Guaranteed Healthcare

You don't have to be an RN or an MD to understand the fact that as human beings age, we may be predisposed to acquiring one or more chronic diseases, such as diabetes, hypertension, emphysema, and heart disease, to name but a few.  We are also more accident prone due to poor eyesight, hearing loss, delayed reflexes, and impaired mobility. It's been said that old age isn't for sissies and clearly, longevity is not without risks. However, most of us prefer it to the alternative.

The headline in the Sacramento Bee (5/30) reads, "CONSUMER REPORTS rates hospitals on aggressive or conservative late-life care".  Forgive my cynicism, after nearly 34 years as a critical care nurse, but I'm here to tell you that the patients who arrive in the hospital these days have run out of choices, and have nearly lost their lives because they couldn't afford primary care, or they've had the misfortune of being the victim of violence, or involved in an accident. And, they don't have the time or the money to go shopping for care, nor the education and expertise to determine which treatments will be therapeutic, safe, and effective at restoring them to their optimal level of functioning. For that, they depend on their doctors and nurses.

If there was any doubt the healthcare has become a "for-profit" commodity, an optional, "consumer good," upon which we can choose to spend our disposable income, I dare you to read between the lines.  If you have the money and the right insurance you get it, and if you don't, lower your expectations, because you're not going to get it. So, you might as well go ahead and die.

According to an article in the SF Chronicle, (5/30), Consumer reports rated hospitals according to how aggressive their care was; meaning, how much time and money was spent on patients. Remember, hospitals are reimbursed for providing nursing care. They make money, then, by denying care. More conservative care, in essence, means spending less money per patient. It sounds good, but is it? Remember, we're not talking about "futile" care that is expected to have no ultimate therapeutic benefit to the patient. I believe the industry is framing the debate by playing with words; for instance, substituting the word conservative, when what they really mean is parsimonious, greedy, and stingy!

The fact that Consumer Reports is weighing in through a web-based "Health Ratings Center" is troubling to most health professionals. We know that most patients are not educated, sophisticated, and experienced in evaluating their diseases, or injuries; and whether or not their treatments are appropriate or effective. In effect, Consumer Reports will be marketing hospitals, healthcare providers, drugs, treatments, and other products, right alongside cars, (Oh, what a feeling!); air conditioners, (Nothing can stop a Trane, but if you do...), and washing machines, (Please, call the lonely repairman.).  The problem is the lack of transparency in the tools used to evaluate the ranking, and whether or not there is full disclosure about how the rankings are bench-marked, and whether or not consumers have sufficient education and expertise to use the information.

In what is sure to trigger a mass exodus of Nor-Cal baby boomers who are nearing the so-called, end-of-life years, comes this revelation: The Bay Area offer less aggressive care to medicare beneficiaries in the last two years of life than facilities in Southern California, "a measure that could be beneficial for patients". REALLY? Says who? Is it really in your best interest to be under-treated, or to have the hospital decide whether the money they receive will be used for your care, or to pad the bonus of the CEO? So, where do you live? Are you paying more and getting less?  Insurance companies have been very efficient at driving up costs, maximizing their profits, and delaying or denying care to meet their shareholder's expectations for a higher rate of return on their investment.  

In the Bay Area, many of the more conservative, (less care=more profit), hospitals were operated by the giant Sutter Health chain.  A not-for-profit hospital chain, Sutter charted a record $587 million profit last year. Sutter Healthcare has been widely criticized by community groups, health care advocates and government officials for business practices that often put community needs last. These practices include reducing critical health care services (often after promising to maintain such services), providing inadequate care for the uninsured, reducing community control over local hospitals, abusing its market power to increase prices for consumers, and refusing to adopt community standards that have been adopted by every other major hospital chain in California.

Sutter officials said the rankings show the hospitals are "efficient" with their Medicare dollars. "Sutter Health patients receive interventions when they need it and not unnecessary services that ... only add extra risk and additional expense," said Bill Gleeson, spokesman for the hospital network, which is based in Sacramento. 

And then, there's the fear factor, deftly and strategically outlined by industry insiders, to get buy in and acceptance from the public for cost cutting schemes that include delayed admissions, early discharges, exclusion of drugs from formularies, limitations on durable medical goods, and the delegation of complex nursing care to family and friends.  According to a vice president of Woodland Healthcare, aggressive (comprehensive) treatment, for more complex diseases or injuries, creates more potential for "risky drug interactions," "hospital-acquired infections," and "medical errors". Why? Because doctors affiliated with more "aggressive" hospitals see chronically ill patients more often; and, the more doctors involved in a patient's care, may sometimes result in poor communication, uncoordinated, and unnecessary treatment.

In another, earlier report on the Consumer Reports rankings, researchers at Dartmouth Medical School, discussed the fact that a large share of Medicare's expenses, "about $1 out of every $3 spent", is due to paying for care of enrollees with chronic conditions in their final two years of life. To me, there's a very onerous, subliminal message embedded in this discussion. And it is the message that it may be a waste of public money to pay for the care of our elderly, especially if they're only going to live another two years. Although know one really knows when those "last two years" will commence, it occurs to me that if care is limited (conservative?) in scope, and treatments are delayed or denied, those last two years of life may sneak up on a patient sooner, rather than later. (Don't tell that to the SiCKO "golden ticket" holders in Congress who are out to privatize health care for the benefit of the insurers. They might get the idea that they can balance the budget by slashing funds for public health entitlement programs, such as Medicare.)

The bottom line is don't get sick. But, if you do, don't go to a hospital. Especially if you're in the final two years of your life. Doctors, specialists, and nursing care is expensive, and besides, hospitals are dangerous places to be when you're sick; they make errors, and they increase your risk of infection. Stay home, and if you can make it into your doctor's office they can take care of you just fine there. That way the hospitals and the insurance companies won't lose any money; indeed, they'll make more for their shareholders. I say we better all watch out and hope that this doesn't become one of those individual mandates and personal responsibilities.

Pssst. Do something! Demand that your elected officials support single-payer legislation, HR676, Guaranteed Healthcare for All. It's the right thing to do!