It depends on what is meant by “best care.” The wealthy might get care a little faster; they might get what is widely considered futile care; they might get what is considered unproven, experimental care; their care centers will likely have better accoutrements. Whether these qualities truly constitute better care is a matter of contention.
ED:
One can choose to use whatever Metric they wish.
The net result is that a Billionaire in a tiered system will receive “better” overall care; and will have access to the best facilities and doctors; than those living in an inner-city housing project or in rural Kentucky.
More often than not its just the dress up of the waiting room/lobby. The nice ones have a Van Gough print, the cheapos have the “Hang In There” kitten from a branch poster.
Usually the same doctors or management group running it though.
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Exactly. Lots of ferns and Muzak in the “better” facilities.
What you describe can be attributed to the current system we have as care is rationed by affordability.
Along with cost/benefit, affordability is an important and legitimate basis upon which healthcare rationing decisions can and should be made.
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You should see the UPMC satellite/outpatient place locally. It’s freakin amazing.
Same MDs as everywhere else(whom are also very good), but the facility is really something. If I remember right, they have a coffee and snack shop in the atrium.
True…in most cases, Zep.
One that comes to mind that may not be is the extremely expensive Neonatal Intensive Care.
Some of the best Neonatal Care in the World are at some of the best Children’s facilities in the World…many of which are right in the middle of areas with some of the worst Infant Morbidity and Mortality rates in the World. (one off the top of my head is Children’s Hospital of Philadelphia or “CHOPS”).
Is that because they are also in areas with some of the worst pre-natal care? Probably.
In most other areas, Zep is most likely correct. (Again…I’m just thinking off the top of my head…)
By the way…Mental Health Care Professional shortages is horrendous across the Board…from children to Adults…in addition to shortages of Mental Health facilities. This often is not the case with those who can afford it. The same is true with Drug “Rehabilitation”. (Boy is that another thread…)
Oh.
Even in rural Areas…Neonatal Transport to a World-Class NICU is usually readily available.
Again…extremely expensive care (when you hear the term “Million Dollar Baby”…it’s not an exaggeration)…but is rarely (if ever) rationed based on Insurance or ability to pay.
If you ever find yourself in agreement with ol Zep, it’s best to double check, lol…
LOL!
Point taken! (Zep is probably an okay guy!)
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I’ve always pictured wacky uncle Eddie from Christmas Vacation.
If ever there was a shortcoming in oversight it is there. I’ve known a few people that have gotten into the after care racket (halfway & three-quarter way houses). They’re fucking scum. I almost got into it myself, but I couldn’t be in the same room as the other people involved.
This highlights one of the reasons certain statistics concerning healthcare outcomes in the US seem far worse than they actually are. In the US, we try to save infants that other countries would simply let die (eg, those with profound birth defects; extreme preemies). Thus, when some of these babies inevitably don’t make it, they show up as deaths on our stats, thereby spuriously increasing our infant mortality rate:
"Explaining the numbers
The first nuance is one of definition. Infant mortality is defined as the death of babies under the age of one year, but some of the differences between countries can be explained by a difference in how we count. Is a baby born weighing less than a pound and after only 21 weeks’ gestation actually “born?” In some countries, the answer is no, and those births would be counted as stillbirths. In the United States, on the other hand, despite these premature babies’ relatively low odds of survival, they would be considered born – thus counting toward the country’s infant mortality rates.
These premature births are the biggest factor in explaining the United States’ high infant mortality rate." [emphasis mine]
It’s like comparing heart surgeons based on the survival rates of their pts. Let’s suppose one such surgeon has a much higher pt survival rate than another–s/he is obviously the better doctor, right? Wrong. Pt selection plays a very important role in survival rates. Thus, what may be happening is the doc with the high survival rate is cherry-picking his/her cases–ie, declining to operate on all but the simplest, least-sick pts. In contrast, the doc with the lower survival rate is taking on the sicker/more challenging cases–the ones that have a very poor prognosis before their backs hit the OR table. Thus, the doc with the worse record may in fact be a far more skilled surgeon.
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Was this the thread where people were discussing grocery stores?
If so, I thought this was interesting (wall of text coming…:
By Heather Haddon and Julie Jargon
July 31, 2017 7:00 a.m. ET
112 COMMENTS
Never before in America has so much retail square footage been devoted to selling food—and it is too much.
A massive build-out by retailers has left the country piled up with grocery shelves as consumers are shifting from big weekly shopping trips to more snacking and to-go meals. The mismatch has flattened retail sales and leaves the industry vulnerable to a wave of closures that some executives, bankers and industry experts think is coming soon.
Commercial square footage of retail food space per capita last year set a record, with 4.15 square feet of food retail per person, according to CoStar Group , CSGP -0.24% a commercial real-estate firm, nearly 30 times the amount of space allocated to groceries at major chains in 1950.
To be sure, major grocery chains weren’t as numerous decades ago, with many Americans shopping for food at mom and pop stores.
But the growth in groceries have extended across many types of retailers in recent years. Part of the expansion comes from grocers, who accelerated their store openings as a way to drive sales growth after the 2008 recession. At the same time, club chains, dollar stores, pharmacies—and even gas stations—increased their fresh food offerings to drive traffic and boost profits.
“Everybody is getting into the grocery business,” said David Hirz, chief executive of Smart & Final Stores Inc., a California-based warehouse grocer.
MORE
Latest Change Hitting Food Industry: Cooking Has Become a Lost Art
While shopper loyalty to conventional chains lifted same-store sales for food retailers by at least 3% annually since 2013, that metric was flat in 2016 and is projected to remain static this year as competition grows, according to FactSet. “There’s only so much food we can buy,” said Suzanne Mulvee, director of research for CoStar.
The food-retail sector has become even more saturated at a time when competition is only getting fiercer, particularly at the two ends of the shopping spectrum. Growing European deep-discounters Aldi and Lidl are vying for U.S. market share, hoping their prices will win over the budget-conscious shopper while internet companies like Amazon.com Inc. are trying to lure higher-income grocery shoppers online. Regional supermarkets and conventional ones such as Kroger Co. and Albertsons Cos. are the most likely to get squeezed in the process, according to analysts.
“We’ve hit that critical moment where traditional supermarkets have realized they can’t keep opening new stores to solve their problems,” Kantar Retail analyst Diana Sheehan said.
Some grocers have already started to retrench, similar to the way the broader retail market has reduced square footage of brick-and-mortar stores as e-commerce drew away customers.
Kroger, the nation’s largest traditional supermarket chain by stores and sales, is reducing its new-store openings this year to 55 from 100, a nearly billion-dollar drop in capital expenditures, and its chief financial officer, Michael Schlotman, recently said that the company expects to continue to invest less in bricks and mortar. Smart & Final plans to build 19 stores this year after opening 37 in 2016.
Wal-Mart Stores Inc. plans to build 55 supercenters and smaller-format stores in its 2018 fiscal year, down from the 132 it opened in the 12-month period ending in January. That has helped the nation’s largest food seller by sales to spend billions of dollars renovating its stores and offer more online-order pickup, a company spokesman said.
There has been consolidation in the sector, too. Kroger and Supervalu Inc. have scooped up stores and wholesale businesses after two Midwest regional chains, Marsh Supermarkets LLC and Central Grocers Inc., declared bankruptcy this year.
But enduring changes in eating and food-shopping habits toward cheaper and more convenient options means consumers will increasingly spread their dollars among a variety of retailers. Food retailers are also chasing a shrinking pool of consumers. Not only is U.S. population growth slowing, America’s largest demographic groups—milliennials and baby boomers—aren’t at their food-buying peaks.
“I don’t have the energy to work full-time and make my own food,” said Leah Steinberg, a 32-year-old unemployed software engineer who recently moved back in with her parents in St. Paul, Minn. Ms. Steinberg struggled to make healthy meals for herself while working, and now relies on her family to shop and cook while she searches for a new job.
Grocery executives say they have survived competition on thin margins in the past, and that they conduct detailed studies before building new stores. “We’re comfortable with the amount of square footage there is [in] the market at the moment,” said Andrew Nadin, chief marketing officer for Schnuck Markets Inc., a St. Louis-based chain of around 100 stores.
Food, beverages and other consumables account for about a third of transactions at pharmacies. Fresh fruit for sale at a Walgreens in New York.
Food, beverages and other consumables account for about a third of transactions at pharmacies. Fresh fruit for sale at a Walgreens in New York. PHOTO: MARK LENNIHAN/ASSOCIATED PRESS
But consumers are increasingly turning to nontraditional options. While about 37% of sales of consumable items such as food and beverages still take place at traditional supermarkets, with the sector posting more than $440 billion in sales last year, it was a 6% drop from 2015, according to Inmar Willard Bishop Analytics.
Meanwhile, convenience stores sold $73 billion worth of prepared foods, beverages and other food service last year, up 72% from 2010, according to the National Association of Convenience Stores. Two-thirds of sales at dollar stores come from food, beverages and other consumables, while they account for about a third of transactions at pharmacies.
Brick-and-mortar supermarket locations also compete for consumers choosing to shop online. For instance, Bill Garrett, a 55-year-old home health-care company officer from Wilmette, Ill., said he sliced about a third off his weekly grocery bill of $150 by shopping on Amazon. Amazon made a $13.7 billion bid for Whole Foods Market Inc. in June, a move analysts say could further acclimate shoppers to the concept of online grocery shopping.
Supermarket chains operating in dense areas where shoppers have more online grocery options are particularly vulnerable to future consolidation, according to Barclays Capital Inc., which said that 38 of the top 50 grocery markets in the U.S. are already too saturated by food retail per capita or are on track to be so by next year.
“Everybody should stop growing,” said Barclays analyst Karen Short. “It would make the whole industry much healthier.”
—Annie Gasparro contributed to this article.
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Speaking of healthcare and supermarkets–from a New Yorker article on a capitation model of HC reimbursement:
“[Capitation] encourages maintaining health. Geisinger Health System, which is based in Danville, Pennsylvania, has used a capitation model for more than a century. Geisinger has long known that many of its diabetic patients live in areas with an abundance of fast-food places but no supermarkets. Last year, it began providing free, healthy groceries to those patients through a hospital pharmacy. “The results are so spectacular,” David Feinberg, the C.E.O. of Geisinger, told me. The average weight and blood pressure among diabetics fell, and fewer required dialysis or eye surgery, a costly side effect of unchecked diabetes. The cost for the food was two thousand dollars a year per patient. The savings from doing fewer procedures will come to more than twenty-four thousand dollars a year per patient. Similar experiments elsewhere in the country show better outcomes at a lower cost for joint replacement, post-surgical care, and over-all population health.” [emphasis mine]
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That’s incredible and should be a wake-up call to certain posters cough cough that can’t seem to grasp how our unhealthy lifestyle greatly influences our health care costs.
*It also highlights one of the obvious (you’d think anyway) shortcomings of healthcare. It’s reactive by nature.
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Agree with that being a significant contributor to our high infant mortality rate.
I can help Leah learn to cook her own food and get another job. It’s the generations-old technique my grandparents handed down to me… It’s called a swift kick in the ass.
“But being an adult is hard! I have to cook my own food?!” Lmao. Her parents failed her. Somewhere right now somebody in Africa is stepping on a landmine or getting a fatal infection. Suck it up princess.
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