Eduardo notes that care in non-profit facilities are superior in care and costs overall than there for profit equals. On that we agree, kinda, sorta. Medicine should not be for profit at all but we have a large variance on what defines "non-profit." Many local hospitals and medical facilities are in fact non-profits. They are charted and in turn registered that way under the IRS code. Many insurance companies are also registered as non profit. Two of which I can point out here in Seattle are Group Health Cooperative as a non profit HMO organization and Lifewise Insurance as coverage agent, also not for profit.Then we have of course all the State and/or University Hospitals. Harborview Medical Center is run by the University of Washington which also owns Northwest Hospitals. Both not for profit.
Having been the victim of the first two and what defines "standard of care" I would rather go to a Veterinary Hospital than set foot in Harborview or have any UW "Doctor" aka "Student" lay their filthy hands on me. I equate my nightmare akin to the Steubenville Rape Gang only with higher degrees and vocabulary (okay maybe not the vocabulary part). And Group Health here is not much better frankly. Its nickname "Group Death" and I cannot disagree.
Not for profit means nothing in this country. NOTHING. We have many many not for profits that seem to have a statement of intent that has NOTHING to do with its operations. Many of these not for profit hospitals and HMO's have millions of dollars in resources of available and in turn millions of dollars in compensation for Executives and Administrative staff. The rank file however, you know the ones cleaning your ass, make well shit. Perfect metaphor frankly. And as a result your care is shit as well. Clean up in Room 10.
However if we do examine what appropriate care is and define it and remove the profit, put appropriate regulation and legislation in place, monitor, audit and in turn manage it appropriately with clear expectations, we might have the ability to have not for profit care for all. But again as in all things in this country we have chickens in the hen house and the Rooster too. Busy he is making sure his needs come first. We have no one available, willing or able to actually do anything in this country.
We need an new Amendment to that wonderfully outdated document that the White Establishment adores so much. One that states: "We the People means now we the Rich People and the Corporations and under that we are permitting who is equal and what it means to be entitled. The rest can go fuck yourself"
This is our Country. If we are ever to restore it, we need to rebuild it.
Health Care and Profits, a Poor Mix
By EDUARDO PORTER
Published: January 8, 2013
Patients entering church-affiliated nonprofit homes were prescribed drugs roughly as often as those entering profit-making “proprietary” institutions. But patients in proprietary homes received, on average, more than four times the dose of patients at nonprofits.
Writing about his colleagues’ research in his 1988 book “The Nonprofit Economy,” the economist Burton Weisbrod provided a straightforward explanation: “differences in the pursuit of profit.” Sedatives are cheap, Mr. Weisbrod noted. “Less expensive than, say, giving special attention to more active patients who need to be kept busy.”
This behavior was hardly surprising. Hospitals run for profit are also less likely than nonprofit and government-run institutionsto offer services like home health care and psychiatric emergency care, which are not as profitable as open-heart surgery.
A shareholder might even applaud the creativity with which profit-seeking institutions go about seeking profit. But the consequences of this pursuit might not be so great for other stakeholders in the system — patients, for instance. One study found that patients’ mortality rates spiked when nonprofit hospitals switched to become profit-making, and their staff levels declined.
These profit-maximizing tactics point to a troubling conflict of interest that goes beyond the private delivery of health care. They raise a broader, more important question: How much should we rely on the private sector to satisfy broad social needs?
From health to pensions to education, the United States relies on private enterprise more than pretty much every other advanced, industrial nation to provide essential social services. The government pays Medicare Advantage plans to deliver health care to aging Americans. It provides a tax break to encourage employers to cover workers under 65.
Businesses devote almost 6 percent of the nation’s economic output to pay for health insurance for their employees. This amounts to nine times similar private spending on health benefits across the Organization for Economic Cooperation and Development, on average. Private plans cover more than a third of pension benefits. The average for 30 countries in the O.E.C.D. is just over one-fifth.
We let the private sector handle tasks other countries would never dream of moving outside the government’s purview. Consider bail bondsmen and their rugged sidekicks, the bounty hunters.
American TV audiences may reminisce fondly about Lee Majors in “The Fall Guy” chasing bad guys in a souped-up GMC truck — a cheap way to get felons to court. People in most other nations see them as an undue commercial intrusion into the criminal justice system that discriminates against the poor. < Our reliance on private enterprise to provide the most essential services stems, in part, from a more narrow understanding of our collective responsibility to provide social goods.
Private American health care has stood out for decades among industrial nations, where public universal coverage has long been considered a right of citizenship. But our faith in private solutions also draws on an ingrained belief that big government serves too many disparate objectives and must cater to too many conflicting interests to deliver services fairly and effectively. Our trust appears undeserved, however. Our track record suggests that handing over responsibility for social goals to private enterprise is providing us with social goods of lower quality, distributed more inequitably and at a higher cost than if government delivered or paid for them directly.
From the high administrative costs incurred by health insurers to screen out sick patients to the array of expensive treatments prescribed by doctors who earn more money for every treatment they provide, our private health care industry provides perhaps the clearest illustration of how the profit motive can send incentives astray.
By many objective measures, the mostly private American system delivers worse value for money than every other in the developed world. We spend nearly 18 percent of the nation’s economic output on health care and still manage to leave tens of millions of Americans without adequate access to care.
Britain gets universal coverage for 10 percent of gross domestic product. Germany and France for 12 percent. What’s more, our free market for health services produces no better health than the public health care systems in other advanced nations. On some measures — infant mortality, for instance — it does much worse.
In a way, private delivery of health care misleads Americans about the financial burdens they must bear to lead an adequate existence. If they were to consider the additional private spending on health care as a form of tax — an indispensable cost to live a healthy life — the nation’s tax bill would rise to about 31 percent from 25 percent of the nation’s G.D.P. — much closer to the 34 percent average across the O.E.C.D.
A quarter of a century ago, a belief swept across America that we could reduce the ballooning costs of the government’s health care entitlements just by handing over their management to the private sector. Private companies would have a strong incentive to identify and wipe out wasteful treatment. They could encourage healthy lifestyles among beneficiaries, lowering use of costly care. Competition for government contracts would keep the overall price down.
We now know this didn’t work as advertised. Competition wasn’t as robust as hoped. Health maintenance organizations didn’t keep costs in check, and they spent heavily on administration and screening to enroll only the healthiest, most profitable beneficiaries.
One study of Medicare spending found that the program saved no money by relying on H.M.O.’s. Another found that moving Medicaid recipients into H.M.O.’s increased the average cost per beneficiary by 12 percent with no improvement in the quality of care for the poor. Two years ago, President Obama’s health care law cut almost $150 billion from Medicare simply by reducing payments to private plans that provide similar care to plain vanilla Medicare at a higher cost.
Today, again, entitlements are at the center of the national debate. Our elected officials are consumed by slashing a budget deficit that is expected to balloon over coming decades. With both Democrats and Republicans unwilling to raise taxes on the middle class, the discussion is quickly boiling down to how deeply entitlements must be cut.
We may want to broaden the debate. The relevant question is how best we can serve our social needs at the lowest possible cost. One answer is that we have a lot of room to do better. Improving the delivery of social services like health care and pensions may be possible without increasing the burden on American families, simply by removing the profit motive from the equation.
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