DOCTORS ' LOUNGE
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The horror stories of patients left on toilets for hours , or lying in bed with unchanged loaded diapers abound . In one nursing home in Florida , a patient died from a feces-contaminated decubitus ulcer . 10 When the family was understandably unhappy and hired a lawyer to determine accountability , they encountered a nightmare corporate structure . One company owned the building , another company obtained the license to run a nursing home , another company provided professional staff and another the custodial staff . The owners and managers had spread control among 15 companies and five layers of firms .
A large dermatology practice in California purchased by a private equity company produced a disturbing lesson in corporate governance . 7 The practice ’ s “ nonclinical ” assets were bought by the private equity company , leaving the physicians in control of all medical decisions after agreeing to pay a management fee to handle administrative tasks such as billing and marketing . The new management team established daily and monthly financial goals , rewarding the offices meeting the goals with cash rewards . The performance of revenue enhancing procedures , Botox , laser treatments and Mohs surgery , for instance , was encouraged . Private equity groups buy existing labs and hire pathologists . The doctors are encouraged to send biopsy specimens to company owned labs and pathologists . Corporate approval was necessary to get office supplies , even toilet paper . Without consulting the medical staff , a manager changed to a cheaper brand of sutures and needles . The quality was so poor that needles would break off during injection and physicians had
to dig them out of the skin and repeat the injection .
These are just a few examples of the litany of conflicts of interest between the goal of providing good patient care and the goal of feeding the investors ’ profit demands . Sadly , we are left with the unanswered fundamental question of whether health care in the US is a commodity , to be exploited by for-profit companies and private equity investors , or is it an essential public service and a government responsibility . The rest of the first world knows the right answer .
REFERENCES
1
www . healthinsurance . org / definitions
2
healthcare . gov / health-care-law-protections
3
New York Times , Business Section , June 9 , 2019
4
cnn . com / 2015 / 09 / 28 / health / us-pays-more-for-drugs
5
New York Times , Sunday Review , November 17 , 2019
6
Am J Med 2009 , 122:741-6
7 www . bloomberg . com / news / features / 2020-05-20 / private-equity-is-ruining health-care-covid-is-making-it -worse
8 pe-insights . com / news / 2020 / 05 / 21 / hoe-private-equity-is-ruining-american-health-care /
9
New York Times , Sunday , September 6 , 2020
10 www . nytimes . com / 2007 / 09 / 23 / business / 23nursing . html
This article was based on a number of radio programs on health care issues that were discussed on Single Payer Radio on Forward Radio WFMP-LP 106.5 FM . These programs are archived and can be listened to as podcasts by logging onto forwardradio . org-programs-single payer radio . Dr . Flynn is a retired surgical oncologist .
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