Metro District of Columbia is saddled with an Emergency Medical Service that is “plagued by…continuous, unnecessary loss of life.” To fix this problem, the District hired someone from outside to reform the department.
After seven months at her new job, Juliet Saussy quit and released her four-page resignation letter on Scribd.com. Whether you live within the Beltway, in Boise, Idaho, or Bend, Oregon, you should be worried, very worried.
What Saussy wrote about D.C. EMS is equally true in your area. Indeed, what she described is what ails all of American healthcare.
(AP/Omaha World-Herald, Ryan Soderlin)
You really should read her letter in its entirety, as my isolated quotes cannot do Ms. Saussy justice.
What's Wrong With EMS Is Worse In Healthcare
“… highly toxic [culture] to the delivery of any semblance of quality pre-hospital patient care.”
Every hospital has a sign at the front door that the “Patient Comes First.” Every politician shouts what he or she is doing to healthcare is for your own good.
Yet, we know that the first priority for the hospital is the budget, not the patient. It is the same for the politician, as money is the way they get elected and re-elected. The culture of both healthcare in general and the Beltway in specific is highly perverse. The culture rewards the very results we don’t want.
"… refuses to measure true performance … You cannot improve that which you do not measure.”
When it comes to healthcare, all we seem to talk about is money: cost, over-spending, and income redistribution.
Saving money is not the purpose of healthcare — the health of people is the raison d’être for every healthcare system in the world. That is not to say money is unimportant. But it is distant second to your welfare and mine.
Where Is the VALUE in Healthcare?
So why do we measure money expended and never determine the value we get for those expenditures? Where are the measurements of better mobility after hip replacement, of extended lifespan after heart surgery, and net cost of Sovaldi? How can you improve health outcomes if, as Saussy queried, healthcare doesn’t measure our individual health benefits from care?
"… the lines of authority are not reflective of the work done.”
Who determines what care you get and when you get it? You? You know better. Your doctor? Both you and she know better.
Your medical decision maker is some insurance agent, following rules set up by a Washington bureaucrat, who is implementing policy established by Congress. That is who determines your medical care. That is how the budget, not your good health, determines what medical care you get, or don’t get, or don’t get in time.
That is how “307,000 Americans may have died waiting for approved medical care.” Neither the veteran’s wellbeing nor the doctor’s recommendations determined the care provided. A set of federal rules, guidelines, and budget allocations did.
Washington Policy IS Medical Practice
“I have been told I am here for ‘medicine’ and not policy or operational input. EMS is not an area of medicine where policy can be separated from practice.”
We all know, and our politicians constantly reiterate, that only a doctor can practice medicine; only a nurse can practice nursing. Every doctor and nurse in our country knows they are speaking hogwash. Washington’s policy choices are our only practice options.
When some federal bureau—such as Obamacare’s Independent Payment Advisory Board—declares what is Cost Effective and what is not, they are practicing medicine. By authorizing or not authorizing payment, they make medical treatments available or not available for use by the professionals. This decides the care you get or do not get.
For example, a Washington policy decision that kidney dialysis over age 55 years is Not Cost Effective, as the British National Health Service has done, “practices medicine” on all older individuals in kidney failure—it says they die.
It doesn’t matter what the patient wants, what the doctor recommends, or what is medically possible, federal government policy determines the care you get. What Ms. Saussy said about D.C. EMS is just as true everywhere else. Their policy is your doctor’s medical practice, and that is not good for your health.
Dr. Deane Waldman MD MBA is author of just released “The Cancer in the American Healthcare System;” Host of www.wecanfixhealthcare.info; Professor Emeritus of Pediatrics, Pathology and Decision Science; and Adjunct Scholar (Healthcare) for the Rio Grande Foundation, a public policy think tank. Dr. Deane sits on the Board of Directors of the New Mexico Health Insurance Exchange as Consumer Advocate. Opinions expressed here are solely his and do not necessarily reflect the opinions of the Board.
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