WHO RUNS MEDICAL CARE IN AMERICA?
By Helen L. Burleson, Doctor of Public Administration

The simple answer to the question is the insurance companies.

It amazes me to hear physicians complain about government interference in medical care. No one should know better than physicians, that THEY do not make all the medical decisions, NOW.

Hospitals are run by MBA’s and non medical people who have degrees in public health or hospital management and administration, and have no medical training. The model they employ is the business model. Doctors have to discharge patients based on how many days a patient can occupy a bed. The decision to discharge is made by the administrative policy. Quality control is a term used by hospital administrators. Simply stated it means how much money can they make for the hospital. Obviously they use cost benefit analysis and not well patient analysis. Of course, hospitals have to make a profit or they cannot survive, but the human element must not be overlooked.

I urge physicians to be honest. They do not have the control over their professional practices as they did in the past. They should support President Obama’s attempts to overhaul medical care in America so they can practice based on their Hippocratic Oath and not on the command of a hospital administrator. Under the Obama health plan, doctors would have more autonomy based on best guidelines for patient care. Physicians need not fear for their income. When the health care system is improved, their incomes may actually increase because there will always be people who do not want to sit in an emergency room or in a crowded HMO waiting room.

Speaking from personal experience, in 1976 I had surgery. My physician, who had been on staff for many years and was highly respected by the administration and the nursing staff, kept me in the hospital a few days longer because I was running a slight temperature. I was a Medicare patient. Almost concurrently, my niece, a public school teacher, who had the same type of surgery was discharged after three days in the hospital despite the fact that she was experiencing difficulty. Her physician was not as well known to the people who determine the culture or politics of the hospital. I was twice her age and had absolutely no complications or discomfort after major surgery. My niece had complications that lasted for an extended period of time.

I have a cousin suffering from advanced MS (multiple sclerosis). As a school principal she was required to have coverage by the medical insurance company chosen by the Chicago Board of Education. In addition to being misdiagnosed in the early stages of her disease, she has been pushed around from pillar to post from hospital to hospital from nursing home to extended care facilities. During the early phases of her hospitalization she was given both physical and occupational therapy and was able to lift her legs slightly and had progressed to the stage of being able to lift her cutlery to feed herself. Later, when she was discharged from the hospital she was put in an extended care facility where she also got physical and occupational therapy. Later the treatment was stopped because her insurance wouldn’t pay for it. She also had to leave the facility when her insurance benefits ran out. The nursing home threatened to seize her home for payment of her enormous medical bill. Transferred to a less expensive nursing home, she received no therapy and thus she had no quality of life. She was put out of that nursing home because her insurance would no longer pay because they said her prognosis was poor and she had no chance for improvement or recovery. The only thing that keeps her from being a vegetable is that her brain functions well and she can speak fluently and coherently. This is because in addition to having a Masters degree, she also has supervisory credentials. At 54 years of age, my cousin has no future.

Because the basement in her home flooded during her hospitalization, she was unable to return to her home because of mold infestation.

Fortunately, her Godmother, opened her home to my cousin. The insurance company that refused payment for her to remain in a 24 hour nursing home facility is now paying for in-home services which consist of therapy, and 24 hour aide coverage. I’m still trying to figure out the rationale.

My niece and my cousin, both employed by school boards, contributed to their medical programs, and both were treated unfairly. I, on a “socialized” medical program, Medicare, get excellent medical care. The only little inconvenience I have is sometimes I have to wait to see a specialist. Does that bother me or affect the quality of my life? No. I have my own physician whom I selected and she makes my referrals to see specialists when I need to.

Is Medicare perfect? No. Is fee for service medical care perfect? No. The minute that fee for service patient enters the hospital system, the private physician has to conform to the rules established by the administrative panel.

Between the two, my “socialized” program is the better and I am satisfied.

To the American public I say, do not be dissuaded by those whose primary purpose is profiteering. The insurance companies have grandiose buildings where they operate and these facilities were not paid for because of eleemosynary interests.

There must be universal health care for all Americans equal to what members of Congress give themselves that we, the taxpayers, pay for. If we do not get what is best for the rest of us, then those few should lose their privilege and we should refuse to pay for it!