Sam Uretsky

Hard Times for Health-Care

It’s like one of those scenes on television, where the clock is ticking, and only the mad bomber knows whether to cut the green wire or the red wire—but not. The newspapers—those that are still around—are filled with articles about the AIG bonuses, $165 million paid to the people who may have destroyed the world economy, and unquestionably destroyed the lives of millions of people, now and possibly for a generation to come. Families are losing their homes, elderly people are losing their retirement savings, younger people are losing their college funds and among the many justifications for paying these bonuses is “we have to make sure these people don’t leave, because they’re so bright.”

Another justification that has been offered is “we have to make sure these people don’t leave because they messed things up so badly that only they know how to fix it.” If they know how to fix this mess, why the delay? Why didn’t they just ask for a share of the original $700 billion?

Possibly one approach to retention would be a National AIG Employee Registry similar to the system now in place for sex offenders. Any company who hired a former employee of AIG’s financial products unit would be required to provide a warning to potential investors and clients. It would be similar to the way Chinese take-out menus print little red peppers to show that some dishes may be uncomfortably hot.

Meanwhile, the Pittsburgh Post-Gazette reported that 80% of Pennsylvania hospitals are considering staff layoffs. A New York City hospital announced that it was balancing its budget by laying off 240 people, including physicians and nurses. There are similar reports from most regions of the United States.

As unemployment rises, there’s a drop in the number of people with health insurance, and this leads to reduced income for hospitals and clinics. To survive, they resort to layoffs, including dismissing nurses and physicians, people with vital skills, but are careful to issue statements saying that the quality of patient care won’t be affected. Wrong. Job insecurity causes problems that can be equal to the effects of unemployment itself.

Even though physicians and nurses can find other employment, there are problems associated with lack of job security, problems working in a hospital with a reduced staff level, problems associated with learning the systems in a new hospital. The work becomes less emotionally rewarding, so that older physicians and nurses who have the option of retirement, or other career paths, may leave patient care, accelerating the staffing shortage that’s already present.

The shortage of health personnel is most obvious in Massachusetts, where a program to provide universal health care has run into the shortage of primary-care providers, and patients who can now get their bills paid can’t find a physician who has an available appointment. Massachusetts, with four medical schools, has more physicians per capita than many other states, but according to the New York Times, the average wait by a new patient for an appointment with an internist rose to 52 days in 2007 from 33 days in 2006.

It has been well documented that layoffs, the increase in unemployment rates, hurts everybody, physically as well as emotionally. For the unemployed, one study showed that for every 1% rise in the unemployment rate, deaths from heart disease, cirrhosis of the liver and stress-related disorders increase by 1.9%, and admissions to mental hospitals, 2.3% for women and 4.3% for men. A European study reported that the severity of emotional and physical effects of unemployment are more severe in rural areas than in urban settings—but rural areas are already underserved by medical resources.

But in addition to the health effects of unemployment, there are adverse effects related to job insecurity. A 2001 report in the Journal of Occupational Health Psychology stated: “Having any kind of personal contact with layoffs is found to be associated with less job security, more symptoms of poor health, depression, and eating changes as compared with having no layoff contact.” So, more people with heart disease and cirrhosis of the liver are being treated by people with symptoms of poor health and depression—if the people with heart disease and cirrhosis survive the wait to see the people with depression and eating changes.

The silver lining to the financial meltdown is badly tarnished, but it has given us a chance to look at our values, and rethink the honors we’ve awarded the investment bankers and their ilk. But maybe we shouldn’t wait to get to part 2. You’ve got a physician, a nurse, and an investment banker—who gets the retention bonus? We should work on that one, shouldn’t we?

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, April 15, 2009

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