(no subject)

[conuly]

Stunning Vintage Photos Capture Street Scenes of Los Angeles in the 1930s

The Misunderstood Roman Empress Who Willed Her Way to the Top

Video Games Need Better Dinosaurs. Paleontologists Can Help

How do you pick the perfect concert piano? Inside the Royal Conservatory’s $300,000 bet

Eleven-year-old Victoria has her sights set on playing Little League with the boys. She goes through tryouts and is told to learn to cook. Instead, she changes history.

Scientists chip away at how ancient Roman concrete stood test of time

Living With Wolves

In the commune I once called home, I was too young to understand what it meant to be born into a Black-liberation movement.

Cities have turned to an old standby to reduce crime: teen curfews. There’s just one problem.

A worrisome trend in American hospitals is hurting poor patients

The Power and Peril of the ICU

Violence soars in Mali in the year after Russians arrive

Comments

[siderea]

A worrisome trend in American hospitals is hurting poor patients

If only Medicaid were a government run program so the government could just step in and fix the things wrong with it so providers would take it.

Oh wait.

ETA: No, wait, I'm angrier than that at this article's framing. I'm generally more than fine with slagging on private equity ruining healthcare. But that's not what this is. This is what happens when unsentimental grownups who can read balance sheets take over from Peter-Principle'd physicians, and realize that their Medicaid patients' insurance doesn't cover Medicaid patients' care. This is a stone cold business decision. Supply and demand, baby. If the US wants single payer, it should do that, but in the meanwhile, we have a market for healthcare and Medicaid has to function in it.

And, wouldya look at that: if you click through from the Vox article, which tries to spin it about the big bad private hospitals, to the actual research paper, right there in the abstract is, "this is partly achieved by differentially reducing the intake of low-income Medicaid patients, who are typically less profitable than other groups due to lower reimbursement rates." "Lower reimbursement rates": man that phrase carries a world in it. In normal reality, someone selling something – a lemonade stand selling lemonade, a gastronenterologist selling colonoscopies – sets a price, and the customer can buy it at that price, or not, or try to haggle. But in modern US healthcare, the buyer – meaning the insurer – names the price they're willing to pay, and the seller – meaning the medical provider – can take it or leave it. But we can't call that a "price", because a price is a number the seller picks. So we call it the "reimbursal rate", meaning the price the insurer picked. "Lower reimbursement rates" means Medicaid has named a price so low that providers won't take it.

And to be clear, part of the problem is that the patients are poor people. It's not that private equity doens't think poor people's Medicaid dollars aren't green, or thinks them unworthy. It's that poverty does a number on people's bodies, and so they are sicker and less provisioned with resources to get better, so wind up more expensive to treat. But Medicaid programs – meaning states – not only want a deal on the price, they (usually) don't want to pay extra to cover patients who need extra care.