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> Not excusing the Portopiccolo Group at all, but it sounds like half the problem is labor shortage. The problem is enormously complex. First, there's been a

> Not excusing the Portopiccolo Group at all, but it sounds like half the problem is labor shortage. The problem is enormously complex. First, there's been a labour shortage in geriatric care for years. Then the pandemic came along and exacerbated things. Meanwhile, elder care in highly supportive settings is very labour intensive, which means it's expensive. But it's also a service people have no choice to buy. i.e., eventually some percentage of elders will require full time care, and right now, in most of the western world, that means an institutional setting. And the consumers of the product are some of the least represented in our political systems. Even with organizations like the AARP, the reality is the needs of an aging population get about as much attention as the needs of the poor. When you combine a product with very high and inelastic demand, combined with high costs, and no consumer advocacy, and then privatize that service, guess what: the quality of the product is going to go down in order to cut costs and maximize profits. Given that the primary cost of elder care is staffing, that creates downward pressure salaries, which drives even more people out of an already very challenging industry. The answer is simple: Elder care should be a publicly delivered service. But, the neoliberal answer is to Privatize All The Things. And so here we are.

ars 4y ago
> The answer is simple: Elder care should be a publicly delivered service. It is. Medicare pays for almost all Elder care. Which of course is the problem - private pay nursing homes are way better than the publicly funded ones because Medicare pays far less. Or at you implying that the Government should directly own nursing homes, and hire the staff directly? That has a whole different set of problems - don't advocate for that without understand what you are asking. You end up with centralized decision making for something very local. You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall.
- BaseballPhysics 4y ago
  > You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall. It's both. America has chosen the worst of both worlds: public under-funding and private delivery. Private delivery leads to cutting corners to maximize profits. Lack of sufficient public funding exacerbates the issue. The solution is to fix the public funding problem by properly investing in the system, and killing private delivery.
- mindslight 4y ago
  nit: Medicaid. Medicare will pay for inpatient rehab after hospital stays and the like, but long term care essentially requires becoming destitute so that Medicaid will pay. A large part of middle-upper-middle class "estate planning" consists of passing wealth to kids well before the lookback period. The private pay burn rate is like $150k/yr last time I checked. I don't think there is any easy answer. Spending drastically more on the problem is necessary, but obviously not sufficient. Then again, dying from laying in your own feces ("bed sores") when you're 80+ years old isn't the worst way to go out in the US.
bedhead 4y ago
Seriously? Let's see, the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. How in the world is complete government subsidization, which will basically just turbocharge demand by making it "free", going to solve the problem? The bottleneck (as you correctly note) is labor, if you can't fix that then anything to increase demand is just going to make it wildly more expensive and completely dysfunctional.
- BaseballPhysics 4y ago
  > Let's see, the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. The US government is not directly delivering either of those systems. The US government is using public funds to subsidize private delivery, and doing it with virtually no cost controls to ensure those private companies aren't gouging the public. The rest of the world has figured out how to make public healthcare and education work. The fact that the US can't is an indictment of US political leadership and, frankly, cultural values.
- crmd 4y ago
  > the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. Education and healthcare are two examples of inherently social enterprises. Allowing profit-seeking firms into these spaces has caused nothing but trouble. Having CEOs in charge of healthcare and education is as stupid of an idea as having government planners deciding the price of cars and how many cars each factory will produce per year. Most enterprises are capitalistic, but some like education and healthcare are inherently social.
- urthor 4y ago
  Making a conclusion off a single data point is ridiculous. Across multiple countries, only the United States has this problem.
commandlinefan 4y ago
> Elder care should be a publicly delivered service Figured this proposal would be on here somewhere. There are government-run nursing homes, always have been, even in America. People do everything they can to avoid them, because they're way worse than the private ones.
- Ar-Curunir 4y ago
  Hm, I wonder if that’s related to the immediate next line of the post your replied to, and which you omitted.
  - drekipus 4y ago
    Public ones do worse than private ones, so the solution is to remove private ones, then there's no comparison. Right.
    - paulryanrogers 4y ago
      Or maybe to fund and run the public ones better. Perhaps newly elected officials should have to live in one for their first week in office.
      - xboxnolifes 4y ago
        "Just run them better" is not a plan of action. As with all things, incentives breed outcomes. What actions would you take to improve public-funded outcomes here?
        paulryanrogers 4y ago
        Other countries do this through single payer healthcare.
rayiner 4y ago
> The answer is simple: Elder care should be a publicly delivered service. Would you put your parents into a facility run by the same people who run the NYC public school system or the DC Metro? I’m not a “neoliberal” by temperament. I want to believe the government can do stuff in an efficient and non-abusive way. I’m just repeatedly disappointed.
- edmundsauto 4y ago
  the people who run government funded health facilities are a different set of people that run education or transportation. Only the funding source is the same. Would you put your parents in a nursing home paid for by Medicare? I would, because I saw the care my grandmother received from such a facility.
  - rayiner 4y ago
    > the people who run government funded health facilities are a different set of people that run education or transportation. Only the funding source is the same. They’re the same people. Government employees, belonging to the same unions, subject to the same incentives. > Would you put your parents in a nursing home paid for by Medicare? I would, because I saw the care my grandmother received from such a facility Medicare and Medicaid go out of their way to not be “publicly delivered services.” Medicare pays for privately managed elder care facilities, which may well be owned by a private equity company.
    - edmundsauto 4y ago
      > They’re the same people. Government employees, belonging to the same unions, subject to the same incentives. Similarly, private equity is the same people with the same incentives as Enron, Toys R Us, Sears, and other major collapses. I'm not sure this is a good argument except as to say that nobody should run anything? Government is supposedly less efficient, I'm not sure this is a bad thing, and I'm not sure government is worse at health care than private industry when we are talking about care for the bottom X% (25%?) of society that can't do private payment.
UncleMeat 4y ago
This is my experience too. My sister has a doctorate in physical therapy and focuses on aid for the elderly. My whole family assumed that given the need that it’d pay well. Turns out everything is run by corporations that incentivize working employees to death and providing care that is billable but not necessary and refusing care that is necessary but less efficiently billable. She loves working with the elderly but the system makes the career so demoralizing.

ars 4y ago

> The answer is simple: Elder care should be a publicly delivered service. It is. Medicare pays for almost all Elder care. Which of course is the problem - private pay nursing homes are way better than the publicly funded ones because Medicare pays far less. Or at you implying that the Government should directly own nursing homes, and hire the staff directly? That has a whole different set of problems - don't advocate for that without understand what you are asking. You end up with centralized decision making for something very local. You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall.

BaseballPhysics 4y ago
> You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall. It's both. America has chosen the worst of both worlds: public under-funding and private delivery. Private delivery leads to cutting corners to maximize profits. Lack of sufficient public funding exacerbates the issue. The solution is to fix the public funding problem by properly investing in the system, and killing private delivery.
mindslight 4y ago
nit: Medicaid. Medicare will pay for inpatient rehab after hospital stays and the like, but long term care essentially requires becoming destitute so that Medicaid will pay. A large part of middle-upper-middle class "estate planning" consists of passing wealth to kids well before the lookback period. The private pay burn rate is like $150k/yr last time I checked. I don't think there is any easy answer. Spending drastically more on the problem is necessary, but obviously not sufficient. Then again, dying from laying in your own feces ("bed sores") when you're 80+ years old isn't the worst way to go out in the US.

bedhead 4y ago

Seriously? Let's see, the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. How in the world is complete government subsidization, which will basically just turbocharge demand by making it "free", going to solve the problem? The bottleneck (as you correctly note) is labor, if you can't fix that then anything to increase demand is just going to make it wildly more expensive and completely dysfunctional.

BaseballPhysics 4y ago
> Let's see, the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. The US government is not directly delivering either of those systems. The US government is using public funds to subsidize private delivery, and doing it with virtually no cost controls to ensure those private companies aren't gouging the public. The rest of the world has figured out how to make public healthcare and education work. The fact that the US can't is an indictment of US political leadership and, frankly, cultural values.
crmd 4y ago
> the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. Education and healthcare are two examples of inherently social enterprises. Allowing profit-seeking firms into these spaces has caused nothing but trouble. Having CEOs in charge of healthcare and education is as stupid of an idea as having government planners deciding the price of cars and how many cars each factory will produce per year. Most enterprises are capitalistic, but some like education and healthcare are inherently social.
urthor 4y ago
Making a conclusion off a single data point is ridiculous. Across multiple countries, only the United States has this problem.

commandlinefan 4y ago

> Elder care should be a publicly delivered service Figured this proposal would be on here somewhere. There are government-run nursing homes, always have been, even in America. People do everything they can to avoid them, because they're way worse than the private ones.

Ar-Curunir 4y ago
Hm, I wonder if that’s related to the immediate next line of the post your replied to, and which you omitted.
- drekipus 4y ago
  Public ones do worse than private ones, so the solution is to remove private ones, then there's no comparison. Right.
  - paulryanrogers 4y ago
    Or maybe to fund and run the public ones better. Perhaps newly elected officials should have to live in one for their first week in office.
    - xboxnolifes 4y ago
      "Just run them better" is not a plan of action. As with all things, incentives breed outcomes. What actions would you take to improve public-funded outcomes here?
      - paulryanrogers 4y ago
        Other countries do this through single payer healthcare.

rayiner 4y ago

> The answer is simple: Elder care should be a publicly delivered service. Would you put your parents into a facility run by the same people who run the NYC public school system or the DC Metro? I’m not a “neoliberal” by temperament. I want to believe the government can do stuff in an efficient and non-abusive way. I’m just repeatedly disappointed.

edmundsauto 4y ago
the people who run government funded health facilities are a different set of people that run education or transportation. Only the funding source is the same. Would you put your parents in a nursing home paid for by Medicare? I would, because I saw the care my grandmother received from such a facility.
- rayiner 4y ago
  > the people who run government funded health facilities are a different set of people that run education or transportation. Only the funding source is the same. They’re the same people. Government employees, belonging to the same unions, subject to the same incentives. > Would you put your parents in a nursing home paid for by Medicare? I would, because I saw the care my grandmother received from such a facility Medicare and Medicaid go out of their way to not be “publicly delivered services.” Medicare pays for privately managed elder care facilities, which may well be owned by a private equity company.
  - edmundsauto 4y ago
    > They’re the same people. Government employees, belonging to the same unions, subject to the same incentives. Similarly, private equity is the same people with the same incentives as Enron, Toys R Us, Sears, and other major collapses. I'm not sure this is a good argument except as to say that nobody should run anything? Government is supposedly less efficient, I'm not sure this is a bad thing, and I'm not sure government is worse at health care than private industry when we are talking about care for the bottom X% (25%?) of society that can't do private payment.

UncleMeat 4y ago

This is my experience too. My sister has a doctorate in physical therapy and focuses on aid for the elderly. My whole family assumed that given the need that it’d pay well. Turns out everything is run by corporations that incentivize working employees to death and providing care that is billable but not necessary and refusing care that is necessary but less efficiently billable. She loves working with the elderly but the system makes the career so demoralizing.