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Greed + Cartels = U.S. Sickcare/ObamaCare
Submitted by Charles Hugh-Smith of OfTwoMinds blog,
Sickcare/ObamaCare is fundamentally broken at every level.
The incremental nature of change makes it difficult for us to notice how systems that once worked well with modest costs have transmogrified into broken systems that cost a fortune. Exhibit # 1 is higher education: 40 years ago, four-year public universities were affordable and two-year community colleges were almost free. Now students have to borrow $1 trillion to pay for the exorbitant privilege of higher education.
And no, the difference isn't that states don't provide the same funding--the difference is costs have soared while the yield on the investment has plummeted. Please read:
Our Two Most Onerous Taxes: College Tuition and Healthcare Insurance
Our Middleman-Skimming Economy
America's Make-Work Sectors (Healthcare and Higher Education) Have Run Out of Oxygen
Longtime correspondent Ishabaka (an M.D. with 30+ years experience in primary care and as an emergency room physician) responded to this article with an insider's account of what happens when greed and cartels take over healthcare. After reading What's wrong with American hospitals?, a scathing deconstruction of for-profit healthcare, Ishabaka submitted this commentary:
I could have told you what was wrong with our hospital system by 1989 - nobody would listen to me back then.
Up til the '70's, almost all hospitals in the United States were not for profit COMMUNITY HOSPITALS. They were LOCAL. The Board of Directors was made up of some senior doctors, maybe the head nurse, and various other prominent local businessmen and professionals. Others (mostly Catholic), were run as non-profits by religious orders. A very few, mostly very small hospitals were for profit, usually owned by a group of doctors, or even one doctor.
The mission of these community hospitals was to provide for the LOCAL COMMUNITY - one and all. Payment was various - private insurance, Medicare, Medicaid, self pay - and the idea was to collect just enough money to keep the hospital going, and provide care for the poor who had no money to pay. If your grandma got bad care - you could go - in person - to the local, say, banker, on the Board of Directors, and tell him - and he would CARE.
THIS SYSTEM WORKED, and kept costs DOWN. Remember, the hospital just needed enough money to stay in the black. Often local wealthy people would will money to the hospital in which they had been cared for.
In the '80's - there was the arrival of the for-profit cartels - and I use the world cartels specifically - these were run by people with the sociopathic Goldman Sachs type mentality - their sole goal was to acquire huge sums of money for themselves, their hospital directors, and their SHAREHOLDERS. They used a typical sneaky technique - they'd come into town, and tell the locals they could run the hospital much cheaper, because of their economy of scale. People believed this, and the cartels bought out most of the community hospitals.
I worked at one such for-profit hospital and had a 21-year old indigent man come in who'd been struck by a car while walking, and was rapidly bleeding to death. The hospital administrator refused to open the operating room, even though I had a surgeon right there, willing and able to operate for free to save this young man's life. The surgeon threw a fit, and he was a big wheel at the hospital and the administrator backed down - otherwise I firmly believe the young man would have died. This was LEGAL back then, before the EMTLA law was passed because similar abuses were rampant NATIONWIDE.
Around this time, the administrators of the remaining community hospitals found out the administrators of the for-profit hospitals were making tens of times their salaries - and bonuses based on profits - and started demanding similar salaries and bonuses based on PROFITS - a contradiction of the old concept of community hospitals (the article does touch on this).
How do you increase hospital profits? Number one - avoid any care for the poor you can weasel out of. Number two - cut staff to the bone and beyond (one of hospital's biggest expenses). Most American hospitals now have UNSAFE nurse to patient ratios because of this.
As far as patient care goes, nurses are the most important people in hospitals. I know of one lady who DIED while in a monitored bed, and wasn't found dead until several hours later due to the criminally low nursing staff ratio in a hospital I worked in. I HAD complained about the dearth of nurses, and was threatened with the loss of my job. Another side effect of this is, nursing in hospitals has become unbearable for nurses who really cared about their patients - many good hospital nurses have left hospital work for other fields. The results are appalling.
I saved the life of a patient an unqualified, under-educated nurse gave the wrong medicine to - a medicine that IMMEDIATELY MAKES YOU STOP BREATHING, because it was cheaper for the hospital to hire her than a knowledgeable and experienced nurse. The medicine is pancuronium bromide, if you want to Google it. The nurse didn't know one of the effects was cessation of breathing - this is Pharmacology for Nurses 101, this drug is used all day long in every operating room in America (where doctors WANT patients under anesthesia to stop breathing, and put them on breathing machines during the surgery - which is very safe if done correctly).
I could go on and on. Simple things, like the instruments you use to suture cuts - community hospitals used to buy Swiss or German made ones that were of the finest quality, sterilize and re-use them over and over. This changed to disposable instruments that sometimes literally fell apart in my hands. Bandage tape that didn't stick, instead of quality Johnson and Johnson tape - anything to save a buck.
It is not getting better, it is getting worse. The nurses I know tell me hospitals are cutting staff even MORE now in preparation for Obamacare.
I will end with a story that illustrates the difference between Old School and New School hospital administrators.
I had the pleasure of working five years in a real community hospital. One of the senior administrators (R.I.P.) was a gentleman who'd made his fortune in the grocery business. In his late 80's, he would arrive at the emergency department entrance every morning between seven and eight am, and proceed to walk throughout the hospital. He would ask various and sundry staff how they were getting along - everyone from janitors to senior physicians. If something was amiss - HE RECTIFIED THE SITUATION. Tragically, this hospital was bought out, and is now part of a chain.
I had the displeasure of working in a "community" (really for-profit) hospital with a middle aged administrator who NEVER set foot outside his office or conference rooms - he NEVER appeared in the (very large and busy) emergency department once. This was in the early 90's, and one year it was revealed that his compensation was $600,000 - and a brand new Lexus as a "performance bonus". He was on the golf course by three pm every single day. That was the hospital where the woman who was being "monitored" (alarms and all that) was found very cold and dead after a delay of who knows how many hours.
Thank you, Ishabaka, for telling it like it really is. Needless to say, ObamaCare (the Orwellian-named Affordable Care Act--ACA) purposefully ignores everything that is fundamentally broken with U.S. sickcare and extends the soaring-cost cartel system, essentially promising to stripmine the taxpayers of however many trillions of dollars are needed to generate outsized profits for the cartels.
Only those with no exposure to the real costs of ObamaCare approve of the current sickcare system. Government employees who have no idea how much their coverage costs, well-paid shills and toadies like Paul Krugman, academics with tenure and lifetime healthcare coverage--all these people swallow the fraud whole and declare it delicious.
Only those of us who are paying the real, unsubsidized cost know how unsustainable the system is, and only those inside the machine know how broken it is at every level. Greed + cartels = Sickcare/ObamaCare. Love your servitude, baby--it's affordable, really, really, really it is.
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Senior management exists to screw the stockholders.
Middle management exists to screw the customers.
Lower management exists to screw the workers.
Unions exists to screw management.
If you aren't screwing somebody, you are just getting screwed.
This shit show is rolling right along according to plan.
Like Barry told the SEIU... "I am a firm beliver in the single payer system" The scripit was written the players took their places and here we are on the way to nervana!
One thing is certain for grandpa and grandma they will be culled much sooner than they may think.
Re: grandpa and grandma they will be culled much sooner than they may think
Let's hope so, these people have been sucking on the public tit for way too long now. Let them die.
You first.
.
Another difference from how things worked in the 80's: Hospitals didn't all have the readily available diagnostic equipment they have now, and there certainly weren't free-standing imaging centers. Facilities were required to apply for things like CT scanners via Certificates of Need and they were granted one or two based on community size and requirements. It was a big deal being a large enough community or teaching facility to have up-to-date equipment.
Later, as every hospital had the equipment it meant that every knock on the head or every drunk was found passed out and MAYBE hit his/her head on the way down, they got a head CT. Some of the street people who were frequent flyers at the teaching hospital I worked at had outstanding balances in the millions based solely on their ER visits.
Just one example of costs gone wild but it is an example of how things took off based on technology.
After the ER I went into critical care. The enormous waste of resources for a nearly always certain outcome was more than downright depressing.
I headed back to Level I trauma. At least it was fast-paced and the odds were better.
if the ER physicians actually examined those frequent flyers before ordering CT scans, maybe they would be done less. But as long as triage nurses are illegally ordering exams or PAs incompetantly ordering exams or even good ER doctors afraid of malpractice lawyers unessesarily ordering them it will continue.
Yes to the over-testing due to worries about missing the one brain bleed out of 1000 and what that would do to the malpractice insurance.
No to them being done without an MD/DO exam. Triage nurses are/were limited to what they could order prior to a physician seeing the patient first.
Things may have changed. Happily, I walked away from the system awhile back and except for the missing the adrenaline of it all I'm better for it.
triage nurses are prohibited to order exams , but wink wink it happens all the time
I'm not a fan of socialism (or any form of collectivism in general), but I think it's worth pointing out that the US public health expenditure per capita has exceeded that of countries like Canada and the UK for some time. Something is, quite obviously, broken, and I don't really want to hear excuses about greater access and superior care anymore. We have neither.
Re: We have neither.
We do for the top 20%. There are two separate societies in the US.
Those who matter (the top 20%) and the bottom 80%; the worthless leaches who aren't really Mericans (most of them are "those people")
So, the society that are really Mericans - 60 or so million patriots - have FAR better care than Canada or the UK.
Who cares about the rest, they aren't even Mericans! They are just the losers in a survival-of-the-fittest society.
You must be a commie if you think the society can give everybody the same healthcare.
if what you say is true, we wouldnt be susidizing them to continually lower the gene pool
Re: we wouldnt be susidizing them to continually lower the gene pool
What percentage of the population is subsidized? The trash-class is the bottom 70%, they don't count. I don't think 70% of the population is subsidized, yet.
Well, unless you count the OldFart and everybody living off of Big-Ag, Big-MIC, Big-Road, Big-Water, Big-Airport, Big-Energy, Big-Ed, Big-House, Big-Fin, Big-OldFart, Big-OldFartHealthcare, Big-AntiDrug, & Big-PoliceState.
What do you mean by "subsidized"
Do you actually believe that the top 20 to 30% are in the clear? I hope you're trolling. Otherwise, you're probably in for a rude awakening.
Re: Otherwise, you're probably in for a rude awakening.
The top 20% OWNS most of the country.
You are right about the 30% range, they are probably screwed if they get sick. And the trash-class in the bottom 70% are absolutly screwed, but they are genetically inferior anyway, so we need some way to eliminate them.
It mostly depends on save wealth when it comes to bad sickness, but good insurance helps.
Not sure if you're trolling or not, but I've definitely sought healthcare since my entrance into the upper tiers. Every time the care itself was shit, and I paid a good chunk out of pocket regardless of the supposed quality of my insurance. I'm not suggesting that we can give everyone the best, nor am I suggesting everyone deserves such care, but with the amount of public spending, the baseline should be higher.
Re; Every time the care itself was shit, and I paid a good chunk out of pocket regardless of the supposed quality of my insurance.
I don't know. I've always worked for large corporations - most of them leaching off the government in some way or another - and we've always had great medical coverage; I don't think I've paid more than a few hundred dollars for anything in my life - and that includes a few surgeries
I guess it just depends how far down the survival-of-the-fittest ladder you go.
It's a survival-of-the-fittest society. Everybody can't win. If you bitch about it, you're just one of "those people".
Don't be so sure you're above me on the ladder, chump. Based on what you're telling me, you're on the brink of financial ruin, just like everyone else that relies on their employment for insurance.
Re: Based on what you're telling me, you're on the brink of financial ruin, just like everyone else that relies on their employment for insurance.
It's all based on financial capacity.
In a survial of the fittest society, if you or a relative gets sick AND you've got good insurance AND you've got enough wealth you'll be covered.
If not, you're just another loser: unfit in our society. (and hopefully, you're genes won't be passed on).
I have no idea where you stand. I know where I stand. I don't honestly care about society. I'm perfectly happy letting the losers die. And that includes the worthless OldFart leaching off their socialist scams. I'm a TRUE Libertarian.
Do you really think financial success in this cartoon economy is a valid metric to use in determining whether one is fit to reproduce? That's fucking stupid; there are more effective ways of assessing viability.
Survival of the fittest, bitchez.
I would rather spend my extra money on booze than pay for someone else's kid's cancer treatments.
If you have EVER spent a dime on something unnecessary, then you're in agreement with me.
I would rather spend my money on something of my own choosing than have it stolen from me by some "majority" using their "vote".
Freedom to choose, how novel. /s
Re: Freedom to choose, how novel.
Yeah, it is actually.
Societies are organized to limiting the freedom to choose. The less wealth you have the less choices. That's why the top 10% buy the policians, to limit the choices of the dumbasses in the bottom 90%.
The top 10% - of any society - doesn't want to lose their wealth to the majority.
Limited choice is a feature - not a bug - of a hierarchical human society.
If you like freedom so much, move to a society that give you more freedom. A few days ago, some of the "Libertarians" were speculating that Norway, Asia, and Russia were much more free than the US because - well, they were Libertarians, so their reasoning was "confused". Norway? Yeah, NORWAY. The guys who invented ObummerCare.
Humans are inherently hierarchical, so every human society is a "hierarchical human society". That said, Norway, as I understand it, has excellent healthcare. They're a great example of how collectivist policies can work in a more homogeneous society.
Re: collectivist policies
Agree, I just had to laugh at "Libertarians desiring freedum from ObummerCare" would move to NORWAY!
Too funny.
Norway simply sits on a gold mine of natural resources that vastly exceeds the needs of the citizen population of the country. It's a natural resource rich country that has a large trade surplus because it has natural resources that exceeds the needs of it's own population. It's basically a Saudi Arabia of Europe, which Saudi does have nationalized oil, and distributes the wealth. Communism can only work in existance of abundance. The reason for economics, and money is because there is scarcity and unequal distribution of resources. Period....
You have a marxian view of class struggle, and zero sum economics. Yes rich people do lobby politicians, but so do poor, and the working class. Politicians like to pander to the poor, and working class, promise of better future with more government laws, and welfare. It's no coincidence that democratic societies have much higher tax rates than old day monarchs. Monarchs didn't play politics to stay in power with the people they rule over.
Freedom allows opportunity. Freedom creates opportunity. You hate freedom because there is people free to be more successful than you. That's why you hate freedom. You think somebody else's success was derived by taking away from you. Low wage jobs are opportunities, but to a marxist, it's slave labor, because they are not making the profits like the employer. Employers create jobs to make a profit. People work to make a profit. In a market economy there is uncertainty. Low wage jobs are low wage, because consumers want cheaper prices. If wages are too high, it can contribute to higher prices for consumer goods, and thus the possibility of losing customers, which mean less profits, or losses, which means the company goes bankrupt, which means no jobs at all.
Do consumers like paying high prices versus low prices? Do people on 30 thousand dollar annual income go to more expensive gourment burger joints than McDonald's? Or do people of lower income levels go to McDonald's more than Red Robbin gourmet burgers that are more expensive? If McDonald's were to jack up prices for their hamburgers, people would go to McDonald's lot less, and McDonald's can potentially lose customers.
Where does wealth come from? Simply dividing money among people? If raising the minimum wage meant a better economy in the long term, why don't african countries like Zimbabwe jack up the minimum wage over there?
Economics is complex, and not subject to white, and black theories. It's complex but not that hard to connect the dots.
The road to serfdom is downhill.
Go to www.ukasiagroup.biz, you can find an alternative there to the obummer rip off
Greed is oversimplifying things. Doctors are greedy, people are greedy. Greed is a constant. There is no chart that measures fluctuations of greed leading to causation of certain events.
Government regulations create cartels, and removes choices. Hospitals as I understand it can't charge lower income people lower prices. It's against the law. Reagan signed a law that made hospitals give unpaid medical care. It's no wonder that hospitals charge very expensive at any opportunity they can get paid, because if they don't, they lose even more money, because there is people who don't pay. If one applies logic on the basis of cause and effect, we can deduce why hospitals charge 800 dollars for bag of salt water. People forget that hospitals contribute to the economy, in the expectation that other people contribute to them. It's not necessarily charity work. People purchase things with goods, and services as Mises exclaimed.
There was an old saying in the Soviet Union. "They pretend to pay us, we pretend to give medical care."
Emergency Medical Treatment and Active Labor Act http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labo...
A lot of the cost of healthcare is cartelization of patent laws & the FDA costs, which even hands patents independently. Yeah they are allowed to give exclusive rights to distribute, and sell to certain companies. There is people who say but we need patent laws, without patents, mankind would have absolutely no incentive to invent anything, we all go back to the caveman days. Personally I chuckle at this. The patent system doesn't just extend to medicine, but also medical equipment. A lot of the technology hospitals use are distributed, and produced solely by monopolized entities. It's also a myth that patent law is the mother of all inventions & discoveries.
Only one solution in America. Use it but refuse to pay for it. The most unaffordable HC in the world.
I think the good Doctor left out attorneys in the changing of health care.....Trial Lawyers and all of their lawsuits have changed medical practices quite a bit...many many tests are done not because they are needed..just to cover their ass in case of a lawsuit...and of course a total waste of money...and the other big item the Good Doctor left out...was all the illegal immigrants demanding the free healthcare....emergency room freebies...that is a big problem today in healthcare...
Re: that is a big problem today in healthcare
How many illegal immigrants are there compared to the entire population?
Krist, you really think the goddamn insurance companies who own the system care about the illegal immgrants one way or another?
Just had a 66 y/o pt. today who's lost 160lbs and is now OFF all medications. So... LIFESTYLE has almost everything to do with health. I say insurance should be for accidents and not lifestyle choices.
College education? HA! I joined the Navy then after discharge got a job in a chemical plant back in '64 as a chem operator...got into the electrician apprenticeship... went to NCE (now NJIT in NJ)... got an ET associates from NCE and journeyman papers from the Board of Labor, went on to Thomas&Betts as an electrician... moved to Owens Illinois as an electronics technician... got an electrician job offer from Merck and Owens Illinois put me on salary as manufacturing specialist in 1981... recession came along and OI laid off but bumped me up to plant engineer slot...things started picking up in '84 and they made me purchasing manager...retired in '98 with full OI pension...got job with Solid State Inc. as electronic kits manager...retired in 2005 and now collect big bucks from SS and my OI retirement.
College? HA!
Re: retired in 2005 and now collect big bucks from SS
And Medicare. Gotta love socialism. I'm almost there too!
A relative of mine worked in the UK in the Home Office, took early retirement on full pension, then they re-employed him within a month doing the same thing, at twice what he was paid before, as a "consultant". He's still there 8 years later.
So, full pension, plus twice his old salary. What a gravy train the state is.
Anyone match that, or better it?
New Yorkers lucky enough to find the time may want to check out Victor Niederhoffer's Junto.
Last Thursday, Feb 6 was a good one, I'm told:
http://www.dailyspeculations.com/wordpress/?p=9085
http://www.dailyspeculations.com/wordpress/?p=9087
I have never been in favor of single-payer national healthcare before, but we really need to look at the chances that Obamacare is going to be overturned. Certainly not in the next 3 years under our current President. Also, not too likely after that unless there is a complete sweep of the White House and both houses of Congress by the Republicans. And even then, it would take a change in the current inept Republican 'leaders'.
So while there are many reasons to hate single-payer coverage, the only way out of this that I can see is to stop handling out free and subsidized health care to everyone and to set up some type of rationing of health care -- which can only be done in a single-payer system. Sure, the best solution is to dump Obamacare, but with the reality being that Obamacare will live on, the very nature of giving out unlimited access to healthcare -- without any rationing -- and using more debt to pay for it -- is unsustainable...
You do realize that you fell for the trick, right?
Your conclusion (unfortunately for us) is what Obamacare was designed to get enough people to think.
To have the sheeple BEG for their enslavement and serfdom.
The problem with Obamacare foremost is the perverse incentives it gives. The subsidies encourage people to make less money, to qualify for more Obamacare subsidies. This puts pressure on the tax payer, which are usually always the sucker in the end, and encourages people to work less, which means less contributions to an economy.
Nevermind that added cost of Obamacare are going to hurt most the small businesses that are looking to grow beyong 49 employees. Employers add more employees to make more profits if their business gets response from customers, but Obamacare makes looking to achieve more profits more precarious, because if you move beyond that 49 employeee total, to 50, bang, you have to pay healthcare for all 50 employees in one swoop, and better hope your profits can take the added costs, and remember, if you raise prices on customers, they may not want your business anymore.
The democrats want to deny any of this happens, or is a factor. Obamacare is suppose to be good for everybody, and everyone, there is no losers, only everyone wins.
Free market healthcare, I mean "TRUE" free market healthcare is the most efficient in my opinion, but democratic society wants everyone covered regardless of ability to pay, so single payer, rationed care, micro managed care by bureacracy is the next best thing.....
Obamacare has been designed to be a stepping-stone to a single payer system like the UK's broken NHS. It's not the end in itself.
Obamacare has been designed to be a stepping-stone to a single payer system like the UK's broken NHS. It's not the end in itself.
The Constitution should have had medical rights within it as well, but that would be hijacked again and again with these bolshevists, neocon, neolib, neoshitheads abusing a gubmint that nobody wants and just wants it to go away.
Healthcare schmealthcare, it's a gulag.
Obamacare just keeps on getting better.
ONWARD!!!
Only when the patient has to write a check at the time of service will things get better.
Greed, sure. But whats most wrong with this crime scene is that the IRS, criminal agents of a foreign power who in addition to their routine theft systematically harass and assault with Americans who hold opinions unflattering to the regime, are going to be in charge of managing health records and determining who gets which medical services. If you piss off tinkerbell you're dead. Simple as that.