My Dad worked for 37 years at a job he loved. He worked at Boston City Hospital in the TB Control Department. His job was to do the intake and keep the records of all the outpatients being treated for active TB. If somebody failed to come in for scheduled treatment, he would alert the public health nurse who would go track the person down and bring them in for care. His department approached the public health crisis, which was swamping the nation, one patient at a time to save a city from an epidemic. Dad was proud of his work and the lives saved and the city that invested manpower and resources in the “general welfare” for the public health of the City of Boston.
It was toward the end of his career, his faith in healthcare was shattered. He watched helplessly as politicians declared the TB epidemic over, closed TB hospitals and merged departments under a larger Infectious Disease umbrella.
“We almost wiped it out. They stopped before it was completely gone. TB will be back. It’s too opportunistic to give it a chance to get away from us again,” Dad said to me after reading another chronic care hospital was closing.
Dad died shortly before it became evident TB was on the rise once again in the US and stronger than ever. Which means, Dad missed the total politicalization of healthcare. I’m glad he didn’t live to see the disgrace we have made of a once noble profession. Work where we worried about saving the world one life at a time.
Healthcare has become a system where decisions are made based on insurance type dictating care dispensed, the duty to die versus being a long term financial drain on a buckling system, and state legislatures and congress deciding what women and their doctors must discuss regarding their most personal care. Do no harm is very low on the decision tree for most providers these days.
The constant strain of doing more with less, generating revenue and cutting costs has shifted our collective focus from the person needing care and the professionals providing care to a bottom line mentality. Politicians and insurance companies are now standing between the ill and their caregivers. They have become the self appointed gatekeepers holding the purse strings.
Politicians and TV’s talking heads have stated as a matter of fact that fixing healthcare means cutting costs. For some reason, most of the public choose to believe this. The truth is closer to these being two separate problems which may be mutually exclusive. Fixing healthcare means getting people the care they need before they are in need of emergency treatment and educating/retaining enough professionals to fill the huge gaps we have in caregiver coverage. Cutting the cost of healthcare means getting serious about fraud, kickback schemes, rethinking for profit healthcare, and equitable prescription drug costs.
Each day the system seems to collapse another millimeter. We professionals grow more callous every time we see the darkness shrouding health squeeze the hope out of the next desperately ill patient on our ever growing list of treats to be seen in 8 hours. People have become IDC9’s and are dealt with in billable units greater than 8 minutes per HCPCS code.
It all sounds so terribly hopeless, doesn’t it? Most days, it feels that way too. But, the solution is really very simple. It is the approach my father and his colleagues used to wrestle the TB epidemic in the 1950’s. You treat one patient at a time, regardless of ability to pay, to arrest the spread of the disease and save your patient. This ensures the general welfare of the public and you save your city one life at a time.
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