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.
I am committed to change. This system has gutted me twice now. I didn't even get sick, though at one point I basically traded a house for someone I loved.
We are long past need for reform.
You can probably understand in the UK how certain groups are systematically trying to gut their NHS. That seems to be the same mentality that is going in the US. Make medical care all about maximizing profit.
Don't confuse that with me understanding them. I am a people before everything kind of guy. In the immortal words of Princess Leia - "If money is all you love, then that's what you'll receive."
I'm vehemently opposed to the NHS being privatized. It's an institution and the crown jewel that sets Britain aside from the rest of the world. To see people supporting their attempts to privatize it and send Britain down the same path as the U.S. in my mind is the ultimate failure of the British people and it infuriates me - worse even than Brexit.
When did we become a people who believed the lies and rhetoric spewed by those on TV over our own education? When did we become a people who just blindly followed what we were told like lambs to the slaughter?
I thought we were better than that, honestly. It makes me sick.
Wanna guess why you cant?
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.
> 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.
Money is fungible.
Hospitals are pretty expensive and probably super inefficient: they are 30% of NHE spending.
Reimbursement is set by the fed (medicare rates) and ins cos base their rates off of that.
It would of course take a hell of a lot of variance for a significant percentage of doctors to be pulling in a million plus. With 713,000 working doctors, there will be a fair number pulling in lots more than average.
I've linked the mean salaries for the US as a whole.
Some really popular charities go well above 25% towards non-cause expenses like administration/advertising.
If you assume that this advertising in net increases the size of the pie of charitable giving, it can be considered an overall good thing. If you assume that this advertising in net just redistributes the contributions that would go to one slice of the pie to another, it is wasteful. Data on which side is true is hard to come by.
That wouldn't give you the whole picture on waste. A big chunk of high health care costs is hidden inside the equipment and patient services. American hospitals have a habit of doing things in much more expensive ways than is strictly necessary.
I honestly believe any company as well as everyone responsible for abusing the term "non-profit" in order to make money for their personal gain should be punished accordingly and be treated as scammers.
Oh, and (mega)churches.
Private insurance companies. EDIT: Out of network specialists. Pharmaceutical companies.
> Three factors contributed to the need for layoffs: (1) reduced reimbursements from payers, including the Massachusetts government, which limits annual growth in healthcare spending to 3.6%, a number that will drop to 3.1% next year, (2) high capital costs, both for new buildings and for the hospital’s electronic health record (EHR) system, and (3) high labor expenses among its largely unionized workforce.
> That, along with higher labor and drug costs, explained the Cleveland Clinic’s economic headwinds, according to outgoing CEO Dr. Toby Cosgrove. And though he did not specifically reference Medicare, years of flat reimbursement levels have resulted in the program paying only 90% of hospital costs for the “older,” “sicker” and “more expensive” patients.
> The challenges confronting these hospital giants mirror the difficulties nearly all community hospitals face. Relatively flat Medicare payments are constraining revenues. The payer mix is shifting to lower-priced patients, including those on Medicaid. Many once-profitable services are moving to outpatient venues, including physician-owned “surgicenters” and diagnostic facilities. And as one of the most unionized industries, hospitals continue to increase wages while drug companies continue raising prices – at three times the rate of healthcare inflation.
> With pressure mounting, hospital administrators find themselves wedged deeper between a rock and a hard place. They know doctors, nurses, and staff will fight the changes required to boost efficiency, especially those that involve increasing productivity or lowering headcount. But at the same time, their bargaining power is diminishing as health-plan consolidation continues. The four largest insurance companies now own 83% of the national market.
* Government sponsorship through HHS of electronic medical records management. Have USDS and 18F to spearhead the project (cc matt_cutts), leveraging their experience revamping technology service delivery within the VA. This removes Epic's profit out of the equation.
* Government management of insurance. Medicare participants are fairly satisfied with it, and it can be just as efficient as Social Security. Cover everyone with Medicare, increase Medicare payroll deductions accordingly, and leave private insurance for additional fanciness some may desire (private rooms instead of shared rooms in hospitals, for example). This removes most of the profit from private medical insurance.
* Make it illegal to advertise drugs to consumers (this is only legal in the US and New Zealand). You immediately eliminate billions (estimates are ~$20 billion/annually) of marketing spend by pharma, and therefore costs they will desire to recoup.
* Let Medicare negotiate drug prices. This reduces profit realized from pharma concerns.
* Remove limits on medical students and residencies to increase GP and specialist supply. Streamline the process of nurses leveling up to nurse practitioners. This reduces the profit motive for practitioners; you'll make a decent wage, but not Lambo money.
* Subsidize medical school to prevent the need to go hundreds of thousands of dollars into debt to become an MD.
Uninsured people with means will pay high prices, it's just that they aren't the big percentage of uninsured people...
recent new hospital in my area of the country was only allowed to open provided they did not take away business from other hospitals. This includes opening a second outpatient surgery room in an existing hospital to offering advanced cancer treatment. This is very common in the US. It usually goes under the name "Certificate of Need".
The reasoning is that health care is improved if health providers do not duplicate expensive services. this has grossly driven up costs in many areas. then throw in rules which can force Emergency Centers out of network for ALL insurers. See a recent example in San Francisco with a PUBLIC hospital 
TL;DR Health care is only this overly expensive because politician meddling. From preventing competition among hospitals to preventing competition among insurers, unless of course you donate properly.
> TL;DR Health care is only this overly expensive because politician meddling.
Certificated of Need were something _hospitals_ themselves lobbied for. It's a case of "this is awesome when it protects me, and an aberration when I'm on the losing end".
Certainly politicians enacted such things, but I'm not losing sleep over the hospitals. Only us mortals, stuck with the cost of the system.
The second sentence seems to contradict the first. What about the insurance providers?
Doctors in the US get saddled with mountains of student debt, and then make mountains of money, once they pay it off.
Most residency funding comes from the federal government. Complain to your Congresspeople, not the AMA.
Complain to everybody.
The AMA also actively lobbies against proposals to give nurse practitioners more patient access. 
I'm having a harder time finding pass rates for the CPA before 2006. They seem to have gone up a little in that 12 year window 2006-2017 . The tax code has also gotten larger and more complex over the past 50 years, so that is worth noting.
Define "free market" : an economic market or system in which prices are based on competition among private businesses and not controlled by a government. (Note: the first definition is a bit vague, so I used the second entry.)
Hospitals aren't competing in a free market. They don't suck because of capitalism, they suck because of government intervention. Right now our medical system is basically the worst of both worlds--it's not affordable nor universal.
If hospitals and doctors were operating in a free market then it would lead to lower prices and an increase in quality. You can see some evidence of this in medical areas which aren't typically covered by insurance and are less heavily regulated, with laser eye surgery probably being one of the best examples.
You've managed to identify that the problem is government intervention, yet you appear to hint at trying to solve the problem with even more government intervention? Historically that hasn't gone over very well. Have you seriously considered alternatives? I believe a medical system cannot provide more than two of the following three guarantees: affordability, quality, and universality. This will probably be an unpopular opinion, but I think dropping universality is the best choice. You can still maintain a social safety net to catch people that fall through the cracks, and I posit that it would be cheaper and superior to our current system.
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.
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
> 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.
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.
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.
I pointed out that they weren’t a charity and that the CEO of the hospital was paid $1.8 million year. 
He changed his mind.
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. :)
It's not radical, it's an old enough form of cruel indifference that it was mocked by Dickens and Swift.
And worry not - those with deep pockets can always pay extra for premium treatments, but some baseline should exist.
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?
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.
What, this doesn't make sense? So, about that...
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).
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.]
Sometimes it is just a matter of what you offer as a hospital, the volume of people you bring in, and what you do.
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.
This was just a local news story, they tend to do a good job:
Now, funding a free clinic in a poor area for 50 years is a great idea.