Hospitals

[BoomBoom.sixpack]

There's a reason that you can actually get healthcare here and that people from countries with government healthcare come here for treatment when it is not available to them in their country. It's a little ironic that one of the key arguments in the US is that only people with money can afford to get decent healthcare, when you see that people with money from socialized healthcare countries are still the only ones who can get good healthcare. They just do it by flying to places like the US to get it. We could socialize healthcare here and ensure that nobody could get good healthcare, i suppose. I personally don't see healthcare as some inalienable right. I went without it for years when I couldn't afford it and never once did I think that someone should be providing it for me. I was thinking, man I really need to get a job that gives me some access to healthcare that is somewhat affordable...

You say socialized, but you mean nationalized. We already have socialized healthcare, we have for decades. We don't have nationalized healthcare like some nations do. We've been trying to split the difference between free-market healthcare and nationalized healthcare for awhile, to mixed success.

For the most part we've socialized care for seniors, with various intentional and non-intentional schemes to transfer costs from everyone else to pay for it. Seniors love it, everyone else not so much.

 

[johnson86-1]

The government totally controls what medical providers are actually PAID, and has for a very long time. Check into it before you go off on me.

Not sure what you are looking at, but I didn't reply to or go off on you.

But regardless, you're sort of right. The government pays for such a large portion of healthcare in the country, they are the most important payer, and what they pay has a huge influence on what private insurance companies pay. But more importantly, the government strangles the supply of doctors and prevents innovation around alternative methods of providing healthcare, which means healthcare is going to cost a metric **** ton regardless of what is done short of the government fully taking over and using monopsony power to limit costs.

Another relevant point is that when government "controls" payment rates, that's not the government acting as a self interested entity or looking out for tax payers. It's lobbyists for powerful interest groups working with congress and administrative agencies, where healthcare providers like doctors and hospitals are the most motivated groups and are willing to spend money on it. Insurance companies care, but as long as all of them are in the same boat, it doesn't impact their bottom line that much, and they are fine with something that increases health insurance costs like obamacare if it comes with a sweetener for them like an employer mandate and individual mandate.

 

[Len2003]

Most hospitals are empty and letting people go or furloughing folks. Going to lose a **** ton of money in this whole deal.

All of the hospitals in the Jackson area are opening up for elective procedure this week.

 

[Go Budaw]

I find your 2% figure highly questionable.

The interesting (albeit not surprising) thing about that graph is that the Top 3 biggest increases (and 4 of the Top 5) came from products / services where we set up elaborate cost-assistance programs to allow normally very expensive things to be paid for through third parties. The third parties being health insurance for hospital / medical services, and student loans / grants in the case of college tuition and textbooks.

It’s almost as if markets know when they have captive consumers with cash on hand going after a service they pretty much have to have (for future income or for their health/life), and adjust accordingly to make sure fatter and fatter revenues keep rolling in. Who knew?

 

[dorndawg]

Yep and a great argument as to why healthcare should be in the same category as schools/military/fire/police/trash pickup/roads. But it's not and here we are.

 

[MedDawg]

Yep and a great argument as to why healthcare should be in the same category as schools/military/fire/police/trash pickup/roads. But it's not and here we are.

Except that those categories don't go through 12-15+ years of training past high school.

I'm not an insider at my hospital and don't know any details, but I would bet my hospital would close if Medicare For All passed. Probably half of the rural hospitals in Mississippi would close without Blue Cross and other commercial insurer money.

While the demand for healthcare would increase, the U.S. supply of doctors would likely decrease, possibly substantially. Medicare may be 'simpler' for patients, but it's much worse for health care providers, and that would end up affecting health care. Waits would increase (after waiting two months to see a doc, the doc decides your kid needs their tonsils out, and you wait 6 months for the surgery). Quality would likely decrease (VA hospital system is a mini-M4A). Innovation would decrease as private companies have less incentive for research.

I'm not sure if Medicare denies tests or procedures ahead of being done, but they absolutely deny payment for services already rendered. If a patient returns to the hospital within three days of discharge, none of that next stay will be paid by Medicare. Medicare has a system where they will deny payment then the hospital can either appeal or take a smaller payment, like 7% or 15% less, instead of appealing. If a doctor messes up coding for a procedure or diagnosis, payment for the entire stay can be denied.

Medicare/CMS/Joint Commission has a TON of rules for providers. The people making the rules for health care aren't health care providers. Think of the IRS, but for health care. The rules for billing Medicare are much more encumbering than those of private insurers, and under M4A it would only get worse.

Don't even begin to bring up other countries. ALL of them are subsidized but current U.S. health care. We pay top dollar for medicines and machines so they don't have to. Sweden is full of Swedes, Germany is full of Germans. Nothing like the U.S. and much easier to care for than the U.S. with our diverse cultures and unhealthy eating. Not to mention we pay for defense of the world so they don't have to so we subsidize them that way, too.

 

[Villagedawg]

Yes. I do. That would be a silver lining in this cloud.

 

[Villagedawg]

Yep. Best in the world. . .except for about 30 other countries.

 

[Villagedawg]

What the role of three country club memberships, 4 sports cars, 3 houses, a cabin, and 6 trips to Europe per year in all this?

 

[paindonthurt_]

I love the insurance I have right now and I pay $334/month for it.

 

[paindonthurt_]

I pay for my own insurance and I love it. Wish I had a job that paid for a portion of it but I Currently have the option to take another insUrance through a union. I still pay for my own policy at $334 a month.

 

[mstateglfr]

Don't even begin to bring up other countries. ALL of them are subsidized but current U.S. health care. We pay top dollar for medicines and machines so they don't have to. Sweden is full of Swedes, Germany is full of Germans. Nothing like the U.S. and much easier to care for than the U.S. with our diverse cultures and unhealthy eating. Not to mention we pay for defense of the world so they don't have to so we subsidize them that way, too.

I see it mentioned a lot that northern Europe doesn't have our 'problems' because they are more homogeneous or whatever.
Germany has basically led the way in immigration for Northern Europe over the last half century due to low birth rates.

14.4% of the US is immigrants.
12% for Germany.
14.3% for Sweden.
And Germany is second in the world(to the US) in actual number of immigrants.

Tough call on those random countries to use for your point, eh?

 

[paindonthurt_]

The Top 2 also have another significant thing in common.

Government intervention.

The ones toward the bottom tend to have very little government in them.

Walk into any government building. City, state, federal and see how quick you can get something done. I guarantee you, if you are honest, 7 out of 10 is a bad experience. DMV. Post office. Health department to get a health permit for a restaurant (experience here). Getting an ABC license (experienc here). Worked at the MDEQ for a year (eyeroll). Call the irs and try to speak with someone abt your taxes.

Shall I go on?

 

[MedDawg]

I see it mentioned a lot that northern Europe doesn't have our 'problems' because they are more homogeneous or whatever.
Germany has basically led the way in immigration for Northern Europe over the last half century due to low birth rates.

14.4% of the US is immigrants.
12% for Germany.
14.3% for Sweden.
And Germany is second in the world(to the US) in actual number of immigrants.

Tough call on those random countries to use for your point, eh?

Not at all.

Other than Germany's 12% immigrants, Germany is German.

Other than Sweden's 14.3% immigrants, Sweden is Swedish.

Other than the U.S.' 14.4% immigrants, Americans are European, Asian, African American, South American, Central American, and Native American.

 

[mstateglfr]

Not at all.

Other than Germany's 12% immigrants, Germany is German.

Other than Sweden's 14.3% immigrants, Sweden is Swedish.

Other than the U.S.' 14.4% immigrants, Americans are European, Asian, African American, South American, Central American, and Native American.

25% of germans have lineage outside of Germany after 1950.
Really odd stst, but apparently its what that country uses to determine who was 'original' and who came to the country by way of immigration thru ancestry.

I have no idea what the US is when it comes to that stat.

I mention it because when 1 in 4 people are viewed as non-native, that's a 17ton of people who aren't native, at least to me.
Thats a lot of other cultures and the 'problems' those people bring. <---i could have put quotes around multiple words in that sentence, its so absurdly wrong to have even typed.

I just don't see how so much racial, cultural, and religious diversity can be viewed as homogeneous.

 

[dorndawg]

I'm not an insider at my hospital and don't know any details, but I would bet my hospital would close if Medicare For All passed. Probably half of the rural hospitals in Mississippi would close without Blue Cross and other commercial insurer money.

This is simply not grounded in reality. Medicaid expansion/ACA is the LIFEBLOOD of rural hospitals. Why on earth would they close with more paying customers?

 

[patdog]

Traveling to another country to get decent medical care is a two way street. People also leave the USA to go to other countries to get affordable medical care. A guy I know did it last year. The USA's healthcare system consistently ranks pretty low among 1st World nations.

 

[OliveBranchDAWG]

My biggest question throughout this entire coronavirus mess is how would the media and our country react to this pandemic if Trump wasn’t president & it wasn’t an election year?

For example, if Obama was in office & it was 2013, would the reaction be the exact same? Fear & panic by the media?

I’m sure this question will piss off people, but it’s one to consider

 

[patdog]

There is no doubt this is being used by a lot of the media and the Democratic Party to try to flip the election this fall. It won't matter though.

 

[OliveBranchDAWG]

There is no doubt this is being used by a lot of the media and the Democratic Party to try to flip the election this fall. It won't matter though.

I’m extremely sad some media and radicals are using this virus as a weapon to torpedo our economy & put Americans out of a job, out of spite for president. That’s asinine if you truly think about it, and it should irritate you, no matter your politics.

Quarantining has served it’s purpose, but now the cost is outweighing the benefit and we need to figure out how to reopen America safely.

 

[paindonthurt_]

You won’t get a logical thought out answer to this from the left on this board. At least not one backed up with evidence.

TWO examples of the media treating trump and Obama/democrats totally different.
1. Children in cages
2. Illegal immigration, border security and border “barrier”

 

[dorndawg]

I’m extremely sad some media and radicals are using this virus as a weapon to kill Americans, out of worship for president. That’s asinine if you truly think about it, and it should irritate you, no matter your politics.

 

[OliveBranchDAWG]

I’m extremely sad some media and radicals are using this virus as a weapon to kill Americans, out of worship for president. That’s asinine if you truly think about it, and it should irritate you, no matter your politics.

We live in a country where common sense & level-headedness is met with irrational, blind hate.

 

[johnson86-1]

Traveling to another country to get decent medical care is a two way street. People also leave the USA to go to other countries to get affordable medical care. A guy I know did it last year. The USA's healthcare system consistently ranks pretty low among 1st World nations.

Only when affordability is taken into account. We are not as good as we should be (our secondary infection rate was ridiculous considering how many ore of our patients are in private rooms), but it's still the best if you are not worried about money.

 

[dorndawg]

Could not agree with you more.

 

[johnson86-1]

I want my hospital to be as profitable as my bank. What’s with this knocking on hospital pricing? Most hospitals operating margins are less than two percent. Hospitals are essential to society, gotta have’em. So that have to survive in a free market or let the government run them.

That's not a fair comparison. Because of the way we restrict the supply of doctors and protect them from competition, they are always going to have the market power to capture any excess profits or rents that a hospital may have temporarily. This is exacerbated by the fact that so many hospitals are non-profits and they often set the market for doctor pay from hospitals, as they don't have any investors looking to fight for more of any rents available to the hospital. So your hospital might not look particularly profitable, but that's because it's making such a large percentage of its employees multi-millionaires. And I have no problem with doctors being rich; I'm just pointing out that they are extra rich because of the protection from competition and as long as you restrict supply of doctors and protect them from competition from alternative healthcare delivery models, we are going to have more expensive healthcare than otherwise.

 

[horshack.sixpack]

Admittedly, I've not seen any objective rankings, my comment was anecdotal. Do you have any ready rankings from an objective source(s)?

A few things stand out to me:

1) Like many issues our healthcare coverage is often socioeconomically related.
2) The primary way that people lack access is to preventative care (e.g. anyone can show up to an emergency room for acute care and cannot be denied).
3) It is questionable whether people having access to preventative care would cause them to take advantage of that access (i.e. would they go for an annual checkup if they could?)

My opinion is that just having access would not change anything/much. Heck, I go for my annual checkups and such as much for my health as to be sure that I take advantage of what I'm paying for. When a person isn't paying for something, they don't perceive much value in it (skin in the game theory, I suppose).

I have some friends who work as dietitians for state hospitals. In that role they attempt to educate people and help them make better decisions about eating healthier. Often they have obese, diabetic mothers coming in with obese pre-diabetic/diabetic children. They have people putting Coke in their baby's bottles, eating every meal at McDonalds, etc. In that situation, the person is just going to be a huge burden on the system and their health is unlikely to get better with access to preventative care.

I'd be all for better access to healthcare if it was tied to patient health decisions. Similar to car insurance, if you have a gazillion tickets and wrecks, you will pay more. Sometimes way more.

Like most big societal issues, there won't be any one easy answer.

 

[johnson86-1]

Except that those categories don't go through 12-15+ years of training past high school.

I'm not an insider at my hospital and don't know any details, but I would bet my hospital would close if Medicare For All passed. Probably half of the rural hospitals in Mississippi would close without Blue Cross and other commercial insurer money.

No, they might declare bankruptcy, but there is plenty of money to pay for those services, there would just be massive disruption as a new market equilibrium was reached.

While the demand for healthcare would increase, the U.S. supply of doctors would likely decrease, possibly substantially. Medicare may be 'simpler' for patients, but it's much worse for health care providers, and that would end up affecting health care. Waits would increase (after waiting two months to see a doc, the doc decides your kid needs their tonsils out, and you wait 6 months for the surgery). Quality would likely decrease (VA hospital system is a mini-M4A).

That's not necessarily the case at all. You would see a decrease initially as older, already rich doctors would decide it's not worth continuing to work. ON the flip side, doctors that have levered up to build their practice or just fuel consumption would be locked in to working much longer. And younger doctors would find also work longer as they would no longer be making the money that would allow them an upper class lifestyle while also having the option of retiring young. You would have some younger doctors leave the field, but even with the reduced pay that would result from a combination of medicaid and medicare rates, they'd still probably have trouble matching their income doing anything else. And the new supply of doctors wouldn't change, although the quality might. We already restrict new supply so much, that even at much lower incomes, the incomes would be high enough and sure enough that people would be killing themselves to get in. Look at the competition to get into something like vet school, where you pay tons of tuition to generally make pretty average money. I'm not saying any of this to support nationalized healthcare; I think it's a bad idea. Just pointing out we've already 17ed it up so badly through regulation that some of the negative impacts wouldn't be worse than the current status.

Innovation would decrease as private companies have less incentive for research.

That's going to be dictated more by what we are willing to pay for drugs and medical devices combined with how available we will make the medicines on the gov't dime. A lot of innovation is already strangled b/c there's not a ton of financial incentive for experimentation in delivery methods but plenty of liability.

I'm not sure if Medicare denies tests or procedures ahead of being done, but they absolutely deny payment for services already rendered. If a patient returns to the hospital within three days of discharge, none of that next stay will be paid by Medicare. Medicare has a system where they will deny payment then the hospital can either appeal or take a smaller payment, like 7% or 15% less, instead of appealing. If a doctor messes up coding for a procedure or diagnosis, payment for the entire stay can be denied.

Medicare/CMS/Joint Commission has a TON of rules for providers. The people making the rules for health care aren't health care providers. Think of the IRS, but for health care. The rules for billing Medicare are much more encumbering than those of private insurers, and under M4A it would only get worse.

Don't even begin to bring up other countries. ALL of them are subsidized but current U.S. health care. We pay top dollar for medicines and machines so they don't have to. Sweden is full of Swedes, Germany is full of Germans. Nothing like the U.S. and much easier to care for than the U.S. with our diverse cultures and unhealthy eating. Not to mention we pay for defense of the world so they don't have to so we subsidize them that way, too.

 

[horshack.sixpack]

Yeah, basically, I think free market gets the best results and I abhor the idea of looking to the government for services and/or putting any more services in the government's charge. I can't think of a single thing that I personally deal with that is run but the government that runs at even a fraction of the efficiency level of private industry, and it all runs at least 100x the frustration level. Competence does not reside there, generally speaking and not discounting that there are some good folks that work there.

 

[johnson86-1]

This is simply not grounded in reality. Medicaid expansion/ACA is the LIFEBLOOD of rural hospitals. Why on earth would they close with more paying customers?

That's true for rural hospitals without many privately insured patients. THey aren't losing much and are replacing unreliable payers with reliable payers. But for hospitals with a decent mix of privately insured patients to go along with their Medicare, Medicaid, and uninsured patients, they will be losing a lot of revenue.

 

[MedDawg]

This is simply not grounded in reality. Medicaid expansion/ACA is the LIFEBLOOD of rural hospitals. Why on earth would they close with more paying customers?

Widgets cost $3 to make. You sell 2,000 at $2 (Medicare/Medicaid) and 1,000 at $6 (Blue Cross) and make $1,000. Give away 200 for free (no insurance) and you still make $400. Then the goverment requires you to sell 3,200 at $2 (M4A) and you lose $3,200.

 

[horshack.sixpack]

And the US is only around 2% Native American, so everybody else is from somewhere else. That's a crazy statistic to me.

 

[Len2003]

Biggest thing about Healthcare Cost is that when you pay your bill, you are also paying for someone else’s bill who is not paying their bill...

That's how all insurance works.

 

[L4Dawg]

Except that those categories don't go through 12-15+ years of training past high school.

I'm not an insider at my hospital and don't know any details, but I would bet my hospital would close if Medicare For All passed. Probably half of the rural hospitals in Mississippi would close without Blue Cross and other commercial insurer money.

While the demand for healthcare would increase, the U.S. supply of doctors would likely decrease, possibly substantially. Medicare may be 'simpler' for patients, but it's much worse for health care providers, and that would end up affecting health care. Waits would increase (after waiting two months to see a doc, the doc decides your kid needs their tonsils out, and you wait 6 months for the surgery). Quality would likely decrease (VA hospital system is a mini-M4A). Innovation would decrease as private companies have less incentive for research.

I'm not sure if Medicare denies tests or procedures ahead of being done, but they absolutely deny payment for services already rendered. If a patient returns to the hospital within three days of discharge, none of that next stay will be paid by Medicare. Medicare has a system where they will deny payment then the hospital can either appeal or take a smaller payment, like 7% or 15% less, instead of appealing. If a doctor messes up coding for a procedure or diagnosis, payment for the entire stay can be denied.

Medicare/CMS/Joint Commission has a TON of rules for providers. The people making the rules for health care aren't health care providers. Think of the IRS, but for health care. The rules for billing Medicare are much more encumbering than those of private insurers, and under M4A it would only get worse.

Don't even begin to bring up other countries. ALL of them are subsidized but current U.S. health care. We pay top dollar for medicines and machines so they don't have to. Sweden is full of Swedes, Germany is full of Germans. Nothing like the U.S. and much easier to care for than the U.S. with our diverse cultures and unhealthy eating. Not to mention we pay for defense of the world so they don't have to so we subsidize them that way, too.

75% of hospitals would close.

 

[L4Dawg]

Widgets cost $3 to make. You sell 2,000 at $2 (Medicare/Medicaid) and 1,000 at $6 (Blue Cross) and make $1,000. Give away 200 for free (no insurance) and you still make $400. Then the goverment requires you to sell 3,200 at $2 (M4A) and you lose $3,200.

EXACTLY.

 

[WeWonItAll(Most)]

That's not a fair comparison. Because of the way we restrict the supply of doctors and protect them from competition, they are always going to have the market power to capture any excess profits or rents that a hospital may have temporarily. This is exacerbated by the fact that so many hospitals are non-profits and they often set the market for doctor pay from hospitals, as they don't have any investors looking to fight for more of any rents available to the hospital. So your hospital might not look particularly profitable, but that's because it's making such a large percentage of its employees multi-millionaires. And I have no problem with doctors being rich; I'm just pointing out that they are extra rich because of the protection from competition and as long as you restrict supply of doctors and protect them from competition from alternative healthcare delivery models, we are going to have more expensive healthcare than otherwise.

What would un-restricting the supply of doctors look like? And what are some alternative healthcare delivery models?

 

[BoomBoom.sixpack]

Yeah, basically, I think free market gets the best results and I abhor the idea of looking to the government for services and/or putting any more services in the government's charge. I can't think of a single thing that I personally deal with that is run but the government that runs at even a fraction of the efficiency level of private industry, and it all runs at least 100x the frustration level. Competence does not reside there, generally speaking and not discounting that there are some good folks that work there.

I ascribe more to a Peter Principle view, that any large bureaucracy is going to be inefficient. AT&T for example. Also, you get what you pay for.

The problem with healthcare is it resides so far from the principles that make free markets work. Buyers have no expertise with what they are buying. They have no means to shop. Often their life depends on a quick purchase. Negotiation is lopsided as hell. Huge asymmetries in market power.

Free market would mean you could run into the hospital with a heart attack, and the hospital could hold that over your head for negotiation: "$1M, or you can try the hospital 30 minutes away....if you make it." Or poor people die for lack of ability to pay for simple care. No one wants that. Morality plays a large role with healthcare policy, and morality and economics don't mix. That leaves us with trying to find the best of bad options. There is no free market unicorn with healthcare.

 

[Drebin]

Widgets cost $3 to make. You sell 2,000 at $2 (Medicare/Medicaid) and 1,000 at $6 (Blue Cross) and make $1,000. Give away 200 for free (no insurance) and you still make $400. Then the goverment requires you to sell 3,200 at $2 (M4A) and you lose $3,200.

Well done.

 

[dorndawg]

Over here in reality, the overwhelming majority of hospitals don't lose money on Medicare/Medicaid. Why would any of them accept it if so? Anyone saying otherwise has a monetary interest in the status quo.

 

[Big Sheep81]

I'll say otherwise. You have no idea of what you are talking about. I have been on the board of a rural hospital since 2004. We get back cost plus a little on what medicare pays and lose money 95% of the time on medicaid. I can tell you no hospital can survive on what these two pay. You have absolutely no clue on what it costs to operate a hospital and clinic system.