By COMMON SCENTS BY CAROLE ORLIN
I received a lot of e-mails in response to my last column (SMDP, March 27, page 5) about the frustrations and shortcomings of our hospitals and health care delivery systems in general. I heard from patients and providers alike, and it was heartening to know that both groups of people feel the frustration of not only receiving, but also giving inadequate care. One response I received from a local physician shined another light on the issue. He spoke about the frustration he feels with the “insurance industry and the legal world hovering around our health care facilities and doctors, literally like vultures, with no incentive other than their financial profit …”
These comments took on added significance as I recently read an interesting article in The New York Times. I was taken back to the 1980s when hospitals began asking their business people to attend clinical meetings. Of course the purpose of that was to see how doctors could cut costs and be more “efficient.” For example, the less time a doctor spends with a “customer” (no longer a patient), the more customers he can see, and you know the rest. More and more business jargon became infused into the medical world. The buzz phrase that that became popular in the 1990s was “throughput,” which basically refers to the number of patients/customers per hospital bed per week. The hospitals make most of their money when the patient is first admitted. The income goes down after that. So the doctors are encouraged to keeps things moving — move ‘em out in as short a time as possible and move new ones in.
Of course, non-hospitalized customers are taking up space too. The New York Times article mentioned that publicly traded HMOs began restricting doctors to seven-minute “encounters” with each “customer.” That’s pretty scary. It seems that doctors now have to be business people first and physicians second. No one is denying that health care expenses have to be reduced, but does it have to be at the expense of the patient’s well-being and self respect?
During a recent episode of The Sopranos, health care found itself enmeshed in the storyline. Even Tony Soprano had to deal with the evil utilization review staff and was forced to leave the hospital much sooner than he and his family felt was warranted. Tony also learned about the “wallet biopsy” he was given in the ambulance on the way to the hospital. For those of you who do not know what that means, it’s the checking of the patient’s wallet by the ambulance staff to see if the injured person has health insurance as a means of deciding to which hospital he or she will be taken. If Tony is not immune from these practices, no one is.
We have been exposed to repeated doses of the “health care crisis” from at least the 1980s to date. The high costs of health care, reflected in skyrocketing insurance premiums, larger deductibles and the huge bureaucracies of managed care have become all too familiar. Perhaps the “crisis” within our health care system has become too commonplace and politically complex. We know there are tremendous amounts of special interest money flowing from insurance companies and pharmaceutical companies to our elected officials. It has become another monolithic issue that causes us to feel helpless and results in our becoming increasingly apathetic.
We can see that it has been pushed to the background for a wide variety of reasons, ranging from partisan politics to all the new crises that have become the headline news stories of the day: terrorism, war in Iraq, illegal immigration, homelessness, Natalie Holloway, Dick Cheney, and the list goes on and on. The media focus our attention on issues that are more sensational than health care. Yet, like a cancer that continues to metastasize, this issue is growing and becoming more difficult to eradicate. It is so multi-faceted that when it is addressed from one perspective, it falls short on so many others. It is interesting to note that the immigration debate that is now on the front burner often finds itself intertwined in the strain that 12 million illegal immigrants have placed on our health care system — especially in California.
A recent health issue was a real wake up call for me. It is time to tackle this seemingly irresolvable problem that many Americans, including myself, have put on the back burner. This issue has virtually been ignored and has been silently metastasizing for a long time, which is precisely what the ones who benefit from it most want it to do. It’s time to deal with health care as a real crisis, and put it on the front burner where it belongs. (Carole)
Originally published in the Santa Monica Daily Press print edition on April 10, 2006. Read the original PDF.