posted on August 25, 2003 09:04:05 AM new
America's Healthcare Scandal
Marketplace Medicine
By DAVE LINDORFF
Politicians are fond of saying that America has the finest system of healthcare in the world, and no doubt it's true that if you have endless resources, or a gold-plated health plan--the kind that is becoming increasingly rare as more and more companies shift more and more of their workers into ever stingier HMO's or take away their healthcare benefits altogether--you can get medical care that is as good as it gets.
But for most of us, the picture is a lot grimmer.
Because healthcare in America is run on a for-profit basis, it is basically controlled by the paymaster, meaning the insurance industry. Medicare is an exception, but as the government continues to lure and push Medicare recipients off onto private HMO-type plans, even that is becoming increasingly a for-profit operation.
What does this mean? That the people who are making the decisions--both in terms of broad treatment policies and also in terms of individual patients' treatment--are primarily motivated by cutting costs and maximizing profits.
Worse than that, because we're talking about American business practices here, the people and companies that are making these critical medical care decisions aren't even thinking about cutting costs and maximizing profits in a long-term sense. Given that most corporations consider long-range planning to mean looking a year ahead, they're not likely to be thinking about what healthcare measures or individual medical treatments are likely to be cost-effective over a five or ten-year period, much less over the life of a patient, but rather, what will be the cheapest health policy or treatment over the next three weeks or three months.
For example, it would obviously be immensely more cost effective as a matter of national health policy over the long term--and certainly for individual patients--to have a national program of free vaccinations for the flu, which annually kills tens of thousands of elderly or infirm Americans. Saving those lives, and reducing the millions of person days thre rest of us spend miserably nursing the flu each year, would obviously represent an enormous cost savings even for the insurance industry that has to pay for all that care, but the initial outlay for all those vaccinations would be an upfront cost that would not be recovered for months. The result: no national flu vaccination program.
The same thing could be said for high blood pressure. If insurance companies all paid for routine screening and treatment of high blood pressure with the most effective medicines available (instead of pawning off only the older, less effective treatments on poorer patients), heart disease could be reduced dramatically, which would actually be a huge cost savings for the insurance industry (and for Medicare and Medicaid). But again, because the initial cost of such a program would be large and would not pay for itself over the short term, no one is doing this.
The list of such idiocies is endless.
Meanwhile, we are treated to scandal after scandal, courtesy of our vaunted free-enterprise medical system.
Consider the tale of Tenet Healthcare, one of the nation's largest for-profit hospital chains. A few days ago, Tenet agreed to pay a $54-million fine to the federal government, in the words of the New York Times, "to resolve accusations" that the company's hospital in Redding California had in conjunction with several of its doctors conducted unneeded heart operations on hundreds of patients who did not need such costly, invasive and life-threatening procedures. As is common in such corporate settlements with the government, Tenet (no stranger to scandal) was allowed to settle without having to admit guilt--a nice concession by the government, since it makes it much harder for those hundreds of victims of the surgeons' knives to sue for malpractice damages than if the hospital company had been forced to admit its craven behavior.
Here's a scandal that simply could not occur in a society with public medicine: Unnecessary heart surgery, performed on hundreds of people because the doctors and the hospital saw a way to make millions of dollars.
Tenet, in fact, is a new name adopted by a company once known as National Medical Enterprises. The name change was in large part an effort to distance the firm from its sordid past, which included an enormous scandal involving NME's psychiatric hospitals, which were hit with one of the largest fines in the history of the U.S. Department of Health and Human Services for reportedly keeping psychiatric patients overlong in the hospital, often against the patients' wishes, so as to collect more from Medicare and insurers. After a change in top management, the company emerged from that scandal, largely intact but with a new alias, though not, as the Redding Medical Center case demonstrates, with a new ethical standard.
Tenet is no exception, though. Columbia Healthcare, another large hospital chain, also has paid huge fines to the government for bilking Medicare--and in the end, much of that bilking inevitably involves unnecessary medical treatments. Smaller scandals, which occur routinely, don't even make the national news. And we're not even talking here about the large scandal--the denial of adequate treatement, or of any treatment at all, to tens of millions of American citizens who are without health insurance.
The sorry state of America's healthcare system--the costliest in the world by far--should have the public screaming for massive reform. So far, however, all we've got on the table are Bush administration calls for more privatization of Medicare, and a bunch of pallid calls for some kind of minimal private insurance coverage for all from some of the Democratic presidential candidates. Only progressive candidate Dennis Kucinich is calling for a publicly funded national insurance program, though even his healthcare scheme continues to rely on private physicians and hospitals to actually deliver services--and even that modest reform is being ignored by the media (along with Kucinich's entire campaign).
Maybe it's time for a health victims' march on Washington. The heart surgery victims of Tenet Healthcare could be the vanguard of the march, chests bared to expose the scars of their needless operations.
Dave Lindorff is the author of Marketplace Medicine: The Rise of the For-Profit Hospital Chains, (Bantam Books, 1992) Killing Time: an Investigation into the Death Row Case of Mumia Abu-Jamal. A collection of Lindorff's stories can be found here: http://www.nwuphilly.org/dave.html
"Be kind. Remember everyone you meet is fighting a hard battle." - Harry Thompson
"I have neither the time nor the inclination to explain myself to a man who rises and sleeps under the blanket of the very freedom I provide and then questions the manner in which I provide it." - A Few Good Men
posted on August 25, 2003 04:54:53 PM new
If Canadas National healh care is in trouble, I think Frances is also. I was watching the news (no links, sorry, no copy paste, sorry) but that 10,000 had died from the heatwave, and they are blaming it on socialized medicine.. just another thought on National Healthcare.
Art Bell Retired! George Noory is on late night coasttocoastam.com
posted on August 25, 2003 05:20:16 PM new
lol - Yes, and on top of the tremendous cost for national health care would be those long long long waits they are so upset they say the Vets are having to endure. Now they want the same for the rest of us....AND we get to pay more in taxes for the privilege. lol
posted on August 25, 2003 06:07:45 PM new
Millions of American get to wait and at the end of their wait there is no health care, they are the uninsured. Some with preexisting conditions ineligible for insurance at any price.
What has the status quo done for you. Has this system served you adequately? And at what cost to you and your loved ones.
Anticipating you comments I will say, I am insured. Actually over insured if such a thing is possible, in addition I am a financial contributor to the UCSF Foundation which helps fund ongoing research at the UCSF Hospital in San Francisco. It is the responsibility of every member of society to care for every member of society, some do so willingly. Others vote Republican in an attempt to impede progressive thought.
posted on August 25, 2003 06:16:18 PM new
davebraun
I am insured, maybe like you, overinsured (I have to be)
but your comment
It is the responsibility of every member of society to care for every member of society, some do so willingly. Others vote Republican in an attempt to impede progressive thought
You know, I (we) give to charitable orginizations on a regular basis.
My brother and I were having a conversation with someone, that wanted to know, exactly who we gave to, and how much.
We thought that totally inappropriate, and it is.
We do research on orginizations, on where monies would do the best in each one.
Please don't say that Republicans are people who do not believe everyone should 'look out for one another' because that is an inaccuarte statement.
Art Bell Retired! George Noory is on late night coasttocoastam.com
posted on August 25, 2003 06:16:33 PM new
Whats really sad is that most elderly people have to break their pills (medication) in half becouse midicare is so expensive.
[ edited by bigcitycollectables on Aug 25, 2003 06:17 PM ]
posted on August 25, 2003 06:21:41 PM new
Wow there Bigcity/Skylite... I was hoping to get to use some of my medical insurance... guess when less of a liar and more a man comes along
posted on August 25, 2003 06:52:34 PM new
My only mention as to the who or why is simply to bypass the right wing argument that I obviously am looking for a free ride as is everyone who advocates a universal one payer health care system which is not the case.
As to the comment about under dosing on Medicare; Medicare currently pays nothing toward prescription drugs. Medicare will pay a minimal amount for diabetic supplies (lancets and test strips) but none of the cost of drugs either oral or injectable and many pharmacies will not accept Medicare reimbursement for supplies as they are a slow payer evidently.
As to my statement or your take on my statement "Please don't say that Republicans are people who do not believe everyone should 'look out for one another' because that is an inaccurate statement."
We have reached a point at which less than 1% of the population controls over 99% of the wealth. I realize that you are not among the 1% but so long as folks like you are willing to support these vampires with your votes the majority of Americans will continue to suffer at their hands denied the most basic services including medical care.
At another point of this thread a statement was made alluding to the long lines for medical care in Canada as some sort of justification for not having the same system instituted in Canada. Obviously this person has not been in an American hospital in any major city lately where bed shortages are the norm not the exception to the rule.
posted on August 25, 2003 08:03:40 PM new
I think what's needed in every country, is to have school classes taught on when you need medical care and when you don't.
posted on August 25, 2003 08:17:59 PM new
Health care is available to everyone who is willing to pay the insurance.
This country was built on you earned your benefits, not given to you, just because you were born here.
Single payer health care is a shambles in Canada and I doubt it would be any better here, too many people want "free" medical care and would be in there anytime they had a slight sniffle or as someone said in another thread a "hang nail".
We can do without that, I for one feel no responsibility to help pay for medical care for "society".
posted on August 25, 2003 08:21:27 PM new
Recently my doctor told me if in doubt to call her office and let her make the judgment as to whether an appointment or consultation is needed. It is not realistic to expect a patient to triage themselves. I do agree however that health care should be taught in some form in schools but traditionally in this country many religious objections have been raised to such an approach to public health policy.
The lack of insurance has turned this nations ER's into clinics which they were not designed to be. Much of the work that defaults to the ER physicians could be more efficiently and economically handled in a clinical setting by PA's and Nurse practitioners. This is impossible in our system as there are no such clinics.
I know many hardworking people who cannot afford health care. When a serious health issue develops they will be toast.
Friends don't let friends vote Republican!
posted on August 25, 2003 08:39:41 PM new
I see no reason why an informed person can't take care of themself before calling a doctor. This is part of the problem. We're taught about math and history but little goes in to teaching us how to look after ourselves. We're taught to get good paying jobs so we can pay everyone to do everything for us. (It's a capitalistic plot.) Learning about medicine should be manditory in schools. It would be a good step in saving a taxed system.
posted on August 25, 2003 08:50:16 PM new
It is unrealistic to expect someone to triage themselves. As far as education goes I agree that it is important however consider this. In many school districts a simple concept, the condom cannot be mentioned as a means of preventing STD's only abstaining from sexual behavior can be discussed. Who would create the curriculum? Jerry Falwell or Pat Robertson?
Do you believe that the average person can recognize the symtons of TB, MS, Lyme Disease, Depression, ATD, STD's, Lung Cancer, IBS and who knows what else.
[ edited by davebraun on Aug 25, 2003 09:33 PM ]
posted on August 25, 2003 09:00:16 PM new
If people were educated about themselves, I believe they'd know. Medical knowledge isn't that tough. Most people self-diagnose anyway and go to the doctor to get a second opinion - especially men! It's sad that we have to hire people to learn about ourselves, but again, it's the capitalist way!
posted on August 25, 2003 09:40:03 PM new
Knowledge in of itself is not always useful. I know as much about my condition as many doctors however I cannot prescribe medication so what would be the point.
You think in terms of sprains, breaks and tears. Consider how many people can be exposed through one undiagnosed case of Tuberculosis sitting in your movie theater.
In many countries medication can be bought over the counter. This is not one of them and I don't advocate becoming one of them.
Friends don't let friends vote Republican!
posted on August 25, 2003 10:10:05 PM newNearthesea, I certainly don't doubt your generosity. Your comment reminds me of Reagan's "a thousand points of light" and voluntary charity.
I have spoken of a thousand points of light, of all the community organizations that are spread like stars throughout the Nation, doing good. We will work hand in hand, encouraging, sometimes leading, sometimes being led, rewarding. We will work on this in the White House, in the Cabinet agencies. I will go to the people and the programs that are the brighter points of light, and I will ask every member of my government to become involved. The old ideas are new again because they are not old, they are timeless: duty, sacrifice, commitment, and a patriotism that finds its expression in taking part and pitching in.
Ronald Reagan
A thousand points of light
were promised by the Right
This is the only way
that we can help the poor
Tell me it's helping
tell me the Big Lie once more
I don't understand the Republican reluctance to welcome universal health insurance for those who
are unable to buy insurance today. Over 43 million Americans have no health insurance and that
number is increasing.
Helen
Kraftdinner, I gave myself a medical degree a few years ago and as a result, I've avoided doctors for several years. Now, if I can locate a prescription pad, I'll be in business. LOL
posted on August 25, 2003 10:13:13 PM new
dave - they are uninsured. They may be, but if they have no assets they will be treated at county hospitals at no cost to them.
And I said the COST and the WAIT would be reasons I wound NEVER support socialized medicine.
It is the responsibility of every member of society to care for every member of society, some do so willingly.
Says who?? You?? Where's that written? You liberals have a way of wanting to take from those who have and give to those who don't have. Fine....but do it youself...you and others who share the same 'mind set'. Just don't try to force me and mine to do it too. That's called socialism. "We're all equal." Well...we're not all equal. Some work for what they want...some want it given to them. Some go to school others choose not to. So when they decided not to better themselves I own them?? I don't think so. lol
You speak to the 1% and we are being led by them....no different to me than having you socialists decide where my hard earned dollars should be spent. Those who wish to give....should give freely to the groups/organizations they wish to. NOT be forced to.
Has this system served you adequately? And at what cost to you and your loved ones.
Yes, it has, thank you. My husband worked for one of those big corporations you liberals seem to be so set against. They paid a very good salary to him and also provided top benefits. He worked for it...no one gave it to him.
posted on August 25, 2003 10:18:48 PM newObviously this person has not been in an American hospital in any major city lately where bed shortages are the norm not the exception to the rule.
posted on August 25, 2003 10:26:09 PM new
The cost of prolonged illness is more than the financial toll taken by the cost of hospitalization. While hospitalized bills do not stop, rent or mortgages must be paid, insurance premiums, electric bills, garbage collection whatever. A working middle class person can expect financial ruin as the result of a long illness and if uninsured runs the risk of destitution and a loss of a lifetimes accumulated assets no matter how grand or how meager. And yes you Republican creeps seem to think it OK to force me to pay for the bombing and devasation heaped upon third world people around the globe and then have the gaul to complain that someone would expect this society to care for it's own. Your greed does not surprise me, nor your lack of compasion beyond the threshold of what you percieve as your own abode.
Friends don't let friends vote Republican!
[ edited by davebraun on Aug 25, 2003 10:30 PM ]
posted on August 25, 2003 10:29:36 PM new
dave - I don't know where you get your information from but you are misinformed on:
This is impossible in our system as there are no such clinics.
Yes, some turn to the ER when it is not necessary. Yes, a lot of visits could most likely be dealt with by a PA or Nurse practitioner. But "there are no such clinics"? Yes there are. Both in CA and here in my little small town of 10,000 people. The medical community has long understood that there are some patients who don't need to see a doctor for simple things. HMO's in CA have been doing this for at least 15 years now.
posted on August 25, 2003 10:40:20 PM new
HMO's will not see anyone who is not a member of the specific HMO. We are discussing the uninsured. In this country no insurance you are out the door. In San Francisco there are 2 ER's UCSF and SF General the county hospital. In the East Bay Oakland has one (Highlands) and Berkeley has one (Alta Bates). If you are uninsured that's it period. The wait at any of them can be considerable (6 to seven hours is typical for a walkin).
If you have no insurance you will be likely classified as a GOMER (Get Out of My ER)and discharged ASAP regardless of your condition.
Friends don't let friends vote Republican!
posted on August 25, 2003 10:43:20 PM newA working middle class person can expect financial ruin as the result of a long illness and if uninsured runs the risk of destitution and a loss of a lifetimes accumulated assets no matter how grand or how meager.
When people have problems like these, which are NOT the majority of cases, they are a very small percentage, there is bankruptcy court. There they can get out from under the extremely large financial burdens that a medical crisis creates. We don't need socialized medicine to be able to take care of them.
And MY GREED? lol How do you feel about the monies I willing contribute to religious groups that work to get people off drugs? To help pregnant girls find a home for their babies? The Boy Scouts? All these areas I'm sure you don't support. And I don't feel you should have to if they're not important to you. You spend your dollars where you wish, and I'll do the same.
That's quite a jump for you to assume and accuse me of greed when you have no clue as to what I do and for whom. I'm just not interested in any form of socialism and I believe if I've earned my money, my lifestyle, I'll keep it thank you. YOU socialists won't be taking it from me as long as I have a vote.
posted on August 25, 2003 10:51:16 PM new
I can only speak from my own experience, but here in my small town and in San Jose there ARE clinics where one can be seen by a PA or a NP. They're not HMOs. I'm sure my town and the clinic I now of in CA are not the only ones in the whole USA that provide these services.
- Harry Thompson
