30% of All Rural Hospitals in the US Are at Risk of Closing [pdf] • Hacker News Board

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#81

Post by sidr » Tue, May 23, 2023, 7:24 PM UTC

cheeseomlit wrote: post #37

hn_throwaway_99 wrote: post #6

I don't know how you can realistically look at this without thinking of the "I never thought leopards would eat MY face!!" meme. Politics matters. Voters in rural areas (generally, of course) have consistently voted against policies that would help support health care in these rural locations, such voting in politicians who are staunchly against Obamacare, who refuse any expansion or even adequate support for Medicai…

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Obamacare won't fix it because it's a gutted compromise. Universal healthcare (which is the only way to get around private insurers not paying out, and not tying healthcare spending to income) is a non starter in this country and it's entirely due to one political faction. It's accurate to blame them for this.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#82

Post by hn_throwaway_99 » Tue, May 23, 2023, 7:24 PM UTC

cheeseomlit wrote: post #37

hn_throwaway_99 wrote: post #6

I don't know how you can realistically look at this without thinking of the "I never thought leopards would eat MY face!!" meme. Politics matters. Voters in rural areas (generally, of course) have consistently voted against policies that would help support health care in these rural locations, such voting in politicians who are staunchly against Obamacare, who refuse any expansion or even adequate support for Medicai…

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> So vote for my party or you don't deserve healthcare? What an enlightened liberal world view.

What a silly mischaracterization of my point. That point being that actions have consequences, and sometimes unintended consequences.

Since you seem to be taking a "tribal" approach to this, I'll flip things on their head. Voters (again, generally of course) in some urban areas have decided addressing inequalities in criminal prosecutions are more important than reducing crime. For example, if you elect a prosecutor who broadcasts that they won't prosecute shoplifting below $1000, you shouldn't be surprised if then many people take it as the green light to take $999 worth of stuff whenever they feel like it.

In the Idaho example I gave, voters got exactly what they wanted, which was a forced birth legal system. But they shouldn't be surprised that most obgyns, even very conservative ones, are not willing to work in a state that puts them in severe legal jeopardy for providing health care.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#83

Post by zamnos » Tue, May 23, 2023, 7:24 PM UTC

sidr wrote: post #51

justrealist wrote: post #18

Earlier quoted context omitted.

I don't mean to start a flame war, but the most positive things I've heard are from Indian colleagues/friends who are used to paying cash for very affordable service back in India. No insurance or national coverage, just low overhead and high skill.

Those colleagues were very wealthy by Indian standards to begin with and have only increased their purchasing power by being abroad. India does in fact have free care at government facilities and they are certainly not "low overhead and high skill". I'd pick rural American healthcare over rural Indian healthcare 10 times out of 10.

From the sound of this article, you'll only be able to pick it 7 times out of 10, unfortunately.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#84

Post by akuchling » Tue, May 23, 2023, 7:25 PM UTC

gs17 wrote: post #67

rqtwteye wrote: post #2

It’s really interesting how the US has managed to get a health system that’s extremely expensive, doesn’t cover everybody, is highly bureaucratic and complex, delivers below average outcomes and has overworked hospital staff. And somehow people defend this system because it works fine for the top few percent (especially the people in Congress) and people who have Medicare or VA.

My opinion of VA healthcare dropped a lot living next to a VA hospital. There were a lot of homeless nearby who seemed to be veterans who had come for the hospital.

I don't see how this is the hospital's fault: they can't keep patients indefinitely. Today's Washington Post has an article on the increasing number of homeless seniors https://wapo.st/3q8Gzeb which includes this passage:

"After treatment for an acute illness, hospitals often discharge homeless patients, who wind up back in shelters or even back into their sidewalk tents and makeshift lean-tos, in what health practitioners in Phoenix ruefully call “treat-and-street.” ... A pinball effect takes hold, said health-care providers, shelter operators and advocates. Homeless people bounce from homeless shelter to hospital, then to a nursing home for a short-term recuperation stay. Once that short-term stay ends, nursing homes must decide if the person is infirm enough to qualify for long-term care. If the answer is no, they must leave the nursing home, starting the cycle over again."

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#85

Post by WoahNoun » Tue, May 23, 2023, 7:25 PM UTC

peepeepoopoo5 wrote: post #47

Loughla wrote: post #30

Earlier quoted context omitted.

>Combine this with a large influx of uninsured, undocumented migrant workers in rural areas I'm sorry to be that guy, but extraordinary claims require extraordinary proof. Claiming that the failure of rural hospitals is due to illegal immigration, even in part, is an extraordinary claim. Do you have anything at all other than anecdotes to back that claim up?

It's hardly extraordinary. This has been a major problem for decades, and it's only gotten worse. I'm sorry it disagrees with your politics, but illegal immigration is bankrupting hospitals. Here is a previous attempt to shore up some of the financial losses: https://www.cms.gov/newsroom/fact-sheets/emergency-health-se...

That's an 18 year old article and the OP's PDF shows hospital's closing in Montana, the Dakotas, Idaho, Michigan, etc that aren't near the border.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#86

Post by Projectiboga » Tue, May 23, 2023, 7:25 PM UTC

jbm wrote: post #15

hn_throwaway_99 wrote: post #6

I don't know how you can realistically look at this without thinking of the "I never thought leopards would eat MY face!!" meme. Politics matters. Voters in rural areas (generally, of course) have consistently voted against policies that would help support health care in these rural locations, such voting in politicians who are staunchly against Obamacare, who refuse any expansion or even adequate support for Medicai…

I do not understand how Obamacare would resolve this issue. This seems to be related to the lack of income; how would Obamacare or Medicaid fix this?

Just over a dozen red states refused the Medicaid Expansion, which would have offered more federal health dollars to their states. Yes the Affordable Health Act was just a band-aid on our for profit health insurance system. Our country spends over 30% on health insurance administration before you count all the billing effort by the medical providers. We have out 27% without any insurance and many more with limited coverage. The money is already there this is a rare example where nationalizing would surely safe money. The thing that should be able to help even the better off is that it should eventually reduce the strain on our emergency rooms. No system would be perfect but our system is about as far as can be from supporting individual health.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#87

Post by ajmurmann » Tue, May 23, 2023, 7:25 PM UTC

explaininjs wrote: post #8

rqtwteye wrote: post #2

It’s really interesting how the US has managed to get a health system that’s extremely expensive, doesn’t cover everybody, is highly bureaucratic and complex, delivers below average outcomes and has overworked hospital staff. And somehow people defend this system because it works fine for the top few percent (especially the people in Congress) and people who have Medicare or VA.

Is there any country with a medical system that people don't complain about? For instance is there anyone in the world that would agree: "Gee, my healthcare is so cheap, it's surprising that it covers everything I want it to without me needing to go out of my way to justify my treatment options and I have so many medical professionals available to me at a moments notice!"

IMO, the problem with healthcare is the same issue as with other labor-intensive things like childcare, education etc. It's Baumel's cost disease. Products hey cheaper due to automation and get cheaper relative to services. This makes these things get really expensive in relation. The most common intervention for this unfortunately is demand-side subsidies which of course make things worse. The other intervention is tighter controls which means more paperwork which also make things more expensive. Happens everywhere.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#88

Post by zamnos » Tue, May 23, 2023, 7:26 PM UTC

hospitalJail wrote: post #36

rqtwteye wrote: post #2

It’s really interesting how the US has managed to get a health system that’s extremely expensive, doesn’t cover everybody, is highly bureaucratic and complex, delivers below average outcomes and has overworked hospital staff. And somehow people defend this system because it works fine for the top few percent (especially the people in Congress) and people who have Medicare or VA.

> And somehow people defend this system The defenders of the system are entirely medical workers and owners. The various medical lobbies/cartels are incredibly strong.

Are medical workers even that loud a defender of the system? A lot of providers are burnt out and leaving the profession due to being overworked.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#89

Post by 0000011111 » Tue, May 23, 2023, 7:26 PM UTC

rqtwteye wrote: post #2

It’s really interesting how the US has managed to get a health system that’s extremely expensive, doesn’t cover everybody, is highly bureaucratic and complex, delivers below average outcomes and has overworked hospital staff. And somehow people defend this system because it works fine for the top few percent (especially the people in Congress) and people who have Medicare or VA.

It is broken for sure.

Re: 30% of All Rural Hospitals in the US Are at Risk of Closing [pdf]

#90

Post by [deleted] » Tue, May 23, 2023, 7:26 PM UTC

jbm wrote: post #15

hn_throwaway_99 wrote: post #6

I don't know how you can realistically look at this without thinking of the "I never thought leopards would eat MY face!!" meme. Politics matters. Voters in rural areas (generally, of course) have consistently voted against policies that would help support health care in these rural locations, such voting in politicians who are staunchly against Obamacare, who refuse any expansion or even adequate support for Medicai…

I do not understand how Obamacare would resolve this issue. This seems to be related to the lack of income; how would Obamacare or Medicaid fix this?

[deleted]