Mis-Managed Care

U.S. soldier near entrance to Walter Reed Army Medical Center, Washington, D.C.
AP Photo
This commentary was written by CBSNews.com's Dick Meyer.

The conditions at some of the veterans hospitals where Iraq war vets are being treated reveal a combination of hypocrisy and injustice that cannot summon enough outrage.

But …

But it is important to remember two things amidst the outrage. First, as with the rest of the American health care system, doctors, nurses and health workers get blamed for the faults of bureaucrats, profiteers, politicians and voters. Second, many Americans receive terrible health care — and many Americans receive none.

"The hospital has got a bad rap, and that angers me, because I know my son would not be alive today without them," Bonnie Whitehead told a Pentagon review board this week. Whitehead's son stepped on a bomb last December in Baghdad and lost parts of both legs and both arms. "He is alive, and thank God that they were here for him."

Her son Luke is alive because of military doctors and nurses. The bulk of the complaints about Walter Reed and the VA hospitals are about facilities, systems, bureaucracy, waits, information and red tape — not the actual care. The healers are indeed getting a bad rap.

That is true in civilian life as well. Doctors are constrained by the mess we blandly refer to as "the health care system." The grand conceit of medicine today was a terrible idea introduced into about 20 years ago: managed care. At a time when the nation - and the nation's big companies - were first freaking out about the growing cost of health care, some geniuses peddled the idea that you could actually save the system money by introducing a whole new layer of management and cost-benefit analysis. These managers of care were going to be so smart that they would save everyone gobs of money even though they would be getting gobs of money.

Well, it didn't quite work out that way. Managed care is simply one more constraint, layer of bureaucracy and hassle for doctors and patients, but especially doctors. On top of the risk malpractice litigation, insurance reimbursements, the red tape of Medicare and Medicaid, and the human toll of a life-and-death job, comes managed care.

Yet we patients ultimately hold the doctors responsible in our own minds. We expect doctors to be perfect (drug companies, too); and we sue when there are bad outcomes. We don't expect lawyers, investment bankers, police, journalists and engineers to be perfect. Yes, the stakes are high in medicine. But human perfection and the ability to control fate do not exist.

We also retain a myth that all doctors are rich. But unless they're plastic surgeons in a big city or true superstars, they aren't doing nearly as well as they were 20 or 30 years ago — before managed care. From 1995 to 2003, doctors' incomes, adjusted for inflation, declined 7 percent.

As for the nurses, all you need to know is that there is a shortage because the pay is so low and the conditions so stressful. The average master nurse with three years or more experience makes $59,600 — with overtime pay.

Like the soldiers at Walter Reed, most of our bad experiences — not all, obviously — come at the hands of The System. Insurance hassles that seem to be intentionally designed to drive you nuts so you don't fight for your rights and money. Endless runarounds from HMOs, PPOs and various other evil Os. Rude treatment from underpaid clerks who deal with stressed, grouchy patients and the most horrible bureaucracies on the planet. Many of the complaints that came about after the Washington Post's reporting on Walter Reed were about how soldiers had no help navigating the bureaucracy. Who can't relate to that?

We also ought to be thinking of the Americans who have no access to health care, who have no insurance or who are in circumstances where they can get only the worst and most minimal care. It is hard to think of anything as contemptible as sending a young person to war and then not providing proper, humane medical care.

But not giving poor people or uninsured working people medical care at all is hardly something to be proud of in this rich country. We are constantly warned that we Americans are spending too big a slice of our national treasure on health care. Well, where would that money be better spent? CEOs' pay? Reality television? Designer jeans? Time shares in Pompano Springs?

Because of the politics, chances are pretty good that the problems at veterans hospitals will be aggressively addressed. No one would say that about the civilian health care system.

Dick Meyer, editorial director of CBSNews.com, is based in Washington.

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By Dick Meyer