Is it possible for a health care system, when organized by institutions with primary objectives that are more tied to their own economic growth than to patient outcomes, to be a truly healthy system? Medicine acknowledges that cancer cells grow in total disregard of the cells around them. We’ve known since the early eighties that health care was becoming just another commodity in a free market with its marriage to the bottom-line of potent institutions. So, should we be surprised to discover that the typical forces that produce the Enron’s of the world are alive and well in the health care industry? A recent article in the New York Times suggests to me that kickbacks have evolved into a fine-art form with stock or options being offered to executives at Premier, one of two powerful buying groups that serve as middlemen for supply purchases for half the country’s non-profit hospitals. It looks like I’m not alone with that thought.
Larry R. Holden, president of the Medical Device Manufacturers Association, according to the Times article by Walt Bogdanich, Barry Meier, and Mary Williams Walsh, had this to say: “Billions of dollars are being controlled by two companies, and nobody knows who they are. Nobody looks at their books. Nobody knows what companies they are investing in.”
The two major hospital-supply buying groups, Premier and Novation, are capable of freezing out small medical device manufacturers that choose not to become “members” of their purchasing group. In the event that a small manufacturer produces a superior product, yet chooses either not to participate or to “move to the head of the line” (usually via a large sum of money) in the buying group’s contract negotiations, patient outcomes can be negatively impacted. When patient outcome is impacted, so are taxpayers, the Medicare system, Social Security, insurers, and our local units of government. Are preventable deaths occurring daily as the result of such a system of purchasing? Could it be that this subliminally influenced the AMA’s call for funding to research patient safety? Could a similar call for non-punitive mechanisms for reporting incidents of adverse purchases prove to be as critical to patient safety as medical errors?
It gets worse. Novation and Premier are financed by the very companies that sell the products they are supposed to evaluate objectively, in order to negotiate fair prices for superior products on behalf of their member non-profit hospitals. At the end of the year, many hospitals—already stressed financially—reportedly received hefty rebates in the form of an “annual disbursement.” You and I would probably call these “rebates” a kickback. If such practices in the private sector should translate into the system of Medicare/Medicaid contractors, it might make the federal government’s pursuit of Medicare “unintentional billing errors” seem trivial by comparison.
If we expect our bodies, our minds, our spirits to remain in balance, why do we allow corporate financial incentive to overstep its natural boundaries in health care delivery, operations, purchasing, and financing? In other words, where was the “preventive care” for the Enron fiasco? A lot of folks seem to have been asleep at the wheel. Yet it will take more than preventive care to address the ultimate pressure squeeze on innovation and the lack of job creation that results as small, creative entrepreneurs lose incentive across professions and industries.
Individual, ecological, and institutional matters need balance to co-exist in harmony. If any one of these is out of whack, the other two become stressed. If attended, there exists a greater opportunity to return to equilibrium. When balance occurs more often than not, it’s much more difficult for money to overstep its natural boundaries to the point that it brings about chaos and abuses. Do you believe that our society, our legal and financial systems, our government, and our health care delivery are flexible enough to cope with the current imbalance?
Are we looking at the etiology of a socio-political disease?
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