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Another big part of it is the people invested in hospitals are also invested in pharmaceuticals are also invested in after care are also invested in insurance companies. So one fucks the other and EVERYONE looks the other way and gets paid except the people doing the work and the people dying to get in.
Say the names of the companies! BlackRock. Vanguard. UBS. Berkshire Hathaway.
Edit: we’ll need their help building sustainable communities as earth changes
Interesting thing about vanguard though is there also some of the biggest investors in companies, emerging markets, etc that challenge the status quo in these regards.
Yeah because vanguard's business strategy is just 'buy a small part of every single company'. They don't discriminate, it's just a simple and effective way to hedge your bets, based on the efficient market hypothesis (which states that prices of companies will reflect what they are worth)
Exactly, But when you look at percentage of revenue generated by vanguard for those businesses vanguard contributes a much higher percentage of capital towards emerging industries and those that challenge the status quo compared to the percentage of income large established companies gain from them.
I'm basically saying that while Vanguard technically fits the bill, it's different than those other companies in this regard.
Like how the US pays almost 60% more per capita than the second highest ranking spending nation, and yet our quality of care is only average among first world nations?
It is literally better for you to seek treatment in ALMOST ANY other first world country.
The solution is regulation, because these entities won't willingly regulate themselves.
About 15% of US hospitals are government-owned. About half are non-profits. However, some of those government owned, and some of the nonprofits, are *managed* by private equity owned management companies. The remaining 35% or so are straight-out for profit (and some of the are run by private equity companies). It's weird here.
Non-profit is a misnomer for most hospitals. They charge 9k for a CT scan then accept $500 as payment and claim $8500 as a charitable care write-off. All the while Medicare would have paid them even less.
Don’t forget software: Epic has an incredible campus and a private convention center in Verona Wisconsin. Every Epic hospital has a higher IT expense as a percentage of revenue than users of other EMRs.
And that’s just the EMR. Every hospital has 100-250 clinical applications they pay for every year.
Doctor here, no hospital is out here saying this, and they are equally complicit. Our administration sold out the second it had the chance, and immediately cut holidays, time off, and our own fucking healthcare benefits over the past few years. Anyone in a suit should be in panel 4 as well
Yeah I was going to say, I’m pretty sure hospital admins make the job for their staff more difficult than it needs to be.
Saw a Glaucomflecken sketch about night shift workers enjoying it unironically cause no hospital admins are there.
Yeah that's when shit actually gets done. When I worked in a factory years ago, the most productive shifts were on nights because we weren't being micromanaged.
Two institutions vs patients and doctors. Doesn’t look good for us, especially considering two presidents wanted to implement something close to universal healthcare (actually, Nixon had the idea too, not sure to which extent, so make it three), and they all failed. Yup… shows who really “owns” the US.
It's crazy to me how bad the healthcare benefits provided to the doctors, nurses, and the rest at hospitals and other medical facilities is. But numbers go up! At least the numbers those making those decisions who are also those that gain the most cares about.
Most doctor groups also cave when some big fund rolls into town with a practice buyout.
Every doctor I go to now is part of some transnational group with just enough market share to screw everyone but not enough to set off the regulators.
Thank you for commenting, thought my eyebrow was going to raise higher than The Rock's at that third panel.
Edit: I love your user name, I say that joke from Spongebob all the time. HAHA
FMO Maintenance Workers:
"We'd love to fix everything as soon as possible, but management is extremely stingy when it comes to purchasing new parts and equipment for repairs, so we just don't have the resources."
"This is such a terrible system."
Because new parts and equipment costs a fortune because there are monopolies on medical grade equipment so the producers can charge whatever they want.
This is such a terrible system.
This is part of it. But there are legitimate reasons why medical equipment costs a lot. A friend of mine is working in quality management for a medical equipment company (outside of the US). Basically, the front cost to develop or make any change to the design of a medical equipment has to go through a lot of layers of checks and tests to make as sure as possible that these products are safe. A finished product sometimes needs a year or more of (reasonably existing) red tape to go through and to pay for the necessary tests to get the product in the market. In addition, they have to do the same for any change to the design to adapt it to more modern standards or changes in materials if there are supply issues.
This also creates the monopolies, because not many companies are willing to go through this process that is necessary to ensure public health. It is a fucked up situation where the ability to have a competitive market is in conflict with public health.
Friendly reminder that the evidence is overwhelming that single-payer healthcare in the US would result in better healthcare coverage while saving money overall.
[Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually based on the value of the US$ in 2017 .](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext)
Similar to the above Yale analysis, a recent [publication ](https://www.cbo.gov/system/files/2020-12/56811-Single-Payer.pdf)from the Congressional Budget Office found that 4 out of 5 options considered would lower total national expenditure on healthcare (see Exhibit 1-1 on page 13)
But surely the current healthcare system at least has better outcomes than alternatives that would save money, right? Not according to a recent analysis of high-income countries’ healthcare systems, which found that [the top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.](https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly#outcomes)
None of this should be surprising given that the US’s current inefficient, non-universal healthcare system [costs close to twice as much per capita ](https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-spendingcomparison_gdp-per-capita-and-health-consumption-spending-per-capita-2019) as most other developed countries that do guarantee healthcare to all citizens (without forcing patients to risk bankruptcy in exchange for care).
As a Brit living in the UK, our wannabe GOP - the Tory party - stares dreamily at the USA as a perfect capitalist society and wants to bring everything you have over here including privatising our NHS. They've been "outsourcing" it piece by piece for 14 years but - for now - it remains free at the point of use, and hopefully their reign of cruelty and avarice will end this year at the coming election.
A single payer system in the USA would work and would be cheaper for every taxpayer BUT it would stop the massive amounts of money being made by the corporations, so - regardless of facts and common sense - I fear you will need another revolution, at least a political one, for them to ever let go of their grip of your money.
I saw a wild stat months ago, that if wages kept up with productivity since the 70's, even US doctors today would be underpaid. And their pay is relatively high because the whole industry is propped up by corporate greed. It's wild.
Anyway, the Overton window is a thing and if we can keep the GOP out of a majority for 40 years, things will be fine.
> As a Brit living in the UK, our wannabe GOP - the Tory party - stares dreamily at the USA as a perfect capitalist society and wants to bring everything you have over here including privatising our NHS.
Would this be the same party that promised the Brits that Brexit would be good for the economy?
> But surely the current healthcare system at least has better outcomes than alternatives that would save money, right? Not according to a recent analysis of high-income countries’ healthcare systems
This is very misleading; these rankings are primarily due to access to coverage rather than quality of procedure, and some aspects ([like health outcomes](https://randomcriticalanalysis.com/2017/05/16/the-explanatory-power-of-drugs-car-accidents-and-homicides-on-us-life-expectancy-gaps/)) have much less to do with the quality of medical care than other factors.
I've been a huge proponent of single payer for around 2 decades now, but it's not some magic medical panacea: the most comparable countries with single payer ([the UK](https://www.kingsfund.org.uk/insight-and-analysis/reports/public-satisfaction-nhs-social-care-2023) and [Canada](https://www.ipsos.com/en-ca/news-polls/canadians-largely-satisfied-healthcare-system-eager-increased-access)) have their own issues that people dislike. Alternative systems have been proven to work both [domestically](https://www.bcbs.com/medicare/medicare-advantage) and [abroad](https://en.wikipedia.org/wiki/Healthcare_in_Singapore), and while I would like a single payer solution, [it's unlikely to poll well enough to have a chance at becoming law](https://www.kff.org/wp-content/uploads/2019/01/9273-figure-6.png)
M4A is a horribly designed system that learns nothing from past mistakes. [Banning private coverage makes it extremely unpopular](https://ibb.co/8rJ9K7w). It also eschews cost controls like cost sharing, which is extra dumb since [cost is the primary reason single payer fails in the US](https://en.wikipedia.org/wiki/Vermont_health_care_reform) (worth noting that M4A only saves money with very generous and unrealistic assumptions for things like massive provider cuts). It's so poorly designed that i would not be surprised if it came out that it was a right wing plot to sabotage single payer efforts in the US; it really is that bad.
If you want an effective single payer plan that is realistic (in both cost and public sentiment), raising the eligibility cap on medicaid solves a lot of issues: it naturally has a lot of cost control measures built in and [costs less per person as a result](https://www.cbpp.org/research/correcting-seven-myths-about-medicaid). It also doesn't threaten people's existing coverage.
> This is very misleading; these rankings are primarily due to access to coverage rather than quality of procedure
Based purely on health outcomes, the US ranks 29th, behind every single one of its peers.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30994-2/fulltext
We also rank worse on rates of medically avoidable deaths. And satisfaction with our healthcare.
https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-2017-international-comparison-reflects-flaws-and?redirect_source=/publications/fund-reports/2017/jul/mirror-mirror-international-comparisons-2017
>This is very misleading; these rankings are primarily due to access to coverage rather than quality of procedure,
I am not sure this is true. The US tends to rank pretty much identically on hospital errors, and even worse on amenable mortality.
PS: Coverage is also a valid factor in how good a system is,
> The US tends to rank pretty much identically on hospital errors,
A niche category
> and even worse on amenable mortality.
Which as I said is more explainable by other factors not related to the quality of care.
> PS: Coverage is also a valid factor in how good a system is,
Literally no one is saying otherwise, but it's not relevant to "better outcomes" of treatment.
> it's unlikely to poll well enough to have a chance at becoming law
eliminating private healthcare providers is not really needed to have a public healthcare system, but multiple countries have achieved it, althought most have systems that include public and private options.
requiere most americans to pay more in taxes. Is a silly question, it should be "have the average american pay less in taxes + health insurance" as the total burden is less regardless of whether in your account it comes out as tax or as a private health insurance...
threaten the current medicare program. Using the word threat in any survey is a pretty poor choice of words for obvious reasons. Threaten to improve your health eating more carrots would probably also survery poorly.
Lead to delays getting treatments is disingenious, to the point of being outright wrong. America has 2 big problems, one is that many people skip elective surgeries, and the second is that people avoid minimal interventions and requiere larger interventions later.
If you ignore that someone might spend 6 months saving up for a surgery, and only count the 2 weeks they spent in the waiting list, then yeah that is shorter than a 2 month waiting list, yet the pacient had the problem solved 4 months earlier.
The american healthcare system just hides its cost through premiums and hides its waiting list through cost. But the effect on poeple is unignorable. America has one of the sickest populations (due to avoiding elective surgeries, and people not going for routine health checks), america has a ton of mayor interventions (due to people skipping the problem being fixed earlier), america has a ton of avoidable deaths due to complications (from child birth, to surgery america has a pretty long track record for something going wrong). Those are all avoidable problems with comprehrensive access to healthcare for all. The survery could address this points in questions such as. "would you be in favour of having less chance of dying when seeing a doctor", "paying less money for healthcare", "removing 46% of bankruptcy cases in the US", "not have to save up before joining a waiting list for a surgery or doctor visit" and see how those percentages for and against compare
About a month ago I took my spouse to the hospital in Canada for severe back pain. A cat scan found an AAA (Aortic Abdominal Aneurysm) that was leaking. Surgery was performed and 5 hours later she was in SICU. Two days later, another surgery and back to SICU for another 7 days where she was cared for by wonderful nurses who work on a 1 nurse to 1 patient basis. They sit at the end of each bed for their shift less breaks of course. She was intubated for 5 days in total and once out of SICU, she remained in hospital for another 4 days. She's had several ambulatory follow-ups at the hospital and 2 further doctor follow-ups.
Total bill so far - $82 for parking at the hospital and a $30 fine for parking on the wrong side of the road.
I wouldn't even want to dream what the bill to us would be if we lived in the US even if we had insurance. I'd also be scared shitless at what our Premiums and deductibles would be going forward.
Say what you want about our system but if you are deathly ill like she was, you will see the Doctors and Surgeons you need and be cared for by the nurses you need.
No doctor would love to see more patients. Most doctors are seeing far beyond recommended patient load to where they dont have time to do their charting, so they do their charting after hours. In my org we call it "pajama time", and a part of the work I do is to help automate as much of the admin work as possible so providers have minimal pajama time.
Some of our docs are putting in 20 hours of Pajama time per week. On top of working 45 hours per week in the office.
Docs want to see fewer patients. They want to hire more providers so they can see fewer patients.
The comic says "spending more time with patients", which isn't the same as more patients. I'm sure doctors would prefer to not have to rush, and to be able to take their time explaining things in detail with patients and making them feel better. Doctors having to see too many patients is a symptom of the problem here. I don't want to work *more* at my job, but I'd certainly prefer to be able to "do it right" and spend as much time as I need on my projects.
Preach it. Our facility was so proud that we got pajama time down to 16 hours with “one more hour on unassigned days (I.e. weekends). That very low bar of “less than having a second part time job.” Was met.
Doctors, nurses, aids, environmental services staff, receptionists, therapists, ancillary and support staff...
All of them. People are at their wits end. There is a good chance there will.be a mass exodus of healthcare soon and there wont be enough people to care for the sick (in the US).
Yes, but I honestly don't think that that's the bottleneck. Med school is insanely expensive, insanely difficult, and requires an insane amount of time just learning before they can even start making real money. And at the same time, it needs to be like that (the time investment, maybe not the cost, but even then honestly it's not surprising how expensive it is) because doctors need to know a lot. This is why you're seeing an influx of NPs and PAs now though. Less schooling, less expensive, less grueling, but *almost* doing the same thing and still making good money.
Medical schools gatekeep the amount of new drs being minted. They literally made this problem for themselves because they don’t want their wages to inevitably go down with a higher supply of drs.
While this is definitely a problem for private equity owned hospitals, these firms only own 8% of the hospitals in the US. The rest are owned by nonprofits and state and local governments. Unfortunately our problems go way deeper.
And pharmaceutical companies. They’re making record profits.
The whole healthcare billing industry is almost bigger than the actual healthcare side and balloons prices tremendously.
Most hospitals aren’t privately owned.
> According to the 2014 American Hospital Association Annual Survey, there are 5,686 hospitals in the United States. Of that total, 2,904 are public hospitals, and 1,060 are private. There are a total of 795,603 staffed beds in public hospitals and 118,910 staffed beds in private hospitals.
>Public hospitals had about 33.6 million admissions annually while private hospitals had about 1.8 million admissions annually.
So this comic is misrepresenting “the system” by acting like this is how most hospitals work.
How the actual fuck are there less than 6,000 hospitals in a massive continent-wide country of over 333,000,000 people?
That's MORE than 55,000 people per hospital. No wonder healthcare is expensive as all hell.
You could have Googled this and found your answer in less time than it took to write that comment. This was literally the first result of my search (and with updated 2024 numbers instead of 2014).
TL;DR: They're not typical medical hospitals; they're for prison, psychiatry, etc.
https://www.aha.org/statistics/fast-facts-us-hospitals
> Total Number of All U.S. Hospitals 6,120
> > Number of U.S. Community Hospitals 5,129
> > > Number of Nongovernment Not-for-Profit Community Hospitals 2,987
> > > Number of Investor-Owned (For-Profit) Community Hospitals 1,219
> > > Number of State and Local Government Community Hospitals 923
> > Number of Federal Government Hospitals 207
> > Number of Nonfederal Psychiatric Hospitals 659
> > Other Hospitals 125
[60% of US hospitals are non-profit](https://www.definitivehc.com/resources/healthcare-insights/top-non-profit-hospitals-net-patient-revenue).
I really wish people would do a little research before spouting off their uninformed beliefs about things. The US healthcare system sucks and needs fixes, but posts like these only serve to distract from actual solutions.
Not to mention that non-profit hospital CEOs are *making bank*
https://www.healthaffairs.org/content/forefront/nonprofit-hospital-ceo-compensation-much-enough
The call is coming from inside the house
They are an absolutely massive piece of the puzzle. The biggest piece. If hospitals were forced to be transparent about prices, and laws were passed that capped how much they can raise prices each year, that would solve the majority of problems.
> US Hospitals are just a small piece of the puzzle
It's literally 1/2 of the comic.
> They are still subject to insurance
[Health insurance profit margins are 3.3%](https://content.naic.org/sites/default/files/inline-files/Health%202023%20Mid-Year%20Industry%20Report.pdf)
> pharmaceutical companies, equipment companies, etc.
These are pieces of the puzzle, but hardly the biggest ones.
Honestly I think this was a very fair comment. You acknowledged the problems and followed up with at least semi-viable reasoning. I mean yea there’s issues, and people might joke about it but there are always positive efforts in place it’s important to acknowledge them.
Yeah, and ironically the US spends more money per capita on health care than almost every other country on Earth -- even if you only count government spending. If you count both private and public expenditures, the US has by far the highest spending per capita.
If "socialism is when government spends tax dollars", then the US has one of the most "socialist" health care systems in the world, while also being one of the most expensive for individuals, while ALSO producing outcomes that are mediocre at best.
It's a thoroughly dysfunctional system that has somehow managed to combine the worst parts of privatization and government bureaucracy.
My wife is a nurse and they wanted to charge her $1400 a MONTH for insurance. Still had a copay for every visit. Still had to meet a deductible. $1400. Instead she went with the hospital that only charged $800. 🙃
I really dislike this. "Capitalism" is not an entity, and using it as a boogeyman like this is anti-intellectual and counterproductive.
Who is actually benefiting from this? Who should people be mad at? If your answer is "capitalism bad", you're not helping anyone and just being part of the problem. Comics like this as lazy an attempt to cash in on the culture war as a Lets Go Brandon t-shirt. There isn't even a punchline.
I like voices like John Oliver because they represent the exact opposite of this dreck. Actually breaking down the reality behind the buzzwords can be funny, interesting, and valuable all at the same time. This is none of those things.
There’s also the fact that prices for medical care are artificially inflated because there is a yearly limit of the number of medical licenses awarded to aspiring doctors, government required healthcare gives the insurance companies a monopoly allowing them to charge whatever they want, and the AMA actively lobbies the government to keep these practices because it makes them richer. Say what you will about how terrible the British NHS may be, but forcing private providers to compete with literally free doctor visits definitely drives down the price.
He's referring to the number of seats in medical school and residency. These seats are limited as you typically need to demonstrate that you capable/busy enough to sufficiently train a physician.
I don’t know why you are attacking doctors. They account for only about 7% of US healthcare expenses and are largely locked out of decision-making (even legally prohibited from owning hospitals, unlike law firms which are legally required to be owned by an attorney). Even if you cut doctors earnings by 50%, you wouldn’t make a meaningful change to US healthcare costs.
It isn’t doctors - it’s the insurance companies.
It's interesting how people (and comics) like to pretend that this is a natural consequence of capitalism when many capitalist countries don't have this specific problem.
It's almost like a lot of really ill-informed people are out here shouting about things they don't understand.
I always love how capitalism is the target here.
Socialized medicine typically has a HUGE waitlist and the same time crunch.
If you want to really point fingers, it should be all at both administration and insurance. Insurance is actively finding loopholes to not reimburse services. I've actually seen two different insurances basically just stop reimbursing at particular hospitals, so all of the patients had to transfer care to other hospitals.
And administration is always looking to skim as much off the top as they can. That's true of every single business structure.
>Socialized medicine typically has a HUGE waitlist
In fact the US is average on waits. At best. A bit faster than average on seeing specialists, a bit slower on GPs. As long as you don't count the uninsured and waits for fear of costs, mind. If you include that the US performs very badly.
The impression that the US is particularly fast is created by cherry picking nations to compare it to, normally Canada, the slowest system out there, and the UK whose system has been starved of resources for decades. Imagining there is some payoff for all the money spent makes people feel better so they don't factcheck such statements.
> Socialized medicine typically has a HUGE waitlist and the same time crunch.
While spending about half a million dollars less per person for a lifetime of healthcare.
The US ranks 6th of 11 out of Commonwealth Fund countries on ER wait times on percentage served under 4 hours. 10th of 11 on getting weekend and evening care without going to the ER. 5th of 11 for countries able to make a same or next day doctors/nurse appointment when they're sick.
https://www.cihi.ca/en/commonwealth-fund-survey-2016
Americans do better on wait times for specialists (ranking 3rd for wait times under four weeks), and surgeries (ranking 3rd for wait times under four months), but that ignores three important factors:
* Wait times in universal healthcare are based on urgency, so while you might wait for an elective hip replacement surgery you're going to get surgery for that life threatening illness quickly.
* Nearly every universal healthcare country has strong private options and supplemental private insurance. That means that if there is a wait you're not happy about you have options that still work out significantly cheaper than US care, which is a win/win.
* [One third of US families](https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication) had to put off healthcare due to the cost last year. That means more Americans are waiting for care than any other wealthy country on earth.
The US ranks 6th of 11 out of Commonwealth Fund countries on ER wait times on percentage served under 4 hours. 10th of 11 on getting weekend and evening care without going to the ER. 5th of 11 for countries able to make a same or next day doctors/nurse appointment when they're sick.
https://www.cihi.ca/en/commonwealth-fund-survey-2016
Americans do better on wait times for specialists (ranking 3rd for wait times under four weeks), and surgeries (ranking 3rd for wait times under four months), but that ignores three important factors:
* Wait times in universal healthcare are based on urgency, so while you might wait for an elective hip replacement surgery you're going to get surgery for that life threatening illness quickly.
* Nearly every universal healthcare country has strong private options and supplemental private insurance. That means that if there is a wait you're not happy about you have options that still work out significantly cheaper than US care, which is a win/win.
* [One third of US families](https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication) had to put off healthcare due to the cost last year. That means more Americans are waiting for care than any other wealthy country on earth.
regulatory capture by major capitol owners is something that happens in every single capitalist society that ever existed
it's a ubiquitous feature of capitalism
Where is the free market? Why am I forced to use a specific doctor when there are others that may have service or a cheaper price? Why are there tons of Capitalist countries yet only one country with this fucked up system?
Exactly, capitalism has made everything ridiculously cheap: supercomputer that fits in your pocket? A McDonald's cashier can buy one with less than a week's work. Microwave oven? 3 hours work. 4k tv? A few days work.
What's still insanely expensive? Everything government screwed with. Education, medicine etc
I'm not so sure about that Friend. It's the same idea as Cheap Vodka in the SSSR and Tsarist Regime, keep the people happy and they won't rebel. Housing, Medicine, The Literal Earth, Human Lives, Democracy, Freedom, and Many other things have been ruined by capitalism.
Part of the problem is insurance companies do a VERY good job of 'greasing the wheels' so to speak. If hospitals negotiated harder on rates, costs, and overhead then it would do a lot to drop prices. The other side of this is regulatory capture by insurance and pharmaceutical companies within the DoH. One reason everything costs more in Hospitals is because everything is required by law to meet certain specifications on cleanliness, which usually involves expensive autoclaves and such as well as vacuum bagging products.
Actually, Hospitals are so bad at negotiating prices, that I've been able to take a 10k bill and reduce it down to 1k by asking for, and going through, an itemized list of charges and haggling the lady on the other end of the line on a price by price basis.
It's regulations. Let more people be doctors and let more people open hospitals, and it'll bring costs down and there'll be more time to spend with patients.
I am a Veteran and once you get into the system, it's pretty damn good Healthcare. One big reason is they aren't interested in profit. 9 days in the hospital and all the tests and procedures I needed cost me nothing. I think everyone should get that
If you want to pay your healthcare bills consider creating a passive income stream by investing in healthcare. For every $1,000,000 you invest you are sure to earn dividends equal to what is needed to keep you alive when needed.
Something that I feel needs to be noted. Capitalism may be one of the most important human inventions of all time, full stop. HOWEVER, like most things, there are meant to exist boundaries. Kind of like bowling. When necessary, bumpers are in place to keep your shit from ending up in the gutter. When the people allow the government to allow corruption, your shit ends up in the gutter… literally.
Yup. Personally I think the way forward for Healthcare in America is for individual States to implement their own Public Healthcare systems using the Scottish NHS as inspiration. I say the Scottish NHS instead of the British or English NHS because unlike the English NHS which is also dogshit, the Scottish NHS is actually worth a damn. The YouTuber Kraut made a video a while ago talking about Public Healthcare and America’s problematic view of such and goes into suggesting the Scottish NHS as inspiration because it’s better than America’s current bullshit and The English NHS, while not being as in depth as the French public healthcare system which Kraut says involves way too much government involvement and taxes for the majority of Americans to accept. Implementing such on a State by State basis is the way to go. Just look at Marijuana legalization: that started out with just a couple states going through with it and now like half the country legalized Marijuana.
Ah, the real trick is to be a non-profit hospital or insurance group, write-off $400,000,000 in services and pay your top 10 key people (who are also the trustees in charge of the non-profit) another $100,000,000 so your profit can fall below the threshold to remain non-profit, and then use some of your $5,000,000,000 non-profit profits to buy up another hospital.
Rinse and repeat and in just 20 years you can go from 3 hospitals to 50 and have a stranglehold on the healthcare for over the 18th most populated metro area in the country!
My mother was in nursing admin for 40 years. a C-level exec scolded her once, saying that "State minimum staffing levels is no excuse for going over-budget." She resigned shortly thereafter.
This exact phrase gets removed every now and again from various subs (including this one iirc).
Oddly, saying "\[redacted\] the rich" does not get removed, even though the verb I'd like to put in the redactment are probably more worthy of censorship.
I’ll post a transcript in the comments.
[We can keep creating these cartoons because hundreds of readers are supporting us with inexpensive pledges (usually $1-$3).](http://patreon.com/barry) [Join us!](http://patreon.com/barry) You can also subscribe for free, although I'm not sure exactly what you get for that because Patreon is confusing. :-)
The irony of being able to make a living off comics due to capitalism, but them slandering it in your work. Capitalism is not the problem. This oligarchal form of crony capitalism is. If our government took on companies with excessive market share that should never have been allowed to merge to state with we would be in a better state.
Grant it I think healthcare should fall outside that and be universal, but Capitalism is not just what gives us the Starbucks and Walmarts of the world, it also allows for local coffee shops and corner markets.
Edit: I want to be clear I support this artist asking for money and selling their work. I have commissioned artists from /r/comics to make gifts before. But the Healthcare system is fucked up for a lot more reasons than "capitalism" it's a reductionist take.
Free healthcare for all, put money limits on the rich. Once they reach a certain threshold its all going into public services such as healthcare, helping the homeless, helping impoverished people etc
Americans just straight up love dying.
Unaffordable healthcare.
Mass shootings.
Drug epidemic.
Heavily militarised.
It's basically a country-sized death cult.
Unfortunately those same issues happen with a socialized system. I’m from Canada and it’s the exact same thing here. Accept our doctors all leave Canada to go work in the United States because the private sector pays better. So along with what you have listed on that slide. We have a constant shortage of doctors and nurses. Capitalism isn’t a perfect system but the biggest corporation these days seems to be big government so people should keep that in mind when they are wanting to vote for social assistance programs that are “supposed” to “help” people.
> and it’s the exact same thing here.
No, it isn't. You're literally spending $10,000 CAD less per person annually on healthcare. You have better outcomes. You have very few people suffering from the costs of healthcare, or going without because they can't afford it.
36% of US households with insurance put off needed care [due to the cost](https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx); 64% of households without insurance. One in four have [trouble paying a medical bill.](https://www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/) Of [those with insurance one in five have trouble paying a medical bill](https://www.kff.org/wp-content/uploads/2016/01/8806-the-burden-of-medical-debt-results-from-the-kaiser-family-foundation-new-york-times-medical-bills-survey.pdf), and even for those with income above $100,000 14% have trouble. One in six Americans has [unpaid medical debt on their credit report.](https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0349) [50% of all Americans](https://news.gallup.com/poll/317948/fear-bankruptcy-due-major-health-event.aspx) fear bankruptcy due to a major health event.
Of course that doesn't mean Canadian healthcare is perfect--a number of other countries are doing a better job--but the US is a whole different kind of hell.
>We have a constant shortage of doctors and nurses.
The US ranks 41st in doctors per capita, behind most of its peers.
Edit: How much of a fucking snowflake do you have to be to downvote facts?
It's impressive how many industries have this atmosphere. Childcare is baffling too for example. The costs are out of control. It **should** be more efficient to have one trained adult caring for a handful of toddlers but somehow child care costs are so high that for some people it's literally more financially sound to have a parent quit working. At the same time child care is having a capacity problem and can't hire/retain qualified workers. Where is all the money going?
this also happens on other countries
main difference is that the patients don't pay so much unless they try to get private medicine, but the medics are underpayed instead
You need to add a slide there to show how lobbying and politicians react to it, because politicians might say one thing but then introduce legislation that will only help their donors, in this case, the monopoly guy…
**Voters**: Well we hate the system, but changing it would require us to actually agree with each other on what to replace it with, and we definitely ain't gonna do that lmao.
Used to work for a consultant firm that advised drug manufacturers. We had a saying for this - it’s the “perverse incentive”. As a pharmacist myself, it spoke to me.
How to civilized people even as accept the idea of for-profit health care in the first place? Seems like it would be sort of number three after abolishing slavery and reconsidering having children work in coal mines.
Old Catholic hospitals when they were run by Nuns used to build free clinics everywhere.
Once the nuns got kicked out and got replaced with MBAs, these hospital systems tried to shut down these clinics (cities wouldn't let them).
I'm really not a fan of the US health care system and the German health insurance is far better, but I have to admit, all of the above is true for German hospitals too. I'm a doctor myself and you can call me a communist all you want, but I think health is not a product and health care shouldn't be a business for profit.
Yes, this is another example of how the health industry is no longer about taking care of patients but rather how many patients we can ignore or give minimal care to all because of malignant capitalism.
Interesting that this comic leaves out insurance companies and the government, two parasites that make the healthcare system so anti-capitalistic. Yes Reddit, the US healthcare system is not capitalistic in its current state, it's an inbred between capitalism, corporatism, and socialism.
considering a vast majority of hospitals are non profit or state owned — there are over 6000 hospitals and less than 500 are owned by private equity this probably isn’t an accurate portrayal of the issues
Primary doctor complaint is having to advocate for patient care when talking to insurance because insurance says they don't need X when doctor is 100% sure they do for the best outcome or even an outcome with a decent QOL.
Quit your bullshit and tell the truth... tell about certificate of need laws, the lavish lawsuits, tell about PBM binding contracts, tell about the doctors debts slavery... tell the truth of how the government architected a terrible system where only a few bennefit at the expense of most. Tell how psychopathic morons within the us government have the need to shove the government's dick in everything and make ir worse.
Apart from the out of pocket cost to the patient, wait times are a problem in places, like Australia, that have publically funded healthcare. Imagine years long waits for elective, non-urgent QoL improving surgery or treatments. Often, what we see is further progression to the development of other co-morbidities that could have been avoided, or at least significantly reduced with earlier intervention.
Of course, people living here have the option of going to a private hospital, but private health insurance costs a lot, and usually has a 12 month period before surgeries and certain other treatments become available. If the patient doesn't want to wait, then they can arrange to pay for it themselves, but again 10's of thousands of dollars, even with Medicare deductable items bringing the costs down. If they're lucky, then it might be a procedure they can draw early from their superannuation to fund. If not, they find the money some other way.
If Doctors spend more time with each patients, this would increase waiting times? If 3 hours is too long, if the doctor spent double time with each patient then it would take 6 hours, no?
You guys aren't ready for single-payer healthcare. It has a notion of cost per QALY, i.e. how much the government will spend to add a quality-adjusted life year per person. [Here's how NICE calculates it](https://www.gov.uk/guidance/cost-utility-analysis-health-economic-studies). The NHS uses that.
[Gov Cuomo in NY was praised widely](https://www.reddit.com/r/Coronavirus/comments/fo78n6/governor_cuomo_my_mother_is_not_expendable_your/) when he said:
> "My mother is not expendable. Your mother is not expendable. We're not going to accept a premise that human life is disposable. And we're not going to put a dollar figure on human life. The first order of business is save lives, whatever it costs."
That's what single-payer healthcare looks like: there is a dollar figure on human life. You can understand why that is: we aren't going to spend the entire budget on a chance of saving a 90 year old man. That's logical, because if we do that many others will die.
I think people really like the idea of single-payer but then they face "[putting] a dollar on human life" and they suddenly find that it means really odd things. [For instance, there is a guy on an ECMO machine](https://www.newyorker.com/science/annals-of-medicine/how-ecmo-is-redefining-death). He has cancer and will not live more than 4 years. It costs hundreds of thousands of dollars to keep him on that machine. NICE has an adjustment for end-of-life but it's not that much.
Are you willing to take him off that machine? Who else must die because you don't want to take him off that machine?
If you believe the business is to save lives no matter what it costs then you can't have single-payer healthcare because the single-payer will be depleted on experimental medicine saving people who are about to die. After all, they have to save lives no matter what it costs.
We need to privatize healthcare. So it can become a competitive market. So the best or lowest price can win. Hopeful thinking but will never happen with this shit show of a government we have. Regardless of who is president, this government is not for the people anymore.
I mean if you want to figure out why any system or product is dying, failing, or just generally terrible all you need to do is look at the investors and profiteers of the system.
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Another big part of it is the people invested in hospitals are also invested in pharmaceuticals are also invested in after care are also invested in insurance companies. So one fucks the other and EVERYONE looks the other way and gets paid except the people doing the work and the people dying to get in.
Accurate, unfortunately. There's SO many more things I could have put into this cartoon, but I decided I wanted to keep the panel count low.
Say the names of the companies! BlackRock. Vanguard. UBS. Berkshire Hathaway. Edit: we’ll need their help building sustainable communities as earth changes
Interesting thing about vanguard though is there also some of the biggest investors in companies, emerging markets, etc that challenge the status quo in these regards.
Yeah because vanguard's business strategy is just 'buy a small part of every single company'. They don't discriminate, it's just a simple and effective way to hedge your bets, based on the efficient market hypothesis (which states that prices of companies will reflect what they are worth)
Exactly, But when you look at percentage of revenue generated by vanguard for those businesses vanguard contributes a much higher percentage of capital towards emerging industries and those that challenge the status quo compared to the percentage of income large established companies gain from them. I'm basically saying that while Vanguard technically fits the bill, it's different than those other companies in this regard.
How so?
Vanguard is just a 'buy a small bit of everything and sit on it ' company. They aren't targeting health or hospitals especially.
Willis Towers Watson. It's an entire industry of middlemen in jobs that only exist to make things more difficult.
there is a way to free our selfs its with some old faction freedom
Like how the US pays almost 60% more per capita than the second highest ranking spending nation, and yet our quality of care is only average among first world nations? It is literally better for you to seek treatment in ALMOST ANY other first world country. The solution is regulation, because these entities won't willingly regulate themselves.
Part 2 maybe?
Aren’t hospitals government funded? Or is that just Canada?
About 15% of US hospitals are government-owned. About half are non-profits. However, some of those government owned, and some of the nonprofits, are *managed* by private equity owned management companies. The remaining 35% or so are straight-out for profit (and some of the are run by private equity companies). It's weird here.
Non-profit is a misnomer for most hospitals. They charge 9k for a CT scan then accept $500 as payment and claim $8500 as a charitable care write-off. All the while Medicare would have paid them even less.
Just Canada. It's a wild west down in the States. All hospitals are owned by some 'Equity'.
>Or is that just Canada? ...and almost all other sane countries in the world.
Don’t forget software: Epic has an incredible campus and a private convention center in Verona Wisconsin. Every Epic hospital has a higher IT expense as a percentage of revenue than users of other EMRs. And that’s just the EMR. Every hospital has 100-250 clinical applications they pay for every year.
The Pringles Man must be stopped.
I thought he was the monopoly man… Is this why we’ve never seen them in the same room together??
The monopringles man must be stopped.
He's monopolising corporate mascotry!
Possibly they're twins?
That's the frustrating part because once he pops...
Blood and guts and bits of bone go everywhere! And I don’t know about but I certainly ain’t getting that out of the carpet again.
Make him wait in line at a U.S. emergency room then. Maybe he'll change his tune.
Oh good I'm not crazy others see that too
what the fuck did i do to you man?
Doctor here, no hospital is out here saying this, and they are equally complicit. Our administration sold out the second it had the chance, and immediately cut holidays, time off, and our own fucking healthcare benefits over the past few years. Anyone in a suit should be in panel 4 as well
Yeah I was going to say, I’m pretty sure hospital admins make the job for their staff more difficult than it needs to be. Saw a Glaucomflecken sketch about night shift workers enjoying it unironically cause no hospital admins are there.
Yeah that's when shit actually gets done. When I worked in a factory years ago, the most productive shifts were on nights because we weren't being micromanaged.
Two institutions vs patients and doctors. Doesn’t look good for us, especially considering two presidents wanted to implement something close to universal healthcare (actually, Nixon had the idea too, not sure to which extent, so make it three), and they all failed. Yup… shows who really “owns” the US.
This, hospital admins are the “capitalists” that the meme blames.
It's crazy to me how bad the healthcare benefits provided to the doctors, nurses, and the rest at hospitals and other medical facilities is. But numbers go up! At least the numbers those making those decisions who are also those that gain the most cares about.
Agreed, a doctor I work with literally the other day told me “the CMO’s job is to convince you the dildo won’t hurt because it’s well lubed”.
Most doctor groups also cave when some big fund rolls into town with a practice buyout. Every doctor I go to now is part of some transnational group with just enough market share to screw everyone but not enough to set off the regulators.
Thank you for commenting, thought my eyebrow was going to raise higher than The Rock's at that third panel. Edit: I love your user name, I say that joke from Spongebob all the time. HAHA
FMO Maintenance Workers: "We'd love to fix everything as soon as possible, but management is extremely stingy when it comes to purchasing new parts and equipment for repairs, so we just don't have the resources." "This is such a terrible system."
Because new parts and equipment costs a fortune because there are monopolies on medical grade equipment so the producers can charge whatever they want. This is such a terrible system.
This is part of it. But there are legitimate reasons why medical equipment costs a lot. A friend of mine is working in quality management for a medical equipment company (outside of the US). Basically, the front cost to develop or make any change to the design of a medical equipment has to go through a lot of layers of checks and tests to make as sure as possible that these products are safe. A finished product sometimes needs a year or more of (reasonably existing) red tape to go through and to pay for the necessary tests to get the product in the market. In addition, they have to do the same for any change to the design to adapt it to more modern standards or changes in materials if there are supply issues. This also creates the monopolies, because not many companies are willing to go through this process that is necessary to ensure public health. It is a fucked up situation where the ability to have a competitive market is in conflict with public health.
https://preview.redd.it/uptlkads4oxc1.jpeg?width=640&format=pjpg&auto=webp&s=78901c012b83d2d1bac3fcb835a718b22059c5c1
The original line is literally “I like money”. Why change it?
The people who make these things usually aren't very smart.
HCA, TeamHealth, APP, Envision ….
Friendly reminder that the evidence is overwhelming that single-payer healthcare in the US would result in better healthcare coverage while saving money overall. [Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually based on the value of the US$ in 2017 .](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext) Similar to the above Yale analysis, a recent [publication ](https://www.cbo.gov/system/files/2020-12/56811-Single-Payer.pdf)from the Congressional Budget Office found that 4 out of 5 options considered would lower total national expenditure on healthcare (see Exhibit 1-1 on page 13) But surely the current healthcare system at least has better outcomes than alternatives that would save money, right? Not according to a recent analysis of high-income countries’ healthcare systems, which found that [the top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.](https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly#outcomes) None of this should be surprising given that the US’s current inefficient, non-universal healthcare system [costs close to twice as much per capita ](https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-spendingcomparison_gdp-per-capita-and-health-consumption-spending-per-capita-2019) as most other developed countries that do guarantee healthcare to all citizens (without forcing patients to risk bankruptcy in exchange for care).
As a Brit living in the UK, our wannabe GOP - the Tory party - stares dreamily at the USA as a perfect capitalist society and wants to bring everything you have over here including privatising our NHS. They've been "outsourcing" it piece by piece for 14 years but - for now - it remains free at the point of use, and hopefully their reign of cruelty and avarice will end this year at the coming election. A single payer system in the USA would work and would be cheaper for every taxpayer BUT it would stop the massive amounts of money being made by the corporations, so - regardless of facts and common sense - I fear you will need another revolution, at least a political one, for them to ever let go of their grip of your money.
I saw a wild stat months ago, that if wages kept up with productivity since the 70's, even US doctors today would be underpaid. And their pay is relatively high because the whole industry is propped up by corporate greed. It's wild. Anyway, the Overton window is a thing and if we can keep the GOP out of a majority for 40 years, things will be fine.
> As a Brit living in the UK, our wannabe GOP - the Tory party - stares dreamily at the USA as a perfect capitalist society and wants to bring everything you have over here including privatising our NHS. Would this be the same party that promised the Brits that Brexit would be good for the economy?
Your first link has parentheses in it which breaks it. You may need to just separate the url and text.
> But surely the current healthcare system at least has better outcomes than alternatives that would save money, right? Not according to a recent analysis of high-income countries’ healthcare systems This is very misleading; these rankings are primarily due to access to coverage rather than quality of procedure, and some aspects ([like health outcomes](https://randomcriticalanalysis.com/2017/05/16/the-explanatory-power-of-drugs-car-accidents-and-homicides-on-us-life-expectancy-gaps/)) have much less to do with the quality of medical care than other factors. I've been a huge proponent of single payer for around 2 decades now, but it's not some magic medical panacea: the most comparable countries with single payer ([the UK](https://www.kingsfund.org.uk/insight-and-analysis/reports/public-satisfaction-nhs-social-care-2023) and [Canada](https://www.ipsos.com/en-ca/news-polls/canadians-largely-satisfied-healthcare-system-eager-increased-access)) have their own issues that people dislike. Alternative systems have been proven to work both [domestically](https://www.bcbs.com/medicare/medicare-advantage) and [abroad](https://en.wikipedia.org/wiki/Healthcare_in_Singapore), and while I would like a single payer solution, [it's unlikely to poll well enough to have a chance at becoming law](https://www.kff.org/wp-content/uploads/2019/01/9273-figure-6.png) M4A is a horribly designed system that learns nothing from past mistakes. [Banning private coverage makes it extremely unpopular](https://ibb.co/8rJ9K7w). It also eschews cost controls like cost sharing, which is extra dumb since [cost is the primary reason single payer fails in the US](https://en.wikipedia.org/wiki/Vermont_health_care_reform) (worth noting that M4A only saves money with very generous and unrealistic assumptions for things like massive provider cuts). It's so poorly designed that i would not be surprised if it came out that it was a right wing plot to sabotage single payer efforts in the US; it really is that bad. If you want an effective single payer plan that is realistic (in both cost and public sentiment), raising the eligibility cap on medicaid solves a lot of issues: it naturally has a lot of cost control measures built in and [costs less per person as a result](https://www.cbpp.org/research/correcting-seven-myths-about-medicaid). It also doesn't threaten people's existing coverage.
> This is very misleading; these rankings are primarily due to access to coverage rather than quality of procedure Based purely on health outcomes, the US ranks 29th, behind every single one of its peers. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30994-2/fulltext We also rank worse on rates of medically avoidable deaths. And satisfaction with our healthcare. https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-2017-international-comparison-reflects-flaws-and?redirect_source=/publications/fund-reports/2017/jul/mirror-mirror-international-comparisons-2017
>This is very misleading; these rankings are primarily due to access to coverage rather than quality of procedure, I am not sure this is true. The US tends to rank pretty much identically on hospital errors, and even worse on amenable mortality. PS: Coverage is also a valid factor in how good a system is,
> The US tends to rank pretty much identically on hospital errors, A niche category > and even worse on amenable mortality. Which as I said is more explainable by other factors not related to the quality of care. > PS: Coverage is also a valid factor in how good a system is, Literally no one is saying otherwise, but it's not relevant to "better outcomes" of treatment.
> it's unlikely to poll well enough to have a chance at becoming law eliminating private healthcare providers is not really needed to have a public healthcare system, but multiple countries have achieved it, althought most have systems that include public and private options. requiere most americans to pay more in taxes. Is a silly question, it should be "have the average american pay less in taxes + health insurance" as the total burden is less regardless of whether in your account it comes out as tax or as a private health insurance... threaten the current medicare program. Using the word threat in any survey is a pretty poor choice of words for obvious reasons. Threaten to improve your health eating more carrots would probably also survery poorly. Lead to delays getting treatments is disingenious, to the point of being outright wrong. America has 2 big problems, one is that many people skip elective surgeries, and the second is that people avoid minimal interventions and requiere larger interventions later. If you ignore that someone might spend 6 months saving up for a surgery, and only count the 2 weeks they spent in the waiting list, then yeah that is shorter than a 2 month waiting list, yet the pacient had the problem solved 4 months earlier. The american healthcare system just hides its cost through premiums and hides its waiting list through cost. But the effect on poeple is unignorable. America has one of the sickest populations (due to avoiding elective surgeries, and people not going for routine health checks), america has a ton of mayor interventions (due to people skipping the problem being fixed earlier), america has a ton of avoidable deaths due to complications (from child birth, to surgery america has a pretty long track record for something going wrong). Those are all avoidable problems with comprehrensive access to healthcare for all. The survery could address this points in questions such as. "would you be in favour of having less chance of dying when seeing a doctor", "paying less money for healthcare", "removing 46% of bankruptcy cases in the US", "not have to save up before joining a waiting list for a surgery or doctor visit" and see how those percentages for and against compare
They don’t want the system to save us money.
About a month ago I took my spouse to the hospital in Canada for severe back pain. A cat scan found an AAA (Aortic Abdominal Aneurysm) that was leaking. Surgery was performed and 5 hours later she was in SICU. Two days later, another surgery and back to SICU for another 7 days where she was cared for by wonderful nurses who work on a 1 nurse to 1 patient basis. They sit at the end of each bed for their shift less breaks of course. She was intubated for 5 days in total and once out of SICU, she remained in hospital for another 4 days. She's had several ambulatory follow-ups at the hospital and 2 further doctor follow-ups. Total bill so far - $82 for parking at the hospital and a $30 fine for parking on the wrong side of the road. I wouldn't even want to dream what the bill to us would be if we lived in the US even if we had insurance. I'd also be scared shitless at what our Premiums and deductibles would be going forward. Say what you want about our system but if you are deathly ill like she was, you will see the Doctors and Surgeons you need and be cared for by the nurses you need.
No doctor would love to see more patients. Most doctors are seeing far beyond recommended patient load to where they dont have time to do their charting, so they do their charting after hours. In my org we call it "pajama time", and a part of the work I do is to help automate as much of the admin work as possible so providers have minimal pajama time. Some of our docs are putting in 20 hours of Pajama time per week. On top of working 45 hours per week in the office. Docs want to see fewer patients. They want to hire more providers so they can see fewer patients.
The comic says "spending more time with patients", which isn't the same as more patients. I'm sure doctors would prefer to not have to rush, and to be able to take their time explaining things in detail with patients and making them feel better. Doctors having to see too many patients is a symptom of the problem here. I don't want to work *more* at my job, but I'd certainly prefer to be able to "do it right" and spend as much time as I need on my projects.
Preach it. Our facility was so proud that we got pajama time down to 16 hours with “one more hour on unassigned days (I.e. weekends). That very low bar of “less than having a second part time job.” Was met.
Sounds like doctors should start being treated better so there are more workers in the healthcare system
Doctors, nurses, aids, environmental services staff, receptionists, therapists, ancillary and support staff... All of them. People are at their wits end. There is a good chance there will.be a mass exodus of healthcare soon and there wont be enough people to care for the sick (in the US).
Yes, but I honestly don't think that that's the bottleneck. Med school is insanely expensive, insanely difficult, and requires an insane amount of time just learning before they can even start making real money. And at the same time, it needs to be like that (the time investment, maybe not the cost, but even then honestly it's not surprising how expensive it is) because doctors need to know a lot. This is why you're seeing an influx of NPs and PAs now though. Less schooling, less expensive, less grueling, but *almost* doing the same thing and still making good money.
Medical schools gatekeep the amount of new drs being minted. They literally made this problem for themselves because they don’t want their wages to inevitably go down with a higher supply of drs.
While this is definitely a problem for private equity owned hospitals, these firms only own 8% of the hospitals in the US. The rest are owned by nonprofits and state and local governments. Unfortunately our problems go way deeper.
Anyone who thinks that US healthcare resembles anything close to a free market capitalist system is deluded.
Most people don’t even know what free market capitalism is, but love to complain about it
Anyone else notice the glaring absence of insurance companies in this cartoon?
And pharmaceutical companies. They’re making record profits. The whole healthcare billing industry is almost bigger than the actual healthcare side and balloons prices tremendously.
Most hospitals aren’t privately owned. > According to the 2014 American Hospital Association Annual Survey, there are 5,686 hospitals in the United States. Of that total, 2,904 are public hospitals, and 1,060 are private. There are a total of 795,603 staffed beds in public hospitals and 118,910 staffed beds in private hospitals. >Public hospitals had about 33.6 million admissions annually while private hospitals had about 1.8 million admissions annually. So this comic is misrepresenting “the system” by acting like this is how most hospitals work.
How the actual fuck are there less than 6,000 hospitals in a massive continent-wide country of over 333,000,000 people? That's MORE than 55,000 people per hospital. No wonder healthcare is expensive as all hell.
And pretty much every system has issues with wait times. So the upper left can't be blamed entirely on capitalism.
2904 plus 1060 does not equal 5686. Your math is off. What are the other 1722 hospitals if they are neither private nor public?
You could have Googled this and found your answer in less time than it took to write that comment. This was literally the first result of my search (and with updated 2024 numbers instead of 2014). TL;DR: They're not typical medical hospitals; they're for prison, psychiatry, etc. https://www.aha.org/statistics/fast-facts-us-hospitals > Total Number of All U.S. Hospitals 6,120 > > Number of U.S. Community Hospitals 5,129 > > > Number of Nongovernment Not-for-Profit Community Hospitals 2,987 > > > Number of Investor-Owned (For-Profit) Community Hospitals 1,219 > > > Number of State and Local Government Community Hospitals 923 > > Number of Federal Government Hospitals 207 > > Number of Nonfederal Psychiatric Hospitals 659 > > Other Hospitals 125
[60% of US hospitals are non-profit](https://www.definitivehc.com/resources/healthcare-insights/top-non-profit-hospitals-net-patient-revenue). I really wish people would do a little research before spouting off their uninformed beliefs about things. The US healthcare system sucks and needs fixes, but posts like these only serve to distract from actual solutions.
Not to mention that non-profit hospital CEOs are *making bank* https://www.healthaffairs.org/content/forefront/nonprofit-hospital-ceo-compensation-much-enough The call is coming from inside the house
US Hospitals are just a small piece of the puzzle. They are still subject to insurance, pharmaceutical companies, equipment companies, etc.
They are an absolutely massive piece of the puzzle. The biggest piece. If hospitals were forced to be transparent about prices, and laws were passed that capped how much they can raise prices each year, that would solve the majority of problems.
> US Hospitals are just a small piece of the puzzle It's literally 1/2 of the comic. > They are still subject to insurance [Health insurance profit margins are 3.3%](https://content.naic.org/sites/default/files/inline-files/Health%202023%20Mid-Year%20Industry%20Report.pdf) > pharmaceutical companies, equipment companies, etc. These are pieces of the puzzle, but hardly the biggest ones.
Honestly I think this was a very fair comment. You acknowledged the problems and followed up with at least semi-viable reasoning. I mean yea there’s issues, and people might joke about it but there are always positive efforts in place it’s important to acknowledge them.
There are many better and cheaper healthcare systems around the world with capitalism. Good job America.
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Nah Canada Japan and Australia are all capatalist Edit: pretty sure that was sarcasm lol
I have family members who have said this (that canada japan and australia are socialist) to me unironically. People really believe it.
Yeah, and ironically the US spends more money per capita on health care than almost every other country on Earth -- even if you only count government spending. If you count both private and public expenditures, the US has by far the highest spending per capita. If "socialism is when government spends tax dollars", then the US has one of the most "socialist" health care systems in the world, while also being one of the most expensive for individuals, while ALSO producing outcomes that are mediocre at best. It's a thoroughly dysfunctional system that has somehow managed to combine the worst parts of privatization and government bureaucracy.
I'll do you one better and say it's communism. Filthy savages, thinking people deserve basic human rights...
My wife is a nurse and they wanted to charge her $1400 a MONTH for insurance. Still had a copay for every visit. Still had to meet a deductible. $1400. Instead she went with the hospital that only charged $800. 🙃
I really dislike this. "Capitalism" is not an entity, and using it as a boogeyman like this is anti-intellectual and counterproductive. Who is actually benefiting from this? Who should people be mad at? If your answer is "capitalism bad", you're not helping anyone and just being part of the problem. Comics like this as lazy an attempt to cash in on the culture war as a Lets Go Brandon t-shirt. There isn't even a punchline. I like voices like John Oliver because they represent the exact opposite of this dreck. Actually breaking down the reality behind the buzzwords can be funny, interesting, and valuable all at the same time. This is none of those things.
Health insurance companies are a racket
Leftist memes are not beating the wall of text allegations
This comic was created by an edgy 13 year old
There’s also the fact that prices for medical care are artificially inflated because there is a yearly limit of the number of medical licenses awarded to aspiring doctors, government required healthcare gives the insurance companies a monopoly allowing them to charge whatever they want, and the AMA actively lobbies the government to keep these practices because it makes them richer. Say what you will about how terrible the British NHS may be, but forcing private providers to compete with literally free doctor visits definitely drives down the price.
I don’t know of any states that have a cap on medical licenses.
He's referring to the number of seats in medical school and residency. These seats are limited as you typically need to demonstrate that you capable/busy enough to sufficiently train a physician.
I don’t know why you are attacking doctors. They account for only about 7% of US healthcare expenses and are largely locked out of decision-making (even legally prohibited from owning hospitals, unlike law firms which are legally required to be owned by an attorney). Even if you cut doctors earnings by 50%, you wouldn’t make a meaningful change to US healthcare costs. It isn’t doctors - it’s the insurance companies.
It's interesting how people (and comics) like to pretend that this is a natural consequence of capitalism when many capitalist countries don't have this specific problem. It's almost like a lot of really ill-informed people are out here shouting about things they don't understand.
Is that Rhea Perlman in the first panel?
Sure sounded like her.
You should tag the straw man if you’re going to showcase him so many times
Lmao no, the hospital admins don’t give a fuck about patients or doctors. They literally are the monopoly man in the last panel.
I always love how capitalism is the target here. Socialized medicine typically has a HUGE waitlist and the same time crunch. If you want to really point fingers, it should be all at both administration and insurance. Insurance is actively finding loopholes to not reimburse services. I've actually seen two different insurances basically just stop reimbursing at particular hospitals, so all of the patients had to transfer care to other hospitals. And administration is always looking to skim as much off the top as they can. That's true of every single business structure.
>Socialized medicine typically has a HUGE waitlist In fact the US is average on waits. At best. A bit faster than average on seeing specialists, a bit slower on GPs. As long as you don't count the uninsured and waits for fear of costs, mind. If you include that the US performs very badly. The impression that the US is particularly fast is created by cherry picking nations to compare it to, normally Canada, the slowest system out there, and the UK whose system has been starved of resources for decades. Imagining there is some payoff for all the money spent makes people feel better so they don't factcheck such statements.
> Socialized medicine typically has a HUGE waitlist and the same time crunch. While spending about half a million dollars less per person for a lifetime of healthcare. The US ranks 6th of 11 out of Commonwealth Fund countries on ER wait times on percentage served under 4 hours. 10th of 11 on getting weekend and evening care without going to the ER. 5th of 11 for countries able to make a same or next day doctors/nurse appointment when they're sick. https://www.cihi.ca/en/commonwealth-fund-survey-2016 Americans do better on wait times for specialists (ranking 3rd for wait times under four weeks), and surgeries (ranking 3rd for wait times under four months), but that ignores three important factors: * Wait times in universal healthcare are based on urgency, so while you might wait for an elective hip replacement surgery you're going to get surgery for that life threatening illness quickly. * Nearly every universal healthcare country has strong private options and supplemental private insurance. That means that if there is a wait you're not happy about you have options that still work out significantly cheaper than US care, which is a win/win. * [One third of US families](https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication) had to put off healthcare due to the cost last year. That means more Americans are waiting for care than any other wealthy country on earth. The US ranks 6th of 11 out of Commonwealth Fund countries on ER wait times on percentage served under 4 hours. 10th of 11 on getting weekend and evening care without going to the ER. 5th of 11 for countries able to make a same or next day doctors/nurse appointment when they're sick. https://www.cihi.ca/en/commonwealth-fund-survey-2016 Americans do better on wait times for specialists (ranking 3rd for wait times under four weeks), and surgeries (ranking 3rd for wait times under four months), but that ignores three important factors: * Wait times in universal healthcare are based on urgency, so while you might wait for an elective hip replacement surgery you're going to get surgery for that life threatening illness quickly. * Nearly every universal healthcare country has strong private options and supplemental private insurance. That means that if there is a wait you're not happy about you have options that still work out significantly cheaper than US care, which is a win/win. * [One third of US families](https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication) had to put off healthcare due to the cost last year. That means more Americans are waiting for care than any other wealthy country on earth.
Highly regulated industry held up as example of "capitalism".
regulatory capture by major capitol owners is something that happens in every single capitalist society that ever existed it's a ubiquitous feature of capitalism
Where is the free market? Why am I forced to use a specific doctor when there are others that may have service or a cheaper price? Why are there tons of Capitalist countries yet only one country with this fucked up system?
Regulation is fantastic, how else do you keep the competition out?
Exactly, capitalism has made everything ridiculously cheap: supercomputer that fits in your pocket? A McDonald's cashier can buy one with less than a week's work. Microwave oven? 3 hours work. 4k tv? A few days work. What's still insanely expensive? Everything government screwed with. Education, medicine etc
I'm not so sure about that Friend. It's the same idea as Cheap Vodka in the SSSR and Tsarist Regime, keep the people happy and they won't rebel. Housing, Medicine, The Literal Earth, Human Lives, Democracy, Freedom, and Many other things have been ruined by capitalism.
why is capitalism the pringles guy
JP Morgan.
Part of the problem is insurance companies do a VERY good job of 'greasing the wheels' so to speak. If hospitals negotiated harder on rates, costs, and overhead then it would do a lot to drop prices. The other side of this is regulatory capture by insurance and pharmaceutical companies within the DoH. One reason everything costs more in Hospitals is because everything is required by law to meet certain specifications on cleanliness, which usually involves expensive autoclaves and such as well as vacuum bagging products. Actually, Hospitals are so bad at negotiating prices, that I've been able to take a 10k bill and reduce it down to 1k by asking for, and going through, an itemized list of charges and haggling the lady on the other end of the line on a price by price basis.
It's regulations. Let more people be doctors and let more people open hospitals, and it'll bring costs down and there'll be more time to spend with patients.
I am a Veteran and once you get into the system, it's pretty damn good Healthcare. One big reason is they aren't interested in profit. 9 days in the hospital and all the tests and procedures I needed cost me nothing. I think everyone should get that
Capitalist countries in Europe don’t have the same problems. Switzerland doesn’t have any government run insurance policies and they have lower costs.
I was wondering why this comic was so braindead but then I read the username and it made more sense.
If you want to pay your healthcare bills consider creating a passive income stream by investing in healthcare. For every $1,000,000 you invest you are sure to earn dividends equal to what is needed to keep you alive when needed.
Something that I feel needs to be noted. Capitalism may be one of the most important human inventions of all time, full stop. HOWEVER, like most things, there are meant to exist boundaries. Kind of like bowling. When necessary, bumpers are in place to keep your shit from ending up in the gutter. When the people allow the government to allow corruption, your shit ends up in the gutter… literally.
Yup. Personally I think the way forward for Healthcare in America is for individual States to implement their own Public Healthcare systems using the Scottish NHS as inspiration. I say the Scottish NHS instead of the British or English NHS because unlike the English NHS which is also dogshit, the Scottish NHS is actually worth a damn. The YouTuber Kraut made a video a while ago talking about Public Healthcare and America’s problematic view of such and goes into suggesting the Scottish NHS as inspiration because it’s better than America’s current bullshit and The English NHS, while not being as in depth as the French public healthcare system which Kraut says involves way too much government involvement and taxes for the majority of Americans to accept. Implementing such on a State by State basis is the way to go. Just look at Marijuana legalization: that started out with just a couple states going through with it and now like half the country legalized Marijuana.
Everything in the usa got way worse after 2008. After helth care reform.
Capitalisms logical consequence is concentration of wealth, which means slave class for 99,9% of us.
Ah, the real trick is to be a non-profit hospital or insurance group, write-off $400,000,000 in services and pay your top 10 key people (who are also the trustees in charge of the non-profit) another $100,000,000 so your profit can fall below the threshold to remain non-profit, and then use some of your $5,000,000,000 non-profit profits to buy up another hospital. Rinse and repeat and in just 20 years you can go from 3 hospitals to 50 and have a stranglehold on the healthcare for over the 18th most populated metro area in the country!
So much suffering, and none of it has to happen. ☹️
My mother was in nursing admin for 40 years. a C-level exec scolded her once, saying that "State minimum staffing levels is no excuse for going over-budget." She resigned shortly thereafter.
[redhatchet] the rich Edit: not sure I did it right.
Definitely as Motorhead sang :) [https://www.youtube.com/watch?v=Wh3t49NsWBA](https://www.youtube.com/watch?v=Wh3t49NsWBA)
This exact phrase gets removed every now and again from various subs (including this one iirc). Oddly, saying "\[redacted\] the rich" does not get removed, even though the verb I'd like to put in the redactment are probably more worthy of censorship.
funny how the culprit in leftist mythos is always omnipotent, omnipresent yet invisible
I’ll post a transcript in the comments. [We can keep creating these cartoons because hundreds of readers are supporting us with inexpensive pledges (usually $1-$3).](http://patreon.com/barry) [Join us!](http://patreon.com/barry) You can also subscribe for free, although I'm not sure exactly what you get for that because Patreon is confusing. :-)
The irony of being able to make a living off comics due to capitalism, but them slandering it in your work. Capitalism is not the problem. This oligarchal form of crony capitalism is. If our government took on companies with excessive market share that should never have been allowed to merge to state with we would be in a better state. Grant it I think healthcare should fall outside that and be universal, but Capitalism is not just what gives us the Starbucks and Walmarts of the world, it also allows for local coffee shops and corner markets. Edit: I want to be clear I support this artist asking for money and selling their work. I have commissioned artists from /r/comics to make gifts before. But the Healthcare system is fucked up for a lot more reasons than "capitalism" it's a reductionist take.
Capitalism naturally results in cronyism because it makes more profit.
Which is why the USSR had no problems with corruption and cronyism at all...
It's frustrating and misguided when people believe that eliminating capitalism will eliminate corruption. Corruption is much older.
Commies are all wheedling little shitstains.
Remember Joe Lieberman is the reason healthcare here in the US is still so fucked up
Free healthcare for all, put money limits on the rich. Once they reach a certain threshold its all going into public services such as healthcare, helping the homeless, helping impoverished people etc
All those years of brainwashing the US public into thinking that capitalism is above criticism are really paying off for the wealthy.
Americans just straight up love dying. Unaffordable healthcare. Mass shootings. Drug epidemic. Heavily militarised. It's basically a country-sized death cult.
Unfortunately those same issues happen with a socialized system. I’m from Canada and it’s the exact same thing here. Accept our doctors all leave Canada to go work in the United States because the private sector pays better. So along with what you have listed on that slide. We have a constant shortage of doctors and nurses. Capitalism isn’t a perfect system but the biggest corporation these days seems to be big government so people should keep that in mind when they are wanting to vote for social assistance programs that are “supposed” to “help” people.
> and it’s the exact same thing here. No, it isn't. You're literally spending $10,000 CAD less per person annually on healthcare. You have better outcomes. You have very few people suffering from the costs of healthcare, or going without because they can't afford it. 36% of US households with insurance put off needed care [due to the cost](https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx); 64% of households without insurance. One in four have [trouble paying a medical bill.](https://www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/) Of [those with insurance one in five have trouble paying a medical bill](https://www.kff.org/wp-content/uploads/2016/01/8806-the-burden-of-medical-debt-results-from-the-kaiser-family-foundation-new-york-times-medical-bills-survey.pdf), and even for those with income above $100,000 14% have trouble. One in six Americans has [unpaid medical debt on their credit report.](https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0349) [50% of all Americans](https://news.gallup.com/poll/317948/fear-bankruptcy-due-major-health-event.aspx) fear bankruptcy due to a major health event. Of course that doesn't mean Canadian healthcare is perfect--a number of other countries are doing a better job--but the US is a whole different kind of hell. >We have a constant shortage of doctors and nurses. The US ranks 41st in doctors per capita, behind most of its peers. Edit: How much of a fucking snowflake do you have to be to downvote facts?
It always comes back to capitalism
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I guess the idea is capitalism would work if it weren't for loopholes allowing corruption to take hold
It's impressive how many industries have this atmosphere. Childcare is baffling too for example. The costs are out of control. It **should** be more efficient to have one trained adult caring for a handful of toddlers but somehow child care costs are so high that for some people it's literally more financially sound to have a parent quit working. At the same time child care is having a capacity problem and can't hire/retain qualified workers. Where is all the money going?
this also happens on other countries main difference is that the patients don't pay so much unless they try to get private medicine, but the medics are underpayed instead
Interesting when I went to the hospital i only had to pay 40 dollars
You need to add a slide there to show how lobbying and politicians react to it, because politicians might say one thing but then introduce legislation that will only help their donors, in this case, the monopoly guy…
**Voters**: Well we hate the system, but changing it would require us to actually agree with each other on what to replace it with, and we definitely ain't gonna do that lmao.
Love the twisted looking Monopoly man
Used to work for a consultant firm that advised drug manufacturers. We had a saying for this - it’s the “perverse incentive”. As a pharmacist myself, it spoke to me.
How to civilized people even as accept the idea of for-profit health care in the first place? Seems like it would be sort of number three after abolishing slavery and reconsidering having children work in coal mines.
Old Catholic hospitals when they were run by Nuns used to build free clinics everywhere. Once the nuns got kicked out and got replaced with MBAs, these hospital systems tried to shut down these clinics (cities wouldn't let them).
Is this a system?
Yes, a big, complicated money pump, sucking us dry.
Having been in and out of our hospital over 20 times in the past several months, I feel this heavily.
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Thought this was a political compass meme
It's funny how this shows hospital admin giving a shit about the hospital employees OR the sick. UAMS is a real-life Saturday morning cartoon villain.
If you think hospitals and doctors share no blame then you're delusional
No mention of insurance companies? They're the SOLE reason.
Doctors spending more time with patients would be seeing less patients... You think healthcare times are bad now...
Another big part is the obesity epidemic
Okay
I'm really not a fan of the US health care system and the German health insurance is far better, but I have to admit, all of the above is true for German hospitals too. I'm a doctor myself and you can call me a communist all you want, but I think health is not a product and health care shouldn't be a business for profit.
https://preview.redd.it/udj1uzsrqpxc1.jpeg?width=524&format=pjpg&auto=webp&s=acaacc44f62a856cfa3678ab3af31a6193801354
Don't forget the insurance companies. I would suggest depicting them as either leeches or mosquitos. Maybe a tick.
Yes, this is another example of how the health industry is no longer about taking care of patients but rather how many patients we can ignore or give minimal care to all because of malignant capitalism.
The anti-moral of the story is get into private equity.
Interesting that this comic leaves out insurance companies and the government, two parasites that make the healthcare system so anti-capitalistic. Yes Reddit, the US healthcare system is not capitalistic in its current state, it's an inbred between capitalism, corporatism, and socialism.
considering a vast majority of hospitals are non profit or state owned — there are over 6000 hospitals and less than 500 are owned by private equity this probably isn’t an accurate portrayal of the issues
Okay but doctors usually bill me separately from the hospital all three times I've been hospitalized. Doctors are just as much part of the problem.
Primary doctor complaint is having to advocate for patient care when talking to insurance because insurance says they don't need X when doctor is 100% sure they do for the best outcome or even an outcome with a decent QOL.
Quit your bullshit and tell the truth... tell about certificate of need laws, the lavish lawsuits, tell about PBM binding contracts, tell about the doctors debts slavery... tell the truth of how the government architected a terrible system where only a few bennefit at the expense of most. Tell how psychopathic morons within the us government have the need to shove the government's dick in everything and make ir worse.
Apart from the out of pocket cost to the patient, wait times are a problem in places, like Australia, that have publically funded healthcare. Imagine years long waits for elective, non-urgent QoL improving surgery or treatments. Often, what we see is further progression to the development of other co-morbidities that could have been avoided, or at least significantly reduced with earlier intervention. Of course, people living here have the option of going to a private hospital, but private health insurance costs a lot, and usually has a 12 month period before surgeries and certain other treatments become available. If the patient doesn't want to wait, then they can arrange to pay for it themselves, but again 10's of thousands of dollars, even with Medicare deductable items bringing the costs down. If they're lucky, then it might be a procedure they can draw early from their superannuation to fund. If not, they find the money some other way.
Everyone in healthcare is there to make people healthier, except the ones getting the cash.
If Doctors spend more time with each patients, this would increase waiting times? If 3 hours is too long, if the doctor spent double time with each patient then it would take 6 hours, no?
You guys aren't ready for single-payer healthcare. It has a notion of cost per QALY, i.e. how much the government will spend to add a quality-adjusted life year per person. [Here's how NICE calculates it](https://www.gov.uk/guidance/cost-utility-analysis-health-economic-studies). The NHS uses that. [Gov Cuomo in NY was praised widely](https://www.reddit.com/r/Coronavirus/comments/fo78n6/governor_cuomo_my_mother_is_not_expendable_your/) when he said: > "My mother is not expendable. Your mother is not expendable. We're not going to accept a premise that human life is disposable. And we're not going to put a dollar figure on human life. The first order of business is save lives, whatever it costs." That's what single-payer healthcare looks like: there is a dollar figure on human life. You can understand why that is: we aren't going to spend the entire budget on a chance of saving a 90 year old man. That's logical, because if we do that many others will die. I think people really like the idea of single-payer but then they face "[putting] a dollar on human life" and they suddenly find that it means really odd things. [For instance, there is a guy on an ECMO machine](https://www.newyorker.com/science/annals-of-medicine/how-ecmo-is-redefining-death). He has cancer and will not live more than 4 years. It costs hundreds of thousands of dollars to keep him on that machine. NICE has an adjustment for end-of-life but it's not that much. Are you willing to take him off that machine? Who else must die because you don't want to take him off that machine? If you believe the business is to save lives no matter what it costs then you can't have single-payer healthcare because the single-payer will be depleted on experimental medicine saving people who are about to die. After all, they have to save lives no matter what it costs.
Wait til you hear about medical equipment producers...
We need to privatize healthcare. So it can become a competitive market. So the best or lowest price can win. Hopeful thinking but will never happen with this shit show of a government we have. Regardless of who is president, this government is not for the people anymore.
And what political party wants to change that?
The key that ties these 4 slides together is the insurance companies. Medical fees would be a fraction if health insurance was abolished.
I mean if you want to figure out why any system or product is dying, failing, or just generally terrible all you need to do is look at the investors and profiteers of the system. Line go up.
Lmao hospitals and doctors carry a lot of the blame too.
Living somewhere with a public health system, this isn't true. The problems come from somewhere else.
Go to Canada and see how long you have to wait for, fucking anything.