This commentary is by Vicki Ward, who has a master’s degree in nursing and lived in Barnard for many years before locating to Hancock County in Maine.
The medical-industrial complex attacks everyone with any credibility who threatens its Corporate Moneycare Narrative.
Nurses have known since the 1990s that, if anyone they cared for was hospitalized, you’d better hop in there to advocate and assist in their care.
As business consultants, initially used by M.D. hospital administrators to maximize their income, have become the owners of new US Moneycare, these same administrators have begun to fire doctors who do not comply with the party line.
Recall, U.S. health care, with the worst coverage in the developing world, is now 20% of the U.S. GDP! Without a significant “good jobs” program, like green jobs, the non-clinical employee staff will not have an alternative worthy relocation. And the physician community that brought business in to increase their reimbursements look on in horror as they lose control over their work environment, patient relationships and patient care choices.
End-stage capitalism eating us alive, and we all seem frozen. We have got to get out of our PTSD response!
Applying business principles to U.S. health care meant every medical procedure, operation, drug or treatment that was highly reimbursed is maximized. According to the U.S. fee-for-service coding program, yearly revised and advocated by the Physicians Union (called Professional Organization-AMA) since the 1960s, this manual is a requirement for billing Medicare/Medicaid and thus used by all private insurers as well.
This was created when the physician community realized that if government health care was established in the U.S., they would lose their income levels and standing without a promise from Congress to bless this Bible of Medical Billing. Do you ask yourself why we have no mental health care, substance abuse, much less public health, community health and home hospice run by nursing nonprofits? These health care activities bring in less income per code. It is that simple.
Why do big hospitals love NICUs, ICUs, CCUs, transplant operations, keeping folk with cancer alive another week in aggressive treatment despite the fact they will die in weeks? Because in this Billing Bible, these are upcoded. You get more money per activity. Professional coders review health care bills before they even go out, to assure maximum reimbursement.
This system is how business skewed U.S. health care from balanced care objectives between multiple human health needs, including inpatient mental health care (whose more person-centered costs were covered by high surgical reimbursement), with physical health care in any individual hospital system. Instead of balancing patient needs, financial gain became the goal and the health care systems got larger, with more profiteers benefitting.
Vermonters, prepare for more U.S. patients who will need women’s health care services, as half the states prepare to treat women as the property we still are, according to U.S. law. Vermonters may want to take a ride to Mexico, as over-the-border primary care visits by a qualified medical provider cost just $8. Can you imagine how different U.S. health care would be if our office visits were as reasonable? Or, maybe the Burlington airport folk can create a weekend round trip to Mexico, which will be less expensive for dental care, primary care, even health care procedure tourism.
Speaking of women as property, all the traditional women’s professions — child care, teaching and nursing — are experiencing shortages. Think there is any theme there? Might it be that in the U.S., despite all attempts at feminist gain, women’s work remains persistently attacked and working conditions degraded? Who will care for you? A robot?
Who will care for your child, since two adults have to work to support a family in end-stage capitalism? As teachers’ pay remains low and their retirement erodes, who will teach? Will we have a group of workers living in some housing ghetto who will never be able to afford their own place, but are expected to perform for us? What do you plan to call this? Bringing in”‘grateful refugees” helps keep costs down.
Other writers have also explained the raiding of Medicare with Medicare Advantage programs that use “creative billing” — really lying and fraud — to gain more money per patient. What is even worse about this AMA coding process is that the physicians got the politicians in the 1960s to write into law that Medicare and Medicaid must use this coding process. The M.D. Union, the AMA, makes huge sums yearly revising this coding system that all must use to bill for health care services. Guess what the AMA does with the money? Lobbies for more power and control over the health care dollar. The No. 3 spender this past year on lobbying was health care. No. 2 was real estate. Who wants the status quo?
Health care entities have bought and sold hospital/health care property we built with taxpayer dollars. Resident doctors, who complain about their income, of which 70% is paid by Medicare dollars, also commonly used to buy property in the state they train for four years (maybe longer), including Burlington, and resell for great value after its use, or keep it in their portfolio as a rental.
Though residents certainly need to have their training program revised, as the demands and demeaning attacks in their hierarchal M.D. system contribute to their unrealistic sense of entitlement, residents make more yearly income than many other U.S. workers.
The poor ole hospitals were given money when the hospitals were empty, when they were too full of patients, and when they were not full enough. There are rubber-stamped growth funds yearly, yet they hold hostage other aspects of human health, now relegated to homelessness, private prisons and dying alone.
The latest horror is the proclamation of hospitals (whose policies have driven care staff out, including nurses) to send patients who ordinarily would be hospitalized back home alone, home all alone, with an IPad and a smartwatch to be “admitted” for “hospital care” at their home. What else will these vulture capitalists come up with?? How long will we continue this nightmare?
US Moneycare will scream bloody murder if we create a health care system for all. Yes, the priorities will change. Some of the folk barely holding on will pass. Millions and millions of children, their families, could regain public health, basic primary care, and attendance to mental health/substance abuse care. The power-and-control people who have created this system will never fix it. We need to replace them with skilled folk who have a broader framework like we had in the 1960s, balancing community care needs, acute care, home care and death with dignity.
The leverage we have to create a better health care system for the U.S. includes the culpability of the entire physician community in the opioid epidemic. The physicians would like you to believe that the “opioid salesmen” overcame their intelligence to overprescribe controlled drugs for 17-plus years, such that a half-million patients directly died, and at minimum another half-million died.
This error has been made by physicians in their past cyclically. The current narrative that patients licked the opioids off the conveyor belt is another lie. There are plenty of guilty partners, including the Drug Enforcement Administration, boards of medicine, Health and Human Services, who saw all this occurring. Worse, clinicians watched as this occurred and if they spoke up, often their careers were destroyed.
The real issue is a class war of the wealthy on everyone else, and this includes the doctors and health care. As Voltaire wrote, “Those who can make you believe absurdities can make you commit atrocities.”
But, like good government, we have to become involved with the process of achieving health care for all, eliminating fee for service, reclaiming all our buildings as taxpayer-owned, revising M.D. training to be more humane and collegial so multiple healthy talents are able to work together, creating good health care systems.
Sometimes, M.D.s would be the leader and sometimes social workers would be. We must get past this hierarchical, strangulating, ever-gobbling end-stage Capitalism Moneycare system.
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