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
