Sunday, August 9, 2009

Political Malpractice

Accidental death and murder-through-malpractice occur at every American hospital, much to the delight of the ambulance-chasers. It's just a sad fact of life -- or fact of death -- that every reasonable person understands, because to err is human and because hospitals, on balance, do far more good than harm.

But the sorts of accidents that go unnoticed or barely-noticed at most hospitals can threaten to shut down a doctor-owned hospital, as this story in today's Denver Post explains. This double standard isn't because such "specialty hospitals" deliver substandard care, as compared to non-doctor-owned counterparts; it's because they are upstarts, which bring competition into a system in which true competition is absent. It's because they threaten the profit margins of other hospitals. It's because they make easy scapegoats for politicians looking for someone "greedy" to blame for a system that politicians and regulators screwed-up. And it's because some interest groups hope to use the health care overhaul being contemplated by Congress to get rid of these rival institutions.

The Post, to its credit, delves into the interest group politics lurking behind the attack on doctor-owned hospitals:

"The debate over doctor-owned hospitals, ongoing since they began to flourish a decade ago, has pitted politician against politician — and doctors and their trade groups, including the American Medical Association, against hospitals and their trade groups — in a battle of wills and dueling studies on the hospitals' impact.

A proposed provision in the health care reform package Congress is debating could effectively end the debate — and kill future doctor-owned hospitals.

The provision would prevent doctor-owned hospitals from collecting Medicare reimbursements, which can be a hospital's lifeblood" . . .

". . . .No sooner did these hospitals start popping up than traditional hospitals started crying foul. Those cries struck consistent themes: The specialized hospitals cherry-pick healthy, insured patients, leaving the really sick, the poor, the uninsured to pile up in generalized hospitals. The advent of doctor-owned hospitals, generalized hospitals say, threatens their very survival."

And their profits, of course. "The American Hospital Association reported that hospitals made a record $43 billion profit in 2007, the largest single-year profit jump in 15 years," reports The Post. And non-specialty hospitals aren't interested in cutting specialty hospitals in on that action.

Conflicts of interest and self-referrals can be a potential problem in doctor-owned hospitals. But this exists with conventional hospitals, too. I've only had a few major surgeries, fortunately, but I've never enjoyed my choice of hospital for having the procedures done. Once I picked my surgeon, my choice of hospital was also decided for me. I didn't ask "why?" I didn't investigate potential conflicts of interest. I didn't wring my hands over whether the surgeon's fee was reasonable or obscene (assuming a layperson has the knowledge to make such a determination).

The system isn't set up for comparison-shopping -- which is part of what's wrong with it. I just showed up at the appointed date and went under the knife, turning my fate over to a system I don't understand and can't control.

With doctor-owned hospitals, "we have individuals who will personally gain from having the control of what happens, of who goes in, who's admitted, what tests are done," a spokesman for the Colorado Hospital Association told the Post. But isn't that an apt description of how most non-doctor-owned hospitals operate?

The problem isn't specialty hospitals; the problem is an impossibly convoluted and covert system in which market forces don't work, and which conspires against a patient's ability to act as a true consumer. The problem isn't malpractice at certain doctor-owned hospitals; but malpractice in the broader, systemic sense, driven not so much by the "greed" of doctors but my the incessant meddling of politicians and government regulators. And now, based on a misdiagnosis of the ailment, Congress wants to do major surgery on a system that Congress made ill.

No comments: