re: Riddle me this about the US healthcare system

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You make my point, perfectly. Well done.

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That’s a neat little sidestep, bubba.

You haven’t said what I got wrong. You just suggested I don’t know enough to say it. Which is about what I expected.

If there’s a hole in the argument, point to it. Otherwise, this is just more of the same.

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Short answer? Politicians.

Long answer? Middlemen, bankers, lawyers and politicians

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... Long way you have come to truth young jedi citizen...

I live in a city that has 2 large hospitals. From what i've seen since the 1990s they never stop upgrading/building new additions/new wings/new parking ramps. The only other "business" that does this locally is the university. Both seem to have unlimited monies. It's interesting how all the roads in this town are s#it except the roads around the university and the roads around the hospital. The whole economy of this city seems to be based on people needing constant medical care. I remember growing up the only time i went in was when i broke my wrist and when i get hit by a drunk driver as a child. Heck my neighbor ran me over on my bike when i was a little kid and all he did was give me a candy bar.

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I live in a city that has 2 large hospitals. From what i've seen since the 1990s they never stop upgrading/building new additions/new wings/new parking ramps. The only other "business" that does this locally is the university. Both seem to have unlimited monies. It's interesting how all the roads in this town are s#it except the roads around the university and the roads around the hospital. The whole economy of this city seems to be based on people needing constant medical care. I remember growing up the only time i went in was when i broke my wrist and when i get hit by a drunk driver as a child. Heck my neighbor ran me over on my bike when i was a little kid and all he did was give me a candy bar.

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Small part of the overall mess that is the healthcare system is that CMS incentivizes such construction as allowable costs in your Medicare cost report. This report is done in arrears so you increase your DRG reimbursements the years after you incur these expenses. All of these calculations are extremely complex and you can't do things to extreme, luxury items, etc., but real stuff like adding beds, renovation of the building, buying a new PET scanner that you may or may not need. Here, we have a CON (certificate of need) process for anything over a certain cost (I have been out of it to long know what that number is).

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What about all the uninsured going to the ER? That is being paid for by everyone else.

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My sister is a retired nurse that spent years working in an ER. It pissed her off royally that some of the usual suspects would come for some trivial thing they could easily buy at a pharmacy, put a lot of money into the vending machines for snacks and talk loudly on their cell phones that were better than hers and then refuse to pay the $3 Medicaid co-pay.

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DSH Patient Percent = (Medicare SSI Days / Total Medicare Days) + (Medicaid, Non-Medicare Days / Total Patient Days)

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Indeed, and systems exact it ... as I guess they should from a fiduciary stance. But in the process it changes their productivity emphasis to a CMS gaming prospective

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My sister is a retired nurse that spent years working in an ER. It pissed her off royally that some of the usual suspects would come for some trivial thing they could easily buy at a pharmacy

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Correct.
The name of the game ... is the game itself.

Here's a different example:

In Charlotte there is a county facility which has quite a nice maternity unit. Private rooms, full service, anesthesia, state of the art, obstetrics, etc. But a pair of branch facilities are more akin to a Four Seasons Hotel. They are designed to attract upper end parturients in the surrounds.

Hispanic patients hear about these "five star facilities." As such care is on someone else's dime, they want to partake. They are followed by the county, are uninsured, and followed at the county hospital, yet show up to the Four Seasons facilities in labor, and can not be transferred.

They know what they are doing.
They understand the system exquisitely.
They game it simply to access more plush facilities.

The problem is two-fold.
From a system perspective, they are paying nothing.
But from their personal care perspective, medical records are sometimes difficult to acquire in the middle of the night, or on a weekend, and critical details of their prenatal care are sometimes obscure. The latter is occasionally not insignificant, much to the detriment of mother and child.

From a medical quality of care perspective, it is infuriating. Because despite enjoying the plush facilities, important prenatal findings are sometimes not available until after the fact.

And 6 dumbasses don't have the IQ to understand that you have explained the problem quite simply.

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So, if all this is true….where is our money going?

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End of life care