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This is where the government could step in and provide nursing homes. They already end up paying for most of it via Medicare, why not have more control over qu

This is where the government could step in and provide nursing homes. They already end up paying for most of it via Medicare, why not have more control over quality and standards. You could even trial it via a (much needed) VA nursing home program for vets

SoftTalker 3y ago
I'm not sure the VA is a good example to hold up. Aren't VA hospitals notorious horror shows?
- sarchertech 3y ago
  VA hospitals have outperformed private hospitals in patient satisfaction for at least a decade. https://www.npr.org/2023/06/14/1181827077/va-hospitals-health-care https://www.npr.org/2023/06/14/1181827077/va-hospitals-healt...
  - oooyay 3y ago
    I'm curious how those surveys are administered. If they're not surveying patients that walk away or don't get treatment then they aren't really capturing the full picture. Unlike private hospitals the VA is obligated to serve all veterans and it's the portion that they miss or manage out that became problematic national news. There's a reason Obama passed legislation allowing veterans to seek outside care and it wasn't always wait times. It also had to do with VA guidelines, standards, and practices which very much differ from private care.
    - sarchertech 3y ago
      It’s possible that all kinds of things skew the results. It’s possible that veterans are more likely to report that they are satisfied in general. But there have been numerous studies comparing the VA to private hospitals that show the VA tends to be safer and more effective as well as having higher satisfaction scores. >There’s a reason Obama passed legislation… People are constantly complaining about other health systems like Kaiser and private insurance companies as well. The VA is the countries largest health network and veterans are a very symptomatic group. My guess is that if you changed history so that Kaiser was in charge of veterans healthcare, with the same guidelines and standard of care they use today, you’d have seen a similar law passed.
      - oooyay 3y ago
        Yeah, I'm not buying it. My experience was bad and I've met many people who've had it worse there. Again, it's the process and bureaucracy. The standard of care, when you get it, is mostly adequate but navigating their system is absolute hell. I suspect they're narrowly defining these studies to standard of care.
        sarchertech 3y ago
        That could be the case. Here’s a meta study with links to all of the individual studies if you want to look deeper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215146/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215146/ But I know plenty of people who say the exact same thing about Kaiser. I know plenty of people who say the exact same thing about medical care in the US in general.
        oooyay 3y ago
        Thanks for the link. They are only studying actual care provided. That's definitely going to fly right over the issues at the VA. I've used Kaiser before and the system is nothing like the VA system. Are you a VA member or are you just trying to normalize it against something you know?
        sarchertech 3y ago
        I'm not a VA member. I have close family who are though. And I hear the same kind of complaints from them as I do from family members with Kaiser. Mostly around availability of specialists. Things like not being able to schedule an appointment with a Kaiser GI doctor for 6 months, but they wouldn't approve going to an outside doctor without going through some kind of byzantine appeals process. As far as the studies go, I was originally posting them in response to the OP's claim that VA hospitals are "notorious horror shows", which implies things like botched surgeries.
morkalork 3y ago
Works great until the next politician in charge reenacts privatization and retires with a sweetheart position on the board like this: https://www.theglobeandmail.com/business/commentary/article-a-look-at-mike-harriss-post-politics-career/ https://www.theglobeandmail.com/business/commentary/article-...
- schneems 3y ago
  Warren ran on a platform in 2020 that had some good systemic solutions to issues like that. We have the power to regulate, we have the power to regulate the regulators. We don’t have to accept the way things are now is the way things will always be. Basically: instead of this being a “can’t do it because of X” how about “let’s do it, but make sure to fix systemic issue X from happening too!”
  - morkalork 3y ago
    Of course! I'm not saying it should be done, it absolutely should. There's no place for profiteering from people's health like that in a civilized society. Just that making it public is not the end of the story either.
deleted 3y ago
[deleted]
oooyay 3y ago
I had a comment here that described the committees that people could write to in order to change things, but it got voted down to zero. > You could even trial it via a (much needed) VA nursing home program for vets I appreciate the gesture but this is not a good idea. The VA's funding, as well as programs administered by the VA, is subject to tit for tat battles in the House Appropriations Committee. That's to say, it will get gutted over time if you create it. When it is gutted the two sides will create competing narratives of which you will never be able to discover truths from. This has been happening for generations and the VA frankly isn't that old. Example: - https://appropriations.house.gov/news/blogs/democrats-vote-against-fully-funding-va https://appropriations.house.gov/news/blogs/democrats-vote-a... - https://democrats-appropriations.house.gov/news/press-releases/house-democrats-highlight-how-republican-funding-bill-fails-to-honor-our https://democrats-appropriations.house.gov/news/press-releas...
- frenchyatwork 3y ago
  The unwillingness, on all sides of political spectrum, to provide physical and psychological support to former military members in modern democracies is something that completely baffles me. In Canada, at least, no-one wants to join the military because it's a shit job with shit pay, and what we end up with is a small contingent of volunteers who are either a) highly idealistic or b) excited to commit war crimes, and that is why the Canadian Airborne Regiment is no longer a thing.
  - deleted 3y ago
    [deleted]
kjs3 3y ago
why not have more control over quality and standards In theory they do, since eligibility for getting paid by Medicare has requirements. Unfortunately, there are too many vested interests influencing the process in the "government oversight is pure evil/of course we can police ourselves" direction.
mensetmanusman 3y ago
That could set the stage for a Canadian situation where if you complain they offer death as an option. https://beta.ctvnews.ca/national/politics/2022/12/2/1_6179325.amp.html https://beta.ctvnews.ca/national/politics/2022/12/2/1_617932...
- CogitoCogito 3y ago
  I think it’s more likely to set the stage for quality nursing homes.
  - junofan 3y ago
    Maybe it could be opt-in. Elect to pay a little bit extra in taxes. Then you get to go to the government home. I’d fully support that. In reality, people don’t really care much about very elderly people. Not even their own families most of the time.
    - CogitoCogito 3y ago
      Ignoring the question of whether the government should actually be involved in this, I don't really see why this specific aspect of society should be opt-in. Basically all things provided by the government are used at different rates (or not at all) by different citizens so I don't see why that reasoning wouldn't lead us to making all things in society be opt-in. Some actually believe that sort of idea makes sense, but I certainly do not. In any case, the government could surely just regulate private nursing homes much more strictly making many of these parasitical companies' business models untenable.
throw10920 3y ago
Think about what you're saying for a second. You're advocating for the same government that has had the ability to regulate nursing homes for the last few decades, and failed to do so, instead be given full control over nursing homes? You're suggesting that the politicians who had the power to fix the problem and did nothing instead be given more power? That's such a self-obviously bad and self-contradictory idea.
- throwawaysugar 3y ago
  https://en.wikipedia.org/wiki/Principal%E2%80%93agent_problem https://en.wikipedia.org/wiki/Principal%E2%80%93agent_proble...
- nothercastle 3y ago
  It would still be bad and a failure but it would be cheaper so why not
  - throw10920 3y ago
    Because it would not necessarily be cheaper. The government can be incredibly wasteful and inefficient, especially when corruption is involved - and the money still comes from you! The fact that the costs are coming from your taxes and in the form of more expensive goods and services and decreases wages due to inflation makes the costs hidden, not lower.
    - avs733 3y ago
      >Because it would not necessarily be cheaper. The government can be incredibly wasteful and inefficient, especially when corruption is involved - and the money still comes from you! Personally, I've come to the following conclusion after dealing with the American health care system far to much in the last three years and several encounters with corporate America throughout my adult life: There is no difference in the potential for waste, inefficiency, fraud, corruption, laziness, and outright stupidity between government and private systems. There is a difference in (1) my (and my fellow citizens) ability to influence between that two and (2) not having to pay for profit and the costs to me resulting from necessary profit on top of the rest of the shit sundae.

SoftTalker 3y ago

I'm not sure the VA is a good example to hold up. Aren't VA hospitals notorious horror shows?

sarchertech 3y ago
VA hospitals have outperformed private hospitals in patient satisfaction for at least a decade. https://www.npr.org/2023/06/14/1181827077/va-hospitals-health-care https://www.npr.org/2023/06/14/1181827077/va-hospitals-healt...
- oooyay 3y ago
  I'm curious how those surveys are administered. If they're not surveying patients that walk away or don't get treatment then they aren't really capturing the full picture. Unlike private hospitals the VA is obligated to serve all veterans and it's the portion that they miss or manage out that became problematic national news. There's a reason Obama passed legislation allowing veterans to seek outside care and it wasn't always wait times. It also had to do with VA guidelines, standards, and practices which very much differ from private care.
  - sarchertech 3y ago
    It’s possible that all kinds of things skew the results. It’s possible that veterans are more likely to report that they are satisfied in general. But there have been numerous studies comparing the VA to private hospitals that show the VA tends to be safer and more effective as well as having higher satisfaction scores. >There’s a reason Obama passed legislation… People are constantly complaining about other health systems like Kaiser and private insurance companies as well. The VA is the countries largest health network and veterans are a very symptomatic group. My guess is that if you changed history so that Kaiser was in charge of veterans healthcare, with the same guidelines and standard of care they use today, you’d have seen a similar law passed.
    - oooyay 3y ago
      Yeah, I'm not buying it. My experience was bad and I've met many people who've had it worse there. Again, it's the process and bureaucracy. The standard of care, when you get it, is mostly adequate but navigating their system is absolute hell. I suspect they're narrowly defining these studies to standard of care.
      - sarchertech 3y ago
        That could be the case. Here’s a meta study with links to all of the individual studies if you want to look deeper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215146/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215146/ But I know plenty of people who say the exact same thing about Kaiser. I know plenty of people who say the exact same thing about medical care in the US in general.
        oooyay 3y ago
        Thanks for the link. They are only studying actual care provided. That's definitely going to fly right over the issues at the VA. I've used Kaiser before and the system is nothing like the VA system. Are you a VA member or are you just trying to normalize it against something you know?
        sarchertech 3y ago
        I'm not a VA member. I have close family who are though. And I hear the same kind of complaints from them as I do from family members with Kaiser. Mostly around availability of specialists. Things like not being able to schedule an appointment with a Kaiser GI doctor for 6 months, but they wouldn't approve going to an outside doctor without going through some kind of byzantine appeals process. As far as the studies go, I was originally posting them in response to the OP's claim that VA hospitals are "notorious horror shows", which implies things like botched surgeries.

morkalork 3y ago

Works great until the next politician in charge reenacts privatization and retires with a sweetheart position on the board like this: https://www.theglobeandmail.com/business/commentary/article-a-look-at-mike-harriss-post-politics-career/ https://www.theglobeandmail.com/business/commentary/article-...

schneems 3y ago
Warren ran on a platform in 2020 that had some good systemic solutions to issues like that. We have the power to regulate, we have the power to regulate the regulators. We don’t have to accept the way things are now is the way things will always be. Basically: instead of this being a “can’t do it because of X” how about “let’s do it, but make sure to fix systemic issue X from happening too!”
- morkalork 3y ago
  Of course! I'm not saying it should be done, it absolutely should. There's no place for profiteering from people's health like that in a civilized society. Just that making it public is not the end of the story either.

deleted 3y ago

[deleted]

oooyay 3y ago

I had a comment here that described the committees that people could write to in order to change things, but it got voted down to zero. > You could even trial it via a (much needed) VA nursing home program for vets I appreciate the gesture but this is not a good idea. The VA's funding, as well as programs administered by the VA, is subject to tit for tat battles in the House Appropriations Committee. That's to say, it will get gutted over time if you create it. When it is gutted the two sides will create competing narratives of which you will never be able to discover truths from. This has been happening for generations and the VA frankly isn't that old. Example: - https://appropriations.house.gov/news/blogs/democrats-vote-against-fully-funding-va https://appropriations.house.gov/news/blogs/democrats-vote-a... - https://democrats-appropriations.house.gov/news/press-releases/house-democrats-highlight-how-republican-funding-bill-fails-to-honor-our https://democrats-appropriations.house.gov/news/press-releas...

frenchyatwork 3y ago
The unwillingness, on all sides of political spectrum, to provide physical and psychological support to former military members in modern democracies is something that completely baffles me. In Canada, at least, no-one wants to join the military because it's a shit job with shit pay, and what we end up with is a small contingent of volunteers who are either a) highly idealistic or b) excited to commit war crimes, and that is why the Canadian Airborne Regiment is no longer a thing.
- deleted 3y ago
  [deleted]

kjs3 3y ago

why not have more control over quality and standards In theory they do, since eligibility for getting paid by Medicare has requirements. Unfortunately, there are too many vested interests influencing the process in the "government oversight is pure evil/of course we can police ourselves" direction.

mensetmanusman 3y ago

That could set the stage for a Canadian situation where if you complain they offer death as an option. https://beta.ctvnews.ca/national/politics/2022/12/2/1_6179325.amp.html https://beta.ctvnews.ca/national/politics/2022/12/2/1_617932...

CogitoCogito 3y ago
I think it’s more likely to set the stage for quality nursing homes.
- junofan 3y ago
  Maybe it could be opt-in. Elect to pay a little bit extra in taxes. Then you get to go to the government home. I’d fully support that. In reality, people don’t really care much about very elderly people. Not even their own families most of the time.
  - CogitoCogito 3y ago
    Ignoring the question of whether the government should actually be involved in this, I don't really see why this specific aspect of society should be opt-in. Basically all things provided by the government are used at different rates (or not at all) by different citizens so I don't see why that reasoning wouldn't lead us to making all things in society be opt-in. Some actually believe that sort of idea makes sense, but I certainly do not. In any case, the government could surely just regulate private nursing homes much more strictly making many of these parasitical companies' business models untenable.

throw10920 3y ago

Think about what you're saying for a second. You're advocating for the same government that has had the ability to regulate nursing homes for the last few decades, and failed to do so, instead be given full control over nursing homes? You're suggesting that the politicians who had the power to fix the problem and did nothing instead be given more power? That's such a self-obviously bad and self-contradictory idea.

throwawaysugar 3y ago
https://en.wikipedia.org/wiki/Principal%E2%80%93agent_problem https://en.wikipedia.org/wiki/Principal%E2%80%93agent_proble...
nothercastle 3y ago
It would still be bad and a failure but it would be cheaper so why not
- throw10920 3y ago
  Because it would not necessarily be cheaper. The government can be incredibly wasteful and inefficient, especially when corruption is involved - and the money still comes from you! The fact that the costs are coming from your taxes and in the form of more expensive goods and services and decreases wages due to inflation makes the costs hidden, not lower.
  - avs733 3y ago
    >Because it would not necessarily be cheaper. The government can be incredibly wasteful and inefficient, especially when corruption is involved - and the money still comes from you! Personally, I've come to the following conclusion after dealing with the American health care system far to much in the last three years and several encounters with corporate America throughout my adult life: There is no difference in the potential for waste, inefficiency, fraud, corruption, laziness, and outright stupidity between government and private systems. There is a difference in (1) my (and my fellow citizens) ability to influence between that two and (2) not having to pay for profit and the costs to me resulting from necessary profit on top of the rest of the shit sundae.