10 states did not fall for the Medicaid expansion trap under Obamacare. The rest are suffering. Private payers (you, one way or another) make up the loss.
Medicaid Expansion Puts Hospitals at Risk
The Foundation for Government Accountability (FGA) reports Medicaid Expansion Dramatically Increases Hospital Shortfalls emphasis mine.
Medicaid expansion ushered in through ObamaCare has led to program enrollment growth well beyond what was promised or projected. While proponents argue that expansion is a silver bullet to keep hospitals financially secure, this is simply not true.
Because Medicaid does not pay enough to cover the costs to hospitals to provide patient care, hospitals rely on private payers to make up for these losses.
The lower payment rate and more Medicaid enrollees—especially those forced out of private coverage—mean increased Medicaid shortfalls, contributing to lower profit margins. This increases pressure on hospitals’ bottom lines, especially for rural hospitals where fewer patients make it more difficult to make up the shortfalls. The result is hospital closures in expansion states across the country. New data from the Department of Health and Human Services shows just how dire the situation is for hospitals in expansion states.
Not every state chose to expand Medicaid when given the chance beginning in 2014. This provides a real-life demonstration with nearly a decade of data, showing how covering so many able-bodied adults is affecting hospitals. This data can be invaluable for non-expansion states, as well as states that have expanded.
Hospitals in expansion states were in better financial shape before they expanded—but this has since flipped.
The reason for this flip in financial stability in expansion states is that hospitals count on private payers to make up for the reduced payments provided by Medicaid. In non-expansion states, private payers averaged payments of 128 percent of hospital costs, whereas Medicaid averaged only 76 percent of costs.
As a higher proportion of hospital services are billed to Medicaid because of expansion, there are not enough private payments to boost back profits. This is especially true in rural areas without a large patient base to draw from. Thankfully, as non-expansion states have resisted calls to expand, they have not suffered from this shift in payers from private insurance to Medicaid as expansion states have.
Because Medicaid does not pay enough to cover hospital costs, hospitals in most states have Medicaid shortfalls. That is, the difference between hospital payments from Medicaid and the cost of providing services to patients enrolled in Medicaid.
Key Findings
- Medicaid does not pay enough to cover hospitals’ costs, meaning hospitals need to make up for the shortfall by charging private payers more.
- In expansion states, hospitals’ Medicaid shortfalls have reached $22.3 billion, increasing by 117 percent since 2013.
- If non-expansion states were to expand, their hospitals’ Medicaid shortfalls would more than double, from $6.3 billion to $13.2 billion.
- Non-expansion states should continue to say no to Medicaid expansion, and expansion states should work to roll it back.
Financial Struggles
Several hospitals, especially in rural areas, have recently closed and more are at risk of closing. Another argument made for Medicaid expansion is that it financially helps hospitals, especially rural hospitals. But the data from expansion and non-expansion states does not bear this out.
The more people that are shifted from private insurance to Medicaid, the higher the Medicaid shortfalls, and the lower hospital profits. Hospitals are learning that you cannot become solvent by providing more and more services below cost. This is a surefire way to bankruptcy, not solvency. Nobody would call offering goods or services below cost a successful long-term business plan.
Reality has born this out, with a broad range of hospitals in expansion states closing across the country. In the South, Arkansas’s Crittenden Regional Health had a nearly $7 million surplus before expansion but soon closed after profits turned to losses. In the West, California’s Colusa Regional Medical Center also saw its profits turn to losses soon after expansion and was forced to close. In the Midwest, Illinois’s Westlake Hospital managed a surplus before expansion but by 2019 was operating at a nearly $7 million loss and was forced to close its doors.
Expansion Would Double Shortfalls
Expansion would more than double the Medicaid shortfalls for hospitals in those states, the equivalent of losing nearly 100,000 hospital jobs
Bottom Line
This evidence is clear that any further expansion would only harm the bottom lines of more hospitals by doubling the Medicaid shortfall in any state that chooses to expand. States that have not expanded should continue to avoid the Medicaid trap and those that have expanded should roll it back.
This was one of the easiest “I Told You So” advance predictions in history.
Best of all, we have a decade of data to prove it thanks to ten states that resisted the trap.
About to Get Much Worse
Thanks to mass immigration, rather the failure to stop it, things are about to get much worse. Denver provides the perfect example.
Please note Denver Health at “Critical Point” as 8,000 Migrants Make 20,000 Emergency Visits
The Denver hospital system is turning away local residents because it is flooded with migrant visits.
Denver Health has treated more than 8,000 migrants who lack legal documentation in the past year, totaling about 20,000 visits, according to Steven Federico, MD, a pediatrician at the health system.
The majority of these patients are coming from Venezuela and arrive needing treatment for chronic and communicable diseases after making the difficult journey.
In 2020, the health system had about $60 million in uncompensated care costs. Last year, costs sprung to $136 million, a quarter of which came from caring for non-Denver residents.
Obama claimed Medicaid expansion would pay for itself.
Whenever you hear that claim please run. Free government handouts are never free and most often backfire completely.
Congratulations to Alabama, Florida, Georgia, Kansas, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming for avoiding the Obamacare expansion trap.
The rest of the states need to reconsider the Faustian bargain they entered.
Why would any educated person think that Medicaid expansion would pay for itself? If a hospital loses money on every Medicaid patient owing to low Federal reimbursement rates, is it supposed to make up the loss on volume? The overturning of Roe v. Wade will make the Medicaid funding problem even worse. It will also raise the costs of monthly welfare benefits (more women on welfare raising babies they can’t afford) and down the road, raise the costs of the prison system.
Allegedly, expanding Medicaid would lessen emergency unpaid hospital services.
It did not happen.
I think that you had better find different sources of information. Soon you will be using Epoch Times for source material.
Read link to kff.org
There are many reasons for differences between expansion and non-expansion states. The non-expansion states had poorer rural service to begin with and their government assistance for medical care was much lower so basically there was almost nothing left to fail.
The United States has about the worst medical care in the world. To paraphrase Charlie Munger, the incentive for the health care system is to get the procedure with the highest reimbursement coded into the billing. Everything else is secondary including the health of the patient and the results of any procedure or service. And for this we pay the highest costs in the world. Medical care is one of the few services where the cost of the purchase is not known prior to making the purchase.
Somehow we need to incentivize the consumer to purchase the most cost effective medical care.
ah, the voice of reason.
As Margeret Thatcher famously said: “The trouble with socialism is that eventually you run out of other people’s money”.
I can tell you 30 years ago Arizona rural hospitals started closing/bankrupt
do to ILLEGALS feds refused to pay for
State said good luck
they closed instead
I call BS on hospital finances. If no one at any level of the organization of a hospital can point to a chart and say it costs us this rate to do one xray ( or name your procedure) for all patients – how the heck do they even know what they are making money on or losing money on.
I challenge you to ask this at any medical organization – how much does a simple procedure cost and they will give you blank stares – because they are not charging based on the actual cost but whatever insurance company pays out the most and alter the prices charged based on that.
Also hospitals shouldn’t be profit based anyway – they should be subsidized as needed and set up regionally based on population needs and not profitability. This should be the purview of the government not for profit entities looking to squeeze every dollar out of their patients.
“Also hospitals shouldn’t be profit based anyway.” Yes, this would stop Private Equity from buying up hospitals. Everything they participate in is done to suck money out of a system until it collapses. It should be illegal for Private Equity to own hospitals.
“I’m from the government, and I’m here to help”
Rings as true today as it ever did, not at all…
TY Ronald
We’re bankrupt.
I give up.
The rule for radicals is to overwhelm the system. Biden is a radical, overwhelming the country with an invasion of illegal aliens. Thus Denver Health is failing, with Tucson and San Diego having no city funds left to deal with the crush of migrants crossing the border.
To radical Democrats, the solution to the medical problems they are creating, is single payer, government authoritarianism.
Do your part and cancel your social security and medicare. Teach those democrats a lesson they will never forget! Break free of government authoritarianism.
What on earth does that have to do with what he posted? I don’t necessarily agree with him but this is nonsensical. Btw, if social security would give me my money back and never charge me again, I’d take it because I know what a lousy deal it is.Until that happens I’ll extract every nickel I can from the program.
“I’ll extract every nickel I can from the program.”
Yes, and poor people will milk medicaid, SNAP, schools, etc for every nickel as will immigrants and anyone else that doesn’t care. But to answer your question about nonsensical, everything and I mean EVERYTHING is connected. There are no silos when discussing anything government. none. Eventually you will figure that out.
At $1 trillion in additional debt every 100 days, both programs will be self canceling in a decade
They’re not quite the same: SSA budget shortfalls are in the “fixable” range; CMS budget shortfalls are in the “it’s going to blow up catastrophically” range.
SSA is fixable only to the extent that the entire US monetary system is sustainable. With federal poised to go parabolic way faster than currently understood, it’s not.
So Texas escaped huh? Then why are 45 rural hospitals at risk of closure in Texas?
link to beckershospitalreview.com
“A recent report from Chartis, a healthcare advisory services firm, found that 45 Texas rural hospitals are at risk of closure. The state’s total composes the highest percentage of the 418 rural hospitals in the U.S. at the risk of closure.”
There is a long held narrative that everyone is leaving big blue cities for rural areas yet rural areas continue to die and the plight of these rural hospitals is proof that something else is at play.
Anyone that does credible research knows the core issue. Population is dwindling and the worst hit areas are rural areas. There may be an exception or two across the entire country but the reality is most people (especially the young) leave rural areas for cities. With a few exceptions, cities keep getting bigger and bigger. People may leave Chicago or New York or San Francisco but they end up in Miami, Houston, Austin or some other big city. There is no point of rural people to leave one rural area for another so rural people end up moving to cities or more populated rural areas.
By the way, it’s easy to go to news.google.com and type ‘rural hospital closures’ and find dozens of articles about the topic and most don’t say anything about medicaid but they do say demographics is a core issue. Across the country we have a ‘misconfiguration’ of population and the only thing that has been helping is immigration.
There are ways to profit off of this too for the prudent investor doing research. Some of the commenters have already noted some big names squeezing juicy profits, who’s ROADING the money train?
People are moving to the flyover areas, not to a farm with chicken coop and cows.
where are your data statistics? link please otherwise it’s hot air.
Data Idaho: I moved and have 9 chickens and 3 steers
Everything Obama said was incorrect and anyone with half a brain knew it at the time
Here is an interesting related story:
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Patients die as ‘private equity’ hospital bosses rake in profits
BY VIVIAN SAHNER
Vol. 88/No. 11
March 18, 2024
The joy felt by Sungida Rashid and her husband, Nabil Haque, a couple who had just become new parents, was short-lived. Within hours of giving birth to a daughter at Boston’s St. Elizabeth’s Medical Center last October, Rashid began bleeding.
That’s when they found out that a medical device that could have saved her life was no longer available at the hospital. It had been repossessed by its manufacturer weeks earlier after it wasn’t paid by the hospital’s owners, Steward Health Care. Rashid was rushed to another hospital but died hours later.
St. Elizabeth’s is one of 33 hospitals owned by Steward, the largest private, for-profit hospital system in the country. While not paying the bills, Steward’s owners paid themselves millions in dividends. Ralph de la Torre, its CEO, acquired a 190-foot yacht estimated to be worth $40 million.
Across the U.S., profit-driven private equity outfits are snapping up hospitals, dental clinics, nursing homes, hospices and other medical facilities, looking to make a quick profit by taking out loans and mortgages while cutting staff, selling off equipment, leaving a trail of unpaid bills and often shutting down or selling off the facilities once they are stripped. In 2021 for-profit firms like Steward spent $206 billion to acquire more than 1,400 health care facilities.
…
link to themilitant.com
Mitt Romney wrote the book on many unsavory practices of the VC industry by pioneering them when he was at Bain Capital. He invented the method of getting management to betray the company they were working for by aligning their monetary rewards with the breakup and selling of valuable assets to Romney’s inner circle of friends, legally of course. His legacy is alive.
Private equity is the scourge of mankind
The upside of time travel! These people have 8 days to deal with this. Please follow up on the real March 18 2024. We move the clocks back 1 hour – not 8 days.
They do an issue every week or so, so they date it in advance. I suspect it is because they have a physical paper they distribute/sell and so you don’t want it to look like it has expired by having an old date.
The old account for 35% of health care costs and that will go up in principle except that a higher percentage is unsustainable. A good part of that is the costs of the last three months of life and if you have the money to get that last three months then good for you for three months. Otherwise there comes a time when you just have to acknowledge that your time is up and refuse to spend all the money you have left to gain those three months. The problem is that the person who is dying if asked in 99% of cases would agree to spend all and anything else to stay alive for just a little more. It is a true conundrum for the family.
If you want to know accurate spend on health care, this link has the best data that I’ve found so far.
link to healthsystemtracker.org
“People age 55 and over account for over half of the overall health spending”
If you want detailed medicare spend it’s on CMS.gov. That’s where a prudent investor vacuums up large data sets and analyzes it to maximize profits. What uncle sam takes out of my pocket, I take right back with the right investments.
Choo! Choo!
….and lose more with the wrong investments.
I’m 61 and think the health care system will collapse in my lifetime. Medicaid, Medicare, Dr.’s retiring and cost of health insurance/deductibles/copays/coinsurance aren’t sustainable. There will be a lot less people insured. Only the extremely wealthy will be able to afford healthcare. More Dr.’s and hospitals won’t accept insurance. – cash only
Per capita country comparison of healthcare cost, note the chart on right – link to en.wikipedia.org
It’s no coincidence that we’re also the only OECD nation that allows direct bribery in the form of campaign “donations”.
We have the best Democracy money can buy.
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Spot on. Our healthcare system is FUBB. Until we can get rid of our corrupt malevolent and incompetent legislators we will continue to suffer at their greedy hands. The solution is single payer healthcare. Medicare has an admin cost of about 5% versus the private insurance companies +30%. So this is one rare example where the govt is actually more efficient than the private industry controlling health insurance. Just think how efficient is it to have hundreds of private insurance companies with layers of bureaucratic admin costs at the same time encriching the investors and executives. Most here will call it socialism but our current system is completely corrupt. Even those on medicare can’t figure out what plan to get. They are bombarded with the advantage plans that promise the world and deliver little once you signed on. We have about double the per capita healthcare costs of the industrialized world with single payer AND the worst f-ing health, DEAD last. Obamacare made things even worse. My premiums doubled and my benefits vanished. It helped those with low income get free insurance, ie medicaid. The rest of those working paid for it. Nice. Typical Obamination political ideology . In the meantime those getting free medicaid make sure to keep their incomes below the threshold that will cause them to lose it. This also contributes to the lack of available labor. BTW these increased costs like elevated premiums and less and less coverage(ie heatlhcare shrinkflation) are not even reflected in the completely made up inflation statistics.
Costs aren’t going to go down just because of a single payer. Costs will be whatever the system can bear.
As long as money buys elections, this is a pipe dream.
All great points. One need only look at Japan. Our system costs at least twice as much and delivers much worse results
I was in favor of single payer until the COVID ongoing scamdemic
Now that one can have ZERO trust in ANY government health authority or private for that matter, I am afraid it now looks like there is simply no solution at all
Ultimately the solution is to hold the evil accountable but other than Ron Johnson, who is safely ignored, that seems unlikely
But its all good. Our Government wants us all to die anyway so everything is proceeding as planned.
You might find this of interest:
link to randomcriticalanalysis.com
The general idea is that the US is not an outlier on graphs that compare health care spending against Purchasing-Power-Parity income — no matter what year!
Google will find discussions of this premise by Scott Sumner, Alex Tabarrok, and others.
Something not often mentioned is the question of how anyone could compute US health care spending. Consider how hard it is to figure how much any one person spends, what with individual medical bills being, um, murky, at best. 🙂
I started to read that but it sounds like a bunch of gobbelygook put out by health insurance companies to justify the FACT that we spend double per. capita on health care. Income per capita should be irrelevant to this..
“should be irrelevant” is what Sumner said, too, at
link to econlib.org
That is, he doesn’t see a linkage to explain the correlation.
RonJ’s comment might explain it, though.
The thing to do would be to give the US single-payer system (Medicare/Medicaid/VA, currently) a per-patient budget that’s the average of peer-country systems. Let it run for 10 or 20 years. Happy with the broad coverage and outstanding performance? Keep it in place. Unhappy? Plan B.
Your admin cost comparison is a perfect example of “statistics don’t lie, but liars use statistics. ” Firstly, your 30% figure is ridiculous. More importantly, you are attempting to compare Medicare to private insurance on a per claim basis. Medicare has much larger claim sizes, thus it appears as if they are more efficient than private insurance processing claims for a baby check- up. When comparing apples to apples, private insurance is more efficient. Regardless, it’s obvious you don’t even know who processes Medicare claims… it’s the big insurance companies, not federal bureaucrats. Spreading misinformation is a canceling offense isn’t it?
Only one with direct-to-consumer drug advertising too. The ‘memorable’ letters J, Q, X, and Z are all popular with the marketing folk to try and get the general public to ask your doctor about…
Combine that with pfizer and pfriends making office calls directly to physicians and watch the $$ roll in!
Exactly. Nothing will get fixed, as long as lobbying and PACS are legal.
Our entire system runs on bribery and people are not nearly angry enough about it.
“…and people are not nearly angry enough about it.”
That part baffles and scares me.
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Try to make it to age 65 when Medicare kicks in. Everything gets much easier (and cheaper) then.
I don’t anticipate my health care costs to ever go down. I’m handicapped. I’ve been in multiple serious car accidents. I had over $125,000 in claims last year. I’m taking 3 medications that cost over $15,000 per YEAR and one of them is a generic. In an attempt to control costs EVERYONE (insurance companies, Medicare, Medicaid, etc.) makes it hard to get care. They try to deny benefits and approvals for medications. They try to force you totake cheaper medications before they will approve the more expensive ones.
And CA just made every illegal alien eligible for medicaid
Most hospitals are inefficient and throw too many people at each individual patient, which raises costs significantly.
Take, for example, lumbar epidural shots, of which I typically get 2-3 yearly due to life-long lower back problems.
When I have this simple procedure done at a hospital, such as Stanford, it typically takes 6-10 directly involved people, a staging/recovery room and an OR room. I get checked in by the reception staff and my insurance info is re-verified. I fill out forms with the same info that is already in my electronic record. I then get sent to the staging room, where I remove my pants, get on a bed, have my vitals checked and eventually get wheeled through corridors with numerous turns into the OR. They transfer me to the OR bed on my stomach. The doctor is here (or will be in shortly). Meanwhile, there are all sort of other assistants and technologists milling around, doing important? things. Once the procedure is completed in perhaps 10 minutes, I get transferred back to the gurney and wheeled back to the recovery room, my vitals get checked again and after 20 minutes, I can leave with the mandatory accompanied ride home. Total time spent is around 2 hours form entrance to exit. And I may also have to impose on someone for the ride home as they often won’t let me leave on my own..
Contrast this with the small MD pain management office I now use where I go in, get sent to a waiting room, have my BP/pulse/temp checked, then walk down the hall to the “operating room” (just another waiting room), where I pull down my pants, lay down on the bed, the portable x-ray machine is wheeled into position by a PA, the MD administers the shot, I go back to the other office, get my BP checked once more and then leave. Total time is around 30 minutes max AND I can drive myself home, so I don’t need to secure a ride home.
Both the hospital and the small office get paid the exact same $$ from Medicare. It’s clear which one comes out ahead.
Hospitals need to operate more efficiently.
Got them twice in NYU Langone hospital 34Th and First Ave NYC : almost got a heart attack twice by the experts. They are killing 100K/y people in accidents, more than fentanyl.
I used to have my injections done at a hosptial. I found a “Pain Dr.”(Anesthesiologists) that do these in their office. This also helps with continuity of care.
Charging what the market will bear?
Great story.
They might be training resident doctors at Stanford.
They do and that is a downside of going to a teaching hospital like Stanford. Usually, there will be one extra person (the trainee MD) in the room/OR to either observe or sometimes, do the actual work.
But this isn’t the reason for their overcrowded OR’s on a simple procedure.
In related news, Job creating tax cuts that pay for themselves over the last 40 years that created those jobs in China, Mexico and India were also supposed to pay for themselves.
Now we get to listen to the beneficiaries of those tax breaks Bitch about spending on those who’ve lost out and doubled their household debt over that 40 years.
We’re talking life and death healthcare here, had we gotten the “public option” back in 2010 that the GOP labelled as “death panels” and “government takeover”, we might’ve seen more competitive pricing, but again we see misguided blame.
Anyone that can afford to bribe Congress gets to make exorbitant profits, meanwhile the rest of us, including the government, get to take out loans to support those profits.
Yay.
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Maybe explain how higher taxes create jobs? I’ve run several businesses and never has less capital been a good thing. But who knows, maybe having less incentive to create wealth makes society better off.
Lowering taxes on the wealthy under the assumption their spare disposable income will generate jobs sure doesn’t.
Those tax cuts have only generated jobs in China, Mexico, India…..
Household debt to income is double what it was in 1980, wages haven’t increased with inflation, but CEO salaries have quadrupled.
If the private sector won’t reciprocate the promised jobs for the “job creating tax cuts”, at the very least we should be using the tax revenues to get our debt down and reallocate those tax cuts to sources that really do create jobs.
Then they need to work smarter to reduce their overhead costs.
Ask the question – you you want the company and your jobs to survive or not? If yes, then everyone has to take a 25% reduction in pay.
You will feel Biden’s response (higher Medicad rates and more printed money) in 3..2..1……
Mish, the only part of the Analysis that needs exploration: PROFITEERING from Health Care. I can draw on numerous examples of how Doctors order out MULTIPLE unneeded tests….I am a “victim” of this thinking, having to visit Labs for a full 6 weeks prior to a major surgery and the AMOUNT of Money that my Dr’s Company Labs, Dignity Health, pulled in was UNREAL: THOUSANDS of dollars of unneeded Labs, many confirming the same DATA POINTS for WEEKS leading to my big day. The cost of my ONE surgery: $356,000 for one surgery. In Singapore: less than 10% of that cost. THIS IS WHAT IS WRONG with American Medical care: PROFITEERING!
“Mish, the only part of the Analysis that needs exploration: PROFITEERING from Health Care.”
Upvoted.
This includes the millions dead from the opioid crisis.
And, not just healthcare, all industries & individuals that make campaign contributions, as justice Scalia used to say “Bribery is free speech”.
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When you have a highly regulated system expect “profiteering”. The Dr is protect by all sorts of well meaning regulations that protect the relationship between the Dr and patient regardless of what the insurers know is really happening. Even better for insurance companies, thanks to the ACA and its cap on insurance profits, is that the only way to grow profits is through growing reimbursements. How perverse is that? Their only incentive to keep costs down is in the current year. The more things insurers are forced to cover the higher their profits.
It isn’t quite that simple. Many times the reasons for this test or that test is liability protection. If something goes wrong with your surgery, and they didn’t do a test–that just happened to be a flashing red light for this time–you will likely be harmed or die.
Then the doctors and the hospital are liable for many millions, and the doctor could lose his/her license.
We live in a litigious society, and the reason you don’t hear more about all of the lawsuits is settlements. When settlements occur, the plaintiff usually must sign a Non-Disclosure Agreement and also an agreement to not defame the doctor or hospital. A lot of money changes hands and no one is the wiser, including future patients. There are many billions that get passed around this way, with very few people knowing about it.
There is a reason for everything, and it’s not as simple as “I want to make a few extra bucks on a lab test.”
Absolutely true. I’m in India. Many years back, my maid had open heart surgery, in a private hospital, at about the same time that my cousin in Washington D.C. had a minor surgery under L.A. for a rotator cuff injury.
I paid the equivalent of around USD1800 for my maids surgery. My cousin’s bill was multiples of that.
Health insurance is costly. Copay is too high. Doctors, pharma, and dentists rob u.The best way to stay healthy is prevention. Prevent clogging, obesity and extreme physical activity. Avascular Necrosis causes porosity in the hips, legs and the Jaws. Bacteria reside in the jaw. They feast on fructose, sugar, and alcohol. A root canal will not help u. Dr Mcdougall, Robert Lusig, Richard Johnson and Dr Bryan on Utube and TiK Tok ==> will. Keep your mass moving. Flexibility instead of power.
Pharma and supplies are where the major costs are.
Doctors and dentists really don’t make that much relative to pharma salesmen.
A friend in medical equipment sales makes half a mil per year with a bachelors degree, most MD’s make less.
Washington will take these Healthcare funding problems into consideration someday. The important thing now is to get another $60 Billion in Military spending funneled to Ukraine. Healthcare problems can be placed on hold.
Obamacare was a bail out of the medical scam because it’s unsustainable. So of course it is on the verge of collapse again. Medical represents 30% of federal spending and more than the entire deficit.
We can shrink costs with a 50% cut of salaries to all that progressive doctors from Harvard, etc. They will be happy sacrificing their income to help poor people and illegal immigrants.
Here in NC, I can attest to the fact that privately insured pay much more. I had 2 same day surgeries about 4 years apart. In the first one, the hospital billed over $20,000 (just hospital … not doctor, anesthesiology, or anything else). Insurance took it down to about $9K and paid it (I was out of my regular clothes for about 4 hours). In the later same day surgery, the hospital bill was over $50,000 and the insurance paid about $25K. How the hospital can make $25K for 4 hours is beyond me … but it is my understanding that 85% of ER visits are from indigents or Medicaid patients (I don’t know what happens if someone doesn’t have any Medicaid paperwork). Either way, I am quite sure that my $50,000 hospital bill for same surgery was a correction to a whole lot of hospital visits where the hospital was underpaid. Maybe we need to be more like Venezuela or Cuba where you have to bring your own sheets and folks in your family have to come bring you food. I could do that (I’m sure Domino’s would deliver) … but the sitting on the floor in the hallway for a few days waiting might be problematic.
No worries here in Kansas…….they are now importing illegals and using the Leavenworth federal prison as a distribution center for the area.
With the masses crossing the national border, importing is happening in every state either directly from the feds or both from the feds and sanctulary citys shipping people out
This is why government run care being cheaper is a fantasy. You can’t run a system where every service costs 30% more than the revenue coming in.
Wow! This has to be the first time the central planners in DC got something wrong.
Hmmm. So I just googled “hospital closings in Kansas.” Kansas, as noted in Mish’s post, is not one of the Medicaid expansion states. The article headline is dire for rural hospitals. Oddly, Kansas is saying just the opposite of Mish’s post. They need to expand Medicaid eligibility. The forces at play they sight in Kansas include hospital operating cost inflation, not enough patients, uncompensated services for those with no insurance, regulatory issues and flat lined reimbursement rates from private insurers. I am not suggesting that Medicaid expansion is nirvana. But I do take issue with the conclusions as one easy google search, in a state that has not expanded Medicaid, is advocating for Medicaid expansion to stem a projected 57% of rural hospitals in dire financial straights. There clearly is more to this story!
It would be good to get a link so we know who it is that claiming medicaid expansion will help rural hospitals. The first result I got was from the Kansas reflector which seems to be more a propaganda outlet than a legitimate news site.
Basically, it’s a common thread as many articles from various news sources beyond “The Reflector” are all saying the same thing. it’s also topical at the Kansas state legislative/governor level. The State of Kansas posted this link which is worth a read:
link to governor.kansas.gov
I stand by my comment: this is far more complicated than just saying that hospital closures are attributable to Medicaid expansion.
Thanks for the link. I’ll take a look. Clearly it’s always going to be more complicated than one thing, but it’s well understood that Medicaid does not fully reimburse for the cost of services which is why so many providers refuse to take it. I’m sure it’s not the whole story. Is it part of it? I don’t think there’s much question.
It probably plays some role but that role is not a consistent one as some states that have expanded Medicaid are not experiencing hospital closures to the extent that others have including those that did not expand. It seems that population density, range of services, financial position of hospital, staff costs, as well as the mix of patients. A Medicare patient is clearly better than a patient with no insurance. But it also seems that private insurance reimbursements rates are a factor. Dig a bit deeper, and those using Medicare Advantage plans are also a source of below cost reimbursements. At its core, I think de population of rural areas, and the costs associated with running rural hospitals is a key driver. Medicaid is part of the story but I think a side dish and not the main course. Also, the gravy train of Federal Covid relief funds has run dry. This is impacting rural hospitals more.
If you scroll down, there are many articles from various news outlets covering the same story. But here is a link from the Governor’s office which is worth a read:
link to governor.kansas.gov
Taking your original link at face value the one thing that is clear is that Medicaid is a losing proposition for hospitals in trouble and an even bigger losing proposition for hospitals that aren’t. It seems clear from the link you provided that expanding Medicaid would make the problem worse. We can argue about what the biggest part of the problem is, and I won’t claim it’s all Medicaid, but the notion you don’t dig yourself out of a financial hole by losing more money on Medicaid patients should be something we agree on.
Agree!
I also note that over a decade ago I could get a doctor’s appointment within a couple days.
Now, I’m told that any number of doctors are no longer accepting patients (too full), and the one I could get was booked out for months for something as simple as a physical. Specialists are booked for 6 months or more.
People don’t realize that a lot of our standard of living is reduced in these subtle ways when government takes over. I am having trouble wrapping my mind around the fact that 100 million people in this country are getting free healthcare.
All this while my annual deductible is $14000, and I still have to wait in line like everyone else, because we are a “fair and equal” society.
I mean, why work? We wonder why the labor participation rates are so bad. There are disincentives in just about every area of our lives. I honestly don’t blame people for abusing the system. They know that they will make no difference.
A decade ago is right when millions of baby boomers started to retire…that included doctors, nurses, specialist, etc. It’s not just healthcare that will be a problem. Pilots, aviation mechanics, engineers, prison guards, judges, lawyers, etc.
Notice how there have now been four airline close calls in the last 30 days? Wheels falling off planes, doors coming off, planes sliding off runways, etc. It’s a random coincidence that there is a massive and growing shortage of aviation mechanics?
This problem will keep growing in all industries everywhere. I told people they should be pooping their pants at what’s coming and got laughed at here. Well they won’t be laughing in a few more years when the crisis leads to massive inflation and other problems.
And in that decade we’ve had all sorts of republican and democratic administrations and the problem wasn’t fix nor will it be unless a focus on getting more people trained and educated is the focus and those people won’t be from here because there ain’t enough of them so they will need to come from somewhere else.
Remember 2030 is when all baby boomer hit 65 so we’re only a few years away from millions more retiring demanding goods and services from everyone left behind. Anyone not planning for it now is setting up for failure.
As a Gen X’er I’m going to miss the Boomers. It’s popular with Millennials and Gen Z to make fun and ride them, but the Boomers showed me just about everything I know. They were the last generation to have a crazy-good work ethic, and they played hard, too. They taught me how to be disciplined and how to have fun, too. They could also take a joke, unlike many younger people, who have zero sense of humor.
I am getting a little worried about when the Boomers are gone and we have people who are less concerned about completing the job properly, and who were brought up in a less rigorous system of education and training. I’m hoping my fears are misplaced, but we have had it really good with well-trained professionals for many years now.
On one hand there are complaints about rising cost of healthcare and on the other hospitals are closing. The truth is the strong systems will survive which is what should happen.
Side note: reading this blog you would think it was 2008 or 2009 from an economic standpoint. It isn’t. The Fed will keep interest rates higher for longer precisely because there is no recession that the doomsayers thought was coming.
Can you guarantee that?
When are folks gonna realize that the recession was put on hold not coincidently precisesly when Congress suspended the debt ceiling imposition until mid 2025, meaning any amounts approved have an UNLIMITED funding source unrestricted and unconstrained by the silly notion of a debt ceiling or budget limitation. Therefore, there has been massive government spending forestalling recession. Debt financing can put off recession until such time that markets question the ability to repay and push interest rates even higher, with the Fed then ultimately raising them after the market already does. This is NOT complicated. Mish’s recent posts showing debt outpacing population 15:1 and the line chart clearly shows where the recessions occurred and where spending shifted more vertically. Why pretend that this blog is wrong–Congress simply decided they didn’t want to take the recession in 2024 and the complicit Fed does what it always does, chastise and jawbone fiscal policy while printing and printing and printing. This isn’t because of our strong economy, pay attention to the rest of the blog posts showing government jobs, government spending vs manufacturing and other cyclical growth engines grinding ever slower to a halt relative to that permanent suckerfish of government.
Have a telethon fundraiser- the dancing tic-toc nurses wearing only a mask.
Ha!
GoFundMe Is a Health-Care Utility Now
Resorting to crowdfunding to pay medical bills has become so routine, in some cases health professionals recommend it.
By Elisabeth Rosenthal
February 5, 2024
GoFundMe started as a crowdfunding site for underwriting “ideas and dreams,” and, as GoFundMe’s co-founders, Andrew Ballester and Brad Damphousse, once put it, “for life’s important moments.” In the early years, it funded honeymoon trips, graduation gifts, and church missions to overseas hospitals in need. Now GoFundMe has become a go-to for patients trying to escape medical-billing nightmares.
One study found that, in 2020, the number of U.S. campaigns related to medical causes—about 200,000—was 25 times higher than the number of such campaigns on the site in 2011. More than 500 campaigns are currently dedicated to asking for financial help for treating people, mostly kids, with spinal muscular atrophy, a neurodegenerative genetic condition. The recently approved gene therapy for young children with the condition, by the drugmaker Novartis, costs about $2.1 million for the single-dose treatment.
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link to theatlantic.com
KTLA notes GoFundMe links to their news stories involving people hospitalized from a violent incident or to help pay for a funeral from same. Other reasons as well.
Mexicans don’t pay.
Blacks don’t pay.
Whites pay triple.
A.k.a Blanc Homme Burden, in partial French. If you type it in English the PC filter will memory hole it like a champ.
Here some the illegals.