I have written about the debacle known as Obamacare ever since I first started blogging, and many times since. In a nutshell, my primary objection is and always has been that it entrenches our wildly expensive, unjust, inefficient and deadly for-profit system, and forecloses any sort of bridge to transition the vast majority of Americans to a single-payer system. For-profit means just what it says: it puts health care in the business of producing profits, and not, you know, health.
A perfect illustration of this fatal flaw comes courtesy of The Washington Post with respect to hospice care:
On several key measures, for-profit hospices as a group fall short of those run by nonprofit organizations.
The typical for-profit hospice:
- Spends less on nursing per patient.
- Is less likely to have sent a nurse to a patient’s home in the last days of life.
- Is less likely to provide more intense levels of care for patients undergoing a crisis in their symptoms.
- Has a higher percentage of patients who drop out of hospice care before dying. High rates of dropout are often viewed as a sign that patients were pushed out of hospice when their care grew expensive, left dissatisfied or were enrolled for hospice even though they were not close to death.
They also deny their patients palliative care they deem too expensive, like radiation treatments to shrink tumors.
Hospice operators have an economic incentive to provide less care because they get paid a flat daily fee from Medicare for each of their patients. That means that the fewer services they provide, the wider their profit margin.
Wow! Who would have thought?
Industry advocates warned against using the findings to rule out care from a for-profit hospice.
That’s because they are industry advocates, paid to advocate for the hospice industry. And they seem to be quite successful at what they do:
The number of hospice firms has risen rapidly, and over the past decade the growth has come almost entirely from new for-profit operations. Between 2000 and 2012, the number of for-profit hospices tripled to 2,196, according to federal figures, compared with about 1,500 nonprofit hospices, including those run by local governments.
Good job, industry advocates! And of course the ultimate villains in this story are never lurking very far away:
The expansion has been driven in large part by investors, including private equity firms, hedge funds and entrepreneurs. More than a dozen private equity firms have invested in businesses that provide hospice care, including giants such as The Carlyle Group, Kohlberg & Company, Summit Partners and GTCR.
“Hospice [mergers and acquisitions] market is red hot (peak valuation levels),” according to a presentation by financial analysts at Cain Brothers last year, which cited, among other things, the favorable U.S. demographics — more old people.
“Hospice continues to be of robust interest to Wall Street,” said Carsten Beith, a managing director at Cain Brothers.
The more neglect and misery inflicted on elderly and terminally ill Americans, the more money these sociopathic weasels make. Red hot market. Robust interest to Wall Street.
If that’s not your cue to run far, far away from for-profit hospice care, I’d really like some of that (illegal!) medical marijuana you’re smoking.
Defenders of market-based healthcare generally and private medical insurance in particular—a.k.a. conservatives—would no doubt attack my reasoning here, perhaps by claiming that the Real Problem™ at the root of such disparate outcomes between for-profit and non-profit hospice operations is too much regulation (nope: as the linked article notes, hospices are absurdly under-regulated), or that there is too much government interference in the Glorious Free Market™. Conservatives can always find hilariously predictable ways to spin or deny reality, with which they prefer to maintain only the most tenuous grasp. That is because in the distorted mirror-maze that is the typical conservative mind, the well-established fact that non-profits and single-payer health systems yield far superior health outcomes across a wide range of measures (and do so much more cost-efficiently) simply cannot be acknowledged as true. Thus stories like this one in The Washington Post must be dismissed or explained away by ever more absurd rationalizations, lest we all fall into a communist death spiral and ruin America. It would be hilarious if it didn’t have a body count.
[a version of this post appeared at perry street palace.]