Sunday, April 25, 2010

Healthcare in America. Or Bangladesh.

Here are some odd thoughts that just occurred to me about hospitals.

1. A well-run hospital is a well-run hospital, whether it is in a small town in Kentucky or in Bethesda, Maryland, where our royal public servants go.

2. A poorly-run hospital is a poorly-run hospital, whether it is is a small town in Kentucky or in East L.A.

3. A hospital which is staffed with people who care, will care for their patients well, even if those patients are indigent.

4. A hospital which allows staff who don't care, will provide poor care for their patients, even if those patients are wealthy.

5. Only competition will weed out poor service, even in hospitals. Every time you build a superior hospital and stock it with superior administrators and staff, you will run a poorly-run hospital out of business. Unless the poor one is run by the government.

6. Government hospitals get clients whether they give good service or not.

7. Fancy equipment is fine, but it doesn't replace caring doctors and nurses. Some of the most poorly equipped medical facilities are in Mexico (and other countries without a lot of money) -- and some of the finest caring doctors and nurses work in those facilities. Sometimes a doctor or a nurse who will sit by your bed all night with a cool damp cloth and concern in their eyes makes up for the lack of medicines. And don't think those people don't exist. Even in the most desperately poor countries of the world. Even in the USA.

Just sayin'.


  1. Kind of like education. If teachers care, it's good. If they don't, it isn't.

    Thank God most of the people I know in either health care or education care very deeply about those they serve.

  2. To some extent, I agree with you. However, it's somewhat telling that you put admininstrators before clinical staff, and refer to running other hospitals "out of business".

    Whilst it's true that a hospital needs efficient administration, I feel very strongly that a hospital's 'raison d'etre' should not be "to create wealth".
    In your country, medicine is regularly seen as a career choice, alongside becoming a lawyer, as a track taken to ensure future riches.
    In Russia, before the crumbling of Soviet rule, along with a group of Finnish doctors, I visited a hospital in Leningrad. The buildings were shabby, and in poor repair, the whole place looked as though it was still in the nineteen-fifties. My Finnish friends had nothing but praise for the healthcare they saw there, and the dedication of the staff. Yet a hospital doctor's wage was less than that of a bus driver.
    No profit motive, no competition with 'rival' hospitals.

    I know you think medicine taken out of the hands of big business is the slippery slope to communism, the death knell to american values, and that you feel that a hospital's stock market price is what drives excellence.
    I'd rather be treated by someone who's there out of a wish to heal the sick, than by someone who looks at me and figures out what I'm worth to him. (or her).

  3. @Shakespeare - What you say is true. I thank God for it, too. And thank you for reminding us about teachers. I couldn't agree with you more.

  4. @Soubriquet - The only reason you don't agree with me more is mostly because of my poor wording and poor expressing of my thoughts.

    "Running a hospital out of business" was a pretty poor way for me to put that. I suppose there may be some for-profit hospitals and clinics in the U.S., but I have never come across any that I can recall. The analogy for a non-profit hospital to be "run out of business" is to be bought out by another group with better management skills, someone who will correct the poor care and poor service and bring in a new crew. I didn't mean that the unsuccessful poor hospital should be turned into a parking garage or razed, unless it needed to be razed.

    But with very few exceptions that I can think of, competition is still the mother of excellence. This is true whether it be a grocery store or a medical clinic or an insurance company. Or a big oil company. I blame the federal government for not providing regulation and law enforcement to insure fair competition. The only exceptions that come readily to mind that seem to thrive without competition are "enterprises" run by governments. Local governments who run city hospitals are best, but often that is not saying much. State governments are not nearly as responsive to local needs, but, in all fairness, many of the hospitals the states run are for mental patients and the criminally insane, so a different standard needs to be used. Obviously the government which is farthest away of all, our federal government, would be expected to do the worst job of all, and they seldom disappoint.

    My own temporary insanity recently, in dreaming that our Federal Government COULD handle a national heath care system, has run it's course and I have awakened from my sleep. Somehow I had thought congress would do the right thing and respond to the needs of the people. Ah, well.

    I don't know the statistics offhand, but I know that a HUGE percentage of the private hospitals in the U.S. are owned, or run by, charities or religious organizations. One seems to get better care, as a rule, in these hospitals than one does in hospitals run by municipalities or counties or state regions. There are shining examples of exceptions, of course - especially on the regional level. Regional hospitals which serve a large section of a state have shown that specialty care services need not be duplicated in every hospital. That's good. So I am all for well-run regional hospitals with reliable helicopters when people need specialized critical care.

  5. If you would like to experience the failing of federal government medicine, through the Public Health Service, the Indian Health Service, or the Veterans Administration, please visit the waiting rooms of any of their facilities and talk to the people waiting. I promise you will have plenty of time to talk to them before they are called.

    All this is not to say that doctors and nurses who are employed by the federal government are all bad or uncaring; far from it. They are just swamped. And grossly underfunded. But the result is still poor service and medical mistakes.

    A hospital's or clinic's reason for existence is not to make a profit, agreed. It is to provide quality medical care. But private hospitals must take in enough income to cover expenses, even if the law doesn't call this a "profit." If I have a choice, and I do, I will choose a hospital with a reputation for fine care which attracts doctors and nurses who are exceedingly competent.

    Nor am I saying that nurses and doctors choose the medical profession only because of the money aspect. But these people spend long years in school and even more years interning. I have a feeling you may not be aware of quite how much a doctor owes in student loans by the time he or she gets into practice. This must be made up for. It must.

    I don't argue that doctors in former communist or present poor countries don't give good, compassionate patient care under less than ideal conditions. In fact I mentioned this in my original post. I have gone on far enough here already, though, to enter into another debate about socialized medicine and the grand result it produces.

    No, I don't think taking health care out of the hands of big business is bad. But it isn't in the hands of "big busness." You might think the Catholic or Presbyterian church is the same as a big corporation, or that St. Jude's or Mt. Sinai is big business. You would be wrong, I say, if you think that. I DO think it should be taken out of the hands of the federal government - whose job (if I read the constitution correctly) is to regulate, inspect, penalize, oversee, and administrate on behalf of citizens, and, if they would get off their political asses and do this, we wouldn't have the problem with price gouging or arrogant insurance companies. Or the greedy pigs on Wall Street, for that matter. Yes, the federal government has a function in all this. I would LOVE to see them carry out their mandate.

    I can't really respond to your last paragraph because I don't know any medical person or institution who does that. Might be some, though.

  6. I must apologize for leaving out another HUGE hospital provider in the U.S., and that is our Universities. No, that's not government.



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