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Hospitals that make profits should pay taxes

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Re: Hospitals that make profits should pay taxes

#171
post #70

Earlier quoted context omitted.

> usually obscenely high due to other regulatory and contractual reasons related to the negotiation process Lets be real its due to greed nothing else.

There are plenty of industries in which purely being greedy is much easier than it is in healthcare. Greed alone does not explain the depth of complexity involved in the US healthcare pricing system. To be clear, I’m not defending the system either. It’s fundamentally broken by design. But it’s certainly not solely the greed of hospitals that got us here.

Healthcare has a cartel restricting supply of new doctors, and new hospitals. Only a small number of new doctors can intern each year ensuring the relative supply decreases vs population. The same for hospitals - even if you have the money and the doctors you can't open one unless the other hospitals in the area agree one is needed and allow you to get a “Certificate of Need”.

But that wasn't enough to juice profits so pricing had to be made as opaque as possible to screw over anyone who isn't a giant insurance company ensuring the little guy without insurance who "pays his bills" pays more than 10x anyone else in the system.

I don't know of any other industry with this level of depravity and greed.

Re: Hospitals that make profits should pay taxes

#172
post #74

Earlier quoted context omitted.

> I always wonder why people seemingly can’t apply their experiences beyond themselves I grew up lower middle class, and I didn't have it easy. I have no idea who my birth parents were. I had an abusive father. I was bullied and beaten relentlessly by the other children that didn't like on-the-spectrum kids. I didn't party like those that abused me, I withdrew into myself and turned that into hard work. So when I see…

What are they demanding that you are not? Everyone wants to be healthy and they want a medical system which helps them get there. If partying is a problem, they should be able to talk to a doctor about it, and it should be paid for as a part of the services provided by society.

Your expectations are unreasonable. The medical system is extremely expensive to operate. Highly paid physicians should be reserved for delivering the most complex care.

If consumers need guidance on making healthier lifestyle choices then doctors aren't even the best source. Utilize cheaper professionals for that stuff: therapists, counselors, social workers, dieticians, personal trainers, etc.

Re: Hospitals that make profits should pay taxes

#173

Earlier quoted context omitted.

The problem is more obvious in reverse: profit is money extracted from community wealth. It may be reinvested to create more community wealth. But until that happens it's effectively removed from the collective resource pool and monopolised by private owners for private ends. This is not great when it's abstract numbers, but it inevitably seems to concretise as privileged individual control over property, land, exclu…

>The problem is more obvious in reverse: profit is money extracted from community wealth. On the contrary, profit is the part of the wealth generated by the company that remains with those who generated it!

Yeah: the old companies take everything argument (quite true for many organisations and departments).

Where's the other side of the ledger: the services and products that the company provided to the community.

Hospitals are a great example. Put money in, get some health out.

How do we value getting our bladder fixed?

It is easy to look at the money and forget what we get in return.

What value do we get from an iPhone? If no more smartphones were produced I wonder where the market price would shift to? We could even find out if China has a war.

Re: Hospitals that make profits should pay taxes

#174
post #31

Earlier quoted context omitted.

Why? To give terrible service and managed by bureaucrats? Or being a leech of the state medical system?

Very poor unsubstantiated viewpoint. The epitome of socialized healthcare would be healthcare in a communist state. And Cuba, in spite of completely inhumane and unreasonable sanctions imposed by the united states, still beats the US on metrics such as life expectancy. This proves the falsehood of the idea that state-run healthcare is inherently less efficient.

False. Cuba has shorter life expectancy than the USA.

But beyond basic stuff like immunizations, antibiotics, and trauma care, healthcare has a very small impact on life expectancy anyway. Once you have a serious chronic medical condition, even the most advanced healthcare system can generally only give you a few extra years.

Re: Hospitals that make profits should pay taxes

#175
post #74
post #58

Earlier quoted context omitted.

It’s really amusing when tech people who have a full understanding of singletons and basic statistics always refer to themselves when making a broader statement about society. I always wonder why people seemingly can’t apply their experiences beyond themselves when they already do that day to day at work. A lot of “personal decisions” are consequences of society. Depending on where you are in society, you’re going to…

> I always wonder why people seemingly can’t apply their experiences beyond themselves I grew up lower middle class, and I didn't have it easy. I have no idea who my birth parents were. I had an abusive father. I was bullied and beaten relentlessly by the other children that didn't like on-the-spectrum kids. I didn't party like those that abused me, I withdrew into myself and turned that into hard work. So when I see…

> The comments and downvotes here are probably from wealthy / well-off people on HN

This is funny because statistically wealthy people are the ones usually against increases in taxes.

I was born in Iran, so I’ve dealt with my fair share of bullshit. My conclusion from my life is that we are individuals and we are a collective as well. A collective where if there’s a lot of illness in a part of it, it makes us all sick.

Second off we literally do not need more taxes to have proper healthcare in this country. We do not have a money problem, but a politics and policy problem. We have a problem that a lot of people think that by helping others, they’re the ones getting punished.

A healthy society means a society that has more energy and time to work on problems that benefit us all.

May I suggest this, instead of seeing healthcare coverage for more people as a punishment for you, see it as a collective investment to allow people to focus on things that matter.

And, note that healthcare isn’t the point of service by a doctor. It means healthy city design. Healthy subsidies for food (instead of subsidies HFCS for example). It means better public transit. It means actual neighbors and neighborhoods. It means longer weekends.

Re: Hospitals that make profits should pay taxes

#176
post #138

Earlier quoted context omitted.

My original post suggests that costs should be attributed to risks. If you take an outsized portion of health care relative to the rest of society, there's a chance that may be linked to behavioral choice. If you smoke a pack every day, eat two McGriddles every morning, film parkour stunts for your YouTube channel, go to the STD clinic monthly, are an alcoholic, etc. Society should not be paying for this in the same…

If health insurance were priced according to individual risk then a huge swathe of the population wouldn’t be able to afford health insurance (as indeed is still the case to some extent, even after Obamacare). And that’s assuming that you leave Medicare and Medicaid in place - which logically you shouldn’t, according to your line of argument. How it could be a malinvestment for a society to invest in the health of...…

Yeah, it’s really amazing I had a republican/now-maga coworker who vehemently opposed Obamacare and said it was unnecessary as people who were risky should shoulder increased insurance costs, and could not understand that my partner literally could not get insurance for any amount, every insurance company was literally saying “you donated a kidney [were healthy enough to donate a kidney] and because you only have one kidney we will not cover you, good luck!”.

It wasn’t even “we won’t cover kidney issues” (ignoring that finding a kidney donor saves insurance companies money) it was a blanket “we will not accept you as a customer”.

To this day the dude thinks Obamacare is bad, and that people should “take responsibility”. (I’m unsure how people born with congenital defects are meant to take responsibility but dudes a maga and thinks a bunch of his coworkers aren’t people so I assume the same applies to people with congenital issues)

Re: Hospitals that make profits should pay taxes

#177
post #87
post #32

Earlier quoted context omitted.

The idea is that we want more of what nonprofits do. No taxes is an incentive. A nonprofit that turns a profit is presumably putting it to work eventually, such as adding a new wing. It's not as if they can do stock buybacks because there isn't any. There are many ways this structure is abused but the idea isn't absurd.

A lot of ideas aren't absurd until they meet reality. The arguments that defend an idea don't really matter in the long run, if we can later see that the outcomes they provide aren't good. I look at one of our local private universities: A non profit with a huge endowment. Their prices keep going up, and then discount enough to make sure the student's price is as heavy as they could possibly bear. They put that money…

> Their prices keep going up, and then discount enough to make sure the student's price is as heavy as they could possibly bear.

Isn't this consistent with their mission? If a student comes from millionaires, they can pay the full rate. Others get a discount according to need.

> They put that money into real estate investment, but they don't actually do anything with the land

This is caused by the opposite of what you're objecting to: What they should be doing is renting out the property and using the revenue to further their mission. But as soon as they do that the state would start collecting both property tax and income tax on the rent, even if 100% of the rental income is going to the non-profit's mission. Between that and the costs of maintaining a rental property, you've made productive use into a net loss and created the perverse incentive to do nothing with the property instead.

In theory the "problem" with this is that a non-profit could operate a profit-making business as a funding source, but why is that a problem? If an independent for-profit business can deduct a donation to a charity, why shouldn't a charity be able to deduct a "donation" to itself?

Re: Hospitals that make profits should pay taxes

#178
post #71
post #32

Earlier quoted context omitted.

The idea is that we want more of what nonprofits do. No taxes is an incentive. A nonprofit that turns a profit is presumably putting it to work eventually, such as adding a new wing. It's not as if they can do stock buybacks because there isn't any. There are many ways this structure is abused but the idea isn't absurd.

I want more of what businesses do. Why are nonprofits special?

Business expenses are tax deductible too. Businesses essentially only pay income tax on net profit.

Re: Hospitals that make profits should pay taxes

#179
post #149

Earlier quoted context omitted.

My original post suggests that costs should be attributed to risks. If you take an outsized portion of health care relative to the rest of society, there's a chance that may be linked to behavioral choice. If you smoke a pack every day, eat two McGriddles every morning, film parkour stunts for your YouTube channel, go to the STD clinic monthly, are an alcoholic, etc. Society should not be paying for this in the same…

Sounds like you want to apply value calculation to people - is this person's life worth the same or more than this other person's? Then they can get healthcare. And we can see that because you're complaining about, for example, parkour stunts, but not the much more common sports that cause significant injuries. I get that it's a common desire to say "this person does not deserve to live because I don't like their cho…

> Sounds like you want to apply value calculation to people

To behavior. If you buy a sports car, you pay higher car insurance. If you buy a motorcycle, you should pay higher health insurance. If you live riskily or unhealthily, your coverage should cost more and not be averaged out over the less risky.

Risk calculus should be considered with everything. It's essential to extending a home loan, but not when granting a college loan. Decoupling risk leads to bad outcomes.

> but not the much more common sports that cause significant injuries.

I think sports players should pay more for injury insurance. And roofers, loggers, etc. Those costs will be absorbed by their respective industries where the costs are generated.

> this person does not deserve to live because I don't like their choices

I'm not saying that at all, and that's such a cartoon way of looking at this. You walk into a hospital in America and you get treatment. That doesn't mean you don't have to pay for it.

> I might have thought you could also see how the costs associated with many illnesses might contribute to the proportionally higher tax rates on things like alcohol and tobacco in countries with public health services.

I never said do not tax negative externalities. By all means, please do. We should tax drugs too.

> Your insurance premiums are priced to cover the YouTube stunters, the alcoholics, the people playing sports, the people driving, etc just like a Public Health Service.

I would like them to not. I would like to cover my risk profile.

Everyone should cover their own risk profile. That's fair and equitable.

> Because the metric for success in a public health service is treatment, the system is optimized to treat the most people.

It already does this. This is simply about who gets the bill.

Re: Hospitals that make profits should pay taxes

#180

I don’t understand why people volunteer at hospitals. These are like the opposite of non-profits.

> don’t understand why people volunteer at hospitals

They’re undeniably helping. Refusing to help one person because it might benefit someone else is a touch petulant.

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