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.