Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, personal anecdotes are allowed as responses to this comment. Any anecdotal comments elsewhere in the discussion will be removed and our normal comment rules apply to all other comments.
Do you have an academic degree? We can verify your credentials in order to assign user flair indicating your area of expertise. Click here to apply.
Hospitals used to be predominantly nonprofit and charitable, evolving from religious/community origins focused on care for the poor, but the landscape shifted significantly from the late 20th century with the rise of for-profit models, government funding, and corporatization, though nonprofits remain the majority in the U.S., now balancing community needs with financial viability, a change marked by the 1973 HMO Act opening doors for for-profit insurers and shifting focus from pure service to commercial product.
Which is sort of the story of nearly every facet of our lives. The deregulation started by Reagan and continued by Clinton has lead to massive consolidation of almost everything. CEO pay up 1000% since the late 70s while everyone else gets lower wages, worse service, worse products at ever increasing prices.
People (especially on the right) say they love capitalism so much, but we basically have no competition in any economic sector anymore. Just the first few that come to mind:
Hospitals/medical - can't see the price and many times you don't have a choice anyway
Grocery stores - controlled by a few companies that agree not to open stores near each other
Internet - controlled by a few companies that agree not to compete in each others' areas
Banks - overwhelmingly controlled by large banks that got bailouts from the government
Housing - a lot controlled by private equity, and they collude on rent prices using RealPage
The corporate merger era has enriched the wealthiest at the expense of everyone else. Our economic system now discourages innovation and competition.
I have to disagree a bit on the bank side at least - there's tons of smaller regional banks and credit unions with significantly better customer service and consumer-friendly policies.
I genuinely don't know why so many people keep using the larger ones when there's no real barriers to using smaller ones and switching is usually easy - unlike the other things you listed.
Except there often barriers. Smaller banks don't have as many branches (which does matter to some people). My wife for example likes Chase because they are huge and have branches literally everywhere! Does she actually do anything with these branches outside of using their ATMs because they don't charge her a fee there? No. Does it matter that I explain a lot of other banks will pay the fee for you no matter what ATM you use? No.
Now there are some legitimate excuses like wanting everything under one name. This is especially true with like business accounts. Not all small banks or credit unions can absorb the swings in equity that stuff like payroll or large expenditures will cause.
And online only banks, like USAA (which you don't need to be a service member to join anymore), actually refund ATM fees at the end of the month. (it used to be unlimited fee refunds, but now it's just a few).
I've even used my USAA debit card at international ATMs (Europe, Australia, and Central America) with no issues.
which you don't need to be a service member to join anymore
Where do you get that?
USAA Membership is open to active duty, National Guard, reserves, veterans who served honorably, Cadets or Midshipmen and employees of certain Federal agencies, as well as, spouses and children of USAA members.
Large Banks are indispensable when traveling abroad. Specifically Citi gives me not only free ATM, but also the best conversion rates hands down. Add this to using USD Hard Currency in most local transactions in S. America gives an extra bonus. It can't be beat.
That being said, I use Unions almost exclusively in the US.
When I switched from Capital One over to Chase, a lot of weird stuff started to happen related to my credit. I think they have more juice behind the scenes with banks and credit and so stuff shifts and moves faster with Chase vs smaller banks. I'd love to move over to a Credit Union however I would be curious how they handle international debit/credit purchases as well as identity theft and fraud. I became a flight attendant and it took months for me to reach the right person at Chase to stop locking my account overseas on layovers. Now it's not an issue but it was in the beginning. Work a Brussels Trip? Card locks up. Today it's fine. But I just know things seemed to move much smoother since moving my stuff to Chase.
I don't travel internationally often, but at least so far, the VISA card I've used through my local regional bank (FNBO) has never had many issues. Even when I forget to tell them I'm traveling internationally, most of the time it doesn't get flagged. And I haven't had an issue of the card being compromised in... well, I don't remember. At least 8+ years. I almost always use tap-to-pay through phone though these days if I'm not using cash.
I was wondering where anti-monopoly competition went. Ty for the list. No idea how we can make this better. I think I'll die before I ever help the world become a better place. (Sigh)
Not sure about grocery stores competing on locations but in my experience (not being in top rural of an area) most towns have 2-3 major grocery stores competing with one another and grocery prices relative to inflation are overall down quite a bit historically speaking (though maybe not the past few years). I realize some of this is economies of scale and improved efficiency for yield in farming and the like, but are groceries specifically overpriced compared to where they would be if there was more competition, or is the market still fairly competitive overall? I'd think it's competitive, but curious as to any data to the contrary
The older I get the less I like him. One good thing is that we balanced the budget under Clinton so we can point to that vs Republican's ridiculous spending sprees.
I don’t disagree with any of your comment, but please explain to me what “nonprofit” really means in the health industry?
Large hospital systems make Billions annually… intermountain health made 17b in revenue in 2024 and paid their ceo 7+ m. How do you even justify that as a nonprofit?! The people at the very top are certainly making huge profit.
Intermountain health is not a nonprofit, it is a not-for-profit corporation. Being a not-for-profit organization just means any profits must be reinvested in the organization. They can't distribute profits to owners or shareholders or anything like that, but nothing says they're not allowed to pay their CEO an absurd salary.
I've gotten 1% for the past two years, which is great compared to my last company which gave me nothing at all unless I threatened to leave with a counteroffer in hand.
The very first sentence of the Federal Reserve website's article on "What is Inflation" is,
Inflation is the increase in the prices of goods and services over time.
Yes. This is over-simplified - I do realize. But when the majority of price increases are to satisfy percentage based year-on demands of a relatively small group of people, then it gets to the heart of it.
This is what is ruining the system. The issue is that insurance companies are squeezing (basically stealing from) both sides. Patients pay higher premiums, deductibles, and copays, yet coverage keeps shrinking, so insurance only really helps once you’ve hit your out-of-pocket max. It’s become catastrophic coverage, not real healthcare.
On the other side, doctors and hospitals get reimbursed less every year for the same care, so they’re stuck trying to collect larger balances from patients who can’t afford them. Patients delay care, conditions get worse, treatment gets more expensive, and the cycle keeps repeating.
Costs go up, coverage goes down, hospitals struggle, patients suffer (and insurance companies post record profits). Hard not to see who the system is designed to benefit.
Don’t forget that on top of costing more. You are also getting less. Because capitalism and health insurance companies and their CEOs and shareholders are entitled to constantly increasing returns.
I asked for a raise a second time in 3 1/2 years this year and they told me it may take up to a year for them to get back to me. I really couldn’t go elsewhere and make more because I make good overtime but my company is just taking advantage of me. I’m the longest hourly worker at my company and they won’t give me a $1 raise. The first time I asked for a raise they offered me salary and it was $1000 a month less than what I make hourly. It was a slap in the face.
The hospitals themselves provide good and have innovation and productivity but the management and insurance providers who prioritize increasing client payments and decreasing costs even when it means cutting care are rent seeking.
Maybe it’s more accurate to say that I don’t agree with how many people interpret Marx’s policy. Too often people treat economic policy as an all or nothing conversation. You can either be capitalist or socialist, but not both. Whereas I honestly think if you read Adam Smith, and then you read Marx, it’s pretty easy to conclude that in order to have healthy capitalist* markets one needs a fairly powerful
(democratically run) socialist* state (I have very particular constrained definitions of each in my own head that I feel that many other people don’t necessarily agree with and that’s fair). What I very deliberately am not saying is that the state must own all means of production. Nor do I believe that all means of production being in private ownership is correct. I think ownership at the end of the day is a belief that we are all having to adjudicate amongst ourselves. I think a lot of economics is more religious than people would prefer to admit to themselves. There are many ways that intellectual property ownership is a form of violence inflicted on the poor by the rich (is a statement that I believe is very true, but that many people will get real uptight about).
The insurance companies have to pay out a percentage of premiums, by law. Conversely, you can imagine that also means their profits are therefore capped as a percentage of premiums. They are also in charge of negotiating prices with healthcare providers and drug companies, which set those premiums. I'm thinking they may not be trying their hardest to keep costs under control, since they are actively incentivized to keep prices going up. The only reason they don't instantly go to infinity is some downward pressure since they can't be vastly more expensive than their competitors... But that's only some pressure since your employer has likely already locked into a provider for a multi year term and you can't really cross shop as an individual. So premiums will continue to slowly creep up as everyone involved profits from it. The government is about the only entity pushing to lower costs.
Hey, don't blame the Mafia. If the Mafia/Mob/Yakuza, or any underground organized crime syndicate ran the system it'd probably work better and be more affordable. They did direct trade work with doctors to get their boys patched up when needed and no one complained.
I've always said the MBA's should be locked in the basement and given no power. Just crunch numbers that we tell you to. Let the competent ones make the choices.
Even the Mafia has rules where you can't openly kill children and women in the streets. The US healthcare industry should look up to the Mafia as mentors.
This is why driving up revenue and driving down costs should not be the thing to optimize on in medicine. It should be patient outcomes, and doctors and medical groups should have flexibility to operate within that mandate.
That is actually the model being adopted currently especially with Medicare plans. Hospital systems will accept part of the risk which incentivizes them to have better outcomes. I know my hospital system is heavily doing this over the last 5+ years.
Who? All those Obama voters? The Trump voters? The Reagan and Clinton(s) and Bush(es) voters? All of them contributed to this problem, and I'm not even sure Trump is the worst. There is no Democrat coming to help on this issue. They are very visibly captured by the same exact money.
That I had to pluralize two names in this short list is also part of the problem.
On the one hand, the US has the strongest military in the world by a significant margin. On the other hand, the US is burning down its soft power like it's going out of style. Neither of those have anything to do with our health insurance system.
Good thing like 15 years ago we as a country didn’t pass a republican drafted, democrat led bill that forced people to purchase private insurance and subsidize private plans with public money thus lining the pockets of insurance companies even more and not changing the incentive structure at all.
Health insurance, rent/housing, college tuition, and the GDP have all grown faster than the average wages since the 80s.
This means corporations make record profits each year on the backs of their underpaid employees.
Reagan destroyed the quality of life for the majority of this country the day he scammed us into trickle down economics.
Corporations are happy to soak up all the extra profit from not paying taxes and double dipping by not increasing wages.
A friend of mine works for a hospital that is chronically understaffed so all the nurses are overworked. Often they are forced to stay past their shift because of legal quotas for nurses per patient. This year she got a whopping $2 raise. The "budget is really tight."
The president/CEO (I've seen it referred to as both) of the hospital got a $2million+ bonus. A bonus... like on top of their regular salary.
Meanwhile, my friend is actively telling me not to go to the hospital she works at because everyone is fried beyond belief. They keep losing nurses because of the conditions so it's all new nurses who don't have a lot of seasoned nurses left to teach them.
Regulatory bodies have made it essentially impossible for Physicians to lead healthcare practices and physician own hospitals are all but gone. This allowed private equity and massive corporations to buy out so much of the healthcare that you’ll go to cities where basically all the clinics are owned by one massive hospital system.
The few physician owned practices I’ve been to give out so much free care and advocate for their patients even when financial incentives aren’t there, versus when they have MBA overseers they don’t have all the wiggle room since the advocacy can be seen as biting into the bottom line.
Doctor here: That wiggle room is often viewed as "theft" by the MBA overseers. Example - I wanted to give a patient a flutter valve (like $15 device). At a previous institution that was very much non-profit no one would blink. At my current institution, I could be fired (or worse) if it isn't billed for.
I’ll be the first to say that doctors are not great businesspeople. A hospital is a very complex beast; hell, even a sufficiently large clinic is tough to run effectively. There needs to be people in place that can actually make sure the lights stay on and the business side doesn’t completely go off the rails — a hospital not making money is just going to close.
That said, the above is taken too far in today’s world. Businesspeople are not just assisting doctors in running the operation, they are in positions where they don’t even need to interact with the medicine. Most times doctors have multiple levels to go through before being at the decision making level. It should be the other way around, doctors saying what the hospital needs from a medicine standpoint, with money guys on the sidelines making sure the doctors keep a business minded reality check.
I think about it as architects and engineers. Maybe an architect doesn’t always think of the ability to actually do when they design; they need the engineer to make sure it works at the end of the day by bringing Talati into the picture. Doctors need businessmen; but doctors need to be the deciding people at the top.
Doctors need business people to do the business stuff, not tell them what to do with regard to patient care. And yet that’s exactly what’s happening, these suits have nothing but their greed bringing them into hospitals and healthcare, they should be at the bottom of the totem pole with regard to authority in hospitals and their salaries should reflect that reality.
The simple fact that hospitals closely guard procedure costs like some sort of holy Grail is simply an anti consumer price fixing scheme that simultaneously prevents consumer choice, cost inflation, and cost outlier investigatons. And before someone tells me "well states passed open pricing laws..." Yeah my state did too and it's ineffective. I can't shop anywhere because the data is obfuscated beyond usefulness.
It's scary as all hell not knowing whether you're going to owe 10 dollars or 10,000 dollars before going to the hospital. I'm personally putting off a major quality of life surgery because I genuinely do not know if I can afford it, and the only way to find out the price is to have the surgery and get the bill. Until then, insurance won't tell me if they will actually cover the surgery and hospitals won't tell me the out of pocket price.
Medical pricing being a game of Russian Roulette has major negative impacts.
Right, it's a fucked up system. But part of that isn't just the hospital, it's what insurance will cover and the insurance company and hospital should be able to talk to one another and be able to communicate this to patients.
The USPS (United States Postal Service) is exclusively funded by charging their customers for the services it provides, they receive no tax dollars for operational costs. Conservatives have been trying to privatize it for decades, and it's frankly a miracle they haven't succeeded yet.
It's all about the incentive, not the knowledge. A person knowledgeable about business working for a public institution at a set salary will do what the job outlines, one who gets a bigger paycheck based on profit will care about nothing besides increasing their cut.
doctors saying what the hospital needs from a medicine standpoint, with money guys on the sidelines making sure the doctors keep a business minded reality check.
Or we could just subsidize Healthcare? Prioritize it as a society like many properly developed countries already do? The profit incentive does not belong in medicine since healthcare is something for which we have inelastic demand.
You’re thinking of a business in the sense of making profit. The critical thing to see it as something that is sustainable.
Anything you just dump money into without any thought about running effectively is bound to fail. At the end of the day, everything costs money to run, be it a store or a hospital. The money might come from private companies or the government, but there is a limited pot per any particular facility.
A hospital that is run without even thinking about the money is going to find itself too costly and when the money runs out so goes the hospital. Sometimes it really is a situation where you can’t keep pouring money because there is no money to pour.
People think the covenant has infinite money. Maybe when you look at it from a super macro view. But when it comes to the individual hospital, even if they were government run, they can’t operate infinite hospitals. Each one needs to be cost efficient for the system to work.
A hospital that is run without even thinking about the money is going to find itself too costly and when the money runs out so goes the hospital.
It's more personal choice to avoid certain hospitals, and Tennessee is a case to see on hospital closures. But one thing on rural hospitals is that they don't have what rural patients want.
In 2017 Tennessee experienced 16 hospital closures, with 13 of those being rural, since 2010 — the second highest rate in the United States.
Haywood Park Community Hospital, the only hospital in Jackson county, shut down its inpatient and emergency room services on July 31, 2014 and converted the 62-bed hospital into an urgent care clinic.
According to a release from the hospital, inpatient admissions had dropped from 1300 in 2009 to less than 250 in 2013. The Emergency Room had also experienced a sharp decline and was averaging 15 or fewer patients per day.
For years, Haywood Park had been hemorrhaging patients and money. It had been years since an obstetrician was on staff, so babies were no longer being delivered. And as treatment for heart attacks, strokes and other life-threatening ailments had become more sophisticated, the hospital had become accustomed to stabilizing patients, then sending them by ambulance for more specialized care at Jackson-Madison County General Hospital, nearly 30 miles away. Eventually, more and more patients decided to skip the first stop and head directly to Jackson.
When people see hospitals get old and not equipped compared to nearby hospitals they go else where. And Rural hospitals are there already
Declining inpatient volume, falling reimbursement rates and failure to bring in enough revenue make rural hospitals the most vulnerable to closure as demonstrated by the most recent string of closure announcements.
Methodist Healthcare announced its hospital, Methodist Fayette Hospital would close March 2015. The hospital has been averaging a daily inpatient census of approximately one patient, which was down from 2010 when the average daily census was 5.1. In a press release Gary Shorb, CEO for Methodist Healthcare, cited the low census as simply not sustainable.
Fayette residents were choosing to drive to a larger hospital rather than go to Methodist Fayette.
In 2004, North Sunflower Medical Center was on the verge of collapse. It averaged 120 people a month in 2004 and the rooms were old, ceilings were crumbling and the technology was outdated. But it serves as a lifeline in a county where nearly 40% of residents are living in poverty.
And it had even less cash
Only enough to operate for eight hours.
Hospital administrators met every afternoon to see if they’d be able to open the doors the next day.
The staff had to cover the lab equipment when it rained because the roof leaked.
Nurses would clock out early and then stay to finish their shifts.
To become profitable and not close down North Sunflower Medical Center changed. Renovating the hospital itself was a must do. But it also had to find new ways to stay open. Rural Medical Centers have to be more than just hospitals, moving to operating Auxiliary Businesses.
Creating an Urgent Care Clinic, and putting it in a location to be closer to people began generating a Cash Flow
Opening a hospice,
Operating Pharmacy
Durable medical equipment facility that sells items such as wheelchairs, back and knee braces
Along with all big changes, the hospital developed extensive marketing campaigns– on billboards and bumper stickers, wrapped around its shuttle vans, in TV advertisements and YouTube videos.
Many area residents started coming, not realizing it had existed for years before.
But now this leads to the same problem North Sunflower Medical Center was facing Now, they travel miles to see doctors there, bypassing closer hospitals along the way.
They absolutely need to be run like a business, just not with profit as the driver. If you don't you'll get awful results as business operations and accounting are still needed.
isn't that the definition of a business to make a profit. That's what they mean not to run it like a business meaning not to optimize profits but to maintain and manage the costs of running and optimizing the service.
Running something "like a business" doesn't mean "maximize profits at all costs". Especially a non-profit, where margins are generally very thin and and it's a lot easier to run things into the ground with a couple of bad financial decisions.
By it's very definition, business is "any activity or enterprise entered into for profit".
What you're looking for is proper administration. You don't necessarily need a finance degree to allocate funds, balance budgets, and make sure operations run smoothly. What you do need is a deep understanding of the organization and the ability to increase efficiency for better outcomes, not profitability.
People with finance degrees are entirely capable of maximizing patient care instead of profit. Every large business has a number of experts in each area who know to both measure and improve their area.
These days, those experts just aren't listened to and hospitals instead balance the minimum of care they can provide against the expense of malpractice lawsuits.
This is completely unacceptable and needs to be treated as an act of war against the people of the United States because this is directly leading to deaths. 45,000 people die every year from not being able to afford health insurance.
7000 people roughy died in the Iraq and Afghanistan wars from 2001 to 2024. That means oligarchs are murdering for profit 6.42 Iraq and Afganistan wars amount of people every single year.
The execs leading this need to be given a very short opportunity to change their course. And if they don’t, they need double digit jail time and charges related to the mass coordination of killing people knowingly for money.
Blaming regulations for this is comical. Physicians alone will never be able to generate enough of the capital to own these things larger institutions, world renown research labs, and/or medical equipment, especially since things have become more specialized and more tech is available. They should be State owned.
I used to live in a small US city of about 65,000 people. There is one hospital that serves the community. My friend is married to the former CEO of the hospital. In 2019 he was making $450,000. When I worked with him in the late 90’s he was Head of Security for the hospital. From Rent-a-cop to CEO of a hospital. That is not the trajectory I would normally think would produce empathetic, medically knowledgeable leadership. On a personal level he’s a degenerate asshole so that doesn’t really help my view.
Health insurance premiums in the U.S. significantly increased between 1999 and 2024, outpacing the rate of worker earnings by three times, according to our newly published research in the journal JAMA Network Open.
Premiums can rise if the costs of the medical services they cover increase. Using consumer price indices for the main components of medical care – such as services provided in clinics and hospitals as well as administrative expenses – based on federal data and data from the Kaiser Family Foundation, we found that the cost of hospital services increased the most, while the cost of physician services and prescription drugs rose more slowly.
Some of the premium increases can be attributed to an increase in hospital outpatient visits and coverage of GLP-1 drugs. But research, including our own, suggests that premiums have rapidly escalated mostly because health system consolidation – when hospitals and other health care entities merge – has led hospitals to raise prices well above their costs.
Hospital CEOs prioritize profit
Hospitals are aggressively raising their prices because hospital CEOs have incentives to do so.
One study found that for nonprofit health systems, the greatest pay increases between 2012 and 2019 went to hospital CEOs who grew the profits and size of their organizations the most. However, the financial reward of delivering above-average quality of care declined. Increased charity care – free or discounted health services nonprofit hospitals must provide some of their patients who cannot afford medical care – was not significantly tied to CEO compensation.
Board members set performance criteria that determine the base salary and bonus payments for CEOs. Over half of board members at top U.S. hospitals have professional backgrounds in finance or business. As a result, researchers and advocates have raised concerns that financial success is the dominant priority at these institutions.
One study found that for nonprofit health systems, the greatest pay increases between 2012 and 2019 went to hospital CEOs who grew the profits and size of their organizations the most.
Absolutely ridiculous. No organization that calls itself a nonprofit should be run by executives focused on profit generation. That's not a nonprofit, it's a greasy tax dodge.
I don't understand how you can write all this and also not mention that there is a cap on insurance companies profits in percentage terms.
This means that if they want to make more profit they have to move more money through the system. Since they take a percentage this legislation encourages them to make healthcare cost as much as possible.
What sucks is that most people would be better off without the ACA; it’s been mangled so badly the only people it still marginally helps are those with expensive preexisting conditions.
Had it not been gutted by Republicans (over and over again) we probably have universal healthcare by now. All of them are traitors to the people of the United States and I hope they get the life they truly deserve.
Liability no longer exists in this country. When you can own something but not be in trouble for what that thing you own does, then everything fails. If you own anything and are not responsible for it, you are part of the problem. You need to start holding actual people accountable for things. Get active in the companies you own and force them to do better. If you don't, you are actively destroying everything. You are saying "I care about no one other than myself." Liability needs to exist again, and equally for everyone.
In 09, my son was in the hospital for 5 days. (He healed up fine with no issues fortunately). At the time, I paid my $500 deductible and that was it, everything else was covered bc it was inpatient. I don't even want to think about the bill if that'd happened today
Also pre ACA our uninsured rate was ~16% of the country. That eventually came down to ~8% because of the ACA. Millions of people would have eaten the entire cost before hand and likely gone bankrupt.
I'm Canadian. Do you have any idea how insane some of these comments sound to me?
Here in Canada, health care is supposed to be a non profit service to help people.
Down in the US, you guys treat health care like a for profit industry and the concept of insurance is ghastly. It's an absolutely horrible system.
An easy solution would be to make each state it's own care provider. Instead of insurance, you pay your taxes, the money goes directly to the government who manage the health care which anyone can access when they need it.
The US's crappy system is ruining our health care up here in Canada because those greedy assholes are trying to do the same thing up here.
The way I think about it is that my quality of life improves when I'm around healthy, happy, productive people instead of being around a bunch of dumb ass sick people.
Crime goes down, the economy improves when people have better access to resources like health care and education.
you guys treat health care like a for profit industry
US health care has lots of problems, but this actually isn’t true. Most insurers and providers are non-profits—you could wipe all profit from the system tomorrow and it would still be the most expensive in the world, by far.
There really is no reason we need insurance companies. They are leeching from hospitals and patients and offering no value. Nationalize healthcare please.
Speaking from personal experience… It was better when the nuns were in charge. They would literally sit in on meetings an question if it was good for the patients and if it were charitable. The hospital could make money, but it had to be paired with a charitable need, otherwise charging more was against the mission. 30-20 years ago they corporatized this process, literally assuming that if the corporation was run by businessmen of the right denomination then they would operate in a way that aligned with their values. This seems to have happened across many religious hospital networks across the country, and it all went exactly the same way.
Ah, America. Country where hospitals and prisons are for profit organisations and most people who go into medicine are driven by promises of high income in the future.
I would agree with you regarding the physician pay being a motivator if they didn’t have to go into mortgage sized debt and be trapped working 80 hours a week for 3-10 years after medical school.
No, Lets say you have $200,000 or a mortgage payment of loan repayment, $1,331 so a reasonable salary assuming a 9% of income for repayment is $175,000 Salary
This isn't surprising to those of us that have worked since 1999. Basically every one of my annual merit raises is countered by the increase in health insurance premiums.
Another reason why you should be on the lookout for a better paying job and also why health insurance should not be tied to employment.
There’s also been an increase in cheaper scammy insurance companies. One example is a company called LIFEX that offers “employees” subsidized insurance via a loophole. They’re currently being sued by BCBS
Hospitals don't set insurance prices. Insurance companies decide how much they are going to reimburse hospitals for things. Our hospital tried to fight back and Bluecross blue shield dropped us as a carrier. A big hospital group bought us otherwise the hospital would have closed. Large hospital groups are the only ones able to push back on insurance prices at hospitals. Having some financial people run large hospital groups that have 10 - 15 hospitals in them I would see as a benefit. Individual hospitals are on their death bed right now.
Doctors’ groups told GAO that consolidation is becoming common partly because the cost to own medical equipment, which is needed to run a private practice, has surpassed the income earned from treating patients, according to the report.
Other reasons include that consolidated physicians could negotiate for higher payment rates with insurers, the GAO found based on survey data from the American Medical Association.
I mean to be fair, why would a physician be dealing with financials? I don’t agree with the system as it is… but being an expert in medicine doesn’t making you good at running an organization, health system, etc.
US healthcare is literally the worst in the developed world, with average cost per individual at least two times the average of all other developed nations, lower life expectancy by over four years, and higher infant mortality.
Anyone in America with a chronic illness already knew this. I've watched the cost of a medication I've taken for over 28 years go from $21 to over $280. I remember when insurance covered everything I needed even paid for alcohol swabs.
What they should be looking at is the fact that these hospital systems making all this money are getting closer and closer to not having any actual clinical staff. our healthcare systems about to implode and nobody seems to notice or care.
The US will see the issues in the next few years. my household makes plenty of money on paper but I can't afford the surprise bills that come with seeing a doctor.
So because I can't afford the MRI and potential surgery, I am just walking with a limp for the rest of my life. Woo, being 28 is great!
Obamacare was designed to inflate prices and make insurance companies rich. To make health care affordable we need to get rid of insurance companies, not give them handouts.
An odd headline. The article is about how underlying healthcare costs have increased in that time frame. Increased health insurance costs are just a natural result of that. It may be that there are health-insurance specific things that also cause the increase, but the article really doesn't mention those.
Worth mentioning: Cochrane Review finds about 95% of medical treatments are either useless, harmful, or unproven. It sure looks like we could cut a lot of medical costs and not suffer any ill effects just by doing better research and better cost containment.
Also, America spent something like 18% of GDP on healthcare, while Spain spends something like 6%. We really could save a lot of money here.
Do you have a source for the %95 claim? Because your first claim seems to be based on findings about "high quality evidence" and not overall effectiveness of treatments.
Thank you for the source. This was my understanding of what was happening from my own search and I was not sure if I was missing something. The comment I responded to seems to be drawing an incomplete conclusion from this study, which while interesting doesn't provide any evidence that there is a financial benefit to broadly cutting treatments based on these findings.
So my reading of that is is saying that most clinical studies are not comprehensive. Which is expected of clinical studies. Most clinical studies aim to be as small as possible to limit risk to patients until there is a strong belief that the drug is safe and effective. It might take 4 or 5 clinical trials to scale up and the first few will definitely be considered not robust enough. It is also probably worth pointing out that these the 95% is based on clinical trials in the database and not procedures or interventions that are performed. Every procedure, medication, or intervention will be approved by regulatory bodies such as the fda before it is widely used, and they will require robust studies. I think the original comment of 95% is very misleading.
Conclusion:
More than 9 in 10 healthcare interventions studied within recent Cochrane Reviews are not supported by high-quality evidence, and harms are under-reported.
That isn't even on the same planet as:
95% of medical treatments are either useless, harmful, or unproven
I do apologize, but More-Dots346's claim regarding this study is ridiculous, and your source does not support it.
"Best advice based on current evidence" does not magically turn into harm the moment new information is found to show that the previous understandings were incorrect. It was still the best answer we had at the time, even if based on low quality evidence.
Also interested to see the study. I am wondering what “treatments” are. Does this mean people are actually undergoing procedures / taking medication that does nothing compared to a placebo? Or is that talking about the doctor visits that essentially are addressed by “you need therapy, you need a better diet, it’s viral” etc…
They misrepresented the study, it’s a review of Cochrane reviews. Cochrane reviews are done on common practices that have mixed evidence so naturally quite a few of them do not find strong evidence.
For example here are some recent cochrane reviews (summarized quite poorly by me):
I'm hugely doubtful of whatever it is that I've never heard of that you just referenced.
Could you please drop a link? NNT is pertinent, but "95% of medical treatments are useless" sounds like a pretty overt lie. "Unproven" sounds like an enormous caveat depending on how proving is defined, and furthermore, is this based on total procedure/pharmacologic/therapy as a percentage of volume? Again, I doubt it. Hugely.
The U.S. medical system has major, major issues, as a widespread and common issue "inventing things that don't work" isn't one of them.
Its been known for a long time that OECD average is so high because we're the outlier. I think only one other country has a higher spending than the average. All of those countries have something the US doesn't.
Haha this sounds like some junk from insurance companies, the same ones who are like “we see sooooOoOoo much fraud, we have to deny all these claims!! Oh, how much of this rampant fraud have we reported? Hehe… ummm…”
Yes, there's proof that antibiotics are prescribed in excess, incorrectly and/or inappropriately. There are medical procedures and such that we know won't help but are actually forced by insurance companies to do in order to get authorization for treatment that will actually work. It would not add up to 95% though
If you are refencing the story linked below, I believe the review is just looking at clinical studies that are performed, not actual procedures or interventions that are performed on patients. Clinical studies are not going to be nearly as robust initially, and many fail and do not require peer review because the scientists know the intervention is not worth pursuing. This is very different from actual procedures being performed. I would like to know more about where your data came from, and if it is in fact a review of clinical trials, or a review of actual procedures being performed.
Meta analysis of Cochrane reviews, not a Cochrane review.
That is a very significant difference because Cochrane reviews are often carried out on common practices with mixed or limited evidence. It would be a waste of resources to do Cochrane reviews on things that are very strongly supported by evidence.
So the takeaway should be that Cochrane reviews are working as intended and challenging things that should be challenged.
Cochrane Review finds about 95% of medical treatments are either useless, harmful, or unproven.
No, they did not in any way.
Conclusion: More than 9 in 10 healthcare interventions studied within recent Cochrane Reviews are not supported by high-quality evidence, and harms are under-reported.
That is not even remotely the same as "95% are either useless, harmful, or unproven." Your conclusion is comically wrong.
I work in Healthcare admin. Single payer would probably cost me my job and I'm still heavily in favor of it.
Single payer/M4All would be more cost effective with better outcomes. You could also increase provider reimbursement compared to private insurance if the majority of private insurance overhead was instead directed towards reimbursement for providers.
If you have ever gotten a rebate check or credit on your private insurance, it's your health plan paying a penalty for essentially paying their executives too much.
My FIL has received between a 2-3% increase over the last 5 years as a COL adjustment in his salary.
In that same time his health insurance premiums have increased well beyond his CoL. he showed me an email he received from HR regarding the his yearly CoL adjustment and they pay themselves on the back for giving all employees an increase in pay, then later in the year, just before enrollment period, they find out what their insurance premiums are for the year and the increase basically wipes out that raise by itself.
Even the physician board members and executives are in on this grift. In my experience they’ve become worse than the business background only leadership.
Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, personal anecdotes are allowed as responses to this comment. Any anecdotal comments elsewhere in the discussion will be removed and our normal comment rules apply to all other comments.
Do you have an academic degree? We can verify your credentials in order to assign user flair indicating your area of expertise. Click here to apply.
User: u/Wagamaga
Permalink: https://theconversation.com/health-insurance-premiums-rose-nearly-3x-the-rate-of-worker-earnings-over-the-past-25-years-271450
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
Hospitals used to be predominantly nonprofit and charitable, evolving from religious/community origins focused on care for the poor, but the landscape shifted significantly from the late 20th century with the rise of for-profit models, government funding, and corporatization, though nonprofits remain the majority in the U.S., now balancing community needs with financial viability, a change marked by the 1973 HMO Act opening doors for for-profit insurers and shifting focus from pure service to commercial product.
Profiteering reshaped the whole landscape
Which is sort of the story of nearly every facet of our lives. The deregulation started by Reagan and continued by Clinton has lead to massive consolidation of almost everything. CEO pay up 1000% since the late 70s while everyone else gets lower wages, worse service, worse products at ever increasing prices.
People (especially on the right) say they love capitalism so much, but we basically have no competition in any economic sector anymore. Just the first few that come to mind:
The corporate merger era has enriched the wealthiest at the expense of everyone else. Our economic system now discourages innovation and competition.
I have to disagree a bit on the bank side at least - there's tons of smaller regional banks and credit unions with significantly better customer service and consumer-friendly policies.
I genuinely don't know why so many people keep using the larger ones when there's no real barriers to using smaller ones and switching is usually easy - unlike the other things you listed.
Except there often barriers. Smaller banks don't have as many branches (which does matter to some people). My wife for example likes Chase because they are huge and have branches literally everywhere! Does she actually do anything with these branches outside of using their ATMs because they don't charge her a fee there? No. Does it matter that I explain a lot of other banks will pay the fee for you no matter what ATM you use? No.
Now there are some legitimate excuses like wanting everything under one name. This is especially true with like business accounts. Not all small banks or credit unions can absorb the swings in equity that stuff like payroll or large expenditures will cause.
Most credit unions use the allpoint network with 50,000+ no-fee atms. Pull up their map for her.
And online only banks, like USAA (which you don't need to be a service member to join anymore), actually refund ATM fees at the end of the month. (it used to be unlimited fee refunds, but now it's just a few).
I've even used my USAA debit card at international ATMs (Europe, Australia, and Central America) with no issues.
Where do you get that?
https://usaa.com/join/get-started/
Large Banks are indispensable when traveling abroad. Specifically Citi gives me not only free ATM, but also the best conversion rates hands down. Add this to using USD Hard Currency in most local transactions in S. America gives an extra bonus. It can't be beat. That being said, I use Unions almost exclusively in the US.
When I switched from Capital One over to Chase, a lot of weird stuff started to happen related to my credit. I think they have more juice behind the scenes with banks and credit and so stuff shifts and moves faster with Chase vs smaller banks. I'd love to move over to a Credit Union however I would be curious how they handle international debit/credit purchases as well as identity theft and fraud. I became a flight attendant and it took months for me to reach the right person at Chase to stop locking my account overseas on layovers. Now it's not an issue but it was in the beginning. Work a Brussels Trip? Card locks up. Today it's fine. But I just know things seemed to move much smoother since moving my stuff to Chase.
I don't travel internationally often, but at least so far, the VISA card I've used through my local regional bank (FNBO) has never had many issues. Even when I forget to tell them I'm traveling internationally, most of the time it doesn't get flagged. And I haven't had an issue of the card being compromised in... well, I don't remember. At least 8+ years. I almost always use tap-to-pay through phone though these days if I'm not using cash.
I was wondering where anti-monopoly competition went. Ty for the list. No idea how we can make this better. I think I'll die before I ever help the world become a better place. (Sigh)
Primary elections. And right now is exactly the best time to get involved.
Internet and housing policy are heavily influenced by local governments, too. It's not just high-profile races.
Not sure about grocery stores competing on locations but in my experience (not being in top rural of an area) most towns have 2-3 major grocery stores competing with one another and grocery prices relative to inflation are overall down quite a bit historically speaking (though maybe not the past few years). I realize some of this is economies of scale and improved efficiency for yield in farming and the like, but are groceries specifically overpriced compared to where they would be if there was more competition, or is the market still fairly competitive overall? I'd think it's competitive, but curious as to any data to the contrary
Clinton was one of the worst Democrats to ever hold office in the post WW2 era.
The older I get the less I like him. One good thing is that we balanced the budget under Clinton so we can point to that vs Republican's ridiculous spending sprees.
The fight to destroy Planned Parenthood(the largest nonprofit healthcare provider in the country) was not primarily about abortion.
I don’t disagree with any of your comment, but please explain to me what “nonprofit” really means in the health industry?
Large hospital systems make Billions annually… intermountain health made 17b in revenue in 2024 and paid their ceo 7+ m. How do you even justify that as a nonprofit?! The people at the very top are certainly making huge profit.
Intermountain health is not a nonprofit, it is a not-for-profit corporation. Being a not-for-profit organization just means any profits must be reinvested in the organization. They can't distribute profits to owners or shareholders or anything like that, but nothing says they're not allowed to pay their CEO an absurd salary.
Revenue isn’t profit
It’s all lawyers and MBAs
Every year I make less and less because my 3% raise is never enough. My health insurance payments outpaced them. It sucks
Look at this guy getting a 3% raise.
I've gotten 1% for the past two years, which is great compared to my last company which gave me nothing at all unless I threatened to leave with a counteroffer in hand.
Y'all get raises?
In all seriousness, this is a real problem. Especially when companies don't even give an adjustment for inflation, which is functionally a pay cut.
And "inflation" is an imaginary thing driven by shareholders demanding infinite growth.
Corporations as a concept are unethical on the basis of infinite growth demands alone. The system needs to be dismantled.
That is not at all what inflation is.
The very first sentence of the Federal Reserve website's article on "What is Inflation" is,
Yes. This is over-simplified - I do realize. But when the majority of price increases are to satisfy percentage based year-on demands of a relatively small group of people, then it gets to the heart of it.
This is what is ruining the system. The issue is that insurance companies are squeezing (basically stealing from) both sides. Patients pay higher premiums, deductibles, and copays, yet coverage keeps shrinking, so insurance only really helps once you’ve hit your out-of-pocket max. It’s become catastrophic coverage, not real healthcare.
On the other side, doctors and hospitals get reimbursed less every year for the same care, so they’re stuck trying to collect larger balances from patients who can’t afford them. Patients delay care, conditions get worse, treatment gets more expensive, and the cycle keeps repeating.
Costs go up, coverage goes down, hospitals struggle, patients suffer (and insurance companies post record profits). Hard not to see who the system is designed to benefit.
Don’t forget that on top of costing more. You are also getting less. Because capitalism and health insurance companies and their CEOs and shareholders are entitled to constantly increasing returns.
This philosophy has ruined the country. I've argued with several CEOs at bars about this.
This Ed Abbey quote comes to mind.
You're hanging out with CEOs at bars?
I asked for a raise a second time in 3 1/2 years this year and they told me it may take up to a year for them to get back to me. I really couldn’t go elsewhere and make more because I make good overtime but my company is just taking advantage of me. I’m the longest hourly worker at my company and they won’t give me a $1 raise. The first time I asked for a raise they offered me salary and it was $1000 a month less than what I make hourly. It was a slap in the face.
TLDR I feel you haha
My ACA plan is going from $160 to $285 this year.
I have a 10k deductible. It is insane.
[removed]
It's almost as if all the wage gains that workers would have gotten over this time period went to higher insurance premiums instead.
If only someone had defined rent-seeking as an economics term decades ago and explained how it could be counteracted through government intervention.
Oh well! Maybe we should keep trying this new Reaganomics thing, it's saving us from Horse-and-sparrow!
Could you explain how rent-seeking is applicable to this case?
The hospitals themselves provide good and have innovation and productivity but the management and insurance providers who prioritize increasing client payments and decreasing costs even when it means cutting care are rent seeking.
There is surely a smart and perfectly fitting Marx quote for that.
I don’t agree with a lot of Marx’s policy conclusions, but boy did he have his finger right on the money of the problems.
For example?
Maybe it’s more accurate to say that I don’t agree with how many people interpret Marx’s policy. Too often people treat economic policy as an all or nothing conversation. You can either be capitalist or socialist, but not both. Whereas I honestly think if you read Adam Smith, and then you read Marx, it’s pretty easy to conclude that in order to have healthy capitalist* markets one needs a fairly powerful (democratically run) socialist* state (I have very particular constrained definitions of each in my own head that I feel that many other people don’t necessarily agree with and that’s fair). What I very deliberately am not saying is that the state must own all means of production. Nor do I believe that all means of production being in private ownership is correct. I think ownership at the end of the day is a belief that we are all having to adjudicate amongst ourselves. I think a lot of economics is more religious than people would prefer to admit to themselves. There are many ways that intellectual property ownership is a form of violence inflicted on the poor by the rich (is a statement that I believe is very true, but that many people will get real uptight about).
No... They also went to increased medical costs too. That's the beauty of percentages, they scale with the price increases.
So a plan that covers 90% of the cost is also more costly by simple fact of the service itself costing more.
Now go one level deeper.
The insurance companies have to pay out a percentage of premiums, by law. Conversely, you can imagine that also means their profits are therefore capped as a percentage of premiums. They are also in charge of negotiating prices with healthcare providers and drug companies, which set those premiums. I'm thinking they may not be trying their hardest to keep costs under control, since they are actively incentivized to keep prices going up. The only reason they don't instantly go to infinity is some downward pressure since they can't be vastly more expensive than their competitors... But that's only some pressure since your employer has likely already locked into a provider for a multi year term and you can't really cross shop as an individual. So premiums will continue to slowly creep up as everyone involved profits from it. The government is about the only entity pushing to lower costs.
Cool, right?
The government is the entity that created those profit caps.
Hey, don't blame the Mafia. If the Mafia/Mob/Yakuza, or any underground organized crime syndicate ran the system it'd probably work better and be more affordable. They did direct trade work with doctors to get their boys patched up when needed and no one complained.
Honestly I'd trust the local mob boss more in this situation. At least then it would be a tangible entity nearby.
The Mob ran Vegas. It was cheap, and fun. They objectively understood the necessity of providing value for money, and keeping it affordable.
MBAs on the other hand only understand maximizing profit. Almost guarantee you that casinos have seen a similar takeover by finance execs.
I've always said the MBA's should be locked in the basement and given no power. Just crunch numbers that we tell you to. Let the competent ones make the choices.
That's because unlike corporations gangsters at least have souls and pragmatism.
Yeah they have. That happened decades ago.
Even the Mafia has rules where you can't openly kill children and women in the streets. The US healthcare industry should look up to the Mafia as mentors.
Yeah the entire US Healthcare system is designed so the rich people can make money off of death, suffering, and disease. Quite literally so.
i recall the headline “is curing patients a sustainable business model?”
This is why driving up revenue and driving down costs should not be the thing to optimize on in medicine. It should be patient outcomes, and doctors and medical groups should have flexibility to operate within that mandate.
That is actually the model being adopted currently especially with Medicare plans. Hospital systems will accept part of the risk which incentivizes them to have better outcomes. I know my hospital system is heavily doing this over the last 5+ years.
We are reaching a boiling point.
Recently huge part of the population voted to make the system even worse and it was done.
Who? All those Obama voters? The Trump voters? The Reagan and Clinton(s) and Bush(es) voters? All of them contributed to this problem, and I'm not even sure Trump is the worst. There is no Democrat coming to help on this issue. They are very visibly captured by the same exact money.
That I had to pluralize two names in this short list is also part of the problem.
If Americans went to one cost health insurance we'd be a world power again
It'd be a major step forward for sure. Investing in public infrastructure New Deal style too.
On the one hand, the US has the strongest military in the world by a significant margin. On the other hand, the US is burning down its soft power like it's going out of style. Neither of those have anything to do with our health insurance system.
(Socialized medicine is still a good idea.)
I wonder how this lines up with rhe reports of the increase of medical facilities being purchased by private equity
Good thing like 15 years ago we as a country didn’t pass a republican drafted, democrat led bill that forced people to purchase private insurance and subsidize private plans with public money thus lining the pockets of insurance companies even more and not changing the incentive structure at all.
Oh wait.
Health insurance, rent/housing, college tuition, and the GDP have all grown faster than the average wages since the 80s.
This means corporations make record profits each year on the backs of their underpaid employees.
Reagan destroyed the quality of life for the majority of this country the day he scammed us into trickle down economics.
Corporations are happy to soak up all the extra profit from not paying taxes and double dipping by not increasing wages.
Don't forget the triple dip - corporate stock buybacks
A friend of mine works for a hospital that is chronically understaffed so all the nurses are overworked. Often they are forced to stay past their shift because of legal quotas for nurses per patient. This year she got a whopping $2 raise. The "budget is really tight."
The president/CEO (I've seen it referred to as both) of the hospital got a $2million+ bonus. A bonus... like on top of their regular salary.
Meanwhile, my friend is actively telling me not to go to the hospital she works at because everyone is fried beyond belief. They keep losing nurses because of the conditions so it's all new nurses who don't have a lot of seasoned nurses left to teach them.
But sure, let's give that guy a $2mil bonus.
A lot of hospitals are unfortunately ran this way. I can attest from personal experience.
Regulatory bodies have made it essentially impossible for Physicians to lead healthcare practices and physician own hospitals are all but gone. This allowed private equity and massive corporations to buy out so much of the healthcare that you’ll go to cities where basically all the clinics are owned by one massive hospital system.
The few physician owned practices I’ve been to give out so much free care and advocate for their patients even when financial incentives aren’t there, versus when they have MBA overseers they don’t have all the wiggle room since the advocacy can be seen as biting into the bottom line.
Doctor here: That wiggle room is often viewed as "theft" by the MBA overseers. Example - I wanted to give a patient a flutter valve (like $15 device). At a previous institution that was very much non-profit no one would blink. At my current institution, I could be fired (or worse) if it isn't billed for.
I’ll be the first to say that doctors are not great businesspeople. A hospital is a very complex beast; hell, even a sufficiently large clinic is tough to run effectively. There needs to be people in place that can actually make sure the lights stay on and the business side doesn’t completely go off the rails — a hospital not making money is just going to close.
That said, the above is taken too far in today’s world. Businesspeople are not just assisting doctors in running the operation, they are in positions where they don’t even need to interact with the medicine. Most times doctors have multiple levels to go through before being at the decision making level. It should be the other way around, doctors saying what the hospital needs from a medicine standpoint, with money guys on the sidelines making sure the doctors keep a business minded reality check.
I think about it as architects and engineers. Maybe an architect doesn’t always think of the ability to actually do when they design; they need the engineer to make sure it works at the end of the day by bringing Talati into the picture. Doctors need businessmen; but doctors need to be the deciding people at the top.
Doctors need business people to do the business stuff, not tell them what to do with regard to patient care. And yet that’s exactly what’s happening, these suits have nothing but their greed bringing them into hospitals and healthcare, they should be at the bottom of the totem pole with regard to authority in hospitals and their salaries should reflect that reality.
The simple fact that hospitals closely guard procedure costs like some sort of holy Grail is simply an anti consumer price fixing scheme that simultaneously prevents consumer choice, cost inflation, and cost outlier investigatons. And before someone tells me "well states passed open pricing laws..." Yeah my state did too and it's ineffective. I can't shop anywhere because the data is obfuscated beyond usefulness.
I'm gonna tell you that you don't want a race to the bottom for healthcare costs.
I don't know what the answer is exactly though either.
It's scary as all hell not knowing whether you're going to owe 10 dollars or 10,000 dollars before going to the hospital. I'm personally putting off a major quality of life surgery because I genuinely do not know if I can afford it, and the only way to find out the price is to have the surgery and get the bill. Until then, insurance won't tell me if they will actually cover the surgery and hospitals won't tell me the out of pocket price.
Medical pricing being a game of Russian Roulette has major negative impacts.
Right, it's a fucked up system. But part of that isn't just the hospital, it's what insurance will cover and the insurance company and hospital should be able to talk to one another and be able to communicate this to patients.
Not a system in which middlemen deny lifesaving coverage and deny critical surgeries because "you didn't do enough pt first".
Not a system which is designed around wearing you down so you don't seek out care.
Not a system in which preexisting conditions were EVER a thing.
Librarians are not good business people. Firefighters are not good business people. Postal workers are not good business people.
How do libraries, fire departments, and post offices work then?
Because the public funds them!
It's going to be hard to put the genie back in the bottle :(
We only need a change in management.
The USPS (United States Postal Service) is exclusively funded by charging their customers for the services it provides, they receive no tax dollars for operational costs. Conservatives have been trying to privatize it for decades, and it's frankly a miracle they haven't succeeded yet.
And the people in charge of those funds aren't librarians, firefighters, or postal workers.
It's people with business and accounting degrees.
Because no matter what, you need people in charge of the money to actually be competent in money.
It's all about the incentive, not the knowledge. A person knowledgeable about business working for a public institution at a set salary will do what the job outlines, one who gets a bigger paycheck based on profit will care about nothing besides increasing their cut.
Setting and committing to budgets are drastically different than trying to maximize profits.
Or we could just subsidize Healthcare? Prioritize it as a society like many properly developed countries already do? The profit incentive does not belong in medicine since healthcare is something for which we have inelastic demand.
Maybe it's just me but I don't think hospitals or any infrastructure that is critical to human life (water utilities) should be run like a business.
You’re thinking of a business in the sense of making profit. The critical thing to see it as something that is sustainable.
Anything you just dump money into without any thought about running effectively is bound to fail. At the end of the day, everything costs money to run, be it a store or a hospital. The money might come from private companies or the government, but there is a limited pot per any particular facility.
A hospital that is run without even thinking about the money is going to find itself too costly and when the money runs out so goes the hospital. Sometimes it really is a situation where you can’t keep pouring money because there is no money to pour.
People think the covenant has infinite money. Maybe when you look at it from a super macro view. But when it comes to the individual hospital, even if they were government run, they can’t operate infinite hospitals. Each one needs to be cost efficient for the system to work.
It's more personal choice to avoid certain hospitals, and Tennessee is a case to see on hospital closures. But one thing on rural hospitals is that they don't have what rural patients want.
In 2017 Tennessee experienced 16 hospital closures, with 13 of those being rural, since 2010 — the second highest rate in the United States.
Haywood Park Community Hospital, the only hospital in Jackson county, shut down its inpatient and emergency room services on July 31, 2014 and converted the 62-bed hospital into an urgent care clinic.
Fayette residents were choosing to drive to a larger hospital rather than go to Methodist Fayette.
In 2004, North Sunflower Medical Center was on the verge of collapse. It averaged 120 people a month in 2004 and the rooms were old, ceilings were crumbling and the technology was outdated. But it serves as a lifeline in a county where nearly 40% of residents are living in poverty.
To become profitable and not close down North Sunflower Medical Center changed. Renovating the hospital itself was a must do. But it also had to find new ways to stay open. Rural Medical Centers have to be more than just hospitals, moving to operating Auxiliary Businesses.
Along with all big changes, the hospital developed extensive marketing campaigns– on billboards and bumper stickers, wrapped around its shuttle vans, in TV advertisements and YouTube videos.
But now this leads to the same problem North Sunflower Medical Center was facing Now, they travel miles to see doctors there, bypassing closer hospitals along the way.
They absolutely need to be run like a business, just not with profit as the driver. If you don't you'll get awful results as business operations and accounting are still needed.
isn't that the definition of a business to make a profit. That's what they mean not to run it like a business meaning not to optimize profits but to maintain and manage the costs of running and optimizing the service.
No, that’s not the definition of a business.
A that’s why people are reacting in such an ignorant way.
The people who make sure that a hospital can actually afford to provide care are the people who specialize in business administration.
They’re the people pushing for new tracking systems, etc etc.
Running something "like a business" doesn't mean "maximize profits at all costs". Especially a non-profit, where margins are generally very thin and and it's a lot easier to run things into the ground with a couple of bad financial decisions.
By it's very definition, business is "any activity or enterprise entered into for profit".
What you're looking for is proper administration. You don't necessarily need a finance degree to allocate funds, balance budgets, and make sure operations run smoothly. What you do need is a deep understanding of the organization and the ability to increase efficiency for better outcomes, not profitability.
People with finance degrees are entirely capable of maximizing patient care instead of profit. Every large business has a number of experts in each area who know to both measure and improve their area.
These days, those experts just aren't listened to and hospitals instead balance the minimum of care they can provide against the expense of malpractice lawsuits.
It sure as hell does in America.
[removed]
What regulatory body and which regulations are making it impossible for physicians to lead a practice?
I would assume regulations would exist to specifically mandate that physicians lead practices and not the other way around.
This is completely unacceptable and needs to be treated as an act of war against the people of the United States because this is directly leading to deaths. 45,000 people die every year from not being able to afford health insurance.
https://insuranceinformant.com/how-many-americans-die-because-they-cannot-afford.html
7000 people roughy died in the Iraq and Afghanistan wars from 2001 to 2024. That means oligarchs are murdering for profit 6.42 Iraq and Afganistan wars amount of people every single year.
The execs leading this need to be given a very short opportunity to change their course. And if they don’t, they need double digit jail time and charges related to the mass coordination of killing people knowingly for money.
Blaming regulations for this is comical. Physicians alone will never be able to generate enough of the capital to own these things larger institutions, world renown research labs, and/or medical equipment, especially since things have become more specialized and more tech is available. They should be State owned.
Working as intended, then.
One of the most (if not the most) morally obscene systems in the Western world.
well the US military is pretty high up there too... I'm not sure it's even worth breaking that tie, they're both deplorable
I used to live in a small US city of about 65,000 people. There is one hospital that serves the community. My friend is married to the former CEO of the hospital. In 2019 he was making $450,000. When I worked with him in the late 90’s he was Head of Security for the hospital. From Rent-a-cop to CEO of a hospital. That is not the trajectory I would normally think would produce empathetic, medically knowledgeable leadership. On a personal level he’s a degenerate asshole so that doesn’t really help my view.
Somehow the assholes always get promoted. Never understood it.
The premier quality of a ceo is sociopathy. It's a feature, not a bug
Health insurance premiums in the U.S. significantly increased between 1999 and 2024, outpacing the rate of worker earnings by three times, according to our newly published research in the journal JAMA Network Open.
Premiums can rise if the costs of the medical services they cover increase. Using consumer price indices for the main components of medical care – such as services provided in clinics and hospitals as well as administrative expenses – based on federal data and data from the Kaiser Family Foundation, we found that the cost of hospital services increased the most, while the cost of physician services and prescription drugs rose more slowly.
Some of the premium increases can be attributed to an increase in hospital outpatient visits and coverage of GLP-1 drugs. But research, including our own, suggests that premiums have rapidly escalated mostly because health system consolidation – when hospitals and other health care entities merge – has led hospitals to raise prices well above their costs.
Hospital CEOs prioritize profit Hospitals are aggressively raising their prices because hospital CEOs have incentives to do so.
One study found that for nonprofit health systems, the greatest pay increases between 2012 and 2019 went to hospital CEOs who grew the profits and size of their organizations the most. However, the financial reward of delivering above-average quality of care declined. Increased charity care – free or discounted health services nonprofit hospitals must provide some of their patients who cannot afford medical care – was not significantly tied to CEO compensation.
Board members set performance criteria that determine the base salary and bonus payments for CEOs. Over half of board members at top U.S. hospitals have professional backgrounds in finance or business. As a result, researchers and advocates have raised concerns that financial success is the dominant priority at these institutions.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2842464
Absolutely ridiculous. No organization that calls itself a nonprofit should be run by executives focused on profit generation. That's not a nonprofit, it's a greasy tax dodge.
Glad research is catching up with anecdote. The MBS trope is present across many industries.
I don't understand how you can write all this and also not mention that there is a cap on insurance companies profits in percentage terms.
This means that if they want to make more profit they have to move more money through the system. Since they take a percentage this legislation encourages them to make healthcare cost as much as possible.
How long are we going to let these leeches suck us dry? Healthcare should never have a profit motive.
Could barely get the ACA into law at all, so for quite some time i'd asy.
ACA is being rolled back right now
What sucks is that most people would be better off without the ACA; it’s been mangled so badly the only people it still marginally helps are those with expensive preexisting conditions.
Had it not been gutted by Republicans (over and over again) we probably have universal healthcare by now. All of them are traitors to the people of the United States and I hope they get the life they truly deserve.
It was never good.
The original version would have been a good starting point, but we never got close to that.
I mean we got people like Luigi seemingly trying to do something about it
America has spoken: they care more about hurting poc, lgbtq+ people, and women more.
Liability no longer exists in this country. When you can own something but not be in trouble for what that thing you own does, then everything fails. If you own anything and are not responsible for it, you are part of the problem. You need to start holding actual people accountable for things. Get active in the companies you own and force them to do better. If you don't, you are actively destroying everything. You are saying "I care about no one other than myself." Liability needs to exist again, and equally for everyone.
In 09, my son was in the hospital for 5 days. (He healed up fine with no issues fortunately). At the time, I paid my $500 deductible and that was it, everything else was covered bc it was inpatient. I don't even want to think about the bill if that'd happened today
At the same time they could deny to sell you a policy if you had some heart problems, as it was pre ACA.
Also pre ACA our uninsured rate was ~16% of the country. That eventually came down to ~8% because of the ACA. Millions of people would have eaten the entire cost before hand and likely gone bankrupt.
I'm Canadian. Do you have any idea how insane some of these comments sound to me?
Here in Canada, health care is supposed to be a non profit service to help people.
Down in the US, you guys treat health care like a for profit industry and the concept of insurance is ghastly. It's an absolutely horrible system.
An easy solution would be to make each state it's own care provider. Instead of insurance, you pay your taxes, the money goes directly to the government who manage the health care which anyone can access when they need it.
The US's crappy system is ruining our health care up here in Canada because those greedy assholes are trying to do the same thing up here.
But how do you stop the wrong people from getting help?
Ok, I’m being sarcastic, but when you realize about half of Americans actually think that way… everything about America will make a lot more sense.
The way I think about it is that my quality of life improves when I'm around healthy, happy, productive people instead of being around a bunch of dumb ass sick people.
Crime goes down, the economy improves when people have better access to resources like health care and education.
US health care has lots of problems, but this actually isn’t true. Most insurers and providers are non-profits—you could wipe all profit from the system tomorrow and it would still be the most expensive in the world, by far.
Just paid an extra $40 in Trump taxes (tariffs) for my medication. America is a terrible place where we're all held hostage
It’s great if you’re rich
You are not a patient, you’re a customer.
There really is no reason we need insurance companies. They are leeching from hospitals and patients and offering no value. Nationalize healthcare please.
Insurance is a scam. This is not new nor should it surprise anyone
Speaking from personal experience… It was better when the nuns were in charge. They would literally sit in on meetings an question if it was good for the patients and if it were charitable. The hospital could make money, but it had to be paired with a charitable need, otherwise charging more was against the mission. 30-20 years ago they corporatized this process, literally assuming that if the corporation was run by businessmen of the right denomination then they would operate in a way that aligned with their values. This seems to have happened across many religious hospital networks across the country, and it all went exactly the same way.
Thanks for sharing our article, which is from two health economists at Rice University, who also published their work in the journal JAMA Network Open.
Thanks for the great content you provide.
Profiting from the sick and dying
Meanwhile, at the Comrade Orange HQ: "Europe heading in the wrong direction"
Heh, wait until you discover how much housing went up in the same time period.
Ah, America. Country where hospitals and prisons are for profit organisations and most people who go into medicine are driven by promises of high income in the future.
I would agree with you regarding the physician pay being a motivator if they didn’t have to go into mortgage sized debt and be trapped working 80 hours a week for 3-10 years after medical school.
No, Lets say you have $200,000 or a mortgage payment of loan repayment, $1,331 so a reasonable salary assuming a 9% of income for repayment is $175,000 Salary
Load hospitals with finance people, you optimize billing complexity, not health outcomes; prices follow incentives.
This isn't surprising to those of us that have worked since 1999. Basically every one of my annual merit raises is countered by the increase in health insurance premiums.
Another reason why you should be on the lookout for a better paying job and also why health insurance should not be tied to employment.
Medicare for all is a very rational alternative.
Of course they do. Gotta farm dying people to afford the yearly Lamborghini. Blood suckers.
There’s also been an increase in cheaper scammy insurance companies. One example is a company called LIFEX that offers “employees” subsidized insurance via a loophole. They’re currently being sued by BCBS
Hospitals don't set insurance prices. Insurance companies decide how much they are going to reimburse hospitals for things. Our hospital tried to fight back and Bluecross blue shield dropped us as a carrier. A big hospital group bought us otherwise the hospital would have closed. Large hospital groups are the only ones able to push back on insurance prices at hospitals. Having some financial people run large hospital groups that have 10 - 15 hospitals in them I would see as a benefit. Individual hospitals are on their death bed right now.
Doctors’ groups told GAO that consolidation is becoming common partly because the cost to own medical equipment, which is needed to run a private practice, has surpassed the income earned from treating patients, according to the report.
Other reasons include that consolidated physicians could negotiate for higher payment rates with insurers, the GAO found based on survey data from the American Medical Association.
[removed]
I mean to be fair, why would a physician be dealing with financials? I don’t agree with the system as it is… but being an expert in medicine doesn’t making you good at running an organization, health system, etc.
damn maybe the government should step in and do something about it,,,OH WAIT!!!
Wallstreet ruined everything.
And they still deny you when you need things.
My premiums doubled this year.
US healthcare is literally the worst in the developed world, with average cost per individual at least two times the average of all other developed nations, lower life expectancy by over four years, and higher infant mortality.
Anyone in America with a chronic illness already knew this. I've watched the cost of a medication I've taken for over 28 years go from $21 to over $280. I remember when insurance covered everything I needed even paid for alcohol swabs.
What they should be looking at is the fact that these hospital systems making all this money are getting closer and closer to not having any actual clinical staff. our healthcare systems about to implode and nobody seems to notice or care.
The US will see the issues in the next few years. my household makes plenty of money on paper but I can't afford the surprise bills that come with seeing a doctor.
So because I can't afford the MRI and potential surgery, I am just walking with a limp for the rest of my life. Woo, being 28 is great!
AND THEN, IN 2025: Republicans voted to remove subsidies for ACA, increasing healthcare costs for millions of people by triple-digit percentages.
Obamacare was designed to inflate prices and make insurance companies rich. To make health care affordable we need to get rid of insurance companies, not give them handouts.
An odd headline. The article is about how underlying healthcare costs have increased in that time frame. Increased health insurance costs are just a natural result of that. It may be that there are health-insurance specific things that also cause the increase, but the article really doesn't mention those.
Are we supposed to be surprised a business hires business people? The undergraduate degree for healthcare administration MA is business BA.
The Affordable care Act banned physicians from having ownership stakes in hospitals, allowing these ghouls to take over.
This problem will remain as long as healthcare is a profit sector.
Worth mentioning: Cochrane Review finds about 95% of medical treatments are either useless, harmful, or unproven. It sure looks like we could cut a lot of medical costs and not suffer any ill effects just by doing better research and better cost containment.
Also, America spent something like 18% of GDP on healthcare, while Spain spends something like 6%. We really could save a lot of money here.
Do you have a source for the %95 claim? Because your first claim seems to be based on findings about "high quality evidence" and not overall effectiveness of treatments.
https://www.sciencedirect.com/science/article/abs/pii/S0895435622001007#:~:text=Summary%20of%20findings,of%20interventions%20have%20evidence%20supported
They basically tested the reviews done by Cochran, not the primary research results.
Thank you for the source. This was my understanding of what was happening from my own search and I was not sure if I was missing something. The comment I responded to seems to be drawing an incomplete conclusion from this study, which while interesting doesn't provide any evidence that there is a financial benefit to broadly cutting treatments based on these findings.
So my reading of that is is saying that most clinical studies are not comprehensive. Which is expected of clinical studies. Most clinical studies aim to be as small as possible to limit risk to patients until there is a strong belief that the drug is safe and effective. It might take 4 or 5 clinical trials to scale up and the first few will definitely be considered not robust enough. It is also probably worth pointing out that these the 95% is based on clinical trials in the database and not procedures or interventions that are performed. Every procedure, medication, or intervention will be approved by regulatory bodies such as the fda before it is widely used, and they will require robust studies. I think the original comment of 95% is very misleading.
It's simply incorrect on it's face.
The study simply said 94% of medical interventions are based on low quality studies.
It does not say that "95% of medical treatments are either useless, harmful, or unproven." That claim would be ridiculous.
That isn't even on the same planet as:
I do apologize, but More-Dots346's claim regarding this study is ridiculous, and your source does not support it.
"Best advice based on current evidence" does not magically turn into harm the moment new information is found to show that the previous understandings were incorrect. It was still the best answer we had at the time, even if based on low quality evidence.
Also interested to see the study. I am wondering what “treatments” are. Does this mean people are actually undergoing procedures / taking medication that does nothing compared to a placebo? Or is that talking about the doctor visits that essentially are addressed by “you need therapy, you need a better diet, it’s viral” etc…
They misrepresented the study, it’s a review of Cochrane reviews. Cochrane reviews are done on common practices that have mixed evidence so naturally quite a few of them do not find strong evidence.
For example here are some recent cochrane reviews (summarized quite poorly by me):
Acupuncture doesn’t do much for insomnia in cancer patients
Calcium supplements don’t do much for preventing pre-eclampsia
Insufficient evidence that probiotics prevent allergies
Antibiotics don’t do any good for the common cold (as in preventing secondary bacterial infection)
Rituximab (actually kinda surprisingly) doesn’t work very well for MG but does kinda work sometimes maybe (more research needed). - This one is why Cochrane reviews are great because it will probably lead to an improved protocol in the future.
Source: https://www.cochranelibrary.com/cdsr/reviews/topics
I'm hugely doubtful of whatever it is that I've never heard of that you just referenced.
Could you please drop a link? NNT is pertinent, but "95% of medical treatments are useless" sounds like a pretty overt lie. "Unproven" sounds like an enormous caveat depending on how proving is defined, and furthermore, is this based on total procedure/pharmacologic/therapy as a percentage of volume? Again, I doubt it. Hugely.
The U.S. medical system has major, major issues, as a widespread and common issue "inventing things that don't work" isn't one of them.
Can you provide a link to that study? Thanks.
https://www.sciencedirect.com/science/article/abs/pii/S0895435622001007#:~:text=Summary%20of%20findings,of%20interventions%20have%20evidence%20supported
Found it
That study in no way, shape, or form says "95% of medical treatments are either useless, harmful, or unproven."
That's a heck of a claim. Do you have a source?
Are you saying that insurance should be denying 95% of all claims?
There is to much money to be made in healthcare with our current system. They have no incentive to change.
But those unnecessary treatments are happening because of the existing incentives structure.
Making them go away without making changes to that incentive structure seems unlikely
Its been known for a long time that OECD average is so high because we're the outlier. I think only one other country has a higher spending than the average. All of those countries have something the US doesn't.
Haha this sounds like some junk from insurance companies, the same ones who are like “we see sooooOoOoo much fraud, we have to deny all these claims!! Oh, how much of this rampant fraud have we reported? Hehe… ummm…”
X for doubt unless you have a source.
Yes, there's proof that antibiotics are prescribed in excess, incorrectly and/or inappropriately. There are medical procedures and such that we know won't help but are actually forced by insurance companies to do in order to get authorization for treatment that will actually work. It would not add up to 95% though
If you are refencing the story linked below, I believe the review is just looking at clinical studies that are performed, not actual procedures or interventions that are performed on patients. Clinical studies are not going to be nearly as robust initially, and many fail and do not require peer review because the scientists know the intervention is not worth pursuing. This is very different from actual procedures being performed. I would like to know more about where your data came from, and if it is in fact a review of clinical trials, or a review of actual procedures being performed.
Meta analysis of Cochrane reviews, not a Cochrane review.
That is a very significant difference because Cochrane reviews are often carried out on common practices with mixed or limited evidence. It would be a waste of resources to do Cochrane reviews on things that are very strongly supported by evidence.
So the takeaway should be that Cochrane reviews are working as intended and challenging things that should be challenged.
No, they did not in any way.
That is not even remotely the same as "95% are either useless, harmful, or unproven." Your conclusion is comically wrong.
TIL Obama began jacking up insurance rates before he ever won any kind of election, that’s next-level evil.
I work in Healthcare admin. Single payer would probably cost me my job and I'm still heavily in favor of it.
Single payer/M4All would be more cost effective with better outcomes. You could also increase provider reimbursement compared to private insurance if the majority of private insurance overhead was instead directed towards reimbursement for providers.
If you have ever gotten a rebate check or credit on your private insurance, it's your health plan paying a penalty for essentially paying their executives too much.
[removed]
My FIL has received between a 2-3% increase over the last 5 years as a COL adjustment in his salary.
In that same time his health insurance premiums have increased well beyond his CoL. he showed me an email he received from HR regarding the his yearly CoL adjustment and they pay themselves on the back for giving all employees an increase in pay, then later in the year, just before enrollment period, they find out what their insurance premiums are for the year and the increase basically wipes out that raise by itself.
Is there a way to call big pharma and have them lower the insurance rates?
Your health is barely considered infrastructure. As soon a robots or AI can replace you, it won't be considered at all.
Even the physician board members and executives are in on this grift. In my experience they’ve become worse than the business background only leadership.