HEALTH CARE/Joan Retsinas

Beyond ‘Never’

A new word in the health-care lexicon: “never.” The Centers for Medicare and Medicaid Services, followed by Blue Cross, have led the way. Predictably, all insurers will soon categorize some events as “never.” In a hospital stay, “untoward” events, “unfortunate mishaps,” “accidents” — those were the old terms — occasionally happened: a sponge left in the abdomen after surgery, a pressure ulcer, removal of the wrong organ. After the fact, staff proclaimed how very sorry they were, pledging “never” to let this happen again.

The new term for such maladies is “never.” All these should not have happened, if hospital staff had followed the exhaustive procedures put into place. Other maladies might – and would — occur, but not the ones that planners could prevent.

For hospitals, “these events now will carry financial consequences. By October 2008, the federal government will stop paying for them. And, even though Blue Cross will have to hone its coding system, the better to define “never,” eventually it too will not pay for untoward, unfortunate accidents.

This definition carries consequences. Predictably, after a “never” hospital event, all involved, from surgeons to administrators to nursing staff, are sorry. Very sorry. But unless malfeasance was involved, the event didn’t hurt anybody’s bottom line.

So insurers have tagged consequences to “never.” Never events can, and do, recur, in hospitals, but severe consequences should thwart them.

Insurers have done health care, and maybe society, a favor by strengthening the definition of “never.”

Historically, “never” is an ironic term. We have “never” again catastrophes that recur with frightening speed. In 1940s Germany, a “never again” holocaust didn’t stop more recent slaughters (Serbia, Rwanda, Darfur). After the catastrophe, world leaders were very sorry.

We should follow insurers’ example and extend the consequences of “never” to the political arena.

Consider the lamentable sight of servicemen returning from battle with injuries. They have been ignored, forced to vault bureaucratic hurdles for substandard care, or been mistreated. The news stories, with photos, of the soldiers who return to abysmal care, have enflamed the ire even of conservatives zealous to cut spending.

Now listen to the political blather of this election season. A lot of candidates are pledging that, if they are elected, “never” again will veterans be mistreated. Decrying the disgrace, the politicos have promised voters that these headline-grabbers are “never” events.

To make “never” meaningful, we the electorate can judge the treatment of returning military personnel after the pledging politicians win. If “never again” happens, we should remove those leaders from office: no salary, no title, no staff.

Candidates are touting their super-duper insurance plans. Without government-funded national health insurance (a la Medicare), no candidate’s plan will cover everybody. But all the major candidates’ plans — permutations of mandates, voluntary nudging, tax manipulations, and government subsidies – will only cover a swath of the 47 million uninsured. It is time to ask politicians precisely how big a swath. How many will be collateral damage in the drive to spare the budget? Then, post-election, we should count the number of people still without insurance. If the number hasn’t dropped to the promised level, we should dismiss the victor.

On the campaign trail, the “nevers” trip blithely out of candidates’ mouths. Typically the candidate holds up a beleaguered family, suffering because of the failed policies of this administration. Under the enlightened policies of the new order. “Never again” will such a family have to suffer such an ordeal. If four years post-victory, the same families are in the same straits, those politicians are very sorry. What a refreshing idea to hold those politicians truly accountable for their pledges!

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, December 15, 2007

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