this post was submitted on 19 Feb 2024
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[–] sugar_in_your_tea@sh.itjust.works 6 points 9 months ago (4 children)

Why not? Companies that make pharmaceuticals, prosthetics, imaging devices, etc are all on the stock market too, so if hospitals weren't on there, you could build a portfolio to approximate it by buying producers of medical equipment.

The real issue isn't whether something is publicly traded, but collusion between groups to keep prices high. For example, it's mutually beneficial for insurance, hospitals, and medical equipment providers to increase costs. Higher equipment costs means care providers can charge more (what's another few hundred when the bill is in the thousands?), and higher total bills means insurance companies can charge higher premiums (they're usually limited to a certain percent of cost as profit). Hospitals generally don't have direct competitors since it's prohibitively expensive to build one and there's lots of bureaucracy based on "need," so you can't just go next door to an org that's not involved in the collusion.

Here's some YouTube videos about it:

There are lots of viable solutions here, but banning them from the stock market isn't going to solve anything. The first order of business imo is making everything more transparent.

[–] HappycamperNZ@lemmy.world 20 points 9 months ago (1 children)

The real issue is the belief that essential services should make profit. Socialized, regulated Healthcare FTW.

[–] TranscendentalEmpire@lemm.ee 6 points 9 months ago (1 children)

The real issue isn't whether something is publicly traded, but collusion between groups to keep prices high. For example, it's mutually beneficial for insurance, hospitals, and medical equipment providers to increase costs. Higher equipment costs means care providers can charge more (what's another few hundred when the bill is in the thousands?

This isn't how pricing is set for medical equipment....... Nor is high equipment cost the reason behind the pricing increase.

Every hospital that accepts Medicare utilizes CMS guidelines when it comes to billing. Medicare sets the general price for items, factoring in things like historic pricing, cost of purchase from vendor, and the price of labour required to fit or make the device function.

The complex and expensive aspect of hospital billing stems from the introduction of private insurance companies. The ones that require more paperwork and processing time than Medicare, and will attempt to make the process as hard as possible.

Hospitals generally don't have direct competitors since it's prohibitively expensive to build one and there's lots of bureaucracy based on "need," so you can't just go next door to an org that's not involved in the collusion.

Because hospitals are a natural monopoly, not only are they prohibitedly expensive, but it's also extremely hard to profit from them in the long term. Which is why there's a large amount of bureaucracy to get them built.

Pretty much every ER room in America is a huge money sink that the rest of the hospital has to economically support. You add too many hospitals, and the services that are profitable get too spread across the area to support their individual ER operations.

Which is why about 10-15 years ago there was a large push from venture capital to build "hospitals" without trauma rooms. These hospitals began to eat up all the funding in the area and began shutting down hospitals with trauma wards. This is when a lot of states adopted legislation that would help curb this behavior.

There are lots of viable solutions here, but banning them from the stock market isn't going to solve anything. The first order of business imo is making everything more transparent.

Banning private insurance is the only thing that would lower prices for Americans. None of the issues you covered are even close to the reason why things are getting expensive.

[–] sugar_in_your_tea@sh.itjust.works 0 points 9 months ago (1 children)

hospitals are a natural monopoly

Not when there's any kind of population density.

private insurance companies. The ones that require more paperwork and processing time

But what are those insurance companies processing? If you look at it, it's "special deals" so the agents can get a bonus, it has nothing to do with actually saving their customers money. Hospitals inflate prices so they have room to make cuts so the insurance sales people feel like they're winning.

The problem here isn't with the nature of insurance, but the collusion between insurance companies and care providers. It's a dance they play so everyone feels like they're winning, and at the end of the day the customer is the one that loses. It's not a competitive market, it's a bureaucratic one where you have HR departments, insurance salespeople, and hospitals all propagating the current system because it's lucrative for all of the middlemen.

Medical suppliers want a piece of the action too. That's why we get things like insulin prices going up:

The high cost can be attributed in part to “evergreening,” a process in which drug companies make incremental improvements to their products that can extend the life of their patents, said Dr. Kevin Riggs, a physician at the University of Alabama at Birmingham Heersink School of Medicine. He co-wrote a study published in the New England Journal of Medicine in 2015 that described the century-long history of the drug.

They prevent competition through the patent and regulatory systems, and hospitals and insurance companies are fine with it because they just pass the costs on to the consumer. Consumers don't really have a choice because most insurance comes from employers (who just pay employees less to compensate) or taxes (ACA subsidies). Nobody actually pays the full price, so the system continues.

The same goes on with medical devices, but volume is much lower so it's easier to prevent real competition. Add to that the legal risk for choosing a cheaper product if anything goes wrong and you'll find no incentive to cut costs.

Let's assume we eliminate private insurance, you just change the private collusion to public collusion, and instead of middle managers getting paid in the public sector, you get political favors to keep prices high (e.g. campaign donations). Moving insurance from private to public just moves money from one pocket to another. The true solution here is to expose the collusion, not politicize it. If you want proof of this in action, look no further than the defense department in the US.

Pretty much every ER room in America is a huge money sink that the rest of the hospital has to economically support

Which is because of free riders. The solution to that problem is different: emergency care should be completely publicly funded. It's so expensive because the hospital has to deal with people skipping on their bills and just move the costs to paying customers.

I think we should make ambulances and all non-elective care completely free, provided a paramedic recommends emergency care.

[–] TranscendentalEmpire@lemm.ee 5 points 9 months ago

Not when there's any kind of population density.

Natural monopolies aren't intrinsically changed by demand.....

But what are those insurance companies processing?

It's not the insurance company that is doing the processing. It's the hospitals, they have to hire more and more billing agents just to extract the money that the insurance has already agreed to pay.

special deals" so the agents can get a bonus

Lol, no. By "special deals" you mean 20% less than the Medicare allowable, and if you don't agree then you are no longer in network.

Hospitals inflate prices so they have room to make cuts so the insurance sales people feel like they're winning.

No, they inflate the prices so that when insurance companies ask for less money it doesn't bankrupt the hospital.

The problem here isn't with the nature of insurance, but the collusion between insurance companies and care providers.

You have no idea what you are talking about about...... I'm a provider at a hospital, specializing in orthopedics and rehabilitation. I've never spoken to an insurance agent about pricing. That's not how it works.

Medical suppliers want a piece of the action too. That's why we get things like insulin prices going up:

Those are pharmaceutical companies, not medical suppliers, they are billed under completely different systems.....

Also, the reason insulin pricing is so high is because Medicare isn't allowed to barter for pricing, largely in part because it would be unfair to private insurance companies who have smaller subscriber groups.

we eliminate private insurance, you just change the private collusion to public collusion, and instead of middle managers getting paid in the public sector, you get political favors to keep prices high (e.g. campaign donations). Moving insurance from private to public just moves money from one pocket to another.

Oh yeah, I forgot how every medical system on the planet was completely fraudulent...... Oh wait, nope, mainly just America.

The biggest way to improve pricing is by group bartering, which is how every other 1rst world nation pays less for medical equipment, treatment and prescription cost than the US.

Again, nothing you said was accurate, and anyone who takes it as so is now dumber than when they began reading. Please stop spreading misinformation about fields of study you do not specialize in.

[–] chicken@lemmy.dbzer0.com 6 points 9 months ago (1 children)

Market competition is fine, but corporations are specifically obligated to focus on profits over other considerations, and in this case that is inappropriate and creates perverse incentives. Consider people like in the OP who have cynically bought in (or are in some retirement fund that bought in on their behalf) and now their financial wellbeing depends on hospitals continuing to be allowed to extract significant money out of people. Are they going to vote for candidates pushing actually effective measures to reduce how much people pay for medical care, if that means the stock will go down? Probably not.

I highly doubt OP actually did what they said they did, this was a SM post for publicity. Even if they did, they are absolutely in the minority, so there's no reason to worry about public policy being impacted.

[–] Shayeta@feddit.de 1 points 6 months ago (1 children)

Because demand and supply don't self-regulate healthcare. How much do you value your health? How about your own life? Oh, you're willing to pay ANYTHING to live? Even if it's not life threatening as long as it leaves you crippled, unable to work, you may as well be dead.

As a customer the only way to be an informed buyer is to be a physician yourself. Even if a treatment doesn't work you still get charged, no refunds!

For-profit healthcare is fundamentally inhumane and is incompatible with capitalism. The forces that would usually regulate the market are non-existant. Demand is infinite, undercutting is pointless, customers have no way to be informed.

There's a huge difference between emergency, life threatening care and relatively routine care. For example, if I need to get a tooth extracted, I can certainly wait to shop around a bit, and living with some pain for a few days could be worth finding a cheaper solution. I can also choose between hospitalization and self-care in many circumstances as well (e.g. normal baby delivery can happen at home or in the hospital).

For those cases where informed decisions are possible, supply and demand can work efficiently. It doesn't work as well when there's a monopoly on care, like in an ER, ambulances, etc.

And no, you don't need to be a physician to be informed, you just need to consult one. I may not know the practical difference between operations, but I do understand chances of success and costs, and I know how to get multiple opinions and decide from there. That works for any field, I can convert a problem from needing an expertise to evaluating experts. Tell me what expected outcomes, the chances of various outcomes, and the costs, and I'll get a second or third opinion if I'm not satisfied.

This gets even better the more transparent things are, because other experts can do independent reviews. A newspaper, for example, can hire a physician to review posted prices for routine operations and give an idea of how realistic those costs are. Insurance companies so exactly that, so I don't see why a private organization couldn't. News organizations routinely consult experts on stories.

But there are areas where there's a monopoly, and those mess up the market's ability to regulate prices. That's why I'm in favor of universal coverage for emergency care, but against universal coverage for other forms of care.