the big advantage of single-payer is that it creates an entity with enough power to tell hospitals and pharmaceutical companies to go fuck themselves. the consistently highest-yielding investment in the United States for a long time now, beyond a few individual stocks, has been hospital REITs. - ThreadSky | a Reddit-style client for Bluesky

theophite.bsky.social • 89 days ago

the big advantage of single-payer is that it creates an entity with enough power to tell hospitals and pharmaceutical companies to go fuck themselves.

the consistently highest-yielding investment in the United States for a long time now, beyond a few individual stocks, has been hospital REITs.

Reposted from River_Tam

This got posted on Twitter and is a good example of what I've been talking about. YOU clearly think it's ridiculous to charge $275K for administering failed CPR to a dying woman with a DNR. You know who else thinks that? The insurance company. But most of the comments are mad they didn't pay it.

Comments

praxisprocess.bsky.social•89 days ago

Which ones are you talking about? Iirc a lot of them have had real trouble last 3 years from reversal of ZIRP. But I could be wrong, I often am.

theophite.bsky.social•89 days ago

yeah they got killed by interest rates because they were levered up so hard but this is true _notwithstanding that downturn._

petergratton.bsky.social•89 days ago

I remember seeing figures in 2022 and thought it was a typo—REITs were murdered that year. Did they leave out negative sign? Anyway I don’t know specific hospital REITs—I know the healthcare ones (which often own small centers and such too) were at near 40% returns this year as of week or so ago.

pheitch.bsky.social•89 days ago

You telling me price is decided by supply and demand and that demand can be better controlled by uniting together? I was never taught that so it must be false. There's just no way to explain why the US spends more on healthcare than single-payer countries.

theophite.bsky.social•89 days ago

a "nonprofit" hospital cannot charge an extortionate rate. the land a hospital sits on, however, can drain what would otherwise be profits out of an entity which holds a gun to your head and tells you that if you don't pay them, they'll die.

beazletown.bsky.social•89 days ago

Is it true that nonprofit hospitals can dramatically overcharge a patient, then forgive the charge and treat it as a charitable donation.

theophite.bsky.social•89 days ago

yes

richardofyork.bsky.social•89 days ago

hospital consolidation is a direct response to this dynamic.

also health care can never be a rational market. you wouldn’t go discount hunting for your mothers cancer care.

saveamerica.bsky.social•89 days ago

But that would work too well and we can’t have nice things

joshjob42.bsky.social•89 days ago

Yeah the recent blowup over anesthesia for instance was a real try to contain costs & fraud by anesthesiologists who mostly won’t get paid by patients for uncovered time due to hardship. But the saner option is to just pay anesthesiologists a fixed rate per procedure plus some patient outcome factor

joshjob42.bsky.social•89 days ago

It would be much easier to put the squeeze on hospitals and providers without putting the squeeze on patients in a single payer system. Now we get terrible kludges and siphon all cost containment into insurance providers in these awkward ways that innately have to directly hit patients and providers

holgate.permanent.red•89 days ago

Or just the German model where providers and insurers thrash out a uniform reimbursement tariff in public every year, compared to thousands and thousands of secret contracts based upon bistromathics.

denis.trailin.ca•89 days ago

Ideally hospitals should be owned by the govt like they mostly are in Canada.
The negotiating happens with drugs and doctors themselves which mostly run their own practices.

far-far-away.bsky.social•88 days ago

We don’t have universal health care in this country because the *doctors* (the AMA) quashed Truman’s attempt in 1948, as it meant limits on their income. In Western Europe, docs are more like college profs, secure and comfortable but not high earners.

synshie.bsky.social•88 days ago

The big disadvantage is that, if America had a single-payer system, RFK Jr would soon be dictating what will be covered for all Americans.

giziti.bsky.social•89 days ago

REITs also have a weird tax treatment that's probably being exploited in a very beneficial way here.