A few decades ago, hospitals were primarily thought of as religious or secular, community, humanitarian institutions governed by benevolent organizations and local boards. Physicians were looked upon as members of a caring profession.
Now both are often viewed as crass, financial gouging, "providers," caring little for patients in the pursuit of the bottom line. Daily, numerous government officials, pundits and "reformers" opine what must be done to restore these providers' caring quality and control spiraling health-care costs. The health-care weather has changed. What happened? Who is to blame? How can we fix it?
Recently the media featured a CMS-released Medicare study on the variations in costs among hospitals to treat certain conditions, inferring price gouging on the part of some providers. Most of these hospitals' boards are controlled by local neighbors. Did they just sit back and let the gouging happen? Doubtful.
Numerous articles instruct physicians they must become more "patient-centered," "family-centered," "integrative" and change patient behavior by "motivational interviewing" as opposed to alleged "scolding." Do most individuals' personal physicians scold them? Doubtful.
My favorite recent admonition reported by Healthwatch blog notes that in a Brookings Institution study "a 'bevy' of health-care 'authorities,' including former Senate Majority Leader Tom Daschle, D-S.D., former HHS Secretary Michael Leavitt, and former White House budget directors Alice Rivlin and Peter Orszag, 'released recommendations ... for cost-conscious reforms to Medicare, Medicaid and private insurance they said could save $1 trillion over two decades' and for 'Washington to embrace small, consensus-driven policy moves to lower health-care costs.' "
Daschle recently has led other Washington groups that often opine as to what new government controls and programs are necessary to realize true health reform. The irony is that Daschle -- as outlined in his book Critical: What We Can Do About The Health-Care Crisis -- was the primary architect of the 2,000-plus-page Affordable Care Act. If this legislative tome, fully embracing Daschle's recommendations, is not able to get the job done, why should we consider his new admonitions?
Perhaps we are looking for solutions in the wrong place and seeking them from the wrong people. Perhaps many of the "solutions" offered by these folks are little more than efforts to clean up the unintended consequences" of past messes many of their policies and programs have created. As best said by Ruby in the movie "Cold Mountain," "They call this war a cloud over the land. But they made the weather and then they stand in the rain and say, s---, it's raining."
Tinkering centrally with the financing and insurance coverage aspects of health care will not restore the caring quality of our local institutions and health practitioners. That will only occur when local community leaders, patients, practitioners and institution come together, reclaim system ownership, hold each other accountable and create the weather.
Felsen, of Great Cacapon, is a retired public health physician.