The Healthcare Manifesto
Hello all, my name is Rob and I work in healthcare. Some of you may or may not know this fact, and some of you probably wonder how in the hell could I be in the whole "healhcare industry". A simple answer would be to freely admit that it is my calling in life to help others. This is very difficult for a person who is as shy and introverted as I am. In fact, its damn exhausting to deal with patients and coworkers every day. Allow me to share my views on the healthcare debate going on right now and you can take my words any way you like.
I get to see A LOT of people with no health insurance. This begs the question of morality in our industry--do we take care of those who can't pay us to take care of them, or do we turn them away and tell them "sorry about your luck, pal"? We are currently on a path towards not treating patients if they can't pay us. I see this on a daily basis. In fact, I have been told fairly recently that all Medicare/Medicaid patients are LOW priority patients. We seek patients with other health insurance, which essentially translates to not only the healthiest individuals seeking care (outpatients), but those who are gainfully employed by insurers who actually PAY the hospital for services rendered. I have actually been told to let patients who are currently in the hospital for various ailments to "sit" because we have more profitable outpatients to get done. Picture your grandparent or parent in the hospital for an extra few days because our department will get paid less money for doing their treatment instead of focusing on more profitable outpatients. How does that make you feel? Our current system has indeed come to this. Forget what you know or what you are "told" because it's most likely a far cry from what actually goes on inside the hospital.
We carefully guard our secrets in healthcare. The less you know as a patient and as a consumer, the better off the hospital fares. I have seen doctors take advantage of this fact. I have seen doctors tell patients "I am the only one who can help you" when this is a lie, for this doctor is merely seeking money for services rendered. They justify this crap by using the cruth of "free-market healthcare" and how competition between doctors and specialists keeps costs down. This is NOT true. In fact, doctors do NOT set how much money they get--insurance companies and hospitals do. That competition between doctors does nothing to help the cost or the quality of your care. In fact, your life may be in jeopardy when you enter that E.R. when all you want is to feel better. Seriously. Doctors will even shun much needed consults because they feel getting an extra opinion/assistance is either a waste of time, or an insult to the physician. Doctors would rather let a patient die than be proven wrong--its very political, and a very dangerous game in which the rest of us steer clear because when a doctor in a hospital snaps his fingers, people like me lose our jobs.
Are you ready for something a bit more sickening? Well, I've seen doctors take money from various vendors of healthcare equipment in order to further that company's sales. I've seen doctors take on a very aggressive treatment stance, especially when involved in interventional/surgical procedures because a certain paying company wants them to use their equipment. For example, a certain company selling a certain catheter used to place cardiac stents tells a certain doctor to use their catheter and receive X amount of dollars. Of course if there is another treatment option available is irrelevant now, for this doctor is focused on doing this procedure and collecting not only his fee for services rendered, but the kickback from the catheter company. When this occurs, and its does a LOT, a doctor is obligated to tell those around him when giving any educational/informational presentations to reveal who he is receiving money from. Would you be shocked to know some of them choose to ignore this requirement? Would you be shocked if they were receiving multiple kickbacks and free trips around the country/world advertising this company's merchandise and not reveal this information (unless the paying company was visually sponsoring these events)? Yes, let's give a big rah rah to the free market approach to healthcare making the rich richer and the rest of us poorer or dead as a result.
And where do you ask is the administration of the hospital? You know, the people who keep track of what doctors are doing as well as enforcing hospital policy regarding all employees? Simple! They turn a blind eye because if they lose a physician to such a scandal, they lose revenue. This doctor simply packs his bags and goes to the next willing hospital (happens every day). Doctors = revenue positive. Patients and employees = revenue negative. Its a horrible fact, but if you in a free market hospital system, the norm and not the exception.
Now what happens in our system when you get an influx of patients who can't pay their hospital bills? For a hospital that is non-profit and accepts all patients, this is very dangerous. Say your hospital is in the green: Their profit is exceeded by hospital expenses. This is fast becoming rare, and even if it is a common thing, the profits are perhaps in the range of $10,000 to $500,000+ per year. For a nonprofit hospital who takes any/all patients, imagine if one year in influx of patients who couldn't pay entered the hospital who required open heart surgery (Typically costing in the range of $38,000 to $60,000 by itself, not including several weeks of recovery in the hospital) as well as a number of premature births where the child required weeks/months of incubation (Procedures notwithstanding, but these bills are rumored to be in the hundreds of thousands of dollars). The hospital, obligated to treat these patients can either solicit money from the government for aid (thank God for Social Workers), or they eat the bill. Eating the bill on say 20 premature births and 45 open heart surgeries and your hospital is now down millions of dollars. What does this mean to the apathetic masses out there? Well, try having your nonprofit hospital closing down, or moving to a remote area away from where "nonpaying" patients reside. This has happened in big cities across the country. And its hardly a racist practice, its pure economics when you research the monetary statistics. If your hospital is lucky enough to NOT shut down, then you will begin to see said hospital cutting staff, services, and expansions. And all that wonderful technology designed to save lives and make providing healthcare easier? Kiss that goodbye too. Hospitals, especially ours, have a philosophy of "make do with what you have" when what you have is an understaffed, overworked (and often underpaid) facility who works on an assembly line with you the patient as the Ford Model T's rolling by every few minutes/hours.
It has really come to this. We are not allowed to refer to you as a patient anymore...you are a customer. We are no longer a hospital, we are both a McDonald's and an early 20th century Ford plant pushing out products. The more we push out, the more we get paid. Only, when the federal government cuts the cost of Medicare reimbursement, we have to do MORE patients to make the same amount of money. I know our hospital who receives most money from Medicare reimbursement has had an easy, unspoken solution--make Medicare patients low priority. Increase the number of non-Medicare and thus revenue positive patients and get more money.
You see the pattern forming here, right? Its not about your health. It never was about your health. Its about money. Its about the money you have, or seem to have, that decides your fate in the health industry. Rich folks who can stroll in and pay their bills with checks are obviously at the very top of the list--the holy patients by which all hospitals want to serve. On the other end you have Medicaid and nonpaying patients--undesirables in a free market system. Right now there is NO balance. Our system is increasing every single day with more people who are uninsured or underinsured and they are like large gaping holes in our ship crossing the Tumultuous Ocean. We're sinking, and eventually we will all be undesirable, revenue negative numbers in a system designed to make money. Some callous individuals in various political groups would think of this as the result of economics, or even have the balls to say "Well, those people made the wrong choices", but "those" people could be you or me. Eventually we're all set up to be receiving the short end of the straw. Its not a matter of "if" but simply a matter of "when".
Some are upset about the cost of fixing the current system. Um, that is next to irrelevant at this point. Merely fixing the system is not enough, for you are merely pumping water out of the ship crossing the Tumultuous Ocean. We gotta plug the holes for good, or build a new ship while in the middle of the Ocean. We have the advantage as Americans to learn from the past, and learn from other countries and their systems of health care. We can actually pick and choose from the work of others in terms of what works and what needs work in remaking our system. This is to our advantage. Cost is indeed a factor, but one of the reasons the costs of our current system have run so rampant is because NOBODY is watching who sets the costs. Its a monopoly and without regulation, whether at local or federal level, the system is doomed. This does not mean government decides your fate, or that government tells your doctor how to treat you. It means the government telling your doctor "Treat them right, treat them well" while telling drug companies and catheter companies "don't screw these patients or we will put you out of business". When you DE-REGULATE such an industry, don't be shocked when people die, or go bankrupt...oops, we already have that.
Ignore the asshats who tell you that "death panels" will decided Grandma's fate. We already HAVE death panels. They are called "Insurance review boards" who accept or deny your claims. And yes, people die on a daily basis because these boards deny claims. Look it up.
Ironically, Medicare currently provides a service for end of life counseling for patients. This system is designed to help families make tough decisions about end of life care, such as putting your loved one in hospice, taking your loved one home, etc. If this is a "death panel" then its a helpful, respectful "death panel" that is dignified. Believe me, when you enter into a situation where you have a mother or father going into hospice, the last thing you want is to make that decision and make those arrangements on your own. Medicare, our own "socialized medicine" program is quite heinous in that regard, don't you think?
This is all food for thought. We need solutions and we need them now. I welcome all comments, and I can elaborate on more details here as requested. Currently there is a thunderstorm outside, so I should wrap this up and hide before my cat rips me to pieces.
I get to see A LOT of people with no health insurance. This begs the question of morality in our industry--do we take care of those who can't pay us to take care of them, or do we turn them away and tell them "sorry about your luck, pal"? We are currently on a path towards not treating patients if they can't pay us. I see this on a daily basis. In fact, I have been told fairly recently that all Medicare/Medicaid patients are LOW priority patients. We seek patients with other health insurance, which essentially translates to not only the healthiest individuals seeking care (outpatients), but those who are gainfully employed by insurers who actually PAY the hospital for services rendered. I have actually been told to let patients who are currently in the hospital for various ailments to "sit" because we have more profitable outpatients to get done. Picture your grandparent or parent in the hospital for an extra few days because our department will get paid less money for doing their treatment instead of focusing on more profitable outpatients. How does that make you feel? Our current system has indeed come to this. Forget what you know or what you are "told" because it's most likely a far cry from what actually goes on inside the hospital.
We carefully guard our secrets in healthcare. The less you know as a patient and as a consumer, the better off the hospital fares. I have seen doctors take advantage of this fact. I have seen doctors tell patients "I am the only one who can help you" when this is a lie, for this doctor is merely seeking money for services rendered. They justify this crap by using the cruth of "free-market healthcare" and how competition between doctors and specialists keeps costs down. This is NOT true. In fact, doctors do NOT set how much money they get--insurance companies and hospitals do. That competition between doctors does nothing to help the cost or the quality of your care. In fact, your life may be in jeopardy when you enter that E.R. when all you want is to feel better. Seriously. Doctors will even shun much needed consults because they feel getting an extra opinion/assistance is either a waste of time, or an insult to the physician. Doctors would rather let a patient die than be proven wrong--its very political, and a very dangerous game in which the rest of us steer clear because when a doctor in a hospital snaps his fingers, people like me lose our jobs.
Are you ready for something a bit more sickening? Well, I've seen doctors take money from various vendors of healthcare equipment in order to further that company's sales. I've seen doctors take on a very aggressive treatment stance, especially when involved in interventional/surgical procedures because a certain paying company wants them to use their equipment. For example, a certain company selling a certain catheter used to place cardiac stents tells a certain doctor to use their catheter and receive X amount of dollars. Of course if there is another treatment option available is irrelevant now, for this doctor is focused on doing this procedure and collecting not only his fee for services rendered, but the kickback from the catheter company. When this occurs, and its does a LOT, a doctor is obligated to tell those around him when giving any educational/informational presentations to reveal who he is receiving money from. Would you be shocked to know some of them choose to ignore this requirement? Would you be shocked if they were receiving multiple kickbacks and free trips around the country/world advertising this company's merchandise and not reveal this information (unless the paying company was visually sponsoring these events)? Yes, let's give a big rah rah to the free market approach to healthcare making the rich richer and the rest of us poorer or dead as a result.
And where do you ask is the administration of the hospital? You know, the people who keep track of what doctors are doing as well as enforcing hospital policy regarding all employees? Simple! They turn a blind eye because if they lose a physician to such a scandal, they lose revenue. This doctor simply packs his bags and goes to the next willing hospital (happens every day). Doctors = revenue positive. Patients and employees = revenue negative. Its a horrible fact, but if you in a free market hospital system, the norm and not the exception.
Now what happens in our system when you get an influx of patients who can't pay their hospital bills? For a hospital that is non-profit and accepts all patients, this is very dangerous. Say your hospital is in the green: Their profit is exceeded by hospital expenses. This is fast becoming rare, and even if it is a common thing, the profits are perhaps in the range of $10,000 to $500,000+ per year. For a nonprofit hospital who takes any/all patients, imagine if one year in influx of patients who couldn't pay entered the hospital who required open heart surgery (Typically costing in the range of $38,000 to $60,000 by itself, not including several weeks of recovery in the hospital) as well as a number of premature births where the child required weeks/months of incubation (Procedures notwithstanding, but these bills are rumored to be in the hundreds of thousands of dollars). The hospital, obligated to treat these patients can either solicit money from the government for aid (thank God for Social Workers), or they eat the bill. Eating the bill on say 20 premature births and 45 open heart surgeries and your hospital is now down millions of dollars. What does this mean to the apathetic masses out there? Well, try having your nonprofit hospital closing down, or moving to a remote area away from where "nonpaying" patients reside. This has happened in big cities across the country. And its hardly a racist practice, its pure economics when you research the monetary statistics. If your hospital is lucky enough to NOT shut down, then you will begin to see said hospital cutting staff, services, and expansions. And all that wonderful technology designed to save lives and make providing healthcare easier? Kiss that goodbye too. Hospitals, especially ours, have a philosophy of "make do with what you have" when what you have is an understaffed, overworked (and often underpaid) facility who works on an assembly line with you the patient as the Ford Model T's rolling by every few minutes/hours.
It has really come to this. We are not allowed to refer to you as a patient anymore...you are a customer. We are no longer a hospital, we are both a McDonald's and an early 20th century Ford plant pushing out products. The more we push out, the more we get paid. Only, when the federal government cuts the cost of Medicare reimbursement, we have to do MORE patients to make the same amount of money. I know our hospital who receives most money from Medicare reimbursement has had an easy, unspoken solution--make Medicare patients low priority. Increase the number of non-Medicare and thus revenue positive patients and get more money.
You see the pattern forming here, right? Its not about your health. It never was about your health. Its about money. Its about the money you have, or seem to have, that decides your fate in the health industry. Rich folks who can stroll in and pay their bills with checks are obviously at the very top of the list--the holy patients by which all hospitals want to serve. On the other end you have Medicaid and nonpaying patients--undesirables in a free market system. Right now there is NO balance. Our system is increasing every single day with more people who are uninsured or underinsured and they are like large gaping holes in our ship crossing the Tumultuous Ocean. We're sinking, and eventually we will all be undesirable, revenue negative numbers in a system designed to make money. Some callous individuals in various political groups would think of this as the result of economics, or even have the balls to say "Well, those people made the wrong choices", but "those" people could be you or me. Eventually we're all set up to be receiving the short end of the straw. Its not a matter of "if" but simply a matter of "when".
Some are upset about the cost of fixing the current system. Um, that is next to irrelevant at this point. Merely fixing the system is not enough, for you are merely pumping water out of the ship crossing the Tumultuous Ocean. We gotta plug the holes for good, or build a new ship while in the middle of the Ocean. We have the advantage as Americans to learn from the past, and learn from other countries and their systems of health care. We can actually pick and choose from the work of others in terms of what works and what needs work in remaking our system. This is to our advantage. Cost is indeed a factor, but one of the reasons the costs of our current system have run so rampant is because NOBODY is watching who sets the costs. Its a monopoly and without regulation, whether at local or federal level, the system is doomed. This does not mean government decides your fate, or that government tells your doctor how to treat you. It means the government telling your doctor "Treat them right, treat them well" while telling drug companies and catheter companies "don't screw these patients or we will put you out of business". When you DE-REGULATE such an industry, don't be shocked when people die, or go bankrupt...oops, we already have that.
Ignore the asshats who tell you that "death panels" will decided Grandma's fate. We already HAVE death panels. They are called "Insurance review boards" who accept or deny your claims. And yes, people die on a daily basis because these boards deny claims. Look it up.
Ironically, Medicare currently provides a service for end of life counseling for patients. This system is designed to help families make tough decisions about end of life care, such as putting your loved one in hospice, taking your loved one home, etc. If this is a "death panel" then its a helpful, respectful "death panel" that is dignified. Believe me, when you enter into a situation where you have a mother or father going into hospice, the last thing you want is to make that decision and make those arrangements on your own. Medicare, our own "socialized medicine" program is quite heinous in that regard, don't you think?
This is all food for thought. We need solutions and we need them now. I welcome all comments, and I can elaborate on more details here as requested. Currently there is a thunderstorm outside, so I should wrap this up and hide before my cat rips me to pieces.