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Ah, but deaths…
Go up too. https://hms.harvard.edu/news/deaths-rose-emergency-rooms-aft...
Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person.
While I agree that what you call "statistical murder" needs to be handled differently, I see problems with doing so that need to be solved. Namely, what counts?
Your example of statistical murder is prioritization can be abstracted as profit over life. A first thought might be to condemn any prioritization of anything over life, but this leads to likely unwanted consequences: it is illegal to drive, ever; it is illegal to feed someone food that is not of the optimal health for their particular situation, ever; it is illegal to sell a product, even used, that California has determined a carcinogen. All of these are related to leading causes of death: traffic accidents, low quality food causing obesity and its myriad of consequences, and cancer. We could use improvement in all of these cases, but such absolute bans go too far.
So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder?
So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder?
If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it.
> Life-or-death care almost certainly needs to be a government-run, single-payer system.
> If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it.
Why do you think a government would choose to cover an additional kid’s cancer medications rather than an additional luxury for government workers? You’re placing a ton of faith in governments.
At least with private companies there is choice (normally). And private companies do not directly wield government power (normally).
We have that in canada and it does not work that way at all. Single payer turns into a big en(ugh line item that there is political "otivation to limit supply and it all goes to crap just in a different way than it has in america. The solution is way simpler: ensuring there is enough supply that price raising bs fails. That gives you a bunch of different ways to get to the solution that will all work vut they all have ensuring enough supply to limit shenanigans at their base.
> Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person.
Society is actually quite consistent on that point (unfortunately). The body doing the statistical murder here is the regulator of the hospital system and it is part of the same organisation (the government) that handles the direct murder through the army. People tend to treat horrible missteps in war and medicine about the same.
It might be nice in a moral sense if there was some consistency. It isn't too late to disgrace George Bush and make the rest of his days a living hell, for example. But as political strategies go that seems like a bad idea.
It's the beauty of a commercial system, no? Businesses have a duty to make a profit for their shareholders first, second to their clients (keeping their customers happy), and no obligation to the wider society, other than following regulation.
If a private hospital figures out that by jacking prices up by 50% they make more profit, keep their fewer customers happier (not even necessarily more alive!) and treat less people, they are 100% following their mission as a private business.
A European PoV might be that you can counterbalance a private system with a public system, whose goals are explicitly to keep the society healthy and help as many people as possible. The NHS, admittedly not the gold standard for anything good recently, optimises for maximising "quality-adjusted life expectancy improvement" over the whole society.
It's not a metric you could ever replicate with private businesses.
> Businesses have a duty to make a profit for their shareholders first […]
[citation needed]
This idea gets bandied about, but it is only one way of thinking that happened to gain popularity in a certain (recent) time period:
* https://en.wikipedia.org/wiki/Friedman_doctrine
* https://en.wikipedia.org/wiki/Shareholder_primacy
There are others:
* https://en.wikipedia.org/wiki/Stakeholder_theory
There is no legal duty/requirement to do so:
* https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2277141
* https://rpc.cfainstitute.org/research/multimedia/2013/the-sh...
* https://skeptics.stackexchange.com/questions/8146/are-u-s-co...
Also: shareholders are not the owners of company.
These are two distinct issues.
The study you linked concerns whether the hospital is owned by a nonprofit or by a private equity group.
The question in this study is whether physicians work for their own practice or for the hospital directly, regardless of the ownership of the hospital.
This issue is much more linked than you think, because its a strategy to upcode to have external practice groups.
Your assertion runs counter to the original article, which says that acquiring external practice groups raises prices.
That article isn’t about hospitals acquiring practices, it is about private equity acquiring hospitals. There is sometimes a relation, but not always.
Interesting. The cost to save a human life is about $4k. Anyone with $4m then is a statistical murderer. Acting to enrich themselves over saving these 1000 lives. Fascinating. Donations to the Rust Foundation have statistically killed thousands. By setting up the Rust Foundation I wonder how many have been murdered statistically.
I think you mean murder via diffusion of responsibility is good for business. Its like the trolley problem, but instead of one lever thete a chain of them and at least one of them is the final one, any number of them are like tumblers in a lock.
Counting in people rather than people-days is problematic, and then you get to qol-people-days. Saying murder is not helpful; see how folks have responded to you.
There is no such thing as "statistical murder". No crime was committed here. I don't like health chain consolidation either, but words mean things.
Ford Pintos exploded way to easily. Ford chose not to fix it because it would cost them $11 per car. It was later revealed that Ford presented flawed data and bad math to hide even cheaper options to fix the Pinto.
In the modern world people can choose obvious evil choices because it makes them money, but because the damage is spread across the entire world and only slightly makes peoples lives worse it is ignored. Our laws are setup for a world like this. But there needs to be then same sort of legal incentives to keep people in line at this scale. Where if your choice results in one million human years wasted/made worse, society sure a shit is going to punish you hard because it benefits society to not waste one million human years.
> There is no such thing as "statistical murder".
Sure there is.
Denying categories of potentially life-saving treatments due to provincial laws causing hospitals to value legal considerations over medical decisions is one example.
Perhaps the phrase "statistical manslaughter" is a better description however.
Varying degrees of negligence? Drink a lot and drive, your chance of homicide goes up.
I hate the US healthcare system but I don't support using the word murder in this context. Murder is very very different from trying to help a person but being greedy while doing it.
I think murder is an appropriate term. There is a long history of company leadership making decisions that they know will lead to the death of thousands of people. See tobacco, opiates, leaded gas and many others. And they are not trying to help people while being greedy but they are only greedy without being motivated to help people.
> trying to help a person but being greedy while doing it.
The doctors are trying to help people, the execs are being greedy while doing it. Leadership doesn’t get the benefit of the doubt at this point.
But it’s not “a person”. It’s millions of them.
Yes, it's much worse.
Australian here.
It's always astounding that no-one in the US mentions the elephant pooping in the living room - that the US spends more tax dollars than Australia and IIRC the UK, and Canada.
Per capita, or as a % of anything reasonable. The US is such bad value that Medicare and Medicaidel, VA, as well as othe government programs cost IIRC more than Canada's system. And Canada has a huge area with poor economies of scale.
Republicans don't want to admit that they're taxing as hard as the French (for healthcare), Democrats don't want to lose the gold plated Medicare system that old people vote for, and literally everyone from nurses to band aid makers to doctors to healthcare CEOs makes more than in other countries.
Maybe I have missed something, but universal single payer healthcare (especially with a hybrid system like Ausralia) seems cheaper than what the US does.
The confusion likely comes from assuming that the U.S. is targeting “cheaper cost of care” as a goal. The target here is “profit for business”. Usually that’s done by businesses withholding wage increases over decades, but occasionally some regulation is canceled or some private capture opportunity is found that jumps profits and prices rapidly. Australian healthcare generates a lower share of private business profit, both per AUD spent on healthcare and per total AUD spent, and so is seen as inferior to the U.S. model by our leaders.
Seen in that light, the increased prices are a universal winner for us: profits go up -> inflation goes up -> GDP goes up. Wages do not go up, and so as a whole we’ve surpassed 25% of all households unable to afford a one-bedroom home. Economists are taught to only model inflation in terms of price level: inflation = profit increases + wage increases, with no way to model their separate impacts. So our policies are economically sound, as long as one disregards the growing poverty.
Despair is, as Demotivators reminds us, highly profitable :-(™
It's basically about racism and control. One of the key reasons the US didn't get universal healthcare in the Social Security Act of 1935(!) was because FDR relied on Southern Democrats who thought it was a threat to segregation. That culture is still very much alive.
Conservatives in the US see the world as a power hierarchy and their most important job is to uphold it, like they are princes next in line to be King. See how hard they fight China and cut social services to funnel money up to billionaires. They will literally die for it.
Their inheritable privilege dies forever if they don’t fight to uphold it, and the one rule of all landed gentry is never to jeopardize the family’s privileges, under penalty of disinheritance and expulsion.
The primary reason that this happens is that medical billing and patient management systems are so complicated that it's cheaper for private practices to outsource this to a hospital that already has a contract with Epic or similar extractive vendors.
If the US had a simpler billing/insurance system (or these extractive middlemen were removed entirely), this wouldn't be happening to the same extent.
Yes, this.
If you’re interested in solving this, check out Camber. They’re building what is essentially Stripe for small clinics.
Higher collections rate + faster time to money = clinics can focus on providing care. Very cool problem!
https://www.camber.health/about
I think that is hands down, the worst website i've visited in my life. No hyperbole.
Everybody needs healthcare. It’s a clear win for society if private actors can’t make it more inefficient by parasitizing a profit. The answer is single payer on the dime of the rentier capitalists. That’s how you reinvest in your society, not crypto and secret police.
Everybody also needs food. Should the government also pay for everyone's food?
You don't need single payer. There are plenty of examples of working health systems in developed countries that don't rely on single payer. You just need some regulations that ensure that the system works mainly for patients and not for shareholders.
The US has reached an almost comical level of insanity and blatant inefficiencies but somehow there is no political will to address anything. Even the current fight over the ACA subsidies is basically about throwing even more money into the fire without addressing any structural issues.
> doctors are rather good at providing care across corporate boundaries
I’ve found that to not be universally true. I say that as someone with eight different health systems in MyChart and who has been treated by two additional hospitals who don’t use MyChart in the past year.
Some systems are very competent about sharing across borders and good at it. I’m lucky my primary hospital is one of those. Others are god awful at it and take multiple calls to get them to even fax records.
Ironically, there are two nationwide networks for sharing patient data - CareEverywhere and Carequality. They even have a bridge between the two, so in effect it's one large network.
But that's all predicated on the provider's EHR being able to talk to it, or at least talk to an interface engine that can be configured to talk to it. And money. It costs money.
Every modern EHR supports those nationwide networks. Many provider organizations have been too lazy to set it up or train their users.
Local regional hospitals and air ambulance companies are being bought up by private equity. And, surprise surprise, privately-owned regional hospitals are cutting critical care specialty services and so air ambulance life flights have increased 900%. I expect mortality has increased too logically because of delays in care.
The Air-Ambulance Vultures (2022) https://archive.ph/2TYGj
Air ambulances, backed by private equity firms, leave patients with $45,000 bills (2018) https://www.latimes.com/business/la-fi-air-ambulance-cost-20...
Not for nothing though, and not defending PE... or insurers (UHC denying air ambulance for serious MVA trauma due to "lack of pre-auth")... but most air ambulance companies have fairly cheap "membership":
Airlift NW has a $60/year membership for families that will bill your insurance, and consider what they get from insurance as payment-in-full (https://www.uwmedicine.org/airliftnw/membership). Many also have reciprocal programs in other areas.
Most of the private practices in my town have been bought out by the local hospital system as the older partners are unable to find anyone to become junior partners as the overhead costs have doubled since Covid. The only way to meet overhead is to have the hospital buy the practice as they can charge 2x to 10x for the same visits. It is a backdoor way to socialized medicine.
It takes the great minds at yale to figure these things out
It's also worth pointing out precisely who owns these hospital systems.
Most hospitals in the US are nonprofits
Nobody has ever said private is less wastefull than public?
Moot. When private equity and conglomerates get involved, operational concerns like waste and quality of service no longer matter. The only thing that matters is making money.
Data vs. feels
Costs go up on paper because now they need to charge people more while pretending they are starving. Costs in all other industries go down with mergers.
Less competition usually means higher prices and inferior service.
Imagine if every restaurant went to being owned by McDonald’s, and the reason we’re told for it is “credit card payment systems are so complicated!”