Let me tell you about a situation in progress that a dear friend of mine is experiencing. She wrote me:
In late November 2023, I experienced severe and sudden onset of pain in my left hip after walking around my yard. I tried to stay off of my feet hoping it was simply a muscle. After 3 weeks I couldn’t take the pain and I contacted my GP, who became immediately concerned that I could have a necrotic hip fracture due to the necessity of steroids used in the treatment of asthma I have had since 2013. I was referred to an orthopedic convenient care clinic for X-rays in early December. X-rays and MRI showed I had severe avascular necrosis with an osteochondral fracture of the femoral head. I was told I needed hip replacement surgery. I probably could have had my surgery in February with a new surgeon but I did not feel comfortable in that facility. I requested transfer to an established surgeon with whom I was more familiar. I had to wait a month to receive the records I needed for my new appointment with his surgical assistant, who told me that the soonest I could have the surgery would be August 2024. The surgeon will re-evaluate me on February 28. I asked how I was supposed to deal with the pain and lack of mobility, and I was told to use my walker and do the best I could. I asked about the possibility of further breakdown of this bone and was told that it was highly likely to continue to break, but that I should just keep being as mobile as possible, so my leg muscles stay strong for the surgery. I was shocked about this lack of concern, and I asked what if it breaks in two? The surgical assistant said that’s why you need to use your walker. I’m astounded at the nonchalant attitude of what is a serious injury, but what could I do? I am to complete my bloodwork prior to my upcoming appointment, and I was left with no other instructions. I thought that this would be a priority situation, but I was sadly mistaken. I’m placing my hope on a special list in case there is a cancellation. This situation began in December 2023. My surgery will not happen until August 2024!
One of the features of socialized medicine is long queues and rationing of health care by poor planning or by design. Sadly, either way, this is what seems to be happening in America under our new evolving system of medical care. Some patients may not even make it to surgery, which is what I have called in previous writings as “rationing by death.”
Indeed, in the last three decades we have moved inexorably toward the concentration of economic power in the hands of health corporate bureaucrats, working in tandem with their governmental counterparts in the public sector—sometimes forming public-private partnerships that are not necessarily in the best interest of patients. This move has turned into a high-speed chase since the COVID “pandemic” in 2020, the lockdowns that followed, and the deterioration in services of all types, especially medical care!
In medicine the erstwhile concepts of American individualism, self-reliance coupled with compassion and charity, and the true sense of community, upon which America was founded, have been gradually eroded. Large pharmacy chains, large hospital systems, and mega health corporations, which are protected by the monopolistic practices of government, have swallowed up small businesses, entrepreneurs, and even physician practice groups. After all, for the CEOs in the private sector as well as the bureaucrats in the public sector, it becomes easier, more efficient, and less competitive as well as more profitable to control and deal with a few large corporations or health entities rather than a myriad of independent, small businesses, hospitals, or physician groups.
The tenets of corporate socialized medicine have evolved, although the basic corporate ethic remains the same—that is, collaboration between public and private entities, eliminating competition, saving money for the government, and maximizing profits for the mega health corporations. It is very helpful to the health corporations that fewer physicians are going into private and independent practice or managed care. These doctors do not want the responsibilities of the former or the hassles of the latter.
Presently, the up-and-coming physicians and surgeons, after they complete their training, no longer wish to go out on their own or join independent older colleagues. They now prefer to become employed by the mega health corporations, large hospitals, or the government at the state or federal level. That way they work more convenient hours, take less call, and their responsibilities end there. They get paid handsome salaries and their overhead expenses are covered, such as malpractice insurance, office expenses, employee salaries, and vacation and sick time.
But those physicians employed by the corporate world today, must earn their money and strive to perform certain treatments and procedures that place them in higher work Relative Value Units (wRVUs). By this methodology hospitals and health care networks use utilization review to monitor productivity. The wRVUs drive employed physician salaries and contract negotiations for clinical privileges. Productive physicians get rewarded. Non-productive physicians are shunned.
Physicians who have not been cost-effective (low productivity) but who may also treat the sickest and most difficult cases that take time and utilize multiple surgical procedures or treatments may be penalized. Those physicians end up with low wRVUs, thereby incurring higher costs for their hospitals and not producing enough profit for their employers. They are penalized for “poor outcome performance” that is, again, attributed to “quality” issues. They may have not only their bonuses withheld at the end of the year but also could lose clinical privileges in hospitals or health care networks when they apply for new, additional, or renewal of clinical staff privileges.
Patients, then, no longer come first; cost containment strategies do, and they are the order of the day for both the government (cost containment) and the mega corporations (profits). Physicians and their patients are the ones who pay the price. This is the evolving essence of corporate socialized medicine that I described and many of us predicted would come to pass at its inception in the 1990s.
And since the advent of COVID in the United States in January 2020 and the violent riots that followed in the wake of the George Floyd incident in May 2021, the methodology of corporate socialized medicine has radically worsened. The medical establishment led by the leaders of “organized medicine” and the upper echelons of the health care management corporations have gone woke; the fashionable bywords have become (and lip service paid to) “equity in health care,” “eliminating racial and sexual disparities in health care,” “diversity and inclusion,” “community outreach to disadvantaged communities,” “sexual orientation and gender identity”—rather than the promotion of the advancement of science for the prolongation of health and the improvement of quality of life for all and every individual patient.
The bottom line is that today, even more acutely than in the 1990s, individual patients will be unpleasantly surprised to find out what it is like to become seriously ill in the corporate socialized medicine world. And it will be those 4% who become seriously ill at any point in time requiring intensive care treatment and advanced specialized therapies and surgeries who will learn the hard way about the deficiencies—that is, from receiving care from impersonal personnel to delayed or outright denied services and needed treatments.
Meanwhile, the corporate health magnates and CEOs of the mega health care corporations are making millions of dollars at the expense of physicians, surgeons, and their patients. For example, Dr. Ninfa Saunders, CEO at Atrium Health Navicent in Macon, Georgia, a medium-sized town in central Georgia, received $4.9 million in salary in 2020 just before retirement. And that is just the tip of the iceberg. Atrium Health in Charlotte, North Carolina, “paid CEO Gene Woods more than $9.8 million in 2021 in total compensation—up from more than $7.8 million in 2020.” How is that for compensation! Let us conclude by observing that CEOs and top executives at the mega health care corporations are making millions of dollars in salaries, while pushing and paying lip service to politically correct slogans to make the public feel good and soothe their minds.
Where the supreme medical ethic once dictated that physicians, hospitals, and other medical care entities place the interest of patients first, in the spirit of compassion and charity, today’s ethic of corporate socialized medicine propounds that physicians and all health entities place cost considerations and the interest of third party payers, including the government, above that of their patients.
In closing, let us state that although seemingly capitalistic at first glance, corporate medicine is a form of socialized medicine because it is based on a collectivist ethic rather than the individual-based or traditional patient-oriented ethics of Hippocrates. Moreover, corporate medicine, based on a close working partnership among private corporations, medical organizations, and government, and operating within modish business paradigms, makes medical care a truly new perverted entity: corporate socialized medicine.
Written by Dr. Miguel Faria
Miguel A. Faria, MD is Associate Editor-in-Chief of neuropsychiatry; socioeconomics, politics, medicine, and world affairs for Surgical Neurology International (SNI). Author of several books on health care and medical history. This article is excerpted from Chapter 25 of his book, Controversies in Medicine and Neuroscience: Through the Prism of History, Neurobiology, and Bioethics (2023), published by Cambridge Scholars Publishing in Newcastle upon Tyne, United Kingdom.
This article may be cited as: Faria MA. Just Don’t Get Sick!—Corporate Socialized Medicine in the 21st Century. HaciendaPublishing.com, January 18, 2024. Available from: https://haciendapublishing.com/just-dont-get-sickcorporate-socialized-medicine-in-the-21st-century-by-miguel-a-faria-md/.
Copyright ©2024 Miguel A. Faria, Jr., M.D.