Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

ruralhospitals.chqpr.org

Post reply on HN
Print view View original

101–110 of 163 posts

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

#101

Post by peepeepoopoo5 »

WoahNoun wrote: post #85
peepeepoopoo5 wrote: post #47

Earlier quoted context omitted.

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.

If I had posted a recent article you would have said that wasn't evidence of a long term trend. The problem has gotten worse and it's impacting the entire country now. My family members work at hospitals in rural eastern WA, and not only has the local hospital system there already collapsed, but the entire Providence medical system for all of the Pacific Northwest is at risk of going under too. This is a direct result of uninsured migrant workers and medicaid underpayment.

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

#102

Post by oatmeal1 »

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's the most obvious case of regulatory capture but also the market with the most calls for further regulation.

That further regulation could be a good thing, but it would have to be substantially different from the way things are currently regulated.

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

#103

Post by wwweston »

kevingadd wrote: post #12
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…

Yeah, but it's not as if all the people who live in these areas voted to shut down the hospitals. There's still a sizable portion of the electorate that wants good things and they get to suffer now. Not great.

Rural voters as a bloc seem determined to vote in support of laissez-faire socioeconomic approaches which incentivize this result. I suppose it’s possible that they don’t intend this and merely are thoughtless about it from a policy standpoint, but if we’re being generous it also seems plausible to assume they’re not being stupid and this is either acceptable or part of the intended result.

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

#104

Post by oaktrout »

nradov wrote: post #73
oaktrout wrote: post #42

Earlier quoted context omitted.

The article is arguing that private payers don't reimburse rural hospitals enough, not that lack of medicaid or obamacare is an issue. Perhaps your premise is correct but it is at odds with the article, I would be interested in hearing more about why you disagree with the article. From the article "The biggest problem facing small rural hospitals is inadequate payments from private health plans. Most “solutions” for…

That part of the article makes no sense at all and appears to be pushing a biased political narrative. Private commercial insurers already pay more than Medicare / Medicaid for the same treatments. Patients with private insurance are effectively already subsidizing those on public plans. Why should the burden of keeping small rural hospitals open fall entirely on private health plans? Perhaps hospitals should advocat…

I found it odd also, I was under the impression that hospitals made their money on private insurance and lost on medicare/Medicaid. I do recall hearing that rural hospitals are reimbursed at a higher rate from the government, perhaps that explains the discrepancy.

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

#105

Post by oaktrout »

judge2020 wrote: post #76
oaktrout wrote: post #42

Earlier quoted context omitted.

The article is arguing that private payers don't reimburse rural hospitals enough, not that lack of medicaid or obamacare is an issue. Perhaps your premise is correct but it is at odds with the article, I would be interested in hearing more about why you disagree with the article. From the article "The biggest problem facing small rural hospitals is inadequate payments from private health plans. Most “solutions” for…

> In reality, about half of the services at the average rural hospital are delivered to patients with private insurance (both employer-sponsored insurance and Medicare Advantage plans). In most cases, the amounts these private plans pay, not Medicare or Medicaid payments, determine whether a rural hospital will have to close If 50% are private insurance, what are the other 50%? Wouldn't that other half influence whet…

Presumably, but if half your customers pay you just above your costs and the other half pays half that, which half is responsible for your business going bankrupt? Probably both, but one half is clearly more of an issue than the other.

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

#106

Post by jmoak3 »

The US is freakishly large. I've lived all over it and driven across it from west to east several times.

I grew up 2 hours outside of Appalachia, and couple that with the other places I've seen I feel safe in my belief that the US has large swaths of sparsely populated regions.

Here's some fun maps if you don't believe me:

https://www.reddit.com/r/MapPorn/comments/l4zr10/red_areas_i...

If you don't like reddit, feel free to reference this night map:

https://www.census.gov/library/visualizations/2021/geo/popul...

It's no surprise that these hospitals are at risk of closing. There are few people there and fewer new people coming in, causing the cost of labor to explode. For example, there's a shortage of new blood entering the workforce compared to retiring boomers:

https://www.populationpyramid.net/united-states-of-america/2...

This leads to labor shortages especially in rural areas because the few young people are fleeing to urban environments to find work and a not-shrinking economy a la Japan & Tokyo. Here's a document referring specifically to some east coast regions, but there is likely one for your local region out there somewhere: https://www.richmondfed.org/publications/research/econ_focus...

Here's a document on Japan and Tokyo's situation:

https://www.cnn.com/2023/01/04/business/japan-pay-families-r....

It sucks that these hospitals are closing but this is what the decline of a region looks like. The labor costs are only going to get worse as time goes on because if you want nice things you have to convince people to hang out there and make it nice. The growing costs of labor will shut down hospitals and prevent the opening of new ones. It was easy to justify the construction of such things when the population of the USA almost doubled between 1970 and today. Now? Not so much:

https://fred.stlouisfed.org/series/POPTOTUSA647NWDB

Widespread immigration into these areas would help alleviate these issues, as would policy decisions that favor the industries that used to exist in them that drew people there in the first place.

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

#107

Post by lelanthran »

hn_throwaway_99 wrote: post #82
cheeseomlit wrote: post #37

Earlier quoted context omitted.

[flagged]

> 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 crimi…

[flagged]

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

#108

Post by cheeseomlit »

hn_throwaway_99 wrote: post #82
cheeseomlit wrote: post #37

Earlier quoted context omitted.

[flagged]

> 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 crimi…

A 'tribal' approach is not my intention, it was a reaction to the clear tribalism in your initial post. Your point on obgyns is well taken and in that specific instance you can point to a pretty clear cause and effect- Local laws are hostile to certain segment of healthcare workers so they don't want to stay- fair enough. But thats just one small segment of healthcare workers, and the financial issues in the article we are discussing don't seem to be related to that specific point. More broadly, what I take issue with is this attitude of "If you don't support universal healthcare you don't deserve healthcare' that seems so pervasive. It's an extremely complex issue and there are many rational reasons to oppose universal healthcare. Some like myself do not have a moral or philosophical issue with the policy, but instead are concerned that the current system is a tangled web of cronyism and cartels, and socializing a system like that will only exacerbate healthcare costs as a whole since the bad actors will only become more entrenched. Does that position make me unworthy of having a functioning hospital in my area?

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

#109

Post by vel0city »

searine wrote: post #94
vel0city wrote: post #64

Earlier quoted context omitted.

Eh, most of the current designs in the US healthcare industry has its roots with the move to employer-sponsored healthcare in the 1940s (see: 1942 Stabilization Act and it's consequences). Private health insurance was barely a thing in the 1920's and pretty much didn't exist before then.

I generally agree. As I said, it was a hodgepoge, with no one solution covering the nation. Lots of proposals for more comprehensive solutions but nothing ever with enough momentum to make it into law. https://en.wikipedia.org/wiki/History_of_health_care_reform_... Or if that wiki is wrong, feel free to correct it.

I'm mostly just speaking of calling the US system archaic compared to Europe's post-WWII, because for the most part the US system wouldn't be how it is until 1943 which most would consider post WWII.

In other words, I don't think it's the age that's the problem. It's that most European countries don't mind as much having their national government run things while the US tends to push more federalistic/distributed systems.

In fact, I doubt most people in 1942 would have even thought about the federal government's ability to regulate healthcare. Wickard v. Filburn was decided in November, which is the case that really opened the interstate commerce clause. Heart of Atlanta Motel v. US wouldn't happen until 1964, only then finally allowing federal laws to prevent restaurants from discriminating racially. If the federal government can't even set standards for restaurants it's rather hard to argue they have the ability to regulate hospitals and healthcare that happens inside a state. Medicare wouldn't get founded until 1965, it's not a bit coincidence this happened after SC decisions widening the interstate commerce clause.

The powers of the federal government looked extremely different in 1942 than they do today.

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

#110

Post by hotpotamus »

nradov wrote: post #73
oaktrout wrote: post #42

Earlier quoted context omitted.

The article is arguing that private payers don't reimburse rural hospitals enough, not that lack of medicaid or obamacare is an issue. Perhaps your premise is correct but it is at odds with the article, I would be interested in hearing more about why you disagree with the article. From the article "The biggest problem facing small rural hospitals is inadequate payments from private health plans. Most “solutions” for…

That part of the article makes no sense at all and appears to be pushing a biased political narrative. Private commercial insurers already pay more than Medicare / Medicaid for the same treatments. Patients with private insurance are effectively already subsidizing those on public plans. Why should the burden of keeping small rural hospitals open fall entirely on private health plans? Perhaps hospitals should advocat…

> Why should the burden of keeping small rural hospitals open fall entirely on private health plans?

Because that's how the majority of Americans get their healthcare? I assume that's the case, but I don't actually know - as mentioned there are multiple single-payer health plans (lol) that cover those we have deemed worthy of them. The paper linked says that rural hospitals need to bill higher because their unit costs to deliver healthcare are higher (which makes basic economic sense). Therefore it would seem like the market solution would be to charge people who live in rural areas more for healthcare/insurance.

I can never tell whether the US is a nation or an economy.

Post reply on HN