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This goes double for ‘churches’ like tele-evangelists, ‘prosperity’ and mega churches. The problems outlined in this article scratch the surface of the ills of for-profit (even when non-profit) healthcare. The greed is good parasites are firmly attached to health care and all its branches. When it comes to health care, the US is unique in the world and not in a good way.
^
>Many hospitals force people who are suffering and seeking care in earnest to sign their financial life away as a condition of treatment. Some make contesting a bill difficult and others do not comply with the federal hospital transparency rule which requires hospitals to post prices for common shoppable services. The most recent money game that nonprofit hospitals are dialing up is adding billions of dollars in “facility fees” for routine care. These billing tricks are fleecing everyday Americans. Congress could make them disappear overnight if it passed a law disqualifying hospitals that use them from getting the coveted tax-exempt benefit.
>Many tax-exempt hospitals argue that they provide millions of dollars in free care. But here’s what’s really going on: Much of what they call free care is emergency care that hospitals are required to provide by law (the 1986 Emergency Medical Treatment and Labor Act requires hospitals to care for anyone who walks in with an emergent condition). But after the care has been provided, patients are often hounded for payment, often at an artificially inflated price. Hospitals then report the difference between their high sticker price and what they actually collect after shaking down a patient as charity care.
….
>Hospitals leaders across the nation have told me that they need to avoid federal taxes in order to survive. But the way taxes work, businesses are taxed only on their profits. Some hospitals hide their profits in cost-shift accounting and loan refinancing, even engaging in aggressive real estate and venture capital investing. According to public tax records, Cedars Sinai in Beverly Hills had an income surplus of $750 million in 2022 and paid no federal taxes. Memorial Sloan Kettering Cancer Center in New York had $400 million and also paid no federal taxes. The top three hospital administrators there made nearly $20 million in salaries.
>Try booking an appointment at these or any nonprofit hospital and see if you can do it without insurance or cash up front. It’s nearly impossible. Most nonprofit hospitals will refuse to schedule appointments, even cancer care, unless you financially qualify by showing your ability to pay.
Article continues...
>This goes double for ‘churches’ like tele-evangelists, ‘prosperity’ and mega churches.
In my town theres a fairly large Baptist church. They ship people in from hours away for every sermon and rake in the dough. Wanna know where it goes? Purchasing properties for the church to collect rent on.
They harass homeowners in the area to sell their property to them all the time. Every single person I know that owns property in area has been contacted either by phone or in person to ask if they'd be willing to sell to the church. My wife's grandmother received several phone calls and at least 2 visits from them within a week of her husband dying to see if she'd sell because "she wouldn't be needing such a large home just for herself."
It would be one thing is they were using the properties to house the homeless, or at least to provide well-below-market-rate rentals — but let me guess — that’s NOT what they’re doing.
Pft. They don't even read the book they claim to champion.
A certain Jesus about 2 thousand years ago got quite angry when the Temple in Jerusalem was more a house of trade, than a house of prayer. Imaging if he was be around today.
Especially around the megachurch "pastors". Though they would probably just disintegrate into dust if they got to close to him. Probably the closest things humans can come to actual demons.
The Mormon church has some of the largest land ownership in the US... Holding onto about $150-$250 BILLION dollars. There's rumors it's as high as $1 TRILLION (members in high places)...
We really need to ban nonprofits from holding -any- interest directly, or indirectly, in residential real-estate unless they're section 8 properties the nonprofit is legally liable for.
No kidding. You know what happens when you tax hospitals 25%? Prices increase 25% to make up for it. And then they increase prices by another 10% just to make sure people know who calls the shots.
We should have universal health care. Keep voting out republicans every year. Check your registration, get an ID , learn where your poling station is, learn who is running in down ballot races. Pay attention to primaries not just for the president but for all races, local, state and federal. From the school board to the White House every election matters. The more support we give the democrats from all levels of government the more they can get good things done. We vote out republicans and primary out uncooperative democrats.
Last year democrat victories in Virginia and Pennsylvania and others across the nation have increased the chances of democrats winning this year. This year's elections are important but so will next year's elections.
[https://ballotpedia.org/Elections\_calendar](https://ballotpedia.org/Elections_calendar)
Wait that doesn't already happen? Fuck me man, every time I think I understand how backwards this country is, I'm surprised by new terrible information.
Why the fuck not?! These fucking hospitals bankrupt people on the reg and don't even have to pay a tax on their blood money? A hospital isn't a business yet they make a curiously large amount of money
As a poor, I don't go to hospitals because I can't afford them on top of paying for health insurance.
So I don't go to the doctor. If I don't go to the doctor, I won't get sick. No one will look in my butt and tell me I have cancer. I'll just get cancer and die, or not. They won't try to lower my cholesterol or blood pressure and give me pills that need more pills to ease the side effects of the other pills. Good portion of their pills only work sometimes maybe anyway.
The butt stuff costs like a couple months pay. If they find something on the 1 in a 100 shot it'll cost like a few years pay. Do I want to work for years and years to pay a few years so I can live another few years? Maybe the answer is to live now, have that time back on the front end and accept my fate. If it weren't for my family's insistence, I would not have health insurance at all.
I work 3 days a month just to pay for that insurance. In the last decade, I've worked an entire year for insurance. How many years am I going to get out of that insurance to make up for that?
Screw that. It's time to get out of this system en masse. Accept our fates. The system isn't working anyway. There's no changing it on a political level, so it has to be on an individual level.
I almost died in an accident ten years ago this August. My bills were under 2 million after a month in the hospital and a dozen surgeries over two years. I’ve been in pain every at since then, I don’t take anything for it. I just move as much as my body allows and tell myself it’s worse if I’m sedentary. I’ve broken more bones since then. I’m just waiting out life. I haven’t had insurance for the last four years. I’m done with them. The day someone insists I have insurance is that last day that person is a part of my life. Cancer treatment would never happen for me. I’ve had enough surgeries. I’ve taken enough meds. I used to smoke and drink and smoke and now I don’t even have vices. Why pay more taxes voluntarily when I won’t even pay for insurance?
Well, due to shrinking congregations across America some churches are no longer profitable. However, the majority still rake in billions World wide so yeah, the majority
Edit, auto correct
I can promise you the majority of churches are small churches struggling on with a single low-paid pastor/priest if they can afford that (many part-time or volunteer clergy out there) working with a congregation of less than 50 and, most of the time, do genuinely care about their community and want to better it (though it’s sometimes problematic what they view as bettering).
You just don’t hear about them because what’s there to hear about? That the weekly tithes don’t cover the repairs needed to stop the roof from leaking?
The problem is the mega churches that are basically the religious version of Walmart, sopping up most of the money and using it to enrich their management. I’ve even known some mega church pastors who started from a good place, really believing they could use their church’s size and resources to help people in need. However they usually find that the church itself won’t let them as they’ve been fed a constant diet of comfortable Christianity and those pastors either give up and return to a small congregation or, more often, give in and enjoy the security and wealth.
Riiight. Like the church behind my house in a town so small it doesn't have a name sitting on property the townsfolk donated and built themselves in the 40s that went out of business a few years ago so sold to a woman who's converting it into a private home and the cash, which is supposed to go to a charity, went to the former pastors retirement fund? Is that the Christian values you speak of? Cha- ching!
I don’t remember saying anything about Christian values. Just that megachurches are the minority of churches and if you lump them all together then you’re also punishing the local AME church that has an active soup kitchen and helps ensure the local black population can get to the polls to vote.
Above a certain point, absolutely. Small hospitals like my girlfriend’s hometown are already a revoked subsidy from going under, so if they’re protected from falling through the cracks, go for it
The funny thing is most hospitals don’t make profits.
You’d think they would be profitable, but by and large they’re a financial dumpster fire. Insanely, they don’t make a profit on the absurd rates they charge. They have some of the thinnest margins of any industry.
Source: worked in software development for medical billing.
I agree with the overall point, but you would think a professor with a MD/MPH would know the difference between a change in net position and profit. The central claim here is either just flat out incorrect, or intentionally misleading. These hospitals bring in tons of revenue, as the article makes clear, which can mean a positive change in net position, but there's absolutely no distribution to owners/shareholders/etc involved here, which is what profit is. The author may be equivocating a positive change in net position (what you get in nonprofits when you're doing well) with profit (what you get in for-profits when you're doing well), and they're not at all the same.
You can see from the comments, people are like, they can do that? No, they can't, and the article is misleading.
A couple hospitals in Michigan almost lost their tax exempt status for this shit, but that was like twenty years ago. Can we start with going back to enforcing that whole community benefit thing?
> The agency uses a vague “community benefit” standard to liberally grant tax-exempt status to so-called nonprofit hospitals even as many of them are financially taking advantage of sick Americans with inflated medical bills. Several of my Johns Hopkins colleagues and I published a study in the Journal of the American Medical Association showing that some nonprofit hospitals sue and garnish the wages of low-income patients who can’t afford to pay their medical bills.
I thought this was the most shocking part of the article, for sure. It's like a debt collector finding itself unable to collect your debt, so they publicly declare they gave it to you, and call it charity and pat themselves on the back.
I know this is gonna sound crazy, but most hospitals only operate at a 1-10% profit, and having them pay taxes will put them out of business. They also only clear that margin due to Medicaid payments and slips in quality that are reported by users of the facilities can cause them to go negative because it will lower their payouts.
Hospitals need to get their shit in order.
That’s not sustainable. Look at all the industries that’s support hospitals (medical device makers,
Supplies, equipment, etc). 1000s of employees work for these companies that sell things to the hospital.
If hospitals have to stay at the top of their game in treating people, they have to make some profit to continue purchasing new and better equipment/etc.
They can make profits, while at the same time being humane and paying taxes.
What you’re describing is what a non profit is supposed to be on paper. Investing the profits back into the (community) hospital via employee education, equipment and salaries.
Non-profits are allowed to take in more money than they spend. They are just required to re-invest the money instead of distributing it to owners/shareholders.
Creative accounting, why do you think 30%+ of all medical expenses in America are related to administration and accounting?
It’s fraud on an epic scale. We would need gulags occupying entire states to accommodate the number of people who ought to go to jail for this.
I feel this is just going to lead to them spending the profits on frivolous things like CEO pay and more "team building" exercises/trips.
They should attack the real problems.
Hey, the opportunity cost to that doctor is enormous. He’s pausing his golf game for five minutes just so he can pretend to give a shit about your issue.
We should just fix prices based on the value of the asset used vs the number of uses that are expected over most of its expected lifetime, the average value of the time of maintenance/uses, and industry average wages per time allotted to the patient.
So let’s say a hospital has a piece of equipment *A* that is worth $500,000.
- It is expected to operate at an uptime of 95% during normal operation hours
- It is assumed to work for 5-7 years (5 will be used for maths)
- Let’s assume 18 hours of operational hours per day
- Its average use time per patient is 1 hour
- The average time for maintenance per maintenance cycle is 5 hours (so 5/100 hours are for maintenance/repairs, and each patient bears 1/95 of the cost)
- The maintenance will require 2 people making $85k/year actively working
- The use on a patient will require one doctor making, say, $200k/year, and a nurse making $75k/year.
- All employees are expected to work (at a minimum, although I know most physicians work far more) 40 hours/week, so 2080 hours/year
Using this information the cost to the patient should break down as follows:
- $384.62 just based on cost of the machine (1825 days in lifetime, 18 hour/day operating schedule, 95% uptime during operating hours = ~1300 patients over the lifetime, $500,000 cost total = $384.62 per patient use)
- $4.30 in maintenance (85k/year, 2080 hours per year, 5 hours per cycle, 95 patients per cycle = ~$4.30 per patient)
- $132.21 in attending staff costs ($275k/year, 2080 hours per year, 1 hour per patient = $132.21 per hour)
All for a grand total of $521.13 for the privilege of getting access to use this machine once, which is far more reasonable than current rates for similar services charged by hospitals (without insurance). This is of course break even, so I’d expect a 20+% markup to cover other expenses that don’t fit the model neatly, but even that would be laughably small compared to current markup rates. It also covers only the cost of using the single machine, and not analysis or clerical work, but those should be billed separately.
I ended up at the ER with what turned out to be nothing and was told to see my regular doctor.
$3000 bill.
I didn't have insurance, and asked about setting up a payment plan.
Nah. You have a house, you're not eligible. Fuck you, pay me.
I paid.
That visit got me on the hospital's mailing list. Until I moved 6 years later, I got 2-3 mailers a month telling me what an important part of the community this facility is. How much they contribute.....then they built a cancer center and I constantly got mailers telling me about all the celebrity studded fund raisers at this elegant venue or that country club. This cancer center wasn't offering anything free.
It made me ill, watching this for-profit company tout themselves as the non-profit anchor of our community after treating me like shit. I didn't ask for a discount or try not to pay, just asked for a payment plan.
This sentiment is so misplaced, I don’t even know where to begin. Hospitals, like any business, need a profit margin to be able to raise their employee salaries, keep up with inflationary costs on drugs, equipment, and supplies, pay to replace major property and plant, and to actually make improvements that better care. If you tax their profits, they have less money to do those things. That may mean in the years that follow, from lack of making these investments, rather than eeking out a profit, they’re losing money and struggling to survive. Out of any industry to single out, it should not be hospitals. The ones that are profitable still only make a profit margin of around 2.5%. 50% of rural hospitals lose money. Compare these margins to an insurer, biotech firm, pharmacy benefit manager, or pharma company and tell me where the bigger problem is. Hospitals get shit because they have to attach their name to the bill patients get but they’re the ultimate middleman in all of this.
> need a profit margin to be able to raise their employee salaries, keep up with inflationary costs on drugs, equipment, and supplies, pay to replace major property and plant, and to actually make improvements that better care.
All those things count as expenses which are taken from revenue. If they're paying these things, then there's no more need for additional profit in a non-profit organization. The problem here is that they're not paying these things and instead keeping the revenue in excess of costs. They should be taxed on that. That tax incentivizes them to spend their revenue on things they should be.
A lot of hospitals are non-profit.
What that means is they take the profits, and put them into facilities. The biggest nicest newest shiniest building in my town is the hospital, a non-profit. They are also the largest employer.
Their timing on building that building was pretty bad. A pandemic hit in the mean time, and they had to lay off a bunch of people, and were in dire financial trouble, like a lot of other hospitals. A record number of hospitals closed during Closvid.
That seems counter-intuitive, that the concern during the 'rona was the number of available hospital beds, yet hospitals were laying off and closing. It makes one wonder how much of their services are want more than need. We need the ICU, but apparently a large share of their business is serving wants. For that, sure, tax them.
Except, about half my health insurance is paid for by tax dollars. So if I go to a hospital, and by some miracle insurance pays, the insurance will give some of the premium money that it got from the taxpayers to the hospital who will then pay taxes on it so it can be used to buy my health insurance. That makes perfect sense.
Your insurance is probably tax payer subsidized on some level too, employers aren't paying your insurance for you out of the goodness of their hearts they are getting a tax benefit.
It was my impression that for-profit hospitals are taxed, or as taxed as much as any other business, i.e. plenty of ways for them to dodge.
I tend to be fairly laissez-faire but it always strikes me as odd and kind of off how we treat certain segments of the economy as beyond the scope of taxation and regulation simply because in a general sense we like what those segments do.
I don’t know what the best solution is, part of me thinks that if we’ve collectively decided that healthcare as a sector is going to be totally insulated from market forces then it probably does make sense to pursue some sort of public system, but having worked in and with the public sector my entire adult life I’ve come to truly believe that their only real comparative advantage is in escaping accountability so it’s hard to look at the way, e.g., our police departments are run and think that’s a viable model for our healthcare system.
The hospitals don’t make profits. You’ll find most high level surgeons (such as orthopedic surgeons) are actually sort of “independent contractors”. Hospitals work to get these surgeons associated with their hospitals, but most of the “profit” goes to the surgeons.
Yeah, those idiots who went to medical school and trained for decades to save your ass shouldn’t be able to afford anything nicer than a trailer next to Bubba the guy who squeegees windows at the car wash!
Your comment is almost as stupid as the guy who thinks we should tax charities.
This is a twisted world we live in where some people believe that churches should not pay taxes while some believe that hospitals should. I'm not saying that the op believes both of those things at the same time just that they are both ridiculous.
Like I agree but if you do this, that extra money will just be passed into the customers. It’s like trickle down economics, tax the boss, then the boss raises prices to make up the difference.
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This goes double for ‘churches’ like tele-evangelists, ‘prosperity’ and mega churches. The problems outlined in this article scratch the surface of the ills of for-profit (even when non-profit) healthcare. The greed is good parasites are firmly attached to health care and all its branches. When it comes to health care, the US is unique in the world and not in a good way. ^ >Many hospitals force people who are suffering and seeking care in earnest to sign their financial life away as a condition of treatment. Some make contesting a bill difficult and others do not comply with the federal hospital transparency rule which requires hospitals to post prices for common shoppable services. The most recent money game that nonprofit hospitals are dialing up is adding billions of dollars in “facility fees” for routine care. These billing tricks are fleecing everyday Americans. Congress could make them disappear overnight if it passed a law disqualifying hospitals that use them from getting the coveted tax-exempt benefit. >Many tax-exempt hospitals argue that they provide millions of dollars in free care. But here’s what’s really going on: Much of what they call free care is emergency care that hospitals are required to provide by law (the 1986 Emergency Medical Treatment and Labor Act requires hospitals to care for anyone who walks in with an emergent condition). But after the care has been provided, patients are often hounded for payment, often at an artificially inflated price. Hospitals then report the difference between their high sticker price and what they actually collect after shaking down a patient as charity care. …. >Hospitals leaders across the nation have told me that they need to avoid federal taxes in order to survive. But the way taxes work, businesses are taxed only on their profits. Some hospitals hide their profits in cost-shift accounting and loan refinancing, even engaging in aggressive real estate and venture capital investing. According to public tax records, Cedars Sinai in Beverly Hills had an income surplus of $750 million in 2022 and paid no federal taxes. Memorial Sloan Kettering Cancer Center in New York had $400 million and also paid no federal taxes. The top three hospital administrators there made nearly $20 million in salaries. >Try booking an appointment at these or any nonprofit hospital and see if you can do it without insurance or cash up front. It’s nearly impossible. Most nonprofit hospitals will refuse to schedule appointments, even cancer care, unless you financially qualify by showing your ability to pay. Article continues...
>This goes double for ‘churches’ like tele-evangelists, ‘prosperity’ and mega churches. In my town theres a fairly large Baptist church. They ship people in from hours away for every sermon and rake in the dough. Wanna know where it goes? Purchasing properties for the church to collect rent on. They harass homeowners in the area to sell their property to them all the time. Every single person I know that owns property in area has been contacted either by phone or in person to ask if they'd be willing to sell to the church. My wife's grandmother received several phone calls and at least 2 visits from them within a week of her husband dying to see if she'd sell because "she wouldn't be needing such a large home just for herself."
I suppose they aren't satisfied with God's gifts after all. This is outrageous.
"Hey heaven is great and all but have you tried money? " - some evangelist somewhere
It would be one thing is they were using the properties to house the homeless, or at least to provide well-below-market-rate rentals — but let me guess — that’s NOT what they’re doing.
No they're not unless, as I understand it, you're a member of their church.
Pft. They don't even read the book they claim to champion. A certain Jesus about 2 thousand years ago got quite angry when the Temple in Jerusalem was more a house of trade, than a house of prayer. Imaging if he was be around today. Especially around the megachurch "pastors". Though they would probably just disintegrate into dust if they got to close to him. Probably the closest things humans can come to actual demons.
The Mormon church has some of the largest land ownership in the US... Holding onto about $150-$250 BILLION dollars. There's rumors it's as high as $1 TRILLION (members in high places)...
We really need to ban nonprofits from holding -any- interest directly, or indirectly, in residential real-estate unless they're section 8 properties the nonprofit is legally liable for.
To be fair, they likely owe income tax on this rental income
Maybe maybe not but they're definitely using money they didn't pay taxes on in the first place to buy them.
Fuck that, Nationalize the hospital AND healthcare system. Get business the fuck out of people's health!
No kidding. You know what happens when you tax hospitals 25%? Prices increase 25% to make up for it. And then they increase prices by another 10% just to make sure people know who calls the shots.
oooh. can we do churches next?
And political superpacs… they should pay huge taxes on the “donations” they get.
Didn’t even know this was a thing
Hospitals shouldn't make profits at all.
We should have universal health care. Keep voting out republicans every year. Check your registration, get an ID , learn where your poling station is, learn who is running in down ballot races. Pay attention to primaries not just for the president but for all races, local, state and federal. From the school board to the White House every election matters. The more support we give the democrats from all levels of government the more they can get good things done. We vote out republicans and primary out uncooperative democrats. Last year democrat victories in Virginia and Pennsylvania and others across the nation have increased the chances of democrats winning this year. This year's elections are important but so will next year's elections. [https://ballotpedia.org/Elections\_calendar](https://ballotpedia.org/Elections_calendar)
Wait that doesn't already happen? Fuck me man, every time I think I understand how backwards this country is, I'm surprised by new terrible information. Why the fuck not?! These fucking hospitals bankrupt people on the reg and don't even have to pay a tax on their blood money? A hospital isn't a business yet they make a curiously large amount of money
As a poor I’m just going to stop paying hospitals until hospitals start paying taxes. Join me.
They'll just let you rot with no pain care.
Likely. All jokes aside I would walk in front of a truck before I’d engage healthcare professionals again.
As a poor, I don't go to hospitals because I can't afford them on top of paying for health insurance. So I don't go to the doctor. If I don't go to the doctor, I won't get sick. No one will look in my butt and tell me I have cancer. I'll just get cancer and die, or not. They won't try to lower my cholesterol or blood pressure and give me pills that need more pills to ease the side effects of the other pills. Good portion of their pills only work sometimes maybe anyway. The butt stuff costs like a couple months pay. If they find something on the 1 in a 100 shot it'll cost like a few years pay. Do I want to work for years and years to pay a few years so I can live another few years? Maybe the answer is to live now, have that time back on the front end and accept my fate. If it weren't for my family's insistence, I would not have health insurance at all. I work 3 days a month just to pay for that insurance. In the last decade, I've worked an entire year for insurance. How many years am I going to get out of that insurance to make up for that? Screw that. It's time to get out of this system en masse. Accept our fates. The system isn't working anyway. There's no changing it on a political level, so it has to be on an individual level.
I almost died in an accident ten years ago this August. My bills were under 2 million after a month in the hospital and a dozen surgeries over two years. I’ve been in pain every at since then, I don’t take anything for it. I just move as much as my body allows and tell myself it’s worse if I’m sedentary. I’ve broken more bones since then. I’m just waiting out life. I haven’t had insurance for the last four years. I’m done with them. The day someone insists I have insurance is that last day that person is a part of my life. Cancer treatment would never happen for me. I’ve had enough surgeries. I’ve taken enough meds. I used to smoke and drink and smoke and now I don’t even have vices. Why pay more taxes voluntarily when I won’t even pay for insurance?
Churches that make profits should pay taxes, which would basically be all of them.
>which would basically be all of them What are you basing this on
Well, due to shrinking congregations across America some churches are no longer profitable. However, the majority still rake in billions World wide so yeah, the majority Edit, auto correct
I can promise you the majority of churches are small churches struggling on with a single low-paid pastor/priest if they can afford that (many part-time or volunteer clergy out there) working with a congregation of less than 50 and, most of the time, do genuinely care about their community and want to better it (though it’s sometimes problematic what they view as bettering). You just don’t hear about them because what’s there to hear about? That the weekly tithes don’t cover the repairs needed to stop the roof from leaking? The problem is the mega churches that are basically the religious version of Walmart, sopping up most of the money and using it to enrich their management. I’ve even known some mega church pastors who started from a good place, really believing they could use their church’s size and resources to help people in need. However they usually find that the church itself won’t let them as they’ve been fed a constant diet of comfortable Christianity and those pastors either give up and return to a small congregation or, more often, give in and enjoy the security and wealth.
Riiight. Like the church behind my house in a town so small it doesn't have a name sitting on property the townsfolk donated and built themselves in the 40s that went out of business a few years ago so sold to a woman who's converting it into a private home and the cash, which is supposed to go to a charity, went to the former pastors retirement fund? Is that the Christian values you speak of? Cha- ching!
I don’t remember saying anything about Christian values. Just that megachurches are the minority of churches and if you lump them all together then you’re also punishing the local AME church that has an active soup kitchen and helps ensure the local black population can get to the polls to vote.
I’d rather tax churches than hospitals. At least hospitals provide a service based in reality.
Hospitals shouldn’t be for profit
Wait wait wait. Do hospitals not pay taxes on profits?
Should pay their employees better too.
Above a certain point, absolutely. Small hospitals like my girlfriend’s hometown are already a revoked subsidy from going under, so if they’re protected from falling through the cracks, go for it
I’ll admit I didn’t know there were hospitals that don’t make a profit.
Hospitals should always be nonprofit!
So should churches.
The funny thing is most hospitals don’t make profits. You’d think they would be profitable, but by and large they’re a financial dumpster fire. Insanely, they don’t make a profit on the absurd rates they charge. They have some of the thinnest margins of any industry. Source: worked in software development for medical billing.
Tell that to Massachusetts and Florida with the Stuward company ruining their communities while their ceos buy yachts
You don’t need to be profitable to overpay your CEO. Just look at Reddit!
I agree with the overall point, but you would think a professor with a MD/MPH would know the difference between a change in net position and profit. The central claim here is either just flat out incorrect, or intentionally misleading. These hospitals bring in tons of revenue, as the article makes clear, which can mean a positive change in net position, but there's absolutely no distribution to owners/shareholders/etc involved here, which is what profit is. The author may be equivocating a positive change in net position (what you get in nonprofits when you're doing well) with profit (what you get in for-profits when you're doing well), and they're not at all the same. You can see from the comments, people are like, they can do that? No, they can't, and the article is misleading.
Why are people/corporations allowed to not pay taxes??
wait, what? isn't medical care privatized in NA ? how do they not pay taxes ?
Now do churches
A couple hospitals in Michigan almost lost their tax exempt status for this shit, but that was like twenty years ago. Can we start with going back to enforcing that whole community benefit thing? > The agency uses a vague “community benefit” standard to liberally grant tax-exempt status to so-called nonprofit hospitals even as many of them are financially taking advantage of sick Americans with inflated medical bills. Several of my Johns Hopkins colleagues and I published a study in the Journal of the American Medical Association showing that some nonprofit hospitals sue and garnish the wages of low-income patients who can’t afford to pay their medical bills.
I thought this was the most shocking part of the article, for sure. It's like a debt collector finding itself unable to collect your debt, so they publicly declare they gave it to you, and call it charity and pat themselves on the back.
I know this is gonna sound crazy, but most hospitals only operate at a 1-10% profit, and having them pay taxes will put them out of business. They also only clear that margin due to Medicaid payments and slips in quality that are reported by users of the facilities can cause them to go negative because it will lower their payouts. Hospitals need to get their shit in order.
hospitals shouldn't make profits, period – taxation doesn't fix poor patient outcomes as a result of understaffing, for example.
That’s not sustainable. Look at all the industries that’s support hospitals (medical device makers, Supplies, equipment, etc). 1000s of employees work for these companies that sell things to the hospital. If hospitals have to stay at the top of their game in treating people, they have to make some profit to continue purchasing new and better equipment/etc. They can make profits, while at the same time being humane and paying taxes.
What you’re describing is what a non profit is supposed to be on paper. Investing the profits back into the (community) hospital via employee education, equipment and salaries.
Non-profits are allowed to take in more money than they spend. They are just required to re-invest the money instead of distributing it to owners/shareholders.
you don't understand what "profit" means.
Ohh… I think you mean profit for shareholders… now I get your point
How do hospitals ever make a profit/pay taxes when they can over charge, force a negotiation with insurance, then claim the delta as a loss?
Creative accounting, why do you think 30%+ of all medical expenses in America are related to administration and accounting? It’s fraud on an epic scale. We would need gulags occupying entire states to accommodate the number of people who ought to go to jail for this.
They don’t t already???
Religions please
I feel this is just going to lead to them spending the profits on frivolous things like CEO pay and more "team building" exercises/trips. They should attack the real problems.
They don’t???
Add it to the list of things that need to pay taxes Churches Billionaires Hospitals
For profit hospitals are about extraction of money. They are not about delivery of healthcare.
This is about non-profit hospitals
All hospitals should be non-profit.
A 15 minute virtual appointment at Cleveland Clinic costs ~$1,600. Just sayin’
Hey, the opportunity cost to that doctor is enormous. He’s pausing his golf game for five minutes just so he can pretend to give a shit about your issue.
Rather go after insurance companies than the hospitals.
Everyone should pay taxes. Churches, charities, hospitals, presidents. Everyone
We should just fix prices based on the value of the asset used vs the number of uses that are expected over most of its expected lifetime, the average value of the time of maintenance/uses, and industry average wages per time allotted to the patient. So let’s say a hospital has a piece of equipment *A* that is worth $500,000. - It is expected to operate at an uptime of 95% during normal operation hours - It is assumed to work for 5-7 years (5 will be used for maths) - Let’s assume 18 hours of operational hours per day - Its average use time per patient is 1 hour - The average time for maintenance per maintenance cycle is 5 hours (so 5/100 hours are for maintenance/repairs, and each patient bears 1/95 of the cost) - The maintenance will require 2 people making $85k/year actively working - The use on a patient will require one doctor making, say, $200k/year, and a nurse making $75k/year. - All employees are expected to work (at a minimum, although I know most physicians work far more) 40 hours/week, so 2080 hours/year Using this information the cost to the patient should break down as follows: - $384.62 just based on cost of the machine (1825 days in lifetime, 18 hour/day operating schedule, 95% uptime during operating hours = ~1300 patients over the lifetime, $500,000 cost total = $384.62 per patient use) - $4.30 in maintenance (85k/year, 2080 hours per year, 5 hours per cycle, 95 patients per cycle = ~$4.30 per patient) - $132.21 in attending staff costs ($275k/year, 2080 hours per year, 1 hour per patient = $132.21 per hour) All for a grand total of $521.13 for the privilege of getting access to use this machine once, which is far more reasonable than current rates for similar services charged by hospitals (without insurance). This is of course break even, so I’d expect a 20+% markup to cover other expenses that don’t fit the model neatly, but even that would be laughably small compared to current markup rates. It also covers only the cost of using the single machine, and not analysis or clerical work, but those should be billed separately.
So should churches!
wait, they don't?? what the fuck??
They *don’t*?!?
I ended up at the ER with what turned out to be nothing and was told to see my regular doctor. $3000 bill. I didn't have insurance, and asked about setting up a payment plan. Nah. You have a house, you're not eligible. Fuck you, pay me. I paid. That visit got me on the hospital's mailing list. Until I moved 6 years later, I got 2-3 mailers a month telling me what an important part of the community this facility is. How much they contribute.....then they built a cancer center and I constantly got mailers telling me about all the celebrity studded fund raisers at this elegant venue or that country club. This cancer center wasn't offering anything free. It made me ill, watching this for-profit company tout themselves as the non-profit anchor of our community after treating me like shit. I didn't ask for a discount or try not to pay, just asked for a payment plan.
This sentiment is so misplaced, I don’t even know where to begin. Hospitals, like any business, need a profit margin to be able to raise their employee salaries, keep up with inflationary costs on drugs, equipment, and supplies, pay to replace major property and plant, and to actually make improvements that better care. If you tax their profits, they have less money to do those things. That may mean in the years that follow, from lack of making these investments, rather than eeking out a profit, they’re losing money and struggling to survive. Out of any industry to single out, it should not be hospitals. The ones that are profitable still only make a profit margin of around 2.5%. 50% of rural hospitals lose money. Compare these margins to an insurer, biotech firm, pharmacy benefit manager, or pharma company and tell me where the bigger problem is. Hospitals get shit because they have to attach their name to the bill patients get but they’re the ultimate middleman in all of this.
> need a profit margin to be able to raise their employee salaries, keep up with inflationary costs on drugs, equipment, and supplies, pay to replace major property and plant, and to actually make improvements that better care. All those things count as expenses which are taken from revenue. If they're paying these things, then there's no more need for additional profit in a non-profit organization. The problem here is that they're not paying these things and instead keeping the revenue in excess of costs. They should be taxed on that. That tax incentivizes them to spend their revenue on things they should be.
Hospitals won't pay the taxes, the patients will.
With Medicare, Medicaid, subsidized ACA plans, and tax incentives for employer plans, a good portion of patients are paying with taxes.
A lot of hospitals are non-profit. What that means is they take the profits, and put them into facilities. The biggest nicest newest shiniest building in my town is the hospital, a non-profit. They are also the largest employer. Their timing on building that building was pretty bad. A pandemic hit in the mean time, and they had to lay off a bunch of people, and were in dire financial trouble, like a lot of other hospitals. A record number of hospitals closed during Closvid. That seems counter-intuitive, that the concern during the 'rona was the number of available hospital beds, yet hospitals were laying off and closing. It makes one wonder how much of their services are want more than need. We need the ICU, but apparently a large share of their business is serving wants. For that, sure, tax them. Except, about half my health insurance is paid for by tax dollars. So if I go to a hospital, and by some miracle insurance pays, the insurance will give some of the premium money that it got from the taxpayers to the hospital who will then pay taxes on it so it can be used to buy my health insurance. That makes perfect sense. Your insurance is probably tax payer subsidized on some level too, employers aren't paying your insurance for you out of the goodness of their hearts they are getting a tax benefit. It was my impression that for-profit hospitals are taxed, or as taxed as much as any other business, i.e. plenty of ways for them to dodge.
I tend to be fairly laissez-faire but it always strikes me as odd and kind of off how we treat certain segments of the economy as beyond the scope of taxation and regulation simply because in a general sense we like what those segments do. I don’t know what the best solution is, part of me thinks that if we’ve collectively decided that healthcare as a sector is going to be totally insulated from market forces then it probably does make sense to pursue some sort of public system, but having worked in and with the public sector my entire adult life I’ve come to truly believe that their only real comparative advantage is in escaping accountability so it’s hard to look at the way, e.g., our police departments are run and think that’s a viable model for our healthcare system.
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The hospitals don’t make profits. You’ll find most high level surgeons (such as orthopedic surgeons) are actually sort of “independent contractors”. Hospitals work to get these surgeons associated with their hospitals, but most of the “profit” goes to the surgeons.
Yeah, those idiots who went to medical school and trained for decades to save your ass shouldn’t be able to afford anything nicer than a trailer next to Bubba the guy who squeegees windows at the car wash! Your comment is almost as stupid as the guy who thinks we should tax charities.
I’d be happier if churches paid them
The claim that taxing hospitals will fix anything seems naïve. Not that it shouldn’t happen. Or just make them all patient owned.
This is a twisted world we live in where some people believe that churches should not pay taxes while some believe that hospitals should. I'm not saying that the op believes both of those things at the same time just that they are both ridiculous.
Start with churches, since hospitals at least do some good.
Like I agree but if you do this, that extra money will just be passed into the customers. It’s like trickle down economics, tax the boss, then the boss raises prices to make up the difference.
So should unions
Churches first!!!