From the new January-February 2013 issue of News & Letters:
by Htun Lin
Banks that were rescued because they were deemed “too big to fail” after they caused the 2008 economic collapse want to sue the government for trying to regulate their reckless behavior. The unspoken corporate motto where I work at the nation’s largest Health Maintenance Organization is, “We’re too big to care.”
Our CEO had a hand in helping write the Affordable Care Act in Capitol Hill’s backrooms. The victims of the HMO interests inscribed in this law have been, and will increasingly be, the patients who paid us to care for them, especially those patients who have paid into the Medicare system all their lives.
DENY CARE WHENEVER POSSIBLE
Obamacare may be able to prevent denial of insurance based on pre-existing conditions. But HMOs have been implementing with a vengeance the denial of care to those who already have insurance.
We are told over and over, at one staff meeting after another, that the HMO is facing decreased federal reimbursement from Medicare as the full launch date of Obamacare in 2014 is looming. The HMO’s mantra is that bottom-line finances demand that operations have to become more “efficient.” That is code for cutting care-staff and further speedup.
The truth is that 30 million working adults who have no coverage will soon be mandated to have health insurance, which will mean more revenue. Just as we are about to enroll millions of new paying members expecting real healthcare, frontline care-staff face layoffs. Yet more supervisors to monitor costs and revenue are being hired.
MARKETING OVER HEALING
With 4 million additional Californians about to get health insurance, there is expected to be an immense doctor shortage. What doctors actually do has already been transformed by new marketing directives. TV commercials brag that the HMO offers “easy access to your doctor” at the click of a mouse. Doctors where I work now complain that they have been forced to do their own clerical work, answering several hundred e-mails from patients a day.
Little time is left to actually see patients in person because, like the rest of us, doctors have become tethered to the computer all day. As one worker expressed it, the problem is not only that HMOs want to replace healthcare workers with robots, but “they actually treat us as if we were robots.”
A Dec. 16, 2012 New York Times editorial, “When the Doctor is Not Needed,” touted the healthcare offered by retail clinics in drugstore chains like CVS and Walgreens. The new trend uses less expensive workers “to consult with patients over the phone by asking questions devised by experts.”
The editorial pointed out the immense cost-saving potential of “self-care,” where for many ailments “the patient could consult by phone or e-mail with a nurse…” and even be “allowed to teach other patients” procedures like hemo-dialysis. The Times concluded, “the Affordable Care Act contains many provisions that should help relieve the shortage of primary care providers, both doctors and other healthcare professionals.”
The only department growing at our HMO is the Call Center because of the tremendous savings afforded by preventing patients from seeing a skilled healthcare provider. Aides and clericals, untrained in nursing or medicine, are left on the floor to give medication advice to patients, because pharmacists and nurses are unavailable, as reductions in staffing levels have made them scarce also. This is the real cost of the HMO’s financial bottom line.
But we rank-and-file workers know it’s a manufactured scarcity, designed by cost-cutting through de-skilling and hi-tech, where mechanization is taking the human beings out of providing healthcare. Our HMO recently announced their intention to lay off approximately 400 registered nurses even as patients continue to be warehoused for hours in the ER due to staffing shortages.
At one of our recent staff meetings, the union rep lectured us workers to “appreciate the job you still have” and not complain about ever growing speedup and staff reductions, “because it’s a tough competitive market out there.” The union rep forgot that her paycheck comes from our union dues.
She was also tacitly saying that the financial health of corporations trumps the health of patients. That is what drives this brave new world of healthcare “reform.” Patients will ultimately have to rely on themselves to deliver their own healthcare. Healthcare cannot compete against the bottom line until we restructure the whole society around human needs.