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

ruralhospitals.chqpr.org

111–120 of 163 posts

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

#111
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 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.

The healthcare industry (it should not be an "industry") in the US is all about extracting maximum profit for the benefit of middlemen.

In a rational system, the only people who should be involved in health care are the patients and the providers (doctors, nurses, technicians, etc) who actually provide health care. Nobody else should be involved, let alone skimming profits from the care.

In the US both the providers and the patients are just an afterthought, the whole system is set up to extract maximum profit to the hospital and clinic administrators and, most and worst of all, to the insurance industry. The latter of course contributes nothing at all in therms of actual health care, it's pure profiteering.

The solutions are quite simple, but they don't maximize the share price and CxO bonuses at insurance companies so it's not possible to implement them in the US.

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

#112
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.

> The defenders of the system are entirely medical workers

No, that's not correct. Doctors and nurses largely despise the US system. They are incredibly overworked and streched too thin to provide great care (and most of them are in it at least partially because they enjoy caring for people).

The US system only benefits the middlemen who provide no healtcare value: insurance companies and hospita/clinic adminitrators.

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

#113

Can we please just implement some level of universal healthcare. The fact that healthcare is tied directly to payers, who fight over how to much to pay, is ridiculous. Imagine your local hospital shutting down because the hospital charged $50 for aspirin but the insurer wanted $40.

If you take an industry cornered by an entrenched cartel and then socialize it as-is you are only cementing their control over it even further, making a healthy competitive market impossible. Prices are criminally exorbitant now, what makes you think they'll go down when the government is the one paying them? If history is anything to go by the effect will be the opposite

This is a ridiculous statement, the government can negotiate prices and has little profit incentive.

Some level of universal healthcare works fine in 32 of 33 developed or mostly developed countries. Stop saying "but it can never be done". It is significantly cheaper in other countries that are able to negotiate drug prices.

I hate this line of logic, it's basically just ignoring that almost every other developed country in the world has figured out and has done it without the need for "healthy competitive markets".

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

#114
I'm sorry to say but there is a lot of nonsense in the other comments here. I wrote Hacking Healthcare for O'Reilly, created the ClearHealth/HealthCloud Open Source EMR system, and most importantly I have, amongst other things, actually managed dozens of rural hospitals and clinics.

First for context, the Center for Healthcare Quality and Payment Reform (CHQPR) is an advocacy organization for the types of institutions this report discusses. I think that is important context.

Second, what is rural? From a healthcare standpoint rural typically refers to area of populations centers of 50,000 people or less. Examples in California that might be familiar to people living in the San Francisco bay area would be Humbolt and Mendocino counties. This report includes some semi-rural areas, places similar to something like Yuba City, CA, a population center of about 160,000.

Thirdly, the main point is that what "rural" hospitals get paid for services from insurance companies and what it actually costs to provide those services, continues to get further and further apart. In my first hand experience, this is true. Number one amongst those is staffing, today staffing costs have risen dramatically faster in rural areas than in urban and semi-urban areas -- though they have risen their as well. The staffing levels and types of personell at what is legally called a hospital are heavily regulated and have continued to to expand. Medicare in particular is pretty "unfair" in its latest fee structures regarding these issues though HHS does provide other types of subsidy to rural areas. The meat of the report is that if that continues unabated, one hundred or more hospitals will likely "close". Closing may mean to completely cease operation or in other cases mean to continue to operate but as something which cannot legally be called a "hospital".

Finally, as a report which is not really in-depth, not really independant of the organizations it is advocating for, provides little in the way of citations and data, I am somewhat dubious of its value being posted to HN at all, other than to act as a punching bag around which everyone can throw the usual jabs at the US healthcare system as a whole.

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

#115

Can we please just implement some level of universal healthcare. The fact that healthcare is tied directly to payers, who fight over how to much to pay, is ridiculous. Imagine your local hospital shutting down because the hospital charged $50 for aspirin but the insurer wanted $40.

Its also incredibly expensive (500k) to become a doctor.

> Its also incredibly expensive (500k) to become a doctor.

That's a large number. I thought it was less.

In any case, in most countries, the number of doctors created is artificially limited (by the professional medical society, by lack of lecturers, artificially small classes, etc).

You want to double the number of doctors? Make each doctor serve (after internship) for at least one year as a fulltime lecturer in medicine. That'll more than quadruple the intake in the first year. The professional health organisation that registers doctors can enforce this.

In fact, they can enforce lots of things, and the question you should be asking is not "Why are the greedy corps taking all the money", but "why is the artificial limit on doctors so low?".

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

#116

Can we please just implement some level of universal healthcare. The fact that healthcare is tied directly to payers, who fight over how to much to pay, is ridiculous. Imagine your local hospital shutting down because the hospital charged $50 for aspirin but the insurer wanted $40.

The problem with US healthcare isnt the payer, its the supply of workers/red tape. Physicians are clearly the worst with their complete control through the ACGME/AMA, but pharmacists were a huge lobbyist in 2008 when it mattered. The various owners, hospitals, pharma manufacturing, pharmacies, all make sure they keep the red tape strong and the medicaid + medicare payments coming.

Nah, the payer system is fundamentally broken. Inability to negotiate and set proper price controls on aspirin for example ends up in a huge fight over who makes the most money out of the system.

While there are other areas that can be improved (supply of professionals) the reality is that the payer model, at its core, is really the big issue.

All the other successful healthcare models across the world have no concept of the American Payer system.

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

#117
post #15

Earlier quoted context omitted.

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?

A huge reason hospitals lose money is due to the amount of charity care they provide. There is a saying that "Reagan instituted universal healthcare in the US, he just didn't institute a way to pay for it." That is, during Reagan's time, laws were passed that required hospitals to provide emergency care regardless of an individual's ability to pay. But no laws were passed then that actually funded that mandate. So in…

This. The USA HAS socialized healthcare, just at the worst point of the system to have it and in the worst way for improving outcomes.

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

#118
post #15

Earlier quoted context omitted.

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 co…

That is not accurate. Only 8% lack medical insurance. And some of those are uninsured by choice: they could afford coverage but choose to spend money on other things.

https://www.hhs.gov/about/news/2022/08/02/new-hhs-report-sho...

I don't know what you mean by "limited coverage". There is no such thing as unlimited coverage in any country. The Affordable Care Act does set a baseline for what all insurance plans must cover.

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

#119

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…

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…

Yeah and guess who keeps voting against single payer healthcare solutions or any kind of healthcare reform?

Representatives from these red rural areas. It's a different big cat that's eating your face, if that makes you feel better.

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

#120
post #78
post #31

This is "too big to fail" logic applied to hospitals. How do our basic life services always become captured by huge organizations that are poorly run and require bailouts by the government? Or is "too big to fail" just a ploy by those organizations to entrench themselves even further in our lives?

Putting on my economist's hat for a second: Services like healthcare inherently have extremely inelastic demand, and are difficult to serve to a large number of people without a large number of resources, which makes it naturally easy to build a monopoly. A monopolicist is incentivized to increase fees and/or reduce spending on the quality of service as long as the demand is inelastic... and here we are. Admittedly,…

> Admittedly, I never got past ECON 201, so I'm probably wrong on something here.

I wouldn't worry about it (myself, only ECON 101); after all the people opining the loudest are the ones who have even less ECON than me, nevermind you.

I think one of the largest mistakes made with medical insurance is removing the price visibility. The hospital cannot tell you how much a procedure will cost until after it is done. They can tell you how much it will cost if you pay in cash, so they have a good ballpark figure.

So the consumer buys something without knowing how much it will cost, and is then legally on the hook for paying whatever the cost is. This is broken.

Maybe it's unavoidable in this particular field (medical care), but the one thing you can be sure of when the consumer buys something without knowing how much it costs (and only paying the cost later) is that the price of that thing is going to skyrocket.

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