Your thoughts on the insanity of building hospitals that look like five-star hotels

And the ways Obamacare seems to have made American medicine worse, not better...

It’s a guarantee, a lead-pipe lock: when I write about the American healthcare crisis, UT readers will fill my in-box with detailed, thoughtful notes about their experiences.

That’s exactly what happened after yesterday’s piece about a hugely expensive outpatient surgery center that just opened in Miami - a building that reveals the perverse priorities of American medicine, and how Obamacare is only worsening them.

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(Pay for me, get your own words for free!)

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As I chase follow-up articles, I wanted to share some of the most interesting perspectives (edited only for length and minor copy fixes). They’re too good for me to keep to myself.

Enjoy.

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First, on how Obamacare rules are making health insurance unaffordable for people who have to buy it for themselves.

Jason:

The problem with Obamacare is even worse than you described. It’s no longer “insurance,” which is why it’s crushingly expensive. When you remove the underwriting, then the pool will inevitably incur bad experience (more claims than offsetting premiums).

The insurance companies are no longer selling insurance; they are simply TPAs (third party administrators). They don’t care if the insurer makes or loses money as in this case the government is on the hook. They are guaranteed their administrative fees. Losses were covered by the government…

As a self-employed man, I am now going to have to pay $3,800 a month for a completely health family of four (up from $3,400)…

But again, the worst part is… you have no other choices. You mentioned a “catastrophic” plan. If but there was such a plan to buy… I’d have done it. But alas, it doesn’t exist. And it’s ILLEGAL to create one! WTAF!? (sorry, this topic infuriates me). And why?

Because if there were one, NOBODY would put up with the ACA [Affordable Care Act, or Obamacare] crap and cost!? We’d all be partially self-insuring. Let me save up a huge deductible (probably take a year at current ACA costs… Does $45,600 sound like a high enough out of pocket savings?)… And also, let me use that how I WANT to use it...

There is no “fixing” ACA. It must be removed, root and branch. Users must be incentivized to make better medical choices. Question what’s happening, being recommended to them as if they were going to be paying for it!

Capitalism works when you let it. America works when you stop trying to make it socialist.

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(Such an expensive pie chart. Please note the biggest slice.)

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A now-retired medical device salesman agrees that hospitals are more powerful than ever — and unafraid to push their favored equipment choices on physicians.

Gary:

I was in the healthcare industry for 37 years… a surgery center like this makes no sense. It’s a very complicated transition that has moved the big bucks to from the doctors and device manufacturers to the big healthcare groups, group purchasing organizations and the insurance companies. Don’t get me wrong, when I sold equipment into the operating room and sterile processing areas I made a very good living.

I can tell you without a doubt that the margins that companies like my previous organization and many others have compressed dramatically. [Hospital chains] did the right thing and started looking at companies’ financial statements and ask the question - You are making how much?? And you want to raise our contract costs by 10%…

The old way of doctors getting whatever they want is long gone. Ambulatory surgery is saving healthcare systems a fortune, but then they blow it on every new toy…

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A surgeon points to the intersection between expensive new technologies and defensive medicine as a hidden cost driver.

Ed:

I appreciate your work on health care. I am an orthopedic surgeon. I think the one thing that you are missing is that physicians are not encouraged to use the new “advanced technologies” in order to make money for the hospitals, but often it is overutilized to “cover our asses” from lawsuits. If we have a brand new MRI available, and we don’t use it to diagnose a hangnail, the trial lawyers will sue us when little Johnny doesn’t go on to be Patrick Mahomes.

Legal pressures drive up the cost of medicine at a similar rate as the salaries of mid and upper level management from my vantage point. Both reasons suck.

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(Writing together, fighting for the truth together.)

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And, finally, a thought I had never considered, on yet another perversity of the new building.

William:

Just a side note on this: My Dad is old. Often these big buildings require him to walk a long way. Just another little way they’re not thinking about the patients.

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Yesterday’s piece: