ARTS & FARCES internet

Addressing the moral issue first puts matters in perspective, especially in the time of influenza.

Is it moral for business entities to realize astronomical profit from the illness of others? How comfortable is our society with such gains? What is the appropriate role of government with regard to protecting public health?

Overstepping its natural boundaries, money begins to behave like cancer cells upon our society, creating havoc in total disregard of the surrounding social fabric. Such cancer is the direction we choose however, when we allow profit motives in the “free” market to hinder patient care. It was recently pointed out last month by Dr. K.J. Lee of Yale University during the Health Care Summit at American University that there’s plenty of money (US$1.7 trillion) existing in our system, it just needs to be more efficiently allocated. And for all this money we have systemic over-use of inappropriate treatments and under-use of universally high value practices.

Short-staffing in medical facilities isn’t always about the shortage of professionals many providers stress. It is as much about the failure of the providers to compensate nurses and other staff working overtime. Havoc is the step we choose when we—in spite of failing to fairly compensate some workers—over-compensate share-holders and executives of healthcare facilities relative to the value they contribute. We do this at the expense of patients, employees, and sometimes even the general public; and certainly in total disregard of our social fabric.

The profit motive in healthcare has, thus far, demanded that patient care be counted as an “expense” that exists in direct competition with the bottom line. Employees don’t even show up on a balance sheet, as Marjorie Kelly of Business Ethics points out. When employees finally make an appearance in a profit and loss statement, it’s as an expense, not as the assets they generally are. What is any company without its employees? No profits are generated without the efforts of employees, yet profiteering proponents of the free market generalize employees as if they were all slackers to be readily dismissed despite the generation of profits.

Given these current accounting measures, how is it not cheaper for hospitals, nursing homes, and dialysis facilities to short-staff? But we already know that short-staffing creates avoidable, unwanted havoc; a poor work environment, deteriorating quality of care, and even death. U.S. dialysis centers have a 20% higher mortality rate than those of other countries. So, when is it not cheaper for these entities to short-staff or to fail to implement best practices? When they are at risk for a law suit.

The Democratic vice-presidential candidate, John Edwards, gets a lot of flack about this because he’s a trial lawyer, but he’s onto something. Tort reform may be less imperative, as he suggests, than keeping frivolous lawsuits out of the system in the first place; but when a case has merits, penalties can serve the public interest. Fortunately, the federal government has already given us a good model for approaching the problem in the way U.S. Equal Economic Opportunity Commission (EEOC) grievances enter the system—with prior review.

The profit-motive is capable of hindering patient care because its components are designated as a line item “expense” in direct competition with a provider’s bottom line. But for whom is it ultimately an expense when a citizen’s medical needs are not addressed? The expense, thus far, has fallen onto patients’ families, adding to the rise in bankruptcy rates. When families are unable to meet the burden, it falls upon a community dependent upon tax revenues but with no “goods” to distribute in the free market. The community is ultimately at risk for bills, services, increases in homelessness, and strains on charitable organizations. This is nothing but the use of a community’s public resources to support private gain for shareholders and executives when patients’ needs turn critical. Such a series of events that constitute a de-facto “system” simply is not sustainable.

Should the profit motive be removed from health care? Dr. Lee doesn’t think so and I agree. We can keep the benefits that the profit-motive brings to an economy for entrepreneurs. But we can think about capping those profits to reasonable levels so that patients, communities, and employees are not harmed, and the presence of big money is less able to wield power over legislators. Shareholders can still see profits too, but they will be much more in line with the value they actually contribute. Therein lie the seeds of a very elegant solution to a very messy problem.