This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
At the end of the day, all the dollars spent on healthcare end in someone's pocket. If not doctors (and I'll believe some aren't hugely compensated compared to their efforts), then who is keeping the dollars my insurance company (and I) pay the local "nonprofit" hospital for care? Obviously insurance gets it's share (capped by Obamacare). Their executives (doctors!) are compensated pretty well as far as I can tell.
I believe the actual answer to this is "Private Equity firms". Where the money eventually goes after that is incredibly complicated to track (by design), but last I checked they played a fairly important role in cost inflation.
Why does Private equity play such a big role in modern investing? Is it a new thing, or did some regulatory change happen, or is there some reason I hear them brought up in almost any economic discussion nowadays, or am I just misremembering a time before private equity was a talking point?
I don't think that private equity is a particularly new thing - it was how Mitt Romney made his money, after all.
My personal belief, which I freely admit has no actual verifiable statistical backing, is that the main reason you're hearing more about them is that the proboscises of parasitic capital are being turned inward. A lot of financial instruments and practices, whatever their legality or the finer points of how they work, essentially functioned as wealth pumps that funneled treasure from various parts of the world to the imperial core. But those wealth pumps develop constituencies and dependents, so they can't just turn off when the flow of lucre begins to slow, and as a result they're forced to target the interior of the empire. These engines of exploitation, which have for years been going into poorer countries and exploiting them for profit, are being forced to turn to the US heartland because that's where the easiest money is. Now, instead of buying hospitals and dramatically raising prices while lowering quality in the global south, they do things like buy Red Lobster and suck out so much capital it dies, or set up cartels in the firefighting equipment manufacturing sector, driving up costs of equipment massively while also simultaneously creating shortages in both repair parts and finished vehicles (https://www.thebignewsletter.com/p/did-a-private-equity-fire-truck-roll).
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
A big piece of it is admin bloat, just as in academia the number of middle managers and other folks like that (assistant infection control nurse - whose job is to make sure we don't order any labs that may show signs of infection!). Also more general middlemen/industries of various kinds.
Examples: PBMs, billing staff, EMRs.
If you look at a surgery a small fraction of the cost is the surgeons professional fee - yes lots of labor costs but thats because their are literally scores of people involved. Supplies, instruments, equipment....all places where someone could be greedy (see: ortho vendors).
Executives in healthcare are increasingly MBAs or nursing and often have authority over the doctors that can lead to both increased cost and decreased quality (see: travel nursing).
Doctor supply issues may be a problem but they are pretty orthogonal to the overall cost disease problems.
More options
Context Copy link
A bunch of it is surely administrative bullshit.
Administrative bullshit maybe, administrators probably not.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link