Home with a cold, nothing to do but scan the news, and blog about how to fix this health care mess…
Part I– Money Corrupts
Congressman Patrick Kennedy has many faults, but I’ll always appreciate that he helped hold off Columbia HCA from buying Roger Williams Hospital in the late ‘90’s because by the end of the decade Columbia was paying huge fines for Medicare fraud and Roger Williams has had a little staff turnover.
The state law covering hospital mergers, the Hospital Conversion Act, prescribes many specific criteria that the attorney general and Department of Health director must use to determine if a transaction is appropriate under Rhode Island law and standards, including: whether patients — especially in traditionally underserved communities — can access affordable health care; whether essential medical services would remain available for safe and adequate treatment, appropriate access, and balanced health-care delivery; how much of the hospital market the new entity would control and whether the hospitals would continue to safeguard the public trust.
The law was first created when Columbia HCA — a large, for-profit hospital corporation with a less-than-stellar reputation — proposed buying Roger Williams Hospital, and permanently altering the voluntary nonprofit nature of our hospital system. Thankfully, this never happened. Nurses and other health-care workers, professional and labor organizations, and community-based health-care advocates worked together to win the passage of the Hospital Conversion Act, and Columbia HCA backed down.
That’s a local case of money corrupting health care. The Columbia connection comes back again in this story of how to grow an astroturf movement…
After six months and lots of money, Scott, founder of Conservatives for Patients’ Rights (and an ally of McKalip), has finally seen the fruits of his multimillion-dollar campaign against reform. Scott, a millionaire healthcare entrepreneur, predicted that when Congress reconvened this September the public option would be dead. “While Victory is near, we must not rest,” Scott crowed on CPR’s Web site. Scott himself never rested. He met with lawmakers, coordinated conference calls with conservative activists, wrote opinion pieces and spoke to the faithful about the evils of socialized medicine. Conservatives for Patients’ Rights targeted elected officials in 11 states with TV ads hoping constituents would pressure the lawmakers to oppose proposed changes. Sure enough, when the public option failed in the Senate Finance Committee Tuesday, Scott took credit in this video.
Scott came to the fight with a background in the business of healthcare; in the 1990s he was the CEO of the country’s largest chain of hospitals, until that company, Columbia/HCA, pleaded guilty to defrauding the government in 1997 and Scott was ousted (he was never charged in the fraud). Determined to reclaim some of his lost clout in the healthcare field and rehabilitate his image, in 2001 he started a chain of walk-in clinics in Florida called Solantic.
Walk-in clinics are one way people can access health care, and if they’re done right they can be a useful part of health reform. Where it gets dumb is when politicians claim that walk-ins and emergency rooms are adequate coverage. They’re good for dealing with the immediate problem, but without primary care they are just a revolving door.
Part II– Image is Everything
The Salon article gets really interesting regarding the weird hiring practices of Solantic…
Yet even before it was fully operational Solantic executives were accused of a pattern of serial discrimination in hiring, a pattern supposedly initiated by Scott himself. The suits alleged a standing policy not to hire overweight women, Hispanics with strong accents, older women and black women.
“One of the first things we needed was an R.N. [registered nurse] to help oversee the clinical part with me,” [Doctor] Yarian recalls. “There was this great young individual who had a lot of experience with clinic start-ups. She interviewed with me, and then with Karen. We both loved her. When I got on the phone with Rick, the first thing he says is, ‘What does she look like?'”
Yarian says he began describing her to Scott, at one point mentioning that “She’s a little bit overweight.”
“Immediately Rick says to me, ‘Fat people can’t work at our centers.’ And that sort of set the trend,” Yarian says. “I’d be interviewing someone and his first concern was what they looked like. He was always sending e-mails that people had to be fit and attractive. And no one was hired without his approval.”
Part III– Sisters Without Mercy, Newport, Rhode Island
Salve Regina University knew Sharon Russell was fat when they accepted her. They knew she was fat when they cashed her tuition checks. They refused to graduate her because she was fat. What were they thinking?
In April of 1988 Russell confronted the five nursing instructors from the college again. “It’s hard to explain how much fear they inspired in me. I had called another fat girl who attended Salve with me and asked her to testify. She had refused because she had been afraid to see those women again. And she had already graduated and had been practicing for two years! There was a great amount of fear. The class started out with sixty students; the drop-out rate was half.”
With the fear came anger, too. “I had paid big bucks for their abuse. My parents weren’t rich. Student loans and scholarships paid my tuition.” By the time of the trial in 1988, Russell had already completed a nursing program at St. Joseph’s in Hartford, Connecticut, and had a position at a hospital in Florida. “I had been working in the real world. No patient cares if you’re fat or not. They care about your skills.”
Part IV–Fit to Serve
What is the role of the Surgeon General anyway, and is Dr. Regina Benjamin qualified?
“I think it [her weight] is an issue, but then the president is said to still smoke cigarettes,” said Dr. Marcia Angell, former editor of The New England Journal of Medicine who is now a senior lecturer at Harvard University Medical School. “It tends to undermine her credibility.”
“We don’t know how much she weighs and just looking at her I would not say she is grotesquely obese or even overweight enough to affect her health,” Angell told ABCNews.com.
“But I do think at a time when a lot of public health concern is about the national epidemic of obesity, having a surgeon general who is noticeably overweight raises questions in people’s minds,” she added.
Benjamin founded the Bayou La Batre Rural Health Clinic in 1990 in the fishing village of Bayou La Batre, Alabama, and has served as its CEO since.
Like many of her patients, the clinic has suffered its own life-threatening challenges. It was heavily damaged by Hurricane Georges in 1998 and Hurricane Katrina in 2005. It also burned to the ground several years ago. But Benjamin rebuilt it after each setback and has continued to offer medical care to the village’s 2,500 residents.
Her commitment to them has meant making house calls during the rebuilding, mortgaging her house and maxing out her credit cards, Obama said.
“Regina Benjamin has refused to give up; her patients have refused to give up,” he said.
Many of her family practice patients are immigrants from Vietnam, Cambodia and Laos who make up a third of Bayou La Batre’s population, and many of them are uninsured.
Benjamin’s expertise goes beyond medicine; she earned a master’s in business administration in 1991 from Tulane University. But her focus has not been on making money for herself, she said.
“My priority has always been the needs of my patients,” she said. “I decided to treat patients regardless of their ability to pay.”
This practice of caring for poor people might be the real reason that Dr. Benjamin is being attacked. When Dr. C. Everett Koop, who was neither young nor slim, served as Surgeon General, he was greatly respected, and very popular for his leadership in public health. The post has become a more precarious and politicized place since Dr. Koop filled it, and Dr. Benjamin can expect to have every aspect of her life and career judged and misjudged.
But what qualities do we want in the nation’s doctor? Good looks and fitness? There’s lots of actors who qualify. Compassion and experience? I’d choose Dr. Benjamin for that. She has a fine resume and if the congressional process shows her to be who she seems to be she should be confirmed.
Part V– Looking the Part
The average nurse is middle-aged. We are an older workforce on average. Part of the problem is retention. Nursing is a high burn-out occupation. Part of the burn-out, I’m convinced, is the relentless corruption of patient care by the profit motive. Labor costs are minimized by stretching staff to the breaking point.
Stress leads to health problems in the people who provide health care, and not a few of us grab a cig or a donut when we shouldn’t. We’re all in it together. Health care workers have the same problems as other workers.
My doctor is lean and fit. He took time to talk to me about diet and exercise. I appreciate that, and that he supports health care reform.
My dentist is not as lean as my doctor. I go to her because of her competence and gentleness. If you want to keep your teeth, she’s the one to see.
If you ever need to check out a nursing home, don’t stop at the front lobby. That’s where they have the chandeliers and mahogany paneling and the fresh flowers. Don’t stop at the private rooms. Go all the way to the top floor where the sickest and neediest patients stay, and see how they are treated. See how the staff behave. Are they all having headaches, or do they take time to talk to the residents?
Glossy, for-profit clinics with buff-looking staff and a high profit margin are there for you right now, if you have the coverage. Rich doctors and attractive drug reps are making a good living.
You could almost forget that this is about sickness and health, life and death.
When the chips are down, I want to be able to count on people who have competence and compassion. I really don’t care what they look like. I want to know what they can do.