How to Prevent Medical Errors: Part II
“The whole aim of practical politics is to keep the populace alarmed – and hence clamorous to be led to safety – by menacing it with an endless series of hobgoblins, all of them imaginary.”
— H.L. Mencken
What is the fundamental difference between conservatives and liberals?
What do liberals fear the most? Although the answer to the question may vary, one aspect of the answer is certain. They will argue that corporations are part of the problem.
What do conservatives fear the most? They will argue that government is the problem.
So a person’s political viewpoint, for most people, is defined by the source of their fear.
Political parties also inspire hope among their members with the promise of freedom. However, the freedom they sell is not freedom at all. Rather, it’s a limited opportunity for their membership—club Democrats or club Republicans. Opportunity isn’t freedom. It’s addiction. It’s the caged rat endlessly pressing the bar for the occasional food pellet.
Democrats argue for tepid improvements in the rights of the poor and middle class, and those victimized by prejudice. Republicans argue for businesses to be free to do whatever they want even though such practices in the past have led to exploitation and public harm. They refer to this as economic freedom which really only works if you’re annual income is more than $1.5 million per year. That is, economic freedom reduces opportunities for the majority of Americans. Therefore, the number of millionaires in the United States is actually in decline.
For conservatives, freedom manifests itself as the freedom from government ineptitude, regulations and lawsuits that interfere with wealth accumulation. Not all conservatives are rich, but despite the aforementioned evidence to the contrary, most feel that they could be if only they were free to make money the way they want to. Thus, their agenda often shows a reckless disregard for the freedom, safety and well-being of others. They are convinced that government is the problem and fail to recognize that fixing the problem of government also requires fixing corporate problems that don’t affect their lives.
The health care whistleblower Wendell Potter gave an excellent example (see above video) of how health insurance companies use distraction to convince conservatives that economic freedom will improve their lives. He said
“The 30-second commercial is a classic example of misdirection, a form of deception frequently used in political advertising (and by magicians) to get people to focus on one thing in order to distract them from something else, to worry about some imagined future rather than the reality of today.”
The misdirection here is that the ad’s sponsor wants us to forget that under our current system, “unaccountable bureaucrats” already exercise the kind of control Vermonters for Health Care Freedom wants us to fear. But the “unaccountable bureaucrats” don’t work for the government. They work for private insurance companies—both the nonprofits like Blue Cross and Blue Shield and the for-profits, like Cigna, where I used to work. And it is those bureaucrats who have the ultimate power to limit—and in many cases deny—access to often life-saving care recommended by a doctor."
Liberals fear for their environment, health, jobs and money. They fear their livelihoods will be taken away by corporate greed and prejudice. They have good reasons to believe this. However, liberal politicians play the same game. Liberal politicians typically do not address the problems of government corruption or ineptitude.
For examples, liberals were happy to see the Affordable Care Act passed. Yet, what has been the response of the Obama administration’s discovery in 2010 that 200,000 Medicare patients die each year from medical errors in hospitals.
The administration’s most obvious reaction to 200,000 deaths per year was to set up a website that asks hospitals to volunteer to do a better job and warns patients to be careful and for two years after those 200,000 deaths per year were reported the current administration has allowed hospitals to continue to not report and fix the underlying problems that cause medical errors. Recommendations to address agency problems have largely been ignored.
The President argues that the Affordable Care Act will solve a few problems that cause medical errors. That argument misses the point. If you have safety regulations that are not enforced, then the passage of any law is largely just for show.
The same government agency found in 2012 that government regulators and hospital administrators were not correcting problems that lead to patient harm in hospitals and not reporting them. That finding demonstrates that the current administration’s response has been grossly inadequate and their recommendations to address some issues of patient safety don’t work.
Although some Republicans vote against whistleblower legislation, some lead the way in proposing new legislation. Thanks to Republican Senator Chuck Grassley, Republicans have some idea of the extent to which our health care and judicial system fails to protect health care workers. Each year, it’s estimated that thousands are retaliated against. Senator Grassley feels the problem is so bad that appeals courts should be prevented from ruling on whistleblower cases because they almost always find in favor of the defendant. In contrast, liberal commentators focus on three dozen cases of government whistleblowers that in several instances were exposed by Senator Grassley.
The end result of these distractions is that the American political system is simply a variation on the theme of good cop/bad cop. Although the Presidential Election superficially appears to involve personal attacks, beneath those personal attacks lies fear-mongering. The costs of this game is far higher than most Americans realize and the consequences go far beyond their ability to accumulate wealth. In fact, the consequences are a matter of life and death for many Americans.
Political misdirection has led to a failure to address the life and death problem of medical errors. The solution to the problem of medical errors is a deeply personal one for stakeholders and that’s why it persists. Unions (e.g., the nursing association) and plaintiff lawyers bolster liberal arguments and insurance companies bolster conservative arguments while others must walk a delicate line.
For example, surgeons who pay high malpractice insurance premiums fear their practice will be wiped out by a single lawsuit. They know even if they win the lawsuit, their increased malpractice insurance premiums may substantially reduce their profit margins.
Surgeons also know that win or lose, the system that contributed to the error will not change. Surgeons may also recognize the extent to which campaign contributions from industry stakeholders and plaintiff lawyers largely account for the failings of government. They know they’ve been grossly overcharged for their malpractice premiums in mass to the tune of billions of dollars while medical malpractice insurance company profits have skyrocketed(pdf). They may not know that conservative majority Supreme Court rulings set up a system that doesn’t allow plaintiff lawyers to go after insurance companies that don’t give surgeons the time and resources to prevent medical errors. Instead, insurance companies and Republicans tell surgeons that the best way to reduce costs is by reducing the compensation given to victims. Surgeons may vote Republican in order to be freed from their fear of lawsuits and because the Democratic party is funded by plaintiff lawyers. Most medical errors are caused by system failures. Yet, they see that in most cases only their colleagues face serious consequences as a result of lawsuits. Perhaps out of their fear and resentment, some resort to patient blacklisting, also known as “risk management” such as the Doctors Know Us website which has still workings years after reporters claimed that the website was taking down.
Proposed solutions by Democrats have been to make it easier for plaintiff lawyers to sue and to bring down malpractice premiums. In addition, the Affordable Care Act has several provisions that could help in the long run. Yet, neither Republican nor Democratic solutions address the specific problems that cause specific medical errors in individual cases. That job is left to hospital administrations, the 1%, whose mandate is the bottom line and not patient safety. That equation doesn’t change with the Affordable Health Care Act because the problems isn’t in the law its in government agency implementation, administrative and insurance company motivations and judicial interpretation.
A true solution must address stakeholders’ realistic fears. Two of the worlds greatest corporate leadership experts were Fredrick Taylor and Mary Parker Follet. Both experts had a simple message. What truly costs businesses is a lack of trust between employees and administration. Communities, workplaces, governments and other organizations work best when everyone believes they will benefit by working together. As Mary Parker Follett argued, leadership can’t be satisfied with a compromise. They must find a win-win solution.
Our government regulatory and legal system focuses on money and not on solving the underlying problem. If it did, it might ameliorate the fears of both Republicans and Democrats. For example, what if malpractice cases focused not on blame but on fixing the problem. Potential fixes might include changing hospital and insurance company policies that force surgeons to rush, to work when they are tired or fail to give surgeons adequate information about the patient. Current systems don’t monitor whether a surgeon’s training is adequate or provide a means to correct deficiencies, and they don’t protect those who speak up when they see problems.
As noted previously, safety regulations are not always enforced in hospitals even when regulatory agencies find problems. That’s the case even though our health care system has a large bureaucracy and private contractors who are supposed to correct safety deficiences. It’s clear that a comprehensive solution is required. A comprehensive solution might be costly, especially for hospital administrations and insurance companies. However, in the end it would solve the problem and that would save future costs. Harmed patients would be taken care of and know that what happened to them would probably not happen to others.
Such an approach cannot be entirely handled by a contentious legal system. Rather, problems need to be handled by a community of independent parties—citizens, national experts and investigators who are compensated for reducing medical errors. This approach shifts the focus from winners and losers to solving the problem.
Cynics argue that these problems are too big to fix. The answer to that argument is “So you admit there is a big problem?”
Others will argue it can’t be done. However, the approach outlined here is similar to the U.S. airline safety system.
There is the possibility for change due to the general dissatisfaction with both parties from the middle and Occupy Wall Street. As more people learn more about what divides and distracts us and what brings us together, their numbers will grow.
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