news/health/2022/01/23/pediatric-doctors-speak-out-against-tufts-childrens-hospital-closure/ https://www.boston.com/news/health/2022/01/23/pediatric-doct...
- Bilal_io 5y agoSo, a hospital can close a service with no repercussions, and if workers at a "critical" secure decide to strike they'd be ordered by a judge to get back to work... I hate every part of it.
- lupire 5y agoAnd then they go to jail if the computer glitches or police kill someone in their presence.
- divbzero 5y agoThere seems to be two sides to this. The first, mentioned already in this thread, is that maximizing profits should not be the ultimate yardstick in all cases. The second is that we are not setting incentives correctly in healthcare: preventative care still plays second fiddle to curative care. If the healthcare industry were purely free market, this could be attributed to individuals not understanding the long-term benefits of preventative care, or overly discounting the distant future. But the healthcare system is not purely free market. The largest payers, public and private, could do a lot to correct the incentives by setting their reimbursements accordingly.
- ugh123 5y agoCapitalism and health care just don't mix
- WC3w6pXxgGd 5y ago