Posted on 12/01/2025 10:19:38 AM PST by CondoleezzaProtege
More than 100 rural hospitals have closed in the United States over the last decade, leaving millions of Americans without access to emergency services, testing, inpatient care, and primary care. While these closures have been on the rise in rural America since the 2008-2009 recession, they’ve increased at an alarming pace over the last few years, including at least 18 that closed or converted to an operating model that excludes inpatient care this year alone.
Currently, more than 700 rural hospitals are at risk of closing—with 300 at immediate risk of closing—meaning that this distance is likely to widen even further for affected residents. And unlike urban residents, rural residents often rely on these hospitals for both primary and emergency care…
These rural hospitals are closing because they simply don’t have enough money to cover the high cost of care delivery to their communities, but the contributing factors behind this lack of revenue are multifold: declining patient volumes, low reimbursements from both private and public insurers, staffing shortages, alternative models of care, and more.
Beyond each of these factors, the broader issue with hospital closures is that no one is accountable for fixing this problem, says Alan Sager, professor of health law, policy & management, “Nobody in state government, Medicare, Medicaid, or private insurance companies has any accountability for identifying where hospitals are needed, how many beds they need, what emergency and other services they should provide, and making sure they generate enough revenue to cover the cost of efficient delivery of needed care.”
Despite this lack of action, affordable and accessible healthcare is easily achievable …the US already spends enough money on healthcare—an estimated $5.6 trillion this year—to deliver and pay for care for everyone in the nation, Sager says.
(Excerpt) Read more at bu.edu ...
Understood.
It’s amazing how crippling some of these regulations, laws, restrictions have become.
Broke the rule and read the article. Knew it was the business model, but didn’t see what I had hoped for: A thrashing of our system of health insurance, the burdens imposed by persons not paying anything in this system (illegals for example), and the net effect of the current insurance scheme resulting in consumers paying for health insurance but unwilling/unable to use it due to the out of pocket cost. The latter impacting preventative care.
Competition drives efficiencies, innovation, service, and price as a differentiator. In healthcare it doesn’t seem exist in this space. Instead it is insurance firms limiting care, adding bureaucratic delays, and complexity in obtaining care. What they have managed to do is continually increase premiums, copays, deductibles with no end in sight.
Where is interstate competition? Where is competitive pricing? Where is oversight of this shXX-show? Where is the rationalization of the combined insurance and care costs to middle class families? Where are the Republicans when a non-socialist solution is required here?
Hell, if the GOP wants to win a few upcoming election cycles - work with private industries to rethink, reimagine, reboot, and retire our current system.
I’m fortunate to have really great healthcare and my family has been taken care of by amazing Doctors. No gripe there. But don’t look me in the eye and try to explain why a single small tablet of ibuprofen is $30. Don’t tell me that removing a fish hook from a finger (10 minutes and a bandaid) can cost $1,800. Don’t tell me that in an emergency situation that going to the nearest healthcare facility immediately is somehow a bad idea (instead of pulling over the truck, grabbing my phone, researching policy coverage online, or maybe calling an 800 number, dialing 2 for English, having an automated system not understand me, and and waiting on hold forever for someone ostensibly in Estados Unidos but with an accent from New Delhi asks for my policy number)
It’s a clusterF and far too many people are getting wealthy of the scheme while others suffer. Shameful that this keeps getting swept under the rug.
It applies to hard leftists areas too.
Just know it’s going to be a thorny issue come election time especially once Trump is off the ballot. It’s part of the rural Democrat playbook plan to lead their campaigns and win (win back in some cases) key seats.
Whether a company provides healthcare or hand grenades, its business model must be profitable.
But how do you get competition in healthcare? When you’re having a heart attack, you don’t exactly have time to weigh all the options.
yes i get it, thanks
we suffer in America from a huge dose of “do it for me, I am trash and can’t do a damned thing for myself”
all taught or indoctrinated by the hard left, of course
it is debilitating
The questions to ask are:
1). How many patients using the hospital are on a government program. That program could be Medicare, Medicaid, or some other government sponsored program,. If the number is greater than 50%, that facility is screwed.
2. How much does the public insurance program pay on the cost of providing service. It is likely that number is in the mid 70% range. This means the hospital is running at a 30% discount to their list prices.
3. How much bad debt does the hospital incur on those services billed to a government insurance company? It is likely that a vast majority of those being billed do not have any kind of “supplemental” programs that would be closing that gap between government reimbursement and the cost to deliver the service.
Bad debt for the system I worked with was about 50-100 million dollars A YEAR.
When you use each of these questions as a multiplier you will see that huge amounts of services are performed by medical professionals go unpaid. Of course, the people working at the hospitals are paid an above average wage. For example, at a local hospital the nurses just got a 7.5% raise and a senior nurse working an overtime shift will earn upwards into $75 an hour. The average salary for a “hospitalist” doctor is well into the $200k range. The hospital would pick up the costs for medical records and malpractice insurance.
On top of this…patients have become more difficult. Patient assaults at even suburban hospitals are rising. In the cities you will find nurses, techs, staff, and even docs getting punched, stabbed, or otherwise assaulted on a regular basis.
The model we use is broken. It will continue to fail.
Inserting thousands of people into this system who have no coverage exacerbates the situation.
For those suggesting we gather together to build more local hospitals, you are describing the “catholic health systems” that were founded in the last century. That model fell apart in the 1990s and what is left of it struggles to maintain relevancy.
You WILL see these hospital systems building services around “surgical centers”, “Diagnostic centers” or “infusion centers.” The reason is that those places cater to those who have insurance as their “ticket to play.” They don’t have emergency services or long term patient care. You should get good service there because people with insurance are generally not jerks to the staff.
Read into that what you will.
The best protection is to stay healthy.
Just another Bammycare success.
and yet, not 70 miles from said Boston University, two hospitals, one rather rural (Nashoba in Ayer) and more urban (Burbank in Fitchburg) were both closed.
.
I have relatives and friends who died because of the last closure. The ride to the hospital which was once 17 or 18 minutes by ambulance became 35-45 minutes and through a city.
Budgetary reasons were cited as the reason.
That is horrible!
It was horrible when they closed.
I have friends that have moved because of this - The Glorious People’s Republic of Massachusetts has a lot of situations like this and its made a lot move - really ugly.
Made worse by government meddling in insurance markets, and no market feedback to health providers.
A few years ago I was surprised to learn that many local non profit hospitals that claimed they were losing too much money on charity cases spent more money on the interest payments on loans they took out to build new facilities. That is a new definition of "charitable" enterprise.
But is that debt accounted for at the hospital list price, or the actual prices the hospital accepts from insurers? Usually the hospital books an inflated fee for services, and then accepts less than 25% as payment from either an insurance company or the government.
Most hospitals show their "bad debt" using the inflated hospital list prices, not the much smaller amounts they would actually get paid if the same patients had insurance coverage.
That kind of fake accounting is a major problem with the medical industry.
In the largest towns in Western Massachusetts, you don’t want to go to the city hospitals, and should really tell relatives and your workplace the smaller hospital(s) you want to use. It’s well worth planning as you age, or have an immediate family.
It is unfortunately a significant new criteria in motivating whether to move, and where to.
Is a “certificate of need” a requirement in every state?
“how do you get competition in healthcare?”
For health care, bring on market force:
1. Break most hospitals into two highly competitive entities
2. Convert other hospitals into real estate leasing entities with competing surgical suites and nursing wings
3. Separate out drug coverage so hospital systems can run care coverage systems and cut out insurance company overhead and meddlers.
4. Create interstate drug plans that don’t have to cover every drug. Group and exchange plans to offer vouchers at plan set amounts for out-of-formulary drugs. Plans without vouchers could be sold to individuals and families only off the exchanges. Non-employer plans with vouchers to have varying premiums.
5. The interstate drug plans would be all the doctors (and AI) prescribe for formulary drugs with co-pays equal to manufacturing cost.
6. reform medical education, breaking down medicine and dentistry into simpler chunks and start it in the first year of college
7. replace most primary care doctoring with AI
(human doctor would confirm AI diagnosis, orders for expensive tests[MRI, genetic], prescribe radiation imaging/treatment, and voucher/government co-pay drugs)
That is a nice set-up, also because it’s nice to have some traditional Native touches to medicine on top of conventional.
But is that possible for regions not adjacent to reservations? 🫤
Thus my proposal to let rural communities declare themselves tribes.
The least expensive way to force people to live in urban areas, leaving the rural areas for great real estate deals and playgrounds for the wealthy, rich, filthy rich, and famous. Socialist dreams coming true.
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