Asset stripping is evil. I think we should have more regulations against asset stripping. How would those regulations be written, though?
In my opinion, as a lay person who reads the news, asset stripping seems to be a way of "hacking the system" - doing a series of things, individually permissible by the rules, to achieve personal gain at the cost of social harm. I think, we should forbid dumping negative externalities on people. But which step is the actual wrong?
cameldrv · 3h ago
We shouldn’t have for profit hospitals.
phkahler · 2h ago
I think by asset stripping the parent is including other plays. Private equity buys a company, sells the real-estate to their friends and leases it back to the company on a long term lease. Then after other shenanigans they IPO and dump the company back on the public. It's better than in the old days because they don't fire everyone and sell the assets. They may even make some positive changes, but the company now has to pay rent.
gruez · 2h ago
>I think by asset stripping the parent is including other plays. Private equity buys a company, sells the real-estate to their friends and leases it back to the company on a long term lease. Then after other shenanigans they IPO and dump the company back on the public.
Your wording strongly implies you think there's something shady going on, but what's the actual issue here? It's a private company, after all. Minus the concern of minority shareholders getting screwed over by the transaction, there isn't anything obviously intrinsically wrong with restructuring the ownership structure of a company you own. If a given company is only limping along because it owns real estate and pays $0 in rent, arguably the right thing to do is let the company fold - creative destruction and all that.
tptacek · 1h ago
I didn't listen to the audio, just the teaser for it in this article, but my guess is they're not digging too much into the issue of hospital mismanagement and misallocation; in Chicago, we've got a lot of hospitals that are more or less slowly shutting down, not because anybody is doing anything shady, but simply because they aren't good and they're in areas with strong competition.
ceejayoz · 1h ago
“Creative destruction” isn’t as fun when it’s a large area’s main access to healthcare. We’re talking hospitals, not Red Lobster.
throw0101d · 6m ago
> “Creative destruction” isn’t as fun when it’s a large area’s main access to healthcare. We’re talking hospitals, not Red Lobster.
When the automobile was created it destroyed makers of buggy whips. When steam ships were created it destroyed sail makers.
What exactly was / is being created here? We're talking about asset transfers and shells games.
gruez · 1h ago
The same argument can be used to justify any keeping any sort of zombie business around. The local sawmill has been loss making for years, but shuttering it would mean losing the main source of jobs for the area. That's arguably worse than losing access to healthcare, because most people can survive without access to healthcare, but most can't survive a month without a paycheck. So why not keep it around? Maybe the local/state/federal government should chip in as well to keep it running?
Of course, there's probably a reason why the business in question is faltering. Either it's being mismanaged, or the market conditions can't support the business any more. Letting it limp along might be the politically expedient thing, but it doesn't fix the underlying issue. Moreover, in the case of a market issue being the cause, not fixing it means there won't be competitors to take its place, which is basically a way to guarantee a "too big to fail" situation. To be clear, I'm not suggesting the area go without a hospital because the market conditions aren't right, it's that the government should fix the problem with rural hospitals (or whatever) rather than letting a bunch of zombie hospitals limp around.
const_cast · 14m ago
Healthcare is not, and will never be, a free market. Applying free market dynamics to it just does not work. It's bad reasoning.
People are quick to jump to free market reasoning because it's quick, easy, and requires little to no thought or nuance. But step number 1 is you have to prove said market is a free market. And, if it's not, you then have to prove forcing it to be a free market is not only possible, but beneficial for society as a whole.
Nobody does that though, because it's hard. So they just hope if they skip the most fundamental part of free market reasoning that nobody would notice. No, we notice.
ceejayoz · 19m ago
It’s not that I don’t understand the free market laissez faire position. It’s that I find the position sociopathically tone deaf.
mindslight · 1h ago
That might be fine if there were extremely strong regulations about the staffing/stocking/capabilities that must be provided as long as they continue to operate. For example the landlord should be getting notice that the hospital will not be paying the full amount of its rent before there is any reduction in hospital capabilities or effectiveness. And if the landlord wants to evict, that should probably require something like six months to a year's notice to allow notice to the public and orderly shutdown or moving.
But it probably just makes more sense to prevent the development of such wildly opposed incentives that necessitate that kind of highly detailed mediation. For example hospitals are public-facing institutions, they shouldn't be primarily operating out of rented buildings like some vape shop.
SoftTalker · 2h ago
I'm reminded of the poem. "You knew I was a snake when you picked me up."
gruez · 2h ago
Except, blaming for-profit hospitals only goes so far. Only 17% of hospitals are actually for profit.
Most hospitals are non-profit. It's not completely clear what the public gets in exchange of that $28 billion tax exemption.
johnebgd · 2h ago
Socialized hospitals have waiting lists while for profit hospitals have health insurance companies denying coverage. The problem is the demand outstrips the supply and you end up with some form of rationing of care, this is not a problem with profit motive.
toomuchtodo · 2h ago
So increase taxes and increase supply until it meets demand. You can still do this while prohibiting private ownership of medical systems and their underlying real estate.
Easy to say, very difficult to do. Public funding and the single-payer portion of the US health care system is responsible for the scarcity of doctors --- Medicare controls residency slots, and deliberately restricts them to prevent an oversupply of doctors. Medical systems around the world in every configuration have these problems in one form or another.
toomuchtodo · 1h ago
Certainly, I expect more of the UHC CEO’s outcome until the system moves towards success versus failure as long as the US for profit machine continues to squeeze the population for healthcare while public funding declines in the near term.
“We’ve tried nothing and we’re all out of options.” seems to be the equilibrium we keep arriving at, despite it being unsustainable.
I'm really not interested in attempts to mascotize the mentally ill guy who pointlessly shot someone to death on the street in Manhattan.
toomuchtodo · 59m ago
I'm not taking a moral perspective on it, I am saying cause->effect. If people run out of options in a failing, suboptimal system (which I'm unsure you can say the US healthcare system is anything but, based on the evidence), they will resort to the options that remain for recourse.
tptacek · 56m ago
The framing smuggles in a moral perspective. You have the cause wrong; the shooting wasn't a policy intervention, except as to how America handles mental health and gun ownership.
const_cast · 11m ago
It was a policy intervention in the sense that Americans have no choice in policy.
Your healthcare is entirely decided by people who are not your doctors. Every medicine you take, how long you go to the doctor, what surgeries you can get - your insurer unilaterally decides this. Not your doctor.
There's no voting system or merit system. You can't just simply find a better doctor - because your doctor is an empty vessel, they make no decisions. You have, legitimately, zero recourse.
Shooting someone is then very rational. We have made that one of the only choices, period. The insurance companies have all but guaranteed this outcome.
inetknght · 2h ago
> Socialized hospitals have waiting lists while for profit hospitals have health insurance companies denying coverage
For-profit hospitals have waiting lists too. I had to wait 6 weeks to see one doc, who referred me to another doc. I waited 3 weeks to see that, then was referred to yet another. Another 5 weeks to see the third, and another 5 weeks to see a fourth. Each time I have to take time and money out of my schedule to do this important runaround.
Give me that socialized healthcare please.
gdbsjjdn · 1h ago
The experience of "socialized hospitals" since the 1980s is also biased by the neoliberal push to cut everything to the bone and then justify privatization. The NHS and provincial healthcare in Canada are two examples where they've gotten less functional over the last 50 years on purpose because the government wants to push for a two-tier system with inferior care for poor people.
FirmwareBurner · 2h ago
>while for profit hospitals have health insurance companies denying coverage
At least you immediately get the treatment you need, in the case of the latter.
fisherjeff · 2h ago
Hmmm, I’m not sure my (very much for-profit) primary care provider is aware of this rule
FirmwareBurner · 1h ago
Care to elaborate?
fisherjeff · 1h ago
I’m lucky to schedule an appointment of any kind less than 8 weeks out, unless there’s a cancellation. Recently, it took me like six weeks to get an MRI to diagnose a broken pelvis.
I live in a rural area and there’s a hospital system here that owns basically all the providers - everything is all remarkably expensive and booked out way into the future. There’s a smaller independent provider that I recently looked into but they’re scheduling new patients out by more than a year!
tptacek · 35m ago
There are apparently more MRI machines in Pittsburgh than there are in all of Canada. Access to imaging is very definitely not a comparative weakness of the American system; most analysts would say part of our problem is we do way too much imaging.
fisherjeff · 18m ago
Agreed. MRI machines are not the bottleneck - we have 3 in my area, serving maybe 100k people. Assuming most people are like me and spend about an hour in an MRI machine every 40 years, we should be at something like 25% utilization, which seems comfortable.
FirmwareBurner · 1h ago
> Recently, it took me like six weeks to get an MRI to diagnose a broken pelvis.
Bruh, where I am in European socialized medicine land, six weeks wait for an MRI is rookie numbers. How about 6-12 months. Sure, you might die until you get your turn, but at least it's "free"*.
*) paid form everyone's taxes
const_cast · 9m ago
The US medical system is objectively bad, period. It's not even an argument so please stop trying.
Not only do we pay significantly more, but we have significantly worse health care outcomes. The hallucination and delusion that Americans get "good healthcare" because they pay so much is just not true. We, objectively, get worse healthcare.
fisherjeff · 1h ago
Six weeks is also very far from “immediate”
EDIT: Spot checking in a Canadian town with similar demographics as my own shows wait times roughly comparable to mine, and nothing anywhere near 6-12 months - worst case is about 14 weeks.
FirmwareBurner · 59m ago
I said I was form Europe, not Canada.
fisherjeff · 53m ago
Right. I still don’t think your original contention that for-profit systems are, in general, orders of magnitude better than socialized ones is accurate, but I do concede that your particular situation seems pretty bad.
EDIT: Just checked NHS too, most recent month had ~3% of MRIs waitlisted more than 13 weeks, so pretty similar in that European country as well.
tptacek · 2h ago
Why stop there? Should we have for-profit grocery stores?
gdbsjjdn · 1h ago
I can't tell how facetious this is, but food is a human right. The government running grocery stores in food deserts or to avoid predatory behaviour from chains exploiting poor people is totally reasonable. This is something cities in the US do.
tptacek · 1h ago
Who are you arguing with here? I asked if we should have for-profit grocery stores, not if we should have non-profit grocery stores.
hvb2 · 1h ago
Healthcare is a concept that few people wish to compromise on.
It's also an area that most people lack the background to make educated decisions for.
For a grocery store, you're talking about 'a commodity' with many suppliers all supplying an equivalent product. So changing grocery stores isn't a big deal.
So if one grocery store charges a fortune, you just go to a different one. For healthcare, how often do you visit a hospital and when you do, how much do you care about price since you cannot tell the difference in quality beforehand
tptacek · 1h ago
Price shopping for hospitals is very much a thing. Read up on surgical centers! Meanwhile: food is a much more fundamental human need than medical care is.
hvb2 · 1h ago
> Price shopping hospitals is a very much a thing
In the US, sure. Where else? Because it's so expensive that literally one admission can bankrupt you
Food is a more fundamental need. It's also available in many more places and easy to compare prices.
Say you need a knee replaced. And one place is 1000$ less expensive, that's where you go? Or do you now read reviews on the doctor etc etc.
When was the last time you read a review on a grocery store? The stakes are very different in cost and outcome
tptacek · 57m ago
It's ironic that you managed to pick a surgery that the US is actually capable of delivering at lower cost than Europe (generally, our procedure costs are integer multiples higher than Europe, because of the doctor cartel). Most Americans getting a knee replacement will "pay" more than Europeans pay (nominally, through their employer-provided health insurance), but price-shopping Americans can significantly outdo Europe by getting that procedure done at a surgical center.
hvb2 · 28m ago
Sure that wasn't the point.
Your point was that healthcare (for profit hospitals) and grocery stores are equivalent.
You've so far argued that they're not. Unless you also go price shopping for your groceries every time.
I don't know of anyone forgoing medical care they needed because of cost. People go deep in debt to pay for it. Most people go to a hospital because they want to get better not because they're looking for a bargain.
And finally, the people that get their healthcare through work probably don't have time/will to get quotes because it's not like that's straightforward
tptacek · 18m ago
That was not in fact my point.
mindslight · 1h ago
Please explain what exactly that would change about this situation.
The entire point is most of the surplus from the hospital is being extracted as real estate rent. The hospital itself doesn't need to post a profit in order for the overall scheme to be profitable for the perpetrators.
Furthermore as far as getting into this situation, administrators of a non-profit are just as capable of asset stripping to post good numbers in short term, and self-dealing to enrich themselves long term.
toast0 · 1h ago
The thing is, asset stripping is how failing companies finance continuing operations.
If you outlaw sale and lease back, businesses and hospitals will fail sooner, but with their real estate intact. At least until they figure out that they could move into a rental and sell their existing facility, but moving facilities is very expensive for hospitals, so they'll probably not be able to afford that.
For hospitals, especially rural hospitals, I think trying to run them for economic gain just doesn't work. They're expensive, they have obligations to provide expensive care without promise of payment in many cases. Municipal hospitals seem to make a lot of sense to me, although the same communities that are having trouble with hospitals failing would likely have trouble paying for a municipal hospital as well.
delusional · 1h ago
> For hospitals, especially rural hospitals, I think trying to run them for economic gain just doesn't work.
In current day America it doesn't seem like anything useful is compatible with making money. From the outside, it looks like you've entirely divorced money from common good.
It is possible to make hospitals profitable, but it requires you to take control over what sorts of things you wish to make a profit.
tptacek · 1h ago
You can just look to any well-run hospital chain to see organizations doing extremely valuable work lucratively. But many of the largest hospital chains are non-profit; in Chicago, Rush, Northwestern, UChicago, and Edwards-Elmhurst --- all of the largest chains --- are non-profit. Non-profit and rapidly expanding.
autobodie · 2h ago
Who cares how they would be written? They would never get passed. It's called capitalism for a reason - capital calls the shots. Why does nobody understand this?
kzrdude · 2h ago
So you mean that there is just one rule, capital calls the shots. Then why do we even have laws and regulation?
I think that every market needs regulation to work well. Different rules for different markets, but they need regulation to keep participants on relatively equal footing, for example to avoid cartels.
SimianSci · 2h ago
This is the thing I think alot of people dont understand.
Capitalism is not about people and their interests, its about capital, its perfectly willing to sacrifice social good, people's lives, etc. all in pursuit of Capital and its interests.
Until people start to wisen up to this, we will continue to hear stories of organizations doing clearly evil things to serve their bottom line.
The opioid crisis being caused by pharmaceudical companies in America being a clear example of this.
toomuchtodo · 3h ago
Medical Properties Trust
ck2 · 3h ago
Well that's now their second biggest problem
13 Million people about to lose insurance
and ACA premiums about to double so people will drop that too to buy food/rent
means America is returning to emergency-room as primary care with unpaid massive bills so many, many hospitals will close
We're basically going to ride this broken system into the ground
ie. bridges are never repaired in USA until they completely collapse
jaybrendansmith · 3h ago
Agree. If this was the movie studios, or the record industry, then this kind of creative destruction would be ok, but we are talking about regulatory arbitrage and financialization leading to a market failure, and in this case it is our health system. Traveling 50-75 miles to the nearest ER will most often just lead to death. This is perhaps the most basic service a modern economy can provide ... third world countries will have better options than many US citizens.
tptacek · 2h ago
Most Americans don't get insurance from ACA exchanges.
yuliyp · 1h ago
Right, but over 20 million people do. And those are generally less wealthy people for whom price increases would be quite a hardship.
tptacek · 1h ago
I'm just saying: that isn't the system driving into the ground. Even after this administration royally screws up the ACA, we'll still be in a better position than we were prior to the passage of the ACA.
jmyeet · 3h ago
The US spends far more per-capita on healthcare than other OECD nations [1] and has objectively less coverage and worse outcomes [2].
Buying up property then leasing it back is straight from the private equity playbook. It almost always ends badly. And it's driving up the cost of everything. Hospitals, vets, housing, etc.
At some point you have to realize that the only innovation under capitalism is building enclosures and rent-seeking.
Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours.
The US government, regardless of party, operates to transfer wealth from the young and poor to the old and wealthy, and the "old" part is on shaky ground. And it can't go on like this.
I think by 2100 we'll see a collapse of this system, the kind that ends in land reform, guillotines, nationalization and sovereign debt default.
>Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours.
It's less because China is a command economy (ie. the government determines the allocation of capital), and more to do with the fact that it's an authoritarian state where the local population and interest groups basically has zero ability to object/block construction projects.
jeroenhd · 1h ago
There are plenty of examples of invidiuals who do object. However, unlike in other countries, developers and the government are free to bully them and ruin their lives for daring not to sell their homes. Plenty of examples of houses in the middle of highways (one famously literally in the middle of the road), packed between huge flats, in the middle of active construction sites, placed on top of huge hills or pits when land height is altered, and other places where you'd never want to live.
That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree.
My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged.
The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.
jjice · 3h ago
Why do we spend so much and still have such a busted system? Is it that the money goes towards price gouged services, or Americans have bad preventative health practices? Other things? Likely a combination of a lot?
toast0 · 2h ago
We spend so much because mostly we're spending other people's money, and no party is really in a position where cost control is possible and beneficial.
The patient might prefer to pay less out of pocket, but they often aren't presented with cost information until a month after the service. Often nobody can tell you how much something costs before hand. Anyway, there is incentive to get more covered care, because insurance is paying for most of it.
Insurance companies are generally limited on administrative costs and profit to a % of medical costs. More costs allowd them to pay higher executive salaries and profits. Insurance companies do have a cost control function, but the incentive isn't there to do it well.
Individual practitioners and medicial facilities and facility groups have incentive to bill more things.
People paying for the insurance, which is often employers, do have cost control incentives, but things are pretty murky at that level.
Somewhere in all of those costs, we're paying for an army of billing specialists and an army of claims handlers.
Throwing out insurance and moving to billing at time of service would be terrible for access but it would make cost control a lot more possible. Single payer systems can make cost control possible too, if the single payer system is able to do analysis and effectively set policies to avoid things that are not cost effective, and curtail billing abuses... Of course, nobody likes it when cost control says the thing they want to do isn't cost effective and they can't do it.
QuadmasterXLII · 2h ago
We have a shitty universal healthcare system where the destitute get unlimited healthcare but only at emergency rooms, which is both extremely expensive and not that effective at making them healthy compared to e.g. regular primary care visits with free insulin and antipsychotics. The unpaid emergency rooms bills bring the hospital down and they have to take it out on the middle 50%
QuadmasterXLII · 1h ago
No money and diabetes? You can’t walk in to a Walgreens and get free no questions asked insulin, but you can absolutely pass out in a walgreens and get a ride to the hospital, diagnostics, and insulin (a $7000 value) and when a habit of this doesn’t keep your diabetes in check, they’ll do the amputation for you too ($50,000 a foot!)
votepaunchy · 3h ago
Yes, from what I have read it is that Americans pay for more for doctors, drugs, and services. And when attempts are made to begin to curtail these costs, the lobbyists swoop in and buy off our politicians.
victorbjorklund · 2h ago
Americans also consume a lot more healthcare than others. Yes, if you are poor and uninsured in US it sucks. But americans go way more to the doctor and wait less in time than in Europe.
theragra · 12m ago
Weirdly, my sister in the US with good insurance waits more then I do in my post Soviet country. Although I have insurance and money to skip the lines.
Still, I was surprised to hear how much she waits.
jmyeet · 3m ago
Yeah, um, citation needed.
As one counterexample, there is a statistically significant spike in cancer diagnoses in the US at age 65 [1]. Why? Because people are on Medicare then so they finally go see a doctor.
Another: the US is the worst for wait times [2].
The US has almost the lowest rate of annual doctor visits of any country, in large part due to lack of access and cost [3].
Sure, you wait less time per visit but you spend far more time overall on medical nonsense for worse outcomes. What is the point?
victorbjorklund · 1h ago
In Sweden we can wait 6 months for a doctors visit. My impression is americans expect same day visit.
const_cast · 4m ago
Okay, but you understand this isn't actually beneficial, right? Because American spend more, but Sweden has significantly better healthcare outcomes. So the American system is just worse, period.
Also: on the topic of same-day visits because I think there's some confusion here. American can, maybe, get same-day visits if and only if they have a PCP, which is increasingly rare.
Your PCP cannot do jack fucking shit. At best, they can swab your throat. Every type of condition management outside of Strep MUST go to a specialist. Your tummy been hurting a lot? That's a job for a gastroenterologist, not your PCP.
For specialists, it's not uncommon to wait many months or even a year. Especially because most insurance plans require a referral - so you have to see two doctors.
antisthenes · 46m ago
Extractive capitalism makes number go up. Bigger number better.
Why don't you think of the poor anesthesiologists, hospital admins and insurance execs?
Those yachts and 2nd vacation homes won't buy themselves.
In my opinion, as a lay person who reads the news, asset stripping seems to be a way of "hacking the system" - doing a series of things, individually permissible by the rules, to achieve personal gain at the cost of social harm. I think, we should forbid dumping negative externalities on people. But which step is the actual wrong?
Your wording strongly implies you think there's something shady going on, but what's the actual issue here? It's a private company, after all. Minus the concern of minority shareholders getting screwed over by the transaction, there isn't anything obviously intrinsically wrong with restructuring the ownership structure of a company you own. If a given company is only limping along because it owns real estate and pays $0 in rent, arguably the right thing to do is let the company fold - creative destruction and all that.
When the automobile was created it destroyed makers of buggy whips. When steam ships were created it destroyed sail makers.
What exactly was / is being created here? We're talking about asset transfers and shells games.
Of course, there's probably a reason why the business in question is faltering. Either it's being mismanaged, or the market conditions can't support the business any more. Letting it limp along might be the politically expedient thing, but it doesn't fix the underlying issue. Moreover, in the case of a market issue being the cause, not fixing it means there won't be competitors to take its place, which is basically a way to guarantee a "too big to fail" situation. To be clear, I'm not suggesting the area go without a hospital because the market conditions aren't right, it's that the government should fix the problem with rural hospitals (or whatever) rather than letting a bunch of zombie hospitals limp around.
People are quick to jump to free market reasoning because it's quick, easy, and requires little to no thought or nuance. But step number 1 is you have to prove said market is a free market. And, if it's not, you then have to prove forcing it to be a free market is not only possible, but beneficial for society as a whole.
Nobody does that though, because it's hard. So they just hope if they skip the most fundamental part of free market reasoning that nobody would notice. No, we notice.
But it probably just makes more sense to prevent the development of such wildly opposed incentives that necessitate that kind of highly detailed mediation. For example hospitals are public-facing institutions, they shouldn't be primarily operating out of rented buildings like some vape shop.
https://www.kff.org/health-costs/issue-brief/hospital-margin...
https://www.axios.com/2025/03/17/private-equity-health-care-...
“We’ve tried nothing and we’re all out of options.” seems to be the equilibrium we keep arriving at, despite it being unsustainable.
https://www.youtube.com/watch?v=AZhCYisIQB8
Your healthcare is entirely decided by people who are not your doctors. Every medicine you take, how long you go to the doctor, what surgeries you can get - your insurer unilaterally decides this. Not your doctor.
There's no voting system or merit system. You can't just simply find a better doctor - because your doctor is an empty vessel, they make no decisions. You have, legitimately, zero recourse.
Shooting someone is then very rational. We have made that one of the only choices, period. The insurance companies have all but guaranteed this outcome.
For-profit hospitals have waiting lists too. I had to wait 6 weeks to see one doc, who referred me to another doc. I waited 3 weeks to see that, then was referred to yet another. Another 5 weeks to see the third, and another 5 weeks to see a fourth. Each time I have to take time and money out of my schedule to do this important runaround.
Give me that socialized healthcare please.
At least you immediately get the treatment you need, in the case of the latter.
I live in a rural area and there’s a hospital system here that owns basically all the providers - everything is all remarkably expensive and booked out way into the future. There’s a smaller independent provider that I recently looked into but they’re scheduling new patients out by more than a year!
Bruh, where I am in European socialized medicine land, six weeks wait for an MRI is rookie numbers. How about 6-12 months. Sure, you might die until you get your turn, but at least it's "free"*.
*) paid form everyone's taxes
Not only do we pay significantly more, but we have significantly worse health care outcomes. The hallucination and delusion that Americans get "good healthcare" because they pay so much is just not true. We, objectively, get worse healthcare.
EDIT: Spot checking in a Canadian town with similar demographics as my own shows wait times roughly comparable to mine, and nothing anywhere near 6-12 months - worst case is about 14 weeks.
EDIT: Just checked NHS too, most recent month had ~3% of MRIs waitlisted more than 13 weeks, so pretty similar in that European country as well.
For a grocery store, you're talking about 'a commodity' with many suppliers all supplying an equivalent product. So changing grocery stores isn't a big deal.
So if one grocery store charges a fortune, you just go to a different one. For healthcare, how often do you visit a hospital and when you do, how much do you care about price since you cannot tell the difference in quality beforehand
In the US, sure. Where else? Because it's so expensive that literally one admission can bankrupt you
Food is a more fundamental need. It's also available in many more places and easy to compare prices.
Say you need a knee replaced. And one place is 1000$ less expensive, that's where you go? Or do you now read reviews on the doctor etc etc.
When was the last time you read a review on a grocery store? The stakes are very different in cost and outcome
You've so far argued that they're not. Unless you also go price shopping for your groceries every time.
I don't know of anyone forgoing medical care they needed because of cost. People go deep in debt to pay for it. Most people go to a hospital because they want to get better not because they're looking for a bargain.
And finally, the people that get their healthcare through work probably don't have time/will to get quotes because it's not like that's straightforward
The entire point is most of the surplus from the hospital is being extracted as real estate rent. The hospital itself doesn't need to post a profit in order for the overall scheme to be profitable for the perpetrators.
Furthermore as far as getting into this situation, administrators of a non-profit are just as capable of asset stripping to post good numbers in short term, and self-dealing to enrich themselves long term.
If you outlaw sale and lease back, businesses and hospitals will fail sooner, but with their real estate intact. At least until they figure out that they could move into a rental and sell their existing facility, but moving facilities is very expensive for hospitals, so they'll probably not be able to afford that.
For hospitals, especially rural hospitals, I think trying to run them for economic gain just doesn't work. They're expensive, they have obligations to provide expensive care without promise of payment in many cases. Municipal hospitals seem to make a lot of sense to me, although the same communities that are having trouble with hospitals failing would likely have trouble paying for a municipal hospital as well.
In current day America it doesn't seem like anything useful is compatible with making money. From the outside, it looks like you've entirely divorced money from common good.
It is possible to make hospitals profitable, but it requires you to take control over what sorts of things you wish to make a profit.
I think that every market needs regulation to work well. Different rules for different markets, but they need regulation to keep participants on relatively equal footing, for example to avoid cartels.
13 Million people about to lose insurance
and ACA premiums about to double so people will drop that too to buy food/rent
means America is returning to emergency-room as primary care with unpaid massive bills so many, many hospitals will close
We're basically going to ride this broken system into the ground
ie. bridges are never repaired in USA until they completely collapse
Buying up property then leasing it back is straight from the private equity playbook. It almost always ends badly. And it's driving up the cost of everything. Hospitals, vets, housing, etc.
At some point you have to realize that the only innovation under capitalism is building enclosures and rent-seeking.
Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours.
The US government, regardless of party, operates to transfer wealth from the young and poor to the old and wealthy, and the "old" part is on shaky ground. And it can't go on like this.
I think by 2100 we'll see a collapse of this system, the kind that ends in land reform, guillotines, nationalization and sovereign debt default.
[1]: https://www.healthsystemtracker.org/chart-collection/health-...
[2]: https://www.commonwealthfund.org/publications/issue-briefs/2...
It's less because China is a command economy (ie. the government determines the allocation of capital), and more to do with the fact that it's an authoritarian state where the local population and interest groups basically has zero ability to object/block construction projects.
That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree.
My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged.
The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.
The patient might prefer to pay less out of pocket, but they often aren't presented with cost information until a month after the service. Often nobody can tell you how much something costs before hand. Anyway, there is incentive to get more covered care, because insurance is paying for most of it.
Insurance companies are generally limited on administrative costs and profit to a % of medical costs. More costs allowd them to pay higher executive salaries and profits. Insurance companies do have a cost control function, but the incentive isn't there to do it well.
Individual practitioners and medicial facilities and facility groups have incentive to bill more things.
People paying for the insurance, which is often employers, do have cost control incentives, but things are pretty murky at that level.
Somewhere in all of those costs, we're paying for an army of billing specialists and an army of claims handlers.
Throwing out insurance and moving to billing at time of service would be terrible for access but it would make cost control a lot more possible. Single payer systems can make cost control possible too, if the single payer system is able to do analysis and effectively set policies to avoid things that are not cost effective, and curtail billing abuses... Of course, nobody likes it when cost control says the thing they want to do isn't cost effective and they can't do it.
As one counterexample, there is a statistically significant spike in cancer diagnoses in the US at age 65 [1]. Why? Because people are on Medicare then so they finally go see a doctor.
Another: the US is the worst for wait times [2].
The US has almost the lowest rate of annual doctor visits of any country, in large part due to lack of access and cost [3].
[1]: https://med.stanford.edu/news/all-news/2021/03/Cancer-diagno...
[2]: https://worldpopulationreview.com/country-rankings/health-ca...
[3]: https://www.visualcapitalist.com/ranked-how-often-people-go-...
Also: on the topic of same-day visits because I think there's some confusion here. American can, maybe, get same-day visits if and only if they have a PCP, which is increasingly rare.
Your PCP cannot do jack fucking shit. At best, they can swab your throat. Every type of condition management outside of Strep MUST go to a specialist. Your tummy been hurting a lot? That's a job for a gastroenterologist, not your PCP.
For specialists, it's not uncommon to wait many months or even a year. Especially because most insurance plans require a referral - so you have to see two doctors.
Why don't you think of the poor anesthesiologists, hospital admins and insurance execs?
Those yachts and 2nd vacation homes won't buy themselves.