On October 13, 2021

Money is now the dominant interest in health care

By Vicki Ward

Editor’s note: This commentary is by Vicki Ward of Barnard, who holds a master’s degree in family nursing and a post-master’s certificate in psychiatric and mental health nursing. This piece was published in VTDigger Oct. 8.

I once thought Vermont OneCare was a functional fox guarding the henhouse when Dartmouth-Hitchcock and UVM Medical Center created this for-profit administrative structure to prepay health care in Vermont to “keep folks healthy.”

However, now we know that the fox is IN the henhouse, as OneCare has become part of UVM Medical Center and will now prepay for medical care.

This bizarre turn of events, just like turning mental health care over to the police, is happening in Vermont, a state that prides itself on being forward-thinking with Yankee frugality. Vermont persists in low-wage jobs, half of folks unable to use their health care despite monthly payments, no benefits, and Social Security for retirement. But, we are going to prepay health care structures, full of non-health-care providers, to keep us “healthy.”

The poor ole doctors just discovered that people’s living situations, whether they have good food, and their domestic tranquility, affect their health. This miraculous discovery has of course been known by community nurses, social workers, mental health providers and midwives for hundreds of years, maybe thousands of years. The good Marcus Welby-type doctors used to understand this and used this obvious awareness in their health care choices.

Now, UVM Medical Center has created a Medicare Advantage plan. Medicare Advantage plans are making more money than ever. They have figured out how to do the billing and have achieved nationally over $500 billion yearly in profits from Medicare.

How much longer will the Medicare fund last as they dig in? Are U.S. seniors healthier, as was the mandate for insurers in the Medicare Advantage plan creation? No.

Over the past 25 years, Medicare Advantage plans have learned how to manipulate data. Any resemblance to Onecare? Prepaying doctors to keep us healthy, the new philosophy? The same. These monolithic U.S. structures, M.D.s, MBAs, hospitals, pharmaceuticals and health insurers will never give up their money. And the persistent increases in their bloated budgets. With threats of destroying other less lucrative health care specialties at their state budget regulator hearings.

It is time for us to debunk the myth that universal health care can be achieved in the U.S. without single-payer. None of our peer countries have achieved universal health care through a private, for-profit insurance system. Their universal health care is not eating 20%-plus of their gross national product and they have achieved health coverage for all.

This is a great time for the U.S. to institute this change, as with the new Jobs Program, these administrative folks can find work. M.D.s can be paid for their work, post the workweek, like everyone else.

I am quoting a Healthcare-NOW! Email dated Sept. 13: “In almost all of Europe, countries constitutionally guarantee their residents comprehensive and equitable access to health care. The vast majority, 29 out of 36 nations, do this through a public, single-payer system; the rest, including Germany and a couple of its neighbors, use quasi-public entities known as ‘sickness funds’ that act as mere administrators of this promise. Progressive, public financing is standard throughout the continent.”

We have seen how our current health care system has rationed health care through this pandemic. We have watched as current U.S. health care business practices have left health care workers, particularly nurses, so unsafe in providing patient care that they are retiring early, separating from nursing until a more rational system is created.

I have recently read commentaries wondering where home health care went. Primary nurse home health care was developing rapidly in the mid-1980s through the early 1990s. More nurses were graduating from bachelor’s degree nursing programs in which the last year of college is training in public health and home health care, including immunization clinics, care of STDs, AIDS patients, elders and RNs visiting homes of new babies/mothers post-birth, as well as special needs babies. Early intervention.

Primary nursing means that one nurse is your primary caregiver and in charge of co-creating your care plan with you, including referrals to relevant community services. Well, guess what happened as those M.D.s brought in those MBAs in the 1990s? We don’t want those nurses out there making decisions with their patients!

Then, truly nonprofit, community-controlled nursing organizations listened to their community needs and responded. Hospital-based MBAs with the M.D.s wanted the money and the control and wrestled it away with the politicians’ help.

Thus, home health became proscribed; you get one nurse visit for this diagnosis, four visits in four weeks for that diagnosis. And, what educated nurses wanted to be an automaton? Not many.

Laptop computers came to dominate the few visits allocated. Next visit by another who did not know you. No continuity.

Computer program with so many words but almost no meaningful data. Then, the politicians allowed home health and hospice home care to be delivered by for-profit agencies. What do you imagine happened then? Less pay, fewer benefits, less staff satisfaction, automaton visits and more administrative pay.

In New England, some of these nonprofit nursing agencies exist but most are tied to big hospital systems to “integrate care.” But, it was never about integrating care, so much as it was tied to the Big Boys getting control of all the health care funds in the community.

So, your hip replacement diagnosis will pay for three days of hospital stay after day of surgery. What do the hospitals do? They try to get you safely out after one or two days of hospital stay. Do your costs get reduced? Of course not, you silly! The docs and hospitals pocket the money. The latest movement of OneCare and Medicare Advantage by the UVM Medical Center will certainly cost more yet.

The U.S. health care players have worked tirelessly toward this current end. More and more money for the few, less and less care for the most. We have been bamboozled.

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