This was written by a dear friend's father, who has been a surgeon for over 30 years. This is the argument that needs to be made. We need to frame this argument as a referendum on private, for profit health care.
The perceived wisdom is that solutions to the problems of the American health care system are just a matter of more efficiency, more cost-cutting, another round of slashing payments to health care providers (a great number of whom already refuse to see Medicare and Medicaid patients because of ridiculously low reimbursement levels), or even going to a single-payer system, as if this is all it would take to solve the problem. In the past our health care system did work. We didn't have rationed care, nor did we have runaway costs. Why? Because health care was not a business. The majority of hospitals were community-based non-profits or religious non-profits. Insurance companies were non-profit mutual companies. When profit motives were added to the health care system, medical costs began to skyrocket, and the quality of medical care began to decline.
Medical care was never meant to be a business. The goals of good medical care are not compatible with business goals. The goal of medicine has to be the treatment of sick patients, not profit. Medical care in the US has been steadily declining in quality in inverse proportion to its profitability. Even "providers" (the insurance industry's term for physicians) are more profit-driven than in previous generations, further reducing the quality of care for the "units" (the insurance industry's term for patients). This language was instituted by insurance companies in order to depersonalize medicine, the inevitable outcome of making it a business.
Insurance companies routinely, and seemingly arbitrarily, deny treatment to patients. Medical reviewers making decisions to deny treatment have no understanding of medicine, in contrast to physicians who have ordered the denied treatment. A decision to deny care is a business decision based on cost. Patients are told, "we are not denying treatment, we are just denying payment." Americans who are fortunate enough to have private insurance, paid for with ever higher premiums, often do not have enough coverage to prevent bankruptcy in the case of serious illness.
In order to boost profits, hospitals now routinely make cost-cutting changes in the delivery of care that impact its quality. One example is the reduction in the number of nurses employed, pooling and floating them as needed for more "efficiency" (read profit). A nurse may work on the pediatric floor on Monday, orthopedics on Tuesday, oncology on Wednesday, and so on. This causes a lack of continuity of care for the patients; the nurses are not familiar with patients, their medical histories or treatment plans, lacking knowledge that is crucial for good patient care. As a result, they sometimes administer the wrong medications and make other mistakes, causing patients to be harmed while in the hospital. This is not a new way of practicing medicine; it is a new way of doing business, profit-driven and seen as more efficient because it is less costly for the hospital and the insurance company. Medical care for the patient is compromised for profit.
As Congress and the Administration wrestle with solutions to our health care problems, the fact that medical care has become a profit-driven business has been ignored as the root cause of the problem, in no small measure because the insurance industry stands in the background as a major source of funding for elections. Be that as it may, if this problem is to be solved without bankrupting our country, this issue must be recognized and factored into any solution. A return to non-profit hospitals and non-profit mutual, or co-op, insurance companies must be a necessary part of any solution. Otherwise we will be throwing a great deal of money, perhaps trillions of dollars, down a very black hole.
Dr. Thomas Sherwood Moore II