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The "Surprising Reason", according the story: "The problem is private insurers." I'm sure that's a factor, but there's more to it: https://www.texasobserver.or

The "Surprising Reason", according the story: "The problem is private insurers." I'm sure that's a factor, but there's more to it: https://www.texasobserver.org/critical-condition/ https://www.texasobserver.org/critical-condition/

devilbunny 1y ago
The federal government has encouraged all this; if Medicare/Medicaid didn't cut payments, the private insurers likely would not have followed their lead. One of the big ways that cost containment has been done is forcing more efficiency. That should be a good thing, right? Except that small rural hospitals will never, ever be as efficient as large urban ones. And the "disproportionate share" (overly large amounts of Medicare/Medicaid patients) payments aren't enough to keep those places open. So while it's definitely saved money, that's not much help when you live an hour or more away from any healthcare facility.
- jmye 1y ago
  Medicare should be cutting reimbursements. It’s the only way to deal with runaway bullshit in a fee-for-service healthcare economy. The real answer is, and always will be, shifting the model entirely away from that to capitated models and better care model incentives (instead of incentives based around just ordering more shit for patients). It’s also an easy way to account for better geographic distribution. That said, you’re also not solving rural healthcare without dramatically increasing the number of providers, so the revenue models are only going to get you so far regardless.
guywithahat 1y ago
> Urban hospitals and large rural hospitals are able to make up for the losses from Medicare and Medicaid patients with what they can charge private insurers. Small rural hospitals can’t do that. The articles argument is that private insurers need to cover medicare/medicaid costs, which seems silly. It also seems to ignore the obvious question in my mind, which is maybe rural hospitals just have to run leaner to meet market demands. It makes me wonder if there's a reason rural hospitals pull large investments, such as regulation demanding unattainably high levels of care, forcing them to be unprofitable.
- veggieroll 1y ago
  > regulation demanding unattainably high levels of care IMO this is the missing gap in a lot of the US economy. Cars, housing, medical care. Kei trucks, SRO apartments, and so many more similar solutions are functionally illegal.
pragmatic 1y ago
How likely are young OBGYNs going to chose deep red states with very restrictive reproductive laws where they could be held criminally liable for standard practices? MAGA is a death cult. Everything they do accelerates the demise of their way of life and communities.
- jmye 1y ago
  OBs, all mid-levels (for different but similar reasons), specialties… the list goes on. Reimbursements hurt, but none of these people are signing up to work in middle of nowhere OK and MO, when they can find work easily (and get paid better) in desirable places, that aren’t fully populated by people who hate them. Blaming United or whatever is memeworthy, but it’s also the easy and only partially correct answer.

devilbunny 1y ago

The federal government has encouraged all this; if Medicare/Medicaid didn't cut payments, the private insurers likely would not have followed their lead. One of the big ways that cost containment has been done is forcing more efficiency. That should be a good thing, right? Except that small rural hospitals will never, ever be as efficient as large urban ones. And the "disproportionate share" (overly large amounts of Medicare/Medicaid patients) payments aren't enough to keep those places open. So while it's definitely saved money, that's not much help when you live an hour or more away from any healthcare facility.

jmye 1y ago
Medicare should be cutting reimbursements. It’s the only way to deal with runaway bullshit in a fee-for-service healthcare economy. The real answer is, and always will be, shifting the model entirely away from that to capitated models and better care model incentives (instead of incentives based around just ordering more shit for patients). It’s also an easy way to account for better geographic distribution. That said, you’re also not solving rural healthcare without dramatically increasing the number of providers, so the revenue models are only going to get you so far regardless.

guywithahat 1y ago

> Urban hospitals and large rural hospitals are able to make up for the losses from Medicare and Medicaid patients with what they can charge private insurers. Small rural hospitals can’t do that. The articles argument is that private insurers need to cover medicare/medicaid costs, which seems silly. It also seems to ignore the obvious question in my mind, which is maybe rural hospitals just have to run leaner to meet market demands. It makes me wonder if there's a reason rural hospitals pull large investments, such as regulation demanding unattainably high levels of care, forcing them to be unprofitable.

veggieroll 1y ago
> regulation demanding unattainably high levels of care IMO this is the missing gap in a lot of the US economy. Cars, housing, medical care. Kei trucks, SRO apartments, and so many more similar solutions are functionally illegal.

pragmatic 1y ago

How likely are young OBGYNs going to chose deep red states with very restrictive reproductive laws where they could be held criminally liable for standard practices? MAGA is a death cult. Everything they do accelerates the demise of their way of life and communities.

jmye 1y ago
OBs, all mid-levels (for different but similar reasons), specialties… the list goes on. Reimbursements hurt, but none of these people are signing up to work in middle of nowhere OK and MO, when they can find work easily (and get paid better) in desirable places, that aren’t fully populated by people who hate them. Blaming United or whatever is memeworthy, but it’s also the easy and only partially correct answer.