
The Business of Health Care Depends on Exploiting Doctors and Nurses - yhoneycomb
https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html
======
oneplane
That's because if you run critical services like a generic for-profit business
you almost automatically exploit everyone who is in it for more ethical or
intrinsically motivated reasons.

There is a big disconnect between why you'd do the doctoring and hospital-
running vs. the admin side of things. Once a business has a certain size it
all becomes the same: bottom line, marginalisation, and bubbles of speculation
under the name of financial management. The issue with doing that to
healthcare is that you have to recoup your business failures in a way that is
incompatible with saving lives; i.e. you have to make things more expensive to
get your money but since for the people at the bottom of the chain that means
having someone die vs. live they will not really be give a choice; choosing
between getting healthy (but paying a butload of money) and getting dead (so
you don't have to pay) is basically extortion.

A lot of excuses are made that 'you pay for what you get' meaning the quality
is super high and thus expensive, or that the cost is very high, and that has
to be calculated in to the prices, or that the business side is very hard and
complex and can only be done that way; but unless they have unicorns and
rainbows we don't know about those excuses are just that: excuses. The cost is
high, and the quality doesn't match it - almost all healthcare systems in
other developed countries is both higher quality and cheaper at the same time
as well as having lower mortality rates.

Exploiting people that are intrinsically motivated to help people who put
their lives their hands is just another sign of the administrative side of
this deal completely doing it wrong.

The same people, buildings, services, machines, procedures in a different
country with a better end-result and lower mortality rate should be enough
proof.

~~~
rayiner
I guess the UK NHS is run like a for profit business:
[https://www.theguardian.com/society/2019/feb/17/nhs-staff-
qu...](https://www.theguardian.com/society/2019/feb/17/nhs-staff-quit-record-
numbers-work-life-balance)

> Health unions have been warning for years that NHS personnel are cracking
> under heavy workloads, rising demand for care and widespread understaffing.
> Many staff report routinely working beyond their normal hours to complete
> all their tasks.

~~~
danmaz74
Cost cutting can happen in the public sector too, especially with governments
which only care about cutting taxes for the rich.

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rayiner
Nurses and doctors in the US work a lot, but they also get paid very well
compared to say the UK. Nurses in particular. Starting salary for a nurse in
the UK NHS is 23,000 pounds: [https://fullfact.org/economy/pay-rises-how-much-
do-nurses-po...](https://fullfact.org/economy/pay-rises-how-much-do-nurses-
police-teachers-and-mps-get-paid). That’s about $29,000. (This is a bachelors
degree required position.) Starting salary for a US nurse with a bachelors
degree is well over double that: [https://online.drexel.edu/online-
degrees/nursing-degrees/nur...](https://online.drexel.edu/online-
degrees/nursing-degrees/nursing-salary-guide/index.aspx).

EDIT: Adding taxes to the calculation adds an additional dimension. Online
calculators show that the total tax on 23,000 pounds with a 9% NHS pension
contribution amount to 25%, leaving 17,500 pounds or about $22,300. In
Maryland the total tax rate is the same for someone making $65,000, leaving
$48,000. That’s after paying for social security, which will pay out about as
much as an NHS pension would pay. A US nurse typically will receive health
benefits on top of the salary. Even if the employer doesn’t cover 100% of
premiums, the out-of-pocket premium payments (which are per-tax) are unlikely
to be more than $5,000.

~~~
di4na
Keep in mind that this salary for the US do not count in healthcare and
pension that the UK nurse is entitled to. I know it may feel like a nitpick,
but it does make a huge difference when you add that cost of living.

~~~
astockwell
This. The American urge to compare only base salaries (because that's all you
have in America) is why Americans don't understand what they're missing. It's
not in the salary! Its in the alleviation of $1000/month medical insurance
premiums, in addition to $4000 ER visits (inclusive of said insurance), and
pensions.

And before someone bemoans the taxes, let me clarify that those medical
premiums and ER visits are AFTER-TAX dollars, so add an additional 15-30% on
top.

~~~
aianus
The annual base salaries Americans quote are AFTER medical insurance premiums.
They are not deducted from your quoted base pay.

~~~
astockwell
This is completely untrue.

I'm an American citizen and not a single one of the 6+ W2 jobs I've held have
quoted the base salary with insurance premiums deducted.

~~~
rayiner
The quoted base salary does not include the employer paid portion of health
insurance. For the 57% of people who receive health insurance coverage through
their employer, that amounts on average to 82% of total premiums.

------
sambull
Health care is the US is broken; I recently hurt myself, the diagnosis alone
(xray, CT and doctor apt) was over $4,000 out of pocket, with good insurance
that my CEO sent a email last year telling me was the reason we won't get
raises.. that damn health insurance cost. I had a cousin talking about
retirement, the only thing preventing them is... health insurance

~~~
nickthemagicman
My aunt was bitten by a rattlesnake on her finger. It cost 46,000 dollars for
a vial of anti-venin and and one night stay for observation.

This happens in India all the time with King Cobras and I know they can't
afford 46,000.

It's a total racket and scam because on a system of supply and demand like
American capitalism... what has a greater demand to someone than a their life
so the only limit to price is on the supply side.

~~~
Wowfunhappy
> This happens in India all the time with King Cobras and I know they can't
> afford 46,000.

Your larger point notwithstanding, it's important to remember that overall
cost of living in India is lower as well. So hospitals are inherently cheaper
to run.

~~~
oneplane
That's not why it's cheaper: money doesn't universally trump wellbeing in Inda
like it does in USA.

~~~
m52go
No, it's because insurance hasn't hijacked the system in India like it has in
the US.

Watch pet health costs...with the recent advent of pet health insurance, it's
just a matter of time before costs skyrocket for veterinary care.

~~~
Wowfunhappy
The prices may well rise somewhat, but demand for veterinary care is always
going to be much more elastic. As much as people love their pets, they will
also eventually decide it's not worth the cost.

You can't really do that with human health care.

------
ineedasername
The article cites the fact that there are 10 administrators for every actual
doctor or nurse, and these lines should be cut in half to instead be spent on
more doctors and nurses.

I think this represents a gross oversimplification, overlooking the necessary
work of administrative staff. It's not unlike the airforce: there are about
23,000 pilots but 500,000 personnel, a ratio of more than 20:1. It takes a lot
to support the enterprise that keeps planes in the air.

In the medical profession, someone has to keep the enterprise running.
Cataloging medical imagery & seek and retrieve records as needed. Accountants
and HR departments, IT departments, working with insurance companies, all of
it. Even with the amount of EMR work doctors & nurses may do themselves, it
takes a tremendous amount of background "plumbing" work to allow them to focus
on the actual treatment. I'm not saying there isn't _any_ administrative bloat
anywhere, but I am saying that non-practitioner staff in the industry feel
this resource crunch quite a bit themselves too. The technician running the
radiology suite feels just as much pressure to help fit in that extra patient
and stay beyond scheduled hours to do so. Treating the entire non-doctor/non-
nursing staff as bloat is an extreme disservice to the mission critical work
they perform.

I am literally taking my 1.5 year old son home from the hospital today after
an emergency visit that kept us there for days, and during this ordeal I dealt
with at least 3 or 4 non practicing staff that went above and beyond their
duties to help with something and smooth the process over for the work that
doctors and nurses needed to perform. These staff feel the ethical drive to
serve every bit as much, it just happens to be less visible.

~~~
danmaz74
How much of the administrative staff you mention is only needed because
hospitals have to work as for profit organizations? And don't forget to add
the administrative staff from the insurance companies themselves.

~~~
nugget
Non profit status isn't an instant fix for a dysfunctional system. Once the
profit motive is removed, other incentives take over as primary motivators.
The not for profit, Government-run Veterans Affairs hospitals have a higher
administrator to physician ratio than most private hospitals and are well
known within medicine for inane administrative roadblocks to effective patient
care.

~~~
ineedasername
Yes, the profit motive does enforce at least a little pressure on reducing
unnecessary overhead. This is of course not universally the case.

------
0815test
That's the nice thing about 996ICU for doctors and nurses: they don't have to
walk very far to get to the ICU.

Oh and also, they're pulling pretty good money for their "exploitation" at
least in the US. Want to address the overwork issue? Increase medical
residency opportunities and available medical-school admission seats.

------
markroseman
Healthcare is under stress everywhere, but those of you in the USA who don't
understand how fundamentally broken your system is need to give your heads a
shake. It's precisely because of how it's treated like a business first,
thinking that competition is the solution to the problem, and applying other
business principles is the way to improvement that things are the way they
are. Read medical forums like KevinMD and you hear constantly about highly
trained physicians ready to abandon the profession because they're treated
like automatons, high suicide rates, and the best way to find a side hustle
because their jobs suck so badly. Your country is being held back by the
ludicrous way healthcare is structured, citizens shackled to employers, with
the worst results for money spent anywhere in the civilized world. Citizens
are so brainwashed they're unwilling to acknowledge the ideological morass
that created and sustains this all. People who remain so frightened when
people say the word 'socialism' that they double down on stupidity. Or refuse
to look outside your borders because you're self-evidently the greatest
country on earth. Pitiful.

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qrbLPHiKpiux
I’m a provider.

Yes, it does. And they have a perfect opportunity. With the amount of student
debt they have, they have to work. It is a perfect exploit. Plus, the license
is on the individual, not the health care entity. They can just get another
provider.

~~~
chapium
The scariest thing about quitting a job you are deeply unhappy with is what to
do about health insurance. I totally agree.

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RandomInteger4
Does it though? Given how much they charge, does it really depend on
exploiting those folks? Are they really being exploited given how high their
salaries are?

Like, just for patient safety, I agree, these folks should not be working the
ridiculous hours they work, but would they really agree to that if it meant a
salary decrease?

~~~
muzani
As it is, everyone accepts that if you want lots of money and no quality of
life, be a doctor. There should be a middle option like in other careers where
they can be moderately well off with only moderate commitment.

~~~
RandomInteger4
I completely agree to be honest, but it seems like when you see Doctors and
nurses complaining on social media, it's almost like they do it as a badge of
honor and not because they actually want fewer hours, given the implications
that come with fewer hours (i.e. lower salaries).

That's assuming hospitals are actually operating on a tiny profit margin, but
if the margin is huge, then there should be more demands. I mean, there's the
nurses union at least, but what about the doctors, or the various technicians.

Either way though, the system is still broken with respect to how much the
patients have to pay.

