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

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

#121

Post by tstrimple »

jjav wrote: post #111
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 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 invo…

> 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.

While I agree with the sentiment, hospitals require management to run well. They certainly don't need the amount of overhead they have, but it can't just be doctors, nurses and patients. Maybe in very small hospitals you could actually have doctors manage schedules and things like that, but once you reach a few dozen people you'll want to have someone coordinating availability and to deal with scheduling at the very least.

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

#122

Post by notacoward »

notaustinpowers wrote: post #28
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 have so many rural family members that are like this. And so much of it is because they just actively and brazenly do not want to help anyone. Their individualistic ideology runs so deep that they view people homeless, struggling, or unable to afford healthcare as a moral failing. To them, the system is working as intended. They're cleaning out the moochers and welfare queens. But by the time they notice they need…

> they view people homeless, struggling, or unable to afford healthcare as a moral failing

...until it's them. If you really want to rile up an old white rural dude with a Trump placard on their lawn, threaten to take away their healthcare subsidies. Or really any other kind, and for most farmers that's a long list. Then the sparks will really start to fly. They believe that government assistance is a God-given right for "salt of the earth" like themselves, but an absolute crime for those "other people" in the cities. It's not hard to see the subtext, even when they're not consciously aware of it themselves.

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

#123

Post by lowercased »

notaustinpowers wrote: post #28
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 have so many rural family members that are like this. And so much of it is because they just actively and brazenly do not want to help anyone. Their individualistic ideology runs so deep that they view people homeless, struggling, or unable to afford healthcare as a moral failing. To them, the system is working as intended. They're cleaning out the moochers and welfare queens. But by the time they notice they need…

Pfftt.. they'll just have a church fundraiser! Then maybe a gofundme to top it off!

I had some family members similar to this, and that was their actual thinking. "God will handle it. Our church always helps its folks". 30 years later... well.. pastor's changed, the focus is always on the younger families with kids and... my relatives, now in their 70s... just don't go to their church of 30+ years because "we don't feel all that welcome any more". So... their plans for church fundraisers is essentially off the table now.

But it took them 30 years to realize this, and they'd consistently voted against their future selves all that time. And I won't even say they "realize" anything profound or deep here. They've not switched party allegiance. Trump will still save them. ugh...

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

#124

Post by cheeseomlit »

jorblumesea wrote: post #113
cheeseomlit wrote: post #52

Earlier quoted context omitted.

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 cou…

When did I say "it can never be done"? Certainly it can, but you'd have to make some pretty drastic changes to the US healthcare market as a whole first- and those changes will be staunchly opposed by all the entrenched healthcare cartels. It wouldn't be easy to do it right, and it'd be very easy to do it wrong and make the whole situation worse (which is what the healthcare cartel would push for). The US healthcare market is a uniquely fucked up monstrosity, comparing it to the universal healthcare system of a country the fraction of our size doesn't make sense.

You say the government has little profit incentive, sure, but they also have little incentive to control costs. It's "other people's money", they spend it like drunken sailors, even when they're 30 trillion in debt. Look at what happened to tuition costs after the government started handing out loans for them. I'd take these calls for universal healthcare more seriously if they talked about addressing the underlying issues in the market first, but from what I can tell it's mostly idealogues pushing their pet policy without grounding it in reality. All the bad actors in the industry aren't just going to disappear or start playing nice when they start getting funded by taxpayers (more than they already are).

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

#125

Post by hospitalJail »

jjav wrote: post #112
hospitalJail wrote: post #36

Earlier quoted context omitted.

> 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…

Doctors like it enough to spend 490 million dollars to keep it in place

https://www.opensecrets.org/federal-lobbying/top-spenders?cy...

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

#126

Post by gs17 »

akuchling wrote: post #84
gs17 wrote: post #67

Earlier quoted context omitted.

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 practit…

I would consider it VA not being an example of "it works fine" if they can sometimes get some help after waiting a long time, then get dumped out in the street to rot. Maybe the specific hospital itself isn't at fault, but the program in general is contributing to the exact issue you're quoting, which is more or less what I'm talking about.

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

#127

Post by rhaway84773 »

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 think it’s a little more nuanced than that.

There is no group of people in the US more subsidized by the government than the rural dweller. Both through direct and indirect subsidies.

Rural voters receive massive agricultural subsidies, they receive significant tax breaks, almost all their infrastructure, from roads, to internet, to the mail, is nearly entirely paid by the federal government with little support from local federal taxes because their tax base is so weak.

But then there’s also the indirect subsidies, such as the U.S. preventing the import of a whole lot of fruits, eve tables and meats altogether, and the ones they do, they do with high import taxes, or the US promoting the sale of rural products both domestically (USDA’s primary goal) and through international trade deals.

But rural voters actually believe, despite all the evidence to the contrary, that they are not the recipients but rather the donors of wealth to the rest of the country, particularly the urban parts. Most other Western countries’ rural areas have no such misgivings, so I suspect it’s a result of them looking at themselves as the archetype US cowboy who pulled himself up by his bootstraps, with no help, etc etc.

So you have this strange situation where the rural voter votes for the party that promises to reduce taxes thinking that they will benefit, since they believe they pay more than they receive, but in reality they are shortchanging themselves.

This worked for a while. The richest enjoyed the real tax cuts, while the rural folks got minor cuts, but nonetheless they didn’t see any downsides, because the roads, hospitals, internet had already been built. Maybe it had a few more potholes than before, and you needed to wait 2 days instead of 1, but you never connected this to the reduction of federal tax money (to be fair, the impact would have been convoluted…tax money being pulled out somewhere else, so the state having to reduce district level funds in one area to plug that hole, which was then possibly pulled out from the hospital maintenance fee by the local administrators).

However, at one point these started accumulating, and what it took was 1 major stress event to go from slowly increasing the temperature of the water the frog was in, to picking them up from the lukewarm water and dropping them in a fire.

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

#128

Post by notacoward »

The main reason seems to be that it costs more for them to deliver services than they're getting paid by insurers (especially Medicaid). I'd love to see a fuller breakdown of how those costs compare to those for urban hospitals. How much is demographics, such as serving a generally older population more prone to "deaths of despair" because rural living is hard? How much is demand, because of different eating/exercise habits or the uneven distribution of addiction to different drugs? How much is logistics, delivering care over a wider area? How much is other factors I haven't even thought of? The question of why rural hospitals don't get paid as much as it costs them to provide care doesn't have to be a political one. It just has to be asked.

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

#129

Post by notaustinpowers »

lowercased wrote: post #123
notaustinpowers wrote: post #28

Earlier quoted context omitted.

I have so many rural family members that are like this. And so much of it is because they just actively and brazenly do not want to help anyone. Their individualistic ideology runs so deep that they view people homeless, struggling, or unable to afford healthcare as a moral failing. To them, the system is working as intended. They're cleaning out the moochers and welfare queens. But by the time they notice they need…

Pfftt.. they'll just have a church fundraiser! Then maybe a gofundme to top it off! I had some family members similar to this, and that was their actual thinking. "God will handle it. Our church always helps its folks". 30 years later... well.. pastor's changed, the focus is always on the younger families with kids and... my relatives, now in their 70s... just don't go to their church of 30+ years because "we don't f…

What's so sad is that is what happened to a grandma of mine. I had come out of the closet (she supported me 100%) and she spoke about it to her church friends and talking about how much she's learned in supporting me. Well, I guess one of those friends didn't share the same beliefs. And the pastor met with her and my grandpa and said that they were no longer welcome at the church. The church they've both attended since they were children.

Thankfully they're fine and don't rely on the church. But it, again, reiterates how much so much of it is viewed as a moral failure. And how much our nation loves punishment more than we love support.

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

#130

Post by nradov »

methehack wrote: post #72
explaininjs wrote: post #8

Earlier quoted context omitted.

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!"

France is #1 in care according to the world health organization for 1/2 the cost per capita. It is all private, well-regulated, and provides universal coverage (your company pays your premium; if you have no employer, the govn't does). We are #37 according to the world health organization and we cost twice as much. I'm sure people in France complain, but they have way less of a reason to. Some reasons for the cost sa…

Cancer patients in France may have reason to complain. They have significant lower 5-year survival rates compared to the USA.

https://doi.org/10.1016/S0140-6736(17)33326-3

Our system has plenty of problems but let's make sure that any reforms don't ruin the best parts.

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