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consumers would judge the merits of various health care plans…was unclear,” Barlett and Steele write in their chapter on the privatization of HMOs. “Even more puzzling was how they would make this decision in an ambulance on the way to the hospital emergency room after an accident.” In fact, the pretence that sick people are shopping when they go to the hospital is a thin one. Under the business model of medicine, patients are a crop. And they are profitable only when they are sick. Our health care system benefits more from letting a patient’s condition worsen until it requires emergency intervention, than from treating it in time. If an ounce of prevention is worth a pound of cure, the health care industry wants the pound. Cost cutting is one profit-boosting practice imported into health care from the business world. Shareholders of publicly owned hospitals pressure staff to keep them profitable by any means necessary. Barlett and Steele tell how surgeons at a hospital owned by the management company Tenet Corporation, discovered in 2000 that they had been performing operations with bacteriainfected instruments. For weeks, administrative staff had known the sanitizer that sterilized the instruments was broken, but had not ordered the expensive repairs. The Tenet-owned Palm Beach Gardens Hospital, in Palm Beach, Florida, kept such unsanitary conditions that 16 people died of staph infections contracted there. At least one Tenet-owned facility found an even grimmer way to bolster its bottom line. At the Redding Medical Center in northern California, an FBI investigation found two doctors had performed a large number of unwarranted cardiac procedures, some on patients with normal hearts. Several of those patients died of complications following surgery. In theory, the business model of medicine was supposed to make health care more efficient and correspondingly cheaper. Ironically, the bureaucracy that manages “managed care” is one of the fastest-growing industries in the world. Entire job sectors have been created to enforce cost-cutting measures; the authors list them in a chapter devoted to the new industry: the Professional Association of Health Care Reimbursement Specialists, the National Association for Claims Assistance Professionals, and the American Medical Billing Association, to name just a few. HMOs also employ a catalogue of shady practices to deny reimbursements to doctors. “Nearly one of every three dollars now spent on health care goes for administration, from processing the voluminous paperwork of billing to enforcing the lengthof-stay guidelines,” Barlett and Steele write. These guidelines, set by insurers, widely reviled by physicians, list the time patients should be kept in the hospital for various complaints. A patient with double bypass heart surgery gets four days, according to one widely used set of guidelines. A child in a coma with seizures gets three days. Anyone who has ever been forwarded to an HMOrun call center may have guessed the truth about another common cost-cutting measure. These labyrinths of phone menus and customer service representatives are indeed designed to keep you from seeing your doctor. Barlett and Steele tell us operators in a call center run by Kaiser Permanente receive bonuses for scheduling fewer doctor appointments, and are chastised if they spend longer than four minutes on each call. KPC Medical Management, Inc. took cost cutting to its logical extreme in 2000, ultimately refusing to pay anyone anything. Barlett and Steele devote an entire chapter to KPC’s spectacular sixmonth meltdown in 2000. First, specialists started refusing to see patients referred by KPC’s doctors. Many specialists eventually canceled their contracts with KPC, saying the company hadn’t reimbursed them for care provided to its clients. Then supplies began running outthe chemicals to process mammogram film, the implements to perform biopsies, even medications. Finally, even doctor’s lab coats were eventually repossessed. It turned out KPC wasn’t paying its vendors, or anyone else for that matter. Checks to suppliers and staff were written, but never mailed. KPC director Dr. Kali Chaudhuri made repeated The WHO’s global health care rankings place us 37thbelow Italy, Malta, and Costa Rica. We did, how ever, beat out Slovenia. Narrowly. promises that the company would mend its ways. Instead, the company simply folded one morning in November 2000. Patients arrived for their appointments to find clinic staff clearing out their offices. Though KPC failed on a grand scale, it is hardly the only company where lives have been endangered and lost through poor business practices. But the difference between KPC and other managed-care operations, Barlett and Steele write, is “only one of degree. Increasingly, all the problems faced by KPC’s patients are confronting patients elsewhere, although in many instances they may not be aware of what’s taking place:’ In Critical Condition, the authors trace the cozy relationship between forprofit health care corporations, Wall Street investors, and government officials that allows fraud and abuse to persist. They also illuminate the triangle of pharmaceutical companies, the FDA, and the media that has led to the boom in prescription medicationsand the discovery of an ever-expanding array of new, medicable conditions. The FDA has leapt to Big Pharma’s defense over the importation of cheaper drugs from Mexico and Canada. The agency has also turned a blind eye while drugs with dangerous and deadly side effects remained on the market long after the were pulled in other countries. The threat of disease almost pales in the face of what could happen in the hospital. “Corporate decisions at a manufacturing plant may have economic consequences affecting the paychecks, continued on page 37 1/7/05 THE TEXAS OBSERVER 15