For anyone with eyes to see the cruelty is the point.

That's not accurate. An aside: these stories do not impress me, in no small part because nobody bothers to understand them. However, an anecdote:

One fine Friday our local hospital sent out a memo saying they were closing labor & delivery the following Friday. Too bad, so sad, fact of the matter is they can't afford to keep the place open because so many nurses and doctors have quit (we know 3 OBGYNs at that hospital that noped out of hospital practice entirely due to how horrible people were during COVID) that they have to book travel nurses, and travel nurses cost 250% what permanent-hire nurses cost, and ain't nobody kinna ford that so fuck you, labor and delivery is moving five exits north to the catholic hospital run by the same conglomerate.

On Friday afternoon we got the memo.

On Saturday we were privy to all the L&D department going "I can't practice at a catholic hospital" "half the procedures we offer are embargoed by the nuns" "I have any number of patients who won't be comfortable with a crucifix on the wall" etc.

On Monday morning the local paper ran "Labor & Delivery closing Friday".

On Monday afternoon the city council wrote a pointed letter to the conglomerate saying "So you're under contract? To provide certain services? That are enumerated in this handy document we're forwarding to you? And a breach of contract is subject to the fines listed? And any alteration to the contract is subject to a ballot measure? So you do you but this is going to fuck your shit up."

On Monday evening the hospital conglomerate rescinded the closure.

-BUT-

We can't hardly transport there anymore because they're running it on a skeleton crew. Nobody works there. The travel nurses are the most awful; we had a patient who... is a little fussy and one of the travel nurses retaliated by writing "addicted to meth" in her chart notes so that social services had to waste everyone's time for a week sorting out an official legal document that was a bald-faced lie fabricated out of whole cloth. Shit is almost as fucked up as if they had closed.

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So there's the provider perspective. Shit's all fucked up. The patient perspective is very similar - shit's all fucked up. How 'bout the hospital perspective? Shit's all fucked up. But what about the corporate perspective?

shit's all fucked up.

See, they got this contract because there was profit to be had. You pay your nurses and doctors as little as possible, you nail the insurance companies to the wall, you bill the shit out of everyone and you deliver phat phat dividends every quarter. And then COVID demonstrates that "essential worker" means "grist for the mill", the people you rely on to make your profits decide their lives are worth more than your quarterly statements and your entire fucking universe fills up with expenses you can't bill.

And now their stock is tanking because everyone knows what a clusterfuck medicine is now might as well pivot to pharma. So their bonds are shit and nobody wants them. Their profit centers are the opposite of profitable and they can save more money by reneging on state contracts than they can on bringing in travel nurses at 250%.

never attribute to malice that which is more easily explained by incompetence.

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It's fucking stupid that we have elastic pricing on an inelastic good. It's fucking stupid that we pay hundreds or thousands of dollars a month for insurance we can't use, and if we use it, we have to fight tooth and claw. It's fucking stupid that my taxes go to an ambulance company that will bill my insurance $25k if I need to use it and my insurance company will tell me they don't cover ambulances. It's fucking stupid that we decided hospitals should be for-profit entities run by publicly-traded corporations. It's all fucking stupid - but none of it is evil. It's just the natural expression of greed.

And if you want rural hospitals fucking raise the goddamn medicaid rate. We've been lobbying for that for eight fucking years and lemme tell ya - Medicaid pays us better than about 2/3rds of the insurance we take so we take about 1/3rd Medicaid.

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This is an easy fix. All it takes is moving beans around. And at this point? I'll bet the insurance companies would take it. So would the corporations. Nobody can make money anymore despite charging people tens of thousands of dollars a year for the privilege of surviving a catastrophic car crash.

And also FFS of the two hospitals at risk of closing in Idaho one of them got its very own New York Times article and fuck you that bitch needs to close. A town with a thousand people in it does NOT need eight full-time hospital beds.