The NYT reports in "Hospitals Knew How to Make Money. Then Coronavirus Happened. Surgeries are canceled. Business models are shifting. Some of the hardest-hit hospitals may close, leaving patients with fewer options for care."
I think I can predict what the top-rated comment over there will be — something about how we should have single-payer health care like other countries and how awful it is that places like the Mayo Clinic have a commerce-oriented mentality, shame on them. Okay, now I will click. Aha! I am right! Here's the top-rated comment:
I can't wrap my head around this article. It's an article about a failed "business model." The business model failed because hospitals are having to take care of urgently sick people instead of performing "lucrative" surgeries.
The purpose of a hospital is to take care of sick people, not to generate revenue. But because hospitals are having to do what they're supposed to do, which is to try to save lives, during a time when hospitals are most needed the "business model" doesn't work and more hospitals may close.
That's ghoulish and insane. Obviously there's something wrong with the "business model"—it's that it's a business model and not an economically sustainable healthcare system with the primary goal of optimizing health for the people of the United States. What more will it take to show us how broken we are? How broken are values are?
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109 comments:
Is this person's idea that if they were government workers in government hospitals they would just be getting paid to remain empty?
(also, what about the people not getting the surgeries that generated the revenue? Are they ok?)
Our neighbor was supposed to go to the Mayo clinic for cancer surgery but it was canceled because of the WuCooties, and she ended up with a local surgeon who screwed up and had to do it twice.
It wasn't the business model that failed. It was the epidemiology model.
All those sick people they cleared the decks for didn't materialize.
Covid patients aren't the only sick people.
Nobody is being treated, but at least now it's fair.
Another advantage of universal healthcare is that doctors' salaries are really low.
In Russia it's a low prestige job. Women do it.
Yes, you were right.
And the comment is insane.
I would also like to let this person know that even the UK has private hospitals.
"'It’s uncontrollable,'"
Fair comment on the insanity epidemic so far.
Of course, it could be controlled: by resistance to government coercion, to MSM fear mongering, and to Karen irrationality.
But in retrospect it will be one more indicator of The Panic of 2020: that supposedly to save health care, we undermined it, including the top institutions in the world.
The top rated comment should have been, “This is why the lockdown should have ended May 1.” People delaying surgery, treatment, testing etc. is causing needless suffering and death, unaccounted for in the Media. Where is the compassion for those who made way for the WuFlu cases?
With single payer the top rated commenter would never see the inside of Mayo. Or M D Anderson. Or any top facility.
"The purpose of a hospital is to take care of sick people, not to generate revenue."
From the NYT comment selected by Althouse. This is more GIGO. Define the hospital differently and you can declare their business model faulty -- producing consequences that are "ghoulish and insane."
But if you simply define a hospital as a place devoted to health care work, than none of the commenter's conclusions apply. Esp the ever-popular chestnut of how "broken our values are." It is purely GIGO.
In the utopia of the left, the world would be a better place without the Mayo Clinic.
Yes, the medical field in the US is a for-profit sector, mostly. Not entirely- obviously, as we have Medicare and Medicaid which do not even cover labor and supplies, let alone the actual work.
In my area, hospitals in both Tampa and Sarasota have had to furlough staff. Doctors and nurses are cut- lower rung staff are cut. But you understand that if you take a facility that was built to service EVERY KIND of possible health need, then cut out everything except Wuhan Virus infections, you go from having a productive business and facility to having a very large, overpriced building being 25% used. Think of it this way: Gov. Cuomo screamed and shouted that they were out of beds, that they could not possibly handle the flow of sick folk. So the Army Corps of Engineers took over the Javits Center and made it a 1000+ bed facility in days. Trump also arranged for the Hospital Ship Comfort to port in New York- in a week. Neither was even used. The hospitals in New York were not out of capacity. So the Javits Center and the Comfort were 'furloughed'. Closed up. This is happening to hospitals and doctors offices all across the country. We talk about losing restaurants and shoe stores. We're also going to lose doctors, clinics and hospitals.
Lastly- the position that medicine- your health- is a right is preposterous. You have no right to good health, no more than you have a right to a 150 IQ. To claim a 'state right' or 'peoples right' to 'free' health care it to make a claim on the time and skills of doctors, nurses, and other healthcare individuals. You are claiming your right to their time of life. Because YOU NEED.
You have two choices:
You can have universal healthcare (ala the UKs NHS). This will create a healthcare system that has the goal of basic coverage for as many as possible. It drags down the overall quality of care to meet the volume of the masses. Forget needed surgeries. Forget research into advancments. Forget overall higher quality. You'll get the lowest common denominator. But it'll be 'free' (though you are still paying for it in higher taxes.)
Or- you can have a for-profit system which attracts the best and brightest in the field, to do the work, do research, invent, improve and bring innovation to the world (so systems like the NHS can at some point use these innovations). Oh- and if you need a surgery or treatment- you can get it quickly, and find a doctor or facility who you can afford. You won't have to wait for 18 months to be able to walk again. You'll be able to get your knee surgery. But, it will cost more at the doctor's office. You will have lower taxes, however.
Your choice: mass healthcare at a low quality level, or high quality for-profit healthcare that you pay for. How much do you like yourself?
There’s nothing wrong with “the model” that ending lockdown wouldn’t have cured. Hospitals are empty nationwide! Why? Why NOW? (Some limited normal operations have resumed in some states but not stupid MN where the Mayo is.)
The business model failed because hospitals are having to take care of urgently sick people instead of performing "lucrative" surgeries.
The problem was the inability/decision not to perform multiple, specialized functions at the same time.
Not sure how single payer would change that, except make the system less responsive to changes in need and demand.
"not an economically sustainable healthcare system with the primary goal of optimizing health"
What a moron. How does shutting down everything but COVID care optimize health for anyone other than a COVID patient? I'm pretty sure someone that needs cancer screening or a colonoscopy or a hip replacement but can't right now is not having their health optimized.
Let me know when you find a single payer system that doesn’t ration the delivery of healthcare. Democrats screwed up healthcare in the United States with Obamacare. You’d think they’d be a little more humble by now.
It's the NYT, easiest prediction EVAH!
Market-derived prices are full of information.
The commenter probably also believes that all we have to do to get the economy to recover is print more money.
And it’s the paying patients who enable care for the poor. Medicaid revenue is marginal revenue. It’s like filling the last seat on a plane for half price at the last minute. The airline can’t afford to charge all customers that rate but in this case something is better than nothing.
'Canada's single-payer healthcare system forced over 1 million patients to wait for necessary medical treatments last year [2017]. That's an all-time record.
"Those long wait times were more than just a nuisance; they cost patients $1.9 billion in lost wages, according to a new report by the Fraser Institute, a Vancouver-based think-tank.
"Lengthy treatment delays are the norm in Canada and other single-payer nations, which ration care to keep costs down. Yet more and more Democratic leaders are pushing for a single-payer system -- and more and more voters are clamoring for one.
....The only thing Canadian patients are "guaranteed" is a spot on a waitlist. As the Fraser report notes, in 2017, more than 173,000 patients waited for an ophthalmology procedure. Another 91,000 lined up for some form of general surgery, while more than 40,000 waited for a urology procedure.
"All told, nearly 3% of Canada's population was waiting for some kind of medical care at the end of last year.
"Those delays were excruciatingly long. After receiving a referral from a general practitioner, the typical patient waited more than 21 weeks to receive treatment from a specialist. That was the longest average waiting period on record -- and more than double the median wait in 1993.
"Canada isn't an anomaly. Every nation that offers government-funded, universal coverage features long wait times. When the government makes health care "free," consumers' demand for medical services surges. Patients have no incentive to limit their doctor visits or choose more cost-efficient providers.
"To prevent expenses from ballooning, the government sets strict budget caps that only enable hospitals to hire a limited number of staff and purchase a meager amount of equipment. Demand inevitably outstrips supply. Shortages result."
Forbes.
This government ordered shutdown is the worst man-made disaster in America. Many people will die because they couldn't get "elective" surgery and treatment at the Mayo Clinic.
China, the Dems and the Fake News are entirely responsible for this.
The Governor of MN should fully open the state up today. Scott Johnson at Power Line has the full story. The median age of the deceased is 83 and over 90% lived in nursing homes or assisted living.
Where are the lawsuits? Why hasn't the Mayo Clinic sued the Governor?
The purpose of a hospital is to take care of sick people, not to generate revenue.
Following that line of thought I guess that doctors, nurses, medical staff, andany and all other health professionals should be indentured servents of the state. It's their "purpose" after all. I mean, they need some food and shelter I guess, but anything beyond that is clearly "ghoulish and insane".
You're not printing money as long as the Fed has an interest rate target. They'll be selling debt to hold the interest rate target, sterilizing any money printing.
Print a dollar, sell a dollar of debt.
Don't know why they didn't take the approach of "we may need to start cancelling elective procedures, and we are creating the associated administrative processes so that they are ready and in place if needed, but we won't start cancelling unless it becomes necessary."
Somebody on these boards has been predicting hospital BKs for a while now.
Anybody know who that was?
Note to NYT commenters:
62% of all US hospitals are non-profits.
The NYT: not deterred by either theory or reality.
Stories must be told, regardless of the facts. Our readers demand it.
I heard that Pelosi's new relieve bill will be denominated in Bolivars.
I wonder if this person knows that "lucrative" surgeries are one of the ways that hospitals write off care for those unable to pay.
Sidebar: when I worked in a psychiatrist's office, the Medicaid payment for a 30 minute appointment was $33.86.
How many quality doctors do you think you're going to get when they have to take on $200,000 of debt in order to make $66 an hour before overhead?
The "top commenter" seems to think that lucrative surgeries means unnecessary surgeries which is incorrect. The Mayo clinic and many other hospitals switched from doing needed but not covid-19 related procedures to not doing any procedures. The over whelming of hospitals did not happen and was never going to happen in 90 percent of the country.
Medicare and Medicaid do not cover 100 percent of the cost of the services provided by hospitals. Hospitals need to provide high cost services covered by private insurance to stay open. Many hospitals will close because of the way we reacted to healthcare during the pandemic. I would be willing to bet that in the US more people will die because of delayed healthcare or unavailable healthcare for non covid-19 illnesses then will die from covid-19.
You can have universal healthcare (ala the UKs NHS). This will create a healthcare system that has the goal of basic coverage for as many as possible. It drags down the overall quality of care to meet the volume of the masses.
New York City has its own hospital system. I testified in a malpractice suit against that city hospital system. It was an interesting experience. I was the expert witness for the plaintiff, a guy who was shot in the leg by his probation officer. Don't ask me why. He was treated in one of those city hospitals and they screwed up his care so he lost his leg. The case was tried in Bronx Supreme Court, the courthouse in "Bonfire of the Vanities." The place was just like in Tom Wolfe's novel.
The jury sent a message to the judge asking if one juror could be forced to bathe, he smelled so bad. They could not stand him in the jury room. No place to sit in the hallways. I asked a guard and he said the benches would be full of bums if they had them.
Anyway, the jury came back with a half million dollar judgement. The lawyer was ecstatic. His biggest fee of his career. He was a criminal defense guy, like Richard Dreyfuss in the movie "Nuts." His office down the street had iron bars to keep his clients from stealing his window air conditioner. Cook's paradise city.
Look at this:
https://www.dailymail.co.uk/news/article-8323353/Louisville-woman-gives-birth-pavement-outside-hospital-doors-locked.html
The woman gave birth on the sidewalk outside the hospital. The husband tied off the umbilical cord with his face mask. While this was happening, the hospital staff (a.k.a. "the heroes") just watched. I wonder how big of a bill the hospital will send these people? Probably a million dollars, which is totally reasonable.
The commenter thinks nonemergency is the same as luxury. They are not the same at all.
If only we could get rid of our broken, profit-oriented food system. Then we would have all the food we need, and nobody would worry about food.
If only we could get rid of our broken, profit-oriented fuel system. Then we would have all the gasoline we need, and nobody would worry about gasoline.
If only we could get rid of our broken, profit-oriented manufacturing system. Then we would have all the goods we need, and nobody would worry about anything.
what is this really about:
https://www.coreysdigs.com/law-order/pih-bobby-rush-and-the-truth-behind-contact-tracing-surveillance/
I don't see how GOVERNMENT intervention in a hospital's business model, justifies GOVERNMENT control of the industry. It was GOVERNMENT that screwed up, so let's give it total control. Also, those more lucrative procedures subsidize the emergency care that usually doesn't get paid, or is substandard compensation like Medicaid. The biggest problem with today's medicine is lack of competition, and lack of cost transparency. Mostly because everyone with insurance is subsidizing the low or non-paying patients. Also, individual insurance companies negotiate different prices for different procedures with the hospitals. That's why those that self pay, pay more. The insurance companies often stipulate that as part of negotiations. Self pays only get discounts if the qualify for need. It's a mess.
Think how much easier it will be for government to shut down "inefficient" or "marginal" medical procedures once Democratics get their wishes for government controlled health insurance. What a panacea.
This dry run of Leftist Collectivist fascism is going gangbusters.
What country do commenters like this imagine have this fantastic "free" universal health care? Last year there were lots of Swedes where I vacationed. They all had private health insurance. They said most who can afford to do. Same in Ireland. Quick google shows 10% of British and 75% of Canadians have private coverage in addition to public options offered by their country. In this country the medicare leftists like actually doesn't cover much, most have a supplemental policy over their medicare.
Reality based health care comes from highly paid skilled medical systems that do chase profitability as success instead of bureaucrat hell designed to fail , fail and re-fail. The VA already proved it.
Let me know when you find a single payer system that doesn’t ration the delivery of healthcare.
And our system rations healthcare on ability to pay.
Comments like that are from people who loathe economics. Where do they think the money come from for single payer? 'The wealthy' probably...
oh
https://www.dailywire.com/news/san-diego-supervisor-says-only-6-of-194-coronavirus-recorded-deaths-pure-coronavirus-deaths
Mayo is not only one of the best run hospitals it is one of the best run organizations in the world. If they are suffering something's wrong with decisions others outside Mayo are making.
Wait until The Panic puts most colleges and universities out of business.
Hard to make a "business model" that is focused on once-in-a-century epidemics. You tend to go out of business in between.
"To claim a 'state right' or 'peoples right' to 'free' health care it to make a claim on the time and skills of doctors, nurses, and other healthcare individuals. You are claiming your right to their time of life. Because YOU NEED."
I used to be amazed that people didn't grasp that. Sadly, I am no longer amazed.
Americans want choices. Yes- good care costs money.
The left will never udnerstnd this.
They want us all to have horrible commie care while the castro-Clinton-Maddow group have the very best care of all.
Maybe people aren’t really as sick as they think they are.
Last year Mrs. Hawkeye was diagnosed with cancer. Good fortune has put us a short distance from a MD Anderson facility. They have worked wonders, maybe even cured her. For this type of cancer, her options in Canada would have been a) die b) go to the USA. Her options in Great Britain would have been the same.
The oncologist is Russian (though not female). Probably lured here by our broken, profit-oriented system.
Making money is bad... unless you are a dem pol and you make money off of international connections.
Diane Feinstein = A-ok!
Burr? not so much.
(also, what about the people not getting the surgeries that generated the revenue? Are they ok?)
@Maybee, in the weeks before my first total knee replacement every step I took felt as though there was a pebble under my kneecap, so you need to define what it means to be “ok.” Alive? Yes. Healthy? No. Wishing they were dead? Some of them, surely.
Due to my thyroid being collaterally irradiated when the tumor at the base of my tongue was zapped in 2016, my thyroid had been slowly failing the last three years. I had reached hypothyroidism and started taking a small does of Synthroid in March. A sonogram was done and there were suspicious nodules. A fine needle aspiration was ordered for 4/3 and then the pathology group who was to participate stopped supporting the fna procedure for two weeks. Since I didn't have cancer officially yet, I was in limbo as the procedure was non-essential where I stood. At the end of the two week period, which happened to be the day my fna had been scheduled, the pathology group opened their schedule back up and I was immediately set for 4/7. FNA was done and one of the nodules was suspicious for cancer. This diagnosis made my thyroidectomy an essential surgery and I had it 4/14. The final pathology report did confirm a very small carcinoma in my thyroid, interestingly not in the node that was suspicious, but a papillary microcarcinoma nonetheless. It probably would never have grown into a problem for me, cancer wise, but my thyroid was not reliably doing its job and I wanted it out so that the medication could be dialed in. It all worked out but I got a taste of the frustration that millions of others whose "non-essential" care has been halted are feeling these days.
I now take 150 mcg of Synthroid a day which is based on my weight (190). That's a little bit more than the formula calls for but my endocrinologist, who I saw the first time on a tele-appointment six days after my surgery, felt like I was already running low and needed to catch up. He was right and I had already started taking 150 a day three days before our visit based on my own calculation of what I should be taking after I started bottoming out three days after the surgery when I continued taking only 50 a day. I'm now feeling like my old younger self again.
that's reasonable,
https://www.dailywire.com/news/transgender-pennsylvania-health-director-melts-down-in-press-conference-after-reporter-uses-wrong-pronoun
Why do these hospitals not resume elective surgery the minute it became clear that they were not going to be overwhelmed by coronavirus cases? Couldn't they cancel the elective surgeries if they think they need to?
the answer:
separate infectious disease centers
https://www.frontpagemag.com/fpm/2020/05/3-out-5-deadliest-coronavirus-outbreaks-were-state-daniel-greenfield/
To properly focus our fight against this deadly invisible enemy, let us shut down all other medical procedures necessary or elective for all other diseases and shutter all hospital spaces and personnel not solely devoted to fight the Covid-19 pandemic.
Better safe than sorry, you Denialists!
Ignorance is bliss.
Had surgery April 14 in a huge empty hospital
Referring to "lucrative" surgeries is where the error begins. Somehow, lucrative translates into some minds as unnecessary or elective... Like nose jobs or something like that.
Really "lucrative surgeries" are things like, cancer surgeries, open heart surgeries, and other exotic procedures.
then there is preventive care, another thing that no one has been able to do for two months, which is one of those "pay now to save later" things that We used to hear about from the single-payer crowd.
but since we live in Scott Adam's world of two movies, half the country can't see that. Or at least are easily misled by loaded terminology.
I've told you his backstory,
https://dailycaller.com/2020/05/14/peter-navarro-disgruntled-rick-bright-obama-trump/
We were told quite explicitly by certain Althouse Karens in recent weeks that the extreme lockdown helped us avoid an economic collapse.
Note: Karens are not to be listened to.
It's pretty simple. All you have to do is convince people to go thru the hell of college, medical school, and residency to get paid the equivalent of a McDonald's employee.
And don't forget the student loans they'll need to take and pay back.
See? Simple.
People will be lining up for miles to get into that.
What "business model" means is a sustainable, economically viable form of organization that collects the inputs necessary to respond to customer demand and preferences: material, equipment, land, labor, capital, and management. People also need food, clothing, shelter, transport, tech, etc. - are all of these things to be provided by all-knowing commissars?
If you feel yourself clinging to one idea, and one idea only, making that your hill to die on as a commenter, please note that you may die as a commenter, but that it may not have been the right hill.
MLL:
Good for you.
There are thousands of less fortunate people who didn't get the medical treatment they needed during this insane shutdown.
The commenter couldn't be more wrong. Hospitals aren't failing because they are taking care of "sick" people instead of doing "lucrative" surgeries. Most of what was suspended was procedures on sick patients (cancer, knee replacements, etc.). The hospitals are failing because the wave of "sick" patients never arrived. No matter what model you use, a fully staffed hospital sitting empty will hemorrhage cash. Mayo suspended all the nonemergency care to take care of the the acutely ill Covid-10 patients. Had those Covid-19 patients shown up at the hospital and their ICU's filled with Covid-19 patients on ventilators - Mayo would have done ok financially. The problem - which isn't stated - is that those patients never materialized. Mayo shut down major portions of it's system in Rochester, and then ended up with very few Covid-19 patients. There have been only a total of 399 cases of Covid-19 in Olmsted County (that's total cases, not hospitalizations) with 9 deaths. I bet they haven't had a total of over 200 Covid hospitalizations during the last 2 months. Mayo was fooled by the models - just like the governor of MN.
We have a home in Rochester MN where Mayo is, and are there waiting on appointments. Mayo is the economic engine in the area. The also have clinics all around the area and into IA that serve small communities. I'd imagine any expansion are over. This won't recover anytime soon. To save our medical infrastructure we destroyed it.
In the utopia of the left, the world would be a better place without the Mayo Clinic.
It sticks out like a sore thumb in the Leftiverse. A little planned smoothing with a swipe here, an injection there... flatten the curve.
It must be infuriating for these people to read the paper and know that every reported problem is because "the rich" won't fund a government program to solve it.
It's no wonder they can hardly keep it together.
Oh no, the "healthcare heroes" who have been insisting to Trust the Science are now begging the proles for a bailout because, get this, you can't shut down the world for two months! At least not while a rapaciously greedy financial class still demands their pound of flesh for work you and they didn't do.
I suspect the public servants and "non-essential" workers who will be demanding bailouts will be bitterly disappointed. Which will mean everyone is going to be disappointed shortly thereafter, but hey. If only they had listened to people who asked hmm, is this disease REALLY so black-plague deadly as to merit shutting down the world?
Ah well. Hope they're ready for the aftershocks.
When my better half and her orthopedist decided it was time to replace her knee, it was done 3 weeks later. That's not a wait time- that's the time it takes to order and receive the knee, they're not "off the shelf", and schedule a time that's good for both the patient and doctor. She could have had it done in 2 weeks, but we had a weekend trip planned already...
In Canada, there are published wait times. In months for some surgeries, years for others.
Our orthopedist can give us an MRI at any time, no need to schedule 3 weeks in advance. He owns an MRI imaging service. Funny thing- up in Niagara County there are all kinds of billboards advertising walk-in imaging services of all kinds, directed at Canadians coming over the border for them. In Canada, there's a wait time for them. In Niagara County, they're a walk-in service. The only thing that surprised me about that it that NY allows it. As a citizen, I can't get a blood test done without 1. Seeing doctor 2. Having the doctor order it. 3. Returning to the doctor to get the results. In other states, I could pop into a lab, order up and pay for what I wanted, and get the results emailed to me. But not NY- it requires two trips to the doctor and one to the lab. All regulations designed to "protect me. Not sure what they're protecting me from, except knowledge.
Everything the panic Nazi's are doing is in bad faith.
Everything.
They do no care one bit about saving lives. They only care about control.
Because not all hospitals can be the Mayo Clinic, none of them should be.
Harrison Bergeron is a warning, not a how-to manual.
You're not printing money as long as the Fed has an interest rate target. They'll be selling debt to hold the interest rate target, sterilizing any money printing.
Print a dollar, sell a dollar of debt. --rhhardin
The Fed is buying debt. They print the money in order to buy the debt.
I Have Misplaced My Pants said... when I worked in a psychiatrist's office, the Medicaid payment for a 30 minute appointment was $33.86.
When I worked as a clinical psychologist, Medicaid paid me $30 for a 45 minute appointment. That did not even cover office expenses. The patients had zero copay.
Guess which patients had the highest no-show rate?
The business model failed because hospitals are having to take care of urgently sick people instead of performing "lucrative" surgeries.
Except that, in most places, there weren't enough urgently sick people to keep the hospitals busy. It's the lucrative, elective surgeries that keep those hospitals in business and make sure they have the space and staff so that if they did have a sudden rush of very ill people, or people injured in a disaster of some sort, they would be open and ready to care for them.
Freder Frederson said...
Let me know when you find a single payer system that doesn’t ration the delivery of healthcare.
And our system rations healthcare on ability to pay.
If only I had known that when I was up all night operating on illegal aliens. Where were you when I needed you, Freder?
Ration by price (US) or ration by supply (universal care) - choose your poison. When I lived in Canada the radio version of NPR there was nonstop complaints over the wait times. When I lived in Japan I learned you “gift” the doctorr if you want any reasonable care.
Most European countries have a mix too - insurance for things you really want and waits for the rest.
But always remember - the Nomenklatura will ALWAYS have private places to go for their care.
@Temujin:
+11
You have two choices:
You can have universal healthcare (ala the UKs NHS). This will create a healthcare system that has the goal of basic coverage for as many as possible. It drags down the overall quality of care to meet the volume of the masses. Forget needed surgeries. Forget research into advancments. Forget overall higher quality. You'll get the lowest common denominator. But it'll be 'free' (though you are still paying for it in higher taxes.)
Or- you can have a for-profit system which attracts the best and brightest in the field, to do the work, do research, invent, improve and bring innovation to the world ...
Your choice: mass healthcare at a low quality level, or high quality for-profit healthcare that you pay for. How much do you like yourself?
You imply what the collectivists among us can never take on board: the impact of time.
Assume that as of today, a single payer healthcare system would more equitably provide healthcare of the same quality and with the same timeliness as what we already have. (An extremely generous assumption, but stick with me.)
Socialized provision is characterized, as in always, by stasis. At any future time, the single payer result I have so generously assumed will remain exactly as it is now.
In contrast, for profit anything is characterized by innovation. Given my, and the NYT commenter's, extremely generous assumption, in the parallel universe of for profit medicine, eventually it will provide healthcare better in all respects than the single payer model, and that gap will only increase over time.
So what the is commenter is saying is more like this: I got mine; screw those coming after me.
(I was supposed to get a hip replacement several weeks ago. As with everywhere else, all "elective" procedures were cancelled to preserve PPE and other healthcare resources. Based upon predictions that long ago have proven themselves 97-99% wrong.)
BTW, I have discovered a NYT paywall hack. (Or, perhaps I'm the last to know.)
Open the article, it will appear with the paywall. Re-load the page, then as soon as it appears, stop the page download.
(In Safari, use the page reload icon at the right side of the URL field, then the moment it changes to an X, click on it; this stops the download before the paywall code can get in the way.)
In PA, the physician leading the response for the state ordered nursing homes to take COVID-19 patients and put her own mother into a hotel.
Can we just accept that people's pronouncements of "What's best for society" who are shown not to follow that same advice for themselves or their family may need to explain themselves? Maybe this is why personal freedom is superior to state-run efforts?
In response to the article and comment....
So wait....a dramatic organizational over-reaction resulting in a shutdown of normal business in preparation for a potential pandemic means the business SUFFERS?!?!? And that the people who work there also SUFFER!???!?!
And that even in a single payer system if a hospital shuts itself down to receive a massive influx of new sick patients and they never arrive - and therefore never trigger payment to that hospital - that would also cause the hospital and it's workers to financially suffer?
...
I'm shocked, SHOCKED by this news. I was assured any and all levels of shutdown for the pandemic was for the public good and there was no acceptable rationale to try to maintain some level of ordinary business-as-usual
Let's ruin the medical system that leads the world in new medical discoveries and treatments... and move toward a system like Cuba! Right Freder?
It's funny seeing NYTers dismissing the Mayo Clinic as embodying a 'failed business model' because it relies on market mechanisms to deal with supply/demand and revenue generation. The 'one payer' model they prefer is a relic from a hundred+ years ago, and wherever it was imposed, was the last century's biggest failure. More generally, command-and-control as a business model requires omniscient commanders-and-controllers, and alas they seem to be in extremely short supply. The very human types who exercised the command-and-control function were adverse to innovation and instead conformed to the usual laws of bureaucracy -- first and most important, protect the in-team, expand its jurisdiction and squash any resistance.
Command-and-control is also very poorly suited as a model for today's rapidly decentralizing economy, in which large institutions of all sorts are failing. It's not just the large retailers of yesteryear (Sears, JC Penny, etc.) or media companies (newspapers, what's that?) that are gone or soon to be -- they are merely the leading indicators. Bureaucratic institutions across the board are having trouble dealing with the new realities of how we live and interact. Decentralization of authority is what market competition is all about -- the aggregate choices of market participants is the engine driving the train. That too is imperfect, but its imperfections have a built-in corrective mechanism (the possibility of failure) that results in replacement. Not so much with command-and-control entities -- failure requires doubling-down on more failure, as the thing just limps along, until it crashes and brings everything down with it.
I can't wrap my head around this article. It's an article about a failed "business model."
Any argument that points to a once-a-century crisis as proof that society needs to change how it functions outside of crisis conditions is DOA.
I can't wrap my head around this article. It's an article about a failed "business model."
Any argument that points to a once-a-century crisis as proof that society needs to change how it functions outside of crisis conditions is DOA.
"I can't wrap my head around this article. It's an article about a failed "business model." The business model failed because hospitals are having to take care of urgently sick people instead of performing "lucrative" surgeries."
NYT readers are idiots. Hospitals are being forced to remain mostly empty, ready and waiting for patients who will NEVER arrive (see USNS Mercy/Comfort) and are being FORCED to cancel other operations, elective and not. A hospital's business model is NOT to turn away the urgently sick, but to treat them alongside those who need a tricky mole removed or a battery of tests for allergies or diabetes or whatever. Many of these "minor" things aren't happening now, and that's a problem. Why are leftists so retarded?
Freder Frederson: And our system rations healthcare on ability to pay.
For the record, I had to invest in a personal policy here in Oregon within the last two weeks. I spoke to a broker who told me that I might qualify for "free" coverage through the state plan. As it happens, my income is too high for that plan, I had to settle for a $660 monthly subsidy. I'm well aware that this is due to "Obamacare" and I feel a bit guilty about it. I also understand that Oregon and every other state is looking at fiscal catastrophe for the immediate future and lots of "free" things will be going away.
One other anecdote about universal coverage: several weeks ago, a friend who is a Romanian national learned that her mother (in Romania) had fallen and broke her hip. She was taken to a hospital in the city, where she was left unattended for a day because she didn't have money for a "tip".
"Print a dollar, sell a dollar of debt." --rhhardin
The Fed is buying debt. They print the money in order to buy the debt.
That means the Fed wants even more dollars out there to keep the interest rate at their target. The point is that the Fed open-market operations work to keep the interest rate at their target no matter how many dollars you create on the side, by either buying or selling debt. Had they not done the stimulus they would have created even more in open market operations.
The open market operations sterilize anything else you do on the side, so long as they're in effect.
"In contrast, for profit anything is characterized by innovation. Given my, and the NYT commenter's, extremely generous assumption, in the parallel universe of for profit medicine, eventually it will provide healthcare better in all respects than the single payer model, and that gap will only increase over time."
This is the biggest point in the whole debate. If we had single payer car manufacturing we all, including the poor, would still be driving Model-Ts.
"And don't forget the student loans they'll need to take and pay back."
Wrong! single payer includes FREE education! Because it's insane that such noble future heroes should have to pay for anything!
I learned it at reddit /medicine /premed /residency
This government ordered shutdown is the worst man-made disaster in America. Many people will die because they couldn't get "elective" surgery and treatment at the Mayo Clinic.
Not just that, but many people will die because the rural hospitals they used to frequent have now shuttered their doors and the nearest hospital - once 20 minutes away - is now an hour and a half to two hours away.
Blood on your hands, leftists. I hope you're happy.
"Obviously there's something wrong with the "business model"—it's that it's a business model and not an economically sustainable healthcare system with the primary goal of optimizing health for the people of the United States. What more will it take to show us how broken we are?"
This fascinating comment stayed with me, since I first read the Althouse post, because it is already obsolete. The most popular of the comments on the NYT article, yet in a world of economic contraction and huge unemployment, this is like a souvenir from another time.
The commenter could easily be a Bernie Sanders fan, it is that style of vague, unfocused expression of some fantasy ideal -- a perfect world in which nothing takes revenues to make payroll, pay the utilities, pay for the equipment, or actually function in a real way.
When unemployment was at a record low, and stocks were selling at record highs, it was possible to think like this and grab a certain amount of the sympathy and agreement of similarly vague, unfocused people who were discontented with economic reality, political reality, physical reality.
They're discontented that things aren't easier. That the world isn't "sustainable" without effort, bills, user fees, and similar annoying little bits of reality. It's the fantasy that someone can wave the magic wand and everything will go along like clockwork without any hitches and certainly without ever costing the fantasists any money.
They really think there is someone else who can pay for it all.
It was a fantasy before, and so was Bernie's entire shtick, but it is even more starkly a fantasy now when there is huge unemployment, tax revenues have cratered, and you have even a lefty like DiBlasio say NYC can't reopen because they're broke. And the people who write comments like this one in the NYTimes are not just annoying kvetchers up with which the rest of us must put, with their moralistic preening and their need to be Taken Seriously! They are now mementoes of a vanished world, of no use to anybody, especially, and most poignantly, to themselves. They have still not even figured out how changed the world is. But the urgencies with which we are now going to have to deal make people like this impossible to take seriously and, I think, their complaints will be disappearing beneath the press of contraction and limited, rather than limitless, capital. They are curiosity pieces best suited for the Smithsonian Institute.
@zippity:
It's pretty simple. All you have to do is convince people to go thru the hell of college, medical school, and residency to get paid the equivalent of a McDonald's employee.
And don't forget the student loans they'll need to take and pay back.
You forgot to include the prospect of being sued for everything they own as a consequence of unforeseen complications that were manifestly not their fault.
@zippity:
It's pretty simple. All you have to do is convince people to go thru the hell of college, medical school, and residency to get paid the equivalent of a McDonald's employee.
And don't forget the student loans they'll need to take and pay back.
You forgot to include the prospect of being sued for everything they own as a consequence of unforeseen complications that were manifestly not their fault.
WWPaulKlee
Take a pencil. Draw the Iron Triangle. Label each point. Use “ACCESS” “COST” “QUALITY”. Put your pencil tip Inside, you cannot leave the Iron Triangle. Put your pencil where your values lie. This is still true, although the Lightbringer posited a superpower of “Bend the Curve”. For extra credit read I, Pencil. Complex Systems collapse catastrophically and no central planning can ever reconstruct them.
@zippity:
It's pretty simple. All you have to do is convince people to go thru the hell of college, medical school, and residency to get paid the equivalent of a McDonald's employee.
And don't forget the student loans they'll need to take and pay back.
You forgot the prospect of being sued for everything you own due to some unavoidable complication that was manifestly not due to substandard treatment.
Lost in all this hyperventilation about the 'failed business model' of hospitals is that the surgeries and other procedures that provide the institution with positive cash flow pay for the free care provided in the emergency rooms, the cost for over 75% of which is never recouped.
The problem with socialism is that the objective is for everyone to suffer equally.....everyone except those in charge who have their dachas on the Black Sea and can show in the hard currency stores where there is plenty of toilet paper and stuff.
The lefties are evil and nasty little shits. It cannot be said often enough.
- Krumhorn
MayBee said...
Is this person's idea that if they were government workers in government hospitals they would just be getting paid to remain empty?
Yes. We'd still be losing money but we wouldn't do anything about it. In left wing fantasies this is an improvement.
"Yes, the medical field in the US is a for-profit sector, mostly." Well, yes, most of it is. Yet hospitals and most of the big healthcare chains seem to mostly be nonprofits.
It sounds as though some NYT reader thinks "nonprofit" means your organization should just be able to draw on unlimited funds and never ever have to worry about meeting payroll, or paying vendors or lenders.
Is it necessary to point out that this is magical thinking, that resources are never unlimited, and therefore economic restraints within any system are inevitable and unavoidable?
The root problem here seems to be balancing "an abundance of caution" against the all-too-real costs of that choice. Such as, the consequences of postponed medical treatments (e.g., delayed diagnostics and treatment for many types of cancer) against the consequence of failing to prepare for a worst-case pandemic.
Next up, perhaps, will be 'plaints that it just ain't fair that decisions must be made even in the absence of full and certain information about the consequences?
Blogger MikeR said...
"Why do these hospitals not resume elective surgery the minute it became clear that they were not going to be overwhelmed by coronavirus cases? Couldn't they cancel the elective surgeries if they think they need to?"
Hospitals and surgical clinics are at the mercy of the local Departments of Public health, or in my case, Emperor Newsome who's decided he's the King of California.
On Feb. 14, I scheduled my hip replacement surgery to happen on April 14. It was the first available slot, and then the lockdown. Then, the date was shifted to May 11, pending the clinic being approved to open again. That day has come and gone and I've had no indication of when I will be rescheduled. I've been told that once the clinic gets the OK to open, they will need to space out surgeries (meaning the reschedule will be at 50% of the norm) and I have no idea where I was on the list when the whole thing got shut down.
I joked with friends and family that I hope to have it done by Christmas. Sadly it's looking like that might be the case after all.
Health Care funding in the US depends on over charging the well employed to pay for the basic care of the poor and illegal folks. BBut Those folks don't pay, their insurance companys pay!! HA HA HA. There is a panoramic sweep: The doctor delivered babies for 3 chickens... WW2 where you could not pay people more to work so you gave them health insurance to draw them in... Unions control the big outfits and demand that you need to have gold plated plans, I just want to walk in and out of the doctors office without a checkbook. The poor don't have care so let illegals get ER care...ER Care is too expensive, let them all have regular care... 2030, everyone will be a doctor with no pay as a draftee for 3 years, you will treat folks without education and they will like it.
A hospital is two places:
- a place where sick people go to get well
- and a place where we’ll people go to get surgery
And the latter pays for the former.
PS The Mayo brothers were surgeons
Freder Frederson said...
Let me know when you find a single payer system that doesn’t ration the delivery of healthcare.
And our system rations healthcare on ability to pay.
Why are you lying again? You get the bill when you leave the hospital. You may not be able to pay the bill, which can be resolved in various ways, but you don't get denied treatment while you're there.
@rhhardin
The open market operations sterilize anything else you do on the side, so long as they're in effect. [rhh]
"Sterilize" is Bernanke's rationalizing word to conceal the truth: that the Fed was creating massive amounts of credit. The supposed idea was to help the economy recover. The actual effect was to reflate asset values in the bond and stock markets.
There is a lot of credit behind those asset values and now one wonders how good it is. The Fed hasn't only bought Treasuries, but all sorts of debt, now including junk. And not just junk, which at least has some degree of claim on a real asset, but also volatility derivatives -- a clever way to directly manipulate the stock market.
Oh, they have been so clever, the Fed. Such smart people.
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