4 ms·

IMHO, the REAL problem is not the individual doctors, it's the system we seem to have implemented to dole out "health care" as if it's a product that has to be

IMHO, the REAL problem is not the individual doctors, it's the system we seem to have implemented to dole out "health care" as if it's a product that has to be rationed according to some metric. I've met doctors that are passionate, but are hamstrung by "the process". The hospital has policies, the insurance company has policies, local health departmen thas policies, whatever it is. I hate that "some process" needs to be in place to keep things in check, lest we end up with patients abusing things, or doctors abusing things (SURGERY ALL THE THINGS, for example). I think it's "the process" we have lost trust in. Individual people really do want to do good things for each other. But "the process" sadly has an awful lot of inertia, and doesn't make it easy to change.

malcolmgreaves 2y ago
Precisely right. The corporate takeover of medicine is dangerous. Private equity firms are buying up hospitals and then illegally shutting them down to cash out. (Yes, I’ve seen this happen first hand. I’ve also read about other cases.) Another example of small local governments getting railroaded by corporations that have more money and lawyers.
- nradov 2y ago
  How does shutting down a hospital allow a PE firm to "cash out"? Let's see some actual numbers on that, not vague claims about tax write-offs. Sometimes PE firms take on too much debt as part of acquiring a hospital and paying out a special dividend to shareholders. But if the hospital later fails due to being unable to make debt payments then the PE firm takes a loss on their remaining equity stake; they would always prefer to keep it running as a going concern so that they can sell it for an additional profit later. There is a legitimate issue with concentrated ownership of provider organizations in some regions. More antitrust enforcement is needed to protect consumers but unfortunately that seems unlikely.
  - bbreier 2y ago
    I would say in your toy example the hospital has been shutdown due to the PE firm "cashing out" excessively
  - jrflowers 2y ago
    > How does shutting down a hospital allow a PE firm to "cash out"? https://www.theatlantic.com/ideas/archive/2023/05/private-equity-firms-bankruptcies-plunder-book/673896/ https://www.theatlantic.com/ideas/archive/2023/05/private-eq... https://www.ineteconomics.org/perspectives/blog/private-equity-is-out-of-control-and-looting-america-this-prosecutor-says-we-can-fix-it https://www.ineteconomics.org/perspectives/blog/private-equi...
nradov 2y ago
What would you propose as an alternative? All healthcare systems have to ration care because resources are limited and demand is effectively infinite. We can discuss the process used for rationing but it has to be done on some reasonably objective basis.
- itchyouch 2y ago
  I had a conversation with my friend. "Look at this new, incredible CPU cooler tech! It's sooo good at removing heat." "What if you didn't generate the heat in the first place?" Personally, I have a hypothesis that there are systemic areas we need to address in our food supply to lower healthcare demand. This will sound kooky, but if we can get more sulfur and trace minerals into the food supply, we could improve the general well-being of massive amounts of the population. We really need to look at doing more research into additionally fortifying our foods. Here's a nature article on the reduction of sulfur from the food supply: https://www.nature.com/articles/s43247-021-00172-0 https://www.nature.com/articles/s43247-021-00172-0 NPK farming has ensured that the food supply doesn't have a rich set of additional minerals outside of (N)itrogen, (P)hosphorous and (K)potassium. Then when looking at sulfur-containing molecules, the research on them tends to herald them as miracle-health molecules: MSM Taurine, B1, NAC. All bring sulfur into the body. Then there's companies like Buoy drops that offer 87 different trace minerals and folks are swearing by the effects of them. Asian countries consume things like seaweed and get trace minerals like this from the the sea water, but a the standard american diet is really lacking in a lot of additional nutrition that would be productive to health.
  - nradov 2y ago
    The majority of healthcare spending goes to chronic diseases primarily caused by lifestyle issues. Collectively we are a nation of obese, sedentary substance abusers. If we could do better on prevention and delay the onset of chronic diseases like type-2 diabetes, hypertension, and heart failure then that would largely fix the demand problem and leave a lot more resources available for patients who randomly get cancer or multiple sclerosis or whatever. But this is a policy issue that goes way beyond the healthcare system and no one has a practical solution. Everyone loves to give health and nutrition advice to others, but we're all undisciplined and do unhealthy stuff even when we know we shouldn't. https://peterattiamd.com/outlive/ https://peterattiamd.com/outlive/ As for the food supply, I have no doubt that many people are impacted by subclinical micronutrient deficiencies, whether it's sulphur or zinc or D3 or something else. But the evidence indicates that's less important than excess macronutrients for most people.
jdietrich 2y ago
Americans already consume more healthcare than anyone in human history by a huge margin. A large proportion of that healthcare isn't really healthcare at all, because it does more harm than good. If you're paying out of pocket, you have the right to demand as many tests and as many treatments as you can afford. If you're relying on an insurer to foot the bill, then that insurer has two choices - refuse to pay for some treatments, or watch costs (and premiums) trend towards infinity.

malcolmgreaves 2y ago

Precisely right. The corporate takeover of medicine is dangerous. Private equity firms are buying up hospitals and then illegally shutting them down to cash out. (Yes, I’ve seen this happen first hand. I’ve also read about other cases.) Another example of small local governments getting railroaded by corporations that have more money and lawyers.

nradov 2y ago
How does shutting down a hospital allow a PE firm to "cash out"? Let's see some actual numbers on that, not vague claims about tax write-offs. Sometimes PE firms take on too much debt as part of acquiring a hospital and paying out a special dividend to shareholders. But if the hospital later fails due to being unable to make debt payments then the PE firm takes a loss on their remaining equity stake; they would always prefer to keep it running as a going concern so that they can sell it for an additional profit later. There is a legitimate issue with concentrated ownership of provider organizations in some regions. More antitrust enforcement is needed to protect consumers but unfortunately that seems unlikely.
- bbreier 2y ago
  I would say in your toy example the hospital has been shutdown due to the PE firm "cashing out" excessively
- jrflowers 2y ago
  > How does shutting down a hospital allow a PE firm to "cash out"? https://www.theatlantic.com/ideas/archive/2023/05/private-equity-firms-bankruptcies-plunder-book/673896/ https://www.theatlantic.com/ideas/archive/2023/05/private-eq... https://www.ineteconomics.org/perspectives/blog/private-equity-is-out-of-control-and-looting-america-this-prosecutor-says-we-can-fix-it https://www.ineteconomics.org/perspectives/blog/private-equi...

nradov 2y ago

What would you propose as an alternative? All healthcare systems have to ration care because resources are limited and demand is effectively infinite. We can discuss the process used for rationing but it has to be done on some reasonably objective basis.

itchyouch 2y ago
I had a conversation with my friend. "Look at this new, incredible CPU cooler tech! It's sooo good at removing heat." "What if you didn't generate the heat in the first place?" Personally, I have a hypothesis that there are systemic areas we need to address in our food supply to lower healthcare demand. This will sound kooky, but if we can get more sulfur and trace minerals into the food supply, we could improve the general well-being of massive amounts of the population. We really need to look at doing more research into additionally fortifying our foods. Here's a nature article on the reduction of sulfur from the food supply: https://www.nature.com/articles/s43247-021-00172-0 https://www.nature.com/articles/s43247-021-00172-0 NPK farming has ensured that the food supply doesn't have a rich set of additional minerals outside of (N)itrogen, (P)hosphorous and (K)potassium. Then when looking at sulfur-containing molecules, the research on them tends to herald them as miracle-health molecules: MSM Taurine, B1, NAC. All bring sulfur into the body. Then there's companies like Buoy drops that offer 87 different trace minerals and folks are swearing by the effects of them. Asian countries consume things like seaweed and get trace minerals like this from the the sea water, but a the standard american diet is really lacking in a lot of additional nutrition that would be productive to health.
- nradov 2y ago
  The majority of healthcare spending goes to chronic diseases primarily caused by lifestyle issues. Collectively we are a nation of obese, sedentary substance abusers. If we could do better on prevention and delay the onset of chronic diseases like type-2 diabetes, hypertension, and heart failure then that would largely fix the demand problem and leave a lot more resources available for patients who randomly get cancer or multiple sclerosis or whatever. But this is a policy issue that goes way beyond the healthcare system and no one has a practical solution. Everyone loves to give health and nutrition advice to others, but we're all undisciplined and do unhealthy stuff even when we know we shouldn't. https://peterattiamd.com/outlive/ https://peterattiamd.com/outlive/ As for the food supply, I have no doubt that many people are impacted by subclinical micronutrient deficiencies, whether it's sulphur or zinc or D3 or something else. But the evidence indicates that's less important than excess macronutrients for most people.

jdietrich 2y ago

Americans already consume more healthcare than anyone in human history by a huge margin. A large proportion of that healthcare isn't really healthcare at all, because it does more harm than good. If you're paying out of pocket, you have the right to demand as many tests and as many treatments as you can afford. If you're relying on an insurer to foot the bill, then that insurer has two choices - refuse to pay for some treatments, or watch costs (and premiums) trend towards infinity.