“The Covid Storm: Yearslong Drive for Efficiency Left Hospitals Overwhelmed” (Page One, Sept. 18) should be mandatory reading for every member of Congress. The Balanced Budget Act of 1997 balanced the federal budget by manipulating the Medicare growth curve to be below real inflation. Hospital administrators attempted to insulate themselves from this market manipulation. As the number of Medicare and Medicaid patients has grown, cost pressures forced hospitals to increase revenues, decrease supplies and lower nursing/patient ratios. Cars have seat belts and air bags not because we are planning to be in accidents, but just in case. The costs of those safety measures being added to our vehicles are equally passed on to all consumers. Not so with hospital costs. By creating price controls, Congress has created a hidden tax on employers and purchasers of health insurance, causing hospitals to limit competition and maximize efficiency to stay profitable. For too long, hospitals that predominantly have relied on Medicaid and Medicare have cut corners, underpaid and overworked their staffs and understocked supplies to balance their budgets. People have been dying for years because of these policies. Covid-19 blew up those systems. As the smoke is clearing, we see that the overwhelming number of American deaths were either nursing-home residents or patients in chronically underfunded safety-net hospitals.
Howard C. Mandel, M.D., FACOG
President, Los Angeles City Health Commission
When a traveling nurse comes in, the staff is well aware that the traveler is making three times an hour more than the hospital staff is. The traveler relies on the permanent staff to answer many questions, making the permanent staff resentful of doing another person’s work for less money. In a way it is like when someone is training a person when a job is outsourced. Hospitals also have used mandatory overtime to keep staffing levels lean in many states. In Ohio, the Hospital Association is opposing a law prohibiting mandatory overtime in Ohio. I have worked hundreds of hours of mandatory overtime in my career. The hospital where I worked switched from giving overtime pay after eight hours to paying after 40 hours. Many times after working 12-14 mandatory hours in a week and missing family events, managers would send me home on a slower day to avoid paying overtime for the week. For a front-line health-care worker who is efficient and effective, your reward is more work for you than your temporary colleagues.
Susan Timko, R.N.
Your article could cause readers to reach the wrong conclusion. After 30 years as a health-care “efficiency expert,” teaching it and doing it, I’m familiar with U.S. health-care costs. The U.S. has by far the highest cost of health care, with below-average outcomes compared with other developed countries. Much of that is due to lots of waste. Real efficiency improvements reduce that waste and improve capacity. It has nothing to do with firing productive employees. A better-run hospital prepares for emergencies. A lean hospital doesn’t do unnecessary tests and has shorter waiting times, for example. A well-organized hospital can react to challenges and is better able to maintain safety and quality. Cutting unnecessary costs is imperative if we are to be able to provide health-care access and affordability when medical costs overwhelm many families. Better efficiency isn’t the problem. Smart management, a responsive system and preparedness for emergencies are goals.
Prof. David Belson
University of Southern California
In the current climate, there is a name for hospitals that haven’t been successful at aggressive cost management: bankrupt. This is the beginning of reaping what “fiscally responsible” policy makers have sown in terms of further waves of hospital closures, loss of inpatient beds and hospital-system mergers leading to the firing of “redundant” health-care workers as the Covid-19 pandemic continues to wreak havoc on a system that was already pushed to the limit.
Shawn London, M.D.
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