Cory Doctorow has a deep dive on the for-profit hospital chain HCA, and shows how it is sending not-dying patients to hospice care to maximize profits.
They provide little or no care at the hospices, because hospices by design provide only palliative care, and once they hit the $32,000.00 Medicare limit, they are kicked loose.
They then have to put their lives back together, including restarting Medicare coverage, because they were removed because they were declared to be dying by HCA:
It's not that conservatives aren't sometimes right – it's that even when they're right, they're highly selective about it. Take the hoary chestnut that "incentives matter," trotted out to deny humane benefits to poor people on the grounds that "free money" makes people "workshy."
There's a whole body of conservative economic orthodoxy, Public Choice Theory, that concerns itself with the motives of callow, easily corrupted regulators, legislators and civil servants, and how they might be tempted to distort markets.
But the same people who obsess over our fallible public institutions are convinced that private institutions will never yield to temptation, because the fear of competition keeps temptation at bay. It's this belief that leads the right to embrace monopolies as "efficient": "A company's dominance is evidence of its quality. Customers flock to it, and competitors fail to lure them away, therefore monopolies are the public's best friend."
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Wealth-based health-care rationing is bad enough, but when it's combined with the public purse, a bad system becomes a nightmare. Take #HospiceCare: private equity funds have rolled up huge numbers of hospices across the USA and turned them into rigged – and lethal – games:
https://pluralistic.net/2023/04/26/death-panels/#what-the-heck-is-going-on-with-CMS
Medicare will pay a hospice $203-$1,462 to care for a dying person, amounting to $22.4b/year in public funds transfered to the private sector. Incentives matter: the less a hospice does for their patients, the more profits they reap. And the private hospice system is administered with the lightest of touches: at the $203/day level, a private hospice has no mandatory duties to their patients.
You can set up a California hospice for the price of a $3,000 filing fee (which is mostly optional, since it's never checked). You will have a facility inspection, but don't worry, there's no followup to make sure you remediate any failing elements. And no one at the Centers for Medicare & Medicaid Services tracks complaints.
So PE-owned hospices pressure largely healthy people to go into "hospice care" – from home. Then they do nothing for them, including continuing whatever medical care they were depending on. After the patient generates $32,000 in billings for the PE company, they hit the cap and are "live discharged" and must go through a bureaucratic nightmare to re-establish their Medicare eligibility, because once you go into hospice, Medicare assumes you are dying and halts your care.
PE-owned hospices bribe doctors to refer patients to them. Sometimes, these sham hospices deliberately induce overdoses in their patients in a bid to make it look like they're actually in the business of caring for the dying. Incentives matter:
https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle
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The paperclip-maximizing, grandparent-devouring transhuman colony organism that calls itself a Private Equity fund is endlessly inventive in finding ways to increase its profits by harming the rest of us. It's not just hospices – it's also palliative care.
Writing for NBC News, Gretchen Morgenson describes how HCA Healthcare – the nation's largest hospital chain – outsourced its death panels to IBM Watson, whose algorithmic determinations override MDs' judgment to send patients to palliative care, withdrawing their care and leaving them to die:
Incentives matter. When HCA hospitals send patients to die somewhere else to die, it jukes their stats, reducing the average length of stay for patients, a key metric used by HCA that has the twin benefits of making the hospital seem like a place where people get well quickly, while freeing up beds for more profitable patients.
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Only one of HCA's doctors was willing to go on record about its death panels: Ghasan Tabel of Riverside Community Hospital (motto: "Above all else, we are committed to the care and improvement of human life"). Tabel sued Riverside after the hospital retaliated against him when he refused to follow the algorithm's orders to send his patients for palliative care.
Tabel is the only doc on record willing to discuss this, but 26 other doctors talked to Morgenson on background about the practice, asking for anonymity out of fear of retaliation from the nation's largest hospital chain, a "Wall Street darling" with $5.6b in earnings in 2022.
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But while cutting staff and leaving hospitals to crumble are inarguable malpractice, the palliative care scam is harder to pin down. By using "AI" to decide when patients are beyond help, HCA can employ empiricism-washing, declaring the matter to be the factual – and unquestionable – conclusion of a mathematical process, not mere profit-seeking:
https://pluralistic.net/2023/07/26/dictators-dilemma/ggarbage-in-garbage-out-garbage-back-in
But this empirical facewash evaporates when confronted with whistleblower accounts of hospital administrators who have no medical credentials berating doctors for a "missed hospice opportunity" when a physician opts to keep a patient under their care despite the algorithm's determination.
This is the true "AI Safety" risk. It's not that a chatbot will become sentient and take over the world – it's that the original artificial lifeform, the limited liability company, will use "AI" to accelerate its murderous shell-game until we can't spot the trick:
https://pluralistic.net/2023/06/10/in-the-dumps-2/
The risk is real. A 2020 study in the Journal of Healthcare Management concluded that the cash incentives for shipping patients to palliatve care "may induce deceiving changes in mortality reporting in several high-volume hospital diagnoses":
Incentives matter. In a private market, it's always more profitable to deny care than to provide it, and any metric we bolt onto that system to prevent cheating will immediately become a target. For-profit healthcare is an oxymoron, a prelude to death panels that will kill you for a nickel.
This is why I think that here should be aggressive criminal prosecutions against business executives.
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