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Sunday, August 25, 1996

Proposition 216 protects public from profiteeringBy Carl Bloice

In the summer of 1994, Columbia/HCA, the giant for-profit hospital chain, acquired the only hospital in the small barrier island community of Destin, Fla. and soon thereafter closed it down. When, on Oct. 4, Hurricane Opal struck with 115 mile-per-hour winds, waves as high as 15 feet fell across the highway linking the town to the Florida Panhandle. Destin was isolated from the nearest functioning hospital at Fort Walton Beach, 43 miles away on the mainland.

The activities of the largest hospital networks and for-profit chains have meant continuing market monopolization efforts and consequent closures of facilities throughout the country.

Ask the people of Westlake Village, a community only a stone's throw from the UCLA campus. For them the consequence of Columbia/HCA's 1995 acquisition and subsequent unloading of their community's hospital has been that as of July 3, the emergency room upon which they had previously relied is no longer.

The closure of public health facilities is only one aspect of the sea change currently under way in the field of health care. Once a field pretty much run by medical personnel, health care is now an "industry." Care has been transformed into a commodity sold for the purpose of maximizing profits.

Those profiting in the current atmosphere say they are acting to reduce costs and improve care. In fact, they are redefining the nature of health care, finding ways to ration it and undermining professional provider standards. A two-tier system of health care delivery is emerging that reinforces our society's growing income disparity.

When the giant insurance firm Aetna Life and Casualty Co. announced it was acquiring the health maintenance organization (HMO) U.S. Healthcare, Inc., the Los Angeles Times called the deal "an early signal of widespread changes" in the way health care is delivered in the country. The New York Times said it offered "A glimpse into the future."

How one reacts to this prognosis depends on one's vantage point. For U.S. Healthcare Chair Leonard Abramson, a by-product of the merger with Aetna will be a windfall reward of $1 billion, a $25 million jet and a $2 million allowance for fuel and maintenance. In 1995, Columbia/HCA's outgoing chair, R. Clayton McWorther's earnings were $54,416 ­ a day. That's $113.37 a minute.

This in a industry allegedly in a desperate drive to "cut costs." This in an industry in which a child born in the morning can be home with her or his mother in time for the evening news and out-patient mastectomies are now quite common. This in an industry in which people are routinely being denied treatment or continued hospitalization upon the determination of HMO operative with no medical training.

From the vantage point of the health care consumer and those charged with caring for them, the future of health care can be a frightening specter. Registered nurses and other caregivers are witnessing a dangerous assault on the quality of the care. From reductions in the ratio of nurses to patients at the bedside, to drive-through surgeries, to care decisions made by non-medical personnel, to the closure of emergency facilities, health care delivery in most of our communities is being altered drastically. And not for the better.

These changes are not restricted to institutions operating for profit. The pressures of "market forces" are being cited to justify the restructurings under way at facilities like the UCLA Medical Center. They are used in an attempt to justify what is, in effect, a decision by the University of California Board of Regents to privatize all of the university system's medical centers.

Health care deliverers and consumers across the country have recognized for some time that something must be done to protect their professional standards and the care afforded patients. In state after state, legislative proposals are being advanced with the aim of protecting patient care. They involve various means of regulating care delivery and restraining the reckless activities of the modern equivalents of the robber barons of old.

In California, the state where the direction of current changes in health care are the most obvious, the most far-reaching, a comprehensive approach to the challenge has emerged from the nursing community. This spring 813,000 Californians signed petitions to place the Patient Protection Act on the November ballot. Proposition 216 is jointly sponsored by the California Nurses Association and consumer advocate Harvey Rosenfield and was drawn up in cooperation with Ralph Nader.

Proposition 216 addresses a number of problems raised by the growth of the managed care system and the practices of health maintenance organizations and for-profit hospital chains. It directly addresses the calamity that has unfolded in Westlake Village.

The central premises of Proposition 216 are timely and crucial. First, decisions as regards treatment, referrals to specialists and medications must be made by competent, trained and licensed health care providers. Second, the coming of managed care, the spread of HMOs and the growth massive hospital systems dictate the need for government regulation and citizen oversight. Three, those masterminding the current wave of mergers and acquisitions which result in market monopolization, consolidation of facilities and the closure of hospitals, clinics, trauma centers and emergency rooms owe it to the communities affected to contribute to the maintenance of essential public health services.

Proposition 216 would establish a fund to guarantee the maintenance of community health services, including trauma centers and emergency rooms and guarantee greater access to health care for the ever-growing number of people rendered uninsured by changes in the employment or affected by looming Medicare and MediCal cuts. Some misleading criticism has been directed at this provision, characterizing it is a "tax." In fact, the enforcement of this aspect of the act will cost taxpayers nothing. Instead, the responsibility is placed on the big players in monopoly health care to make some restitution for any curtailment of health care services resulting from their activities.

Proposition 216 also contains a provision setting up a self-financing citizens' watchdog agency to facilitate public oversight of the health care delivery system.

The nurses, physicians, consumer activists, labor unions, community health groups and senior organizations backing Proposition 216 are well aware that the campaign for its passage is going to be an uphill battle. Just by placing the question on the ballot has ready raised the level of the debate in the state and the country over the future of health care.

Carl Bloice is the editor of the California Nurse, a publication of the California Nurses Association.