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Don’t Believe The Democrats’ “Medical Bankruptcy” Narrative

Don’t Believe The Democrats’ "Medical Bankruptcy" Narrative

Authored by Sally C. Pipes via RealClear Health (emphasis ours),

Americans collectively have about $140 billion in outstanding medical debts, according to a recent study published..

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Don't Believe The Democrats' "Medical Bankruptcy" Narrative

Authored by Sally C. Pipes via RealClear Health (emphasis ours),

Americans collectively have about $140 billion in outstanding medical debts, according to a recent study published by the Journal of the American Medical Association.

Alyssa Keown/Battle Creek Enquirer via AP

Those hefty bills are driving many people into bankruptcy – at least according to prominent progressives. Left-wing leaders have long stoked fears of "medical bankruptcy" to boost support for government-run, single-payer healthcare.

During his last run for president, Senator Bernie Sanders, I-Vt., declared that enormous medical bills force a staggering 500,000 people to declare bankruptcy each year – a fact that, if true, would justify drastic reforms to the healthcare system.

But the dystopian portrait painted by Sanders and his allies doesn't reflect reality. Medical bills can certainly be onerous to many families. But they're rarely the sole, or even the main, cause of personal bankruptcies.

Sanders based his numbers on a 2019 editorial published by the American Journal of Public Health. The authors conducted a study in which about two-thirds of the 700,000 debtors surveyed said medical expenses contributed "somewhat" or "very much" to their bankruptcy.

That's not exactly a direct, causal relationship. A more accurate conclusion would be that medical expenses played a role in families' deteriorating finances.

Often, the main cause of bankruptcy isn't a surge in debt – it's a precipitous drop in income. Someone diagnosed with cancer may certainly face burdensome medical bills. But the far bigger threat to one's finances comes from no longer being able to work full-time – or at all – during a treatment regimen.

Other research confirms that healthcare bills alone rarely drive people into bankruptcy. A 2018 study in the New England Journal of Medicine analyzed the percentage of people with medical bills who went bankrupt, rather than how many bankruptcy filings included some level of medical debt. The study concluded that medical bankruptcies, specifically those caused by hospitalization, make up just 4% of all bankruptcies.

Facts like these haven't slowed the push for single payer. Representative Pramila Jayapal, D-Wash., the chair of the Congressional Progressive Caucus, seized upon the JAMA study's $140 billion statistic soon after it was published, tweeting that the solution was Medicare for All.

The thinking goes that enrolling most Americans in a fully government-run healthcare system funded by tax dollars – rather than the current mix of public and private money – will prevent people from going bankrupt.

But once again, the math doesn't check out. Government-sponsored, single-payer healthcare isn’t "free." It’s funded by enormous, broad-based taxes on businesses and workers alike. Those taxes constrain economic growth and, by definition, leave people with less cash on hand to meet their other financial obligations.

Consider Canada, which has a single-payer system revered by American progressives. A family making the average income of 75,300 Canadian dollars – about US$59,700 – pays $6,500 in taxes just to cover its share of the national health insurance tab, according to a September 2021 report from the Fraser Institute, a Canadian think tank. An average family of four pays an estimated $15,039 in healthcare taxes. Those figures are on top of all the other taxes Canadians pay to support everything from education to national defense.

Canadians pay a higher share of their total compensation to the government than Americans, according to OECD data.

That explains, in part, why Canadians declare bankruptcy at higher rates than their U.S. counterparts. In 2019 – the year before the pandemic and its ensuing flood of stimulus programs caused a marked decrease in bankruptcies in both countries – about 137,000 Canadians sought protection from insolvency, out of a total population of almost 38 million, a rate of 3.6 bankruptcies per 1,000 residents.

That same year, slightly more than 770,000 Americans declared bankruptcy, out of a total population of 329 million at the time – a rate of 2.3 bankruptcies per 1,000 residents.

Medical bills don't cause nearly as many bankruptcies as progressive lawmakers want people to believe. And single payer certainly wouldn't prevent people from going insolvent.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Healthcare Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.

Tyler Durden Sat, 01/22/2022 - 20:20

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Spread & Containment

Ontario election gives voters the chance to choose people over profits in long-term care

Ontario voters can bring about change by prioritizing people over profits and casting our ballots for those committed to transforming long-term care into…

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Flowers sit on a bench in front of a for-profit long-term care home in Pickering, Ont., where dozen of seniors died of COVID-19, in April 2020. THE CANADIAN PRESS/Frank Gunn

In the wake of the COVID-19 pandemic, there’s a once-in-a-generation opportunity to correct how public funds will be allocated for long-term care in Ontario. The choice is between more profits for shareholders or reinvestment in care for seniors and improved working conditions for employees.

Ownership in Ontario’s publicly funded long-term care is currently split between two types of providers.

First, there are for-profit facilities, owned largely by real estate companies that hold and/or manage licences to provide care. My research has found that currently, 60.1 per cent of the beds are owned or managed by for-profits. This group is a mixture of public corporate chains, real estate investment trusts and private equity firms. Six in 10 people who live in long-term care in this province do so under a profit-taking model.

The second group are care homes that happen to own real estate and reinvest surplus back into the home. Nearly four of 10 bed licences (39.9 per cent) are owned by this group. The latter are typically called not-for-profit, although they may also be publicly owned.

Even before the pandemic, for-profit facilities were associated with significantly higher rates of mortality and hospital admission, suggesting there’s significantly worse quality of care overall in for-profit than in non-profit and public homes.

In addition, the devastation in long-term care during the height of the pandemic’s first and second waves happened mostly in for-profits, where a higher proportion of residents died. There was a 25 per cent higher risk of death from COVID-19 in for-profit facilities.

A row of white crosses on a green lawn. A small Canadian flag is attached to one of the crosses.
Crosses are displayed in memory of elderly people who died from COVID-19 at a for-profit long-term care facility in Mississauga, Ont., in November 2020. THE CANADIAN PRESS/Nathan Denette

Renegotiating licences

The Ontario government is currently approving licences with operators for up to 30 years. About one-third of the existing bed licences (26,531 beds) in 257 long-term care homes will expire by June 30, 2025. These licenses are in various stages of being renegotiated for the next 30 years.

The current government also announced there will be 30,000 new beds and 28,000 upgraded beds in place by 2028, also at various stages of approval. With the renewals, renovations and construction, what happens to long-term care licences in the next calendar year will shape the course of long-term care for the next 30 years.

A vote in this election therefore represents a choice between more for-profits or a move towards non-profit long-term care.


Read more: Canadians want home care, not long-term care facilities, after COVID-19


Long-term care licences can be very lucrative. Each new bed built is eligible for a construction funding subsidy, known as a CFS, calculated per day. The CFS ranges from $20.53 to $23.78 per day depending on where the home is located; large urban settings have higher subsidies. This is in addition to the funding an operator receives from government to provide care and food.

If a home has 160 beds, an additional 75 cents per bed per day is added to the subsidy. In the most expensive urban market with 160 beds (five units of 32 people), tax dollars will fund that organization $3,924.80 per day in capital costs to a maximum of $51,376 per bed — or a subsidy for the building of $8,220,160.

These subsidies are meant to cover between 10 to 17 per cent of capital costs. Rural beds are capped at a maximum subsidy of $29,246 per bed annually, while large urban centres cap at $51,376 per bed.

There are no upper limits on bed numbers, so it’s difficult to calculate the maximum subsidy. There are few homes in the province exceeding 160 beds, but that could change. The public doesn’t have a stake in the ownership of a home due to the subsidies.

Accommodation fees

Facilities also collect and retain rental accommodation fees from residents. For semi-private, shared nursing home rooms, a resident will pay $2,280.61 monthly at current rates, and for a private room, residents are charged up to $2,701.61 per month. Those living in for-profit retirement homes, many of whom are on waiting lists for a long-term care bed, are not included in this model.

If 60 per cent of the rooms are private and not shared, and assuming current accommodation rates, my calculations show the home will collect and retain $116,719,810 in accommodation fees over the 30-year licence, or nearly $4 million per year.

These funds collected for accommodation rental are completely separate from the funds publicly paid to support care, currently set at $187.73 per day for a home operating at 100 per cent based on the complexity of the needs of its residents.

If the current government or any successive government replicates past decisions, more than 65,000 Ontarians a year will live in a for-profit facility — many run by corporations focused on their real estate investments — in the next decade. If we follow a different path, these subsidies could fund operators that are primarily care organizations and where real estate holdings support the care, not the other way around.

A man pushes his walker as he strolls outside a long-term care home.
A man takes a walk outside the not-for-profit Seven Oaks Long-Term Care Home in Toronto in June 2020. THE CANADIAN PRESS/Frank Gunn

No one should assume they or their loved ones won’t need long-term care. All modern and caring societies have long-term care. The difference is that in countries like Norway, the focus is on high-quality, publicly delivered care, not on favouring for-profit real estate models.

Certainly not everyone will need long-term care. Not everyone needs open-heart surgery. But we do need high-quality public health care so that no one has to contemplate losing their life savings to survive. Those who need long-term care are among society’s most vulnerable members, and they deserve the very best quality of care and for every dollar to be invested in ensuring their care is top-notch.

No further study of this issue is required. Those living in for-profit facilities fare worse than those in non-profits and public homes.

In Ontario, we can prioritize people over profits by casting our ballots for those committed to transforming long-term care into a non-profit model focused on high-quality care. Know which party supports non-profit, long-term care and vote accordingly.

Tamara Daly receives funding from the Canadian Institutes of Health Research and Social Sciences and Humanities Research Council

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Economics

Hotels: Occupancy Rate Down 3.5% Compared to Same Week in 2019

From CoStar: STR: Weekly US Hotel Revenue per Available Room Reaches Highest Level Since July 2019U.S. hotel performance increased from the previous week, according to STR‘s latest data through May 21.May 15-21, 2022 (percentage change from comparable …

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U.S. hotel performance increased from the previous week, according to STR‘s latest data through May 21.

May 15-21, 2022 (percentage change from comparable week in 2019*):

Occupancy: 68.6% (-3.5%)
• Average daily rate (ADR): $151.75 (+13.4%)
• Revenue per available room (RevPAR): $104.06 (+9.5%)

*Due to the pandemic impact, STR is measuring recovery against comparable time periods from 2019.
emphasis added
The following graph shows the seasonal pattern for the hotel occupancy rate using the four-week average.

Click on graph for larger image.

The red line is for 2022, black is 2020, blue is the median, and dashed light blue is for 2021.  Dashed purple is 2019 (STR is comparing to a strong year for hotels).

The 4-week average of the occupancy rate above the median rate for the previous 20 years (Blue).

Note: Y-axis doesn't start at zero to better show the seasonal change.

The 4-week average of the occupancy rate will mostly move sideways seasonally until the summer travel season.

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Economics

“This Is A Crucible Moment” – Sequoia’s Ominous Warning To Companies On How To “Avoid The Death Spiral”

"This Is A Crucible Moment" – Sequoia’s Ominous Warning To Companies On How To "Avoid The Death Spiral"

"This is not a time to panic. It is…

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"This Is A Crucible Moment" - Sequoia's Ominous Warning To Companies On How To "Avoid The Death Spiral"

"This is not a time to panic. It is a time to pause and reassess," begins the thought-provoking presentation from veteran venture capital firm Sequoia Capital.

But that's about as 'positive' as they get as the founders of the firm warn of a prolonged market downturn and urges the startups in its portfolio to preserve cash and brace for worse to come.

"We believe this is a Crucible Moment, one that will present challenges and opportunities for many of you. First and foremost, we must recognize the changing environment and shift our mindset to respond with intention rather than regret."

And in its somewhat ubiquitous historically grim outlooks (its "R.I.P Good Times" in 2008 and "Black Swan" memo in March 2020 have become legendary) don't expect a quick rescue and recovery this time.

"Sustained inflation, and geopolitical conflicts further limit the ability for a quick-fix policy solution. As such, we do not believe that this is going to be another steep correction followed by an equally swift V-shaped recovery, like we saw at the outset of the pandemic," the note said.

They argue that it will be "Survival of the Quickest"...

In particular, Sequoia urged companies to look at cutting projects, R&D, marketing, and other expenses, noting that companies should be ready to cut in the next 30 days.

"We expect the market downturn to impact consumer behaviour, labour markets, supply chains and more. It will be a longer recovery and while we can't predict how long, we can advise you on ways to prepare and get through to the other side," it said.

The founders/CEOs who face reality, adapt fast, have discipline rather than regret will not just survive, but win, noting that "It is easier to preserve cash when you have more than six months left. Recruiting is about to get easier. All the FANG have hiring freezes."

They conclude their presenttation by noting that:

"At Sequoia, we believe that the one who wins is the one most prepared."

In other words America, brace for capex cuts, hiring freezes to accelerate, and growth to evaporate.

*  *  *

Read the full presentation below:

Tyler Durden Thu, 05/26/2022 - 15:45

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