Katrina showed that for-profit medical care produces a more dangerous frame of mind

Though I disagree with the conclusion of this post on the blog 'corrente' (the blogger opposes HR 3200 on the grounds that it doesn't include mandating that only non-profit hospitals be allowed to operate; I support HR 3200 because I recognize the difference between what is possible now and what one might wish),

the blogger lays out very clearly the difference in mindset between what happened at two New Orleans hospitals-- one for-profit and the other non-profit in almost identical situations in the days after Katrina four years ago. Both hospitals lost all power, were flooded out and the staff was desperately short having to care both for sick patients who were already in the hospital and others who were arriving from out of the storm.

In New Orleans Memorial Hospital, a for-profit institution that since 1995 has been under the management of the hospital chain TENET, the staff, operating under the for-profit model imposed by management stretched to the breaking point, literally making decisions about which patients were worth saving and which ones had to die so they could care for the others. One doctor, Anna Pou, even was accused of making arbitrary decisions to end patients lives because of the lack of adequate resources during the disaster. Dr. Pou was eventually not indicted by a grand jury given the horrific circumstances she had to work under but nevertheless you did have a single doctor at the hospital making that decision on behalf of patients. Patients awaiting evacuation were assigned to one of three groups, '1,' '2,' or '3' depending on their health. Patients assigned a '1' were the healthiest and were evacuated first. Many of the patients assigned a '3' were the sickest and received little care and were evacuated last. A significant number of them died.

In contrast, at New Orleans Charity Hospital, a non-profit institution that has always served primarily the poor, the goal (achieved almost to perfection) was very simple. It was to save every patient. Both hospitals were evacuated on about the same schedule but at Charity hospital it was the sickest patients, rather than the healthiest who were tabbed to evacuate first so they could be transported to a facility with electricity, clean water and adequate staffing.

Now, it is easy to sit here online four years later and second guess tough decisions that were made in a truly horrible situation (one of the reasons the grand jury declined to indict Dr. Pou for murder.) However, one has to wonder how much previous training and priorities played into it. At Charity the priorities were pretty clear-- save the lives of the patients, and not decide that any one patient was more or less worth saving than any one other patient. At Memorial the mindset was different. Patients could be prioritized, and in an emergency this priority could even extend to the point of hospital staff deciding that some should die so that others might live.

People first or a system in which some are more equal than others when it comes to receiving care? Which kind of health care system would you rather be a patient in?

Tragically, it happened again. In a different hospital the same sad story.

Remember this post, Death while waiting to be seen about a patient who died in a waiting room after being there for nearly 24 hours while hospital staff just ignored her?

Well, unfortunately something similar happened again, this time at a North Carolina mental hospital.

(CBS/ AP) Investigators say a North Carolina mental patient died after nurses at a state mental hospital left him in a chair for 22 hours and failed to feed him or help him to the bathroom....

Video showed hospital staff watching television and playing cards while Sabock was in the same room. One technician hugged and kissed another staff member and appeared to be dancing.

The staff, who were supposed to be helping him, were making out and playing cards!

Just remember that we had a chance to change the system in 1994. But we lost that battle. Remember? What we got was the Republican-and-insurance-industry alternative. We got it, warts and all. Insurance headaches, bean counters making decisions about your health based on cost, three or four separate bills for the same procedure, massive bills for both insured and uninsured particularly when they are sick, full day long waits in emergency rooms, and (especially and) a system in which patients are just commodities to milk for money, and when they are unprofitable of no more worth than a worn out piece of clothing, and treated accordingly.

True the New York case I discussed in July was at a private hospital and this one was at a state hospital, but the philosophy that led to each death was the same. It is a poisonous philosphy that if a patient is a financial burden, then they don't deserve the time of day, let alone even a minimal level of treatment.

And THIS is supposed to be the best health care in the world?

Soaking the Poor

Yesterday's print edition of the Arizona Republic featured an article about how hospital charges are more unequal than even I had thought, with hospitals routinely billing uninsured patients as much as three times what they bill insurance companies for the same thing for patients who have insurance.

Conservatives will suggest that it is the uninsured patients' fault, for not shopping around.

This of course is ridiculous. If you need emergency bypass surgery or for that matter have to go to the ER, you won't have time to compare costs. And even if you are going in for say, elective surgery, they won't quote you a price, certainly not until they have diagnosed you. And unlike asking a plumber or a roofer for an estimate, the diagnosis itself will likely carry a significant price tag-- and if you want a second opinion (not that I'm against getting one if one can do so) you will have to pay for that as well. Further, the article indicates that the extreme overcharges extend across hospitals, so even if an uninsured person did comparison shop, they would still likely end up paying two or three times what an insurance company was charged.

To be sure, there are a number of reasons that play into this. The most obvious is the fact that because some people don't pay at all, and medicaid often pays hospitals less than they spend to treat the indigent, they lose money there and so have to charge more to those who can pay. Insurance companies of course can spot bogus or inflated charges (i.e. upwards of $40 for a 'mucous recovery system' which turns out to be an eighty-nine cent box of kleenex-- and yes, that is a real charge that some patients have been charged.) Consumers may not understand technical or official medical sounding names and just go ahead and pay an outrageous charge like that.

Another factor, closely related to the first, is likely to be that even when hospitals are doing well, they know they can take advantage of uninsured patients so the temptation to gouge just becomes hard to resist. And those who can't pay, they send to collection agencies and after squeezing out every drop they can they ruin the patient's credit and move on to the next victim. The concern they actually have for the poor has been amply demonstrated by (as I've blogged on several times by now) the practice of just dumping poor homeless people in the middle on the street and drivng off.

And this is why we do indeed need universal coverage. Very few, if any patients without insurance are trained enough to really understand their bills and dispute it. For that reason, wouldn't it be better if every hospital bill was reviewed by someone whose job it was, to know what was in it and how much it should cost?