The profit-obsessed monster destroying American emergency rooms • Hacker News Board

Re: The profit-obsessed monster destroying American emergency rooms

#21

Post by arcbyte » Sat, Oct 05, 2024, 3:50 PM UTC

ryandrake wrote: post #11

giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

> The thing that doesn't get mentioned much This gets mentioned every time. The regulation boogeyman always shows up. If only there were fewer rules... everyone could make more money, the little guy would be able to enter and play fast and loose, and nobody would do the wrongdoing those rules were meant to correct/prevent. Yes, there are regulations in health care. There are regulations in almost every industry, and…

Tell me you don't know anything about healthcare without telling me...

Sheesh.

Doctors are medical technicians, not lawyers, and the more you bury them in (largely billing) regulations, the worse care you get and the less time with that doctor you get, and the more money you pay for worse healthcare.

Re: The profit-obsessed monster destroying American emergency rooms

#22

Post by charleslmunger » Sat, Oct 05, 2024, 3:51 PM UTC

ryandrake wrote: post #11

giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

> The thing that doesn't get mentioned much This gets mentioned every time. The regulation boogeyman always shows up. If only there were fewer rules... everyone could make more money, the little guy would be able to enter and play fast and loose, and nobody would do the wrongdoing those rules were meant to correct/prevent. Yes, there are regulations in health care. There are regulations in almost every industry, and…

>Yet people still start businesses, make money, grumble endlessly about those regulations, and society marches on.

One such regulation is "certificate of need" laws, where you effectively need to ask the incumbent for permission to open your would-be competitor.

https://spn.org/articles/certificate-of-need-laws/

Re: The profit-obsessed monster destroying American emergency rooms

#23

Post by mattnewton » Sat, Oct 05, 2024, 3:51 PM UTC

nilawafer wrote: post #19

Isn’t huge profits the definition of success in capitalism? As a capitalist society shouldn’t there be cheers instead of complaining? This part I don’t understand about American culture.

Huge profits mean a lot of value is being captured. That can be because of a large amount of value being created, which is successful capitalism, but it can also mean a lot of rent is being extracted from an existing value stream.

Not saying this is the later case, but when people are critical of large profits they usually are critical of the later, where they believe that the value being created has not really gone up, it’s just being funneled away to rent seekers now.

This is especially true for things that are seen as “essentials” where buying is fairly mandatory and so prices are inelastic, like housing, food and medical care. If these markets become uncompetitive consumers can’t just walk away from rising prices.

So rising profits + the same value being generated point to the market being uncompetitive and are not celebrated in the way rising profits + new value are.

Re: The profit-obsessed monster destroying American emergency rooms

#24

Post by alan-hn » Sat, Oct 05, 2024, 3:52 PM UTC

robertlagrant wrote: post #16

api wrote: post #9

Earlier quoted context omitted.

MBAs and similar types are the Western capitalist equivalent of the Soviet apparatchik: https://en.wikipedia.org/wiki/Apparatchik Entities like PE or conglomerates are a lot like Soviet bureaus: giant bastions of bureaucrats appointed to run things they have no direct expertise in running. The underlying issue here is what I call the "big dumb money problem." You get entities with more resources to deploy than intell…

> Money needs to be redistributed so the ratio of dollars to brain cells is more balanced. It will likely do that naturally unless something gets in the way in the name of progress.

Money and greed naturally get in the way. Is that not obvious? People are finding any way to game the system just to get more money

You're thinking of using money as a measure but everyone else is using it as a target...

Re: The profit-obsessed monster destroying American emergency rooms

#25

Post by titanomachy » Sat, Oct 05, 2024, 3:54 PM UTC

404mm wrote: post #18

I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons: 1. Anytime one of my family members gets sick, it’s rather…

$300 is your part of a regular doctor visit? Or the total bill?

Do you have one of those high-deductible plans designed to discourage people from seeking any healthcare?

Re: The profit-obsessed monster destroying American emergency rooms

#26

Post by bluecalm » Sat, Oct 05, 2024, 3:55 PM UTC

ryandrake wrote: post #11

giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

> The thing that doesn't get mentioned much This gets mentioned every time. The regulation boogeyman always shows up. If only there were fewer rules... everyone could make more money, the little guy would be able to enter and play fast and loose, and nobody would do the wrongdoing those rules were meant to correct/prevent. Yes, there are regulations in health care. There are regulations in almost every industry, and…

Or maybe regulation is in fact a problem. In my country there is less regulation in healthcare services. I can walk into multiple private facilities in my town, get full blood panel with almost everything you can think of included (hormones, vitamins/mineral levels, liver markers etc) for around 100$. The results are going to be available online the same day (with the exception of those that require more lab time). This is fully private enterprise which has nothing to do with "universal healthcare" my country has.

I don't need prescription or doctor recommendation to get it done. I can also take my own urine/hair/swabs, walk into a lab, pay and have the requests results online in a few days.

If I need MRI I can usually schedule it for the next day in multiple private points and again the results are going to be there the same day. The price is around 200 bucks for say cervical spine.

How is it in your country? Do you know how much is required to get those basic services in other countries?

Re: The profit-obsessed monster destroying American emergency rooms

#27

Post by thfuran » Sat, Oct 05, 2024, 3:55 PM UTC

skhunted wrote: post #10

giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people). It’s interesting that the one specific thing you mention is insurance. That particular complexity doesn’t come from regulation. It comes from the immoral insurance industry.

The federal government is one of the largest insurers, and dealing with them entails a lot of effort and expense.

Re: The profit-obsessed monster destroying American emergency rooms

#28

Post by ghaff » Sat, Oct 05, 2024, 3:55 PM UTC

404mm wrote: post #18

I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons: 1. Anytime one of my family members gets sick, it’s rather…

You also have Insta-clinic in chains like CVS. Not sure it's a bad thing. Came back from a trip with minor but persistent cough symptoms that were a LOT like the time I had COVID even though I tested negative. Got an appointment the next day at a clinic with a nurse practitioner who prescribed me an inhaler and said it was a "virus" after listening to my chest, etc. I think I maybe had a $40 bill.

Told my primary care at my next appointment and she basically said she'd have done the exact same thing.

Re: The profit-obsessed monster destroying American emergency rooms

#29

Post by SoftTalker » Sat, Oct 05, 2024, 3:56 PM UTC

giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

There are one or two doctors here who operate individual cash-based practices. They don't deal with insurance companies or their paperwork. The seem to mostly focus on services that insurance is unlikely to cover anyway: weight loss, hormone therapy, but also still run a general/family practice.

They stay in business so the model seems to be viable, but perhaps only because there are so few of them doing it.

Re: The profit-obsessed monster destroying American emergency rooms

#30

Post by grecy » Sat, Oct 05, 2024, 3:56 PM UTC

nilawafer wrote: post #19

Isn’t huge profits the definition of success in capitalism? As a capitalist society shouldn’t there be cheers instead of complaining? This part I don’t understand about American culture.

I think Americans were always happy with profit because they got a share, they had jobs, etc. it was good for everyone.

Now they’re learning first hand what happens when it escalates to outright greed and hoarding, and that life gets pretty shitty for the very vast majority when this happens to the basic needs of a decent life (groceries, education, healthcare, safety, roads, transit)