More on Cadillacs
Yesterday I woke up to my morning Boston Globe. The headline of the right side of the front page — its major story — was “AG finds clout of hospitals drives cost.” “State’s insurers pay twice as much to some providers. http://www.boston.com/news/local/massachusetts/articles/2010/01/29/attorney_general_says_clout_drives_up_health_costs/. The gist of the story is that the big giants in Mass health care, Partners,i.e Massachusetts General Hospital, the Brigham and Women’s are paid “15 to 60 percent more for essentially the same work as other hospitals, even though the equality is not superior.” In other words, it’s not the users of health care, i.e. patients who are driving up health care costs, but doctors, hospitals, medical equipment companies, insurers, Big Pharma. Big Surprise!!!
So why are economists, health policy experts, political representatives, and our President promoting — nay broadcasting — this myth, that people who have decent health care plans — those pesky Cadiallacs — plans the ones at fault. These Cadillacs are really Chevies, i.e. plans that everyone should have, not just the diminishing few who can bargain for them or who have enough individual bargaining power with an employer to get them. Yet instead of holding these plans up as a minimum standard, our p0litical representatives are bad mouthing them and, by extension, those of us who use our health care judiciously.
It may seem that health care reform is dead in Washington. Maybe it should be. What we need is a movement to bring it back to life in a form that we all can use. Which is some form of tax supported national health care. We should all be broken records on this.
Please don’t get me started on “wastage”! The government, Big Pharma, Big Insurance, and even hospitals want to blame escalating costs on the people who have to utilize the health care system. I don’t understand at all! People like you are paying your premiums every month. Then, when you have to use it, you are penalized with a hike in your premiums and letters denying coverage of certain aspects of your care! By the way, I read some of the comments on your Cadillac piece. What planet are some of these people living on? These irate dissenters are in denial. They simply haven’t been victims of the system yet. The facts are out there for anyone who cares to look. I know a lot of hospitals are having a hard time right now, but make no mistake. Many are doing just fine. Ours just introduced the Apache documentation system. Yet another thing for us to have to chart. What happened to all these incentives to make documentation simpler for nurses? This system is not incorporated into patients’ medical records. It’s something the hospitals’ critical care departments are keeping up with. It is a system designed to determine patient acuity and predict mortality. Theoretically, that’s great. What this system DOESN’T do is take into account the patient’s level of confusion (a factor in mortality if a patient falls out of bed and develops a subdural hematoma or a hip fracture), or the patient’s emotional status. Someone who is afraid is going to want a nurse in the room more often than someone who is not afraid. There are lots of things that Apache does not account for. I think it’s another trojan horse for finding more ways to contain cost. The system supposedly gauges the nurse’s workload as well. But we are not using it for that purpose. Workload is a non-issue for everyone but the nurse on the front line. I know I got off topic, but my whole point is to say this: If costs are rising exponentially and there is so much waste, why are we spending all this money on a technology that will not be used as part of the patient’s medical record and adds to the heavy documentation load nurses are already carrying? Who is benefiting from this system – other than administration? There’s the “wastage”!
I could not agree with you more. It is simply impossible to technologically factor in all that is included in patient care. People are just too complex. I have watched nurses and doctors become increasingly focused on the computer rather than the patient. I am going to write some more about this, but it is disturbing. I feel sometimes like the computer has become another patient. You should go on line and read Ross Koppel on this. He has written on the hidden consequences of health care information technology, HIT, for JAMA and elsewhere.
Thank you, Suzanne. I will.