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Re:If you imagine a business making surgical facemasks is wo... by mrosett on Sunday April 05, 2020 @07:18PM (#22789554)
One angle that this article missed: anti-price gouging sentiment has a lot to do with why the factory isn’t running 24/7. Imagine if he could charge 10x his normal price (ie $1/mask, which is much less than the value a mask provides.) I suspect plenty of employees would happily work 100 hour weeks for the duration of the crisis if they were getting paid $150/hr. Instead, he’s forced to take a slower, more conservative approach to ramping up to avoid risking bankruptcy.
Re:If you imagine a business making surgical facemasks is wo... by juiyout on Monday April 06, 2020 @02:27AM (#22791322)
Same in Taiwan, mask making has not been very profitable. Taiwan imports 93% of masks from China.

Govt stepped in quickly on the brink of this outbreak though. Govt called 34 companies together each responsible for different parts of mask manufacturing from material, machine parts, installation, assembly, etc and govt up front paid 6 million USD for 62 production lines to be installed and assigned military personnel to help man the lines 24/7.

Daily mask production ramped up from 3 million to 10 million in 3 weeks. This is only barely covering Taiwan's domestic needs. Taiwan is now aiming for daily production of 20 million.

For distribution, govt rations out all manufactured masks. Currently each citizen gets 9-10 masks every 2 week and I believe each doctor receives 40 per week. The price of the masks for regular folks is fixed at around 1 USD for 6 masks. It is free for med staff.

As for the installed production line, once the mask maker reached the production quota of 5 million masks for a particular production line, the mask maker gets to keep that production line for free. Note that the mask makers, once involved in this project, pretty much gave their business as usual.

I would think it is tax dollar well spent.

EDIT: Try and include some English references: - [https://focustaiwan.tw/business/202003090013] - [https://www.taipeitimes.com/News/taiwan/archives/2020/03/10/...] - [https://www.taipeitimes.com/News/editorials/archives/2020/03...] - [https://www.straitstimes.com/asia/east-asia/coronavirus-how-...] - [http://www.taipeitimes.com/News/front/archives/2020/02/15/20...]

Re:If you imagine a business making surgical facemasks is wo... by sebii on Monday April 06, 2020 @05:51AM (#22792169)
A comment in The Journal of the American Medical Association on Taiwan:

https://jamanetwork.com/journals/jama/fullarticle/2762689

and a timeline:

https://cdn.jamanetwork.com/ama/content_public/journal/jama/...

Re:If you imagine a business making surgical facemasks is wo... by jawilson2 on Monday April 06, 2020 @09:17AM (#22793429)
This sounds like artillery shell production in WW1.
Re:If you imagine a business making surgical facemasks is wo... by tedk-42 on Monday April 06, 2020 @04:15AM (#22791769)
Great post! Very informative. Crazy to think these masks are basically an essential item for many now
Re:If you imagine a business making surgical facemasks is wo... by eaenki on Monday April 06, 2020 @04:58AM (#22791961)
My Taiwanese friend living there that I met at Stanford says 3 masks per person per week.
Re:If you imagine a business making surgical facemasks is wo... by greedgenius on Monday April 06, 2020 @05:46AM (#22792150)
About a 1 month ago it is 3 masks/week. Now it's 9 masks/2 week. I live in Taiwan and can confirm the information is correct.
Re:If you imagine a business making surgical facemasks is wo... by MrsPeaches on Monday April 06, 2020 @03:24AM (#22791535)
This is pretty impressive. Do you have any sources?
Re:If you imagine a business making surgical facemasks is wo... by gpm on Sunday April 05, 2020 @07:28PM (#22789607)
From one perspective this is true.

From another perspective, he's having trouble getting long time contracts. Hospitals could give him that extra 90c per mask (10c per mask per the article, 1$ suggested price in your comment) by signing a contract to buy x masks every year for 10 years instead of just signing a contract to buy x masks.

It seems that the actual problem might just be hospitals being stingy.

Re:If you imagine a business making surgical facemasks is wo... by arkades on Sunday April 05, 2020 @11:16PM (#22790655)
> It seems that the actual problem might just be hospitals being stingy.

Hospitals have to stay afloat just like everyone else. If they go bankrupt, they close, just like everyone else.

If the government agrees it's a national security matter for us to have our own PPE production pipeline, then it needs to stop in. It can't expect private facilities, that have to make their own budget targets, to take on the cost of keeping up national priorities. That's literally what the government is for.

Re:If you imagine a business making surgical facemasks is wo... by taneq on Monday April 06, 2020 @03:33AM (#22791572)
Hospitals aren't going to sink or swim depending on whether they can save 10-15c per face mask, and being the U.S. they probably charge the patient $10/mask regardless.
Re:If you imagine a business making surgical facemasks is wo... by prostheticvamp on Monday April 06, 2020 @09:28AM (#22793505)
Hospitals don’t generally buy line items. Tiny healthcare centers do. Hospitals get tied into group purchasing organizations (GPOs), which control the supply pipeline to hospitals in exchange for buying at scale.

But that’s beside the point. Almost all disposable medical supplies are cheap in isolation. They build contracts for a whole bunch of supplies, in massive quantities, over time.

Those pennies add up.

Again, operating margins <2%.

Until you’ve internalized what that means, I don’t see a high value in going back and forth.

Re:If you imagine a business making surgical facemasks is wo... by cerberusss on Tuesday April 07, 2020 @01:40AM (#22800585)
Parent noted they're a a medical professional involved in procuring PPE for a small health chain. Above comment should not be voted down, IMHO.
Re:If you imagine a business making surgical facemasks is wo... by Aeolun on Monday April 06, 2020 @08:46AM (#22793208)
If they could pay $0.1 per mask before exporting the job to China for $0.02, then presumably they can do the same thing again and make marginally less profit.
[dead]
Re:If you imagine a business making surgical facemasks is wo... by PeterStuer on Monday April 06, 2020 @04:52AM (#22791926)
That is not a 'Republican' narrative, but a neo-liberal narrative. In the US that is available in two colors, red and blue.
Re:If you imagine a business making surgical facemasks is wo... by randallsquared on Monday April 06, 2020 @06:33AM (#22792409)
> the [Republican] party does not condone excessive government intervention.

Well, that's the rhetoric, but it's only that for most. Power first, principles later.

Re:If you imagine a business making surgical facemasks is wo... by Cyberdog on Monday April 06, 2020 @06:32AM (#22792402)
What Republican party are you looking at? The one that passed a law last week for $2 trillion in government intervention? The one that shut down my state for at least three weeks, causing me to lose my side job?

Sadly, small-government types (of which I am one, if by "small" you include "no") no longer have much of a home in the Republicans.

Re:If you imagine a business making surgical facemasks is wo... by mikemotherwell on Monday April 06, 2020 @02:05AM (#22791236)
So you think this policy was in place starting with Trump? Or was it with a Bush, but Obama chose NOT to repeal it? Or has it all started with Republican governors very recently?

This partisanship seems crazy to me, especially given that the bureaucratic system seems plain broken. Not broken based on Republican or Democratic ideology, just plain broken.

I'm not American, and it doesn't seem like in my country Australia these supply issues have been as bad, despite almost all of our supply coming from China.

Re:If you imagine a business making surgical facemasks is wo... by lazyasciiart on Monday April 06, 2020 @06:50AM (#22792513)
They haven’t been good. Australian doctors are wearing homemade masks just like Americans. https://www.physiciansweekly.com/were-not-hungry-we/
Re:If you imagine a business making surgical facemasks is wo... by Melting_Harps on Monday April 06, 2020 @07:36AM (#22792782)
> They haven’t been good. Australian doctors are wearing homemade masks just like Americans.

Wow, I had thought that due to political alliances and mutual dependence as well as proximity that Australia would be the first to get supplies from China. I guess this provides further credence that being politically cozy with CCP doesn't benefit you any more than a country who puts trade sanctions in place like the US.

That was a really sobering read, but this highlights the chaos that is currently taking place best:

> But staff in some stretched hospitals in NSW are facing tight restrictions on the use of higher specification N95 face masks and are relying on face shields made from plastic and rubber bands from hardware stores to stay safe.

> “Some are even using scuba gear,” said Andrew Miller, President of the Western Australia state branch of the Australian Medical Association.

> “We have doctors and nurses who have been disciplined for trying to wear a mask at work. It’s a situation full of conflict and confusion.”

The CCP (and by extension the WHO) should have to answer for Crimes against Humanity for trying to cover up COVID19 outbreak which got medical workers killed, and dissapearing citizen journalists who were trying to expose the dire nature of all of this.

I hope People now begin to realize (and support) why what Hong Kong is doing is imperative to not just their own interests, but in curtailing the expansion of this Authoritarian regime from being a dominant power in the World. For most people it's one thing to see it going on elsewhere and dismiss it as other People's problems, but a stark realization comes into focus when you see it's implications have affected not just your safety and livelihood but the whole World as its exhausting the foundations of daily Life.

Its par for the course for the CCP, I highly recommend people watch a documentary on how the CCP has and will continue to censor media and jail those who fail to repeat their narrative that ultimately lead to the World being in disrepute, as all of this could have been avoided:

https://www.youtube.com/watch?v=cKbd4EsbgMM

Also, if anyone works in the medical field and needs to get a source on masks, a yellow leaning Hong Kong factory (Yellow Factory) has begun making masks:

https://tinyurl.com/uw4umrd

https://www.facebook.com/yellowfactory2020/posts/12316591596...

Re:If you imagine a business making surgical facemasks is wo... by presumably on Monday April 06, 2020 @02:31AM (#22791343)
Clinton: https://en.wikipedia.org/wiki/Strategic_National_Stockpile

Republican ideology is abhorrent; one doesn’t have to be part of the Democratic Party to recognize that.

https://www.theatlantic.com/ideas/archive/2020/03/conservati...

Re:If you imagine a business making surgical facemasks is wo... by champagneben on Monday April 06, 2020 @11:35AM (#22794615)
From your Wikipedia link:

"In 2005 and in preparation for a predictable pandemic influenza, the Bush administration called for the coordination of domestic production and stockpiling of protective personal equipments.[6] In 2006, the US Congress funded the integration of protective equipment to a Strategic National Stockpile: 52 million surgical masks and 104 million N95 air-filtration masks were acquired and added.[6] During the 2009 flu pandemic, 100 million masks were used, but neither the Obama administration nor the Trump administration renewed the strategic stocks."

Re:If you imagine a business making surgical facemasks is wo... by mrosett on Sunday April 05, 2020 @09:39PM (#22790231)
Note that getting hospitals to agree to long term contracts at prices that are higher than they'd normally pay is basically a backdoor form of raising prices. From a financial perspective, there's not a huge difference between a) a hospital paying $0.80/mask for the next year and $0.02/mask for the following decade or b) $0.10/mask with a decade long contract.
Re:If you imagine a business making surgical facemasks is wo... by pdonis on Sunday April 05, 2020 @11:34PM (#22790709)
> From a financial perspective, there's not a huge difference between a) a hospital paying $0.80/mask for the next year and $0.02/mask for the following decade or b) $0.10/mask with a decade long contract.

Yes, there is: the cash flow for the two cases is very, very different. Case b) is doable for a reasonable cash flow. Case a) is impossible unless someone else besides the hospital provides the huge up front amount of cash required to pay $0.80/mask for the first year.

Re:If you imagine a business making surgical facemasks is wo... by gpm on Monday April 06, 2020 @01:07AM (#22791039)
Masks aren't a large enough portion of a hospitals budget for cashflow to be a major concern. Besides which loans exist (though we are neglecting to properly account for the future value of money in our napkin math).
Re:If you imagine a business making surgical facemasks is wo... by pdonis on Monday April 06, 2020 @11:41AM (#22794674)
> Masks aren't a large enough portion of a hospitals budget for cashflow to be a major concern.

Maybe not under normal circumstances, but these are not normal circumstances. Also, we're talking N95 masks, not ordinary surgical masks.

Re:If you imagine a business making surgical facemasks is wo... by gpm on Monday April 06, 2020 @11:49AM (#22794745)
Compare the cost of masks to the cost of the salary of the people using them. Under no circumstance is the cost of masks a major cashflow concern.

Nothing in the article says these are N95 masks, I don't believe you are correct. But also, what does that have to do with my comment?

Re:If you imagine a business making surgical facemasks is wo... by gpm on Sunday April 05, 2020 @10:26PM (#22790422)
Exactly! Financially the word for this is regulatory arbitrage. Since he was selling the masks at the same price before the crisis though I suspect that long term contracts would not fall afoul of whatever price gouging laws there are. It's also what it sounds like he is already doing, and maybe more socially acceptable.
Re:If you imagine a business making surgical facemasks is wo... by lugged on Sunday April 05, 2020 @10:03PM (#22790314)
If you can make masks for 10c its not price gouging to sell it at a normal markup from those costs. Its not even "basically a backdoor form of raising prices" It's literally just what it costs.

Also, I highly doubt this guy is using 10 year contracts.

If I was him I would only be selling to those hospitals that sign 100 year contracts with strict non compete clauses and defined rules around sourcing / pricing and failures to comply.

Re:If you imagine a business making surgical facemasks is wo... by rch on Monday April 06, 2020 @12:49AM (#22790981)
> 100 year contracts with strict non compete clauses and defined rules around sourcing / pricing and failures to comply.

Exactly. IIRC Sysco negotiates 50-99 year contracts with e.g. universities to supply on campus dining. It seems that firms in the healthcare supply chain would do the same.

Re:If you imagine a business making surgical facemasks is wo... by michaelt on Monday April 06, 2020 @09:50AM (#22793661)
Interesting. What does a customer do, in a 50-year contract, if the level of service drops or the product becomes obsolete?
Re:If you imagine a business making surgical facemasks is wo... by djyaz1200 on Sunday April 05, 2020 @11:15PM (#22790653)
Totally agree, he should accept orders from any org willing to sign a long term deal at his usual prices and run the factory 24/7.
Re:If you imagine a business making surgical facemasks is wo... by londons_explore on Monday April 06, 2020 @12:05AM (#22790827)
Most companies go bankrupt in a lot less than 100 years... In most cases, the full value of the contract would never be paid.
Re:If you imagine a business making surgical facemasks is wo... by Sabinus on Monday April 06, 2020 @04:22AM (#22791804)
It would still solve the problem of companies not purchasing while they're solvent but not urgently needing masks.
Re:If you imagine a business making surgical facemasks is wo... by bluGill on Monday April 06, 2020 @11:16AM (#22794465)
If a hospital agrees to purchase so much over time I'd give them a discount. Cash flow works much better if you get it, one time purchases are the most expensive because you have to pay for all of your costs now.
Re:If you imagine a business making surgical facemasks is wo... by richajak on Monday April 06, 2020 @06:42AM (#22792458)
not sure about giving him $1 per surgical mask is a right thing to do. The big component is the material, which need to be refined and coated. The material needs to be processed with expensive machine. According to article from NPR, even manufacturers in China depends on this German machinary supplier. It looks like the difference between 2c masks and 10c masks from his company is due to either business efficiency or labor cost. To pay 10c or 20c per mask to his company looks reasonable if he bought machine from Germany and made end-to-end production from raw material. However it does not seem reasonable to pay $1 if he simply buys ready-to-use materials, cut, and package.

As for long term contract, the argument is ok up to certain extend. The cost of machine is quite high, several $m, it is a fixed cost, but negligible with high production volume - not that high to justify 10y contract.

https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...

Re:If you imagine a business making surgical facemasks is wo... by mapgrep on Sunday April 05, 2020 @07:34PM (#22789640)
Not an extra 90 cents per mask, an extra 8 cents per mask.

“His masks may cost a dime each, but a made-in-China mask might go for two cents.”

A hospital charged my friend $5k for three stitches. They could pay 8 cents more per mask. But they care more about $$$ than the long term health of the country.

And I’m not even making a moral statement with that. It’s the natural consequence of making health care a capitalist endeavor. There are other approaches.

Re:If you imagine a business making surgical facemasks is wo... by arkades on Sunday April 05, 2020 @11:19PM (#22790668)
Not to undermine your dramatic point[1], but:

Most hospitals run at profit margins well below 10%. Median operating margins are in the vicinity of 2% (https://www.modernhealthcare.com/providers/operating-margins...) And for the last few years, expenses have been growing faster than revenues (though the rate of growth of expenses has slowed.)

Whatever you imagine they're bringing in, they're not.

Nor is their job to maintain the long-term health of the country. That's literally the government's job.

[1] Those numbers have a historical reason behind them, which people are either ignorant of or choose to ignore. The short version is: hospital prices are set as a part of the negotiations with insurers. Insurers account for the vast, vast majority of dollars going into hospitals, so their business operations are built completely and entirely around insurance dollars. Uninsured patients register as barely more than a rounding error. So while, yes, being uninsured in this context sucks, hospitals aren't gleefully rubbing their hands and going "muahaha, $5K for stitches!" They don't expect to see that 5K, they don't rely on that 5K, and they're not trying to gouge that uninsured person who's almost certainly not good for that 5K. That person has just fallen into the crack(s) in our healthcare system, which are more complicated than "evil greedy hospital", or "evil greedy insurer."

Re:If you imagine a business making surgical facemasks is wo... by pdonis on Sunday April 05, 2020 @11:36PM (#22790717)
> Nor is their job to maintain the long-term health of the country. That's literally the government's job.

No, it isn't. It's everybody's job. The government is a tool we use to delegate certain aspects of that job--and often it's a very bad tool to use and we should be relying on it less, not more. The idea that "it's the government's job" to do things causes all kinds of problems, because people think they can just let the government take care of it and not have to worry about it any more. You can't do that. Ultimately it is we, the people, who are responsible.

Re:If you imagine a business making surgical facemasks is wo... by chimprich on Monday April 06, 2020 @07:26AM (#22792719)
> Ultimately it is we, the people, who are responsible.

What a bizarre position. This distributed approach to the emergency health of nations hasn't worked out well in the current situation.

I can't see how it would suddenly start working better in the future under our current economic system either. Everything is set up under economic pressures such that inefficiencies are ruthlessly exposed and eliminated.

This maybe works out OK for creating new generations of electronic gizmos but it is catastrophically fragile for things like PPE as described in the article.

To avoid something like this in the future, the only options I can see are more government control or rethink how economic systems work.

Re:If you imagine a business making surgical facemasks is wo... by pdonis on Monday April 06, 2020 @11:41AM (#22794669)
> What a bizarre position.

I don't see how it's bizarre to recognize what the US Constitution says.

> This distributed approach to the emergency health of nations hasn't worked out well in the current situation.

In the US at least, what hasn't worked is waiting for centralized authorities to tell people what to do, instead of just doing obvious common sense things like social distancing and wearing masks. Not to mention allowing the FDA to prevent state and local health authorities from taking obvious common sense measures to develop tests, either on their own or in cooperation with private labs, when it was clear that the FDA and CDC didn't have tests ready.

> more government control

Would be a bad idea, since the more centralized authority controls things, the worse the consequences are when the centralized authority makes a mistake.

> rethink how economic systems work

What you call the "catastrophically fragile" economic system is a product of government control. So again more government control seems like a bad idea.

Re:If you imagine a business making surgical facemasks is wo... by deathanatos on Monday April 06, 2020 @01:02AM (#22791024)
I have a hard time believing and reconciling that against the cost of treatments.

E.g., I had my vocal cords looked at; took only ~1/2 hour of an ENTs time, and is a (somewhat) common and non-risky procedure. $4,000. I have no way to justify that price — I highly doubt the ENT is making $8k/hr! It was one of the big reasons that drove me away from PPOs in general: completely opaque, expensive, retroactive billing. Going to the doctors puts you on the hook for near unlimited liability.

Now, Kaiser was a nice contrast; I had the opportunity to get my wrist operated on for RSI. Somewhat invasive, would require weeks of healing, not guaranteed to be successful (it had a ~50% success rate!): $300, priced out before the operation.

(Sadly, I'm no longer with Kaiser, as they were west-coast and the rent was too high.)

Re:If you imagine a business making surgical facemasks is wo... by boulos on Monday April 06, 2020 @01:37AM (#22791145)
The Economist had an article about this last year [1, but paywalled, obviously]. A helpful quote though:

> As the drug industry has come back down to earth, the returns of the 46 middlemen on the list have soared. Fifteen years ago they accounted for a fifth of industry profits; now their share is 41%.

An example of a middleman firm is Express Scripts (a prescription management / negotiation firm) which had an operating income of $5B in 2017 on revenues of $100B. The parent company Cigna (NYSE:CI) handles a broader array of insurance things and had an operating income of almost $10B in the last twelve months but on revenue of $160B.

Medical billing in this country is insane and full of inefficiency. A little bit of each part gets collected along the way, and it adds up. I don’t even think ExpressScripts would have been counted in the methodology that The Economist was using (excess profits are considered a >10% return on capital) as part of Cigna.

[1] https://www.google.com/amp/s/amp.economist.com/business/2018...

Re:If you imagine a business making surgical facemasks is wo... by WillPostForFood on Monday April 06, 2020 @01:08AM (#22791047)
Only 25% of hospitals in the US are for profit. 56% are non profits, and the rest are run by the government.

https://www.kff.org/other/state-indicator/hospitals-by-owner...

Re:If you imagine a business making surgical facemasks is wo... by grok22 on Monday April 06, 2020 @01:33AM (#22791133)
NYTimes article, so may be pay-walled; but it sorta seems like non-profit hospitals in many places really do make money: https://www.nytimes.com/2020/02/20/opinion/nonprofit-hospita...
Re:If you imagine a business making surgical facemasks is wo... by kube-system on Monday April 06, 2020 @10:00AM (#22793742)
I see this confusion come up in just about every discussion about non-profits.

“Profit” and “income” are two entirely different things. All businesses, whether for-profit or non-profit, aim to generate income (i.e make money) so they can further their goals.

Profit is when you take that income and distribute it to shareholders. The main difference between for-profit and non-profit companies is that non-profits cannot do this.

The distinction of “non-profit” means a lot less than most people assume it does.

Re:If you imagine a business making surgical facemasks is wo... by grok22 on Monday April 06, 2020 @11:57AM (#22794794)
But one of the ideas of being a non-profit (atleast in my mind) is that they are driven by idea of service to the community. It seems like a lot of hospitals are structured as non-profits, but really with a profit motive (not community service) with the profits being funneled to individuals and stake-holders (in manners that take advantage of the law!).

Basically it's hard to reconcile the fact that hospitals are "non-profit" while also charging what seems excessively for everything.

I haven't looked through financial statements of one of these hospitals, but does anyone else have any experience with doing so and do they actually see that hospitals do need to charge those enormous amounts for everything to run effectively or to survive?

Re:If you imagine a business making surgical facemasks is wo... by kube-system on Monday April 06, 2020 @01:37PM (#22795826)
Sure, hospitals have a mission of providing a service to the community. They treat patients.

Non-profit does not mean volunteer. It doesn't mean they don't make money. It never has. Non-profits are businesses. They operate like businesses. Any impression you had that they do anything differently is a misconception.

It is common for people to equate the word "profit" with "making money", and therefore mistakenly assume that "non-profit" must mean they don't make money. But the word here is specifically referring to the ownership of the organizations net-assets: all assets belong to the business itself, rather than it being the equity of shareholders.

Non-profit only means that the company must use it's property for its own organizational goals, and it does not have owners that the property can be distributed to.

> I haven't looked through financial statements of one of these hospitals, but does anyone else have any experience with doing so and do they actually see that hospitals do need to charge those enormous amounts for everything to run effectively or to survive?

From a link someone else posted elsewhere in the comments:

> Median operating margins reached 1.7% in 2018

https://www.modernhealthcare.com/providers/operating-margins...

Re:If you imagine a business making surgical facemasks is wo... by briffle on Monday April 06, 2020 @02:53AM (#22791421)
in Madison, WI about 10 years ago, one of the local, non-profit hospitals plunked down $140M cash to build a new wing. didn't ask for donations, or take a loan. non-profit does not mean you don't make money...
Re:If you imagine a business making surgical facemasks is wo... by fencepost on Monday April 06, 2020 @08:55AM (#22793268)
Quite probably the physician got 10-20% of that supposedly charged amount, possibly less, and from what (s)he received was paying a variety of expenses including a billing person to deal with the insurance company.

If you have the procedure codes that were billed you can likely look up the Medicare reimbursement rates for them. Private insurance would pay more than that, but not orders of magnitude more.

Re:If you imagine a business making surgical facemasks is wo... by indymike on Monday April 06, 2020 @10:37AM (#22794088)
You've explained the problem in healthcare well: 80-90% of the cost of seeing a physician is not seeing the physician.
Re:If you imagine a business making surgical facemasks is wo... by arkades on Monday April 06, 2020 @10:42AM (#22794141)
Your ENT saw a tiny fraction of that.

He billed 4K. The contracted rate he got from an insurer is significantly below that. A huge chunk of that disappeared to malpractice insurance before he got to paying the rest of his overhead.

He saw, as another poster said, maybe 15% of that.

Re:If you imagine a business making surgical facemasks is wo... by craftinator on Monday April 06, 2020 @02:16AM (#22791272)
It's really, really easy to be broke with a six figure salary. All you have to do is spend 99.9% of it every year.

Have you seen the lavishness of the modern US hospital? The art pieces, high vaulted ceilings on every floor, solariums, gardens, decorative architecture... These things are not free. They are very, very expensive! And at the same time, they are fucking worthless in regards to making people healthy. I pay my insurance because I want to be healthy, not so the hospital I go to looks pretty. They are marketing machines that live outside their means, and I should not owe them $5k for stitches. It's fucking insane, and it's greed to use those massive markups on people who are in life or death situations. It's equivalent to wartime profiteering.

Re:If you imagine a business making surgical facemasks is wo... by jimmaswell on Monday April 06, 2020 @07:11AM (#22792646)
The artwork and everything has been found to improve patient outcomes. Gardens and paintings aren't that expensive compared to other costs at a hospital.
Re:If you imagine a business making surgical facemasks is wo... by vl on Monday April 06, 2020 @02:53AM (#22791425)
Oh, please, have you been to the hospital? This is typical visit: check-in with security, wait in line, check-in with receptionist, wait, talk to the nurse assistant (wtf? I kid you not, now nurses have assistants!), wait, repeat exact same thing you said to assistant to the nurse, wait, see doctor for 5 minutes and repeat exact same thing again! How the fuck is it supposed to be efficient?
Re:If you imagine a business making surgical facemasks is wo... by evgen on Monday April 06, 2020 @06:31AM (#22792394)
It is actually rather efficient, you just lack the wisdom to understand anything beyond your own narrow point of view.

Check-in with security: Yes, because this is 'Merica and it has actually become necessary to do a preliminary screen to make sure you are not a raving nutjob.

Check-in with receptionist: Enter you into the system, until this point is hit you are not even at the hospital as far as the system is concerned.

Talk to nurse assistant: No, this is not just an assistant for a nurse, but rather a term used to describe someone who has a particular level of training and commensurate duties. A CNA can take vitals, ensure that they have the proper records for you (e.g. records say vi is a 45 year-old white male and we have a 60 year-old Latina, maybe we need to double-check things.) This is also the first real step in the triage process where someone with medical background can make a quick decision as to whether or not you need to be seen quickly or can wait.

Talk to nurse: Ok, now we actually start doing more fine-grained examination and diagnosis. Chances are this is where the real diagnosis and treatment was decided, but you don't need to know this.

Talk to doctor: Now someone who is very busy will take a few moments to examine you and make a decision. The nurse you talked to earlier put markup on your chart indicating what she noticed and found as well as possible standard treatments for same so the doctor was able to confirm that it was horses and not zebras and then sign off on the treatment.

In a hospital all of that process you think of as inefficient does not give a shit about you or your time, it is trying to maximize the value and impact of the time that really matters in a hospital: the attention of doctors and RNs. The process may have been inconvenient for you, but it means that the people who matter at that hospital only spend their time where it is needed and trivial tasks or downtime are handled elsewhere in the process.

Re:If you imagine a business making surgical facemasks is wo... by bluGill on Monday April 06, 2020 @11:20AM (#22794497)
There might be too many layers, but those same layers mean that there are multiple people any one of which might notice that you are the rare 1 in a million case not the common thing with almost the same symptoms that they see hundreds of every week.
Re:If you imagine a business making surgical facemasks is wo... by Red_Leaves_Flyy on Monday April 06, 2020 @04:11AM (#22791750)
Why don't you go to urgent care instead? If you define why think you need a doctor you'll probably be fine at urgent care. If urgent care won't take you then you'll probably be seen quickly at a hospital.
Re:If you imagine a business making surgical facemasks is wo... by vl on Monday April 06, 2020 @04:19AM (#22791790)
Because it wasn’t an ER visit, it was an appointment.
Re:If you imagine a business making surgical facemasks is wo... by Aeolun on Monday April 06, 2020 @08:53AM (#22793261)
> more complicated than "evil greedy hospital", or "evil greedy insurer."

Evil greedy medical industrial complex?

I think most of the issues in the US medical situation come from everyone trying to profit as much as possible.

Re:If you imagine a business making surgical facemasks is wo... by gpm on Sunday April 05, 2020 @07:39PM (#22789672)
> Not an extra 90 cents per mask, an extra 8 cents per mask.

We're suggesting the hospital giving him 1 dollar per mask instead of 10 cents during the crisis, that's an extra 90. 98 cents compared to the Chinese prices.

I guess my proposal makes it a bit less. With the 10 year contract, assuming that the demand spike only exists in the first year, it would be an extra 90 cents - savings of (9 years * 2 cents / year) = 72 cents per mask. This could be "fixed" by extending that contract for a few more years.

Re:If you imagine a business making surgical facemasks is wo... by droithomme on Sunday April 05, 2020 @10:13PM (#22790364)
I paid $4 per N95 mask in January.

$1 is an absolute bargain.

$0.10 is vastly below the cost of manufacture and only being promoted by people who mean harm.

Re:If you imagine a business making surgical facemasks is wo... by gpm on Sunday April 05, 2020 @10:38PM (#22790479)
The $0.10 figure comes from the article... I think these might just be surgical masks not N95 masks.
Re:If you imagine a business making surgical facemasks is wo... by PeterStuer on Monday April 06, 2020 @03:20PM (#22796895)
Did you buy them at quantity (lot of 50k masks), or in a small box of 10 at the DIY store?
Re:If you imagine a business making surgical facemasks is wo... by readme on Sunday April 05, 2020 @09:27PM (#22790180)
>A hospital charged my friend $5k for three stitches

https://www.youtube.com/watch?v=VGDUqBLtyNM

DIY can save money. I've used superglue for this in the past.

Re:If you imagine a business making surgical facemasks is wo... by vl on Monday April 06, 2020 @02:47AM (#22791398)
You don’t have to use superglue, there is special medical glue for this purpose you can buy. Also great for treating cuts before swimming, etc.

Search for “tissue adhesive” or “liquid bandage”.

Re:If you imagine a business making surgical facemasks is wo... by godelski on Sunday April 05, 2020 @09:52PM (#22790267)
Please don't do this at home.
Re:If you imagine a business making surgical facemasks is wo... by concordDance on Monday April 06, 2020 @04:16AM (#22791772)
My family used superglue at home for cuts all the time. Not really much worse than doctor stitches.

The difference between you and a doctor for little things like stitches that causes the $5k price tag is a couple of hours of study, credentialism, beurocracy and malpractice insurance. Only the couple of hours study is actually needed and you can do that yourself pretty easily with the internet.

Re:If you imagine a business making surgical facemasks is wo... by himinlomax on Monday April 06, 2020 @05:23AM (#22792053)
There's medical grade superglue, it's a bit more expensive than regular superglue which has mildly toxic byproducts.
Re:If you imagine a business making surgical facemasks is wo... by godelski on Monday April 06, 2020 @12:08AM (#22790836)
For the downvoters: SERIOUSLY DO NOT DO THIS AT HOME! Let the medical professionals put in your stitches.

I seriously can't believe I have to say this.

Re:If you imagine a business making surgical facemasks is wo... by dgoodell on Monday April 06, 2020 @02:01AM (#22791223)
I cut my index finger pretty bad, it must have been all the way through the skin as there was a big flap. It definitely needed stitches. I used superglue to hold it together until it stayed stuck on its own. I couldn’t use the finger for like a week because it was all bandaged up. Probably not as a good job as if I went to the doctor, but my finger didn’t fall off. HDHP turns you into a do-it-yourselfer. My mother had a much more serious gash when she dropped a piece of glass on her foot. This was on Croatia. We went to the ER in the city, and she got stitches fairly quickly for like $20 cash. If I would have cut my finger in Croatia, I would have gone to ER to get stitches.
Re:If you imagine a business making surgical facemasks is wo... by lovehashbrowns on Monday April 06, 2020 @02:26AM (#22791317)
Had a coworker do this as well. Cut his finger, used superclue to hold it together. Turned out well, apparently.

With the Healthcare situation in the US, it's basically past the point of just saying "go to a doctor, don't diy." Now it's just better to give out accurate information for diy people to do it safely.

Re:If you imagine a business making surgical facemasks is wo... by vl on Monday April 06, 2020 @02:48AM (#22791403)
Get normal medical glue instead of superglue - search for “tissue adhesive” or “liquid bandage”.
Re:If you imagine a business making surgical facemasks is wo... by jschwartzi on Monday April 06, 2020 @12:38AM (#22790940)
This is America. It’s much cheaper here to risk our lives than to risk bankruptcy from visiting a hospital.
Re:If you imagine a business making surgical facemasks is wo... by readme on Wednesday April 08, 2020 @08:58PM (#22818835)
I have to assume the guy who says not to do this is from a country with universal healthcare.
Re:If you imagine a business making surgical facemasks is wo... by craftinator on Monday April 06, 2020 @02:19AM (#22791284)
For 5 grand? Yeah fucking right. Why would you recommend that?
Re:If you imagine a business making surgical facemasks is wo... by godelski on Monday April 06, 2020 @02:50AM (#22791415)
Because a high chance of an infection/botched job would lead to a much larger bill and more pain.
Re:If you imagine a business making surgical facemasks is wo... by Zanni on Monday April 06, 2020 @07:07AM (#22792629)
You can keep saying it, until you provide an argument. ALL CAPS is not an argument, you're just stating your opinion louder.
Re:If you imagine a business making surgical facemasks is wo... by jmckib on Sunday April 05, 2020 @07:53PM (#22789752)
If healthcare was really a capitalist endeavor then it wouldn't cost $5k for three stitches. Prices would be transparent, there would be a free market with competition, and healthcare wouldn't be linked to employment. You can thank regulations for all of those problems.
Re:If you imagine a business making surgical facemasks is wo... by monocasa on Sunday April 05, 2020 @08:11PM (#22789835)
Why wouldn't capital use the inability of people who are literally passed out and bleeding out on stretchers to price shop, to capital's advantage?
Re:If you imagine a business making surgical facemasks is wo... by dogma1138 on Sunday April 05, 2020 @08:29PM (#22789928)
Because someone would then do it for cheaper when medicine was a trade that’s how it used to be.

And it’s somewhat how it’s still is in some fields of it primarily cosmetic, elective surgery (including LASIC and the likes) and dentistry.

There are plenty of countries where the majority of the health care is provided by private firms even if the state picks up the bill or part of it including almost all countries with universal healthcare.

The US is pretty much unique in costs and distribution of burden and it’s not because of the free market approach to healthcare.

When 9 out of the 10 most profitable hospitals in US aren’t even private/for profit you can’t simply claim that the investment firm or HMO that owns the hospital tries to suck out as much profit as possible for their shareholders.

P.S. I don’t agree that regulations are the problem anyone who thinks that you somehow would get better results with deregulating healthcare is likely very wrong, the entire system in the US is however broken and not because of simply campitalism.

Re:If you imagine a business making surgical facemasks is wo... by roenxi on Monday April 06, 2020 @03:36AM (#22791593)
Great comment; agree all the way. But I do think that it lost the specifics here so I want to highlight them:

Stitches are very easy to administer. Nobody needs a uni degree to stitch up a wound. They need lots of practice.

It is impossible for a reasonably free market to charge $5,000 for 3 stitches; because an independent doctor would set up next door with a sign saying "Stitches; $4,500!" and drive home in his Lamborghini every day. The hospital and the independent doctor would then start undercutting each other until the margins were no longer outrageous and they have to think a bit before dropping their prices any further.

If a hospital can get away with charging $5k for 3 stitches, any market freedom has long ago been exorcised.

Re:If you imagine a business making surgical facemasks is wo... by perl4ever on Sunday April 05, 2020 @09:33PM (#22790202)
"When 9 out of the 10 most profitable hospitals in US aren’t even private/for profit"

How exactly do you measure the profit of a non-profit?

Re:If you imagine a business making surgical facemasks is wo... by cosmie on Monday April 06, 2020 @12:57AM (#22791008)
The same as you measure the profit of any business. They're just referred to as net assets[1].

Non-profit is a misnomer - not for profit is a more apt phrase. While they can't operate with the intent of generating profit, they're perfectly allowed to actually generate profit from various activities. With the intention that the profits from that activity will be a revenue stream that funds loss-making activities elsewhere which support their nonprofit mission (such as issuing grants). Hence it's kept on the books as net assets.

[1] https://smallbusiness.chron.com/non-profit-accounting-defini...

Re:If you imagine a business making surgical facemasks is wo... by dogma1138 on Monday April 06, 2020 @11:26AM (#22794543)
They don’t even have to fund loss making activities they just aren’t allowed to share profits with investors / shareholders.

They have to reinvest their profits back into the business that can be grants but can also be increasing pay to their staff or expanding their operation.

Two thirds of US hospitals are NFP (public, community, university etc) or government hospitals.

Ironically the more money they make and the bigger they are the higher prices they tend to charge because they can negotiate higher rates with the insurance providers.

The US system is simply broken the US healthcare has a huge problem with uncompensated care which is one of the primary reasons why most hospitals lose money on primary care.

This means that hospitals are “forced” to extract as much money as possible form insurers so your healthcare costs do not only incorporate the risks of all policy holders for your specific provider but also the uncompensated care costs of the hospitals.

The insurers then extract as much money as they can from their clients which primarily are business which don’t seem to care that much as they can often write of much of that cost as operating expenses.

This pretty much causes a cycle of inflation that is unsustainable under normal circumstances and will utterly brake the entire systems under extremes like the current pandemic.

Re:If you imagine a business making surgical facemasks is wo... by matwood on Monday April 06, 2020 @07:40AM (#22792810)
I would add those clinics to your list of places we see competition drive prices. I have 2 near my house that handle things like cuts, fractures, sprains, sinus infections, etc... They were $100 for pretty much everything included in a visit (x-rays, tests), but have started competing. They went down to $95, and may be $90 now.
Re:If you imagine a business making surgical facemasks is wo... by BurningFrog on Sunday April 05, 2020 @09:23PM (#22790163)
Because that would be the worst imaginable PR.

Also that kind of emergency care is quite rare. It's a very small part of the healthcare system and mostly confuses the discussion.

Re:If you imagine a business making surgical facemasks is wo... by ardy42 on Sunday April 05, 2020 @11:35PM (#22790714)
>> Why wouldn't capital use the inability of people who are literally passed out and bleeding out on stretchers to price shop, to capital's advantage?

> Because that would be the worst imaginable PR.

You're wrong. "Bad PR" has not worked at all to encourage the healthcare industry to fix medical billing on its own. See this article for an example:

https://www.nytimes.com/2017/03/29/magazine/those-indecipher...

It's literally impossible to comparison shop healthcare, and I've tried. You can't properly diagnose yourself, for the same reason a doctor can't properly debug your code. You have no idea how treatment is going to be coded (and you'd have to be an expert to understand the codes and their implications, anyway). Hospitals will only tell you their inflated "list prices." Your insurance won't tell you anything about what they've negotiated with the hospitals in your area until you've been billed, since they consider that information proprietary.

Most healthcare is to solve real health problems (from mild to extremely serious). People won't decide to live with those problems unless they're forced to, so they can't opt out of the system until it's fixed.

Re:If you imagine a business making surgical facemasks is wo... by stale2002 on Monday April 06, 2020 @05:01AM (#22791968)
> It's literally impossible to comparison shop healthcare, and I've tried.

Indeed this is true.

The solution to this, though, is to make it required for hospitals to post their prices, as well as to make it illegal for hospitals to give preferential rates to insurance deals.

Re:If you imagine a business making surgical facemasks is wo... by iguy on Monday April 06, 2020 @06:30AM (#22792387)
Something like this would be great. And the posted prices ought to include all complications / unexpected weird things -- they have the information (and the volume) to average such costs, you don't.

But not trivial to implement correctly. What exactly is the menu of procedures, and who standardizes (and updates) it? It would be much harder to comparison shop if there were a million entries (and every hospital offers a subset). Can hospitals select their patients, e.g. post great prices & outcomes by only accepting patients under 50 (or just with few other health issues)?

Re:If you imagine a business making surgical facemasks is wo... by BurningFrog on Monday April 06, 2020 @11:02AM (#22794338)
There are places actually doing this today: https://medium.com/@russroberts/health-care-lessons-from-dr-...

If you have time to listen to the podcast, it can be very eyeopening.

Re:If you imagine a business making surgical facemasks is wo... by BurningFrog on Monday April 06, 2020 @11:05AM (#22794371)
> You're wrong. "Bad PR" has not worked at all to encourage the healthcare industry to fix medical billing on its own. See this article for an example:

Huh?

The question I answered was about "people who are literally passed out and bleeding out on stretchers to price shop"

I agree that medical billing is a corrupt disaster.

Re:If you imagine a business making surgical facemasks is wo... by henrikschroder on Monday April 06, 2020 @07:42AM (#22792821)
The funny thing is that dentists are perfectly able to give you an accurate price quote, taking your insurance into consideration, and before you've committed to anything.

If they can do it, why the fuck can't doctors do the same? The system is so obviously rotten.

Re:If you imagine a business making surgical facemasks is wo... by yks on Monday April 06, 2020 @12:20PM (#22794985)
I don’t know, maybe I don’t have luck with my dentists or my insurance but on every bill some procedures are either downgraded or outright refused to be covered based on some technicality. As usual, insurance finds a way to scam you.
Re:If you imagine a business making surgical facemasks is wo... by neltnerb on Monday April 06, 2020 @09:07AM (#22793355)
Agreed, my neurologist can't even confidently tell me blood work absolutely required for my condition will be covered, much less the price.

It took years to find that almost every facility nearby does the tests he orders for no copay at all. But Beth-Israel doesn't see a problem with charging literally over a hundred dollars after insurance for a blood draw.

I guess a very big and very evil problem for another time, but our health care system is a house of cards.

Re:If you imagine a business making surgical facemasks is wo... by jacobsenscott on Monday April 06, 2020 @12:41AM (#22790954)
Bad PR doesn't matter much when demand is inelastic. Everyone hates comcast, their cell phone provider, and the oil companies for example. They are all doing just fine.
Re:If you imagine a business making surgical facemasks is wo... by BurningFrog on Monday April 06, 2020 @10:59AM (#22794302)
At least the two first are semi monopolies in highly regulated industries. Much like your local hospital.

No one hates their food stores that I'm aware of, even though that demand is at least as inelastic as for healthcare.

Re:If you imagine a business making surgical facemasks is wo... by stale2002 on Monday April 06, 2020 @04:57AM (#22791958)
If you aren't able to purchase food, you die. And yet food prices are reasonable in almost the entire world.

Also, I would like to point out that the vast majority of medical issues are not emergencies.

Maybe there is a reasonable argument that ambulances, and emergency rooms should be highly regulated. But, fortunately, the vast majority of medical issues do not involve going to an emergency room.

Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @12:15AM (#22790861)
> If healthcare was really a capitalist endeavor then it wouldn't cost $5k for three stitches.

Before the government got heavily involved in healthcare in the 1960s, healthcare was cheap.

Edit: requested cite: https://www.thebalance.com/causes-of-rising-healthcare-costs...

Re:If you imagine a business making surgical facemasks is wo... by PaulDavisThe1st on Monday April 06, 2020 @12:38AM (#22790936)
Citation required. Preferably with inflation adjusted dollars, compensation for expansion of treatment options, and the Reagan decision that ER departments are legally required to treat any patient.

Feel free to make a moral case against Reagan's decision if you feel like it.

Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @01:28AM (#22791115)
I received 3 stitches in my face around 1987 from the emergency room. Cost was $289. I don't know why I remember the figure. Today that would be $658.08 according to the inflation calculator at https://www.usinflationcalculator.com/

I bought a 383 big block engine for my dodge, and a friend of mine was helping me move it into the garage. I tripped and fell on top of the block, making quite a gash in my eye socket. Lucky I missed my eye. Still have a scar! Sadly, the block turned out to have a crack in it and was not salvageable.

Re:If you imagine a business making surgical facemasks is wo... by Cyberdog on Monday April 06, 2020 @06:40AM (#22792451)
You put a crack in an engine block with your head?
Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @07:13PM (#22798836)
That would make a better story, but the crack in the block was discovered when I set about rebuilding it, and had nothing to do with my soft head hitting it. The machined edges of a block are sharp, and by falling on it it made a deep gash in my face. Bled all over the engine and the floor.
Re:If you imagine a business making surgical facemasks is wo... by Cyberdog on Tuesday April 07, 2020 @09:49PM (#22809347)
I know, I know. I was misinterpreting your story for comedic effect. :P
Re:If you imagine a business making surgical facemasks is wo... by umanwizard on Monday April 06, 2020 @08:43AM (#22793190)
He didn’t say his head caused the crack, just that there was one.
Re:If you imagine a business making surgical facemasks is wo... by foldr on Monday April 06, 2020 @08:31AM (#22793115)
>Today that would be $658.08

That's still more than most Americans could easily afford. And that's for stitches.

Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @07:15PM (#22798847)
That's also 20+ years after the big inflation in medical prices started. I did think it was high at the time, likely why I remembered the number.
Re:If you imagine a business making surgical facemasks is wo... by foldr on Tuesday April 07, 2020 @08:05AM (#22802413)
If you go back as far as the 60s then you're not really comparing like for like. People don't want the level of medical care that the average American got in the 1960s.
Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Tuesday April 07, 2020 @03:41PM (#22806714)
Stitch technology hasn't changed.
Re:If you imagine a business making surgical facemasks is wo... by jacobsenscott on Monday April 06, 2020 @12:46AM (#22790966)
Re:If you imagine a business making surgical facemasks is wo... by gamblor956 on Monday April 06, 2020 @01:10AM (#22791052)
This citation supports the point of the comment you are replying to.

Healthcare was cheaper before Reagan interfered in the health care industry to artificially inflate costs to the financial benefit of his buddies.

Re:If you imagine a business making surgical facemasks is wo... by giantrobot on Sunday April 05, 2020 @08:10PM (#22789828)
What regulations are those exactly?
Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @12:19AM (#22790882)
One is you need a medical license to practice. To get a license, you need to be a graduate of an approved medical school. Slots in medical school are controlled by the AMA, which has a strong interest in limiting the number of doctors being minted, to keep doctor fees high.

That's just one.

Re:If you imagine a business making surgical facemasks is wo... by sct202 on Monday April 06, 2020 @09:51AM (#22793667)
Part of the reason behind restrained increases to med school spots is because traditionally they tried to get very close to full placement to residencies. In recent years, med school attendance has grown much faster than residencies, and that would be a very terrible position to be in to go $400k+ in debt and pass med school to only get stuck when you don't place into a residency the first round. https://www.aamc.org/news-insights/us-medical-school-enrollm...

EDIT: There are also separate osteopathic graduate schools and foreign med schools (Caribbean) that aren't limited by the AMA and still funnel thru the same match program.

Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Tuesday April 07, 2020 @12:54AM (#22800442)
Sounds like a chicken-and-egg problem. Which came first - the number of AMA slots, or the number of residency openings that matches it?
Re:If you imagine a business making surgical facemasks is wo... by kevin_thibedeau on Monday April 06, 2020 @12:51AM (#22790991)
I know a trained foreign surgeon who switched to law after immigrating because of this red tape.
Re:If you imagine a business making surgical facemasks is wo... by Melting_Harps on Monday April 06, 2020 @09:26AM (#22793498)
> I know a trained foreign surgeon who switched to law after immigrating because of this red tape.

I had a few of my undergrad bio and chem labs with a Vietnamese doctor who came to the US, I always tried to be in his group whenever possible because he had the most insight into the Industry as a result of his transition.

Apparently, because he was educated and practiced in Vietnam he was forced to have to repeat the entire process to enroll into Medical school. I'm not sure if was on loans or doing it on his own, but he must of have been determined to make it happen, because I'd probably do the same as your colleague if forced to do it all again.

He was an older guy, I was 18 or 19 so anything over 25 was 'old' to me but I think he was in his 30s while we were in our 2nd year courses.

With all of the polemics surrounding COVID19, I think the least we should do is take away the power of the AMA-like Institution to determine how many medical students can be enrolled into any program and make any necessary accommodations to ensure it happens.

Making the current medical staff do the equivalent of an understaffed, under supplied death march has to make reason prevail regardless of our stance.

Private and Public medicine is an issue to come back to, but being short staffed in a pandemic is suicidal--Italy recalling retired medical staff was alarming, but also highlighting that a Public Medical system is not yielding the panacea many suggest, either.

And for anyone asking for a source on the AMA's practices look at his, I remember reading this in 2005 as I was in school, and being schooled and trained as if I wanted to take MCAT because of the looming shortages caused by retiring boomers, even though I had no interest in Medicine:

https://usatoday30.usatoday.com/news/health/2005-03-02-docto...

Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @07:10PM (#22798823)
Another source:

"Competition and Monopoly in Medical Care" by Frech

https://www.amazon.com/Competition-Monopoly-Medical-Care-Fre...

Re:If you imagine a business making surgical facemasks is wo... by gpm on Sunday April 05, 2020 @08:55PM (#22790064)
The ones that let them not tell you how much they will charge you for a service until after they provide it, and then still demand payment (and have the government enforce that demand)?

(I'm pretty sure that's not what the person you were replying to is going for - but it is a very problematic piece of the regulatory environment which is unique to hospitals)

Re:If you imagine a business making surgical facemasks is wo... by mixmastamyk on Sunday April 05, 2020 @10:37PM (#22790476)
The certificate of need is one regularly mentioned.

The attachment of medical insurance to employment is another.

If you don't already know at least a few of these, you're probably a student or not interested.

Re:If you imagine a business making surgical facemasks is wo... by BurningFrog on Sunday April 05, 2020 @09:12PM (#22790128)
Healthcare is probably the most regulated industry in the country.

Nobody knows all the regulations, and asking for a list seems a bit clueless.

Re:If you imagine a business making surgical facemasks is wo... by giantrobot on Sunday April 05, 2020 @10:07PM (#22790338)
If you're going to claim specific problems are caused by regulations is not too much to ask which specific regulations cause specific problems.

What's clueless is to use the word "regulations" like it's some incantation.

Healthcare is heavily regulated because medical care is not usually something you can restitute after the fact. If you sell me a defective widget my life doesn't depend on I can get my money back or sue you to get it back. If a doctor sticks a defective medical widget in my body and I die, I can't really do much about it afterwards.

I'd prefer that doctor's certifications have some sort of regulatory oversight. I'd also like medical widgets to be regulated so there's stringent QA and manufacturing process qualifications.

Re:If you imagine a business making surgical facemasks is wo... by jlebar on Sunday April 05, 2020 @08:21PM (#22789880)
> A hospital charged my friend $5k for three stitches. They could pay 8 cents more per mask. But they care more about $$$ than the long term health of the country.

Couldn't we say the same thing about the owner of this factory? He could gear up and then pay unemployment for laid-off workers after the crisis ends; he did it once.

I am also not a fan of our health-care system, but...it's complicated.

Re:If you imagine a business making surgical facemasks is wo... by hedora on Sunday April 05, 2020 @09:26PM (#22790178)
Last time, ramping up almost bankrupted the business, and left it with an extra $1M in debt.
Re:If you imagine a business making surgical facemasks is wo... by moftz on Sunday April 05, 2020 @11:03PM (#22790605)
Seems like the government should just remove the risk of being the business of critical supplies. Obviously we didn't have enough supplies in stockpile it would benefit the US to have a dedicated factory to produce a constant stream of PPE for the next 10 years. This stuff is so cheap to make that not stockpiling it is just stupid. These kind of supplies are used by everyone everywhere that it's a waste of time and money trying to negotiate critical supply stockpiles on the local or state level. This needs to be at the national level to be able to leverage the power of the US govt. Using the DPA, the govt can come into 3M or any of the other manufacturers and say "you are going to sell us 50M masks per year for the next 10 years". After a couple years, you have a healthy stockpile that can either be used in a pandemic or changed out for fresh supplies over time. It's a shame to throw out expired medical supplies but having a consistent supply chain going for years is good to make sure that there is a standard product out there that you don't need to worry about changing.
Re:If you imagine a business making surgical facemasks is wo... by vl on Monday April 06, 2020 @02:56AM (#22791435)
FYI, 50M masks in pandemic is 1/7th of what country needs in a day.
Re:If you imagine a business making surgical facemasks is wo... by piokoch on Monday April 06, 2020 @09:10AM (#22793380)
That's the way free market works. If masks were more expensive, it would make sense to invest and produce more of them. Instead governments and institutions all over the World are trying to keep prices low and the only result they get is shortage of masks (and similar equipment).
Re:If you imagine a business making surgical facemasks is wo... by darkerside on Monday April 06, 2020 @09:34AM (#22793544)
Free market solutions break down when demand is inelastic. Governments are trying to prevent price gouging due to inelasticity. The root of the problem is supply, so stop the government intervention and you pay more money for the same problems.
Re:If you imagine a business making surgical facemasks is wo... by DuskStar on Monday April 06, 2020 @10:12AM (#22793847)
Free market solutions break down when demand AND SUPPLY are BOTH inelastic, and that's only if you count 'price goes up' as market failure. Think of it this way - the demand for food is inelastic. Does this mean free market solutions for food have broken down?

Governments preventing price increases just means that supply doesn't increase nearly as quickly as it would otherwise.

Re:If you imagine a business making surgical facemasks is wo... by darkerside on Monday April 06, 2020 @06:10PM (#22798379)
Letting masks sell for $25 a pop so that companies are incentivized to build infrastructure to churn them out at an optimal rate 6 months from now just doesn't seem like a realistic solution
Re:If you imagine a business making surgical facemasks is wo... by DuskStar on Monday April 06, 2020 @11:39PM (#22800162)
Letting masks sell for $25/ct now so that companies can afford to go to 24/7 production NOW and not have to worry about paying unemployment in 2 months might be, though.
Re:If you imagine a business making surgical facemasks is wo... by bretthoerner on Monday April 06, 2020 @10:14AM (#22793864)
> The root of the problem is supply, so stop the government intervention and you pay more money for the same problems.

The company in the article is closed on nights and weekends. Don't you think there's a price at which they'd stay open, thus increasing supply?

Re:If you imagine a business making surgical facemasks is wo... by RhodesianHunter on Monday April 06, 2020 @10:35AM (#22794070)
You literally cannot scale up the production of the underlying fabric that goes into N95 masks quickly. These assembly lines take 6 months to set up.

There is no price at which these masks can be sold which will meaningfully impact supply before Covid 19 burns itself out.

Such price increases are honestly more likely to incentivize people digging their P100 masks out of their garages and workshops and donating those.

Re:If you imagine a business making surgical facemasks is wo... by ric2b on Tuesday April 07, 2020 @06:53AM (#22802072)
They're closed on weekends and nights. The number of machines isn't what's keeping their production capacity down.
Re:If you imagine a business making surgical facemasks is wo... by DuskStar on Monday April 06, 2020 @03:49PM (#22797113)
And this factory makes surgical masks, not N95s. The material is not a bottleneck as far as I'm aware.
Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @12:11AM (#22790845)
Shortages are the inevitable result of anti-gouging laws.
Re:If you imagine a business making surgical facemasks is wo... by jayd16 on Monday April 06, 2020 @03:44AM (#22791626)
The article is about not being able to get long term contracts to actually make ramping up production worthwhile. Being able to gouge for a few months doesn't seem like it would help that.
Re:If you imagine a business making surgical facemasks is wo... by icelancer on Monday April 06, 2020 @04:41AM (#22791878)
Sure it would. If he could increase his margin by 500% he wouldn't need the long term contracts as much due to the massive surplus of profit he'd be able to bank while also paying his employees double time.
Re:If you imagine a business making surgical facemasks is wo... by jayd16 on Monday April 06, 2020 @12:06PM (#22794883)
As the article lays out, it doesn't make sense to ramp up for a month when the demand will die down. The company can't compete in normal circumstances. It would make way more sense to simply gouge the 500x prices at the current capacity and wait it out.
Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @07:17PM (#22798869)
If gouging were legal, a mask maker could easily go to three shifts a day instead of one, and would do everything he could to make more.

But with it illegal, you'd be relying on self-sacrifice and altruism, which isn't very reliable. Greed is a much more effective motivator.

Re:If you imagine a business making surgical facemasks is wo... by gumby on Sunday April 05, 2020 @07:30PM (#22789623)
He could make two SKUs, one at the regular price made by the normal shift and one made on the other two shifts with different cost structure and pricing.
Re:If you imagine a business making surgical facemasks is wo... by whatshisface on Sunday April 05, 2020 @07:40PM (#22789679)
That's exactly the type of loophole abuse that a judge would be likely to strike down.
Re:If you imagine a business making surgical facemasks is wo... by gumby on Sunday April 05, 2020 @09:31PM (#22790193)
I didn't mean it at all as a loophole -- I said different cost structure.

I read his article: he claims can't get the volume to justify adding more shifts. Well, right now he could, even though the additional shifts would presumably cost more (more expensive labor costs, more inputs (e.g. energy), and likely a higher cost for the new raw materials wheich he'd have to get on the spot market as opposed to the long term agreements he already has.

There's really nothing stopping him from doing this, except he's busy appearing on Bannon's podcast. And he says "well it would just be a drop in the bucket" -- likely it would be meaningful for Texas though, and then Texas's external demand would drop a little, allowing someone else to get access. This is how the economy is supposed to work.

But instead he says the government should give him a long term contract. Well boo hoo. He describes the capabilities he has but complains instead of taking advantage of them. And the newspaper doesn't call him on it.

Re:If you imagine a business making surgical facemasks is wo... by im3w1l on Sunday April 05, 2020 @10:06PM (#22790334)
It's easy to sit on the sidelines and say "nothing is stopping him". Even if his fears and concerns are unfounded, I don't doubt they are sincere.
Re:If you imagine a business making surgical facemasks is wo... by mixmastamyk on Sunday April 05, 2020 @10:40PM (#22790491)
And when you abandon them next month, then what?
Re:If you imagine a business making surgical facemasks is wo... by gumby on Monday April 06, 2020 @12:15AM (#22790856)
At this point there are many people who would be glad to have a month's income!
Re:If you imagine a business making surgical facemasks is wo... by mixmastamyk on Monday April 06, 2020 @12:23AM (#22790903)
People, but not businesses with capital expenditures.
Re:If you imagine a business making surgical facemasks is wo... by gumby on Monday April 06, 2020 @01:30PM (#22795734)
There's typically not much cap ex when you add another shift as your'e running when existing equipment is idle. He even mentions this possibility. But any such risk should be baked into the higher price. Nobody's going to complain that he has to charge more for added emergency volume.
Re:If you imagine a business making surgical facemasks is wo... by mixmastamyk on Monday April 06, 2020 @02:34PM (#22796451)
It's as if you haven't read the article or discussion.
Re:If you imagine a business making surgical facemasks is wo... by godelski on Sunday April 05, 2020 @09:50PM (#22790262)
I suspect that there would be major outcry about people paying $1/mask. People are going after just about everything right now. Unfortunately I'm seeing a lot of mob mentality. But that could be selection bias.
Re:If you imagine a business making surgical facemasks is wo... by gruez on Sunday April 05, 2020 @07:52PM (#22789745)
IANAL, and also too lazy to research the relevant laws for the jurisdiction he's in, but wikipedia[1] says there are usually exceptions for price increases that can be justified.

>Laws often include exceptions for price increases that can be justified in terms of increased cost of supply, transportation, demand or storage

[1] https://en.wikipedia.org/wiki/Price_gouging#What_the_law_pro...

Re:If you imagine a business making surgical facemasks is wo... by mrosett on Sunday April 05, 2020 @09:23PM (#22790165)
Those exceptions are somewhat useful, but they're not enough.

First, he may be in the clear legally, but that doesn't mean he has no legal risk. Some enterprising DA could try to dispute that that his price increases could be justified.

Second, I tried to be precise when I said "anti-price gouging sentiment." Even if it's legal to raise prices, the risk of a public backlash makes it safer to just keep the factory working normal hours. That's a harder problem to fix than bad laws, though.

Re:If you imagine a business making surgical facemasks is wo... by edge17 on Monday April 06, 2020 @02:48AM (#22791402)
There seems to be a lot of misconceptions about N95 style masks. N95/KN95 are made from melt-blown nanofiber fabric which 20x'd in price due to sudden demand and constrained supply, through early March from its price 6 months prior. When your inputs 20x in price the actual cost of the product is naturally going to increase.
Re:If you imagine a business making surgical facemasks is wo... by symplee on Monday April 06, 2020 @12:41AM (#22790952)
Quick four and a half minute video going into a little more depth about the above concept:

https://www.youtube.com/watch?v=_2STbdWkgyg

Re:If you imagine a business making surgical facemasks is wo... by kevingadd on Sunday April 05, 2020 @08:25PM (#22789899)
I get that this is a hypothetical but the idea of his factory workers getting paid anything more than a couple extra bucks an hour for overtime is ridiculous. That simply doesn't happen unless owners are forced to do it.

Is it supposed to be a good thing that people would work 100hr weeks during a pandemic and compromise their immune systems? Why not just hire more staff and have them work healthy 40 hour weeks? It's not as if unemployment is low right now.

Re:If you imagine a business making surgical facemasks is wo... by mrosett on Sunday April 05, 2020 @09:31PM (#22790195)
The article makes it clear that he's looking to hire more people, but a) finding people and training them takes time and b) if he hires too many, he has to fire them later (and incur substantial costs related to that.)

Let me reframe is this way: There is some emergency wage where his employees would enthusiastically work substantially more than they are right now. There's some price-per-mask where the owner would enthusiastically pay them that wage to get extra masks out of the factory. That price-per-mask would still count as a steal compared to the cost of a healthcare worker developing COVID-19. Everyone would be better off if hospitals were paying that price. So why aren't they?

Re:If you imagine a business making surgical facemasks is wo... by ardy42 on Monday April 06, 2020 @12:27AM (#22790906)
> Let me reframe is this way: There is some emergency wage where his employees would enthusiastically work substantially more than they are right now. There's some price-per-mask where the owner would enthusiastically pay them that wage to get extra masks out of the factory. That price-per-mask would still count as a steal compared to the cost of a healthcare worker developing COVID-19. Everyone would be better off if hospitals were paying that price. So why aren't they?

Because your analysis is wrong? You seem be assuming workers are some kind of machine that turns wages into output, and the more wages you put in, the more output you get, and you can freely adjust output by adjusting wages. You also seem to thing he has a lot of pricing flexibility due to the demand. I think those ideas have several problems:

1. There's an obvious limit to individual output, and his existing employees are probably operating close to that, especially since his business was already under stress.

2. Human psychology is complicated, and you're ignoring morale. A logical robot might have the same satisfaction with a certain wage before and after he's made much more than that, but a human probably won't (and that's even an oversimplification).

3. His customers are probably going be unhappy with him for raising prices in a crisis, regardless if he had good reasons for it or not. He's already dealing with the problem of customers leaving after a crisis for cheaper competitors, and a price increase now would probably make that problem even worse.

Re:If you imagine a business making surgical facemasks is wo... by mrosett on Monday April 06, 2020 @09:36AM (#22793562)
> There's an obvious limit to individual output, and his existing employees are probably operating close to that, especially since his business was already under stress.

I'm as big an advocate as anyone for sustainable work practices, and I absolutely agree that most of the time working longer hours is counterproductive over the long term. But isn't working on an assembly line during a crisis pretty much the canonical counterexample? Output scales linearly with time even if you aren't feeling creative/fresh/energetic, and there's an urgent need for more masks now.

Re:If you imagine a business making surgical facemasks is wo... by lonelappde on Sunday April 05, 2020 @10:36PM (#22790469)
Why can't he hire people on a fixed term contract to avoid unemployment?
Re:If you imagine a business making surgical facemasks is wo... by WalterBright on Monday April 06, 2020 @12:21AM (#22790890)
Businesses that try that often get sued by those employees after-the-fact to get the benefits of employment. Then the courts decide if they were really employees or not.

Like the current Uber driver case.

Re:If you imagine a business making surgical facemasks is wo... by BeetleB on Monday April 06, 2020 @03:23AM (#22791532)
> Why can't he hire people on a fixed term contract to avoid unemployment?

There are laws about what constitutes contractors vs employees - both federal and state. If you satisfy N out of M items in a checklist, you are an employee, regardless of whether both parties want you to be.

Controlling how you do your job is one of them. If the employer directs how you can do the job and doesn't give you freedom to do it your own way, that's a major item.

If your employer doesn't let you bring your own equipment, that's another one.

If you do not have a chance of losing money on the contract, that's another one. Say you hire a contractor to repair your roof, and he screws it up. Typically he is expected to fix it even if he ends up with a net loss (or he can refuse and not get paid at all). When an employee screws up, the worst that will happen is he'll get fired.

And so on.

It's very unlikely these people can be contractors unless he's hiring experienced folks who know the equipment.

Re:If you imagine a business making surgical facemasks is wo... by jlokier on Monday April 06, 2020 @04:54AM (#22791939)
Fixed term employment contracts are an option too. They are quite common. E.g. nearly everyone in academia.

I think you have misunderstood the suggestion; it's not about contractors vs. employees, it's about fixed-term versus not.

Fixed-term employees are not classed as contractors. They are regular employees with all the usual benefits and rights of employement - except that it comes to an end at a pre-determined date, unless extended.

Re:If you imagine a business making surgical facemasks is wo... by fidelramos on Monday April 06, 2020 @07:51AM (#22792860)
How do you expect businesses to gamble with a predetermined end date that will probably not match the actual end of the pandemic?

Regulations have many unseen side effects that end up causing damage, people should think harder about them and they would realize that in many cases (most in my opinion) they do more harm than good.

Re:If you imagine a business making surgical facemasks is wo... by BeetleB on Monday April 06, 2020 @10:19AM (#22793923)
I see. So what happens when the contract ends? Can they not apply for unemployment? And if they do, will it still not affect the business's premiums?
Re:If you imagine a business making surgical facemasks is wo... by austhrow743 on Monday April 06, 2020 @12:34AM (#22790925)
Likely such a contract would be unattractive to potential desirable candidates unless he could pay a rate that would require higher mask prices.
Re:If you imagine a business making surgical facemasks is wo... by kevingadd on Monday April 06, 2020 @02:05AM (#22791239)
There are plenty of unemployed people who need to pay rent. If such a short term contract - getting paid to do relatively safe work and help fight the pandemic by making masks - isn't appealing that's probably because he's not paying enough.

Everyone's already charging more for masks, he should be able to manage a decent market rate. To begin with, unemployed people in a pinch are probably willing to accept slightly lower pay.

Re:If you imagine a business making surgical facemasks is wo... by swiley on Monday April 06, 2020 @07:20AM (#22792692)
But then he would be “profiting off a crisis” and that makes him a horrible person.
[dead]
Re:If you imagine a business making surgical facemasks is wo... by Zenbit_UX on Sunday April 05, 2020 @11:58PM (#22790800)
N95s? The articles about surgical masks and they cost, $0.02ea from China.
Re:If you imagine a business making surgical facemasks is wo... by fiblye on Sunday April 05, 2020 @07:46PM (#22789710)
Even if companies were legally and easily selling masks for 100x normal price, I doubt any employees on the factory line would ever make more than a small double digit percentage in overtime payments.
Re:If you imagine a business making surgical facemasks is wo... by bsder on Sunday April 05, 2020 @10:48PM (#22790543)
You are asking the business owner to arbitrage his business (place a bet that he can carry expenses until some crisis allows him to gouge).

Why do you want the business owner to arbitrage his business when the people who do arbitrage for a living won't do it for him? If the experts at arbitrage declare it a bad idea, then he probably shouldn't do it either.

And he's not. That's sensible.

Re:If you imagine a business making surgical facemasks is wo... by keanzu on Monday April 06, 2020 @05:08AM (#22792001)
Arbitrage is a transaction that involves no negative cash flow at any probabilistic or temporal state and a positive cash flow in at least one state; in simple terms, it is the possibility of a risk-free profit after transaction costs.

https://en.wikipedia.org/wiki/Arbitrage

There's no arbitrage for the factory taking a loan, it is just a business risk.

Re:If you imagine a business making surgical facemasks is wo... by bsder on Sunday April 05, 2020 @10:39PM (#22790489)
Someone like Bill Gates or Warren Buffet could have this man up and running 24/7 by simply providing a guaranteed contract valid for 5 years. Given that a million dollars was a big deal to this guy, it seems like a contract for $10 million would be way more than sufficient.

NOT A SINGLE WEALTHY PERSON has done this. None. Zero. Nada.

There's your answer as to the priorities of capitalism.

Re:If you imagine a business making surgical facemasks is wo... by gruez on Sunday April 05, 2020 @10:58PM (#22790585)
Can't this argument be applied to literally any project that benefits society? eg. "Bezos should be funding roads/schools/healthcare, but he isn't because he's a greedy fatcat!" This is a role for the government, not philanthropic patrons.
Re:If you imagine a business making surgical facemasks is wo... by Finnucane on Sunday April 05, 2020 @11:27PM (#22790683)
Indeed, this is basically correct. The premise should be rephrased as ‘corporations and the wealthy should pay their fucking taxes so the government can provide services.’
Re:If you imagine a business making surgical facemasks is wo... by PaulDavisThe1st on Monday April 06, 2020 @01:01AM (#22791021)
Which could be rephrased as "governments should write tax law such that corporations pay taxes, to help governments provide services".

Granted, companies work hard to be devious. But when we allow them to spend their profits on a whole slew of stuff that reduces their tax rates to zero percent, it seems churlish to blame the companies. Government specifically waived taxes in order to encourage e.g. R&D and now we, the people, are paying the price of the details of a large raft of this sort of law making.

Re:If you imagine a business making surgical facemasks is wo... by Finnucane on Monday April 06, 2020 @08:07AM (#22792968)
No, government waived taxes because wealthy donor as and corporate lobbyists pay politicians to give them good tax breaks.
Re:If you imagine a business making surgical facemasks is wo... by PaulDavisThe1st on Monday April 06, 2020 @02:57PM (#22796674)
Governments use tax law all the time to create incentives and disincentives to various sorts of things.

Governments also use tax law to reward specific groups of people, for reasons both honorable and nefarious.

Identifying the motives for a given tax law is often quite difficult. Companies currently get to avoid most taxes on profits that are reinvested in activities that they certify as "research and developement". Is this possible because the government wants to encourage R&D or as a payoff to their political sponsors, or both?

It's non-trivial to answer, but what's easy to say with certainty is that is an example of _how_ companies avoid paying taxes, and if you want to stop it, you need new tax laws which don't permit/encourage this.