We must rise up against the hospital-industrial complex

In his farewell address to the nation on January 17, 1961, President Dwight D. Eisenhower warned the American people about the looming “military-industrial complex” which would sway public mindset and enhance money flow from government to the defense industry. This concept persists today with the practice re-adapted and launched against the health and welfare of the American people through the “hospital-industrial complex.”

Health care organizations like the California and American Hospital Associations have managed to evolve into the most powerful monetary groups in the nation. They contribute to state and national elected representatives boosting influence in self-serving legislation. The result has been an escalation of complex laws, marginalization of the physician medical profession, and dehumanizing the health care industry for the sole purpose to gain vast profits.

Three decades ago, hospital care was in disarray and in clear need of re-organization. Recognized as an economic vacuum, astute business people saw opportunity to cash in huge benefits including salaries, bonuses, and golden parachutes. With their windfall came some improvement in medical care.

Electronic medical records (EMR), pushed by these organizations to streamline billing and collection, allows me to read my colleagues thoughts instead of their handwriting. Communication through doctor orders, notes, and test results speeds care for our patients.

With this though came dehumanizing bullet-point medicine. Some criteria was established by financially conflicted scientists influenced by the hospital industry touting evidence-based studies for patient care. Every facet is calculated and lined up into a profit and loss column, statistically stigmatizing your care. Should your illness be even slightly outside normal, an industry decision shoves you out of the system onto the street, sometimes into a nursing home or bankruptcy.

Hand-in-hand with this were insurance companies coat-tailing their policies with higher deductibles, lessened coverage, and the right to deny care. Doctor organizations were inept against this onslaught as their lack of business understanding, leadership, and sometimes inflated egos and arrogance only contributed to this disservice.

Today, for the practicing doctor, continual rejection of insurance billing is rampant sometimes forcing them to give up in frustration. The need for authorization of specific ordered care wastes physician and office staff time. Self-governance and independence of decision-making is infringed upon by hospital and insurance companies (including Medicare), while financial credentialing eliminates a doctor seeing inpatients if the hospital feels that MD is costing too much money. As well, an all out effort is being made to silence the voice of any physician whistleblower.

Even at university hospitals, we see professor physicians eliminated from patient care and replaced by payroll hospitalists. Instead of a doctor, you may see a hospital-paid nurse practitioner or physician assistant when you are critically ill. We as a nation are now receiving substituted medical care at the expense of profit, and should you not believe this, inquire into the salary of the CEO at your local hospital.

President Eisenhower stated: “The potential for the disastrous rise of misplaced power exists, and will persist. We must never let the weight of this combination endanger our liberties or democratic processes. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals so that security and liberty may prosper together.”

Heeding this warning has been elusive, but as the hospital-industrial complex continues to evolve, the citizenry must learn from the past and recognize this overwhelming threat.

Collectively raising our voices and echoing President Eisenhower might then “compel the proper meshing” of health care for the American people.

Gene Uzawa Dorio is an internal medicine physician.

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  • whoknows

    Great article. I have a bread and butter problem that in the past could have been handled in 2 appts by a specialist in a matter of a week. Now there are few private docs around my area to see, which sort of forces my hand to go to the HIC.
    The HIC (hospital industrial complex) has created complete incompetence in my care to the point I am frightened and lost. I finally got an URGENT MRI via the hospital (which no doubt cost thousands of dollars paid to them.)
    The first problem is that they NEVER notified me of the results! I of course called and left multiple messages with multiple admins. All I got was a call from a midlevel referring me somewhere else but no appts for yet another month.
    The mid level was not helpful and after one month passing, I STILL have no diagnosis. I have to wait yet another month to get a consult.
    If I had not called I am sure there would have been NO followup of results. They would have gotten their money for the test but NEVER NOTIFYING me of the results.
    The radiologists did not compare the previous MRI done there a year ago with the new one. Basically no one is doing their job. The more I try to call it makes me feel crazy as they are not resolving my problem and only upsetting me. Every conversation asks for 3 pieces of the same data for HIPAA I need to repeat to multiple admins.
    I give up on this HIC

    • disqus_qJEMXTKtR1

      Your problem is the epitome of our problem: depersonalization of a system that is based and relies on interpersonal communication and contact. Business contrived bullet point medicine unfortunately controls too many doctors.

      Whether you be in California or on the east coast, everyone of us is effected in the same way. Don’t give up, and continue to voice your concern with the system.

      Thank you for the comment, and my best to you.

      Gene Uzawa Dorio, M.D.

      • whoknows

        Thank you for your speedy reply. Both being a doc as well as a patient are horribly exploitive under the guise of the HIC. But I think being a pt is worse. Literally have my life in these incompetent HIC hands.

    • NPPCP

      Ummmm….don’t blame the “midlevel” my friend. They aren’t in charge. At least one talked to you.

    • CPO_C_Ryback

      ” .. Eisenhower warned the American people about the looming “military-industrial complex ..”

      Actually, he was warning about claims of a “missile gap” by a young, inexperienced JFK. Who pushed 50,000 Americans into Vietnam.

      Same as today? Yup.

      • disqus_qJEMXTKtR1

        Thanks, but not being a well-read historian, I was not aware of this allusion. Most reference was to payoffs from highly financed military companies influencing congressional votes.

        You’re right, still the same today, but additionally money comes from hospitals, pharmaceutical companies, big insurance, and even physician organizations. There is definitely a “gap.”

        Gene Uzawa Dorio, M.D.

  • John C. Key MD

    Great article. I fear it is too late…except for those souls brave enough to start their own direct pay or concierge practice, the great mass of other physicians seem to be like willing sheep led to the slaughter.

    • disqus_qJEMXTKtR1

      Thank you for the comment John.

      The American people have been propagandized into thinking the medical system we have is the best in the world. Indeed, we have the best technically, but using it to provide patient care falls drastically behind many industrialized nations. Physicians are not able to provide adequate care anymore, and have lost the ability to make a difference. Business profit took over, but I firmly believe ALL of us can rise up and take it back. I still have faith this will happen.

      Gene Uzawa Dorio, M.D.

  • buzzkillerjsmith

    CorpMed is in the driver’s seat for the foreseeable future. Strap yourself in. It’s going to be a rocky ride.

  • disqus_qJEMXTKtR1

    In my California neighborhood, ACO contracts have been advanced, but there haven’t been a lot of physicians signing on the bottom line. One easily sees the “bait” hospitals offer, but many realize attached to the line and reel is their business self-serving scheme.

    Physicians will not be the ones to lead a charge for change…that will be up to the American people. But certainly those doctors who raise their voice on blogs and other media sources will need to be the guide for revealing the outrageous control business now has on the medical profession.

    Giving up or being afraid plays into the hands of the “Hospital-industrial complex”. Finding the core strength and wisdom endowed by the spirit of those who fought for our freedom and democracy is still latent in many of us. This is a wrong that must be rectified, and I know there are a handful of you who won’t give up and fight the fight.

    I’m still searching for you.

    Gene Uzawa Dorio, M.D.

  • Bob

    Pull up a seat Doctor and you will see exactly what the vast Hospital industrial complex started back in the early 1980′s when profit and non-profit hospitals facing DRG’s decided making profits was better than providing care.

    At the time, I ran the best non-profit buying group in the Nation at least that was what I was told the Claude Pepper Committee on Aging told me. And I had everything hospitals use under contracts that provided the lowest costs, better than National chains and all large hospitals then trying to force small community hospitals into “systems” which was difficult to do since the small hospitals participated with my group for free, at much lower prices, while the hospital systems charged $100,000 a year dues per hospital.

    So now hospitals have finally been put into extremus for now they are faced with only having government customers, i.e. Medicare currently being the largest while they have ignored Medicaid patients which this year will flood their ER’s, while only half the states have accepted increased Medicaid payments, so the taxpayers in states that don’t accept Medicaid increases will see their tax money go to those who do, while the hospitals in those states probably won’t get DSH payments.

    So do these states reimburse for indigent care, or eat the costs.
    While physicians and nurses don’t make house calls and are not organized, systems like the Cleveland and Mayo Clinics still don’t recognize the flood of Medicaid patients that will descend on then as of now as the ACA has just started with 4 million new Medicaid patients added as 11,000 seniors turn 65 each day and join Medicare.
    Are you ready to return to those days of Eisenhower where towns and cities had two hospitals, one for the public, usually with city or county in their names and the others called mainly Doctors Hospitals. That was before “Charitable immunity” died in 1954.

    History does repeat itself and a doctor can practice all by themselves or with colleges while a hospital w/o physicians is just brick and mortar!

    • disqus_qJEMXTKtR1

      Thanks Bob. Interesting point, but for clarity, let me counterpoint some of your comments.

      I am a housecall doctor, which I have been doing for 26 years in our small community. Most of my patients are Medicare, some Medicaid (Medi-Cal here in California), with about 20% being bedridden at home. Part of my practice is hospitalization of those patients allowing continuity through palliative and hospice care until end-of-life.

      Certainly, the financial arrangements of the new healthcare law (ACA) are cryptic, but there is no doubt in my mind the massive hospital organizations have lobbied to assure their piece of profit is maintained or increased.

      In our small community hospital, I have seen an attempt to stratify care, for those who have great insurance, to those who have none. For the latter, they are whisked in and swept out, sometimes with minimal care and treatment. Yep, hospitals are getting our tax dollars, but wisely cut corners and deliver inferior care to those they have economically selected.

      Hospitals now employe hospitalists, nurse practitioners, and physician assistants thereby affecting decision-making in discharge. Length-of-stay has become threatening words as they use this statistic to leverage those employees to prematurely discharge patients. They willingly accept re-admissions as a statistical part of doing business.

      The physician medical staff for every hospital in California has been legally declared “self-governing” to separate the business profit-motive from patient care. Unfortunately, many medical staffs have been overrun by “contracted” doctors who vote for the hospital game plan, hence quality patient care has been usurped.

      Certainly, I do not wish to move back to the Eisenhower days of medicine, but moving forward in seeking better care for ALL Americans must be a battle physicians, and the public, now fight.

      Gene Uzawa Dorio, M.D.

      • Bob

        You misunderstand me Doctor; Doctor’s hospitals were owned and run by Doctors for their patients, while the city and county hospitals did the uninsured or underinsured as Medicaid and Medicare didn’t arrive for 10 more years in 1965.
        Now everybody admitted to hospitals gets the non-doctors care, until doctors get upset and start their own hospitals again and writing off indigent care costs, instead of trying to work under rules they know are inept. Mayo, Cleveland clinics, et al charge more.

        • disqus_qJEMXTKtR1

          Thank you.

          I stand corrected.

          Gene Uzawa Dorio, M.D.

  • Thomas Luedeke

    Pity the article neglected to mention that Obamacare basically represents a crony capitalism capture by the big hospital/pharma/insurance conglomerate.

    Many examples, perhaps the most egregious of which is the effective ban on physician-owned hospitals and regulatory overload on private practices, which provide superior health care outcomes at significantly less cost. Naturally such an outcome is completely unacceptable to the cartel…

    • disqus_qJEMXTKtR1

      You are correct. The American people have been propagandized by big-money healthcare organizations, including the “Hospital-industrial complex”, to enhance their profit. They claim our system is the best, and the rest of the world is inferior.

      Other nations laugh at us for the poor medical care we render to our people and the cost we incur, most going to administrative salaries, bonuses, and their retirement plans.

      Therefore, we must unite our voices and explore the existing world healthcare models so we might better apply them to improve the falsely-created ones endorsed by these profit-seeking groups.

      Thank you for the comment.

      Gene Uzawa Dorio, M.D.

      • Guest

        OK, but here’s my question. I’m an engineer, but know a number of doctors. I can’t think of one that actually believes in what the AMA/AARP/Obama adminstration is doing, even though it directly impacts them.

        From my perspective, the very people at the center of this mess, the folks who swear the Hippocratic oath, aren’t rising up in protect at this attack on the patient-doctor relationship. Why? I know you’re all busy, but so am I as a nuclear engineer (laff – who is currently working my butt off on MCATs to try and become a physician…)

        If the physicians rise up, even the full weight of the government can’t defend themselves – people love their physicians ::far:: more than their politicians…..

        - Tom

        • disqus_qJEMXTKtR1

          Doctors will NOT be the group which brings the many problems our healthcare system face to the forefront. Why? Good undergraduate grades, MCATs, and Board certification do not evaluate leadership qualities that will be needed in this battle. Thirtysomething years ago, a student had to be at the top of their game to gain admission to medical school. Now these older doctors in their 40s, 50s, and 60s, are mostly followers, and not leaders.

          Many have NO opinion because this are shackled by high overhead, bureaucratic red tape, their children’s (and grandchildren’s) college costs, and contracts they cannot afford to lose. Voicing an opinion might result in financial decline, and jeopardize their pending retirement.

          Those physicians working for or who have contracts with hospitals, HMOs, or insurance companies will not risk the financial loss if they stand against Goliath. So our thoughts and sentiments are restrained to the detriment of society.

          What do we do? Find good writers and bring these problems to the public’s attention. Work with professionals in the media to bring this threat forward. Doctors are on the frontline and the impact of the Hospital-industrial complex (as well as the total business takeover) must be clarified. Comparing world-wide healthcare systems to ours easily demonstrates the laughable and distainable role profit plays to the disservice of the American people.

          Leaders must be found, then organized. Will you be one of them?

          Thanks for the comments Tom, and keep voicing your opinion.

          Gene Uzawa Dorio, M.D.

      • Thomas Luedeke

        OK, but here’s my question. I’m
        an engineer, but know a number of doctors. I can’t think of one that
        actually believes in what the AMA/AARP/Obama adminstration is doing,
        even though it directly impacts them.

        From my perspective, I can’t understand why the very people at the center of this mess, the folks who swear the Hippocratic oath, and those having the core of who and what they are, aren’t rising up in protest at this attack on the patient-doctor relationship. Why? I know you’re all busy, but so am I as a nuclear engineer (LOL – one who is currently working my butt off on MCAT study to try and become a physician…). I find this highly disappointing…

        If the physicians rise up, even the full weight of the government can’t defend themselves – politicians are literally viewed at the same approval as cockroaches and Genghis Khan….

        It’s *your* profession, and too many of you seem passive in light of what you endured to get where you are…
        - Tom

  • EmilyAnon

    I am currently in a group of 60,000 active and retired employees from many trades under a single industry umbrella that provides a great healthcare package for its workers and families. We have 6 private health centers around the city comprised mostly of primary care doctors, some of the bigger centers have gyns, derms and rehab facilities. Or we can choose from a liberal list of outside doctors and specialists and 4 local hospitals. Compared to other employer plans, this one is tops. But I fear not for long.

    Last month a form letter arrived announcing that our health plan will be taken over by the UCLA health system starting next year.

    When I last saw my PCP, he was grim faced about his future, The rumor is that our health clinics, along with its captive patients, will be used for the training of UCLA hospital residents, interns and students from their medical school. I don’t know where the original in house doctors will go. And I’m sure outside physician choice will be gone as well, along with smooth running continuity of care.

    I guess this is just another sorry episode in the build-up of the hospital industrial complex you describe. I’m really depressed about this change.

    • disqus_qJEMXTKtR1

      Your options will now be limited, and medical care ultimately compromised.

      An “attending” physician specialist I knew at UCLA was not allowed “continuity” of medical care at their facility because hospitalist assumed most in-patient care. Elimination of this effected him immensely, but he was forced to follow their rules.

      Doctors now have no say nor control over many aspects of hospitalized care, and many have lost the valuable part of “continuity” patients expect and deserve.

      Unless we coalesce, physicians and the public will continue to be physically and mentally depressed.

      Keeping expressing your views.

      Gene Uzawa Dorio, M.D.

    • whoknows

      Let me get this straight. The HC plan you have is being taken over by UCLA? How do they force your hand on that one? Your current MD will just not be on their list of providers? Or is it worse that he is loosing his job? But how can they physically kick him out? How can UCLA legally take over his clinic?
      sorry it sounds awful.

      • EmilyAnon

        The clinic doesn’t belong to my doctor. The doctors run the clinics and are employed by the health plan catering to thousands of employees in the entertainment industry. If UCLA does get rid of these doctors in favor of their own, it will probably be a slow process letting contracts run out. Or if the doctors remain they’ll probably be under the thumb of UCLA bureaucracy. Up to now, the doctors and clinics have been like an independent island answering to no one but the leadership of the health plan, which gave them a lot of autonomy. Everybody was happy with the system.
        I don’t know if UCLA approached our plan leadership or vice versa. I’m sure money or lack of was the reason.

        • whoknows

          That really is pretty lousy Emily. It sounds like your group was fortunate to have such a great plan. It sounds like an ideal arrangement. Any idea why you think the plan might have been struggling- you mention lack of money perhaps-but any idea why?
          It is odd that this is happening right now, right after the ACA. Do you think there is any relationship? I guess I ask because it seems like Obamacare has fostered the HIC medical bureaucracies that are at the same time wiping out private practices right under our noses. Coincidence?
          I really hope that this does not disrupt your care but there is no substitution for a good doctor you have had a relationship with for years. Very disheartening.

  • shimon oami md

    Wow. Great article and even better discussion. I long laboratories the rise of hospitals and in the 80s subsequently saw what I perceived to be the slow demise of said hospitals.

    The practice of medicine has changed and I believe that we physicians with few exceptions will have much of our clout usurped by NPs and PAs if not already. Clearly this is all in the interests of cost containment, until somebody invariably screws up.

    I agree that the public has been subjected to the propagandists with financial agendas not favorable to most practicing physicians. But the problem is more complex I fear. Big insurance pumped up.the price of most healthcare and inflated it to the point where a doctor’s visit became something that could break the bank, leading to a vicious cycle where people started buying non catastrophic insurance and a positive (really negative) feedback loop ensued. This pulled through supply prices and an entire economic microcosm developed around insurance. Unfortunately, instead of fighting it, all too many physicians saw this as a springboard for wealth in the worst case and were just passing on the costs and keeping stride in the best case.

    I fear we have lost control and have been cogs instead of the motors of healthcare. The only way to wrench control back from the HIC is to provide affordable healthcare to the public. It’s just impossible to do that without deflationary pressures on the non physician aspects of practice, I.e. malpractice, supplies, labor, etc. The Wal-Mart’s of the world have taken over.

    • Thomas Luedeke

      The left always falls into the same trap (to be gracious, out of optimism). First comes price controls. Then comes the consequential shortages (as blatantly defined by the classical economics school and the preponderance of history). Then comes rationing to address the shortages, rather than the actual solution….

      Look at the price of LASIK – *that* is what the free market offers medicine (granted, with protections against the vulnerable in our society.

      Perhaps the MCAT should demand some extraordinarily basic economics in addition to whether “Traveling at an initial speed of 11.5 x 10^6 m/s, a proton enters region of constant magnetic field of magnitude 1.5 T. If the proton’s initial velocity vector makes an angle of 30 degrees with the magnetic field, compute the protein’s speed 4 seconds after entering the magnetic field”….

    • Guest

      The left always falls into the
      same trap (to be gracious, out of optimism). First comes price
      controls. Then comes the consequential shortages (as blatantly defined
      by the classical economics school and the preponderance of history).
      Then comes rationing to address the shortages, rather than the actual
      solution….

      Look at the price of LASIK – *that* is what the free market offers
      medicine (granted, with protections against the vulnerable in our
      society.

      Perhaps the MCAT should demand some extraordinarily basic economics in addition to whether “Traveling at an initial speed of 11.5 x 10^6 m/s, a proton enters region of constant magnetic field of magnitude 1.5T. If the proton’s initial velocity vector makes an angle of 30 degreeswith the magnetic field, compute the proton’s speed 4 seconds after entering the magnetic field”….

    • Thomas Luedeke

      The left always falls into the same trap (to be gracious, out of optimism). First comes price controls. Then comes the consequential shortages (as blatantly defined by the classical economics school and the preponderance of history). Then comes rationing to address the shortages, rather than the actual solution….

      Look at the price of LASIK – *that* is what the free market offers
      medicine (granted, with protections against the vulnerable in our
      society.

      Perhaps the MCAT should demand some extraordinarily basic economics in addition to whether “Traveling at an initial speed of 11.5 x 10^6 m/s, a proton enters region of constant magnetic field of magnitude 1.5T. If the proton’s initial velocity vector makes an angle of 30 degreeswith the magnetic field, compute the proton’s speed 4 seconds after entering the magnetic field”….

      That said, it is probably too late – all doctors will soon be Big Hospital/Big Pharma/Big Government employees….

  • shimon oami md

    Sorry that was supposed to be studied the rise of hospitals not laboratories. Damn autocorrect.

  • EmilyAnon

    Thanks for your feedback. I have no personal history with UCLA, but it is known to give priority to training. I am with Cedars Sinai as are my 2 oncology doctors for the past 10 years. Now it seems freedom of choice is a thing of the past.

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