Saw this today and got an email from "Atena".

[lappir]

https://who13.com/news/oskaloosa-pharmacy-foresees-closure-unless-drug-reimbursement-policies-change/

Yesterday I called the pharmacy in the news report to renew my prescriptions. They said they would have to charge now for the shipping and I said fine. I want to support a business where I grew up and have spent many summers near. 

Then today I got the following email encouraging me to utilize on of the mail order companies they have contracted with and who knows where they are located. As George Carlin said "there is no such thing as free enterprise" or something like that. 

 

https://click.em.silverscript.com/?qs=bbefc10341ce3da0ff31c46dc8e177777438bf4fe881fb7ecca7e8b75ba1cc577fdb6d2137eb5a906f3b3faf53ba8e9425ea956e43457f7469d8bd06055e183f

Don't know if either links will work. (or allowed)

 

Rod

[Kirk W]

2 hours ago, lappir said:

Don't know if either links will work.

The first leads to a very interesting article. It makes me wonder about pharmacies in the larger communities. We tried Walmart pharmacy but the service was so poor that we went back to CVS which is where we were getting them before. 

The second link didn't lead to any email but rather to the site of Aetna insurance and they are the parent of the prescription coverage that we have for part D medicare. Aetna Insurance Co. is owned by the CVS Health Group. 

[lappir]

Remember when there was a Walgreens and then a CVS pharmacy across from each other for a time. I notice one or the other are closing their locations in various areas if that lets you know how the Pharmacies in larger communities are doing. 

I think it's wrong for my Medicare to send out information leading me away from a good local pharmacy and encouraging the use of a huge corporation that controls insurance, medications, durable health goods and most likely a large portion of the Health Care FOR PROFIT machine. 

Caring for people should never make a monetary profit it should be for the good of all. 

Rod

[Kirk W]

17 minutes ago, lappir said:

I think it's wrong for my Medicare to send out information leading me away from a good local pharmacy and encouraging the use of a huge corporation that controls insurance, medications, durable health goods and most likely a large portion of the Health Care FOR PROFIT machine. 

I think that is mostly the result of efforts to bring prices down for healthcare of all kinds. There are economies of scale and that isn't just a theory but it is what is ending retail business in small towns and rural America. Big companies are not causing small town stores to close, but the people who buy from them are. Improved highways and automobiles have made it easier and less time consuming to drive a distance to save money and that also plays a part in the change. When I was growing up there were 2 grocery stores, a pharmacy, and several other retail stores in Dwight, KS where I went to school. About once a quarter we would all load into the car and travel the 18 miles to the county seat (Council Grove) where the big stores were to do major shopping. Once or twice a year we would travel the 32 miles to Manhattan for the bargains there!  If residents would pay the higher prices to shop close to home those stores would still be there, including the pharmacies. You might be willing to pay extra, but would you pay that difference for prescriptions if Medicare only paid what the chains charge and you had to pay all of the difference? Very few people would do so and some could not afford to. I agree that it is sad to see the small retail stores going away, but I also admit to being part of the problem because I try to save money too.

[lenp]

We have lost two pharmacies here in the small town of Madras, OR.  First it was an employee owned chain (Bi-Mart) and then a privately owned drug store.  All in the last two years and both due to low re-imbursement rates.

Lenp

[lappir]

9 hours ago, lenp said:

We have lost two pharmacies here in the small town of Madras, OR.  First it was an employee owned chain (Bi-Mart) and then a privately owned drug store.  All in the last two years and both due to low re-imbursement rates.

Lenp

Yes the small town has had a couple other pharmacies come into town over the years and none were able to survive. It will be a very sad day if this business isn't able to survive. They don't rely solely on the Pharmacy and health care items, but the other stuff is not things I buy very often. They did do a remarkable job on retouching an old aerial photograph of my Grandparent's farm several years ago and I have used there "Frame Shop" a few times, but I don't print and frame many photos living full time in a home on wheels. They just tend to fall off the walls too often. 

I hope one day it become illegal for health care providers to provide better care to their "Investors" than they do to their actual patients. 

Rod

[Kirk W]

1 hour ago, lappir said:

I hope one day it become illegal for health care providers to provide better care to their "Investors" than they do to their actual patients. 

Tell me more about this. Who does it and what evidence do you have? How do they know which patients are investors? I have never heard of this but I do have some money healthcare equity funds. Is that why we get good healthcare or should we expect more? 

EDIT: I did some digging on the internet and didn't find any evidence of preferential treatment, but I did find some negative information.

What Happens When Private Equity Takes Over a Hospital 

from Harvard Medical School, December 26, 2023

Edited March 9 by Kirk W
add a link

[lappir]

9 hours ago, Kirk W said:

Tell me more about this. Who does it and what evidence do you have? How do they know which patients are investors? I have never heard of this but I do have some money healthcare equity funds. Is that why we get good healthcare or should we expect more? 

EDIT: I did some digging on the internet and didn't find any evidence of preferential treatment, but I did find some negative information.

What Happens When Private Equity Takes Over a Hospital 

from Harvard Medical School, December 26, 2023

I'm not saying that someone who has invested in "Health Care" is better cared for. I'm saying Administrators of various "Health Care Corporations" are more concerned about showing a profit to their "Investors" than they are about taking care of the patients. 

The only first hand information I have about this is 30+ years working at various Hospitals across the US. I have little first hand information as a "Patient" (thankfully) and most of my family has been without the need of significant intervention by a health care provider.  I do know much of what I experienced earlier in my journey as a health care provider has changed and not for the good of the patient. IMHO. 

 

Rod

[Chalkie]

17 hours ago, lappir said:

I'm not saying that someone who has invested in "Health Care" is better cared for. I'm saying Administrators of various "Health Care Corporations" are more concerned about showing a profit to their "Investors" than they are about taking care of the patients.

I think this is likely true. When I was younger it seemed that insurance was at least balanced. Patient care was good, insurance paid the providers well, and the investors made money. Today with all the consolidations in the medical industry into giant medical providers that control multiple aspects of health care under one umbrella, profit has become king.

Just one example, I recently got an email saying that Tricare was going to start using Accredo for specialty prescriptions. I did a little digging and Accredo is a subsidiary of Express Scripts which is owned by Cigna Healthcare. Now if you look up Cigna is says - "The Cigna Group is a for-profit American multinational managed healthcare and insurance company" - and you can bet that a profit is expected at every level.

[Randyretired]

Nearly all of health care is for profit.  I remember many years ago when my Grandmother owned a nursing home.  It was her business and like any small business owner she worked day and night to make it run to support her.  Without a profit motive that nursing home would not, could not exist.  Today it might be physician starting a practice. The profit I don't have a problem with as long as customers, patients have choices.  This competition will keep providers honest or they won't have a business.  Unfortunately it seems we are forced to deal with large institutions without other choices to many times.  Without choices or competition things can get skewed and profit can rule.

[Kirk W]

1 hour ago, Chalkie said:

When I was younger it seemed that insurance was at least balanced. Patient care was good, insurance paid the providers well, and the investors made money. Today with all the consolidations in the medical industry into giant medical providers that control multiple aspects of health care under one umbrella, profit has become king.

HISTORY OF HEALTH INSURANCE IN THE UNITED STATES

Only 9 percent of the population had insurance on the eve of World War II. That percentage had more than doubled to nearly 23 percent by the end of the war. It more than doubled again by 1950 and was close to 70 percent by 1960.

The History of Health Insurance: Past, Present, and Future

Because medical technology wasn’t very advanced, the actual cost of obtaining healthcare was relatively low. Prior to the 1920s, most surgeries were performed in people’s own homes, so hospital bills were rare. People were more concerned about the wages they’d miss out on if they were sick and unable to work. For this reason, “sickness insurance” products started popping up to help people cover their living expenses when they couldn’t earn an income due to illness or injury. 

Even a doctor in private practice by himself is a for-profit business. Publicly owned corporations attract investors by paying out profits and must do so in order to survive. Neither my parents or Pam's had any kind of healthcare insurance when we were growing up in the 40's & 50's, although my parents did get some coverage in the late 50's.

What percentage of hospitals in the U.S. are non-profit?

According to our database and research from the Annual Review of Public Health, nearly 60% of acute care hospitals in the U.S. are non-profit. Definitive Healthcare tracks nearly 3,400 non-profit hospitals in our database.

Profitability of Large Pharmaceutical Companies Compared With Other Large Public Companies

Large, for-profit companies play a central role in providing medicines to the public. Virtually all of the US Food and Drug Administration–approved medicines in the United States were developed by for-profit corporations.12 The 25 largest pharmaceutical companies accounted for 73% of all pharmaceutical sales in 2015.

[sandsys]

In the Minneapolis/St Paul area we have the Hennepin County Medical Center and the Ramsey County Hospital that are non-profit. Plus, lots of for-profit ones. I have received care in one non-profit and three for-profit here and got good care in all of them. Our daughter was born in a non-profit since it was on an Army Base and I was born on a Navy base. Dave was born in a for-profit here that no longer exists. (Swedish Hospital reflecting his family's Scandinavian heritage.)

Linda

[Chalkie]

I think the term "non-profit" or "not-for-profit" is misleading when it comes to health care at least. These entities absolutely make a profit, it is all in what is done with that profit. The non-profits plow their profits back into building new facilities, improving existing facilities, adding technology, etc. rather than paying out a stock dividend. But make a profit they do, and it is substantial. 

For example, in Colorado Springs there is a city owned hospital that operated for a long time as a successful venture. Then one year some misguided people got an initiative on the ballot to force the city to sell it because, while it had operated in the black for years, it might become less successful and become a tax burden. The initiative passed but fortunately some legal folks put the brakes on it because it turned out that the original land deed and founding money required that it always remained city property, was always to be dedicated to healthcare, and had to remain non-profit. To satisfy the "let's get rid of it" folks the city leased the building(s) to the UCHealth system, a "non-profit" under the auspices of the University of Colorado. Since then UC Health has added 3 Urgent Care, 5 Primary Care, 7 Medical buildings, 1 new Hospital, and 1 stand alone Emergency Room to its portfolio. I daresay this was not all done with donations and grants.

[Randyretired]

There is one more thing.  The highest paid UCHealth executive earns $20,000,000+.  It may be nonprofit but someone(s) are doing well.  There doesn't seem to be a discernable difference in patient cost but that is difficult to calculate.  I am pretty sure that Medicare and Medicaid pay the same.

[lappir]

I was going to just let this post run it's course, but cannot today. Maybe it's because I used my left hand (non dominant) to brush my teeth while standing on one foot or maybe not. I have been a lot more productive today than what has been the normal since sort of "Retiring". 

I do understand that with any job, position, lifestyle and mostly a persons career choice money is paid for services. My issue is how the determination of who gets paid the most and what they are doing to get paid. 

You can post all the "Studies" and news reports you want. I don't subscribe to the Wall Street Journal or any of the other news sources. I do not watch anything more than the local news and weather if I happen to put up my TV antenna and scrolling through the "Internet" news I only click on certain items that may have interest to me. Maybe I'm ill informed or less informed as others here. 

I began working for a wage the summer after I turned 16 years old. I'd done some work for pay before that like many who were raised in the country on a farm. I wasn't a big strapping lad so putting up "Hay" wasn't my favorite job for money, neither was pulling weeds and/or cutting corn out of beans. If that was a winter job I'd be all for it. Being out in the sun with high humidity wasn't me cup of tea. At least at the "Gas Station" I started working at had "Air-conditioning" in the office. 

After I graduated High School I started working a company called "Wausau Homes" a prefabricated home building company. I started working in the factory stuffing batt insulation into roofing panels. Again it was summer and being inside in the heat working with Fiberglass Insulation wasn't for me. Luckily my Uncle was a "Supervisor" for the "Erection" crew where the parts were trucked to the homesite and put together with a huge (at the time to me) crane. Or with a smaller Crane mounted to one of the Semi Tractors that also pulled a trailer with walls, floor or roofing panels. I did that for about a year before my older children were born, then it was back to Gasoline Service Station work for a few more years. During the last part of my time working in my families station I started volunteering for the local Fire Department, that led to Advanced First Aid ( to go out with the Ambulance calls) and finally to getting my Emergency Medical Technician certificate. After a failed attempt to run my own Service station on my own I began working for a County Ambulance Service thanks to my EMT certification. I progressed through EMT-1 and finally EMT-Paramedic before attending Nursing School graduating in 1989 as an RN. Things in health care were starting (in my mind) down hill very quickly. When I first started working for the "Ambulance Service" it was a "County" run service. There were two hospitals in the town and in my opinion health care for that area was top notch. The Physicians at the time were fairly young, but had seasoned mentors who had been in town for many years. Dr's took care of there patients in the ER or in the hospital. There were no "Emergency Room" Specialists, no Hospitalists, no intensivist Drs. Your family Dr. knew you, your history and if they needed assistance there were Surgeons, Internists and maybe a Cardiologist on call from the University Hospital. Yes a big portion of the job with the Ambulance was making the 90+ mile trip with patients to the University Hospital that was and still is a Top Notch facility. Unfortunately the facility where I gained so much very good experience and knowledge was sold to a "For Profit" corporation not many years ago and I wouldn't suggest anyone cross the threshold for healthcare now. 

So this has gotten quite more long winded that I intended. And I'm not being as productive as I was this morning. I thought reading the forum while enjoying my lunch would be OK. Maybe not. 

Do I even know where I was heading when I started this? Not sure. I guess the comment of the 20 Million dollars for a "Non Profit" administrator maybe hit a nerve. The last Hospital I worked in had a very highly paid administrator who also took much more from the facility before being terminated causing the "Staff" to have a pay deduction for a time before that was found to be TOTALLY the wrong way to go. I still have contact with some of the employees, but much of the middle management staff I'd worked for have gone to better pastures or decided it was time to retire. It's really not looking good for that facility and it's one of the "Catholic Health" network that usually had better concentration on "Care" at least in their outward appearance.   

To finish up. I worked at many many health care facilities through my 30+year career. Some were better than others in the early years, but they all seem to be heading down the path of selling vs caring, cost cutting without evaluating the true costs and stuffing the pockets of people only interested in money. That's my opinion and why I started the post. 

 

Rod Lappin RN

[Kirk W]

2 hours ago, Chalkie said:

Since then UC Health has added 3 Urgent Care, 5 Primary Care, 7 Medical buildings, 1 new Hospital, and 1 stand alone Emergency Room to its portfolio. I daresay this was not all done with donations and grants.

So are those facilities sitting empty and unused, or was it needed expansion? Any "non-profit" or not for profit organization still has to take in more than they pay out in salaries and expenses, plus funds to pay for maintenance and upgrades, replacement of equipment and structures, and all of the other things that any for profit business does, with the exception of paying any dividends to investors. Organizations that attempt to operate on a break-even financial status, sooner or later find themselves facing bankruptcy. 

This thread got me to poking about trying to find more information about who owns hospitals nationwide and some of what I discovered has been quite surprising. 

Relative to skilled nursing facilities (SNFs), hospitals are more likely to be non-profit and government-owned and less likely to be for-profit. Across all ownership types, 54.6 percent are structured as corporations, 26.6 percent as limited liability companies, 2.6 percent as partnerships, and 16.2 percent as “other.”   Aug 2, 2023

Ownership of Hospitals:

Control type Non-profit  2,286 hospitals ~ 49.2% ~ 209 beds

For-profit  1,677 hospitals ~ 36.1% ~ 107 beds

Government  681 hospitals ~ 14.7%  ~ 175 beds

 

Edited March 11 by Kirk W

[Vladimir]

On 3/10/2024 at 9:34 AM, Chalkie said:

I think this is likely true. When I was younger it seemed that insurance was at least balanced. Patient care was good, insurance paid the providers well, and the investors made money. Today with all the consolidations in the medical industry into giant medical providers that control multiple aspects of health care under one umbrella, profit has become king...................

 

I noticed the same thing.

I do think that insurance was better and fairer in the past.

The computerization of medical care has allowed companies to "steal" money a little money from everyone on a large scale.

The TWO the fraud cases I have been involved in the past two years were just that.  Stealing a little bit of money from a lot of people.

Computers make it easy.