The trends I have noticed, working in healthcare for over 30 yrs: the outsourcing hospitals do. No longer is laundry being done at the hospitals. Environmental services, patient transport, and food/nutrition are being contracted out to other companies where their employees get paid poorly. There is very high turnover in those areas. Clinical staff are now getting flexed out of their shifts early if the hospital census is low. The managers get rewarded for doing that flexing, with big bonuses. No longer can hourly employees rely on getting paid for a 40hr work week. Do you want someone taking care of you when they are worried about making their bills for the month? The bonuses that the administrators and CEOs make are disgusting. In my career, I’ve only worked at 1 hospital that dispersed a significant portion of “profits” to the employees without any hoops to jump through. If we get any share of “profits” now, we must meet unattainable metrics to where our yearly “bonus” is so small, the hospital must make numerous announcements prior so that we will even notice. (Usu less than $200 gross). The very institutions you rely on for care only care about MONEY; the people who actually care for you? (those who clean your room, nurse you, draw your blood, image you, feed you, move you, or otherwise touch you in any way- THEY (we) are the people who care about you.
As the judge mentioned, these non-profit hospitals are mostly a work of legal fiction. I believe that the right fixes here have to do with fixing the incentives. Of bureaucrats first and foremost.
I do not believe the solution is greater regulatory oversight. When jobs and employment are on the line, or a bad PR move on the line, it is unlikely that a regulator is likely to challenge the status quo. A bureaucrat is not empowered to make decisions that cuts deep into issue, and state/local elected officials would be more interested in jobs than getting into the weeds of complex medical care laws (I like to distinguish that the real issue is not a discussion of *health*care, but rather access to *medical*care).
If anything, your last point is probably the most salient: "Stronger government-run care options and for-profit private systems instead of “non-profit” private health systems, but I feel like a lot of people calling are going to call me a communist for this one." <-- this balances the needs of those with inadequate care with those who have the means of purchasing private medical care.
I didn't understand the part where non-profit hospitals are incentivized to invest in infrastructure? I get that they can't return their profits to shareholders, but how does building infrastructure serve the shareholders? Is it as simple as "people like pretty things"?
Interesting! Are teaching hospitals, like the ones attached to universities and medical schools, nonprofit hospitals? Are their finances treated like extensions of the colleges they're attached to?
The trends I have noticed, working in healthcare for over 30 yrs: the outsourcing hospitals do. No longer is laundry being done at the hospitals. Environmental services, patient transport, and food/nutrition are being contracted out to other companies where their employees get paid poorly. There is very high turnover in those areas. Clinical staff are now getting flexed out of their shifts early if the hospital census is low. The managers get rewarded for doing that flexing, with big bonuses. No longer can hourly employees rely on getting paid for a 40hr work week. Do you want someone taking care of you when they are worried about making their bills for the month? The bonuses that the administrators and CEOs make are disgusting. In my career, I’ve only worked at 1 hospital that dispersed a significant portion of “profits” to the employees without any hoops to jump through. If we get any share of “profits” now, we must meet unattainable metrics to where our yearly “bonus” is so small, the hospital must make numerous announcements prior so that we will even notice. (Usu less than $200 gross). The very institutions you rely on for care only care about MONEY; the people who actually care for you? (those who clean your room, nurse you, draw your blood, image you, feed you, move you, or otherwise touch you in any way- THEY (we) are the people who care about you.
As the judge mentioned, these non-profit hospitals are mostly a work of legal fiction. I believe that the right fixes here have to do with fixing the incentives. Of bureaucrats first and foremost.
I do not believe the solution is greater regulatory oversight. When jobs and employment are on the line, or a bad PR move on the line, it is unlikely that a regulator is likely to challenge the status quo. A bureaucrat is not empowered to make decisions that cuts deep into issue, and state/local elected officials would be more interested in jobs than getting into the weeds of complex medical care laws (I like to distinguish that the real issue is not a discussion of *health*care, but rather access to *medical*care).
If anything, your last point is probably the most salient: "Stronger government-run care options and for-profit private systems instead of “non-profit” private health systems, but I feel like a lot of people calling are going to call me a communist for this one." <-- this balances the needs of those with inadequate care with those who have the means of purchasing private medical care.
I didn't understand the part where non-profit hospitals are incentivized to invest in infrastructure? I get that they can't return their profits to shareholders, but how does building infrastructure serve the shareholders? Is it as simple as "people like pretty things"?
https://imgflip.com/i/469hkr
Interesting! Are teaching hospitals, like the ones attached to universities and medical schools, nonprofit hospitals? Are their finances treated like extensions of the colleges they're attached to?
https://melanietheconstantreader.substack.com/publish?utm_source=menu