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Willygolightly t1_j19ooq1 wrote

Reply to comment by SolitaryMarmot in ‘Major Trustee, Please Prioritize’: How NYU’s E.R. Favors the Rich by goodguyfdny

Bellvue is the only mental health hospital in the city, and receives patients from many situations.

It is also what is called a “safety net” hospital, and is intended by the city to be a hospital that takes in people regardless of ability to pay or insurance status.

Among other things, NYU is a research hospital, working to advance new medical practices.

You aren’t totally without a point but this is a bad example.

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SolitaryMarmot t1_j1a1gwu wrote

So what you are saying is...some hospitals are for poor people and some hospitals are for people with money and good insurance.

And Bellevue isn't a mental health hospital. Its an acute care general hospital with psych beds, same as any other hospital in the city.

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DressOwn9783 t1_j1b7b6g wrote

appreciate you fighting the good fight here. crazy how some people will literally sit down and write out paragraphs about why a segregated healthcare system is fine and dandy

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Willygolightly t1_j1d7aje wrote

I never said our broken healthcare system was fine and dandy- just that the fact that if some wealthy individuals have given their money to make some facilities better it isn’t the fault of those individuals and their contributions that the rest of the system is broken.

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Willygolightly t1_j1c8cle wrote

No, what I’m saying is that Bellevue receives almost all of its funding from the NY State gov, and NYU receives most of its funding from outside sources.

Bellevue is also significantly larger in terms of capacity, and more has a larger ER and in patient facility.

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SolitaryMarmot t1_j1dk1nh wrote

That's not how hospitals work. All hospitals...including the publics run on net patient service revenue. They send the bill for services off to Medicaid, Medicare or private insurance and get reimbursement. All the hospitals that treat mostly Medicaid patients, including the privates, get some type of "extra" funding but usually not a lot. It's usually through the Disproportionate Share program and the Indigent Care Pool. In the years we have a mayor that chooses to support NYC Health and Hospitals (which so far has been deBlasio) - there is also a city subsidy. A lot of that is for outpatient services which runs at massive losses because its servicing the undocumented population of NYC as well.

But no outside funding stabilizes losses which are structural and built into the payer mix. Hospitals that don't have enough private insurance patients run at a loss. And while they aren't supposed to turn away Medicaid patients - they obviously do. NYU and Bellevue are literally right next to each other. NYU has 15% Medicaid and Bellevue has 81% Medicaid. All things being equal.. Why wouldn't Medicaid patients choose the "better" hospital if they actually could?

That isn't because of some freak of statistics. It's because NYU gives privileges to doctors who keep very few Medicaid patient appointments a month and have a long waiting list for new Medicaid patients. And when Medicaid patients come through the ED they tell them the wait is shorter at Bellevue or they don't have the right kind of physician for them on, or they don't have beds in case of an admit...in the case of psych patients they literally wheel them over to the Bellevue ED even though NYU does have psych beds (Bellevue is larger because it has more psych beds but otherwise they are both in the 800-900 bed range.) Bellevue would never say or do these things because it's contrary to their mission.

Your socioeconomic class...including the type of insurance you have, determines the quality of health care you get in NYC and around the country. But NYC happens to be particularly stratified. If you ever need to use Medicaid (or even Medicare to a lesser degree) be prepared to only be allowed to use the shitty hospitals and providers.

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ctindel t1_j1dts0y wrote

> Your socioeconomic class...including the type of insurance you have, determines the quality of health care you get in NYC and around the country.

This happens even in western europe, where everyone has coverage but people with more money can pay for upgraded service or to skip the queue. I don't know any country where a billionaire or whatever their equivalent of a senator is differently in the hospital.

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