Sunday, December 13, 2009

Rick Scott, For-Profit Medicine, and the Health Care Debate.

It's a damn shame the current administration isn't hearing and disseminating more stories like this one:

I think most people would describe me as soft-spoken, mild-mannered, hardly the kind of person you'd find expressing frustration by shouting at a speaker at a town hall meeting.

Yet there have been times this year - especially this time of the year, as I inevitably think about losing my father - when I have imagined being in such a situation.

Only in this case, the person in front of the crowd isn't a politician. It's Rick Scott, a businessman in the middle of the health-care debate. And in this case, the crowd is made up entirely of people like me who in the 1990s had questions about the care a loved one received at one of Scott's hospitals.

People whose questions only grew when they later learned about the greed and misdeeds that led to the nation's biggest health-care scandal. People who were dismayed when Scott emerged from the mess with a $10 million severance package and $300 million in stock. People who can't believe he has returned in such a big way.

People like me.

Scott, who rebounded and founded Jacksonville-based Solantic in 2001, has been in front of the cameras and behind the scenes a lot this year. He put up $5 million of his own money to start a group he dubbed Conservatives for Patients' Rights. He appeared at a Tea Party in Jacksonville. He put together a documentary with horror stories from other countries. He went on cable news shows, saying that government-run health care in other countries kills people.

And people have heard his message and responded.

I certainly understand the distrust of government, the qualms about whether increasing its role in something as complex as health care actually will help, or will only mess it up more. I get that.

I don't trust big government either. But I also don't trust Rick Scott. And because of his past, I have qualms about his for-profit, free-market visions for the future.

I know there are people in this town who do trust and respect Scott. I know my vision on this is clouded by emotion. I readily admit that. Because in the past decade, I have come to link Rick Scott to my father's death.

In 1996, shortly after I moved from Florida to Kentucky, my parents came to visit for Thanksgiving. On the way back to Wisconsin, they were in a car accident and my dad ended up in a Kentucky hospital. He spent several days there, was released and returned home. He was back at work, at the hospital where he was the chaplain, when he collapsed and died.

After the autopsy revealed a massive infection, several of his friends - including doctors and administrators at his hospital - told us they believed he should have still been alive, that the infection was the result of a procedure they believed never should have been done. One doctor told my mom he would gladly testify if we wanted to sue.

We didn't even think about that. Even when doctors and nurses do everything possible, people die in hospitals every day. And even though my dad, not one to complain, had done so repeatedly during this hospital stay, I wrote that off. So he felt like the nursing staff seemed distracted or overwhelmed? And an emergency call button didn't work? And, in many ways, he felt like the care was inferior to hospitals where he had worked or been a patient?

I figured these were exaggerations, signs of frustration by being stuck there near the holidays. It wasn't until the following spring that I began to think more about his complaints and his co-workers' comments.

That's when the FBI began a series of raids, seizing records from more than two dozen Columbia/HCA facilities across the country. That's when I realized that the hospital in Kentucky was part of this health-care provider, the largest in the world at the time and a 1990s darling of Wall Street.

That's when details of fraud and questionable leadership began to emerge.

Shortly after the feds swooped in, the company's board pushed out the chairman and CEO, Rick Scott.

The company eventually pleaded guilty to routinely turning in inflated Medicare bills for reimbursement and giving kickbacks to doctors who steered patients to its hospitals. The company also paid a record-setting tally of fines: $1.7 billion.

Scott never was charged with any crimes. He took his golden parachute and landed smack dab back in the middle of the health-care debate. But today it's not so much the illegal actions that took place in his hospitals in 1990s that most concern me. It's the legal ones.

Maggie Mahar, the author of "Money-Driven Medicine: The Real Reason Healthcare Costs So Much," has written extensively about Scott and the Columbia/HCA scandal. And of all the details she includes, this one jumps out at me:

Internal hospital records would later show that hospital executives were paid enormous bonuses, not for reducing infections or lowering mortality rates, but for meeting financial targets such as "growth in admissions and surgery cases."

This, in a nutshell, is what concerns me about for-profit medicine. And makes me wonder about Conservatives for Patients' Rights. Is the priority really the patient's interests? Or is it the profit margin?

Or, as Scott argues, do patients and profits go hand-in-hand, with the free market producing the best possible health care?

I miss my dad horribly, especially at this time of the year. And I know that for me to blame Scott for what happened 13 years ago is an unfair connecting of the dots, although no moreso than some of those made on the elaborate chalkboard drawings of Glenn Beck.

Still, I think it is fair to be leery not only of the government but of someone who built and oversaw a hospital chain that defrauded the government of hundreds of millions of dollars.

Mike Snow, president and CEO of Wellmont Health System in Kingsport, Tenn., recently wrote a story titled "When ethics fail" for Modern Healthcare magazine.

Snow, a former Columbia/HCA executive, began by describing the scene at an annual meeting in Washington on the night of March 19, 1997. Scott took the stage and said that earlier that day the FBI had raided their offices in El Paso. He defiantly reassured Snow and others in the room that everything was fine.

"At the end of Mr. Scott's impassioned remarks, I jumped to my feet alongside my fellow executives as our applause filled the room," Snow wrote. "Like so many others that night, I drank the Kool-Aid."

A decade later, Scott is back on stage, giving impassioned speeches, bringing people to their feet, offering a cup of antidote to the plans he says will kill people.

Forgive me if I pass.

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Blogger professor cz said...

It’s not about Greed

There are between 7 and 14 articles and blogs a day all identifying the crisis of 2008, CEO behavior and bankers bonuses as all about greed. We are quickly moving towards an accusatory cultural position that if one gets too much (a relative term) then one is filled with greed. It is similar to the diagnosis of narcissism that has been grossly misused and misapplied. Misused to the degree where if one is selfish or lacks empathy or takes more, one is called a narcissist. This places the accuser in the position of blaming those who have more and fails to understand what motivates them to engage in this behavior.
What brought about the banking crisis in America was not about greed, it was about the pathological need to increase one’s status. Studies have demonstrated that high levels of testosterone do not necessarily lead to a macho man hell bent on being aggressively consumptive but a man excessively focused on status, filled with envy, and an overwhelming desire to have what the other guy has. Consider this: At a “gin and tonic” party at a mansion of a successful banker an attendee reported the following. “After I got my drink our host led us to his greenhouse and showed his magnificent collection of valuable and delicate orchids. It was his hobby and he would travel the world collecting rare and exotic plants. Upon return to the house I could not help but notice two sets of women; an old or original group of wives at one end of the large room and a group of trophy wives at the other end, nervously eyeing each other.” What drives these men to engage in one-upmanship is not greed — but one-up-man ship status. They see their colleagues with a more expensive car, they start thinking about getting a one, they see a colleague with a jet and they have to have one too, they see a colleague with a beauty and they want one. Houses, cars, wives, art, orchids, watches, office, etc.; these are status symbols and for these men they are exceedingly important. They become a measure of their self worth. The parties, the country club, the university club, the yacht club, and the workplace are all places where executives parade their stuff. Many suggest this is nothing more than narcissistic characters impressing others to obtain love. But this may not be the case. They live and work within a culture that is status driven and issues of exclusion and inclusion are associated with the attainment of status. In this culture those who have more create envy and they aggressively engage in the struggle for ever higher status. The “my d--k is bigger than yours,” is ever present. The truth of the matter is underneath they believe they will always an inadequate d--k.

December 19, 2009 at 2:38 PM  
Blogger L A Neumann said...

Quite a post, Professor. You and I could engage in a discussion on the subtle differences between greed and status, gender issues and dick size (yes, dick is more than acceptable on this blog) but still, as I see it, it comes down to this:

Our government failed to employ adequate regulation to both medical industry and Wall Street. The "capitalistic" forces that destroyed our economy turn out to believe in socialism so long as the funds flow their way (without strings).

And the same forces have destroyed any idea of patients' rights to the extent that the most logical, inexpensive, efficient way to provide health care to the entire country wasn't even considered in this attempt at health care reform.

Thanks for stopping by. Ann

December 19, 2009 at 5:15 PM  

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