8 ms·

As they acknowledge, this factor is extremely difficult to isolate from demographics, geography, religion, etc.

synetic 3y ago
But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare. All systems have ration care but it is immoral for someone to profit by denying care. Profit motive does not make for a good healthcare system.
- kjghkjghkjgh 3y ago
  Should a Lasik surgeon provide Lasik to everyone regardless of their ability to pay?
  - deleted 3y ago
    [deleted]
  - synetic 3y ago
    The lasik surgeon in your example isn’t profiting by denying care. Their profit does not increase by declining service.
    - kjghkjghkjgh 3y ago
      Is a PE hospital profiting when it denies care too? How is that different from a lasik surgeon denying care?
      - synetic 3y ago
        I didn’t make claims about how PE hospitals make a profit. I just said that no one should profit from denying care. I can think of a situation in which a hospital’s owners want to make sure their return on their investment exceeds x% per year and the hospital administrators deny care based on this consideration (otherwise they might get fired for not generating enough profit). This isn’t the scenario I had in mind when I wrote that no one should profit from denying care. WhenI wrote that I was thinking of insurance companies and wanted to convey a sense that profit driven motives in health care can have bad consequences. Some things ought not be profit driven.
  - worik 3y ago
    > Should a Lasik surgeon provide Lasik to everyone regardless of their ability to pay? Yes
- dcow 3y ago
  Nobody should profit from healthcare at all. I don't care if doctors and nurses and board members and janitors all make fuck you money, or if hospitals reinvest tons of money to perpetually have state of the art facilities. But the profit dynamic is too much.
  - kjghkjghkjgh 3y ago
    How would vaccines and new drugs be invented without any profit incentive?
    - thfuran 3y ago
      Isn't a lot of that coming out of universities already?
      - kjghkjghkjgh 3y ago
        Many are but they also work with for profit pharma companies to fund the work.
        worik 3y ago
        > Many are but they also work with for profit pharma companies to fund the work. It is sad to think that making profits for your masters is the only incentive to do good. It is the way the system has been built. It is not done much for many people's suffering https://en.wikipedia.org/wiki/Neglected_tropical_diseases#Economic_effects https://en.wikipedia.org/wiki/Neglected_tropical_diseases#Ec...
    - boondoggle16 3y ago
      Don't people live long enough already? We can't pay for our retirees. Old age medical care costs $1M+. I know the morally correct thing to do when I get old - give that money to kids instead. Vampires.
      - thfuran 3y ago
- cscurmudgeon 3y ago
  > But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare How does one profit from denying services?
  - synetic 3y ago
    Is this a serious question? You can’t think of a scenario in which a company in America profits from denying care? You should research insurance companies and understand how it is they make a profit.
    - toast0 3y ago
      Medical insurance in the US has strict limits on profits. If they deny a little care, they can hit their cap, but if they deny too much, they have to send premium refunds. Really, the way to increase costs is to increase spending on care --- then they have more profit available, if they also increase premiums.
      - synetic 3y ago
        The CEO of United Healthcare makes around $50 million a year. The Medicare administrator makes around $400,000 a year. Administrative costs for Medicare are around 10%. Healthcare companies balked at being held to the same standard. Health insurers have their profits regulated but not lab services and whatnot. There are ways around the limits. What is your overall point though? Do you think it’s a good idea to have profit motives governing healthcare? Do you believe PE owned hospitals are good? Do you disagree that there are instances of companies profiting from denying care?
  - xenospn 3y ago
    Ask your health insurer. They have an army of people whose job is exactly that.
- starcraft2wol 3y ago
  That's using the theme of the study to support what you already believe, without examining what the study actually shows. I don't disagree that your reasoning sounds plausible, but that's irrelevant of the study's quality.
  - synetic 3y ago
    We live in an imperfect information world. We do studies and try our best to determine cause/effect. Rarely can such a study be a proof. This is where common sense comes in. Sometimes it is wrong too.
verteu 3y ago
> As they acknowledge, this factor is extremely difficult to isolate from demographics, geography, religion, etc. No? They used "a within-facility differences-in-differences design to address nonrandom targeting of facilities" so they're measuring the change in outcomes at the same facility before & after takeover.
- cscurmudgeon 3y ago
  That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.
  - wpietri 3y ago
    If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.
    - cscurmudgeon 3y ago
      > If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. My standard is authors (and random internet commenters) to have an inkling of the progress in causal analysis and related progress in the last two decades. Edit: Some resources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700403 https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700... https://www.hsph.harvard.edu/miguel-hernan/research/causal-inference-from-observational-data/ https://www.hsph.harvard.edu/miguel-hernan/research/causal-i... From 1999: https://liberalarts.tamu.edu/sociology/wp-content/uploads/sites/9/2021/07/winship_morgan_1999_causal_analysis.pdf https://liberalarts.tamu.edu/sociology/wp-content/uploads/si...
      - verteu 3y ago

But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare. All systems have ration care but it is immoral for someone to profit by denying care. Profit motive does not make for a good healthcare system.

kjghkjghkjgh 3y ago
Should a Lasik surgeon provide Lasik to everyone regardless of their ability to pay?
- deleted 3y ago
  [deleted]
- synetic 3y ago
  The lasik surgeon in your example isn’t profiting by denying care. Their profit does not increase by declining service.
  - kjghkjghkjgh 3y ago
    Is a PE hospital profiting when it denies care too? How is that different from a lasik surgeon denying care?
    - synetic 3y ago
      I didn’t make claims about how PE hospitals make a profit. I just said that no one should profit from denying care. I can think of a situation in which a hospital’s owners want to make sure their return on their investment exceeds x% per year and the hospital administrators deny care based on this consideration (otherwise they might get fired for not generating enough profit). This isn’t the scenario I had in mind when I wrote that no one should profit from denying care. WhenI wrote that I was thinking of insurance companies and wanted to convey a sense that profit driven motives in health care can have bad consequences. Some things ought not be profit driven.
- worik 3y ago
  > Should a Lasik surgeon provide Lasik to everyone regardless of their ability to pay? Yes
dcow 3y ago
Nobody should profit from healthcare at all. I don't care if doctors and nurses and board members and janitors all make fuck you money, or if hospitals reinvest tons of money to perpetually have state of the art facilities. But the profit dynamic is too much.
- kjghkjghkjgh 3y ago
  How would vaccines and new drugs be invented without any profit incentive?
  - thfuran 3y ago
    Isn't a lot of that coming out of universities already?
    - kjghkjghkjgh 3y ago
      Many are but they also work with for profit pharma companies to fund the work.
      - worik 3y ago
        > Many are but they also work with for profit pharma companies to fund the work. It is sad to think that making profits for your masters is the only incentive to do good. It is the way the system has been built. It is not done much for many people's suffering https://en.wikipedia.org/wiki/Neglected_tropical_diseases#Economic_effects https://en.wikipedia.org/wiki/Neglected_tropical_diseases#Ec...
  - boondoggle16 3y ago
    Don't people live long enough already? We can't pay for our retirees. Old age medical care costs $1M+. I know the morally correct thing to do when I get old - give that money to kids instead. Vampires.
    - thfuran 3y ago
cscurmudgeon 3y ago
> But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare How does one profit from denying services?
- synetic 3y ago
  Is this a serious question? You can’t think of a scenario in which a company in America profits from denying care? You should research insurance companies and understand how it is they make a profit.
  - toast0 3y ago
    Medical insurance in the US has strict limits on profits. If they deny a little care, they can hit their cap, but if they deny too much, they have to send premium refunds. Really, the way to increase costs is to increase spending on care --- then they have more profit available, if they also increase premiums.
    - synetic 3y ago
      The CEO of United Healthcare makes around $50 million a year. The Medicare administrator makes around $400,000 a year. Administrative costs for Medicare are around 10%. Healthcare companies balked at being held to the same standard. Health insurers have their profits regulated but not lab services and whatnot. There are ways around the limits. What is your overall point though? Do you think it’s a good idea to have profit motives governing healthcare? Do you believe PE owned hospitals are good? Do you disagree that there are instances of companies profiting from denying care?
- xenospn 3y ago
  Ask your health insurer. They have an army of people whose job is exactly that.
starcraft2wol 3y ago
That's using the theme of the study to support what you already believe, without examining what the study actually shows. I don't disagree that your reasoning sounds plausible, but that's irrelevant of the study's quality.
- synetic 3y ago
  We live in an imperfect information world. We do studies and try our best to determine cause/effect. Rarely can such a study be a proof. This is where common sense comes in. Sometimes it is wrong too.

verteu 3y ago

> As they acknowledge, this factor is extremely difficult to isolate from demographics, geography, religion, etc. No? They used "a within-facility differences-in-differences design to address nonrandom targeting of facilities" so they're measuring the change in outcomes at the same facility before & after takeover.

cscurmudgeon 3y ago
That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.
- wpietri 3y ago
  If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.
  - cscurmudgeon 3y ago
    > If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. My standard is authors (and random internet commenters) to have an inkling of the progress in causal analysis and related progress in the last two decades. Edit: Some resources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700403 https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700... https://www.hsph.harvard.edu/miguel-hernan/research/causal-inference-from-observational-data/ https://www.hsph.harvard.edu/miguel-hernan/research/causal-i... From 1999: https://liberalarts.tamu.edu/sociology/wp-content/uploads/sites/9/2021/07/winship_morgan_1999_causal_analysis.pdf https://liberalarts.tamu.edu/sociology/wp-content/uploads/si...
    - verteu 3y ago