The landlord gutting America’s hospitals

I think by asset stripping the parent is including other plays. Private equity buys a company, sells the real-estate to their friends and leases it back to the company on a long term lease. Then after other shenanigans they IPO and dump the company back on the public. It's better than in the old days because they don't fire everyone and sell the assets. They may even make some positive changes, but the company now has to pay rent.

Except, blaming for-profit hospitals only goes so far. Only 17% of hospitals are actually for profit.

https://www.kff.org/health-costs/issue-brief/hospital-margin...

Most hospitals are non-profit. It's not completely clear what the public gets in exchange of that $28 billion tax exemption.

Socialized hospitals have waiting lists while for profit hospitals have health insurance companies denying coverage. The problem is the demand outstrips the supply and you end up with some form of rationing of care, this is not a problem with profit motive.

Why stop there? Should we have for-profit grocery stores?

Please explain what exactly that would change about this situation.

The entire point is most of the surplus from the hospital is being extracted as real estate rent. The hospital itself doesn't need to post a profit in order for the overall scheme to be profitable for the perpetrators.

Furthermore as far as getting into this situation, administrators of a non-profit are just as capable of asset stripping to post good numbers in short term, and self-dealing to enrich themselves long term.

> For hospitals, especially rural hospitals, I think trying to run them for economic gain just doesn't work.

In current day America it doesn't seem like anything useful is compatible with making money. From the outside, it looks like you've entirely divorced money from common good.

It is possible to make hospitals profitable, but it requires you to take control over what sorts of things you wish to make a profit.

So you mean that there is just one rule, capital calls the shots. Then why do we even have laws and regulation?

I think that every market needs regulation to work well. Different rules for different markets, but they need regulation to keep participants on relatively equal footing, for example to avoid cartels.

This is the thing I think alot of people dont understand. Capitalism is not about people and their interests, its about capital, its perfectly willing to sacrifice social good, people's lives, etc. all in pursuit of Capital and its interests. Until people start to wisen up to this, we will continue to hear stories of organizations doing clearly evil things to serve their bottom line. The opioid crisis being caused by pharmaceudical companies in America being a clear example of this.

Right, but over 20 million people do. And those are generally less wealthy people for whom price increases would be quite a hardship.

There are plenty of examples of invidiuals who do object. However, unlike in other countries, developers and the government are free to bully them and ruin their lives for daring not to sell their homes. Plenty of examples of houses in the middle of highways (one famously literally in the middle of the road), packed between huge flats, in the middle of active construction sites, placed on top of huge hills or pits when land height is altered, and other places where you'd never want to live.

That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree.

My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged.

The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.

We spend so much because mostly we're spending other people's money, and no party is really in a position where cost control is possible and beneficial.

The patient might prefer to pay less out of pocket, but they often aren't presented with cost information until a month after the service. Often nobody can tell you how much something costs before hand. Anyway, there is incentive to get more covered care, because insurance is paying for most of it.

Insurance companies are generally limited on administrative costs and profit to a % of medical costs. More costs allowd them to pay higher executive salaries and profits. Insurance companies do have a cost control function, but the incentive isn't there to do it well.

Individual practitioners and medicial facilities and facility groups have incentive to bill more things.

People paying for the insurance, which is often employers, do have cost control incentives, but things are pretty murky at that level.

Somewhere in all of those costs, we're paying for an army of billing specialists and an army of claims handlers.

Throwing out insurance and moving to billing at time of service would be terrible for access but it would make cost control a lot more possible. Single payer systems can make cost control possible too, if the single payer system is able to do analysis and effectively set policies to avoid things that are not cost effective, and curtail billing abuses... Of course, nobody likes it when cost control says the thing they want to do isn't cost effective and they can't do it.

Yes, from what I have read it is that Americans pay for more for doctors, drugs, and services. And when attempts are made to begin to curtail these costs, the lobbyists swoop in and buy off our politicians.

We have a shitty universal healthcare system where the destitute get unlimited healthcare but only at emergency rooms, which is both extremely expensive and not that effective at making them healthy compared to e.g. regular primary care visits with free insulin and antipsychotics. The unpaid emergency rooms bills bring the hospital down and they have to take it out on the middle 50%

Americans also consume a lot more healthcare than others. Yes, if you are poor and uninsured in US it sucks. But americans go way more to the doctor and wait less in time than in Europe.

Extractive capitalism makes number go up. Bigger number better.

Why don't you think of the poor anesthesiologists, hospital admins and insurance execs?

Those yachts and 2nd vacation homes won't buy themselves.