April 06, 2005

Do you think that the doctors, hospital owners, etc. are "greedy", or "filthy rich", without a thought for what people have to pay for medicine or medical care? If so, you have not been paying attention.

Even more than any other industry or business, medicine is bound hand and foot with laws, regulations, requirements, licenses, "permits", and absolutely endless paperwork that serves no purpose but job security for clerks and bureaucrats. Many of these "rules" are contradictory, arbitrary and it all costs a LOT of money. Let me give you just a few examples.

If you know what a business plan is, you have a head start understanding this problem. If not, a business plan is an outline of what you propose to sell or service you will render, how the administration and staff are to be organized, and how you will pay for it, just to mention a few things. It can be as simple as a lemonade stand or as complex as General Motors. The basic, original business plan is vital for a sound and profitable company, but the government has taken it and created a monster of it. With the possible exception of the lemonade stand, all businesses have their plans, policies and procedures buried under the massive load of regulations, taxes and bureaucracy gone mad. In medicine the burden is the size and temperament of Godzilla, and growing daily.
The resulting mess is a multi-million dollar industry in itself because of the complexity and the constantly changing climate of government requirements and whims. Medical businesses, from the country doc making house calls (yes, there are still a few), to the megacorporations that run hospitals and insurance companies have no choice but to employ some or a lot of these people just to fine tune the "plan" and do their best to keep it current with the latest dictates of the bureaucrats.

Nobody could hope to remember or follow every word of such massive and detailed policies, - let alone the "laws" and regulations that drive them - so someone, somewhere is always "out of compliance" and this not only gives the bureaucrats and their minions endless remunerative employment at taxpayer expense, it costs medical businesses millions of dollars a year more in fines and further restrictions on their operations.

Hospitals/ Clinics

The word "mandatory" runs rampant through every hospital and clinic in the country. There are so many "mandatory" programs, staffing requirements, notices, signs, policies, and forms that it is a wonder anyone actually ever gets anything else done.

Consider this: "Pain measurement" is now considered one of the "vital signs" and every nurse in the country has been instructed in all the paperwork required to fulfill this mandatory reporting item. Now the reality: You are a patient in bed three-oh-nine A. You are in pain. You put the nurse call light on... and you wait... and if you are very lucky, someone comes - usually the CNA, or the clerk talks to you over the intercom. You tell her your problem and she goes away... and you wait. IF the nurse actually comes, she may or may not have a clue how to assess where and what your pain is or know what to do about it. Inevitably, she will tell you that she will "check" the medication record and come back with medication if she can... and you wait. All too often, if anyone comes back at all, you will hear that it is "not time" or "it's too soon" for you to have any more medication. Then they leave and you have to start all over again "later".
Several things are very wrong with this all too common picture. The most obvious one is the fetish over "time" and the very real but bogus fear that you will get "too much" or "become addicted" if your pain is actually controlled. You fare much better if you are considered "terminal", but just feeling that way doesn't qualify.

If, by some miracle, you have a nurse who really believes you have pain and that something should be done, another circus starts. She must call the doctor and convince him that you are having more pain than the current orders cover. If she can reach him and if he agrees, she writes the telephone order and sends it to the pharmacy. If you are really lucky, she can get the medication quickly out of the unit stock - if she is authorized, has keys, has time, and remembers... or you wait until the pharmacy delivers the drug to the floor. In any case, you wait... and the pain goes on.

All this is, of course, partly thanks to the "war on (some) drugs", but is almost unavoidable because of the layers and layers of regulations that have to be satisfied in order to accomplish anything. Notice that the new "mandate" and instructions do not result in better pain management most of the time, just a new entry required on each patient chart.

How comforting.

Emergency Rooms/ Trauma Centers

Do you know the reason the ER is so crowded? Do you understand how the "regulations" cause people to wait in pain for hours on end? Do you think the people who work in the ER like it that way? Believe me they don't... and they can't do anything about it except slog on day after day with the mess.

They are not "allowed" to turn anyone away! It doesn't matter if they are bleeding or have a hangnail, everyone must be taken in and processed. Fortunately, those who are bleeding or not breathing can be taken first, so those with hang nails must wait... but so must people who are in severe pain, or with undiagnosed problems that can - and often do - become acute and life threatening while the circus goes on. I'm sure this regulation was proposed and implemented so that "the poor" would not be denied care, but many people - and not all "poor" - use the ER instead of a regular doctor. Why not? They can't be forced to pay for it and they can't be refused. It's the "law". Such a deal.

Some places have an "urgent care center" now and the hang nails and other non-emergencies can be sent there, but the upshot of this "compassionate" law is that hundreds of emergency rooms across the nation have closed permanently because they can't handle the load or the cost of the freeloaders.

This is just as true for the trauma centers, super emergency rooms that are set up to handle major injuries, full body burns, and multiple injuries from disaster type situations. All of the patients who are brought in are minutes or seconds away from death, but these centers were plagued almost from the beginning with massive lawsuits and expensive extra regulations, so most of them have closed as well. Now those who are happy to accept care without a total guarantee of outcome have no place to go and they do die... every day.

Home Health/ Hospice

With hospital care so expensive and technology growing that allows a great deal of care to be given in the more healthful and economical setting of the patient's home, it seemed that this was the direction medicine was heading. But that solution made too much sense and was too practical for the politicians. Besides, the bureaucrats and regulators had far less control and they don't like that for one minute. So, they set out to sabotage that and have succeeded.
Since Medicare and state government pays for a great portion of the home health and hospice (end of life) care provided in this country - both directly and through the HMOs - they indeed "call the shots" and couldn't care less if the paperwork and regulatory nonsense makes the care cost more to the provider than they pay. The home health provider comes up with creative ways to cut corners on other things, such as staffing, and everybody suffers. Or... they go out of business. I've seen a lot of that in the last ten years. Good companies, giving good care, with nurses and other team members working themselves to the bone, all for nothing in the end.

Here is an example: You are a patient in your own home and tell the nurse that you have a problem. No matter what the nurse suggests you do for that pain, or wound, or constipation or anything else, she must first call the doctor. Nine times out of ten she can't talk to him from your home, so it may take hours or days to accomplish this. Once she does talk to the MD, and assuming he agrees with her (they usually do), she can then perform the procedure or order the medication. But the job isn't over until the paperwork - and all the wasted time and effort that goes with it - is finished.
Once she has the verbal order she must write it on a special form. She takes it to her company office where it is copied, recorded, and mailed to the doctor. A clerk in his office copies it, files it in the patient record, puts the original with the mountain of other such paper for the doctor to sign and nags him until it is done (if you are lucky). She then mails the signed paper to the home health office where the clerk records it and files it, disposing of the copy.

All this has to be accomplished in a certain time frame and it doesn't matter a darn bit if the order is for major wound care or a Band-Aid, narcotics or an aspirin! I'm not kidding. Nothing can be done legally without an "order", and the fact that doctors don't want to be called with most of it is quite beside the point to the "regulators". Of course, it is no surprise that many of these "orders" are written without any contact with the doctor, simply because he knows the nurse, is confident that she knows what she is doing, and she is comfortable that he will back her up by signing the "orders".

It should be obvious to anyone that this is insane, and of course nobody would admit to doing such a thing, but it is just one of the inevitable consequences of unnecessary regulation. Just think what that all costs in time and money and how much that adds to each and every medical bill you pay - or don't pay. Just remember that SOMEBODY pays for it eventually. The taxpayers are the usual somebody.

Nursing shortages

Now, as if it was a big surprise, the media is starting to report on the new nursing shortage. Unfortunately, they never mention any of the real causes. It isn't because of a lack of funding for nursing programs in community colleges, low wages, poor benefits, unions or staffing ratios. Those things contribute to dissatisfaction after the fact, but the major reason nurses decide not to enter or to leave the profession is the paperwork and legislated nonsense that prevents or distorts real patient care.

As a natural consequence of the "dumbing down" of our young people, those entering community college nursing programs are increasingly unable to read, write, reason or problem solve. The few with the intelligence and incentive to really learn and grow take years to become competent nurses. Then consider the danger to experienced nurses when they are forced to work with under-educated new graduates and "alternative caregivers" who have no real education at all. Nurses are often made responsible for the actions of these people, and so - all things considered - it is no wonder that so many good, experienced nurses retire or drop out each year. They have little reason to continue to beat their heads against a wall, and risk going to jail for something someone else did... or didn't do.

The real answer: Remove government from the entire sequence of events. People must keep what they earn and make their own decisions on what is good for them and what they need. They must control what happens by their ability to do and use what they feel they need, decide if they need a doctor's opinion or not and hire someone else if they are not satisfied. The government has no more business dictating (or paying for) our health care than they do our sex life or diet. Think about it.

Doctors and nurses (and everyone else) must be free to give the very best of their skill and experience to each patient (or customer) every day, being held completely responsible for their actions and mistakes like anyone else, but not bound into a "one size fits all" (nobody) straight jacket of regulations that can't possibly prevent mistakes or deliberate malfeasance, but certainly and demonstrably limits the choices and the care available to the people who need the services and the expertise of professionals. Laws do not make people honest or competent. Only enlightened self- interest and eternal vigilance can protect anyone from anything. Laws against force and fraud are only useful after the fact, and only when simple, clear and applied with justice and integrity.

Think about it: If all the regulations and paperwork and insane drug laws were wiped off the face of the earth tomorrow, what would you do? Would you want to educate yourself and take back real responsibility for your health and life? Would you be willing to pay the honest cost of the care you chose, the same as you do for the car you drive and the house you live in? If not, why not? Think about it.

Why do we put up with it? What can we do about it?

Related articles:

Medicare's Origin: The Economics and Politics of Dependency

Medicare's Long Term Impact "somebody else is supposed to pay for health care mentality"

The War on Doctors

Cloudy Future For Retirees

Medicare Seen Insolvent by 2019

Senate Approves ‘First Step Toward Dismantling Medicare’

Americans for Free Choice in Medicine (AFCM) is a national non-profit, non-partisan educational organization.

Heartland Institute
Is The Legal System Killing Health Care? In Illinois, The Answer is 'Yes'
by Maureen Martin
"Scores of doctors have already left medicine or have moved their practices out of Illinois because they cannot afford malpractice premiums or can no longer obtain coverage at any price .... Such concerns led the American Medical Association to declare Illinois a state 'in crisis.'" (3/26/04)

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