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

ruralhospitals.chqpr.org

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

#151

Post by maxerickson »

hn_throwaway_99 wrote: post #39
jbm wrote: 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…

Even hospitals disagree with this.

https://www.aha.org/fact-sheets/2020-01-06-fact-sheet-uncomp...

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

#152

Post by rayiner »

positron6000 wrote: post #149
rayiner wrote: post #91

Earlier quoted context omitted.

Except rural hospitals in blue states that expanded Medicaid, etc., are also at risk of closure: https://www.beckershospitalreview.com/finance/631-rural-hosp... . For example, 41% of rural hospitals in New York are at risk of closing, similar to the 38% in Florida, and a lot more than the 18% in Kentucky. Solid blue Washington is at 33%, worse than Iowa or Indians at 24 and 21%. Idaho, which you call out specifically…

Based on the data here (which your source is based on) four out of the five rural hospital closures in NY are in counties that voted for Trump in 2016: Irving, NY - Chautauqua County - Trump Fulton, NY - Oswego County - Trump Ticonderoga, NY - Essex County - Clinton Amsterdam, NY - Montgomery County - Trump Sidney, NY - Delaware County - Trump - https://www.shepscenter.unc.edu/programs-projects/rural-heal... - https:…

You’re begging the question. 90% of rural counties voted for Trump. The phrase “rural hospitals” is pretty much synonymous with “hospitals in counties that voted for Trump. That doesn’t prove that the policies people voted for caused the problems with rural hospitals.

Healthcare is handled at the federal and state levels, not the county level. Thus, rural areas in blue states like New York should be doing better than ones in red states like Florida. They all voted against these policies that supposedly would have helped them—but in Florida they were successful in opposing them while in New York they were overruled by urban areas and got those policies anyway.

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

#153

Post by selimthegrim »

rayiner wrote: post #152
positron6000 wrote: post #149

Earlier quoted context omitted.

Based on the data here (which your source is based on) four out of the five rural hospital closures in NY are in counties that voted for Trump in 2016: Irving, NY - Chautauqua County - Trump Fulton, NY - Oswego County - Trump Ticonderoga, NY - Essex County - Clinton Amsterdam, NY - Montgomery County - Trump Sidney, NY - Delaware County - Trump - https://www.shepscenter.unc.edu/programs-projects/rural-heal... - https:…

You’re begging the question. 90% of rural counties voted for Trump. The phrase “rural hospitals” is pretty much synonymous with “hospitals in counties that voted for Trump. That doesn’t prove that the policies people voted for caused the problems with rural hospitals. Healthcare is handled at the federal and state levels, not the county level. Thus, rural areas in blue states like New York should be doing better than…

You really think counties have zero influence whatsoever (note I didn’t say formal role) in issuing certificates of need?

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

#154

Post by rqtwteye »

nradov wrote: post #130
methehack wrote: post #72

Earlier quoted context omitted.

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.

Life expectancy is pretty low in the US though. Seems all in all the system doesn’t work well.

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

#155

Post by MichaelZuo »

duffpkg wrote: post #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 institution…

> 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.

Nowadays a large fraction of upvoted HN posts don't contain much genuinely substantive discussion at all. The farther away the post is from a purely technical topic, the higher the likelihood of this.

Instead they are often filled with what I call pseudo-substantive discussion, meaningful superficially, but that don't make much sense, or based on faulty assumptions, once anyone tries to investigate or question a bit.

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

#156

Post by rqtwteye »

sidr wrote: post #35
ethanbond wrote: post #17

Earlier quoted context omitted.

The NHS is one of the most beloved institutions on the planet AFAICT. Of course everyone would prefer if everything were better all the time, but complaints about the US system and clearly not on the same plane as those about UK’s.

It used to be. https://www.kingsfund.org.uk/press/press-releases/british-so...

The conservatives are actively trying to destroy it.

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

#157

Post by rqtwteye »

AvocadoPanic wrote: post #57
ethanbond wrote: post #17

Earlier quoted context omitted.

The NHS is one of the most beloved institutions on the planet AFAICT. Of course everyone would prefer if everything were better all the time, but complaints about the US system and clearly not on the same plane as those about UK’s.

Unless you're reading news items about no ambulances or beds, being left on trollies in corridors, waiting lists for procedures lack of available GP appointments. Before covid not as a result.

I have experience in Germany and the US. I don’t think there is much difference in these aspects. As far as GP appointments go, here in new Mexico the wait time is measured in months and years.

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

#158

Post by rqtwteye »

ajmurmann wrote: post #87
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!"

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…

The US is doing way worse than other countries as far as cost goes. And the bureaucracy is way worse.

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

#159

Post by ajmurmann »

rqtwteye wrote: post #158
ajmurmann wrote: post #87

Earlier quoted context omitted.

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…

The US is doing way worse than other countries as far as cost goes. And the bureaucracy is way worse.

Of course, because comp is much higher in the US than in most countries, including most western countries, maybe worth the exclusion of tiny, unusual places like Switzerland.

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

#160

Post by nradov »

rqtwteye wrote: post #154
nradov wrote: post #130

Earlier quoted context omitted.

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.

Life expectancy is pretty low in the US though. Seems all in all the system doesn’t work well.

Life expectancy in the USA is lower than France primarily due to other factors like obesity, sedentary lifestyles, substance abuse, suicide, and violence. Those problems can't really be fixed through healthcare system reforms (although making our healthcare system more efficient might eventually free up some funding for other social issues).
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