Hospice Patients Alliance: Consumer Advocacy

"Love & the Corporate Money Machine"

By Ron Panzer
President Hospice Patients Alliance
July 28, 2004

When we think about health care as a field of service, we must consider the mission involved. Why does the health care industry exist? It may seem a silly question to ask, but often, asking the simple questions forces us to focus on the essential issues confronting our society.

Health care as an industry exists to care for the ailing, prevent disease and promote health, not just for society as a whole, but for each individual life served. If every decision made in our health care corporate board rooms was based upon that mission, many of the problematic situations that exist today would be much improved or eliminated. While every health care corporation's leaders tell the public that they are acting for the benefit of those served, the reality is something quite different. Health care has become a money machine!

Many, many billions of dollars are poured out to health care corporations through the Medicare, Medicaid and other programs of the federal and state governments. Private health insurers pay out billions as well. And billions of those dollars are going into the collective pockets of those who are exploiting the system! According to some who have been caught committing health care fraud, it's easier to scam Medicare or a private insurer than to push drugs or commit other forms of ordinary organized crime. So organized crime has moved into the corporate boardroom, in health care, as well as other business fronts. With billions of dollars pouring out like a water faucet, is it surprising?

We like to think that our health care corporations and institutions are run by dedicated, charitable individuals who have nothing but the public's best interests at heart. The reality could not be more different! The days when major health care agencies were heavily influenced by the good wishes of dedicated public servants is long gone.

Hospitals, nursing homes and even hospices are being swallowed up by corporate chains that excel not only at committing health care fraud, but also excel at keeping the millions of dollars stolen from the taxpayers, even if the corporation gets caught by the US Justice Department. Examples of such corporate corruption continue to be brought to light. Beverly, a corporate nursing home chain, and HCA, a corporate hospital chain are some of the most glaring examples: convicted of felony fraud against the Medicare system, yet still operating without major setbacks for the corporation that was responsible for scamming the U.S. Treasury through Medicare fraud.

When a corporation commits fraud, gets caught, and pays back only a small portion of the amount stolen, it's called a "settlement" arrangement. The crook (read "corporation") promises to "be good" (read "corporate integrity agreement") and gets to keep millions of dollars stolen from the US Treasury.

Crime in health care pays bigtime!

When chief executive officers of health care corporations arrange to have themselves paid millions of dollars per year, something is very wrong with the system. CEOs earning less than $150,000 per year is almost unheard of, even in relatively small health care corporations, whether they are for profit or "nonprofit." And executives at large corporations are commonly receiving multi-million dollar compensation packages annually. All the while they pay themselves handsomely each year, they cry "poverty" when explaining why their agencies can't hire a few more nurses aides or nurses to properly staff a facility and care for the patients!

The U.S. Office of Inspector General warns the public that scams are proliferating in health care. The OIG tells us that nursing homes may have kickback arrangements with hospices or hospitals for exclusive referrals, or that health care providers may take federal and state funding, and not provide all the services needed by the patient. These are the actions of manipulators of the money machine, not caregivers!

What health care professionals working for the very large health care corporations continually report is the oppressive pressure by management to squeeze more work out of the health care staff, to cut corners by minimizing services, and to maximize profit (or the "revenue stream" for "non"profits. People who enter health care as frontline caregivers do so, because they feel the call to serve and wish to help others in need. They are willing to work hard and endure what are often very difficult conditions, in order to make a difference in the lives of those they serve.

Those who enter high level administration in large health care corporations today have less lofty motivations, from the outset, and their actions reflect the different values they hold. For the most part, they do not enter the field out of a dedication to the needy, rather they are seeking career advancement, power, wealth and prestige. They know how to talk the talk (promising that their corporation will serve the public's interests as the first priority), but are not guiding their business in order to maximize patient care services; they do not "walk the walk."

The legitimate role for administration is to provide vision, guidance and management so that services are maximized and patient care made more effective. The actual role today for administration in large health care corporations is to maximize profit by short-changing services. Patient care service is regarded as a burden that must be endured to make that profit. Milking the money-machine is the prime directive behind all decision-making.

What does real health care look like? How would we recognize the ethical administration of health care? It's not a difficult matter. Ethical health care serves the needs of the patient, relieves suffering, treats disease, facilitates the well-being of the patient, respects the patient's individual rights as a citizen as well as a human being and does not intentionally cause harm to the patient. In short, ethical care is guided by a deeply held positive regard for the patient. Some would call it "love."

But using "love" as a guide in "modern" health care is "unprofessional" and "unprogressive," we are told. Health care workers are taught to be objective and not get too caught up emotionally in the lives or needs of their patients. Well, it is true that it is necessary to maintain one's emotional balance in order to survive the stresses encountered within the field, but that does not mean we cannot love. Many of the caregivers who enter the field do so out of a love for people.

Love is a word that means many things to different people. The love of a caregiver is what we are considering here. How can it be described? What attitude must we hold towards those served?

We can learn from various forms of love and relationships. When a child is born, the parents look to see if the baby is breathing, if the color of the skin is pink, if the child responds normally. "Airway, breathing, circulation ... and consciousness." Just as in the provision of first aid, we look to assess the "A, B, C's" of the patient's condition. But when a mother looks at her own child, it's an ongoing, never-ending pursuit, day after day, week after week, year after year: "A, B, C and D," "A, B, C and D" over and over. Ever watchful, attentive, she evaluates and looks to see if everything is "ok," or if action is needed. The mental checklist is reviewed moment to moment.

We can certainly incorporate the attentiveness of a mother's love. The constant vigilance. The motivation and ability to act immediately when needed. The intense devotion to serve. A caregiver also reviews the mental checklist moment to moment, assessing the patient's condition on an ongoing basis. She looks for any change and constantly evaluates whether the changes are significant. If significant, she intervenes or gets guidance from a physician or other expert.

Parental love has another constant quality: protectiveness. Dare to cross between the path of a bear cub and its mother and you will learn about protectiveness. It's all about preventing harm to those loved. And our patient's are entrusted to us for a time. While they are with us, we are responsible to protect them from any harm, to the best of our ability.

I remember when my son was born. My wife labored for 23 hours to give birth, and it was real "labor." Not easy. But when he was born, it was miraculous: where there was no independent, tiny life before, now a little child was present, dependent, and needing our care and protection. Holding him on my chest while he slept, I felt that his every breath was a miracle, and I learned how careful one had to be with him. I would look in on him regularly just to make sure he was breathing. And I continue to think of ways of helping him grow and do well in life.

Loving mothers and fathers think of their children throughout the day. They think of ways to help their children grow, learn, and have happy, health lives. They do what they can to accomplish those goals. Dedicated caregivers work to help the patients grow and learn (if children), and have happy, healthy lives as possible. The dedicated caregiver is constantly thinking of the patient's condition and what might help the patient or what might improve the outcome.

We know that we hold our patients lives in our hands. A little fear of that ultimate responsibility is a healthy thing. Good nurses can all tell stories of student nurses who had no fear of providing patient care, who rushed right in and always acted like they "knew everything" that had to be done. These student nurses who had no sense of their own ignorance were often thrown out of the program for one huge mistake or another. They are dangerous because they had no healthy fear at being responsible for another life.

Caregivers need to have a little awe at the tremendous responsibility they have to protect and care for the patient. They need a little fear to keep them on their toes and to motivate them to act immediately when needed. When you truly care about a patient, what happens to the patient matters.

During the time we serve our patients, we need to view our patients as just as important as our own family. We need to treat them as we would wish our loved ones to be treated. We know that just about everything we do in health care must be done in just such a very specific way or harm could result. That is why there are standards of care and protocols for every technique and procedure within nursing and medicine. In health care, love is the "gold standard" of care, against which all our actions are to be measured. And love demands that we not only feel for our patients, but that we are competent, professional and well-trained professionals.

Are we treating our patients' lives with such love, respect and reverence? Are the caregivers in the health care system receiving proper training? Do they have the knowledge necessary to successfully intervene to relieve suffering and promote the well-being of the patient? Do we provide the maximum in needed care, or only that which would provide a solid excuse to bill for services "rendered?" Before the corporate spokesman cries "poverty," protesting that there isn't enough funding for that kind of service in health care, I say, stop the fraud! Stop the personal pocket filling at the trough of the health care money machine. Stop plundering the system!

When health care executives are paid on a reasonable basis (certainly not more than ten times a nurse's salary), and when priority is given first to patient care services, then it will be appropriate to determine whether there is enough money to pay for the services needed. Now top administrators are getting one hundred times a nurse's salary in compensation! I am not convinced that health care resources are so "scarce." I know that what is scarce is honesty and integrity within the health care administrations of the very large health care corporations. These huge health care corporations are increasing their control over the health care industry and the provision of services to the patients in our nation. They are motivated by profit first and the trail of patient abuse, neglect and actual harm speaks for itself.

Government efforts to rein in fraud and corruption in health care have been woefully inadequate for decades and have been intentionally so. They are not sincere at all! Millions of dollars in contributions to our elected officials flow from the health care corporations as "protection money," and the elected officials make sure to appoint industry-friendly "regulators" so that the regulatory departments do not become too serious about cleaning up the widespread fraud within the industry. Should an inspector be hired who takes the job seriously, that inspector is reprimanded or fired. Sometimes, should they dare to become whistleblowers revealing the corruption of the agency, they are blackballed and their reputations are smeared.

The only conclusion an objective person can make, as shocking as it may seem, when observing how the US Justice Department allows the huge health care corporate criminals to keep so much of that which they have knowingly stolen, is that the government officials have chosen to reward the criminals (health care administrators) who contribute so regularly to their re-election campaigns in an unbroken circle of shameful "payback." Health care crime is a very safe and profitable choice.

Health care is absolutely a money machine, for top administrators in the very large health care corporations as well as for the government officials who accept the bribes disguised as campaign contributions; health care workers who are trying to serve the patients are merely caught in the middle. Dedicated physicians, nurses, social workers and others try to provide services as best they can, while the administrators manipulate the money machine to maximize their own personal gain. The conflict in values could not be greater. We repeatedly see losing battles by caregivers who seek to maximize care; losing battles, because all the power within the health care corporate structure resides in the hands of the administrators who care nothing about patients and care everything about personal profit. With certainty, both patients and staff suffer needlessly.

To reform health care as an industry, we must remember why the industry exists and stop rampant fraud within the system. When health care takes up so much of the federal and state budgets, we can no longer tolerate a US Justice system that pays criminals to steal. Reform is needed in government first so that laws against fraud are enforced. When the corporations realize that they can no longer scam the system without risking jailtime, and when they know that they would have to repay all stolen funds, the risks of committing fraud and getting caught would outweigh the benefits. Only then will the fraud stop.

Health care must return to being administered as a labor of love. Only then will our patients and society be well-served. Only then will care givers be freed to provide the services needed by the patients. Only then will doctors be free to provide services that truly serve their patients. We need not pretend that our health care corporations provide the very best; we need to actually provide the very best. It is the administrators of our health care corporations who could allow that to happen. Rather than stuffing their own pockets through the money machine, they need to place patient care services first. And it is the government regulators and criminal justice forces who could make sure they do just that.

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