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Harry Tuttle is offline Harry Tuttle

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Mar 2003
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  Old Post 10-06-2004 06:53
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quote:
Originally posted by KrazyHorse


Depends on how you count revenues and how you count expenditures. If you're doing a cost efficiency analysis you count certain things as expenditures which may be funded by a source not generally counted as revenue (his example was grants of equipment and private donations, IIRC)



Why? It doesn't matter where the money's coming from, it just matters how much money they each spend (including all sources of expenditures).

Too lazy to even read the rest of the standard 10 page Berzerker reply.


Well I would have gone ino immense detail, but your answer to my intial post wasn't very inspiring.

Also, have you taken the issue of "risk" into your calculations? A Non-Profit that has its utility costs subsidized has a very free hand to spend its money elsewhere.

Remember, revenues may not be taken directly into your cost efficiency model, but the impact of revenues and cash flow on the ebb and flow of the accounts in your model are immense.

EDIT: deleted "account"

Last edited by Harry Tuttle on 10-06-2004 at 07:30

Asher is offline Asher
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quote:
Originally posted by Aeson
CostOfProduction, while a variable, is the same across both equations.

It most certainly is not. CostOfProduction depends on the market situation, which is dramatically different across both situations.

Berzerker is offline Berzerker
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  Old Post 10-06-2004 07:01
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quote:
Remember, revenues may not be taken account directly into your cost efficiency model, but the impact of revenues and cash flow on the ebb and flow of the accounts in your model are immense.


Exactly! Money is fungible, and one of the complaints about comparing Catholic schools with public schools is that the Church heavily subsidises it's schools thereby lowering tuition.

quote:
Why? It doesn't matter where the money's coming from, it just matters how much money they each spend (including all sources of expenditures).


But if they don't have the same input, comparing the output becomes problematic.

quote:
Too lazy to even read the rest of the standard 10 page Berzerker reply.


Were you too lazy to read the article? Most of my post addressed the article, are you going to complain to Sava for posting a lengthy article now?

KrazyHorse is offline KrazyHorse
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The for-profit spends money on insurance. If the government is effectively a free insurance provider to the non-profit then why can't this expense be taken into account?

Non-profits (at least in Canada) have a similar or even bigger problem when it comes to revenue uncertainty. The government does not write a big blank cheque to cover all expenditures; it authorises a certain amount of money to be spent by each hospital, pays doctors a certain amount per patient up to a limit of billable hours per year etc. If you have to treat more patients than normal then you run into very serious trouble.

At least a for-profit knows that every time it treats a patient it gets money (excluding bad debts, which are certainly covered by yet another insurance policy).

notyoueither is offline notyoueither
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  Old Post 10-06-2004 07:03
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quote:
Originally posted by Berzerker
quote:
"It should be driven by evidence, not people's ideology."


quote:
Woolhandler and Himmelstein, both prominent in a group called Physicians for a National Health Program, have long argued for comprehensive, nonprofitmaking health insurance for all Americans.




It took this long for someone to notice that? Heh.

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  Old Post 10-06-2004 07:11
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quote:
Originally posted by Asher

It most certainly is not. CostOfProduction depends on the market situation, which is dramatically different across both situations.


It should be simple for someone like you with a computer background. You define a variable. Whatever that variable is, while unchanged, remains unchanged... imagine that. My use of CostOfProduction, without modifiying CostOfProduction between uses, obviously means CostOfProduction remains the same between equations. Yet you disagree that it is the same thing in my equation.

Now, I think what you were trying to say is not that "[CostOfProduction] most certainly is not [the same across both equations]", but rather that "CostOfProduction should not be used in both equations without modification to accurately model all factors involved."

I would agree with that statement, and as I have noted (and you have failed to acknowlege), the intent of my statement was not to model every factor, but to make a specific reference to the direct link between profit margin and price.

Do you suggest that profit margin and price are not linked?

notyoueither is offline notyoueither
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  Old Post 10-06-2004 07:13
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quote:
Originally posted by KrazyHorse
Why? It doesn't matter where the money's coming from, it just matters how much money they each spend (including all sources of expenditures).


Yes, it does.

If a non-profit or state owned entity is assured to be there tomorrow and next year due to stipends from the public purse, they will behave in different ways than would a private enterprise which has to constantly justify it's continued operations to either a bank or shareholders, or both. So, a private enterprise hospital might have to invest heavily in marketing and advertising, which is something a state-suckling entity would not do much of at all. Bang, up go your costs and down goes your 'efficiency'.

I'm not an expert on hospital administration, but I'd bet my left nut that adminstrative expenses could also be lessened by pooling some functions among the various publically funded hospitals in a region, rather than having each fend for itself. Of course, that might also be offset if there were large combines of privately run facilities in the same geographical area, but if not... Bang, up go your costs and down goes your 'efficiency'.

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  Old Post 10-06-2004 07:16
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quote:
Originally posted by Aeson
CostOfProduction, while a variable, is the same across both equations.


No, it's not. See above.

quote:
Tax status (among other things) has been left out of the equation. I've noted it isn't an equation designed to simulate the universe. It's just to point out a simple factor involved. Increasing profit margin, while cost of production remains the same, increases price. How doesn't that make sense to you?


OK, but you are discussing apples-apples equations in an apples-oranges situation.

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quote:
Originally posted by Aeson
It should be simple for someone like you with a computer background. You define a variable. Whatever that variable is, while unchanged, remains unchanged... imagine that. My use of CostOfProduction, without modifiying CostOfProduction between uses, obviously means CostOfProduction remains the same between equations. Yet you disagree that it is the same thing in my equation.

What I'm saying is there's no point in saying it unless they were the same, and they are clearly not the same.

You are either trying to mislead people, or you were stupid and now are trying to backtrack.

Simple stuff.

My computer background tells me what you wrote is an unreachable branch, and would be discarded by the compiler in an optimization stage.

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orangesoda
Nov 2001
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  Old Post 10-06-2004 07:25
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Your computer background is misleading you then.

To analyze a factor you must first isolate it. You isolate the factor by minimizing the impact of all other factors. Here is a very simple example for you: (I'm sure you'll see where this is going right off )

What temperature does water boil at?

Asher is offline Asher
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  Old Post 10-06-2004 07:27 Visit Asher's homepage!
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quote:
Your computer background is misleading you then.

To analyze a factor you must first isolate it. You isolate the factor by minimizing the impact of all other factors. Here is a very simple example for you: (I'm sure you'll see where this is going right off )

What temperature does water boil at?

Do you have any clue what's going on?

The problem was your statements are unrealistic, misleading, and completely ficticious. It's fine as far as fantasy land mathematics go, but that's not what the context was. Deal.

notyoueither is offline notyoueither
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  Old Post 10-06-2004 07:28
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quote:
Originally posted by KrazyHorse
The for-profit spends money on insurance. If the government is effectively a free insurance provider to the non-profit then why can't this expense be taken into account?

Non-profits (at least in Canada) have a similar or even bigger problem when it comes to revenue uncertainty. The government does not write a big blank cheque to cover all expenditures; it authorises a certain amount of money to be spent by each hospital, pays doctors a certain amount per patient up to a limit of billable hours per year etc. If you have to treat more patients than normal then you run into very serious trouble.

At least a for-profit knows that every time it treats a patient it gets money (excluding bad debts, which are certainly covered by yet another insurance policy).


Except, we aren't allowed to have for-profits that deliver anything on the covered services list, and then there are even more restrictions. Like hip replacements.

Throw the above into the equation with your only so many billable hours bit, and you might see why we have waits measured in months and years for procedures that take days and weeks in the States.

Also, since the funding for beds by the government is a choke on the system, no entity running a hospital in Canada could ever be short of clients. The demand is that high. A private hospital in our system would make a killing delivering high quality services, fast. They wouldn't have to advertise. That is why the unions are so paranoid about even the possibility of the field being opened up. They prefer the system where they are assured jobs, and Joe Public can die for all they care if he can't last through the waiting line.

Aeson is offline Aeson
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orangesoda
Nov 2001
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  Old Post 10-06-2004 07:29
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Yes, you are avoiding all my questions. That is what is going on.

Asher is offline Asher
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quote:
Originally posted by Aeson
Yes, you are avoiding all my questions. That is what is going on.

What's going on is you're clearly insane. I don't see what point there is to answering when water boils.

Aeson is offline Aeson
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orangesoda
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  Old Post 10-06-2004 07:31
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To illustrate a principle in a manner which I feel you can understand.

Asher is offline Asher
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quote:
Originally posted by Aeson
To illustrate a principle in a manner which I feel you can understand.

Why do you think I don't understand?

I understand you made a statement which is valid strictly mathematically. What it fails in is being accurate in the sense you used it in, which is the context of this thread.

I understand what you were trying to do, and you were blatantly wrong, so you should quit trying to "make me understand" and think hard about what you said...

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orangesoda
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  Old Post 10-06-2004 07:35
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If you understand then why did you say you didn't understand why I would offer the question?

I still don't think you understand. You certainly don't understand what I was trying to do.

Harry Tuttle is offline Harry Tuttle

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  Old Post 10-06-2004 07:36
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I'd make the assertation that a for-profit "hospital" - meaning over 250~ beds, cannot thrive in North America, just for the simple fact that the most profitable procedures usually do not require a hospital stay. Basic emergency care and basic surgeries just aren't profitable enough to sustain a for-profit.

So again, I'll say that the article, while noting a few decent points, is really comparing two different animals.

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  Old Post 10-06-2004 07:43
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Could you elaborate on that, Harry? You've actually been in the middle, so I'd like to know why you think that $ per day for a bed couldn't be profitable. It is for hotels, but they do it by the night.

Asher is offline Asher
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quote:
Originally posted by Aeson
If you understand then why did you say you didn't understand why I would offer the question?

I still don't think you understand. You certainly don't understand what I was trying to do.

I don't think it matters what you were trying to do, because your statements were wrong.

And it's that simple.

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orangesoda
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  Old Post 10-06-2004 07:49
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No, they were mathmatically correct.

Also, I've told you my intent 3 times already and you still haven't figured it out. I'm sure your intent has something to do with this, but that's not important now is it?

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quote:
Originally posted by Aeson
No, they were mathmatically correct.

This is not a mathematical thread, and once you actually use the real values of CostOfProduction, it is incorrect.

I don't care how you're trying to backpedal and obfuscate this, it's pretty damn clear.

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orangesoda
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  Old Post 10-06-2004 07:56
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The point wasn't dependent upon CostOfProduction. The point was to isolate profit and price and show the relation. You fail to grasp this, and keep saying CostOfProduction isn't static across all situations, which I have repeatedly agreed with.

You have yet to even reference my point. All you are doing is agreeing with me in an obtuse and argumentary manner. When I ask you a direct question, you duck it, because you are afraid to answer.

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quote:
Originally posted by Aeson
The point wasn't dependent upon CostOfProduction. The point was to isolate profit and price and show the relation. You fail to grasp this, and keep saying CostOfProduction isn't static across all situations, which I have repeatedly agreed with.

You still don't get it.

My point was you were misleading people. It's obvious the quote was intended to show that CostOfProduction is the same across both formulas, which it most certainly is not.

You supposedly agree with that now, but in doing so you admit you were misleading people to begin with, or just being stupid.

It's so utterly simple I'm perplexed that you're so confused.

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  Old Post 10-06-2004 08:12
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I get what you're saying. You're just ignoring what I am saying and going off on your own halfwitted guesses as to my intent instead of actually listening to what I stated it was. You do this so you can conjure other intentions on my part to support your inane arguments.

I did not make the statement that CostOfProduction was the same across all hospitals. Only that it was the same in a given hospital compared to itself. You saying CostOfProduction != CostOfProduction because you don't understand the context.

I assumed that the reader would be intelligent enough to understand the use of variables, which seems to have alluded you. First you called my variable a *gasp* variable, which is a laughable argument in that all you are doing is pointing out what you were trying to refute. Then you ignore every explaination on my part as to what my intent was. Then you duck every question I ask. Then you call me insane and that you can't understand where I am coming from, then that you understand where I am coming from. And you still haven't once referenced my point.

This has been one of the most entertaining conversations I've had in a long time. Thanks!

Harry Tuttle is offline Harry Tuttle

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quote:
Originally posted by notyoueither
Could you elaborate on that, Harry? You've actually been in the middle, so I'd like to know why you think that $ per day for a bed couldn't be profitable. It is for hotels, but they do it by the night.


Well it's not the amount charged for a room per say. All hospitals make some money off of overnight room stays. The problem is that a lot of the cost involved with the room stays is in the form of nurses on call, laundry, medical supplies, etc... Hotels make a profit because they have low overhead, don't really provide much in the way of ample service for a room besides the usual cleaning, and have a small staff. Hospitals of course demand steriliziation and a large amount of trained professionals so the costs per room are higher.

As for the procedures I'll point out a nice Harvard Business school example I read while getting my MBA. There is a for-profit facility/hospital (can't recall where, probably Maine or something) that focused exclusively on hernia operations. The facility had a new way of repairing the torn tissue that allowed a quicker recovery period for the patient. Because the profit from each patient consisted predominantly of the operation itself and the majority of the costs involved were from overnight stays, the facility simply had a policy of limiting stays to one night. Behold, they make a fortune.

In that example they focused exclusively on where their profit lies, the operation itself. Now, in a traditional hospital that is non-exclusive in its procedures (ER, basic surgeries like gall bladder removal, broken legs) the revenue generated is low and the costs are high. The procedures are numerous, but the profit margin for each procedure is not.

Anyways, what I'm trying to say is, that because for-profits are not privy to the benefits that a non-profit would enjoy they cannot afford to offer the traditional array of hospital services and expect to remain profitable much less solvent. Specialization and niche marketization seem to be the only key to for-profits to stay in business.

So when I say that a 250+ bed traditional for-profit hospital cannot thrive it's because there is to much overhead - just from traditional procedures and hospital stays alone.

Asher is offline Asher
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quote:
Originally posted by Aeson
I get what you're saying. You're just ignoring what I am saying and going off on your own halfwitted guesses as to my intent instead of actually listening to what I stated it was.

The reason being I don't care about your intent, because it doesn't matter. I've said this twice now.

If it was your intent to make a point, you failed miserably.
If it was your intent to make a bullshit post, you succeeded.

Why? I've no idea, nor do I really care. Just saying how it is...

quote:
I did not make the statement that CostOfProduction was the same across all hospitals. Only that it was the same in a given hospital compared to itself. You saying CostOfProduction != CostOfProduction because you don't understand the context.

I assumed that the reader would be intelligent enough to understand the use of variables, which seems to have alluded you.

Just how much math have you actually done? It's all about the context.

You were trying to make the point that non-profit organizations are somehow more efficient. You did it by posting two equations with parallel structure, and it's very clear that the implication was the one with the variable plus another variable is higher than the one with the originally variable only.

Perhaps you were underestimating the intelligence of the reader, because the reader called you on the ridiculousness of the statement, something you cannot even fathom yet...

Your statement was this:
quote:
CostOfProduction = Price1
CostOfProduction + Profit = Price2

There is no relevance, at all, to this debate unless it is assumed CostOfProduction is the same. And when this is the case, it is obviously false. When it is not the case, it makes as much sense as saying:
quote:
Exactly Spiffor!
3 = 3
1 + 1 = 2


Then you try to overcomplicate things in an attempt to save face, and when that backfires you just back out...

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  Old Post 10-06-2004 08:28
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As a contrast to the opening post which seems to show that public healthcare has all the answers.

http://www.ctv.ca/servlet/ArticleNe...086696932080_14
quote:
Medicare goes on trial in Supreme Court case
CTV.ca News Staff

The Supreme Court is hearing a case that could have significant implications for universal medicare. A Quebec doctor and a patient are arguing their rights are violated by a law against queue-jumping.

George Zeliotis spent more than a year waiting for a hip replacement in 1997. He says he should have had the right to pay for the surgery himself. So, he's brought his fight to the Supreme Court, along with another man, Dr. Jacques Chaoulli.

It's illegal in Canada to pay for surgery that's covered by medicare. Chaoulli and Zeliotis say that months spent waiting for surgery amounts to a violation of the constitutional right to receive treatment within a reasonable time.

They argue that patients should have a right to pay for certain services from private doctors. Doing so, they say, would pose no threat to the public health-care system.


They want the court to overturn portions of the Quebec Health Insurance Act and Quebec Hospital Insurance Act that prohibit payments for medically necessary services.

The argument has divided the medical community in a debate over the effectiveness and implications of a parallel private system. Advocates contend private services would take advantage of existing capacity in the medical system.

But critics say it would further restrict access for those who can't afford to pay. They say if the court rules in favour of Chaoulli and Zeliotis, Canada would be forced into two-tier health care. They want the current system fixed, not scrapped.

As the case began in Ottawa on Tuesday, protesters on both sides of the argument gathered outside the Supreme Court to register views. Canadian Health Coalition lawyer Martha Jackman was one of those on hand to say the Supreme Court case is no way to cure what ails medicare.

"We agree the publicly funded health care system has problems," Jackman told CTV News. "But lets fix it. The remedy they're suggesting is like euthanizing a patient who has the flu."

Two years ago, the Quebec Superior Court ruled that the provincial law's intention was to prevent discrimination based on ability to pay. They said that was in line with the Charter of Rights.

In a decision last year, the Quebec Court of Appeal also dismissed Chaoulli and Zeliotis' challenge to the provincial law.

The Supreme Court could allow the existing law to stand, strike it down, or order the government to find another cure, such as injecting more money to reduce wait lists.

A ruling isn't expected until this fall.


Emphasis added.

I am told that people in need of hip replacements can be in significant pain. So much so that a woman paid $30,000 to go to the States to have her's done in 3 weeks instead of the 6 months she was told to weait in BC. [She was in a related spot that was in the news on this last night, but does not appear in the on line version of the SCoC case.]

Why do we Canadians tolerate what is being done in our names in the name of health? The italicised bit is standard fare. Hysterics is the correct word, I believe. We are led to believe that the alternative to the ONLY 100% public system in the G7 is the complete destruction of health care for the masses.

Canadians should not have to wait for over a year to get a needed procedure. Americans should not face the prospect of no coverage and being cast adrift. The answer is in neither of the systems as they exist today in Canada and the US.

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Oh, and the last bolded bit has to be false. Should the SCoC ever pass a judgment that would require expenditures on a massive scale...

Can you say taxation without representation?

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quote:
Originally posted by Harry Tuttle


Well it's not the amount charged for a room per say. All hospitals make some money off of overnight room stays. The problem is that a lot of the cost involved with the room stays is in the form of nurses on call, laundry, medical supplies, etc... Hotels make a profit because they have low overhead, don't really provide much in the way of ample service for a room besides the usual cleaning, and have a small staff. Hospitals of course demand steriliziation and a large amount of trained professionals so the costs per room are higher.

As for the procedures I'll point out a nice Harvard Business school example I read while getting my MBA. There is a for-profit facility/hospital (can't recall where, probably Maine or something) that focused exclusively on hernia operations. The facility had a new way of repairing the torn tissue that allowed a quicker recovery period for the patient. Because the profit from each patient consisted predominantly of the operation itself and the majority of the costs involved were from overnight stays, the facility simply had a policy of limiting stays to one night. Behold, they make a fortune.

In that example they focused exclusively on where their profit lies, the operation itself. Now, in a traditional hospital that is non-exclusive in its procedures (ER, basic surgeries like gall bladder removal, broken legs) the revenue generated is low and the costs are high. The procedures are numerous, but the profit margin for each procedure is not.

Anyways, what I'm trying to say is, that because for-profits are not privy to the benefits that a non-profit would enjoy they cannot afford to offer the traditional array of hospital services and expect to remain profitable much less solvent. Specialization and niche marketization seem to be the only key to for-profits to stay in business.

So when I say that a 250+ bed traditional for-profit hospital cannot thrive it's because there is to much overhead - just from traditional procedures and hospital stays alone.


Couldn't need for profit from procedures be reduced by rates for stays per day being profitable as well? What would prevent that?

 
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