Healthcare, a New Civil-Rights Movement?

By NT Contributor on Fri, Sep 07, 2012

patient on the wheelchair

What's the healthcare billing code for easing an old man's grief, or a healing connection? What's the billing code for holding someone's hand as they lie dying because they have no relatives or visitors?

Or maybe a better question would be, how much would you pay? What's it worth to you not to die alone or be heard rather than given a pill? Like pennies on a convenience store counter there for the taking, these healing acts of care are free.

In nursing care a patient was stoic and distant as he sat on the edge of the bed waiting for me to give him the bath I had promised an hour earlier. Quickly, I gathered my supplies and began by washing the old man's back. But suddenly, he burst out sobbing.

"Did I hurt you?" I asked concerned.

"No, no!" He ordered gruffly, "Go on now."

After several minutes of silence, he softly shared.

"I'm sorry. You see, my wife died 22 years ago and no one has touched my back since that day." In the longest bath I've ever given, he told me why she liked the rain and what she always planted in her garden — but it's nowhere in my charting.stethoscope on an American flag

Similarly, a good nurse I respect sat down and talked for 30 minutes to an elderly woman with high blood pressure. He listened to her story then counseled her to lose weight and take her meds. The current healthcare bill and financial structure is so lean that these most fundamental and humanistic interventions are now in peril — because there is no price tag.

Maybe it's time to look at our most fundamental premises in healthcare by following the money.

The U.S. spends twice as much for half the quality care of other industrialized countries and has poorer outcomes. Hundreds of millions of dollars were squandered lobbying for sacred cows in the 2010 federal healthcare reform law to protect vested interests (our health insurers cost us 20 cents on the dollar versus 3 cents in other countries).

Hospital leaders struggle to cut costs to protect their bottom line, while physicians and nurses try with inadequate time and resources to keep their patients from being one of the 22 who die on average every hour from preventable errors and infections.

Why? Because sick people are only profitable when there are enough of them and someone else pays the bill. "Well" people, on the other hand, generate little, if any, income. From a business perspective, the current structure is a conundrum: we need plenty of sick people to sustain a system supposedly dedicated to health.

It's time to acknowledge the elephant in the room and make a collective decision for the betterment of all society: Is health care a business, or public service? What should it be?

If it is only a business, then acknowledge the obvious: No business can give away its resources for free. There are no billing codes for easing grief or spending time with a patient so we give them a pill. Within the business model, all the free stuff will have to go away — as much of it has already.

If healthcare is a business, our best hope is to create a healthcare billing code for wellness so that hospital leaders can stop focusing on revenue from disease out of dire necessity and redirect their efforts to safety, quality and directions

Or perhaps, embedded in the chaos and polarity, passion is an opportunity. Maybe health care is the civil-rights movement of the 21st century. It certainly has the same emotional charge as pushing blacks to the back of the bus, or refusing the vote to women.

The poor don't deserve health care! Let them suffer! Though it is labeled as socialism by the "haves" and virtually unreachable by the "have-nots," we have found our next frontier: improving the wellness of America. And in that quest, maybe the services we give away for free are not worthless after all, but rather the harbingers of a healthier society where every citizen has the inalienable right to healthcare.


Anonymous 2 years ago

Today, it has been over a year since my DH had emergency surgery to clean out the mess left by work-related mesh hernia repairs years prior. Docs argue over whats next, but all agree this will plague him for the rest of his life, and need on-going care. MEANWHILE, providers from last year have yet to be paid. ALL involved insuring and L&I entities are arguing who pays. ALL providers are coming after the patient & family, demanding payment. ALL are finger pointing, and kicking this dog after he's already been kicked, even though they admit "of course this condition exists, we are sorry he's had to go through this, but, we cannot help the rules". THIS IS OUR MEDICAL INDUSTRY; THIS IS OUR INSURANCE INDUSTRY. WHERE is care? WHERE is relief? HOW can there be healing? The proof the planet is overpopulated, is in how people are treated: humans get treated badly when humans become too numerous; the first to suffer and die prematurely, are those who are poor or otherwise compromised. Life becomes cheap, easy to kick to the curb, when there are so many. THIS is what industrialized politics, services and "civilization" has brought us to.

Anonymous 2 years ago
Nurses have been pushed so hard to take on greater loads, preceded and followed by bean-counters telling us how many minutes it takes to give a shot, empty a bedpan, etc.
AS IF patients were identical cogs in wheels of industry.
They are NOT.
Neither are nurses.
Industry cannot force irregular, amorphous humans to fit one-size-fits-all parameters.
I curse today's industry methods, and hope they implode.
Industry trying to force humanity to become uniform cogs, has wrought havoc and untold suffering on humanity; it is a wonder that any cures or relief happen!
INDUSTRY CAUSED COSTS TO ESCALATE. Yes, I said it. Industry caused it's own problems with cost containment, which never existed before medicine became the industry we know today.

Anonymous 2 years ago
When I worked in home health-we had codes for everything we did based on the patient's diagnosis. This included any treatment that was given. To get paid by Medicare/Medicaid, we had to justify care. That was the first time I saw nursing care quantified. Hospital nursing is part of the room charge. That is part of the problem, we are to work miracles with a supposedly seamless 24/7 workforce and expectations are that the care be the same no matter who you plug and play into that scenario. Nursing care needs to be quantified just like medical care-based on time spent, diagnosis, and outcomes/evaluations. But you have to remember that the Medical model is based on illness rather than wellness-which is the nursing model. The two are always at odds on how to bridge the gap and you see who gets the most money. We have a great opportunity to use this reform act as a way to quantify and define what we do as nurses and by quantifying our work it will offer incentives to other nurses to increase their education and experience to more complex patient care-where the nurse is paid according to the patient acuity and the needs of the patient rather than a rolled in charge of shift time. There would be no refusal to take certain cases or do certain procedures. You would staff according to acuity of patients, not just by the number of patients in your unit shift by shift on a daily basis. And the training would be more relevant.

Anonymous 2 years ago
Nurses need healthcare too. The Boards are not protecting the Civil Rights and due process of many nurses. When nurses have a conviction outside the job and serve a sentence or preserve their parenting rights, the boards invoke double jeopardy. If time is done, don't take away the 'visible means of support' by being a second judge, jury and executioner and ask nurses to protect the rest of the world.

Anonymous 3 years ago
Government needs to stay out of healthcare, and out of the insurance business as much as possible. If they would allow the selling of insurance across state lines we would have more competition amongst insurance companies. Why did they forbid sales across state lines? All it did was make things worse. We need a free capitalist market, not a socialist one.

Anonymous 3 years ago
I am a nurse for 20 years now and i so agree with this article but we as nurses need to find a solution. The first place corporation cuts are, housekeeping, dietary, nurses , cna and doctors. I ask you how can you run a hospital without these people. We as nurses and doctors have not had an across the board raise since 2004. Research see how much CEO and such are making. You can;t cut the workers.

Anonymous 3 years ago
Math error in my previous comment, my NM makes sl over twice what I make, not 51%

Anonymous 3 years ago
I am a nurse for 10 years plus and have come to the conclusion that nursing care is not what is taught by nursing school(you cannot fit all that you were taught in a 12 hour plus day)nor do you get to use what you were taught. It is all about production; not about how much time and the quality of time that you spend with your patients. Remember, you are on the clock!!! It is all about statistics!!!

Anonymous 3 years ago
Nurse for 37 years, always Trauma care. My manager ( who would give verbal/written council for personal phone calls, using unit resources for personal business, etc) left their income tax stuff on the fax machine. I innocently picked it up and was shocked to see that NM made 51% more than me. This person is rabid about the budget. I am convinced there is either a threat or financial incentive (or both) to keep the costs way down. Meanwhile the patient load and acuity has become greater. There is more regulatory stuff than ever (I am all about safety but documenting every detail takes time). Nursing--the love of my life--has broken my heart.

Anonymous 3 years ago
No, health care is not "only" a business but neither is it a civil right. "Rights" are not an imposition upon another. As much as I enjoy being part of an emergency services team, if I can't provide for my family, I'm in another line of work. Notice that word "work". It imjplies that I'[m providing a service that I'm being paid for. It also implies that the service provider is earning an income, supposedly at the will of the consumer making a choice via the free market. Unfortunately government regulations imposed on both the consumer and the provider have so fouled the doctor patient relationship that "health care" as we know it is in danger of following the mistakes of socialism in to the trash bins of history. Health care providers are generally highly motivated people, attracting the best and brightest. They are compensated in kind. Remove that reward and you remove the insentive for the sacrifice. Applied socialism simply does not work. Make no mistake, calling health care a "right" is socialism by another name, with the same unfortunate result.

Anonymous 3 years ago
Cold, hard facts! The vast majority of healthcare is a business. There are a few "non-profit" providers out there, but even they must operate in the black. But the dedicated healthcare businesses are there for one thing....PROFIT. With increasing government regulations, which generally cost $$$ to implement, these companies will often make that profit on the backs of their employees and Patients. It's sad. I have been a nurse since 1992. If given the choice again with the knowledge I have now I would not make the same choice. I so look forward to the day I can retire (2017), until then I will just do the best I can for those under my care

Anonymous 3 years ago
Health care is both a business and a public service. As much as we don't like to put a monetary value to healthcare, the people who provide the services don't work for free, the facilities where care is provided cost money to build/lease and maintain, among other costs of providing any kind of service to people. Unfortunately, the people who make the business decisions often have not been at the bedside level of care in many years, if they even have a healthcare background at all. The average patient is now sicker and has more health issues than 20 years ago, yet what is covered by Medicare, Medicaid and private insurance decreases every year. It is easy for a new nurse to be overwhelmed and conflicted between wanting to provide the best care, or please her peers and supervisors by providing the fastest care so that she can take on even more work. This leads to nurses becoming jaded, cynical and unengaged with their patients.Can we put a price tag on every little action we perform? Not according to insurance companies - nursing services are lumped into the "room charge". So you see, the business side and service side of healthcare go hand in hand. You cannot have one without the other, as much as we don't like to think of money when providing care and services.

Anonymous 3 years ago
Excellent article. I would like to see a more about potential solutions. I may have to check ou the books.

Anonymous 3 years ago
I have no health insurance. I make too much money to qualify for programs. I can't afford to pay cash to see a doctor. I will surely die because I don't have health insurance.

Anonymous 3 years ago

Anonymous 3 years ago
Well said! I am a nurse now employed in the health insurance business. As a case manager I can counsel patients to take better care of themselves, but it gets more difficult everyday when their benefits become so expensive, they are unable to afford the things that will help with their health care needs. It should not be a business. Healthcare has lost its focus.

Anonymous 3 years ago
I've been an RN for over 25 years. When in the last few years, we were ordered to call patients customers, the writing was on the wall.
Older nurses cannot find new postions. We're too experienced and expensive.
Administrators are making 7 figures.
I will not go to a hospital. I have no health care insurance. Within the next 30 days, I will achieve my new license as a Massage Therapist. I can determine how much time to spend with a "client", and what is needed. I won't be spending my time with useless documentation that will be meaningless in 30 years.
However, I will be spending time with people, soothing backs, listening, and giving comfort. I remember when this was a nursing function.
Happy to take a pay cut to do what I do best.

Anonymous 3 years ago
Most of the ursing jobs that I have had in my 37 yearsof nursing-- all boils down to upper mangement making their money to heck with the nurse who are over whelmed with patient load and trying to do their best to care for their patients---I have been in situations where your lucky to see your patients at least one time a shift-and the way they teach now paper work is more important than good patient care

Anonymous 3 years ago
I am an R.N. and have had to leave the profession for a while to recover from the stress of not being able to do all the things that being a nurse require. As a ambulatory surgery center nurse, I was just able to keep my patients safely cared for in "disaster nursing" mode. I could not sit and talk with a patient about what they could do to stay healthy (dietary changes, what exercise they could safely do for their condition, importance of hydration and not smoking--the list goes on and on). Plus the "nurse to Nurse hostility" was very much alive and well. When I tried to be a nurse instead of a vital signs taking/medication pushing robot: I was labeled "Lazy, slow and not a team player" by my colleagues. Plus you better demonstrate that you know how and when to wash your hands to the "clandestine hand washing monitor" or you will be labeled a "bad Nurse"

Anonymous 3 years ago
This is an excellent description of what is wrong with our health care system. I wish I could have said this as well. With our pay for service model, we have totally lost our bearings as healers, and our patients suffer as a result. Too many mistakes, misunderstandings, stressful situations arise due to lack of time and attention to those things that would bring humanity to our practices.

Anonymous 3 years ago
nice one