he said that if he bought a hospital, he would operate it like a startup, strip out unnecessary overhead

And then he would charge whatever the market would bear in order to maximize return on his investment.

"Running it like a business" *is* part of the problem.

Health care is not just another business. Once you're in the hospital, it's a little late to go price shopping. And with your life on the line, do you really want to choose the low cost provider?

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mixdup 3 hours ago | parent | next [-]

The thing is he'd find a lot of the "unnecessary overhead" is necessary to deal with the payers in the system. You need a massive billing organization to make sure insurance actually pays you. You need a massive compliance organization to make sure Medicare pays you (and that you don't kill your patients and get sued)

If you reformed the whole system you could trim a lot of hospital overhead, but it's a systemic problem. More overhead and waste is happening in the insurance companies which is what needs to be cleaned out first, then you can start dealing with providers' overhead that exists to serve the rest of the system

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infecto 3 hours ago | parent [-]

I was wondering the same thing. I see the difference in my primary care doctor who does not take insurance. So much less overhead, same salary, and better patient outcomes. There is a multiplier effect, as you add people at some point you might need an office manager and then more nurses to keep up quota but for every new dollar of revenue you make the margin goes down.

You wonder how much of a hospital is true emergencies vs scheduled care. While ERs are indeed busy, how many of those should actually go to a primary care doctor instead. Even then I would imagine your schedule appointments are the bulk of the volume at a hospital.

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mixdup 2 hours ago | parent [-]

The ER vs. having a regular doctor is a big impact. It's partially why there are so many urgent care centers, but a lot of uninsured use the ER as their primary care as the ER has a duty under law (and ethics) to treat anyone who comes through the door for anything, regardless of whether they can pay or not, where a primary care physician can turn people away if they can't pay

	▲	infecto an hour ago \| parent [-]
		Agree and I cannot help but think we in the US always digs this hole. I wish at the federal level we required citizens buying into health insurance with a very generous sliding scale for those at lower incomes. It reminds me of medicaid/care. Folks will not go to the doctor because of costs and then once they age or cost into assistance their condition is now permanent.

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seidleroni 3 hours ago | parent | prev [-]

He didn't charge "whatever the market would bear" for prescription drugs. Also there is obviously a huge difference between urgent/emergency care vs more routine procedures. If you're getting a routine colonoscopy every few years, it may be feasible to shop around.

	▲	jqpabc123 2 hours ago \| parent [-]
		He didn't charge "whatever the market would bear" for prescription drugs. His prices are fairly comparable for his limited selection of cheap generics compared to other mail order options. Also, his pricing is cash only --- no insurance. But dispensing drugs is not really comparable to "health care". Running a hospital comes with a lot more unknowns and risk. If he has it all figured out, why hasn't he bought a hospital? Let me guess --- it's not a good investment. If you're getting a routine colonoscopy every few years, it may be feasible to shop around. Have you actually tried this? Most won't give you a fixed price up front because of the potential for things to go wrong.