The Surprising Reason Rural Hospitals Are Closing | Hacker News Reader

The Surprising Reason Rural Hospitals Are Closing

time.com

17 pointsdotcoma18 comments

The "Surprising Reason", according the story: "The problem is private insurers."

I'm sure that's a factor, but there's more to it: https://www.texasobserver.org/critical-condition/

The federal government has encouraged all this; if Medicare/Medicaid didn't cut payments, the private insurers likely would not have followed their lead.

One of the big ways that cost containment has been done is forcing more efficiency. That should be a good thing, right? Except that small rural hospitals will never, ever be as efficient as large urban ones. And the "disproportionate share" (overly large amounts of Medicare/Medicaid patients) payments aren't enough to keep those places open. So while it's definitely saved money, that's not much help when you live an hour or more away from any healthcare facility.

Medicare should be cutting reimbursements. It’s the only way to deal with runaway bullshit in a fee-for-service healthcare economy.

The real answer is, and always will be, shifting the model entirely away from that to capitated models and better care model incentives (instead of incentives based around just ordering more shit for patients). It’s also an easy way to account for better geographic distribution.

That said, you’re also not solving rural healthcare without dramatically increasing the number of providers, so the revenue models are only going to get you so far regardless.

How likely are young OBGYNs going to chose deep red states with very restrictive reproductive laws where they could be held criminally liable for standard practices?

MAGA is a death cult. Everything they do accelerates the demise of their way of life and communities.

OBs, all mid-levels (for different but similar reasons), specialties… the list goes on. Reimbursements hurt, but none of these people are signing up to work in middle of nowhere OK and MO, when they can find work easily (and get paid better) in desirable places, that aren’t fully populated by people who hate them.

Blaming United or whatever is memeworthy, but it’s also the easy and only partially correct answer.

> Urban hospitals and large rural hospitals are able to make up for the losses from Medicare and Medicaid patients with what they can charge private insurers. Small rural hospitals can’t do that.

The articles argument is that private insurers need to cover medicare/medicaid costs, which seems silly. It also seems to ignore the obvious question in my mind, which is maybe rural hospitals just have to run leaner to meet market demands. It makes me wonder if there's a reason rural hospitals pull large investments, such as regulation demanding unattainably high levels of care, forcing them to be unprofitable.

> regulation demanding unattainably high levels of care

IMO this is the missing gap in a lot of the US economy. Cars, housing, medical care. Kei trucks, SRO apartments, and so many more similar solutions are functionally illegal.

Death toll is also going to increase in 4 years with the BBB and people losing Medicaid/Medicare.

A lot of people gonna discover that capitalism does in fact have a finite price on a human life.

Healthcare is a state responsibility. If an when eg the California Medi-Cal program reduces coverage, it will be because the California Democratic Party decided they don't want to pay for it.[1] When California causes anyone to lose coverage, you will have no idea (because it won't be published until LII gets hold of them years later). The fact that no one else will mention this outside of HN comments should be a wake up call about what you think you know.

[1] https://www.law.cornell.edu/regulations/california/title-22/...

You say that like it's a capitalism problem, when some of the longest wait times and worst care occur in countries with government-run healthcare. Lots of people die waiting for care in Canada, and the UK will regularly allow their healthcare system to get so bad people are dying in hallways, and then some "hero" politician will bring in a bunch of money just to restart the cycle. The article itself places plenty of blame on medicare/medicaid.

What you've presented is not an argument against public healthcare, it's actually an argument against poorly funded public healthcare.

Conservative politicians in both of the countries you mentioned have been systematically, over the course of decades, been defunding their own government-run healthcare programs, specifically in the hopes that people like you will conclude that because of this the system is "broken" and that we must as a result switch to the private, profitable healthcare that said politicians are being paid to support.

If you want to talk about properly funded public healthcare, there are plenty of good examples in the EU to look at.

My go to analogy is that conservatives will underfund the assembly of a car, deliver a car that only has two wheels that are both the wrong size, and then say "See? Cars will never work!"

I think it is amazing that in a country as "exceptional" as the US, the answer to "Why can't we provide affordable and accessible healthcare to everyone?" is "We are going deport liberal scum like you".

> Lots of people die waiting for care in Canada, and the UK will regularly allow their healthcare system to get so bad people are dying in hallways

That all happens in the US too—and worse—but also we pay more and get worse health care.

In the typical conservative fashion, you take very small issues (in terms of number of occurrences) and make it seem like they are huge.

At this point, it should be pretty clear that privatization of healthcare just doesn't work that well in general.

They still have higher life expectancy and lower costs.

It's easy to have lower wait times when you don't have to serve everyone.

The relationship between healthcare and life expectancy is sketchy at best. If you want to increase life expectancy you're better off touching on public health issues.

> The relationship between healthcare and life expectancy is sketchy at best

How do you define "healthcare" exactly?

>You say that like it's a capitalism problem, when some of the longest wait times and worst care occur in countries with government-run healthcare.

That's still a capitalism problem.

Neoliberal scum politicians (regardless of party) will underfund, sabotage and dismantle piece by piece, previously working fine government-run healthcare (and other infrastructure) to the benefit of private health interests.

Besides "people die waiting for care in Canada" is only a valid argument if more people don't die NOT waiting for care because they can afford it in the US.

Comparing the wait times of a system catering to everybody vs a system that excludes from even considering care a huge chunk of the population is cheating - even if we ignore the underfunding and neoliberal reforms issue.

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