When at the same time this country has an unquestioned love for profit motive in the rule of law? I'd wager that "healthcare" would be much more affordable for all in a system where the privileged weren't seeking to maximize profits in the name of obfuscating justice in the fields of law (be it civil service or any of the 'jobs' that derive income as lawyer types)
Why the hate for profit motive in "healthcare"
By errc Follow Mon, 29 Nov 2010, 8:08am 1,235 views 19 comments
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It's not hate, it's just unconstitutional when the Government tells you to BUY anything from Iwog's favorite STOCK Pick.
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Tenouncetrout says
I'm no fan of being forced to buy into the drug industry, that i'd prefer to avoid if left to my own devices. After reading Patricks thread about the Realtor (TM) gestapo harassing him, and saw the letter signed by some broad that profits by harrassing folks with less resources, in the name of the law, I wondered why Obama didn't help out all the little guys, like all democrats do, by affording equal rights for all under the law. 'Socialize' the lawyer industry
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We "hate" the profit motive in healthcare because healthcare decisions become profit driven - in the favor of the entity denying benefits. I don't mind people being paid handsomely for their efforts - physicians go to school and dedicate years of their lives to helping people and they should be paid more than a guy who sells houses (for instance). I don't have a problem with nursing homes making profits - but they shouldn't be allowed to dump people on the street if they don't pay. And hospitals shouldn't be for profit, because they attempt to hold down costs by denying benefits. Insurance companies rake in premiums but deny benefits to the sickest of their patients.
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Its simple logic. When a company is run for profit, profit is THE goal. What they do to get there is secondary. There is an inherent conflict in providing healthcare and making a profit because the profit goal encourages shortcuts in the service, or as ellie says, denying benefits. Its this drive for continuously greater profits that requires the need for regulation from the outside.
But I'm not sure what you're trying to say, to me its kind of muddled. Are you saying that if only lawyers were unable to sue healthcare companies things would get cheaper?
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Lawyers are easy to blame, and the underlying distrust for Lawyers makes them a likely story when the fat Pharm Pigs and Health care industry claims their services are high because of LAWYERS.
For the rest of us, it's a GODDAMN insult to my intelligence, NO! to a Third grader's intelligence.
A pill here in the states can be as much as $125 for one little pill. While that same pill goes for under a dollar in countries like New Zealand and Canada. It would seem to me, that if litigation made the cost of products and services one price in the country where they originate, then that price would follow it across borders.
Name one damn thing that comes from the UK, yet it is cheaper to buy in America...
OH that's right there isn't anything, because that isn't the way buying and selling "Widgets" work.
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elliemae says
How do you expect them to make profits if people don't pay? Overcharge the ones that pay to pay for the ones that don't? Oh wait, that's what the hospitals are doing...
I don't want granny to be dumped on the street - but how is someone supposed to run a for-profit business if they have no recourse when someone doesn't pay? No easy answer here. Of course, in the past, families actually took care of their elderly relatives. Now they just drop them off at the home and visit them on holidays. I saw a bumper sticker once - it said "Be nice to your kids - they'll choose your nursing home someday".
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No, there's no easy answer. But once a nursing home accepts a patient, they're obligated to provide care for that patient. Administrators, Directors of Nursing, Corporate officers make quite a bit, including bonuses.
The lowest paid workers are those that do the most work - the nursing aides, housekeeping and dietary workers. They rarely get bonuses to help with their minimum wages and they are often treated like they're dispensable. Administrators receive bonuses for holding down costs, when they could actually provide better care and have more staff on the floor - which would result in a better reputation...
A quick google check of nursing home lawsuits brought up this company:
http://www.rocklintoday.com/news/templates/community_news.asp?articleid=3495&zoneid=4
They settled in 1999 with the feds by paying $4 million dollars in penalties for, among other things, billing Medicare for liquor at company parties, cigarettes, lotto tickets, and other crap. (Paragraph 5). And yet, this 2006 suit details more crap they're up to. But wait, there's more:
http://auburnjournal.com/detail/149984.html
Jury awards $28 million in elder abuse lawsuit (2010)
...and then there's:
http://www.kcra.com/r/24317261/detail.html
They settled this one, undisclosed amount.
.......................
I did a quick check of the facilities mentioned in the first article; nearly every one of them has a "below average" rating or worse, either overall or for the inspection results. There was only one of their facilities anywhere that I found to have an excellent rating. And when considering the five star rating system for Medicare, it's good to know that they're generous with their ratings. Only the worst of the worst will receive a low over-all rating because of the way they're computed, meaning it takes work to be bad.
Yet the company brags on its website that it strives for excellence. It doesn't say that, according to the state & federal governments, they don't provide it. But they do strive for it.
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"When at the same time this country has an unquestioned love for profit motive in the rule of law?"
I don't see how you can compare healthcare and the law. Healthcare companies are for profit. Are courts for profit?
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So, I wrote this book (soon to be published, whoppee!) that describes how nursing homes operate. It's not a negative thing, it explains in detail the different payment sources, etc which makes it easier to understand the process.
There are laws that mandate that nursing homes can't force family members to pay, can't dump patients out on the street, and must act above-board when dealing with patients & families.
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Also, if you are bringing up nursing home abuse and neglect (which unfortunately is wider spread than I'd like), you need to acknowledge it occurs in non profit nursing home settings as well.
I'm guessing that EllieMae was trying to link the substandard care with the low pay (thus higher profits) of certain nursing homes. And, yes, you would certainly get a higher quality, more compassionate care if you had highly skilled, highly educated, highly motivated caregivers around you. But who can afford to run a nursing home with RN's doing the toilet transfers? CNA's do hard work, no doubt. But consider this: It would be difficult enough to for you to help your cranky father, who may be in pain and virtually immobile, to the toilet and wipe then wipe his feces for him - and you presumably love your father. What do people expect occurs to the dignity of their parents when they leave them with someone making $10-$15/hr who has no memory of the wonderful support and love that your formerly handsome father once offered you? Abuse occurs because we as a society leave our vulnerable elderly, totally dependent and helpless, at the mercy of strangers. It is, unfortunately, human nature that a certain percentage of people take advantage of that vulnerability. It's disgusting but true. Eightball is correct: be nice to your children, they pick your nursing home.
Or...maybe....let's deal with the REAL issues behind the expense of healthcare instead of making the assumption that excessive profits are the primary problem, because I don't think that is the MAIN issue. The main issue is that we have made so many advances in science and technology that we are a victim of our own success. We can keep people alive longer, sometime to linger for YEARS (although the quality of life is highly questionable). In the past, you got a fatal illness .... you got pain meds and faded away. Now, you are vented, stented, J-tubed, G-tubed and left in ICU's for weeks and weeks until you are transferred, tubes and all to a nursing home. End of life care is where most of our healthcare dollars are spent. Do you think that hospitals, nursing homes, doctors, nurses, CNA's, etc should do this for free? Do you work for free? Or do you profit from your labor?
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artistsoul says
No, but a CNA's case load is 10-15 patients, while the administrator is getting bonuses for keeping costs down. Care would be better if there were more cna's per patient, even one more makes a huge difference. RN's don't do all the work, nor do LPN's. The CNA's are changing, bathing and spending time with patients - but don't have enough time to provide personal service because they're busy with a high caseload.
artistsoul says
Nope, they shouldn't work for free. These aren't the patients who are usually free - they deplete their assets and go on Medicaid after Medicare pays the full 100 days. And hospices are hanging out at hospitals grabbing every patient possible. Hospice is unbelieveably aggressive (some of them are) and make shitloads of money serving patients in nursing homes. Medicaid could be paying $200 a day to the nursing home while Medicare pays $6,000 a month to the hospice for "end of life care" which the nursing home provides. They shouldn't allow hospice to serve nursing home patients at full cost, should reduce the reimbursement to 30% because the hospice doesn't do much in nearly every case. These are the most desireable patients to hospices because the nursing home does all the work - thereby reducing costs. Unless there is pain or symptom management needed, hospices shouldn't serve patients in nursing homes.
Every hospice will tell you how beneficial they are. But not in nursing homes - they're just another drain on the healthcare dollar there. There are many patients who, if the treatment stopped, would die sooner than later. They don't need hospice to do that, even tho the hospice will say that they do. I worked for a huge national hospice that paid a $20 million dollar fine about 5 years ago because of their high pressure marketing tactics and not allowing patients to sign off service. I've seen some amazing fraud, but the patients don't usually realize it because of the song & dance from hospice.
End of life care is expensive, but not where out $$$ are spent the most IMHO. $ are spent on profits and high salaries, while those workers who do the most are paid the least. And insurance profits are huge, as are the hospital corporations. End of life care is usually the last few months of someone's life and most people opt to go off life support.
We pay nursing homes a shitload of money to provide care, and they should have to provide it. Not for free in all cases, but they should have to provide some free care. There should be a cap on the profits based on their care - if all of the facilities are providing below average care, they should be paid less. That would force them to be better.
The "free" patients usually can't provide income proof or something stupid because they don't have bank accounts - so Medicaid denies them and the nursing home dumps them on the streets. If they admit the patients, they're responsible for them and should be held accountable. There are many nursing homes that have benefits specialists who help patients apply - but if they don't, the patients are sent home or the family is charged for their care. Families aren't liable but don't know it - and when and administrator is threatening to ruin your credit for your mom's bills, you feel intimidated.
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It sounds as though, from your account, that (at best) some hospices are using aggressive marketing to lure business their way or (at worse) it is more than opportunism but fraud. I'm curious about the profit margins of the average hospice.
The thread was, in fact, about profit margins. Again, I do assert medical care providers are entitled to a profit margin. The question is how excessive is it. Sometime ago I read an article in Forbes that discussed the fact that most hospitals in America aren't breaking even. The article went on to survey the top 25 hospitals nationwide which were making a profit. The profit for these "top" institutions was on the order of 25%. So for every dollar of patient revenue they are getting $.25. However, the Forbes study was done to question WHY these few hospitals were making a profit when others were just barely breaking even. The implication was that it had more to do with those facilities having a monopoly in their area & thereby were able to charge more....not that they ran a tighter ship.
Anyway, I'm certainly no expert on the healthcare system. Perhaps you are. My point is not to inflame you but to understand why our healthcare system is so dysfunctional. I still have to insist that profit margins are not the root of the high costs. For one, other than pharma, I'm not sure high profit margins exist across the board (correct me if I'm wrong). Further, no profit of any amount can be made if a bunch of unnecessary procedures which extend life are done. End of life care is insanely $$$$$. The bill for a month in the ICU?? Sounds like you know. We do things in America (IMHO) for a variety of reasons, many of which are not in the best interest of society as a whole. We have the expertise to do some pretty amazing interventions which extend life. On the individual level, it can be wonderful. It can be life saving. Even if the patient is only a shell of him/herself, it can give family time to say goodbye or grieve. Health care rationing is only good for "the other guy", not my family. This is why it is going to be a huge problem to deal with. If we want to continue to give EVERYONE the latest and newest "standard of care" we are gonna go broke IMO.
We treat things very aggressively in America. That is not necessarily a bad thing. But who will foot the bill? You know how many on the site refer to the superior care in countries such as Germany? Well, in some cases, yes & in other cases no - it depends on your definition of good care.
Germans have some fantastic care that they provide their healthy population (for goodness sake you have a week's hospital stay after delivering a child in this country). But, they view death a little differently I think. I'll preface this by clearing stating this is anecdotal evidence; however, I am thinking of a particular situation involving an ex-pat married to a German citizen. He received his dx from his normal German provider that he had lung cancer. This German doc essentially knew that this type of lung cancer was aggressive and offered a very poor chance of recovery. He was given meds and that's about it. Distraught, his wife took him to the docs at the American ARMY base b/c he was a veteran. We Americans go for it. If we can try to resect it, we do. If we can offer chemo or radiation, we do. If the chemo or whatever is successful and he lives until month 4 but the cancer has now spread to his bones & he has compression fx in his spine than we offer a vertebroplasty. And on and on. Ringing up the tab to what end.
NOW: do not misunderstand. It is a very serious ethical question about when to ration medical care. Like I said, what is good for the whole is not always good for the individual. But, just keep in mind, the better we get at curing and extending life, the more the costs will rise. When the boomers start requiring end of life care, the country might hear one giant collective gulp when the bills come in. End of life care is, IMHO, the root of the escalation of costs - across the board, to include insurance premiums. If you have information that specific HMO's, hospitals, nursing homes, insurance companies are enjoying profit margins which are beyond the norm and sinking us, please correct me. Seriously, because I am not here to offend you or "prove" I'm right (unlike many other folks on some of these threads). I'm here to learn from others. I may not agree with you but I will always listen to you.
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artistsoul says
Doctors refer to the hospice or home health agencies they work for or own. People die every day without hospice; I'd venture to guess that at least half of the people on hospice would do just fine without it. We pay (Medicare that is) $150 or more every day for these patients, even if they don't need anything. That's on top of the $6000 Medicaid is paying a nursing home to care for a patient.
The company I discussed above makes the exact same amount as one with an above average score card. The CEO gets huge ass bonuses whether or not the patients are well cared for - and it shouldn't be that way.
I'll get specific info on profits sooner or later - but healthcare should never be an option. A little profit is okay, but rewarding companies because they hold down costs by denying benefits is wrong.
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Okay - I'm seeing a littler clearer picture of what you were exposed to which has shaped your views. Naturally, I don't think anyone would argue that a CEO that gets a "huge ass" bonus regardless of whether their patients were well cared for is appropriate. Any more than a CEO of a Fortune 500 company should receive the ridiculous compensation they often do even when their company fails on every measure of success from stock performance to profits to customer satisfaction. The structure of CEO's pay is an entirely different subject from the question of profit motive for the healthcare provider.
But you bring up some interesting points which make me question how we can possibly unravel the medical care issue in our country. First, you mention that it is absurd that the company you were previously employed by made the exact same amount as other companies with an "above average score card". Watch out: because, unfortunately, that is what socialized medical care can produce. Medicare is awful on so many levels. It's tough to begin.
Secondly, in theory, I 100% agree that it sounds atrocious that HMO's are rewarding providers for holding down costs by denying benefits. I need to understand the basis of these denials. On some level we do need to ration healthcare (i.e. deny benefits). To "reward" a doctor is, I would agree, repulsive. If the literature shows that the px is very poor, there are times when it is appropriate to deny a procedure. It is tough to make a hard and fast rule. Each patient is different. What are the physician's findings? What is the age of the patient? Is this the only failing organ system? Etc. So many variables go into deciding when to move ahead with a procedure.
I guess I'm really saying that you are correct to be upset and outraged over some of the things you have witnessed. But, please do step back to consider the larger picture. It might be too simplistic to assume that profits of insurance companies and hospitals are responsible for the spiraling healthcare costs. I'd bet you are incorrect. You might be able to google the topic and find examples of a host of differing medical care providers that were operating with high profits. But, again, that is ONE piece of the picture.
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HousingWatcher says
Generally speaking, are law firms for profit? What is the typical law firm profit margin vs. other industries? Since many law firms are set up as partnerships, what is the typical income of a partner of a law firm that makes the majority of its revenue by suing components of the health care industry? Was the wealth of John Edwards somehow more justified than the wealth of the CEO of a health care industry company?
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artistsoul says
You have been "corrected" on the issue of insurance company profit margins numerous times, but have no interest in the facts of the matter. That is, unless you believe that profit margins of 3-4% are "beyond the norm and sinking us" despite your own partial recognition above of some of the significant drivers of costs ...
Is it the fault of hospice CEOs that half of the people they serve don't really need it? Is it the fault of insurance or pharma CEOs that the costs of such things as CAT scans, MRIs, artificial heart valves, etc., have risen substantially since the middle of the 20th century?
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artistsoul says
If doctors ran the system, things would be different. It's businessmen that run the system. We should be rewarded on the number of people we treat and their satisfaction, not the amount of money we save by "managing" their healthcare.
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If Paralithodes feels a 3-4% profit margin is justified, then I would agree. However, his post is not entirely clear. My argument is, in fact, that it is NOT the profit margins that are driving costs. Read the thread.
I did seek information (facts) regarding profit margins of the average healthcare provider. At no time did anyone "correct" me with facts on profit margins? Facts, not feelings.
Paralithodes, despite his condescension, does raise some provocative questions. (1)" Is it the fault of hospice CEO's that 1/2 the people they serve don't really need it?" Morally, yes. I have to side with doing the right thing. This is a cost driver then. I believe in profit for fairly made gains. Making profit from people who don't require your service is wrong. (2)" Is it the fault of insurance or pharma CEO's that costs of such things as CAT scans, MRI's, artificial heart valves, etc., have risen substantially since the middle of the 20th century?" I think he means to say that these innovations/inventions have driven up costs. CT and MRI have been around like 25 yrs. They are standard of care now. The physical exam is going extinct. No doc makes a final dx without them. Why would they? It is much safer to SEE what is wrong. This is EXACTLY my argument: we are the victims of our own success in healthcare.
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I am not referring to *insurance* companies but rather the profits of the healthcare provider. Insurers use premiums to invest and part of their "profits" is investment of revenue over required reserves. It was another poster who suggested the 3-4% profit margin. The question I have is what is the primary cause of spiraling healthcare costs? Certainly, you can't believe that profit margins just started escalating in the last decade because business owners got greedier. There is more involved. I still believe it is the level of care we offer (doing more than other socialized systems do for their population). We do so much to intervene in America. It's a learning process. We keep perfecting it. But, if you combine the level of care we provide with the poor state of the American population's health (see thread on Obesity), and you have the perfect storm.
Japan is not a true socialized care system in that the government revenue covers only 70% of care costs. But, most folks would label them socialized care. Most of their service is given through large hospitals, etc. They do, I understand, have the same issues as Canada in terms of being turned away and longer waits. As far as their MRI's, yeah....much cheaper. The government dictates what they will pay the medical equipment suppliers...so look to THEM for the mark-up. The med equipment supplier, for their part, indicate that poorer quality, lower density scans go to Japan at those bargain basement prices. Whatever. We could still learn from this country, as we can from other socialized systems.
Let me clear up a couple things: (1) I agree there is some collusion between providers. However, I do believe it is much less than say in the 1980's when the orthopedic surgeon had a stake in the MRI company he referred patients to. When he wasn't referring patients there, he was being treated to a cruise in the Caribbean by a pharma co whose drug he often prescribed. Greed has always been in medicine but if you are old enough to remember the 1980's, you would know collusion isn't as easy now as then. (2) The massive bureaucracy is a huge ball and chain around our current system. I didn't mention it only because I was focusing on what I believe is the MAIN issue. However, the bureaucracy issue is a close second. It is maddening how many resources are devoted to working the system (esp with respect to Medicare). There are days long seminars on how to bill, which CPT codes to use, etc to maximize return. I have been in a place where I know that the same procedure in a hospital is one price for someone covered by Workers' Compensation Insurance, one price for Auto and Liability carriers, one price for the pay for service, one price for Medicare, a huge set of complicated prices for Health Insurers (dependent on the agreements), etc. It is, unquestionably, ridiculous. It is done to shift costs - which is unfair. I hate this about the current system. Cost shifts occur because EVERYONE does ultimately get coverage whether you have insurance or not. Those that have insurance have to pay already for those uninsured. So, whether the insured continue to pay through higher premiums or pay through higher taxes, what is really the net difference??
I am only pointing out that we do a lot here in America. That we will have some tough choices in America with respect to Medicare (which covers end of life care). Costs are up, I still contend, not so much from profits but from the extent of the care we provide. And, from the fact that our elderly die outside of our homes. You need to examine how death and dying is treated in other countries where medicine is socialized.