Good intentions for the New Year? Whether more exercise or less spending or healthier diets, if good health is your objective you’re likeliest to succeed by adding a key ingredient: address America’s health care system. In fact, it is no “system” at all. Fourteen years ago, Dr. Richard Jackson (then the CDC’s Director of Environmental Health) pointed out to us the irrationality of America’s chaotic approach to health care. That chaos is costing real people a lot more than money. Ersatz people (corporations) don’t get sick. Now that corporations run America through the Republican party, the health of real people doesn’t really matter.
Already grave consequences of substituting inflated profits for a healthy citizenry are, of course, now made appreciably worse by Republicans gleefully undercutting Affordable Care for millions thereby pushing America toward a healthcare abyss of uncontrolled costs and diminished access to care and prevention. With the new year, their resolve is to plunder Medicare and Medicaid which serves millions more in order to fund booty for their wealthy masters.
Since we have direct experience with both Canadian and American approaches to addressing health issues, it’s all the more painful to watch Republicans trashing America. On average, Canada delivers better health outcomes.
The Government of Canada describes two principal attributes of the plan:
…(A)ll Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket. … The provincial and territorial plans must provide all residents reasonable access to medically necessary services. Access must be based on medical need and not the ability to pay. (emphasis added)
“Greed” is not a central fixture in Canada’s single payer prescription for a healthy life. In 2015, Americans spent twice as much per capita on healthcare as Canadians spent … with less satisfactory results. Republicans plan to make the results even worse, much worse.
Until America wakes up to single payer, what can be done? Lots!
Dr. Evan Levine has a prescription. Several in fact. He is a practicing cardiologist in New York City, author of What Your Doctor Won’t (Or Can’t) Tell You: Doctors, Hospitals, Drugs, and Insurance and podcaster. Continuing his longtime crusade to fix the often life-threatening abuses and failures inside American’s healthcare enterprise (NOT system), he suggests we push for reasonable, doable changes in how medicine is practiced:
- Hospital workers are being overburdened by excessive work, while their administrators appear to be overburdened only with how to use their enormous salaries. Here is what I might do if I were a hospital CEO:
- Cut salaries of all administrators (including the CEO), and use the extra funds to improve staffing and patient care. Studies agree that improved staffing can save hospitals money by diminishing errors, infections, and length of stay, but there is no study to suggest that paying administrators more improves patient care.
- Choose department chiefs based on their leadership qualities, not their resume. Departments work more efficiently and patients get better care if the heads of medical services put their staff and their patients ahead of their egos.
- Be kind to the nurses and staff --upgrading their working environment can lead to improved morale, less sick leave, and improved patient care. Maybe it's time to redo the twenty-year-old nurses' lounge instead of the five-year-old executive office!
- Stop all physician rating systems. Doctor rating services like Press Ganey ask patients to rate their physicians, and hospitals use these scores to determine the doctor's bonus pay. How can doctors provide objective care when their bonuses are based on ratings given by patients who may want them to prescribe medications or tests that they don't need? And hospitals pay huge amounts of money, sometimes millions of dollars, to these companies. If hospitals truly want improved patient care, they should stop contracting with these patient rating services and use all that extra cash to fix patients' rooms and improve the quality and quantity of their staff.
- All doctors on staff must accept all healthcare insurance including Medicare. Some people believe that doctors who decline insurance are better than those who accept it. I believe that doctors who decline insurance are simply greedier that the ones who accept it. In order for physicians to admit to my hospital, they will need to accept Medicare and other insurances.
- Doctors working for the hospital are NOT permitted to prostitute for Big Pharma. And I say prostitute, because I am aware of physicians who accept a check for $4000 for an hour dinner talk with a stipulation that they will prescribe that drug. Pharma can sponsor talks as long as that talk is NOT associated with any of their products.
- Stop huge pay disparities. A urologist at a NYC hospital took home 7 million dollars in one year, while a pediatrician at the same institution received a yearly salary of $120,000. I realize that some specialties bring in more money than others, but these great disparities insult the doctors who are just as responsible for good patient care.
- Board members cannot do business with the hospital. It seems insane that board members can be permitted to sell a product to their own hospitals, and yet this is prevalent.
- Hospital administrators cannot be on the board with any company with whom they have financial ties. This one takes the cake -- there are hospital CEOs who are on the board of directors of a company that sells products to their own hospital!
- Mandatory nurse staffing ratios similar to those mandated in California should be implemented everywhere. Would you rather be a patient in a hospital that has one nurse for every four patients, or one for every eight? So far only California has a law that requires specific nurse staffing ratios, but I would mandate strict staffing ratios at our hospital. And there are published studies that show that improved staffing --by reducing medical errors -- not only saves lives, but even saves hospitals money.
Since any one of these suggestions reorients a dramatically under-performing, very expensive enterprise (not system) toward healthier outcomes, imagine implementing all of them. Start towards the proven successes of single payer systems, the foundation of a genuinely healthier (and happier!) New Year ... for millions of people (NOT corporations).