“It could be like a Lehman Brothers scenario, where a couple of big health care companies take the economy down.”

[deleted1114045]

Covid has wreaked havoc on our nursing system, creating escalating nursing discontent, and escalating nurse pay. The supply chain is precarious and prices for everything, from gloves, to masks, to medicines, is escalating. Costs to run hospitals are escalating and revenues lost from out-patient ortho procedures, etc. are decreasing. They are making it because of COVID subsidies, but how long will those last? At what cost? While making record profits in the early pandemic, insurance companies have to be suffering lately as massive numbers of twenty to sixty year-olds end up hospitalized, sometimes in the ICU, incurring HUGE bills, that previous insurance financial models never could have supported. Large numbers of employees have exited the insurance market with layoffs. The COVID winter numbers for the USA are starting to creep up, with immunization hardly putting a dent in the spread of the disease and large numbers of unvaccinated middle aged and Boomers just waiting to fall ill with perhaps what will be the most deadly surge of COVID thus far.

Will Medicine in general, and specifically hospital systems, experience a debt crisis? How would that affect Emergency Medicine?

A couple of thought provoking articles to generate discussion:

This first article was written in 2017. Surely, the problem has gotten worse in the past 4 years.

The health care industry is bound to collapse soon, experts say

The US health care sector may be incubating the next big Lehman-style disaster that could tip the economy into a full-blown recession, according to industry analysts. Forget about the subprime mort…

nypost.com

And this article talks of the recent effects of COVID on personal debt incurred by patients.

Concerns Mount Over Looming Surge in Bankruptcy as COVID Medical Debt Soars

A recent 30 percent increase in bankruptcies could be a harbinger of more financial pain to come as millions of Americans grapple with rising medical debt from COVID treatment. Says one expert: "It's going to get ugly."

www.newsweek.com

---

Members don't see this ad.

 

[southerndoc]

We're on a trajectory to a national health system. Face it, healthcare is not sustainable with our current rising costs, for profit insurance industries, etc. I'm not saying it's better than what we have, nor am I advocating for it, but it's a high probability that in the next 15 years we will have a national health system.

The debt crisis with hospitals is real. I don't think the insurance industry is suffering as much as you think they are. They're getting record profits despite being in the middle of a pandemic. A lot of the Covid admissions were offset by the numerous people who had telemedicine visits or simply skipped seeing a physician for a scheduled follow-up. Those that delayed procedures will incur expenses down the road, but it is shifting a known expenditure from one year to another. It's not a surprise expenditure.

 

[bronx43]

There simply doesn’t exist the resources to continue to feed the leviathan which we know as the US healthcare system.
I’m also not sure that the government will continue to favor healthcare given the current macroeconomic landscape - there needs to and will be a significant restructuring of the American economy.

Large complex health systems that suck up too much money and resources simply isn’t a smart move for the country as a whole. I suspect medicine will trend back towards independent practitioners and small groups.

 

[namethatsmell]

We're on a trajectory to a national health system. Face it, healthcare is not sustainable with our current rising costs, for profit insurance industries, etc. I'm not saying it's better than what we have, nor am I advocating for it, but it's a high probability that in the next 15 years we will have a national health system.

Agreed.

Ironic that increasing PE and for-profit ownership of the HC market is perhaps the major force sending us barreling down the tracks away from a competitive market and towards single-payor.

Pigs eat, hogs get slaughtered.

I hope the public wakes the eff up and pressures elected officials to a) start taxing/regulating the heck out of these big corporate entities siphoning off $$$ from the "system" while offering no value to patients or those who care for them and b) reform Stark to increase competition and quality. Either these things happen or we wind up with medicare for all. Time's up.

 

[bronx43]

I hope the public wakes the eff up and pressures elected officials to a) start taxing/regulating the heck out of these big corporate entities siphoning off $$$ from the "system" while offering no value to patients or those who care for them and b) reform Stark to increase competition and quality. Either these things happen or we wind up with medicare for all. Time's up.

if we’re gonna rely on the public to make any changes in healthcare, then it’s already over…

 

[Dr Mantis Toboggan]

if we’re gonna rely on the public to make any changes in healthcare, then it’s already over…

Yeah my kid wants to go into medicine. Trying to figure out the best way to let her make her own decisions in life and also guide her to a better path is not easy.

 

[VA Hopeful Dr]

Yeah my kid wants to go into medicine. Trying to figure out the best way to let her make her own decisions in life and also guide her to a better path is not easy.

I hear this frequently and maybe I'm just lucky in my work situation, but I would be pretty pleased if my kids ended up physicians.

 

[Dr Mantis Toboggan]

Covid has wreaked havoc on our nursing system, creating escalating nursing discontent, and escalating nurse pay. The supply chain is precarious and prices for everything, from gloves, to masks, to medicines, is escalating. Costs to run hospitals are escalating and revenues lost from out-patient ortho procedures, etc. are decreasing. They are making it because of COVID subsidies, but how long will those last? At what cost? While making record profits in the early pandemic, insurance companies have to be suffering lately as massive numbers of twenty to sixty year-olds end up hospitalized, sometimes in the ICU, incurring HUGE bills, that previous insurance financial models never could have supported. Large numbers of employees have exited the insurance market with layoffs. The COVID winter numbers for the USA are starting to creep up, with immunization hardly putting a dent in the spread of the disease and large numbers of unvaccinated middle aged and Boomers just waiting to fall ill with perhaps what will be the most deadly surge of COVID thus far.

Will Medicine in general, and specifically hospital systems, experience a debt crisis? How would that affect Emergency Medicine?

A couple of thought provoking articles to generate discussion:

This first article was written in 2017. Surely, the problem has gotten worse in the past 4 years.

The health care industry is bound to collapse soon, experts say

The US health care sector may be incubating the next big Lehman-style disaster that could tip the economy into a full-blown recession, according to industry analysts. Forget about the subprime mort…

nypost.com

And this article talks of the recent effects of COVID on personal debt incurred by patients.

Concerns Mount Over Looming Surge in Bankruptcy as COVID Medical Debt Soars

A recent 30 percent increase in bankruptcies could be a harbinger of more financial pain to come as millions of Americans grapple with rising medical debt from COVID treatment. Says one expert: "It's going to get ugly."

www.newsweek.com

Any major, major healthcare company (HCA level etc) is too big to fail and would be propped up by the feds IMO.

 

[bronx43]

Any major, major healthcare company (HCA level etc) is too big to fail and would be propped up by the feds IMO.

I think pre-covid that was true. Post-covid with inflation hitting highest in 30 years is a different story. What's more likely is fire sale to other private investors, as opposed to direct federal level bail out.

 

[Tenk]

Evergrande is a hell of a lot more like Lehman brothers than anything else right now because they are actively defaulting and like 300 billion in debt.

 

[turkeyjerky]

Okay, am I the only one asking WTF is the OP talking about?

HCA had it's most profitable year ever. PE, while truly fing evil, is smart and still piling into physician ownership. UnitedHealth continues to post multi-billion dollar profits every quarter.

No disagreement that this country's "healthcare system" is economincally unsustainable (also, not news, it's been obvious since I started reading the paper), but I don't see the imminent collapse of any healthcare giants.

Also, wtf are you talking re covid?

 

[Franzd'Epinay]

We're on a trajectory to a national health system. Face it, healthcare is not sustainable with our current rising costs, for profit insurance industries, etc. I'm not saying it's better than what we have, nor am I advocating for it, but it's a high probability that in the next 15 years we will have a national health system.

The debt crisis with hospitals is real. I don't think the insurance industry is suffering as much as you think they are. They're getting record profits despite being in the middle of a pandemic. A lot of the Covid admissions were offset by the numerous people who had telemedicine visits or simply skipped seeing a physician for a scheduled follow-up. Those that delayed procedures will incur expenses down the road, but it is shifting a known expenditure from one year to another. It's not a surprise expenditure.

I highly doubt this will happen--at least not during our lifetime. There isn't enough political will for it to happen. The government will bail out healthcare organizations and pile on the debt before seriously considering a national socialized healthcare system.

Remember when the individual mandate was being considered and people convinced themselves this was the same as "death panels"?

Remember when Rand Paul said supporting a right to healthcare was akin to supporting slavery?

 

[Birdstrike]

As long as for-profit hospital systems like HCA continue to find a way to make record profits during the worst of times, I find it hard to envision any type of industry-wide Lehman-style collapse. Perhaps a few system will collapse, for lack of speed in adopting the HCA model. But as much as I dislike how HCA operates, they've proven they can profit from the crisis and misery.

What's to prevent a few, or even more than a few hospital systems from collapsing then the pieces being bought by HCA (or HCA-like systems) and turned into new profit-spewing HCA sites?

 

[EctopicFetus]

While it may seem a national health system makes sense deep pockets say otherwise. UHC is the 5th most valuable company in the US. You would decimate big pharma, hospitals, and all the insurers. I’m not asking anyone here to feel bad for them but do understand this would collapse our economy if not done carefully and i dont think we have the ability in this country to do that.

 

[DoctwoB]

I can fix the biggest problem in the American healthcare system with a single Medicare rule:

“To be eligible to receive federal healthcare dollars, a hospital/clinic/healthcare facility can not have a full time clinical staff to administrator ratio of less then 2:1.”

Current overall US healthcare has 10 administrators for every 6 clinical staff (of which 1 is a physician), though many of those admins are not employed by the health care system/practice.

An alternative I would accept is
“To be eligible to receive federal healthcare dollars, a hospital/clinic/healthcare facility must pay $.75c (or whatever number is aggressive but appropriate) out of every dollar spent on payroll to purely clinical staff.”

 

[bronx43]

While it may seem a national health system makes sense deep pockets say otherwise. UHC is the 5th most valuable company in the US. You would decimate big pharma, hospitals, and all the insurers. I’m not asking anyone here to feel bad for them but do understand this would collapse our economy if not done carefully and i dont think we have the ability in this country to do that.

A rapid change could be disastrous but a slow decade long transition would be beneficial, where manufacturing jobs are onshored, and the US returns to its industrial foundation. A proper approach would be to slowly transition with a public option, then expand it as this economic transformation takes place.

 

[WorkNoteEmergency]

The US Healthcare system may be struggling but the large hospital corporations cannot be counted in that. Patients are literally waiting in line to get into 100+% capacity filled hospitals. I spend more time hospital shopping now for my patients than I did during the worst of Covid surges and this is from staffing shortages. I don't think staffing shortages cause too much concern amongst upper level executives as empty beds don't affect the bottom line too much if they're not paying for a nurse to staff it. Pay a couple thousand dollar signing bonus and a new grad can be hired to replace the veteran nurse who calls it quits or finds a better paying M-F 9-5 job at an outpatient clinic. There is probably an inflection point where nursing and ancillary staff shortage would reduce bed availability below a level where profit could be made but I don't think we're anywhere near that.


I haven't seen a local reduction in elective surgeries since spring 2020.

 

[Dusn]

Congress will not even allow CMS to negotiate with pharma to lower drug prices. This is a popular, easy fix. The VA already pays a fraction of Medicare prices for the same drugs.

So until the govt can get rid of lobbyists and special interest groups they cannot fix healthcare or lower healthcare costs.

Republicans are strategically smart enough not to touch healthcare. If the dems are foolish enough to try to fix it, the Republicans will sit back and then blame the dems for the inevitable continued decline of healthcare quality and increased spending. Americans, in general, are also a hard to please bunch. The general public is not going to be happy with any healthcare system.

There really is no good solution.

 

[EctopicFetus]

A rapid change could be disastrous but a slow decade long transition would be beneficial, where manufacturing jobs are onshored, and the US returns to its industrial foundation. A proper approach would be to slowly transition with a public option, then expand it as this economic transformation takes place.

This is old school thinking. You do understand we have moved to a service economy. It is unlikely we move back to manufacturing in the US. We live in a global economy. Unskilled Labor is cheaper abroad. I dont see that changing any time soon. I have looked more and more at a virtual assistant and the better educated and skilled are abroad and they come for half or so of a US based VA.

 

[Franzd'Epinay]

This is old school thinking. You do understand we have moved to a service economy. It is unlikely we move back to manufacturing in the US. We live in a global economy. Unskilled Labor is cheaper abroad. I dont see that changing any time soon. I have looked more and more at a virtual assistant and the better educated and skilled are abroad and they come for half or so of a US based VA.

Can you elaborate on this virtual assistant? Is it just a secretary working remotely?

 

[EctopicFetus]

Can you elaborate on this virtual assistant? Is it just a secretary working remotely?

Yeah but can use them for personal tasks. Just google it. They can help with basic office tasks, formatting PowerPoints formatting word docs, paying your bills etc.

 

[EctopicFetus]

Can you elaborate on this virtual assistant? Is it just a secretary working remotely?

GetFriday: Virtual Assistant Services | Virtual Executive Assistance for Everyone

GetFriday is your personal virtual assistant helping you offload your time-consuming mundane tasks. Virtual assistance and business process support for small businesses & entrepreneurs.

www.getfriday.com

tons of companies. Here is one of them.

 

[deleted1114045]

Also, wtf are you talking re covid?

COVID numbers are going up globally, as well as in the US, especially in the northern and mountain west states (those experiencing winter weather). We are entering exponential growth phase with 90,000 daily cases. That is a higher nadir than we've seen in any other interpeak COVID surge. Vermont, the most vaccinated state is having the 12th highest rate of new cases in U.S. The Delta variant gave a much worse 2021 spring spike than 2020. It gave a much worse 2021 Summer spike than 2020. I see no reason why the delta strain won't give us a much worse 2021 winter wave. There are vast numbers of susceptible unvaccinated, who haven't got the vaccine, and the immunity from previous infections and vaccinations is very short lived. This winter, we are entering with mosh pits, professional sports, unfettered travel, and numerous other strains of virus obscuring the diagnosis and isolation of COVID. We are having daily super spreader events with no masks, no social distancing, and in-person school K-12, as well as university. Nobody, myself included is going to isolate themselves if they've got a cough. Its back to snorting afrin, taking cough medicine and hoping nobody notices. To top it all off, we have RSV putting COPDers and pediatrics in the hospital now. This has the potential to really strain society, and hospitals, at a time when most of us have seen record percentages of ER nurses and floor nurses quit.

 

[deleted1114045]

What caused the subprime housing crisis? Encouraging people to take out loans that couldn’t actually afford them. What do we do as a society? Force people to get “health insurance” that they can’t afford. What do we do in the emergency department? Encourage people to get as much healthcare in the ER as is possible. How do we do this? We hide the prices. We delay the financial decisions for 2 months and allow those decisions to be made by two different third party people who know nothing about the patient, the doctor, the care provided or the finances of the patient or the provider. This is not a free-market, or anything close. The corporations involved run on margins that tend to be less than 5%. They aren’t able to withstand huge swings in volumes, up and down. The corporations in medicine have all taken out massive loans to outcompete each other. This is smoke and mirrors. Debts are counted as assets, and assets (people) are treated like ****.

The subprime housing crisis happened because it was overleveraged. Healthcare systems are overleveraged. Insurance companies depend on premiums to fund their operations. Are corporations hiring more employees and giving them good jobs with good insurance? Or are they increasingly following the Walmart model where they don't offer benefits. Consider this news story:

With a record 4.3 million Americans quitting their jobs in August recent supply chain issues may continue to remain a problem.

So when will the help signs go down and more Americans get back to work?

We reached out to a labor leader to find out why the problem exists and ask him about potential solutions to get our country's economy growing again.

A union leader with the Mahoning-Trumbull County AFL-CIO joined Lindsey McCoy on WFMJ Today.
He says the pandemic was a catalyst for MILLIONS of workers leaving the workforce.

"What workers are really upset about is the sort of on going erosion of benefits, wages, and working conditions over the last 20 to 30 years," said Jose Arroyo, Vice President of Trumbull Political Affairs at Mahoning-Trumbull AFL-CIO.

Labor leader explains why workers are quitting in record numbers or not returning to jobs

With a record 4.3 million Americans quitting their jobs in August recent supply chain issues may continue to remain a problem.

www.wfmj.com

 

[deleted1114045]

The hospitals are receiving the equivalent of TARP bailout money. This crisis has made them financially insolvent, dependent on government bailout.

The money is ultimately coming from the patient, whether in the form of taxes, employee benefits, or whether directly billed to the patient, or as copays.

Anneken Tappe, from CNN business said two days ago, “Between July and September, US household debt climbed to a new record of $15.24 trillion, the Federal Reserve Bank of New York said Tuesday.”

US household debt climbed to a new record of $15.24 trillion last quarter

Americans are increasingly cash strapped and debt riddled. The US government is increasingly cash strapped and debt riddled.

Wages, though, have swelled during the period, with average hourly earnings up 4.9% year over year in October. However, compared with inflation, real hourly wages actually have declined more than 1.2% during the same time frame, according to the Labor Department.

Inflation has taken away all the wage gains for workers and then some

What looked like a big jump in workers' wages during October turned into just another gut punch after accounting for inflation.

www.cnbc.com

It stands to reason that our wages will go down, independent of the coming tsunami of residents graduating with more and more debt.

Healthcare Money-Go-Round

Robert W. Morrow, M.D. New York Times, February 3, 2018: Interest rates that are set every day in the global bond markets are already leaping higher, in anticipation of central bank rate increases …

contraryperspective.com

 

[EctopicFetus]

COVID numbers are going up globally, as well as in the US, especially in the northern and mountain west states (those experiencing winter weather). We are entering exponential growth phase with 90,000 daily cases. That is a higher nadir than we've seen in any other interpeak COVID surge. Vermont, the most vaccinated state is having the 12th highest rate of new cases in U.S. The Delta variant gave a much worse 2021 spring spike than 2020. It gave a much worse 2021 Summer spike than 2020. I see no reason why the delta strain won't give us a much worse 2021 winter wave. There are vast numbers of susceptible unvaccinated, who haven't got the vaccine, and the immunity from previous infections and vaccinations is very short lived. This winter, we are entering with mosh pits, professional sports, unfettered travel, and numerous other strains of virus obscuring the diagnosis and isolation of COVID. We are having daily super spreader events with no masks, no social distancing, and in-person school K-12, as well as university. Nobody, myself included is going to isolate themselves if they've got a cough. Its back to snorting afrin, taking cough medicine and hoping nobody notices. To top it all off, we have RSV putting COPDers and pediatrics in the hospital now. This has the potential to really strain society, and hospitals, at a time when most of us have seen record percentages of ER nurses and floor nurses quit.

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Good post but over time not only are more people getting vaccinated though I realize its a trickle now. On top of that the number of people who had covid is also higher. Also, we shouldn’t assume that just having covid is the same as hospitalizations. I think the US is about 50% vaccinated (number to rise with kids 5+ now being eligible. You are right re RSV and the overall strain on hospitals but lets be honest every winter was a mess in hospitals. We shouldn’t expect that to go away. The loss of nurses is going to make what would otherwise be A manageable situation a hot mess. Luckily my hospital offered our nurses (read non travelers) great incentives to keep them around until April (at least) so hopefully we have an ok run.

 

[EctopicFetus]

The hospitals are receiving the equivalent of TARP bailout money. This crisis has made them financially insolvent, dependent on government bailout.

The money is ultimately coming from the patient, whether in the form of taxes, employee benefits, or whether directly billed to the patient, or as copays.

Anneken Tappe, from CNN business said two days ago, “Between July and September, US household debt climbed to a new record of $15.24 trillion, the Federal Reserve Bank of New York said Tuesday.”

US household debt climbed to a new record of $15.24 trillion last quarter

Americans are increasingly cash strapped and debt riddled. The US government is increasingly cash strapped and debt riddled.

Inflation has taken away all the wage gains for workers and then some

What looked like a big jump in workers' wages during October turned into just another gut punch after accounting for inflation.

www.cnbc.com

It stands to reason that our wages will go down, independent of the coming tsunami of residents graduating with more and more debt.

Healthcare Money-Go-Round

Robert W. Morrow, M.D. New York Times, February 3, 2018: Interest rates that are set every day in the global bond markets are already leaping higher, in anticipation of central bank rate increases …

contraryperspective.com

I dont think you are seeing it quite right.

From the CNN article
Now that the stimulus sugar rush has worn off, consumers are going back to their old ways of spending with their credit cards. Credit card balances rose by $17 billion, just as they had during the second quarter. But they're still $123 billion lower than at the end of 2019 before the pandemic hit.
Mortgages, which are the largest component of household debt, rose by $230 billion last quarter and totaled $10.67 trillion.

As we have seen housing prices soar of course total debt will drop. I also dont think the workers are leaving due to the stuff some union boss says. He has all the incentive to push his own narrative. I do think we will see wage growth for the bottom which is of course what democrats and the unions want. I think a market reset is healthy whereas I do not think moving minimum wage is as helpful.

I also think we are seeing tremendous inflation which is noted everywhere. I-bonds are paying 7+%. In the end the workers will have to come back and work. Eventually the market will correct itself. I went to a brewery yesterday and they were out of 1) brisket, 2) salsa, 3) Diet Coke 4) their pint glasses and one of their most popular beers.

Supply chain issues are what they told me. Issues getting these items from their supplier. Of course if you or I ran the place we would have simply bought cans of diet coke from costco, salsa from there as well.

 

[aafisahar]

We're on a trajectory to a national health system. Face it, healthcare is not sustainable with our current rising costs, for profit insurance industries, etc. I'm not saying it's better than what we have, nor am I advocating for it, but it's a high probability that in the next 15 years we will have a national health system.

The debt crisis with hospitals is real. I don't think the insurance industry is suffering as much as you think they are. They're getting record profits despite being in the middle of a pandemic. A lot of the Covid admissions were offset by the numerous people who had telemedicine visits or simply skipped seeing a physician for a scheduled follow-up. Those that delayed procedures will incur expenses down the road, but it is shifting a known expenditure from one year to another. It's not a surprise expenditure.

lol we can't even agree what color the sky is. We couldn't even get one side to agree that there is a healthcare problem and the other side is hampered by arcane procedural hang-ups that prevent any meaningful change not to mention being bedded to industry executives. Even discussion of a public option is a non-starter. Nevermind having Medicare negotiate drug prices or expand coverage.

It's going to be more of the same. The people dying are of no consequence to the meat grinder that is the American healthcare system. Until someone meaningful dies (eg senator, CEO, relatives of said persons) due to our current system, it'll plod along, chewing up and destroying lower and middle-class lives in perpetuum.

IMO, the only way we will have meaningful change is If we have a wholescale deconstruction of US society ala USSR in the 90s. Until something of that magnitude happens, it'll be status quo for our forseeable lives.

 

[Dr Mantis Toboggan]

I hear this frequently and maybe I'm just lucky in my work situation, but I would be pretty pleased if my kids ended up physicians.

LOL it could be way, way worse for sure. Just not sure the sacrifices required will be worth it for the next generation. Ultimately if that’s what she wants I of course will support her.

 

[EctopicFetus]

lol we can't even agree what color the sky is. We couldn't even get one side to agree that there is a healthcare problem and the other side is hampered by arcane procedural hang-ups that prevent any meaningful change not to mention being bedded to industry executives. Even discussion of a public option is a non-starter. Nevermind having Medicare negotiate drug prices or expand coverage.

It's going to be more of the same. The people dying are of no consequence to the meat grinder that is the American healthcare system. Until someone meaningful dies (eg senator, CEO, relatives of said persons) due to our current system, it'll plod along, chewing up and destroying lower and middle-class lives in perpetuum.

IMO, the only way we will have meaningful change is If we have a wholescale deconstruction of US society ala USSR in the 90s. Until something of that magnitude happens, it'll be status quo for our forseeable lives.

The outcome of the wholesale deconstruction of the USSR hasn’t exactly been great. Also you know that an important person will never deal with the reality of our system. if you have done this long enough you understand how the system makes room for vips and doesn’t let them suffer like all the other saps.

 

[aafisahar]

The outcome of the wholesale deconstruction of the USSR hasn’t exactly been great. Also you know that an important person will never deal with the reality of our system. if you have done this long enough you understand how the system makes room for vips and doesn’t let them suffer like all the other saps.

The collapse of the USSR could have gone better, maybe Europe in the '50s is a better analogy.

And your point about VIPs is precisely why my scenario is absurd. We all know that important people won't ever want in our system and only rarely be harmed mostly because of their own self-importance. Meanwhile, it's regular folk who get ground up by the system when they can't afford life-saving meds or treatments.

To quote Judge Lex "[Healthcare] is a ****ing meat grinder. People go in one end, and meat comes out the other. All we do is turn the handle."

 

[EctopicFetus]

The collapse of the USSR could have gone better, maybe Europe in the '50s is a better analogy.

And your point about VIPs is precisely why my scenario is absurd. We all know that important people won't ever want in our system and only rarely be harmed mostly because of their own self-importance. Meanwhile, it's regular folk who get ground up by the system when they can't afford life-saving meds or treatments.

To quote Judge Lex "[Healthcare] is a ****ing meat grinder. People go in one end, and meat comes out the other. All we do is turn the handle."

You aren’t wrong but meaningful change is far far away. You could say Obamacare was major and it was but it fixed nothing. More people got access to a dysfunctional system and forced the rise of idiot practitioners (noctors, MLPs). As someone else said access to bad care is worse than access to no care.

 

[xaelia]

Interest rates.

Everyone who has debt right now has no difficulty servicing it.

This is why the Fed is desperately trying to hold off fighting inflation with increasing interest rates – because it knocks the legs out from under so many other industries right now. Large swathes of the economy are dependent on the government (free money) or loans (cheap money), and central banks are hoping these industries can pull themselves back to sustainable operation before they're forced to raise interest rates.

The liquidity crisis will crash crypto speculators as well. It'll be like the dot-com bust, in which so many paper millionaires suddenly had nothing.

 

[EctopicFetus]

Interest rates.

Everyone who has debt right now has no difficulty servicing it.

This is why the Fed is desperately trying to hold off fighting inflation with increasing interest rates – because it knocks the legs out from under so many other industries right now. Large swathes of the economy are dependent on the government (free money) or loans (cheap money), and central banks are hoping these industries can pull themselves back to sustainable operation before they're forced to raise interest rates.

The liquidity crisis will crash crypto speculators as well. It'll be like the dot-com bust, in which so many paper millionaires suddenly had nothing.

The debt the CMGs carry will become unserviceable. USACS I think at near $500m with terribly bad 💩 terms. Envision and team also with huge debt at bad terms. I think both over $1b. Throw in OON bills and the win in implementation I wouldn’t want to be an investor there. Of course they will expand use of MLPs and cut pay to docs. Future is bright though as the old idiot acep director said.

 

[bravotwozero]

Envision and team are backed by PE/shareholder money. Why would they need to be in so much debt? Especially when envision has a joint partnership with HCA?

 

[EctopicFetus]

Envision and team are backed by PE/shareholder money. Why would they need to be in so much debt? Especially when envision has a joint partnership with HCA?

You do realize that they almost defaulted on their debt in early covid.
not a little bit of debt either. Per this article $7.5B.

Envision explores restructuring $7.5B debt load - Becker's Hospital Review | Healthcare News & Analysis

Envision Healthcare, a Nashville, Tenn.-based physician staffing company owned by private equity firm KKR, has hired investment bank Houlihan Lokey to explore debt restructuring options, according to Reuters.

www.beckershospitalreview.com

 

[EctopicFetus]

Envision and team are backed by PE/shareholder money. Why would they need to be in so much debt? Especially when envision has a joint partnership with HCA?

Bloomberg - Are you a robot?

Note the joint venture is just a part of envision.
TeamHealth with $4b in debt.

https://www.fitchratings.com/research/corporate-finance/fitch-downgrades-team-health-holdings-to-ccc-removes-rating-watch-negative-14-09-2020

USACS with $500m in debt.

Moody's - credit ratings, research, and data for global capital markets

thing to think about. Who pays the interest. The labor (aka docs and MLPs).

 

[turkeyjerky]

Envision and team are backed by PE/shareholder money. Why would they need to be in so much debt? Especially when envision has a joint partnership with HCA?

KKR et al probably loaded them up with debt to afford locums, etc in order to expsnd and acquire contracts. Plus, doesn’t envision own done surgical centers as well?

 

[Old_Mil]

Yeah my kid wants to go into medicine. Trying to figure out the best way to let her make her own decisions in life and also guide her to a better path is not easy.

If she refuses to leave the country, NIH/CDC/FDA research doc...

...if she's willing to leave the country, go to college and medical school in a country where socialized medicine has already been established with better rules of engagement for pit docs (Australia, NZ, Canada).

 

[Old_Mil]

Envision and team are backed by PE/shareholder money. Why would they need to be in so much debt? Especially when envision has a joint partnership with HCA?

When money is almost free, and winning is based on the score at the end of each quarter and not at the end of the game, why not?

It's the thinking of people making $50k a year who bought million dollar homes in 2008 with no credit check and no down payment on an institutional scale, legitimized by MBAs and JDs.

 

[WilcoWorld]

The debt the CMGs carry will become unserviceable. USACS I think at near $500m with terribly bad 💩 terms. Envision and team also with huge debt at bad terms. I think both over $1b. Throw in OON bills and the win in implementation I wouldn’t want to be an investor there. Of course they will expand use of MLPs and cut pay to docs. Future is bright though as the old idiot acep director said.

Don't you know? Ownership Matters (tm)

 

[EctopicFetus]

Don't you know? Ownership Matters (tm)

Thats what Apollo says. They own the thing. If you read the fine print on the money they loaned out they can FORCE a sale of the group. That sounds like someone an OWNER can do lol.. yes Ownership matters hence they took preferred shares not the ones they sell to stupid EM docs who dont know the difference.

 

[DoctwoB]

There is a lot of bad debt in medicine right now. PE firms generally want to buy shops, lop off costs to increase EBITDA even if not sustainable long term, and resell. This works well in the current low interest environment but eventually when rates rise and cost of debt goes up we’re going to see bankruptcies as someone is left holding the bag. It will be interesting/disheartening to see how bankruptcy courts treat medical practices, if any consideration is given to patient care and the greater good or squeezing every last drop for creditors.

 

[EctopicFetus]

There is a lot of bad debt in medicine right now. PE firms generally want to buy shops, lop off costs to increase EBITDA even if not sustainable long term, and resell. This works well in the current low interest environment but eventually when rates rise and cost of debt goes up we’re going to see bankruptcies as someone is left holding the bag. It will be interesting/disheartening to see how bankruptcy courts treat medical practices, if any consideration is given to patient care and the greater good or squeezing every last drop for creditors.

These guys are not borrowing cheaply. envision was borrowing at 8.75%.

Envision Healthcare (the “Company” or “Envision”) announced today the completion of debt exchange transactions previously announced to the Company’s lenders on April 3, 2020. Pursuant to the transactions, Envision has exchanged approximately $724 million in total of both the 8.750% Senior Notes due 2026 (the “Notes”) and Floating Rate Private Placement Notes due 2026 (the “Private Placement Notes”), representing approximately 41% of the total Notes and Private Placement Notes outstanding, for approximately $395 million aggregate principal amount of new First Lien Senior Secured Term Loans maturing 2025 of the Company.

Envision Announces Completion of Debt Exchange Transactions

Envision Healthcare announced the completion of debt exchange transactions previously announced to the Company’s lenders on April 3, 2020.

www.evhc.net

 

[sylvanthus]

COVID numbers are going up globally, as well as in the US, especially in the northern and mountain west states (those experiencing winter weather). We are entering exponential growth phase with 90,000 daily cases. That is a higher nadir than we've seen in any other interpeak COVID surge. Vermont, the most vaccinated state is having the 12th highest rate of new cases in U.S. The Delta variant gave a much worse 2021 spring spike than 2020. It gave a much worse 2021 Summer spike than 2020. I see no reason why the delta strain won't give us a much worse 2021 winter wave. There are vast numbers of susceptible unvaccinated, who haven't got the vaccine, and the immunity from previous infections and vaccinations is very short lived. This winter, we are entering with mosh pits, professional sports, unfettered travel, and numerous other strains of virus obscuring the diagnosis and isolation of COVID. We are having daily super spreader events with no masks, no social distancing, and in-person school K-12, as well as university. Nobody, myself included is going to isolate themselves if they've got a cough. Its back to snorting afrin, taking cough medicine and hoping nobody notices. To top it all off, we have RSV putting COPDers and pediatrics in the hospital now. This has the potential to really strain society, and hospitals, at a time when most of us have seen record percentages of ER nurses and floor nurses quit.

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Ya Ive been saying the same thing for the past few months. Its gonna be a rough winter. Waning immunity, antivaxxers doubling down, people over it and meeting up for the holidays, schools open, the cdc taking their sweet ass time getting people their booster shot. Sorry dudes too late thanksgiving is next week. Shoulda had that **** figured out a month ago.

Im currently going to enjoy the next few weeks of relatively low numbers of covid in the icu before mid december F’s it all up.

 

[DocEspana]

Ya Ive been saying the same thing for the past few months. Its gonna be a rough winter. Waning immunity, antivaxxers doubling down, people over it and meeting up for the holidays, schools open, the cdc taking their sweet ass time getting people their booster shot. Sorry dudes too late thanksgiving is next week. Shoulda had that **** figured out a month ago.

Im currently going to enjoy the next few weeks of relatively low numbers of covid in the icu before mid december F’s it all up.

Epidemiologists (I hang with nerd crowds and am going to be a best man at TWO different epidemiologist's weddings... in 2023) are saying that Florida or southern georgia/alabama/lousiana will be an epicenter of a new outbreak in the last week of december. The increase will hit same week as christmas, it will be very noticeable by 2nd week of january and will pleateau sometime in february (for the epicenter) and then spread throughout the rest of the country with a geography-dependent delay pattern.

Its strange how certain they are about this stuff, but I see it being completely right - even down to knowing florida will be the cause of it all.

 

[bronx43]

What caused the subprime housing crisis? Encouraging people to take out loans that couldn’t actually afford them. What do we do as a society? Force people to get “health insurance” that they can’t afford. What do we do in the emergency department? Encourage people to get as much healthcare in the ER as is possible. How do we do this? We hide the prices. We delay the financial decisions for 2 months and allow those decisions to be made by two different third party people who know nothing about the patient, the doctor, the care provided or the finances of the patient or the provider. This is not a free-market, or anything close. The corporations involved run on margins that tend to be less than 5%. They aren’t able to withstand huge swings in volumes, up and down. The corporations in medicine have all taken out massive loans to outcompete each other. This is smoke and mirrors. Debts are counted as assets, and assets (people) are treated like ****.

The subprime housing crisis happened because it was overleveraged. Healthcare systems are overleveraged. Insurance companies depend on premiums to fund their operations. Are corporations hiring more employees and giving them good jobs with good insurance? Or are they increasingly following the Walmart model where they don't offer benefits. Consider this news story:

Labor leader explains why workers are quitting in record numbers or not returning to jobs

With a record 4.3 million Americans quitting their jobs in August recent supply chain issues may continue to remain a problem.

www.wfmj.com

Over leverage is the name of the game. My academic institution decided to go ahead with billions of dollars of real estate construction, despite that the current infrastructure is more than adequate to provide necessary care. There's very little chance that they can actually remain solvent, especially given the exponential increase in labor and supply costs. The bean counters are, of course, just looking to pad their CV so they can hope to jump to a higher position having had "spearheaded a multi-billion dollar expansion of a major health system."

 

[xaelia]

Its strange how certain they are about this stuff, but I see it being completely right - even down to knowing florida will be the cause of it all.

I will say, no one has yet been wrong predicting continuing impact of the pandemic vs. those who have predicted the worst is over.

I would probably imagine it has sometime to do with relatively waning vaccination- and infection-based immunity resulting in an increase in cases to further seek out those remaining unvaccinated to experience another surge in hospitalisations.

 

[Dr Mantis Toboggan]

Epidemiologists (I hang with nerd crowds and am going to be a best man at TWO different epidemiologist's weddings... in 2023) are saying that Florida or southern georgia/alabama/lousiana will be an epicenter of a new outbreak in the last week of december. The increase will hit same week as christmas, it will be very noticeable by 2nd week of january and will pleateau sometime in february (for the epicenter) and then spread throughout the rest of the country with a geography-dependent delay pattern.

Its strange how certain they are about this stuff, but I see it being completely right - even down to knowing florida will be the cause of it all.

More delta or is there some new badness that awaits us?

 

[DocEspana]

I will say, no one has yet been wrong predicting continuing impact of the pandemic vs. those who have predicted the worst is over.

I would probably imagine it has sometime to do with relatively waning vaccination- and infection-based immunity resulting in an increase in cases to further seek out those remaining unvaccinated to experience another surge in hospitalisations.

I will point out that waning immunity (at least among the vaccinated) really represents an incredibly minimal amount of the cases. I don't disagree with the plays a part, just pointing out that it is truly a minimal element in reality. There are still unvaccinated souls who have not yet experienced this, and there are people who will find that natural immunity is pretty good but it distinct step worse than vaccinated immunity. I hav been seeing plenty of people getting their second case, and a decent chunk of them end up hospitalized