Healthcare and hospitals should all be not-for-profit

originally posted by: seasonal
a reply to: JoshuaCox

One of the major problems I can see is that with share holders, you damn well better have year over year profit growth. This can mean that cost to consumers go up, this means that $200 blood test is now $210. Only to satisfy the constant growth in profits.

Lol year over year....

You mean QUARTERLY PROFITS!!

I think that is at the root of a lot our economic issues..

It creates an enviorment where they are constantly trying to save money to make the people who bought stock this quarter a profit. You can't make materials cost less, but you can find some one who will work for a hair cheaper..

I even think all these dishwasher level jobs would be far more efficient and cheaper to pay more and demand more production long term.

In a quarterly report it will look like you are spending more money, but if you carry that out over a decade I bet you would save money on all the turn over and things like training pay and loss in production that go with it.

a reply to: JoshuaCox

Yes, you are right. The only numbers that matter are the next quarter, and they better be bigger than last.

It is called inflation driven by fractional reserve lending.

originally posted by: stolencar18

originally posted by: blueyedevilwoman

originally posted by: musicismagic

originally posted by: dfnj2015
a reply to: musicismagic

So you are for the profit-motive in healthcare. Getting rid of people with pre-existing conditions will be HUGE profit for the CEOs. This is America!

All the cancer patients who can't get out of bed should be on the hill lobbying their congressmen.

Ask yourself, what does profit motive mean. I will tell you , it means GREED over caring. What I stated was that the politicians get what the Americans want but until recently were not allowed to have.
In Japan there is NO such such thing as a 5000 up front fee before the insurance kicks in.
Americans need to WISE up. Insurance co. are also gansta's.

Insurance companies should be banned, all of them.

Doctors in America should know:

Uncalcified gall stones can be passed without surgically removing the gall bladder.

Parasites are the primary root cause of many afflictions.

Type 2 diabetes is curable.

But they dont teach this in school.

And this is just one of many created problems.

Cigarettes legal, mj largely not legal.

Against the law to drink and drive, perfectly legal to sell alcohol in an establishment that is inaccessible except by automobiles.

Pharmaceuticals companies make billions selling drugs that "treat" but do not cure anything. And now they come with side effects like....cancer?

Many more things are just plain wrong.

I do not buy into the greedy corporations or stupid politicians though.

It is clearly by design.

Kill the poor off............first.

Due to recent technological advances. I predict within ten years, many people will be awarded the useless eater label.

The last groups to be awarded the useless eater label will be L.E. and medical personnel.

Tinfoil Hat of the Day Award goes to....

WTH? Exactly what part of her post was BS? This particular resident skeptic (me) thinks you dismissed basic logic far to easily here.

originally posted by: luthier
a reply to: SlapMonkey

Can you provide an ethical argument for profit medicine?

Profit meaning on top of expense and research.

I don't have to--I've argued that I don't like the health insurance system, I've argued about getting the federal government out of the health insurance/care industry, and I've noted that for-profit hospitals are only about 20% of the hospitals that exist in America. The rest are not-for-profit and government hospitals. I have never argued FOR for-profit hospitals, but...

That said, I absolutely can make an argument that there should not be a law against for-profit hospitals--choice is generally a good thing, and if there is a segment of society willing to prefer a for-profit hospital over a not-for-profit one, they should have that option. But, the onus is on the patient (in non-emergency situations, of course) to research their available medical facilities and find the one that they like best, even if it means traveling farther to use it (like I do and have done).

a reply to: SlapMonkey

I think we mostly agree. And yes cosmetic stuff or a 70 year old man that wants sports surgery so he can keep swimming maybe.

However you miss the point that insurance and drug companies are the ones setting up policies for the hospitals. Drug companies do the clinical testing and even provide diagnosis and treatment regimen often times, and the insurance companies set up the hoops for the dr's to jump through.

The pricing in hospitals including non profits are effected by the for profit insurance and pharmaceutical companies.

a reply to: blueyedevilwoman
So, what you're doing is using anecdotal evidence to make a sweeping claim for all of the healthcare industry--got it.

Maybe you should call those places and read them the Emergency Medical Treatment and Labor Act (EMTALA, 1986) and remind them that they have a legal obligation to treat emergency medical conditions. Now, this act does only affect hospitals with emergency departments AND who accept Medicare payments, but that's nearly every single hospital in America.

The thing is, the definitions of what constitutes an "emergency medical condition" is very vaguely written, stating that:

EMTALA defines an emergency medical condition as “[a] medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in – (i) [p]lacing the health of the individual . . . in serious jeopardy; (ii) [s]erious impairment to bodily functions; or (iii) [s]erious dysfunction of any bodily organ part[.]” (42 C.F.R. § 489.24(b)). EMTALA also defines an emergency medical condition to include a pregnant woman who is having contractions.

Now, it can easily be argued that not setting and casting (or splinting, if appropriate) a broken bone 'could reasonably be expected to result in ... serious impairment to bodily functions," so if these places that you note are "dumping" these emergency patients on to another medical facility when they have the means to properly treat the broken bone (and are not doing so) is in violation of the law.

Another interesting thing of note from that that link is found in the "Common Areas of Concern" portion of the page:

Another significant area of concern for hospitals is the amount of uncompensated care that they are required to provide. A majority of emergency medical care goes uncompensated under EMTALA. In order to address the amount of uncompensated emergency care given, hospitals are faced with difficult decisions concerning cost shifting to paying patients and/or reduction or closure of services.

So, under this federal law, hospitals are forced to give out free care and then either shift the cost to paying customers (something that is known to dramatically raise the cost of our health care visits) or to limit/close some of their health service. But note--the majority of emergency visits that fall under EMTALA go uncompensated--THIS is what I'm citing when I say that emergency care does not go untreated in American hospitals, regardless of one's ability to pay. It is an irrefutable fact.

As for your last sentence in your comment, getting sick or injured, and it not being an emergency (i.e.: "Placing the health of the individual . . . in serious jeopardy"), does not always necessitate hospitalization or medical care at all. But my good friend and neighbor is a corrections officer in our county jail, and they bend over backward (sheesh...not the best metaphor) to take care of their sick and injured inmates, almost to the point of babying them. Like I said, anecdotal evidence...

So, the bottom line is that if you or others are experiencing "patient dumping" from these hospitals, YOU need to report it to the appropriate authority (HHS, I believe) in order to have it investigated--my mom doesn't need to do that (although in her capacity as the compliance officer, it would be something that she would address at her own hospital). But to use those hospitals as an example to imply that all U.S. hospitals act this way is dishonest, because we have no proof that it is a systemic problem everywhere. The reality is, though, that a fractured bone should not be turned away from an emergency room until properly cared for--but maybe in the instance that you cite, an ace bandage was all that was required--I'm not a doctor, and I don't know the specifics. I do know, though, that there are types of fractures that do not require a cast.

originally posted by: luthier
However you miss the point that insurance and drug companies are the ones setting up policies for the hospitals. Drug companies do the clinical testing and even provide diagnosis and treatment regimen often times, and the insurance companies set up the hoops for the dr's to jump through.

The pricing in hospitals including non profits are effected by the for profit insurance and pharmaceutical companies.

I'm not missing that at all, but I was under the impression that this thread was about the premise that single-payer, government-run healthcare/insurance would be best because of the epidemic of for-profit hospitals (which doesn't exist). My argument from the start was that basing a pro-single-payer arguments on the amount of for-profit hospitals being the problem is not an appropriate argument to make. This thread has derailed into demonizing hospitals by many people who are obviously woefully ignorant (not in a demeaning way) of many of the why's behind the cost of healthcare.

Big Pharma and lobbyists are certainly major players in the game, but they absolutely are not the only problems. Federal intrusion is also a major, major ingredient in the issue of cost, if not the main driver of it (especially since lobbyist for Big Pharma get to both federal legislators AND hospital administrators and doctors).

Like I noted in my comment (presumably) above this one, just the simple fact that nearly every hospital is mandated by federal law (the Emergency Medical Treatment and Labor Act) to treat all emergency medical conditions without regard to patient's ability to pay (and the majority of those treated under the EMTALA don't pay their bills for whatever reason) results in shifted costs within the hospital to paying insurance companies and patients ($15 Motrin, anyone?) is a major reason why healthcare costs are so high in hospitals.

There are many hands in this overpriced cookie jar, and there is no single, simple fix to the high costs of healthcare (and by extension, health insurance premiums), but demonizing one or two players isn't a solution to the problem.

I don't have a problem with for-profit insurance companies--it makes sense as a business model--but I do have an ideological and moral issue with for-profit hospitals and government intrusion into a private industry (health insurance and health care).

ETA: And for the record, I ALWAYS ask what the price discount will be at any medical office (ortho, eye doctor, chiropractor, etc.) if I pay cash instead of using insurance, and there is always a pretty decent discount, specifically because it saves them the hassle of dealing with insurance companies' proverbial hoop jumping.

originally posted by: SlapMonkey

originally posted by: luthier
a reply to: SlapMonkey

Can you provide an ethical argument for profit medicine?

Profit meaning on top of expense and research.

I don't have to--I've argued that I don't like the health insurance system, I've argued about getting the federal government out of the health insurance/care industry, and I've noted that for-profit hospitals are only about 20% of the hospitals that exist in America. The rest are not-for-profit and government hospitals. I have never argued FOR for-profit hospitals, but...

That said, I absolutely can make an argument that there should not be a law against for-profit hospitals--choice is generally a good thing, and if there is a segment of society willing to prefer a for-profit hospital over a not-for-profit one, they should have that option. But, the onus is on the patient (in non-emergency situations, of course) to research their available medical facilities and find the one that they like best, even if it means traveling farther to use it (like I do and have done).

That's fair, every other modern country on the planet (I think everyone.. they all have state healthcare, but I think they all have a provate option too.. ) has both..

They have state health care thats free and then Cadillac plans for people who want more...

And guess what??

Because the state version is there, the Cadillac plans are literally 1/3 of what Americans pay for about 50% of the services..

The math is super easy to see..

Every other country pays less per person AND gets literally twice the services.

We are getting SOOOO RIPPED OFF!!

a reply to: SlapMonkey

Fair enough. I disagree with medical insurance. Of you go into this industry the motive being profit is already an ethical problem. I haven't seen a good argument supporting for profit insurance for medical companies.

With pharmaceuticals we are at a real big problem. My wife works as a professor in this field.

We aren't making vaccines for epidemics because of the profit system.

And then there is this. The real and true problem.

www.collective-evolution.com...

There is no single fix but competing nonprofits would take away some of the lobby and ethical problems and oversight that has become the norm.

a reply to: SlapMonkey

If there is no easy fix, then why does every modern country on the planet ;

A) have a single payer option.

B) every country with a single payer option literally pays less than half as much per person, both state and private Cadillac plans.

C) even though they are paying half as much, they get twice the services...

That's not hard math..

WITHOUT a government option the US government still spends twice as much percapita than any other modern country.

So they are paying for every citizens healthcare and still spending less than the US does...

So how is that possible???

Mainly Because we are allowing insurance companies to take 30% off the top of every dollar any Americans spend in healthcare AND THEY DO NOT EVEN PREFORM A MEDICAL FUNCTION!!

They are middle men paper pushers , nothing else..

a reply to: SlapMonkey

The US absolutely has for profit hospitals and even the nonprofits are making crazy profits...

In Bai's and Anderson's study, 59% of the hospitals were nonprofit, 25% for-profit and 16% public. In a press release, Anderson indicated that “the system is broken when nonprofit hospitals are raking in such high profits. ... Bai added that “some hospitals are obtaining outrageous profits.”May 8, 2016


www.google.com...

originally posted by: luthier
a reply to: SlapMonkey

Fair enough. I disagree with medical insurance. Of you go into this industry the motive being profit is already an ethical problem. I haven't seen a good argument supporting for profit insurance for medical companies.

With pharmaceuticals we are at a real big problem. My wife works as a professor in this field.

We aren't making vaccines for epidemics because of the profit system.

And then there is this. The real and true problem.

www.collective-evolution.com...

There is no single fix but competing nonprofits would take away some of the lobby and ethical problems and oversight that has become the norm.

Screw ethics...

Those are too subjective to actually measure..

I think the efficiency is plenty of a good enough reason without going all feelings...

Insurance companies are a middle man taking 25+% off the top and do not preform a medical function..

Every other country spends less and gets more services...

Obviously we are getting screwed.. no erhics required..

The ethics argument makes it seems as if "private insurance is more efficient, but ethically we should go public.. "

When in reality private insurance is less ethical AND less efficient.


We are spending twice as much on a pizza for half the toppings.. that is very easy math.

a reply to: JoshuaCox

Ethics is not subjective to measure when it's already defined in the industry. It's a subject and part of training for dr's.

But yes you also have an overall point. However, the us making a single payer system would be a mistake. It would be a veiled profiteering measure. I think changing lobby laws has to come before anything. We are putting the bull before the cart.

a reply to: JoshuaCox

Oh you and your well thought out logical post. To shame.

a reply to: JoshuaCox
I agree with your disdain concerning the role that insurance companies play, but you also pretend (or, at the very least, imply) that "every other modern country on the planet" has a perfect healthcare system, implying that this is the 'simple fix' for our healthcare/insurance costs.

I am in the middle of figuring out an internal shoulder injury (have an MRI scheduled tomorrow), and the ortho surgeon whom I have been seeing worked in the British healthcare system for more than two years. I briefly asked him what the pros and cons of each system is, and it all boiled down to this (extremely simplified, of course): We have better and quicker access to specialists, but pay the financial cost for that access. Also, in the UK, apparently not everyone is a specialist--here in the U.S., if you need a hip replacement, for example, you tend to go to a surgeon who specializes in hip replacements. In the UK system, all surgeons are required to perform hip replacements, and the wait in the UK to (more often than not) get a hip replacement from possibly a hand specialist, for example, is longer than here in U.S. for us to see a hip specialist, to the tune of almost five times as long from start to finish.

So, yes, we may be getting ripped off, and there are absolutely changes that we can make in our system that would make it "affordable care," but having the federal government meddle in it and mandate this and mandate that is not going to ever lower costs for Americans--the government needs to take it's happy hand out of the healthcare cookie jar, not grab the cookie jar and run with it.

By the way (referencing your pizza with half of the toppings comment), sure, I can go get a crappy frozen Red Baron pizza a the grocery store, or I could go to a pizza parlor and actually get a well-made pizza with good ingredients. Sure, the end result is that they are both pizza, but there is definitely a difference between the two that validates a higher cost.

You keep saying, "That's very easy math," but it's not always only about the bottom line for everyone. Quality matters, time that it takes to access medical services matters, and to some of us, we'd rather have higher confidence in who we see (in a shorter amount of time) than wonder if the guy about to do my shoulder surgery specialized in feet, but got tasked with my surgery because the government said he had to because there was a waiting list for shoulder surgeries and they want to reduce the wait time.

originally posted by: SlapMonkey
a reply to: JoshuaCox
I agree with your disdain concerning the role that insurance companies play, but you also pretend (or, at the very least, imply) that "every other modern country on the planet" has a perfect healthcare system, implying that this is the 'simple fix' for our healthcare/insurance costs.

I am in the middle of figuring out an internal shoulder injury (have an MRI scheduled tomorrow), and the ortho surgeon whom I have been seeing worked in the British healthcare system for more than two years. I briefly asked him what the pros and cons of each system is, and it all boiled down to this (extremely simplified, of course): We have better and quicker access to specialists, but pay the financial cost for that access. Also, in the UK, apparently not everyone is a specialist--here in the U.S., if you need a hip replacement, for example, you tend to go to a surgeon who specializes in hip replacements. In the UK system, all surgeons are required to perform hip replacements, and the wait in the UK to (more often than not) get a hip replacement from possibly a hand specialist, for example, is longer than here in U.S. for us to see a hip specialist, to the tune of almost five times as long from start to finish.

So, yes, we may be getting ripped off, and there are absolutely changes that we can make in our system that would make it "affordable care," but having the federal government meddle in it and mandate this and mandate that is not going to ever lower costs for Americans--the government needs to take it's happy hand out of the healthcare cookie jar, not grab the cookie jar and run with it.

By the way (referencing your pizza with half of the toppings comment), sure, I can go get a crappy frozen Red Baron pizza a the grocery store, or I could go to a pizza parlor and actually get a well-made pizza with good ingredients. Sure, the end result is that they are both pizza, but there is definitely a difference between the two that validates a higher cost.

You keep saying, "That's very easy math," but it's not always only about the bottom line for everyone. Quality matters, time that it takes to access medical services matters, and to some of us, we'd rather have higher confidence in who we see (in a shorter amount of time) than wonder if the guy about to do my shoulder surgery specialized in feet, but got tasked with my surgery because the government said he had to because there was a waiting list for shoulder surgeries and they want to reduce the wait time.

Not withstanding there is a reason all the 1%ers, government officials, and the elite in those countries come to the US anytime they need have life threatening medical needs...

a reply to: dfnj2015

Agreed.

I believe it is as egregious the way pharmaceutical representatives court doctors in order to have them prescribe their drugs.

a reply to: SlapMonkey

Sorry about the shoulder man. My dr's never figured it out. I went to a cousin who is a PT and she was able to get two mri prescriptions. Elbow and shoulder. Turned out I tore my bicep tendon. When I injured it the first time in a Sambo match my elbow hyper extended yet the Dr was sure all the damage happened in my labrum. It can be a long road to figure out.

I do a lot of broom stretches, resistant band exercise and rotator cuff exercises. If you work at a desk your shouldera start to face in towards each other and the humerus travels down out of the shoulder joint.

I think I remember you are a martial artist. The rotator cuff exercises stabilized my shoulder enough to avoid surgery and compete again. But I do it 4 days a week.

Sorry to go off topic. But dr's often do t listen long enough to the patient to even examine the whole situation. My elbow had to heal before I could do pt and the Dr had no idea there was even damage there. Of coarse it was Texas not know for great care.

a reply to: luthier
Yes, I am, and I'm officially going to take a couple of months off at this point in order to let it rest (plus I'm going on a three-week vacation where I will be out of state and country, so I won't have access to my school). It's very frustrating, and I assume that the martial arts had something to do with it, or it could have been compensating with my left shoulder when I was having sever AC-joint issues in my right shoulder. Who knows.

Just by doing resistance tests in the initial consult, the ortho surgeon said that it's a possible SLAP tear, which doesn't seem like it will be a fun fix if that's what it is. I'll just have to see.

The funny thing about this whole thread is that I'm doing a little experiment--I'm in the VA system, and I decided to forego private medical offices for my shoulder and see how the VA system does. As of now, I'm over three two months into the process and I'm just now getting into an MRI tube.

I had lined up an appointment yesterday with a private ortho place here in town, and they were going to have my intial consult (no referral by my primary-care doctor needed) and any further tests (including an MRI) accomplished with four working days.

Yes, it would have been much more expensive, but sometimes speed and efficiency of care, like I noted in an earlier comment, really is what matters. The only reason I set up that appointment with the private facility was because it was taking so long with the VA, but the VA doc was able to set up my MRI appointment because there was a cancellation, otherwise it would have been another two weeks because one of their MRI machines is down and there is a back log.

I know from personal experience how terrible the U.S. is at running healthcare and hospitals--there is zero way in hell that I would advocate that the federal government usurp control over everyone's healthcare, hospitals, and health insurance. And I still may end up going back to the private doctor, just to get a second opinion if surgery is involved, because that's just smart to do. I doubt that would be an option if all healthcare was run by the government.

Well good news scoping is making things pretty efficient.

I am all for nonprofit competing insurance and pharma, I can not imagine the government running health care as a single payer.


True story, my brother in law was saved by the VA. His private urologist missed his stage 3 prostate cancer. He would be dead without the VA.

I think that may be the first case of that ever happening though.

In my opinion we could model something similar to the Swiss.

en.m.wikipedia.org...