Why hospitals and patients are sick

Imagine going to the hospital for an operation and being told the surgery was canceled and you need to reschedule.

With many hospitals in deep financial trouble, there is a good chance of such a postponement, often due to the lack of a piece of equipment for an orthopedic procedure or some other necessary device. Many hospitals are over-extended and in debt to the companies that equip and supply them, which will provide the materials only after they receive payment from the hospital.

In New York state, as elsewhere, the hospital business represents a very large section of the economy. And the hospital industry here owes $15 billion in outstanding long-term debt. (New York Times, April 11) Many of the most prestigious teaching hospitals in Manhattan, like Mt. Sinai and St. Vincent’s, as well as nearby Westchester Medical Center, have been operating in the red over the past five years, to the point of “hemorrhaging money.”

In the past 15 years, 20,000 beds have been lost in the state. A dozen hospitals have closed over the past two years and another dozen are at risk.

In this period many technological advances have impacted on health care, from new drugs to treat infections to laser equipment that allows smaller surgical inci sions so people can go home shortly after surgery. In the 1990s a new class of anti-viral drugs was produced, making it possible for thousands of people with HIV-AIDS to be treated in outpatient clinics rather then spending weeks in the hospital. All these changes decreased the need and length of stay for thousands of patients.

Several factors contribute to the present crisis. Health maintenance organizations (HMOs), which are turning enormous profits, have taken the hospitals to the cleaners by negotiating rates that do not cover the actual cost for procedures and hospital admissions. They have also pressured hospitals to shorten the time they keep patients.

Another cause for lost revenues is that millions of people have no health insurance. Their only access to health care is to go to emergency rooms. If they have serious conditions, they may require admission to a hospital.

In 1997 New York Gov. George Pataki got rid of price-setting laws that protected the hospitals. The rise in managed care organizations squeezed the hospitals nationally. New York, already in debt, was harder hit than other parts of the country.

Kenneth E. Raske, president of the Greater New York Hospital Association, says: ”These HMOs have eaten the hospitals’ lunch. They have made obscene profits by strip-mining communities.”

In the 1990s a “medical arms race” began in New York with hospitals rushing to get in on high-profit businesses. They began opening cardiac centers, orthopedic surgery centers and cancer centers. With many institutions vying for patients, there was often saturation of the market—
capitalist overproduction—and these pro jects then lost money. The state had some respon sibility because it approved the projects.

Perhaps one of the biggest changes to affect the national health-care system is in federal aid policies.

The federal government has spent billions of dollars on the invasion and occupation of Iraq—at the expense of the people in the U.S. There have been draconian cuts in Medicare, Medicaid, Aid to Families with Dependent Children, food stamps, family planning, pre-natal care and Ryan White funds. Those hardest hit are poor and working people in the oppressed communities. Meanwhile the U.S. government is spending $10 million per hour for the wars in Iraq and Afghanistan.

This money brings death and destruction to the people of Iraq and to the U.S. troops, who are into extended terms of duty. Since the first Gulf War, GIs have been complaining about a variety of illness called Gulf Syndrome. In the second Iraq war the troops have had extended exposure to depleted uranium and are coming back with multiple health problems. The federal government is nevertheless closing down Veterans Administration hospitals, even though some returning veterans have to wait up to a year to be seen.

Need for universal health care

A Hatian boy is examined by by Magdalena Mauri Gomez, one of more than 500 Cuban health care professionals serving in Haiti.

All this amounts to an urgent need for a universal health-care system that plans for people’s needs, not corporate greed and profits. A system that provides free, quality health care to all the people—disabled, seniors, immigrants, people of color, infants and children, straight or gay—from the cradle to the grave. A system based on socialist planning.

Such a national health program would provide health care to all sectors of the country, urban and rural. It would train a variety of health care providers at government expense so there would be enough health workers to take care of the people.

Cuba has a socialist health-care system that meets the basic needs of all the people even though it was developed with limited resources—a consequence of the 45-year-old U.S. blockade. In fact, the Cuban system is world-famous for having radically reduced infant mortality and for producing new vaccines for meningitis and hepatitis before any other country. Pre sently the Cubans are working on developing vaccines for cancer and HIV-AIDS.

The small island of Cuba has provided thousands of doctors and nurses to countries hit by natural disasters and has helped develop health care programs in many countries in Latin America and Africa. The Cuban example in the health-care field is an example for the world today.

Eolis is a nurse practitioner in New York City.