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Comment by jfghi | Hacker News Reader

Be less profitable by not price gouging?

In America, hospitals cannot refuse emergency care.

So, while price gouging and insurance gouging are a thing, the actual hospitals may be poorly compensated in many places.

That's why rural areas are losing hospitals.

I agree entirely but just don’t think that credit reports solve or help anything in this domain.

> don’t think that credit reports solve or help anything in this domain

They help hospitals collect. Not saying that makes it right. Just that it has a purpose beyond greed and gouging.

I’d have to see data in order to confirm this is true. Once a delinquency gets placed on a credit report paying the bill doesn’t help the person that owes. It also assumes that the people not paying are choosing to do so rather than not being able to. Given the debts are sold at a steep discount, I’d say it’s more efficient to have lower prices up front which could potentially be affordable for more of the customers.

When one is applying for a mortgage one of the conditions is to pay off any debt in collection status. I agree that lack of universal healthcare with reasonable out of pocket costs is the underlying issue.

>In America, hospitals cannot refuse emergency care.

Can they do this in any developed country?

>That's why rural areas are losing hospitals.

Maybe a system with only privately run hospitals is a stupid plan.

Sorry, forgot to clarify: most other places provide socialized medicine.

So too in the US. You are probably not aware of the insane socialized mess that is the US health system due to initial good intentions.

Medicare, Medicaid, govt supported controls on number of new doctors per year, so much regulation and red tape.

The US govt spends more on healthcare than most other nations. If that isn’t socialized medicine, I don’t know what is.

Thankfully we are just indirectly socialized unlike our neighbors to the North who suffer from many things like longer wait times for emergencies and vital surgeries.

It is hard to operate a rural hospital. Rural areas not only are dwindling in population but tend to be poorer. There's a higher mix of Medicaid/Medicare plans versus employer health plans. With our current fee for service medical service economic model, rural hospitals that don't do as many surgeries or have to transfer people to the city hospital literally send patients and the revenue they bring in off to big cities. Recruiting staff is harder due to in demand professionals wanting the services and opportunities a big city provides. County hospital are partially local taxpayer supported but once again rural areas have a thinner tax base. HHS sends Federal dollars but this is limited.

Certain states are trying extra hard to exacerbate the problem by not expanding Medicaid.

> In America, hospitals cannot refuse emergency care.

How is that unique to America? What other developed nation doesn't have this rule?

The way it is funded in the US is probably special. EMTALA is enforced by making it mandatory part of Medicare participation.

If you don't bill Medicare you don't have to provide care to anyone.

Meh, hospitals put uncompensated care at about $40 billion a year in 2020:

https://www.aha.org/fact-sheets/2020-01-06-fact-sheet-uncomp...

That's not just unpaid emergency care that they are forced to provide, it's all their billing that isn't paid.

That's out of $1.3 trillion of hospital revenues in 2020:

https://www.cms.gov/data-research/statistics-trends-and-repo...

3% is a lot (because it's coming out of their net income from other procedures), but it shouldn't be driving hospitals out of business.

> That's why rural areas are losing hospitals.

Yes. And they are being run into the ground by "venture capital" as if they were local newspapers.

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