One of the first modern era spirit crushing capitalistic moves was the assembly line. Instead of a skilled craftsman gaining pride and satisfaction in building a product from start to finish, he spent all day, every day building the same little widget over and over. He was paid more. He could provide more for his family. However, accomplishment became more defined by quotas and money than by pride and ownership of a quality, finished product.
Many politicians enter the field of public service with a strong desire to help constituents and humanity. They believe that they have an important view point and can get things done “the right way”. They see corruption and want to right wrongs. I imagine it is extremely difficult to navigate halls lined with lobbyists funded by businesses trying to improve their market positions. It costs so much to run for office, that some may start compromising their beliefs to collect. They need to hit fundraising goals or not only will they be limited in advertising, but others will see them as weak. Who wants to put their name behind the weak guy? One little compromise leads to another and as their spirit is crushed, they become players in a game that they never wanted to play.
Healthcare seems to be defined more and more by quotas and pay checks. Sales people are paid to sell. Every year their quota goes up. At what point do medical equipment, pharmaceuticals, and services reach saturation? The pressure and incentives can lead to inappropriate up selling or over selling. A lovely lady I met needed an electric chair to be mobile outside of the house. The equipment company pressured the doctor to recommend a super high tech and expensive version that was originally designed for patients with severe spinal cord injuries that had to spend most of the day in the chair and had limited sensation to pressure points. Not only would this chair cost thousands of dollars more, but it could have actually discouraged the lady from using the mobility and strength she did have. Making her worse!
Insurance companies have to make more money every year to keep investors happy. They demand increased paperwork and administrative costs from providers. They demand patients pay a greater share and negotiate lower reimbursement rates for providers.
Providers have to see more patients to keep budgets balanced. This leads to even more paperwork. Crushed by administrative headaches and late nights of paper pushing, some practitioners look for ways to return their focus back to clinical work. Independent doctors are becoming a rarity as hospitals buy out as many as they can in order secure more patients and internal referrals. There is also a bundled payment system that makes this model desirable for all involved.
Patients are forced to accept higher premiums, deductibles and co-pays. As patients have to pay more, their relationship with practitioners can become almost adversarial. Their, once, independent doctor now has a new set of rules to follow and a higher quota dictated by the conglomerate that owns them. “No, we cannot talk about your meds today because your visit is coded as a test result follow up.” -a friend’s true story.
At the beginning of this week, I thought I would have to make a choice between a job that valued volume over care and a job that valued quality but was not as administratively buttoned up as I would like. (Their can be huge ramifications if done wrong.) This tore at my spirit until I realized that nothing is perfect and I should be happy to have the luxury of choice. Then it just became sad that the allied health fields have become so polluted. I entered healthcare to help people. It was more of a calling than a career choice. Am I ready to work an assembly line?
Luckily, the choice was taken from me. For the moment, I have been spared the choice between stability and providing a higher quality product. At some point, I may likely need to seek out stability. I have never been particularly good at taking the riskier path. Growth, here I come.
Assembly lines did lead to several advancements. Hopefully, these are just growing pains.