US Politics Mega-thread - Page 344

Hospitals can make much more money when surgery goes wrong than in cases that go without a hitch.

And that presents a problem for patients. The financial incentives don't favor better care.

"The magnitude of the numbers was eye-popping," says , a professor of surgery at Harvard Medical School, and an author of the study, which was just published in JAMA, the Journal of the American Medical Association. "It was much larger than we expected."

If a patient with private insurance had complications after surgery, hospitals made $39,017 more profit than if all had gone well. That's compared to an additional profit of $1,749 for a Medicare patient with complications after surgery.

"That's an indication of the level of perversity here," Gawande says. "Having a complication was profitable, and fighting complications was highly unprofitable."

It's not surprising that health care costs are higher when there are complications, since patients need more care to get better. And it's not surprising that hospitals bill private insurers at a much higher rate than Medicare.

There was no profit with Medicare patients. The paper used "contribution margin," which is revenues minus variable costs. In other words, the expense of items used directly for a patient's care, not overhead or other fixed costs.

The much higher margin on cases involving mistakes is enough to make a patient think that hospitals aren't highly motivated to reduce medical errors. In fact, one reason that Gawande and his colleagues embarked on the study is that many hospitals have been slow to adopt practices proven to improve the quality of care and save money.

On July 22 2013 03:11 farvacola wrote:
Since we're on the subject.



Quality Conundrum: Complications Boost Hospital Profits

On July 22 2013 03:17 Shiori wrote:

Well, that's horrifying. Remind me never to get my healthcare done in the US unless I'm paying up front in cash and tipping the doctors 10k each . I kid, but this is really scary to me ><

Whether it’s immigration reform, the budget, or President Obama’s nominees, a faction of more moderate Republican senators are increasingly splitting from both their leadership and the tea party and partnering with Democrats on key issues.

The growing signs of division are remarkable after years of exceptional Senate GOP unity under the reign of Senate Minority Leader Mitch McConnell (R-KY), during which minority use of the filibuster to thwart governance has soared to unprecedented heights.

This week, large numbers of Republicans, led by Sen. John McCain (R-AZ), broke with McConnell and voted with Democrats to secure the confirmation of controversial Obama nominees to the Labor Department, Environmental Protection Agency and Consumer Financial Protection Bureau. In all eight cloture and confirmation votes, McConnell voted “no.”

The most controversial nominee so far, Tom Perez for labor secretary, overcame a GOP filibuster by the thinnest of margins, 60-40. The six Republicans who joined Democrats in his favor, whom Democrats will look to for cooperation on other matters, were Sens. McCain, Bob Corker (TN), Lamar Alexander (TN), Susan Collins (ME), Mark Kirk (IL) and Lisa Murkowski (AK).

In a clear sign of boiling rank-and-file frustration, Corker reportedly cried “bullshit” loudly while McConnell was discussing the issue of nominations and Democrats’ nuclear option threat during a closed-door GOP meeting on Wednesday. He later declined to apologize for it and said he’s “glad that that occurred.”

On immigration, 14 Republicans joined every Democrat in voting to comprehensively overhaul the system and offer unauthorized immigrants a path to citizenship.

On the budget, numerous Republican senators are urging conservative colleagues to stop blocking conference negotiations with the House, and are pushing for a long-term budget agreement with Democrats that includes new revenues — anathema to the tea party.

McCain has led the dissent in each of these cases, earning effusive praise from leading Democratic senators and prompting jokes this week by Democratic aides that he is the new minority leader.

On July 22 2013 03:44 cLutZ wrote:


While nominees are one thing, the question I would pose is: What is the point of a Republican party that just signs on to bills? I feel like Democrats think that Republicans should just take Democratic bills and insert the pork that they also want. This is kinda fundamentally at odds with the entire purpose of the party.

On July 22 2013 03:46 farvacola wrote:

The "fundamentals" of the Republican Party are up in the air, judging by the split between RINO's and Tea Party'ers. I'm sure Lamar Alexander and Ted Cruz have rather different ideas as to what constitutes a proper Republican. I expect '14 to be one big Republican "No True Scotsman" party

Hospitals can make much more money when surgery goes wrong than in cases that go without a hitch.

And that presents a problem for patients. The financial incentives don't favor better care.

"The magnitude of the numbers was eye-popping," says , a professor of surgery at Harvard Medical School, and an author of the study, which was just published in JAMA, the Journal of the American Medical Association. "It was much larger than we expected."

If a patient with private insurance had complications after surgery, hospitals made $39,017 more profit than if all had gone well. That's compared to an additional profit of $1,749 for a Medicare patient with complications after surgery.

"That's an indication of the level of perversity here," Gawande says. "Having a complication was profitable, and fighting complications was highly unprofitable."

It's not surprising that health care costs are higher when there are complications, since patients need more care to get better. And it's not surprising that hospitals bill private insurers at a much higher rate than Medicare.

There was no profit with Medicare patients. The paper used "contribution margin," which is revenues minus variable costs. In other words, the expense of items used directly for a patient's care, not overhead or other fixed costs.

The much higher margin on cases involving mistakes is enough to make a patient think that hospitals aren't highly motivated to reduce medical errors. In fact, one reason that Gawande and his colleagues embarked on the study is that many hospitals have been slow to adopt practices proven to improve the quality of care and save money.

On July 22 2013 04:04 farvacola wrote:
You made an exaggerative claim in regards to McCain's schism and their refusal to continue playing Mitch McConnell's game, as though their signing off on Obama's nominees is somehow against the fundamentals of the Republican Party. I'm suggesting that many other Republicans think differently, and the question as to who will lead the party moving forward can only be determined by seeing how these next few election cycles play out, during which we will see a great deal of people continue to make appeals to "fundamentals".

I'll tell you this much. Ted Cruz loves his fundamentals.

On July 22 2013 03:11 farvacola wrote:
Since we're on the subject.



Quality Conundrum: Complications Boost Hospital Profits

On July 22 2013 04:52 cLutZ wrote:


I was saying that executive nominees are not really that important to anyone. The problem I was trying to talk about is this POV that the old Bob Dole/Bush Republicans had it right and the new Tea Party types are wrong.

Now I totally agree that there will be a battle in primaries/etc to see which view of the Republican Party continues on, but my point is if the milktoast Jeb Bush/McCain faction wins, there is really no point to having the Republican Party anyways.

On July 22 2013 03:11 farvacola wrote:
Since we're on the subject.



Quality Conundrum: Complications Boost Hospital Profits

On July 22 2013 04:52 cLutZ wrote:


I was saying that executive nominees are not really that important to anyone. The problem I was trying to talk about is this POV that the old Bob Dole/Bush Republicans had it right and the new Tea Party types are wrong.

Now I totally agree that there will be a battle in primaries/etc to see which view of the Republican Party continues on, but my point is if the milktoast Jeb Bush/McCain faction wins, there is really no point to having the Republican Party anyways.

On July 22 2013 03:11 farvacola wrote:
Since we're on the subject.



Quality Conundrum: Complications Boost Hospital Profits

Supreme Court Justice Antonin Scalia's warnings on judicial activism appear to have gained a new chapter at the Utah Bar Association's 2013 summer convention.

The Aspen Times reported Sunday that Scalia drew upon the Holocaust as an example of how judicial activism can lead to problems. According to the Utah Bar Association's website, Scalia was slated to be the keynote speaker for the 2013 Summer Convention event, which was held from July 17-20 in Snowmass, Colo.

Via The Aspen Times:

Scalia opened his talk with a reference to the Holocaust, which happened to occur in a society that was, at the time, “the most advanced country in the world.” One of the many mistakes that Germany made in the 1930s was that judges began to interpret the law in ways that reflected “the spirit of the age.” When judges accept this sort of moral authority, as Scalia claims they’re doing now in the U.S., they get themselves and society into trouble.

About a month ago, Scalia delivered a speech to the North Carolina Bar Association, stressing his concern about how moralist judges are growing more prevalent. He classifies the Constitution as a living document that has laws of the land serve as a guide to interpreting changing circumstances.

"We have become addicted to abstract moralizing," Scalia said last month. "I am questioning the sanity of having value-laden judgments made by judges."