The standard business model around which our world revolves has no place in the “business” of human life, which is what the commercialized industry of health care has become. To be the most successful, businesses work to optimize profits by minimizing their operating costs, which include material resources and all the steps involved in distributing their product. This business model, in some form, is applied universally from the manufacturing and marketing of microchips, televisions, and Halloween candy to farming harvests and consulting firms. But it is not meant to be applied to human life.
If the microchip is faulty and not performing as expected, the company scraps it and redesigns a better one. If it is simply a bad batch that was produced, that batch is recalled, and the next lot number is sent in its place. The product version is always expendable for the good of the company. Businesses focus on their profit margins, and their products are only a means to that end.
That game cannot be played with human life. There is no monetary value that can ethically be applied to a human being, and humans frequently “do not perform as expected.” Sometimes this may be because the physician did not offer the most up-to-date, cost-effective treatment, but sometimes it is because the patient was non-compliant, and even more frequently, it is because human life is not neat and tidy like microchips and televisions.
Too often, the venture capitalists who own and manage health insurance companies, hospital systems, and pharmaceutical companies, have neither knowledge nor prurient interest in human physiology and psychology, and yet, they create the algorithms by which care is provided.
Our current system treats medicine as a commodity, not as an essential service. We the people are preyed upon by tycoons who wish to sell their services, and for whom quality control is not a moral directive but a necessary expense. There is no acknowledgment of the sanctity of human life, and caring for humans has become equivalent to manufacturing microchips. I keep asking myself: how can we adjust our course?
An important first step would be to equalize reimbursements from insurers and to allow any qualified physician to be able to collect from their patient’s insurance company for services rendered. The decreased “negotiating power” of small group practices has been a catalyst in forcing physicians to buy into corporate systems; currently, a service performed by a cardiologist in a solo practice earns him a fraction of the reimbursement provided to a cardiologist for the same service in a large group practice. This discriminatory nature of insurance companies has shepherded physicians into large corporate systems in order to survive because the individual doctors cannot afford to support their practices on the remittances they receive. This, in turn, has impelled patients to leave doctors who have known them for years and who understand their health nuances.
Complex administrative requirements have been artificially increased to satisfy companies that have no understanding of what it really means to care for human beings, and these have necessitated hiring additional staff just to code and submit records for payments. This further constitutes a financial burden on a small or solo practice.
If each physician were to receive the same payment for the same service and needed to pay salaries only to those competent individuals who contribute to the quality treatment of patients, large corporate structures would not be able to force physicians to maintain that company’s standards of high levels of “productivity” (i.e., volume of patients per day), nor would doctors be judged and penalized by surveys in which the patient may downgrade the practice because an inappropriate antibiotic was correctly not prescribed for a cold, or the coffee creamer selection in the waiting room was not to a patient’s liking. Patients would likewise be able to stay with the doctor who knows them well and reestablish long-term relationships built on trust, camaraderie, and mutual respect.
When corporate medicine, in true adherence to the business model, sends “customer satisfaction surveys” to patients, the corporation’s consumers are invited to criticize the care they receive, and this shifts the priority of treatment from healing the patient to pleasing them instead. And all the while, the whip is being flogged on the doctor to see more patients, code more procedures, and move patients along more quickly. All to the ultimate goal of increased revenue. Is it any wonder that physicians are experiencing burnout and depression, and have the highest rate of suicide per capita than any other profession in the U.S.?
I fear that if we do not address these issues at their roots, we will soon no longer be able to expect anyone to invest 11 to 14 years after high school and a half to three-quarters of a million dollars training to become a physician. In their place, we will have physician assistants and nurse practitioners exclusively, with no access to an experienced doctor for consultation; good people but with markedly less experience, training, and acumen. America will still have the “product” of excellent medicine without the means to “distribute” it. Thus, ultimately, the current business model, as applied to health, will fail. But how many humans will have to die or suffer unnecessary morbidity first?
It is not that we do not have the financial resources to provide appropriate care; they are just being rerouted into the pockets of large corporate holders. Human life is being forfeited for the sake of the profit margin, and it is being done “legally.” How much is it worth to save a life? How is this not human trafficking?
Debra Blaine is a family physician and author of Code Blue: The Other End of the Stethoscope. She can be reached at her self-titled site, Debra Blaine.
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