COVID 19: Violence; Threats; Criminal Activity

[Welder]

This is about more than the pandemic; the pandemic just makes things easier to see, like contrast dye in a radiology chart of a diseased body.

I think this sentence is really, really important. One of the most aptly worded thoughts I've read in years, actually.

[Baldanders]

I see the difference between viable and unviable based on patient census, yes.

Whether republicans, democrats or the lizard people coulda/woulda/shoulda is pretty irrelevant to decisions based on the situation in reality. If there's no money to run the hospital, there's no money to run the hospital.

So fuck much of the rural area of my state, stupid poors should move to somewhere with a hospital?

We are talking about huge chunks of North Carolina.

And again, there was money--Republicans decided we didn't need it cuz' Social Darwinism is great.

[Baldanders]

I think this sentence is really, really important. One of the most aptly worded thoughts I've read in years, actually.

I'm stealing it. 😇

[TGS]

So fuck much of the rural area of my state, stupid poors should move to somewhere with a hospital?

Reality can be a bitch sometimes. I'm not sure what you barking at the wind in an unrelated internet thread is supposed to do about it.

I'd like rural places with no census to have world-class medical care, and I'd also like densely populated cities to have properly staffed police departments that don't take 45 minutes to show up for a shooting because they check-in to shift and already have an entire shifts' worth of calls for service waiting.

Neither is reality, and that's just how it is.

[Paul D]

Reality can be a bitch sometimes. I'm not sure what you barking at the wind in an unrelated internet thread is supposed to do about it.

I'd like rural places with no census to have world-class medical care, and I'd also like densely populated cities to have properly staffed police departments that don't take 45 minutes to show up for a shooting because they check-in to shift and already have an entire shifts' worth of calls for service waiting.

Neither is reality, and that's just how it is.

This is an unfortunate reality in medical care. In order for a hospital to be successful, it has to do high income type services to cover their margin. High revenue stuff include: spine and orthopedic surgeries, cardiovascular services, and imaging services. Money losers: OB, peds, prolonged hospital stays, and treating medicaid and indigent patients. Volume is important. If you don't have enough paying customers on a consistent basis, you ain't gonna survive. I have read of stories where hospital networks have shut down a hospital that has served a once vibrant but now poor community for decades and just moved it to a neighborhood that has better payer profile. I used to drive 50 miles one way every Friday from Phoenix to a rural clinic in Black Canyon City and Spring Valley in AZ to do cardiology clinic. Pretty soon I had to stop because my Phoenix was practice blowing up busy and overhead to see a few patients so far away was untenable. I had to stop it and they simply drove down to see me. One time, a patient asked me when I was going to build a cath lab up there: I told him as soon as they opened an IMAX theatre there.

[Baldanders]

Reality can be a bitch sometimes. I'm not sure what you barking at the wind in an unrelated internet thread is supposed to do about it.

I'd like rural places with no census to have world-class medical care, and I'd also like densely populated cities to have properly staffed police departments that don't take 45 minutes to show up for a shooting because they check-in to shift and already have an entire shifts' worth of calls for service waiting.

Neither is reality, and that's just how it is.

These aren't ghost towns. They have enough population that Vidant went back and built urgent care centers to "replace" the hospitals they closed.

No, none of this (including your wants) "is just how it is."

That's got to be one of the most pathetic thought-terminating cliches of our time. The motto of the water carriers for the rich.

It's the sad shit we accept as unchangeable because we have been convinced anything better is impossible and the poors need to get a work ethic/have better decisions/stop doing drugs and they don't deserve government handouts that make them lazy, anyway. And we need to watch out for those fucking poors, especially the ones with very poor representation in Congress, because we all know they are going to eat everybody's lunch one day, and then we'll be Venezuela and then cannibalism.

The important thing is to provide knee-jerk defenses of the status quo. Because we'll be Venezuela. No other options. Either ruthless capitalism and the America you know, or ......OMG socialism, then the inevitable slippery slope towards communism and famine.

No $$ for rural hospitals, but massive insurance subsidies for the rich living on precarious, often destroyed coastlines? "It is was it is...." The natural capitalist order of things, unchangeable.

It is what we make it. It is what we are willing to bend over and take.

American "realism" is often another word for "slave mentality."

[Baldanders]

Reality can be a bitch sometimes. I'm not sure what you barking at the wind in an unrelated internet thread is supposed to do about it.

I'd like rural places with no census to have world-class medical care, and I'd also like densely populated cities to have properly staffed police departments that don't take 45 minutes to show up for a shooting because they check-in to shift and already have an entire shifts' worth of calls for service waiting.

Neither is reality, and that's just how it is.

These aren't ghost towns. They have enough population that Vidant went back and built urgent care centers to "replace" the hospitals they closed.

No, none of this (including your wants) "is just how it is."

That's got to be one of the most pathetic thought-terminating cliches of our time. The motto of the water carriers for the rich.

It's the sad shit we accept as unchangeable because we have been convinced anything better is impossible and the poors need to get a work ethic/have better decisions/stop doing drugs and they don't deserve government handouts that make them lazy, anyway. And we need to watch out for those fucking poors, especially the ones with very poor representation in Congress, because we all know they are going to eat everybody's lunch one day, and then we'll be Venezuela and then cannibalism.

The important thing is to provide knee-jerk defenses of the status quo. Because we'll be Venezuela. No other options. Either ruthless capitalism and the America you know, or ......OMG socialism, then the inevitable slippery slope towards communism and famine.

No $$ for rural hospitals, but massive insurance subsidies for the rich living on precarious, often destroyed coastlines? "It is was it is...." The natural capitalist order of things, unchangeable.

It is what we make it. It is what we are willing to bend over and take.

American "realism" is often another word for "slave mentality."

[TGS]

This is an unfortunate reality in medical care. In order for a hospital to be successful, it has to do high income type services to cover their margin. High revenue stuff include: spine and orthopedic surgeries, cardiovascular services, and imaging services. Money losers: OB, peds, prolonged hospital stays, and treating medicaid and indigent patients. Volume is important. If you don't have enough paying customers on a consistent basis, you ain't gonna survive. I have read of stories where hospital networks have shut down a hospital that has served a once vibrant but now poor community for decades and just moved it to a neighborhood that has better payer profile. I used to drive 50 miles one way every Friday from Phoenix to a rural clinic in Black Canyon City and Spring Valley in AZ to do cardiology clinic. Pretty soon I had to stop because my Phoenix was practice blowing up busy and overhead to see a few patients so far away was untenable. I had to stop it and they simply drove down to see me. One time, a patient asked me when I was going to build a cath lab up there: I told him as soon as they opened an IMAX theatre there.

Yep, we had the same thing happen. Closed down one of our hospitals in the city which was plenty busy, and opened the most expensive per/sqft in the US (at that time) hospital in the middle of a bunch of cornfields surrounded by rich communities with a focus on a high end Neuro program and high paying inpatient electives.

Shortly after opening, a competing hospital did the same thing and then another hospital poached the neuro docs. Hospital went into a death spiral that triggered default warnings on the HUD loan, which meant a consultant group came in to run the hospital. Almost all the free programs to the public were cut overnight, staffing was set to the state minimums, capital purchases were denied across the board, etc.

How that played out in my sector in EMS is that just in the division I supervised, we went from 48 to low 30s for staff and couldn't pursue more 911 coverage contracts for small, high paying towns since they wouldn't approve position increases or capital purchases for extra rigs. We couldn't even purchase replacement trucks, which meant that when I left in 2015 we still had 2 ambulances in service that had served at Ground Zero on 9/11, at least 1 truck caught fire on a job, and we had numerous mechanical failures that caused us to scrub jobs on a regular basis (i.e. lost revenue). All of these problems compounded to where we lost our biggest paying 911 contract after I left.

One of our free services to the area was actually our dispatch center for countywide EMS services, which the evil hospital operated for free since the 1970s. The equipment was old and needed updating when everyone in the county wanted to move to digital trunked systems, but the consultants wouldn't approve the capital purchase of that new equipment which meant we couldn't fulfill the services which we had put together a proposal to turn into a billable revenue service to the municipalities. More lost revenue.

These aren't ghost towns. They have enough population that Vidant went back and built urgent care centers to "replace" the hospitals they closed.

No, none of this (including your wants) "is just how it is."

That's got to be one of the most pathetic thought-terminating cliches of our time. The motto of the water carriers for the rich.

It's the sad shit we accept as unchangeable because we have been convinced anything better is impossible and the poors need to get a work ethic/have better decisions/stop doing drugs and they don't deserve government handouts that make them lazy, anyway. And we need to watch out for those fucking poors, especially the ones with very poor representation in Congress, because we all know they are going to eat everybody's lunch one day, and then we'll be Venezuela and then cannibalism.

The important thing is to provide knee-jerk defenses of the status quo. Because we'll be Venezuela. No other options. Either ruthless capitalism and the America you know, or ......OMG socialism, then the inevitable slippery slope towards communism and famine.

No $$ for rural hospitals, but massive insurance subsidies for the rich living on precarious, often destroyed coastlines? "It is was it is...." The natural capitalist order of things, unchangeable.

It is what we make it. It is what we are willing to bend over and take.

American "realism" is often another word for "slave mentality."

Neat.

[Bio]

I think the disconnect between the points of view espoused by @TGS and @Baldanders is that TGS is saying "In our current system, X is a financial requirement" and Baldanders is saying "we need to change our system". I'm not sure you guys actually disagree with each other (although I'm certainly not sure you agree on the matter either).

I think most reasonable people understand that the health system in the US is deeply suboptimal for a variety of reasons.

My brother-in-law, a pediatrician, was recently lamenting how he gets payed more to do a 3 minute wart treatment than discussing mental health with a patient for 30+ minutes.

[RoyGBiv]

I think the disconnect between the points of view espoused by @TGS and @Baldanders is that TGS is saying "In our current system, X is a financial requirement" and Baldanders is saying "we need to change our system". I'm not sure you guys actually disagree with each other (although I'm certainly not sure you agree on the matter either).

I think most reasonable people understand that the health system in the US is deeply suboptimal for a variety of reasons.

My brother-in-law, a pediatrician, was recently lamenting how he gets payed more to do a 3 minute wart treatment than discussing mental health with a patient for 30+ minutes.

In the early stages of contemplating retirement, wife and I are trying to balance wanting to live rural with the inevitability of increasing health care needs as we age. It's not a foot stomping exercise demanding economic realities change. It's an exercise in assessing reality and looking for places that can provide a good balance.

More Medicare funding rarely makes for good long term outcomes.