Hold up. We already have to pay through the nose for medical care, so where is all this money going that these hospitals need to ask for more? Is non-profit a different class that is somehow left out of the con that is the US healthcare system?
> Ms. Grupp, 66, said she wasn’t rich, and was disturbed by the letter. “I kind of resent it,” she said. “I don’t think they need the money.” The hospital last year reported nearly $48 million in net income and paid its chief executive officer $1 million.
This is where it goes. That said, if I could spare $200k, I would if I had the information about which % of that money went to actual equipment and patient services. I think that information is available for non-profits, but I am not sure about hospitals. There will always be admin waste, but the best way to decrease it is to reward more efficient hospitals.
Money is fungible.
Some really popular charities go well above 25% towards non-cause expenses like administration/advertising.
If you assume that this advertising in net increases the size of the pie of charitable giving, it can be considered an overall good thing. If you assume that this advertising in net just redistributes the contributions that would go to one slice of the pie to another, it is wasteful. Data on which side is true is hard to come by.
That wouldn't give you the whole picture on waste. A big chunk of high health care costs is hidden inside the equipment and patient services. American hospitals have a habit of doing things in much more expensive ways than is strictly necessary.
Hospitals are pretty expensive and probably super inefficient: they are 30% of NHE spending.
Reimbursement is set by the fed (medicare rates) and ins cos base their rates off of that.
https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
It would of course take a hell of a lot of variance for a significant percentage of doctors to be pulling in a million plus. With 713,000 working doctors, there will be a fair number pulling in lots more than average.
https://transparentcalifornia.com/salaries/search/?q=PROF-HC...
I've linked the mean salaries for the US as a whole.
I honestly believe any company as well as everyone responsible for abusing the term "non-profit" in order to make money for their personal gain should be punished accordingly and be treated as scammers.
Oh, and (mega)churches.
Private insurance companies. EDIT: Out of network specialists. Pharmaceutical companies.
https://www.forbes.com/sites/robertpearl/2017/11/07/hospital...
> Three factors contributed to the need for layoffs: (1) reduced reimbursements from payers, including the Massachusetts government, which limits annual growth in healthcare spending to 3.6%, a number that will drop to 3.1% next year, (2) high capital costs, both for new buildings and for the hospital’s electronic health record (EHR) system, and (3) high labor expenses among its largely unionized workforce.
> That, along with higher labor and drug costs, explained the Cleveland Clinic’s economic headwinds, according to outgoing CEO Dr. Toby Cosgrove. And though he did not specifically reference Medicare, years of flat reimbursement levels have resulted in the program paying only 90% of hospital costs for the “older,” “sicker” and “more expensive” patients.
> The challenges confronting these hospital giants mirror the difficulties nearly all community hospitals face. Relatively flat Medicare payments are constraining revenues. The payer mix is shifting to lower-priced patients, including those on Medicaid. Many once-profitable services are moving to outpatient venues, including physician-owned “surgicenters” and diagnostic facilities. And as one of the most unionized industries, hospitals continue to increase wages while drug companies continue raising prices – at three times the rate of healthcare inflation.
> With pressure mounting, hospital administrators find themselves wedged deeper between a rock and a hard place. They know doctors, nurses, and staff will fight the changes required to boost efficiency, especially those that involve increasing productivity or lowering headcount. But at the same time, their bargaining power is diminishing as health-plan consolidation continues. The four largest insurance companies now own 83% of the national market.
Possible solutions:
* Government sponsorship through HHS of electronic medical records management. Have USDS and 18F to spearhead the project (cc matt_cutts), leveraging their experience revamping technology service delivery within the VA. This removes Epic's profit out of the equation.
* Government management of insurance. Medicare participants are fairly satisfied with it, and it can be just as efficient as Social Security. Cover everyone with Medicare, increase Medicare payroll deductions accordingly, and leave private insurance for additional fanciness some may desire (private rooms instead of shared rooms in hospitals, for example). This removes most of the profit from private medical insurance.
* Make it illegal to advertise drugs to consumers (this is only legal in the US and New Zealand). You immediately eliminate billions (estimates are ~$20 billion/annually) of marketing spend by pharma, and therefore costs they will desire to recoup.
* Let Medicare negotiate drug prices. This reduces profit realized from pharma concerns.
* Remove limits on medical students and residencies to increase GP and specialist supply. Streamline the process of nurses leveling up to nurse practitioners. This reduces the profit motive for practitioners; you'll make a decent wage, but not Lambo money.
* Subsidize medical school to prevent the need to go hundreds of thousands of dollars into debt to become an MD.
Uninsured people with means will pay high prices, it's just that they aren't the big percentage of uninsured people...
recent new hospital in my area of the country was only allowed to open provided they did not take away business from other hospitals. This includes opening a second outpatient surgery room in an existing hospital to offering advanced cancer treatment. This is very common in the US. It usually goes under the name "Certificate of Need".
The reasoning is that health care is improved if health providers do not duplicate expensive services. this has grossly driven up costs in many areas. then throw in rules which can force Emergency Centers out of network for ALL insurers. See a recent example in San Francisco with a PUBLIC hospital [1]
TL;DR Health care is only this overly expensive because politician meddling. From preventing competition among hospitals to preventing competition among insurers, unless of course you donate properly.
[1] https://www.beckershospitalreview.com/finance/zuckerberg-hos...
> TL;DR Health care is only this overly expensive because politician meddling.
Certificated of Need were something _hospitals_ themselves lobbied for. It's a case of "this is awesome when it protects me, and an aberration when I'm on the losing end".
Certainly politicians enacted such things, but I'm not losing sleep over the hospitals. Only us mortals, stuck with the cost of the system.
The second sentence seems to contradict the first. What about the insurance providers?
Doctors in the US get saddled with mountains of student debt, and then make mountains of money, once they pay it off.
The AMA also actively lobbies against proposals to give nurse practitioners more patient access. [1]
[1] https://www.ama-assn.org/press-center/ama-statements/ama-sta...
I'm having a harder time finding pass rates for the CPA before 2006. They seem to have gone up a little in that 12 year window 2006-2017 [2]. The tax code has also gotten larger and more complex over the past 50 years, so that is worth noting.
[1] https://analystprep.com/blog/cfa-historical-pass-rates/
[2] https://en.wikipedia.org/wiki/Uniform_Certified_Public_Accou...
Most residency funding comes from the federal government. Complain to your Congresspeople, not the AMA.
Complain to everybody.
Define "free market" [1]: an economic market or system in which prices are based on competition among private businesses and not controlled by a government. (Note: the first definition is a bit vague, so I used the second entry.)
Hospitals aren't competing in a free market. They don't suck because of capitalism, they suck because of government intervention. Right now our medical system is basically the worst of both worlds--it's not affordable nor universal.
If hospitals and doctors were operating in a free market then it would lead to lower prices and an increase in quality. You can see some evidence of this in medical areas which aren't typically covered by insurance and are less heavily regulated, with laser eye surgery probably being one of the best examples.
You've managed to identify that the problem is government intervention, yet you appear to hint at trying to solve the problem with even more government intervention? Historically that hasn't gone over very well. Have you seriously considered alternatives? I believe a medical system cannot provide more than two of the following three guarantees: affordability, quality, and universality. This will probably be an unpopular opinion, but I think dropping universality is the best choice. You can still maintain a social safety net to catch people that fall through the cracks, and I posit that it would be cheaper and superior to our current system.
[0] https://www.merriam-webster.com/dictionary/capitalism
[1] https://www.merriam-webster.com/dictionary/free%20market