The Business of Health Care Depends on Exploiting Healthcare Providers

From the New York Times, a striking editorial suggests for the first time something that healthcare workers have long known firsthand–that if there is any flexibility in the healthcare system, it falls squarely on the shoulders of the people providing care. As author Danielle Ofri, MD, PhD states, “the one resource that seems endless — and free — is the professional ethic of medical staff members.”

Who went into the field based on a sense of altruism, charity, and a desire
to help others in the most fundamental way? The for-profit insurance industry? Private equity firms buying up medical practices? The CFO of your local hospital? Or maybe your congressperson with their own separate healthcare plan pushing “universal coverage”?

No, it’s your doctors, nurses, and other health providers. So if care has to
be delivered, and there are limited resources, there is only one group willing to make that happen at all costs: your providers. They are the ones who will work the extra hours, do the prior authorizations, provide unbillable services, and get you the samples you need when your insurance company stalls. For us, there is no acceptable walking away from our duties no matter how bad things get. That’s why medical employees going on strike, physician unionization, and other standard labor moves that occur in bad work situations almost never happen in healthcare.

And this willingness to be abused allows the healthcare industry to keep
chugging along, dysfunctional as it might be. Not only does it chug along, it
is profitable. Mostly for the insurance industry, regulators, and large
healthcare systems. Yes, doctors and nurse make a living, some doing very well. But when you see your premium go up at a much faster rate than wages or cost of living, look elsewhere to see where that money goes. The patients? They are squeezed between high premiums, high deductibles, limited access to specialists, denials, and then seeing doctors and nurses too overworked to give them optimal attention.

To be clear, I don’t think this is a conscious business decision. I think it
is a de facto business model which has evolved over time. At the end of the
day, healthcare organizations have learned that things will get taken care of. Doctors will document with whatever crappy EMR they select. Nurses will pull shifts with no break. ER physicians will see and treat all people equally without regards to reimbursement. Surgeons will spend many hours doing life-saving surgeries although Medicare has fixed reimbursements well below the cost of doing business.

What is the end results of all this? Physician burnout, a broken healthcare system, escalating insurance profits, and burgeoning hospital management instead of increased healthcare delivery. Your healthcare providers are at their breaking point. And worker exploitation in this field is the reason why.




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