
U.S. Hospitals Are Asking Their Own Patients to Donate Money - petethomas
https://www.nytimes.com/2019/01/24/business/hospitals-asking-patients-donate-money.html
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balabaster
Coming from, and only ever having lived in countries that have socialized
medical care, I will never understand the general lack of goodwill towards
one's fellow countrymen that your country continually rails against it. All to
live with a medical industry that is, for all intents and purposes, run by
corrupt insurance companies who will bleed you dry sooner than they would
cover your bankruptcy inducing medical bills.

I just don't get it.

And now on top of this, having paid an arm and a leg to an insurance company
that would just as soon stab me in the back as pay the medical bill my premium
is supposed to cover, hospitals want donations? What the fuck is going on?

Sure the medical systems I've lived with aren't perfect, and sure they _could_
be improved. But by and large, knowing that I can go into any medical care
facility in the country and walk out fixed, without having to fight for
medical care, fight for my right to be treated, fight for my right to have my
medical costs taken care of. I would rather have that every day of the week,
even knowing that there are others abusing this, than the alternative.

~~~
hnuser1234
>I will never understand the general lack of goodwill towards one's fellow
countrymen

Homogeneous populations are required for this. When the US was least diverse,
during the 1930s-60s, the public was largely supportive of public social
welfare. Despite right-wingers guffawing over European nations importing more
"diversity" of late, the US is way ahead in diversifying the nation into
islands of "diversity" with a rump "historic" American nation in the outlying
surrounding areas. The "diverse" populations (and their "historic" allies) are
inculcated with neo-Marxist propaganda that frames the people whose nation
they are invading and whose largesse they are seeking to exploit as class
enemies. The "historic" population has long sensed this animosity but cannot
articulate it publicly and oppose it in a straightforward manner without their
opponents, including the vast majority of major media, ostracizing them as
dangerous lunatics. The "diverse" are deemed inherently virtuous while the
"historic" inherently evil -- blood libel updated for the 21st century. What
sane person who is a part of the "historic" American population would support
having most of his money taken in tax to support a growing population of
people who do not share his ancestry, culture, or values and who view him as
inherently evil? Thus we see opposition to social welfare programs that
disparately impact/benefit the "diverse" populations.

TL;DR: Most "Americans" are not "fellow countrymen" at all but distinct
factions engaged in a simmering war with each other.

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hnuser1234
Alright, I'm the creator of this user account and the one that made it public,
and I'm going to claim it back now. Maybe I'm a dumb kid, but I think if any
country can maintain a highly diverse population without internal "simmering
war", it's the US. The greed of hospitals is not somehow explained by
xenophobia. Generations of people born in perverse power structures, doing
their best to strengthen and reinforce them, seems much more suitable of an
explanation. Genetics will mix and people will evolve. Deal with it.

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tbirrell
Hold up. We already have to pay through the nose for medical care, so where is
all this money going that these hospitals need to ask for more? Is non-profit
a different class that is somehow left out of the con that is the US
healthcare system?

~~~
capdeck
From the article:

> Ms. Grupp, 66, said she wasn’t rich, and was disturbed by the letter. “I
> kind of resent it,” she said. “I don’t think they need the money.” The
> hospital last year reported nearly $48 million in net income and paid its
> chief executive officer $1 million.

This is where it goes. That said, if I could spare $200k, I would if I had the
information about which % of that money went to actual equipment and patient
services. I think that information is available for non-profits, but I am not
sure about hospitals. There will always be admin waste, but the best way to
decrease it is to reward more efficient hospitals.

~~~
conanbatt
A 1 million salary for a CEO of a hospital is nothing thogh. Any specialist
doctor makes that much.

Hospitals are pretty expensive and probably super inefficient: they are 30% of
NHE spending.

~~~
biotech
Specialist doctors do _not_ make 1 million dollars (exceptions are generally
those who run/manage their own business, or run a hospital - basically it's
their business role that puts them at that salary range). You can easily look
at job ads and see common salaries for different specialties, they very
dependent on specialty but they do not even approach 1 million.

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staticassertion
Plenty of specialists make > 1m without running a hospital.

~~~
eatbitseveryday
Twice this claim is made with no reference. If there are plenty, it would not
hurt to cite a source, rather than make a seemingly baseless claim to the
contrary.

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throwaway5752
Nonprofit hospitals soliciting donations from former patients is the least
controversial thing possible. The part where they screen patients and give
them preferential treatment is worrisome. I think the cited bioethicist had it
pegged with the "not illegal but unseemly" (paraphrased).

If hospitals are going to treat indigent populations, absent universal
healthcare, they are going to operate at losses and require grants and
donations to operate.

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Para2016
Non-profit is just a tax structure. They make plenty of money and reward
themselves handsomely.

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throwaway5752
A quick first point: you're making a blanket statement against a heterogeneous
population. Some non-profits are definitely not efficient, and some are very
efficient.

The big difference, and there is one, is related to ownership and operations.
There are no distributable earnings, and they cannot be sold/acquired. This
definitely factors into decisions balancing profitablity and ethics. There are
laws about nonprofit compensation, too:
[https://www.guidestar.org/ViewCmsFile.aspx?ContentID=3890](https://www.guidestar.org/ViewCmsFile.aspx?ContentID=3890)

~~~
Para2016
I'm a physician for a non-profit and I'm going to continue making my blanket
statement. But thanks for the link.

~~~
throwaway5752
I am not a physician at a non-profit! But I had read a few years of Tenet and
HCA annual reports a while back, and have a few other points of exposure to
non-profit vs teaching vs private systems. Perhaps we can agree that there are
many opportunities to improve the system in many ways.

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brandonmenc
> Many hospitals conduct nightly wealth screenings — using software that culls
> public data such as property records, contributions to political campaigns
> and other charities — to gauge which patients are most likely to be the
> source of large donations.

> Those who seem promising targets for fund-raising may receive a visit from a
> hospital executive in their rooms, as well as extra amenities like a
> bathrobe or a nicer waiting area for their families.

Fabulous.

So when my parents are in their 80s and out of it on painkillers after a
surgery, they'll be preyed upon for donations by some fast talking executive
who has trolled through their public records to see how much their home is
worth.

Are your bedsheets uncomfortable? (guess what - everything is uncomfortable
after major surgery) Just donate and we'll fix that for you.

Sleazy to the max.

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helipad
I wonder what their approach is to 'ungrateful' patients – the ones who get
billed every little things, or are otherwise unsatisfied with the service?

It is after all a service in the US. It's transactional. I'm happy medical
science solves my complaints, but the way it's set up I'm not often left with
an overwhelming sense of gratitude to the hospital.

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chrisbennet
When my Dad told me he was going to donate his house to the local hospital I
told him “I’ll support whatever you decide.”

I pointed out that they weren’t a charity and that the CEO of the hospital was
paid $1.8 million year. [1]

He changed his mind.

[1]
[http://www.mainebiz.biz/article/20150924/DATAJOE/150929969/m...](http://www.mainebiz.biz/article/20150924/DATAJOE/150929969/maine's-highest-
paid-health-care-professionals)

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dkdbejwi383
I am so thankful for the NHS when I see things like this.

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CorruptedArc
I like a lot of things about the U.S. over the U.K. but our healthcare system
is definitely not one of them.

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sincerely
This happens in canada too, so im not sure its uniquely a problem of private
vs socialized healthcare.

~~~
CorruptedArc
Yeah but U.S. and Canadian corporate culture is pretty intertwined.

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throwaway456321
We already donate a shit ton, like $5000 for a 8 minute ambulance ride or
$1300 for an 5 minute assessment in an ER

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rixrax
I’d like to throw something out here as maybe a starting point for a
discussion: we should immediately make it illegal to have medical insurance in
the US. Everything should be out of pocket. Period.

After initial chaos, misery and death, we would have no choice but to
restructure healthcare system in a manner that its costs are in line with what
people can afford to pay with their salaries.

Ok, that was pretty radical. :)

~~~
burlesona
I wouldn’t make insurance illegal, but as a thought experiment I think if you
banned employers from providing health benefits then you’d find a sudden huge
pressure for change. If the wealthy class in the US had to deal with what the
self-pay / self-insured deal with, there’d be hell to pay.

~~~
cujo
I'm completely on boar with preventing employers from providing it as a
benefit, but I think you may be overestimated how much the wealthy class will
give a shit. They can foot the bill for their care.

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BucketSort
Next thing you know they will have a patreon.

~~~
ceejayoz
I'm sure they'd be very happy to set up a recurring donation.

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uberman
If they can get more in donations than the cost of procuring them, why not
ask?

Universities ask alumni to give all the time even though they have already
paid. Why not hospitals (many already attached to universities).

To be clear, I think it is a terrible practice but if your hospital sees that
it works for the university it is attached to, why not explore the
opportunity?

~~~
dplgk
I can also walk up to anyone in the street and ask for a hand job. Why not
ask?

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uberman
While I tried to make it clear that I found their behavior inappropriate my
direct answer in the context of universities and alumni and hospitals and
patients is:

If your dad was walking around asking for and getting hand jobs left and right
so brazenly that the givers wanted to name your father's dick after then, then
you would probably be foolish not to at least try to ask for one yourself and
see what happens.

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raverbashing
Sure, I'll donate $15 but ask them to consider it a $1000 donation

What, this doesn't make sense? So, about that...

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mrnobody_67
Tip for good service? 20%, 25%, Other:

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RandomInteger4
This isn't new. There was an episode of Scrubs that brought up patient
donations.

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steanne
there are a few hospitals i'd say that's okay for.

[https://www.deborahfoundation.org/pages/about-
us](https://www.deborahfoundation.org/pages/about-us)

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tannranger
Doesn't seem so radical compared to other systems. I have heard in China
doctors will give preferential treatment to patients who give sufficient
'hongbao' (red envelope = money). I imagine (with no evidence) this might be
common in many developing world/traditional societies.

So we are just evolving toward that kind of system.

If anything this provides another lever for free market principles to decide
who survives based on willingness to pay (WTP - likely familiar to those who
went to business school).

~~~
eatbitseveryday
> I have heard in China doctors will give preferential treatment to patients
> who give sufficient 'hongbao' (red envelope = money).

Yes, this is true. Hospital admissions requires approval of a doctor, and you
essentially have to out-bribe other patients to get a bed, or even convince
doctors to pay attention to you. [Personal experience.]

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dajohnson89
Are hospitals actually struggling?

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duxup
Depends on the hospital, but very possible. It's also very complex.

Sometimes it is just a matter of what you offer as a hospital, the volume of
people you bring in, and what you do.

Example:

Obstetrics is becoming a major money looser due to changes in the insurance
market. So insurance companies how require a hospital who handle's births to
also have a surgery center and be able to handle c-sections in order to insure
any birthing. The thing is that requires an on call surge and staff and things
that previously a lot of hospitals didn't have.

So in order provide that service the overhead just skyrocketed. Many rural
hospitals just don't offer it anymore or if they are / are taking big losses
to provide the service.

That's just one area.

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abrichr
Thank you for the insight! Can you reveal where you learned this? I would love
to get a better understanding of the financials of the healthcare industry.

~~~
duxup
Sadly it's not from an site that covers it all. I too am interested in the
topic.

This was just a local news story, they tend to do a good job:

[https://www.mprnews.org/story/2019/01/22/rural-clinics-
end-b...](https://www.mprnews.org/story/2019/01/22/rural-clinics-end-baby-
delivery-small-town-minn-pays)

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onetimemanytime
waste of money.

Now, funding a free clinic in a poor area for 50 years is a great idea.

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zozbot123
Good move. The closer we move our healthcare system towards "pay what you
want" and get rid of all middleman positions (both private and government-
based), the better.

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andrewguenther
How do you envision "pay what you want" healthcare working?

