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NEWS & LETTERS,
January-February 2003
Workshop Talks
Walls surround ER
by Htun Lin If you build it, they will come. That was the memorable
line in the movie about baseball called "Field of Dreams.” Now, after
more than a decade of the nightmare of healthcare restructuring it is clear that
our capitalist rulers have been driven by the motto, "If you don't build
it, they won't come." "If you build walls, they can't come"
describes many seniors who are abandoned altogether by their health providers
because of the Bush administration's deliberate under funding of Medicare. In
this same vein, if huge health chains swallow existing hospitals and clinics in
order to eliminate them, their slogan could be "If you destroy it, they
can't come." GIFT TO HMO'S With "Doctor" Frist as Bush's new majority
leader in the Senate to replace the openly racist Trent Lott, a slash and burn
program for our healthcare system is exactly the aim of the Bush regime for the
next several years. Frist has had plenty of experience doing exactly that. After
all, his family owns major investments in the HMO industry. Frist is Bush's
point man to finally end health care as we know it. Even as Frist had barely started his reign as majority
leader, Bush issued the first salvo in his war against healthcare with an attack
on those least able to fight back. The Bush administration had ruled that
managed care organizations could limit coverage of emergency services for poor
people on Medicaid. This openly flouted the Congressional mandate for Medicaid,
which specifically makes normal emergency care open to everyone. The administration had to rescind this ruling after
massive pressure–from Senators who had written the original bill, and from
their constituents. Bush also does not want anything to distract from his effort
to make even more drastic cutbacks to medicare in coming weeks. States are facing the worst fiscal crisis in more than
50 years, in part because of federal cutbacks, and are desperately looking for
ways to reduce health costs by cutting benefits or restricting eligibility.
These draconian measures are happening on top of cutbacks that have already
occurred in the private sector. DIGITAL MAZE For example, in the shop where I work, there are already
many types of barriers erected in order to discourage the patient from accessing
our services. Patients who telephone the “call center” enter a maze--the
electronic voice-mail system--and are put on hold interminably. When the patient
finally reaches a person at the other end of the line, she is speaking not to a
nurse, but to a clerical employee who is answering questions based on a script
in a manual, like a recipe book. The call center clerk is also looking at a computer
screen with the patient's profile, containing not just medical information, but
how much co-payment the patient owes or whether the patient is a "drug
seeker.” Many patients get frustrated trying to obtain an appointment and may
end up in an emergency room. The very first person the patient encounters there is
not a nurse or a clerk, but a security guard, who tells you where to stand in
line. The guard has the authority to throw you out if you misbehave. Emergency
waiting rooms have been deliberately downsized, to make waiting hours for your
turn as unpleasant as possible in a crowded room. While right-wing officials bemoan health care cost
overruns due to "inappropriate" emergency room use, the emergency room
has become the health care of last resort for a huge army of uninsured. In the
hospital where I work, even though nurses are trained to triage to sort out the
less urgent cases, patients with severe emergencies will still have to wait
intolerably long hours (up to 24 hours as sanctioned by the state) in the
emergency room, because the system has spent the last 15 years dismantling
hospital wards and closing down and reducing the number of available hospital
beds. COST SHIFTING Even those structural barriers set up ten years ago are
not enough for private industry. Now they have resorted to many forms of cost
shifting. This strategy has gained favor with corporate employers like GE, whose
unionized workers went on strike for two days over the increasing burden of
co-payments on their insurance premiums. Part of my job is to collect
co-payments, especially from Medicare patients who are now charged $500 for each
admission. One day, I was about to register an elderly man with a
possible stroke into a hospital bed. When I brought up the $500 co-payment, the
wife became visibly upset. She said there was no way they could pay that amount,
since they were on a fixed income. She then said, "I'll just take him home
and take care of him myself." The nurse called the doctor to inform him of the
patient's inability to pay. She requested that he consider downgrading the
patient to a "short stay" status, which doesn't have the same
co-payment. The Short Stay Unit itself was an accounting gimmick originally
created in order to free hospitals from long-term budgetary bed count
allocations. INABILITY TO PAY The purpose of co-payments is to get patients to
discipline themselves according to capital's dictates. In other words, people
will weed themselves out of health care services based on their inability to
pay. Our Marketing Director said cost shifting was going to be the wave of the
future. "If you think our co-payments are high right now," she
continued, "wait till next year." However, workers are not going to take this kind of treatment this year or next as demonstrated by recent strikes. Workers’ past battles on the picket line made the modern health care system a reality. It is time to fight to build a health care system for everyone, and they will come. |
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