Greed Threatens To Ruin Health Care
Sens. Bill Bradley, D-N.J., and Nancy Kassebaum, R-Kan., have introduced a remarkable bill in Congress.
Title of their would-be law is “The Newborns’ and Mothers’ Health Protection Act of 1995.” The bill could, perhaps, be described more accurately as the “Save Moms and Their Babies From Naked Greed Act.”
Before this nation rejected President Clinton’s efforts to reform the health care system, the average stay in a hospital for a woman who had just given birth was three days for a normal delivery and five days for a Caesarean section. But now that the job of cost-containment has been abandoned by government and doctors and has been left to the whims of the free market and the graduates of business schools, women and newborns are being shown the hospital door very quickly.
Some insurance companies and managedhealth-care organizations refuse to pay the cost of a hospital stay that exceeds one day. Three days in a hospital is seen by some bean counters as plenty if a mother has had her child via Caesarean section.
A few babies have died because doctors were pressured into booting moms out of hospital beds before the mothers were able to feed and take care of their newborns. Other children have suffered brain damage because infections and other conditions were missed due to the pressure to save money by making quick discharges a key element of obstetrical practice.
The Bradley/Kassebaum proposal insists that insurance companies let doctors keep new mothers hospitalized longer without penalty if they think it is medically necessary.
The senators are not alone in their concern that mothers and newborns are among the easiest targets of a health care industry that is becoming more and more obsessed with making a buck. New Jersey and Maryland have enacted versions of the Bradley/Kassebaum law, and a number of other states are considering similar legislation.
But the problem with such laws is that they do not address the core problem. The issue is not simply whether the effort to drive down costs is going to lead for-profit health care companies to make you, your wife or your daughter stagger out of the delivery room and recover from the trauma of birth in the hospital parking lot.
The way to balance the interests and welfare of patients against the economic considerations which are driving the organization and management of health care today is not by passing laws that protect particular groups of patients or mandate particular forms of treatment.
If your health maintenance organization or insurance company is told by the state or federal government that new mothers and their babies must have the right to stay in the hospital for more than a day, its drive to save money simply will lead management to turn elsewhere. If moms and babies cannot be tossed out the door, then why not those recovering from heart surgery, those recovering from a stroke or children requiring kidney dialysis or ventilator care?
Disease-specific or patient-specific protection is not the way to go; our medical system needs a more systematic way to protect patients against greed.
The decisions made by third-party payers about what to pay for and what to reimburse need to be more open to public scrutiny. Those who buy coverage and who must live within the limits companies set have the right to know from their health care providers exactly what those limits are and how to challenge them.
We must figure out how to get those holding the purse strings to be accountable for setting limits to what a doctor can order. If not, we are going to need many more laws to protect us when it is an M.B.A. rather than an M.D. who decides how much medical care is enough.
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The following fields overflowed: CREDIT = Art Caplan King Features Syndicate