Wait… what’s wrong with motivated by profit? If the service sucks, they’ll lose customers.
Focusing on profit is fundamentally sound unless you’re a monopoly, which tend to be when Gov sticks its beak into things it shouldn’t.
Focusing on profit is fundamentally sound unless you’re a monopoly, which tend to be when Gov sticks its beak into things it shouldn’t.
We’re talking about hospitals. Many areas are served by one local hospital. And where there are several, it’s typically the ambulance who decides where you go. It’s also pretty difficult to compare one hospital with another.
IMO hospitals resemble utilities where market forces aren’t enough to guarantee good service.
Don't necessarily disagree with most of your sentiment, however the vast majority of hospital patients do not arrive in an ambulance, or even through the ER.
A lot of hospital services are elective or planned (surgeries, pregnancies, etc) and for those I've found it very helpful to 'shop' for the best options.
Also, the one time I was in an ambulance, they asked which hospital I wanted my daughter transported to.
All that said, it isn't always possible or feasible to choose - but it's not because of an ambulance.
Ok, if "many areas have one hospital"... I don't think that's true at all. Most areas have multiple hospitals. Most people live in metropolitan or suburban areas.
Increasing taxes and removing alternatives is never a good deal.
"market forces aren't enough" government forces aren't enough either.
The VA is the penultimate example and I wouldn't wish that upon my worst enemy. That's where our veterans go to commit suicide in the parking lots waiting on help.
22 Veterans.
The people I know who use the VA are quite OK with it. It's not perfect but none of them would want to put up with the insanity the rest of us has to.
"it's not perfect" It's garbage and a prime example of government programs. Works for a few and fucks over the rest.
The ACA helps a few... and is built on lies - keep your plan? keep your doctor? save $2500 a year? Lies, lies, lies... a few million get help. The other 100m pay more, higher deductibles, lose their plans, lose their doctors.
But who cares about the 100m if the 1m get helped, eh?
the biggest problem is the wasted money, the lies and the people dying in the parking lots.
But who gives a f' about them eh?
The problem is the suggestion that government solutions will solve government created problems.
I have no problem admitting things can be fixed... but stuff like the unAffordable Care Act which is built on lies (Like your plan? Like your doctor? save $2500/year) is not going to solve the issues - nor is single payer, government ran solutions.
You'll never solve government created problems with government ran beauracracy.
The problem is that the conversation only focuses on the good parts of those systems and ignores the issues.
You can't have a real conversation and claim "have it better" when that may be true in parts but not in whole.
I don't claim the US system is better... or the best. But claiming that government ran or government overregulation leads to better is a lie. The VA is proof of that. the lies around the unACA is proof of that. The ever increasing prices and decreasing results due to government influence is proof of that.
Destroying what we have with something like the ACA isn't proof that government ran will be better... it's simply proof that people are willing to destroy what was working and claim that the destroyers will do a better job if only they have more money and more power.
That's like CA solving homelessness. "more money, more power and we'll solve homelessness" and there's never been more homelessness or less affordability in CA.
Paramedic here. It's typically, effectively, your insurance that dictates how we decide where you go.
If you're an acute, time-sensitive patient, then from a multitude of angles, "closest appropriate facility" makes sense.
Perhaps you dislike a hospital, or it's inconvenient, and you're not as acute or timely a patient, and your view is "I want to go to X hospital, and since I'm paying, why shouldn't I get to choose?"
As a paramedic, personally, I don't care.
However.
Your insurance does. And their perspective (sometimes rightly, and quite regularly wrongly) is that if you are well enough to bypass a hospital or multiple hospitals en route to a "chosen" facility, then did you need the ambulance? And if you didn't need it, why are "they" paying for it? And they can, and absolutely will, kick bills back to the ambulance company with a "please justify why an EMS transport was required versus advising POV (privately owned vehicle) transport or physician followup".
What they want to see happen, and what generally is actually the better option, as a provider is "we will go to the closest facility where they will assess and stabilize you as needed. if you then wish to be -transferred- to your facility of choice, they will organize that" (and, since the insurance criteria and questions are met, and a physician ordered the EMS transport, you should be covered). Though it is certainly less "convenient" for you.
Even beyond that, the area I'm in we have two hospitals. One is a Level 2 Trauma Center, one is a Level 3, but they're mostly comparable except for, well, acute trauma. We as providers will have a solid perspective of patient load in the ED of those hospitals, so I might ASK, not TELL you, hey, we might want to go to Hospital B, not A. And occasionally, though diversion is a convenience, not a concept under EMTALA (we can still absolutely show up at the ED with a patient even if they're "on divert"), some of the facilities here will round-robin to balance patient loads.
(Also, don't start me on Certificates of Need, where new hospitals essentially have to get the permission of existing hospitals in the area before they can open - essentially, "will you be okay if we take patients away from you"...)
The "non-profit" organizations are given tax-exempt status because they are centered around providing a public or social benefit, they explicitly should not be focused on providing a profit to their owners.
In my opinion the majority of people can't afford to choose their hospital. Often it's the one that is within their means to travel and provides the service they require, regardless of the quality of their services. And, of course, after a serious accident you end up wherever the ambulance brings you.
This isn't a discretionary purchase, let's stop pretending one can go shopping for care.
The language you've chosen is baldly ideological and leaaves no room for good faith discussion.
If a sandwich shop produces bad sandwiches then eventually people stop buying them and shop around. This doesn't work with hospitals. In the worst case, dead people can't shop around.
It's the idea that a comment that supports the basic foundation of the organization who run this board gets so severely downvoted.
I'm justing calling out how ironic it is.