Or if you say we should slow down your competence is questioned by others who are going very fast (and likely making mistakes we won't find until later).
And there is an element of uncertainty. Am I just bad at using these new tools? To some degree probably, but does that mean I'm totally wrong and we should be going this fast?
There is a saying: slow is smooth and smooth is fast.
I have personally outpaced some of my more impatient colleagues by spending extra time up front setting up test harnesses, reading specifications, etcetera. When done judiciously it pays off in time scales of weeks or less.
Most people are just trying to get through their day and not worry about ethical questions.
I'd say that's terrible, but I'm not confident I'd be a better person if my livelihood depended on doing that sort of work, though I hope I'd be better.
I'll not dispute the impact on expansion and consolidation, but I will say in recent months I have seen a number of hit pieces on the 340B program, mostly bankrolled by pharma companies (not this one just calling out the trend).
The exact implementation might be flawed, but if 340b is eliminated it will kill many hospitals in underserved communities.
So any plan to change 340B should really also explain how to fund these critical hospitals.
In the way that surgeries used to be the "money maker" to subsidize other expensive service lines like an ED, pharmacy has filled that gap in recent years.
It is less hospitals getting rich off overcharging insurance for drugs and more hospitals overcharging insurers for drugs since everything else they do is a drain on finances.
Hi, I wrote this article and largely agree with you. 340B is important and without it many hospitals likely wouldn't survive. However, it's pretty evident at this point that 340B has expanded beyond its original intent.
For example, Northwestern University (in the middle of downtown Chicago) got itself reclassified as a rural hospital in order to participate in the program.
Moreover, it's grown extremely rapidly over the past ~5 years, and the gravity of the program is starting to create bizarre second-order effects like the one outlined.
My intent with this article is just to highlight some of those effects, not to advocate for eliminating 340B.
Also, not bankrolled by pharma, just a researcher for Turquoise Health (a healthtech startup). I get to dig around in their data and publish occasionally, but editorial control / opinions are my own.
For example, Northwestern University (in the middle of downtown Chicago) got itself reclassified as a rural hospital in order to participate in the program.
This is also a bit misleading though right? Northwestern was obliged to put 11 other hospitals and something on the order of like 150 to 200 clinic/other locations on its books largely for the purposes of access. So that rural communities across northern Illinois can also have the same access as people in Chicago.
The fact is, they are a rural healthcare system. Because the options that were in those locations previously were unable to make a long term go of it.
I was being a bit glib/imprecise before, but I'm specifically talking about the Northwestern Memorial campus downtown Chicago [0]. That location qualifies for 340B as a Rural Referral Center (RRC), and got itself reclassified by CMS/HRSA as rural to do so, despite being in the middle of downtown. RRCs need to meet a lower threshold of Disproportionate Share Hospital (DSH) adjustment percentage (8% vs the usual 11.75%). Northwestern Memorial needs to be an RRC because it doesn't meet the higher DSH threshold.
AFAIK, the other hospitals/clinics under the Northwestern umbrella don't really factor into whether the downtown Northwestern Memorial campus qualifies for 340B (insofar as they all have their own CCNs and qualify independently). In this case, Northwestern Memorial qualifies because it a) got reclassified as rural b) became an RRC (likely based on its staff specialty mix) c) meets the RRC DSH threshold of >= 8%.
Northwestern Memorial does treat a lot of rural patients, so maybe it does deserve 340B. That said, it seems clear that it's not they type of struggling safety-net/rural hospital 340B was originally intended to subsidize.
AFAIK, the other hospitals/clinics under the Northwestern umbrella don't really factor into whether the downtown Northwestern Memorial campus qualifies for 340B
The money is shared at the system level. The referrals are to/from other hospitals/clinics in the system. Many of the other facilities in the system, exist because of Northwestern Memorial. This is what needs to be done to ensure access.
It's incredible how far we'll bend over backwards as a country to avoid single payer healthcare. It's especially ironic that the most common argument against it is "taxes" when ...the outcome here is higher taxes.
Single payer would reduce choice and increase costs. People fantasize that price caps would fix everything, but they can't. Healthcare is just a resource and people pay high prices for it due to limited availability and regulatory requirements.
Do we really know what single payer would do with any certainty?
There's not really been a real test what a healthcare system with any kind of "natural" market forces at work. The current system is just a mess of tax breaks, middle man companies, hidden pricing, strange federal and local laws, employer choices and so on...
Even when someone talks about single payer, I'm still unsure what they imagine that looks like.
Similar things have been tried in other countries, and they have different failure modes. Ultimately the basic laws of economics predict with high accuracy what would happen. Now, I will grant that the current system is not based on the free market and might be substantially improved by changing to a different system, but the free market would solve problems created by all of the interventions that have been tried. Healthcare might still be unaffordable for some, but that is true of many scarce and desirable resources anyway.
Bullshit. The rest of the industrialized world is laughing at you for saying that. There are zero credible studies that show that socialized healthcare increases costs and plenty of bankrupt Americans because of our broken healthcare system.
I went to the doctor because of chronic acid reflux. They charged me a copay. They couldn't help so they referred me to a gastro doc. The gastro charged me a copay (more because it was out of network—there's no in network gastro doctors in my city). I was given an upper endoscopy, but insurance only covered 10% of the cost of the procedure. I spent $500 on the medication I was prescribed afterwards.
I have "good" insurance through my employer. If I didn't have insurance, I wouldn't have been able to get treated. The fantasy universe that you're describing is the one we live in: I have almost no choice, nothing is in network, and I spent $10k on healthcare on top of what's already taken out of my pay. Nobody in countries with socialized medicine has any of these problems.
>There are zero credible studies that show that socialized healthcare increases costs and plenty of bankrupt Americans because of our broken healthcare system.
You can just look at the budgets of other countries and see that they pay dearly for their inferior healthcare where you will die waiting for care. At least in the US you can get taken care of and flush the debt down the toilet in bankruptcy.
>I went to the doctor because of chronic acid reflux. They charged me a copay. They couldn't help so they referred me to a gastro doc. The gastro charged me a copay (more because it was out of network—there's no in network gastro doctors in my city). I was given an upper endoscopy, but insurance only covered 10% of the cost of the procedure. I spent $500 on the medication I was prescribed afterwards.
I'm sorry to hear this. Chronic or routine issues are not what insurance is supposed to cover. Just as you cannot insure the motor oil or tires on your car and have it be worthwhile, you won't find insurance that is favorable for this under any system, no matter who is paying. The simple reason for this is mathematical and baked into the actual purpose of insurance. Insurance is supposed to protect against low probability, high cost events. The only way an insurer can stay in business, much less make a profit, is to charge more than they pay out. This applies to the government as well. Guess what happens when that gang gets permission to extract as much money as it takes to provide a modicum of healthcare? You get a lot of corruption and a shitty experience, and don't have the money to pay for anything better either.
>I have "good" insurance through my employer. If I didn't have insurance, I wouldn't have been able to get treated. The fantasy universe that you're describing is the one we live in: I have almost no choice, nothing is in network, and I spent $10k on healthcare on top of what's already taken out of my pay.
Your limit is $10k per year out of pocket no matter how much the treatment costs. Of course, the premiums technically come out of pocket too, just like taxes would in the case you dream of.
>Nobody in countries with socialized medicine has any of these problems.
You have no idea. I see stories all the time about people who wait for months to see a specialist in those utopian countries, and even die waiting to be seen "for free" (as 40% of their pay or more goes to fund the damn system). If you're in Canada, you may find your complaints about the system met with a recommendation for euthanasia, like that disabled veteran who made the news a couple of years ago. I suggest you do some research into these kinds of stories and temper your expectations...
> it will kill many hospitals in underserved communities.
At some point it makes more sense to move every person from their remote hamlet than to create a hundreds different programs and exceptions to deliver broadband, groceries, and healthcare there. Many of these towns are leftover from when farming was 100x more labor intensive or industry had to be located next to a river.
>I'm not qualified to know who will make a good president. You probably aren't either. Pushing the process further into American Idol territory would make it worse, not better.
I reject this premise. I'm not omniscient but I have a pretty good idea.
There could be a world where mineral supplies are exhausted/inaccessible to the point that extraterrestrial metals are needed to maintain the supply chains we need to feed billions of people.
Edit to say - that's probably a long way off / not likely
> There could be a world where the muon radiation fallout of WWIV has contaminated all unmined terrestrial mineral sources.
All unmined terrestrial mineral sources? I don't know what the heck you're talking about, but that sounds like a world where everyone's dead. Pretty sure all the bomb shelters in the world are shallower than the deepest mine.
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