3 ms·

Ever hear of loss leaders? Some parts of a typical hospital make money while others lose it hand over fist. The overall margin isn’t across the board, it’s afte

by EA-3167 2mo ago

Ever hear of loss leaders? Some parts of a typical hospital make money while others lose it hand over fist. The overall margin isn’t across the board, it’s after everything hopefully balances out. ER’s for example are money pits, but society really needs them. https://www.definitivehc.com/resources/healthcare-insights/hospital-operating-margins-united-states#:~:text=the%20median%20operating,-2.9%25%20in%202024%2C https://www.definitivehc.com/resources/healthcare-insights/h...

nradov 2mo ago
That's true, but obscuring the true costs through hidden cross-subsidies isn't helping anyone in the long run. We would probably be better off with state and local governments setting requirements for ER capacity in each region, and then running an annual reverse auction system where hospitals can bid on maintaining that capacity in exchange for cash payments.
robot_jesus 2mo ago
Exactly this. They need to offset the areas where they lose money. And we have federal laws (justifiably so, IMHO) that ERs must provide stabilizing services regardless of insurance and ability to pay. And while that law is obviously humane and reasonable, my only gripe is that the rest of our system is so backwards that it increasingly forces people to leverage that. There was a story about a woman who needed dialysis but had no insurance. So basically, she had to wait every couple weeks until she started breaking down, go to the ER, get emergency dialysis, get sent home. Rinse, repeat. I don't blame her but really just the system that made this her best possible option. https://kdvr.com/news/local/every-week-this-woman-nearly-dies-before-she-can-get-medical-treatment/ https://kdvr.com/news/local/every-week-this-woman-nearly-die...
- avgDev 2mo ago
  But wouldn't nationalized healthcare help with this? The amount of uninsured individuals would drop drastically.
  - nradov 2mo ago
    Nationalized healthcare might help with certain things but it can't create capacity out of thin air. Just because the government theoretically covers everyone doesn't mean that services are actually available when needed. In general the countries with the highest levels of nationalization also have the most problems with shortages. When everything comes straight out of the government budget there's always a political tendency to cut costs by reducing provider payrolls, imposing waiting lists for expensive treatments, or refusing to cover certain treatments at all.
    - tga_d 2mo ago
      > In general the countries with the highest levels of nationalization also have the most problems with shortages. Do you have any citations for this? I've heard this rhetoric before, but every time I look into it, searching around for studies on google scholar or the web, I can only find studies and reports indicating that health outcomes trend better in countries with more universal coverage. There are think pieces with anecdata of course, but no actual peer reviewed publications I can find.
      - s1artibartfast 2mo ago
        One way to begin is look for studies on wait times or procedures of a given type per capita.
        hardolaf 2mo ago
        Those studies have all, to my knowledge of them, shown no system mode that is better or worse than any other. The USA for many categories of care has often in those studies had worse wait times compared to nations with fully nationalized healthcare. Heck when I went to college in Ohio's capital, the recommendation on how to get psychiatry or therapy as a new patient was to call the suicide helpline and claim that you were suicidal. That would get you a new patient appointment within 72 hours versus over 3 months on average for patients looking to get into care through normal channels.
- orangecat 2mo ago
  There was a story about a woman who needed dialysis but had no insurance. And who was in the country illegally so she couldn't use Medicare or Medicaid. Still a terrible situation, but not representative of the typical American.

by EA-3167 2mo ago

nradov 2mo ago

That's true, but obscuring the true costs through hidden cross-subsidies isn't helping anyone in the long run. We would probably be better off with state and local governments setting requirements for ER capacity in each region, and then running an annual reverse auction system where hospitals can bid on maintaining that capacity in exchange for cash payments.

robot_jesus 2mo ago

Exactly this. They need to offset the areas where they lose money. And we have federal laws (justifiably so, IMHO) that ERs must provide stabilizing services regardless of insurance and ability to pay. And while that law is obviously humane and reasonable, my only gripe is that the rest of our system is so backwards that it increasingly forces people to leverage that. There was a story about a woman who needed dialysis but had no insurance. So basically, she had to wait every couple weeks until she started breaking down, go to the ER, get emergency dialysis, get sent home. Rinse, repeat. I don't blame her but really just the system that made this her best possible option. https://kdvr.com/news/local/every-week-this-woman-nearly-dies-before-she-can-get-medical-treatment/ https://kdvr.com/news/local/every-week-this-woman-nearly-die...

avgDev 2mo ago
But wouldn't nationalized healthcare help with this? The amount of uninsured individuals would drop drastically.
- nradov 2mo ago
  Nationalized healthcare might help with certain things but it can't create capacity out of thin air. Just because the government theoretically covers everyone doesn't mean that services are actually available when needed. In general the countries with the highest levels of nationalization also have the most problems with shortages. When everything comes straight out of the government budget there's always a political tendency to cut costs by reducing provider payrolls, imposing waiting lists for expensive treatments, or refusing to cover certain treatments at all.
  - tga_d 2mo ago
    > In general the countries with the highest levels of nationalization also have the most problems with shortages. Do you have any citations for this? I've heard this rhetoric before, but every time I look into it, searching around for studies on google scholar or the web, I can only find studies and reports indicating that health outcomes trend better in countries with more universal coverage. There are think pieces with anecdata of course, but no actual peer reviewed publications I can find.
    - s1artibartfast 2mo ago
      One way to begin is look for studies on wait times or procedures of a given type per capita.
      - hardolaf 2mo ago
        Those studies have all, to my knowledge of them, shown no system mode that is better or worse than any other. The USA for many categories of care has often in those studies had worse wait times compared to nations with fully nationalized healthcare. Heck when I went to college in Ohio's capital, the recommendation on how to get psychiatry or therapy as a new patient was to call the suicide helpline and claim that you were suicidal. That would get you a new patient appointment within 72 hours versus over 3 months on average for patients looking to get into care through normal channels.
orangecat 2mo ago
There was a story about a woman who needed dialysis but had no insurance. And who was in the country illegally so she couldn't use Medicare or Medicaid. Still a terrible situation, but not representative of the typical American.