Tuesday, March 23 marked the two-year anniversary of the passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) and the largest transfer of power from Congress to the Administration in the history of this nation. As the Supreme Court hears arguments about PPACA on Constitutional grounds - the individual mandate, in particular - let's not be lulled into thinking its broader assumptions and provisions are otherwise innocuous or valid. Setting aside the need to address legitimate reform, including egregious problems with pre-existing condition rules on the insurance side, there's the bigger problem of healthcare delivery and the fundamental safety of this sector of the industry.
In his March 23, 2012, "Opinionator" column for the New York Times, Dr. Ezekiel Emanuel, previously a CMS official closely tied to the White House, proudly points to the accomplishment of PPACA and suggests that even if the individual mandate is struck down, we're all better off because of PPACA. His analysis reflects an arrogance and blind faith in the power of the State.
Dr. Emanuel is very familiar with PPACA; he was frequently called upon to help craft the legislation by the Senate Finance Committee, in particular guiding language related to Accountable Care Organizations (ACOs) and Comparative Effectiveness Research (CER). He is a physician by training and his economic views, widely critiqued, emphasize making societal choices reflecting the utilitarian philosophy of John Stuart Mill... the greatest good for the greatest number. In this thinking, investments in public health benefitting society as a whole are better than investments that benefit individuals, especially late in life.
Aside from his philosophy, he applauds PPACA's Partnership for Patients "aimed at reducing hospital-acquired infections, errors and other preventable complications" for a mere $500 million. He goes on to note correctly that "the act also requires Medicare to begin posting online each hospital's rate of certain medical errors and infections, and to cut payments to hospitals with the highest rates."
As a result of the law, he points out that "hospitals across the country are working to reduce preventable hospital errors." Now that PPACA has made clear this is a priority, "significant progress can be made." He also notes that his current employer, the Hospital of the University of Pennsylvania, actually started to "pay attention to reducing preventable errors"... just a few years before PPACA was passed.
Now isn't that interesting?
Why is it that federal cash incentives are required to make it clear to healthcare delivery organizations that washing hands, giving the right medication, and operating on the correct side of the body is "a priority"? If "tens of thousands of Americans die" because of these simple-to-fix issues, just what more important priorities are distracting our hospitals? And if their priorities are so misaligned with common sense, why does it require cash payments to make the point?
When the auto industry cranks out defective cars that kill people, does the department of transportation start a multi-million dollar Partnership for Drivers program that pays manufacturers to fix the problem? Since when is it the job of the taxpayer to pay hospitals to fix the mistakes that they can't otherwise find time to pay attention to?
More than that, why was legislation needed to "authorize" taking action on this problem at all? CMS is responsible for oversight of the quality of the services provided with its money (our tax dollars) to participants, so why didn't CMS take administrative action on the issue - to stop paying for HAIs medication errors, etc., a long time ago? It's entirely within the mandate of CMS to do so. We didn't need to pass a 2700-page law to ensure hospitals would be safe. Where is the public outrage?
And finally, why is it that "tens of thousands of Americans die because of hospital-acquired infections every year, and far more are harmed by medical errors", and we haven't heard about the Congressional hearings that grill healthcare executives about why such issues haven't been a priority? Where are the multi-million dollar fines, the threats of congressional action, the public outrage?
In the 2010 Toyota brake recall, 37 people were alleged to have lost their lives, and the Congressional debate was intense. Between HHS, CMS, the Surgeon General, and Congress, why isn't someone paying attention? And don't tell me we needed 2700+ pages of legislation and a trillion dollars to fix it. We didn't and we don't.
How Dr. Emanuel and others think it is the responsibility of the taxpayer to pay for industry errors is beyond comprehension. If this was a pharmaceutical error, or medical device error, my guess is that the CEO of the offending companies would be hauled before Congress and affected families and patients would be called to testify against them - just like Congress did with Toyota.
Aha! Maybe that's it. Maybe the issue is that these hospitals have a designation of "not-for-profit." So in some people's distorted view of the world, maybe they can do no wrong, and for-profit business enterprises can do no right. If this line of thinking is out there, then no amount of regulation will make us safe.