[aaavl2821]

30% of US healthcare spend goes to hospitals, and 20% to physicians (many of whom are employed by hospitals even if they are outpatient clinics -- the % of physicians employed by hospitals in the US is at an all time high)

Hospital consolidation has been increasing the last few decades. Many hospitals are regional monopolies and have a ton of leverage in negotiations with insurers. Insurance companies put the squeeze on smaller providers, increasing pressure on them to sell to big hospitals. After buying a smaller hospital or clinic, the hospital system can bill insurance companies at the hospital systems' much higher negotiated rate -- for the exact same care (at least this is what i heard from several execs at big hospital systems).

My first job out of college was an investment banking analyst and our most profitable clients were hospital systems (HCA, Community Health, Tenet Healthcare, etc). They were so profitable that their profit margins were 20-30% even after writing off 30% of their revenues as uncollectible (this was before the Affordable Care Act).

These hospital systems were major targets of private equity buyouts. A buyout fund would buy a big hospital system, finance the deal with a ton of debt, then buy more hospitals and clinics and roll them up into the bigger system. They made so much cash that they could pay down huge amounts of debt quickly so the private equity groups made tons of money. Many non-profit hospital systems engage in similar aggressive behavior

[vkou]

How can we fight this, when so much money is on the line, to make sure that this golden goose keeps fleecing the middle class?

[aaavl2821]

I think tackling hospital / physician costs is even harder than drug pricing. Hospitals are major employers in almost every county. For a politician to break up hospital monopolies, they would be fighting against the one of the biggest employers in their constituency.

The American Hospital Association (the biggest hospital industry lobbying group) spends about as much as Phrma (the big pharma lobbying group) according to open secrets [0][1]. But the hospital industry has much more "soft power" because they are such a huge employer.

One solution is for payers to own more of their own providers, although that is challenging to implement and can lead to its own issues and bad incentives. I think one effective angle is to help more physicians stay independent -- there is probably a way to do this without legislation and i think some companies are working on this.

But i think one thing people can do is spread awareness of this issue -- you dont see it talked about in the media that much bc no group has an incentive to do so

[0] https://www.opensecrets.org/orgs/lobby.php?id=D000000116

[1] https://www.opensecrets.org/lobby/clientsum.php?id=d00000050...

[claudeganon]

Medicare for All. Help try to get Bernie elected, as he’s the only candidate who actually backs the policy. Warren has back-pedaled now that she’s secured the top position as the moderate alternative.

https://jacobinmag.com/2019/09/elizabeth-warren-campaign-med...

[s3r3nity]

I believe Andrew Yang also supports this to some extent IIRC.

[claudeganon]

You can only bring down costs and combat things like hospital consolidations through a single payer system and dismantling private insurance (i.e. Bernie or Jayapal’s bills), so none of the “compromises” proposed by other candidates will do anything too meaningful. If you want a good breakdown on why, I recommend Tim Faust’s new book:

https://www.mhpbooks.com/books/health-justice-now/

https://www.stitcher.com/podcast/the-death-panel/e/63311382

[aaavl2821]

A single-payer system isn't the only way to bring down costs and fight hospital consolidations. Enforcement of antitrust laws on regional hospital monopolies is another potential way. Although tipping the scales more in favor of payers, with single payer being the extreme variant of this, could work as well

The issue with any political solution is that hospitals will fight any legislation like crazy. Hospitals probably have more political power than even the drug industry, and the drug industry has obviously been able to fight price controls pretty well.

The risk I see with any political solutions is that politicians create watered-down legislation that makes voters think they are tackling the issue, but don't really have much teeth. That's the win-win for politicians -- if you pass a toothless medicare for all bill, voters will applaud you, and you won't anger potential donors from industry.

[claudeganon]

> The issue with any political solution is that hospitals will fight any legislation like crazy.

> The risk I see with any political solutions is that politicians create watered-down legislation that makes voters think they are tackling the issue, but don't really have much teeth

I agree, which is why you have to start from the strongest possible negotiating stake with a corresponding infrastructure of mass organization and support (again, Bernie and his bill).

These industries are absolutely ruthless, profit from people at their most vulnerable, and will fight tooth and nail to continue this deeply predatory behavior. If you approach them with even the slightest indication that you will bend to their will, they will eat you for lunch.

[dominotw]

allow doctors on H1B to come from india. That's what they do in UK.

[basementcat]

Wouldn't that help the bottom lines of hospital conglomerates even more?

[vkou]

If two million trained software engineers magically arrived in the US overnight, it would certainly help the bottom lines of AMFGOOG in the short-term, but would probably drive down the long-term cost of 'I want some software built'.

[dominotw]

Yea i guess its helping the bottom lines of tax payers in UK.

[tonyedgecombe]

It’s ironic that Enoch Powell started that.

[benj111]

Maybe you want to accelerate it?

Merge all the regional monopolies into one big national hospital monopoly, with all the drug buying power that brings. Then get the Trump/Clinton Care bill passed that controls insurance prices and regulates this new 'National Health Service' as the hospital monopoly might be called.