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1. bnralt+(OP)[view] [source] 2023-11-20 15:46:05
> Now the cat is out of the bag, and people no longer believe that a non-profit who can act at will is a trusted vehicle for the future.

And maybe it’s not. The big mistake people make is hearing non-profit and think it means there’s a greater amount of morality. It’s the same mistake as assuming everyone who is religious is therefore more moral (worth pointing out that religions are nonprofits as well).

Most hospitals are nonprofits, yet they still make substantial profits and overcharge customers. People are still people, and still have motives; they don't suddenly become more moral when they join a non-prof board. In many ways, removing a motive that has the most direct connection to quantifiable results (profit) can actually make things worse. Anyone who has seen how nonprofits work know how dysfunctional they can be.

replies(4): >>maksim+Y5 >>vel0ci+Qa >>throw_+9g >>campbe+sI
2. maksim+Y5[view] [source] 2023-11-20 16:20:07
>>bnralt+(OP)
> Most hospitals are nonprofits, yet they still make substantial profits and overcharge customers.

Are you talking about American hospitals?

replies(1): >>deaddo+08
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3. deaddo+08[view] [source] [discussion] 2023-11-20 16:30:54
>>maksim+Y5
There are private hospitals all over the world. I would daresay, they're more common than public ones, from a global perspective.

In addition, public hospitals still charge for their services, it's just who pays the bill that changes, in some nations (the government as the insuring body vs a private insuring body or the individual).

replies(2): >>swagem+Ap >>sangno+zu
4. vel0ci+Qa[view] [source] 2023-11-20 16:44:45
>>bnralt+(OP)
> Most hospitals are nonprofits, yet they still make substantial profits and overcharge customers.

They don't make large profits otherwise they wouldn't be nonprofits. They do have massive revenues and will find ways to spend the money they receive or hoard it internally as much as they can. There are lots of games they can play with the money, but experiencing profits is one thing they can't do.

replies(1): >>bnralt+fd
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5. bnralt+fd[view] [source] [discussion] 2023-11-20 16:56:07
>>vel0ci+Qa
> They don't make large profits otherwise they wouldn't be nonprofits.

This is a common misunderstanding. Non-profits/501(c)(3) can and often do make profits. 7 of the 10 most profitable hospitals in the U.S. are non-profits[1]. Non-profits can't funnel profits directly back to owners, the way other corporations can (such as when dividends are distributed). But they still make profits.

But that's besides the point. Even in places that don't make profits, there are still plenty of personal interests at play.

[1] https://www.nytimes.com/2020/02/20/opinion/nonprofit-hospita...

replies(3): >>bbor+Ji >>vel0ci+Em >>araes+Mn
6. throw_+9g[view] [source] 2023-11-20 17:06:09
>>bnralt+(OP)
I've worked with a lot of non-profits, especially with the upper management. Based on this experience I am mostly convinced that people being motivated by a desire for making money results in far better outcomes/working environment/decision-making than people being motivated by ego, power, and social status, which is basically always what you eventually end up with in any non-profit.
replies(4): >>bbor+ai >>father+Rk >>kbenso+nm >>SoftTa+3r
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7. bbor+ai[view] [source] [discussion] 2023-11-20 17:12:38
>>throw_+9g
Interesting - in my experience people working in non profits are exactly like those in for-profits. After all, if you’re not the business owner, then EVERY company is a non-profit to you
replies(2): >>father+ml >>golerg+jz
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8. bbor+Ji[view] [source] [discussion] 2023-11-20 17:14:38
>>bnralt+fd
This seems like pedantics…? Yes, they technically make a profit, in that they bring in more money in revenue than they spent in expenditures. But it’s not going towards yachts, it’s going toward hospital supplies. Your comment seems to be using the word “profit” to imply a false equivalency
replies(2): >>scythe+Cm >>aaronb+0o
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9. father+Rk[view] [source] [discussion] 2023-11-20 17:20:53
>>throw_+9g
This rings true, though I will throw in a bit of nuance. It's not greed, the desire of making as much money as possible, that is the shaping factor. Rather the critical factor is building a product for which people are willing to spend their hard earned money on. Making money is a byproduct of that process, and not making money is a sign that the product, and by extension the process leading to the product, is deficient at some level.
replies(1): >>adverb+bz
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10. father+ml[view] [source] [discussion] 2023-11-20 17:22:17
>>bbor+ai
Upper management is usually compensated with financially meaningful ownership stakes.
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11. kbenso+nm[view] [source] [discussion] 2023-11-20 17:25:38
>>throw_+9g
> people being motivated by ego, power, and social status, which is basically always what you eventually end up with in any non-profit.

I've only really been close to one (the owner of the small company i worked at started one), and in the past I did some consulting work for anther, but that describes what I saw in both situations fairly aptly. There seems to be a massive amount of power and ego wrapped up in the creation and running these things from my limited experience. If you were invited to a board, that's one thing, but it takes a lot of time and effort to start up a non-profit, and that's time and effort that could be spent towards some other existing non-profit usually, so I think it's relevant to consider why someone would opt for the much more complicated and harder route than just donating time and money to something else that helps in roughly the same way.

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12. scythe+Cm[view] [source] [discussion] 2023-11-20 17:26:10
>>bbor+Ji
Understanding the particular meaning of each balance-sheet category is hardly pedantry at the level of business management. It's like knowing what the controls do when you're driving a car.

Profit is money that ends up in the bank to be used later. Compensation is what gets spent on yachts. Anything spent on hospital supplies is an expense. This stuff matters.

replies(1): >>vel0ci+pp
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13. vel0ci+Em[view] [source] [discussion] 2023-11-20 17:26:12
>>bnralt+fd
> Non-profits can't funnel profits directly back to owners, the way other corporations can (such as when dividends are distributed). But they still make profits.

Then where do these profits go?

replies(5): >>jfim+Wr >>userna+ks >>guhcam+8x >>s1arti+cB >>icedch+MC
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14. araes+Mn[view] [source] [discussion] 2023-11-20 17:29:21
>>bnralt+fd
501(c)(3) is also not the only form of non-profit (note the (3))

https://en.wikipedia.org/wiki/501(c)_organization

"Religious, Educational, Charitable, Scientific, Literary, Testing for Public Safety, to Foster National or International Amateur Sports Competition, or Prevention of Cruelty to Children or Animals Organizations"

However, many other forms of organizations can be non-profit, with utterly no implied morality.

Your local Frat or Country Club [ 501(c)(7) ], a business league or lobbying group [ 501(c)(6), the 'NFL' used to be this ], your local union [ 501(c)(5) ], your neighborhood org (that can only spend 50% on lobbying) [ 501(c)(4) ], a shared travel society (timeshare non-profit?) [ 501(c)(8) ], or your special club's own private cemetery [ 501(c)(13) ].

Or you can do sneaky stuff and change your 501(c)(3) charter over time like this article notes. https://stratechery.com/2023/openais-misalignment-and-micros...

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15. aaronb+0o[view] [source] [discussion] 2023-11-20 17:30:13
>>bbor+Ji
https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonpro...
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16. vel0ci+pp[view] [source] [discussion] 2023-11-20 17:35:17
>>scythe+Cm
So from the context of a non-profit, profit (as in revenue - expenses) is money to be used for future expenses.

So yeah, Mayo Cinic makes a $2B profit. That is not money going to shareholders though, that's funds for a future building or increasing salaries or expanding research or something, it supposedly has to be used for the mission. What is the outrage of these orgs making this kind of profit?

replies(1): >>s1arti+nk1
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17. swagem+Ap[view] [source] [discussion] 2023-11-20 17:36:10
>>deaddo+08
Its about incentives though.
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18. SoftTa+3r[view] [source] [discussion] 2023-11-20 17:41:51
>>throw_+9g
The bottom line doesn't lie or kiss ass.
replies(1): >>ikekkd+NU
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19. jfim+Wr[view] [source] [discussion] 2023-11-20 17:44:28
>>vel0ci+Em
Some non profits have very well remunerated CEOs.
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20. userna+ks[view] [source] [discussion] 2023-11-20 17:46:08
>>vel0ci+Em
One of the reason why companies distribute dividends is that when a big pot of cash starts to accumulate, there end up being a lot of people who feel entitled to it.

Employees might suddenly feel they deserve to be paid a lot more. Suppliers will play a lot more hardball in negotiations. A middle manager may give a sinecure to their cousin.

And upper managers can extract absolutely everything trough lucrative contracts to their friends and relatives. (Of course the IRS would clamp down on obvious self-dealings, but that wouldn't make such schemes disappear. It'll make them far more complicated and expensive instead.)

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21. sangno+zu[view] [source] [discussion] 2023-11-20 17:53:38
>>deaddo+08
> There are private hospitals all over the world. I would daresay, they're more common than public ones, from a global perspective.

Outside of the US, private hospitals tend to be overtly for-profit. Price-gauging "non-profit" hospitals are mostly an American phenomenon.

replies(1): >>deaddo+Ez2
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22. guhcam+8x[view] [source] [discussion] 2023-11-20 18:01:55
>>vel0ci+Em
If you don't have to turn a profit to investors, you suddenly can pay yourself an (even much more astronomically high) salary.
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23. adverb+bz[view] [source] [discussion] 2023-11-20 18:09:12
>>father+Rk
Excellent to make that distinction. Totally agree. If only there was a type of company which could have the constraints and metrics of a for-profit company, but without the greed aspect...
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24. golerg+jz[view] [source] [discussion] 2023-11-20 18:09:47
>>bbor+ai
People across very different positions take smaller paychecks in non-profits that they would do otherwise and compensate by feeling better about themselves, as well as getting social status. In a lot of social circles, working for a non-profit, especially one that people recognise, brings a lot of clout.
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25. s1arti+cB[view] [source] [discussion] 2023-11-20 18:16:19
>>vel0ci+Em
They usually pile up in a bank account of stocks and bonds or real estate assets held by the non-profit.
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26. icedch+MC[view] [source] [discussion] 2023-11-20 18:22:01
>>vel0ci+Em
They call it "budget surplus" and often it gets allocated to overhead. This eventually results in layers of excess employees, often "administrators" that don't do much.
replies(1): >>s1arti+Ri1
27. campbe+sI[view] [source] 2023-11-20 18:41:54
>>bnralt+(OP)
> removing a motive that has the most direct connection to quantifiable results (profit) can actually make things worse

I totally agree. I don't think this is universally true of non-profits, but people are going to look for value in other ways if direct cash isn't an option.

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28. ikekkd+NU[view] [source] [discussion] 2023-11-20 19:27:16
>>SoftTa+3r
Be the asshole people want to kiss
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29. s1arti+Ri1[view] [source] [discussion] 2023-11-20 20:58:58
>>icedch+MC
Or it just piles up in an endowment, which becomes a measure of the non-profit's success, in a you make what you measure, numbers go up sort of way. "grow our endowment by x billion becomes the goal" instead of questioning why they are growing the endowment instead of charging patients less.
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30. s1arti+nk1[view] [source] [discussion] 2023-11-20 21:03:58
>>vel0ci+pp
The word supposedly is doing a lot of heavy lifting in your statement. When it's endowments keep growing over decades and sometimes centuries without being spent for the mission, people naturally ask why the nonprofit keep raising prices for their intended beneficiaries
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31. deaddo+Ez2[view] [source] [discussion] 2023-11-21 05:03:14
>>sangno+zu
> Price-gauging "non-profit" hospitals are mostly an American phenomenon.

That just sounds like a biased and overly emotive+naive response on your part.

Again, most hospitals in the world operate the same way as the US. You can go almost anywhere in SE Asia, Latín América, África, etc and see this. There's a lot more to "outside the US" than Western+Central Europe/CANZUK/Japan. The only difference is that there are strong business incentives to keep the system in place since the entire industry (in the US) is valued at more than most nations' GDP.

But feel free to keep twisting the definition or moving goalposts to somehow make the American system extra nefarious and unique.

replies(1): >>sangno+DK2
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32. sangno+DK2[view] [source] [discussion] 2023-11-21 06:45:16
>>deaddo+Ez2
There are 2 axes under discussion going back to the root of this thread: public/private and nonprofit/for-profit, and you seem to be missing that I'm mentioning a specific quadrant^w octant, after adding the cost axis that's uniquely American. There are not a lot of pricey nonprofit hospitals in Africa, for instance.
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