Speaking from experience, the only people who can afford to live as nursing home staff (typically LPNs) are the poor. In my metro area, only the presence of a large low-income high-crime area allows for a low enough cost of living for its residents to survive on nursing home pay. I think these folks can make more working at McDonalds. The quality of care is garbage... Less than 10% of nursing homes in my area provide the care I'd want for my relatives.

Oddly enough, even homes that advertise RNs and a high number of staff still don't provide the care I'd want for me relatives. The only homes I've been to where the staff are genuinely great are nursing homes out in the boonies, in rural areas at least an hour outside of my city.

Anecdotally, my friend's mom was is a nurse at a hospital that got bought up a while ago. During COVID, her pay and the hours were awful. She left shortly after. It blows my mind how little some hospitals can pay a nurse, while others are paying much more, all for the same core work. I believe she has since found a new hospital to work at and is making significantly more.

And to extend your statement, and not to imply this was what you were saying: overwork in Nursing doesn't just happen either, the scheduling and staffing is very intentional and very much a management decision

These are the hospitals that are essentially all travel nurses.

Worked to death, but well paid. Don't actually have to care anything more than the bare minimum because at the end of the day, there's an end of the day (contract).

Is anyone else here also see the insane schedules nurses often work as unsustainable? 12 hour shifts seem incredibly common. I get there's risks in patient handoffs, but there are risks in understaffing and overworking people as well.

I personally know of several people who ended up having to leave acute nursing because they just couldn't continue with the schedules while trying to have any kind of sane family life. It seems to me hospitals need to change up schedules to have better options for work.

But I'm a lay person tech bro looking at an industry I only have a small window in. What are the other arguments for and against these kind of long schedules?

I can anecdotally confirm this, based on my father's experience in a private-equity owned facility in California. It was astonishing how under-staffed they were for the amount of care the patients needed. (I'm sure they were at least nominally in compliance with whatever the regulations said, but that doesn't mean they were adequately staffed.)

Thing is, I loved those nurses. I watched them walk in with the look I remember from my restaurant days when you knew you'd be in the weeds all shift - call it a hundred-yard stare, if you like. They were all completely burnt out, and openly and cheerfully cynical and contemptuous towards the owners and administrators, but for the sake of the patients they just got on with it, as best they could. I don't think I ever saw the head nurse sit down.

There weren't enough supplies, because the laundry service was late, so I went back to my dad's house and brought him an extra blanket. The next day I got another for his neighbor.

There weren't really any rules, because nobody had time for that. The blanket thing? Shouldn't have been allowed, especially giving one to someone else. I asked about visiting hours, and just got a raised eyebrow, and "just put 8pm on the signout sheet". I said "well, then, I'll come back with a six-pack and stay until midnight!" She laughed at me, because I was (half) joking, but I'm pretty sure that would have been fine.

More substantively, when my dad needed the heavy-duty painkillers - prescribed by his doctor, mind - the administration (reached by phone) wouldn't allow them to be dispensed - supposedly because of the liability of having that kind of controlled substance on site; we sorted it out, but it took a couple of of days - when that happened, I said I'd bring in the bottle he had at home and give them to him myself. The nurse said pretty much "we can't do that - but if I didn't see it, it didn't happen," so I did. Then she made sure to give him his other medications herself, so she could check on how much I'd given him, and that it wouldn't cause a problem with the other pain-killers he was on.

I'm sure all of those things were wildly "wrong", from someone's point of view - ethically, or legally, or fiscally, or something. But I viewed the whole situation as so morally appalling - people live there for months, waiting to die - that I can't view those nurses' ethical commitment to whatever it takes to make their patients' lives more tolerable as anything but admirable.

Thing is, we're eating our societal seed-corn. The more awful those jobs are made, the more quickly people burn out of them, and the worse the care provided will become. Those folks were dying on their feet, and there was no help coming, and I don't know how much longer that facility - let alone the whole medical system - can stay afloat on those admirable people's dwindling store of compassion.

But hey, some folks got a little richer by owning that place. All the rest of it's a small price to pay for living in such a land of glorious opportunity, right?

The Catholic Church is still the largest non-governmental provider of healthcare in the world.

We'd be better of if heathcare was never provided for profit.

Careful what you wish for. The two major hospitals in my area are run by (1) the Catholic Church, and (2) the local major research university. While I'm sure they could get worse, if PE took over - I've got friends and family who received disastrously poor care at both of 'em. And neither hospital ever cared about that.

Universal healthcare is such a painfully obvious improvement. Only literally every other OECD country has figured it out.

Does that extend to the staff or do you just have some weird hangup about collective groups? Because you know NGOs often pay their CEOs huge salaries, well beyond what they need to survive. It's all profit.

This is an impossible argument to make in America because the mindshare and persuasion behind the idea that free markets are best have clouded all humane judgement.

We have to move the argument to “this is an illegal business”. The Right is an amalgamation of extreme Libertarianism and race-centric Nationalism currently, and making a persuasive argument to them requires breaking everything they think they know about what is “good” in the world.

I say this with respect to actually politically reshaping the discourse dynamic (it has to start at debate).

The Right is the obstacle to solving this, not the Left. This is not a universal issue, it’s only a universal issue for people to politely agree and get along, but all actionable items are against the ideology of the Right. To put it simply, to get to where we need to get, we have to chisel and whither away their narratives and mindshare in debate, they skate freely on this topic. Their stance and narrative actually have no place in a problem-solving environment (we can’t solve it if the underlying ideology holds free markets paramount, over humanity).

I was charged $6000 for literally walking into the ER of a hospital in 2022 when I had covid and was having trouble breathing. This did not include the 20 mins of tests they ran for me before telling me I was fine and booting me out within the hour, those were billed seperately. Literally just the cost of using the ER was $6000 (this was the adjusted price after insurance), in addition to anything else. As you can tell from this comment, I'm still mad about it.

One of the most important provisions of the ACA was the caps on the "medical loss ratio", the percent of insurance premiums paid out for medical care. The act required insurance plans to maintain a MLR no lower than (IIRC) 70-80%. Before then, plans (eg, targeting college kids) had MLRs as low as 10%.

(For comparison, Medicare/Medicaid has something like a 95% MLR, because it has low administrative overhead and isn't returning a profit to shareholders.)

17x upcharges, if they were extracted at the insurance level instead of the hospital level, would be the equivalent of a MLR of around 6%.

This. I want to know which places to avoid at all costs.

Isn't trading higher profit for +11% more deaths also violence?