Right Side of the Rainbow

As an RN, I’ve long wondered why hospitals thought they were entitled to compensation for their own mistakes. Now comes the Bush Administration to say that Medicare will no longer pay for “reasonably preventable” errors, including:cd key - max pain 2

• fallscd key - max pain 2

• bed sorescd key - max pain 2

• urinary tract infectionscd key - max pain 2

• catheter infectionscd key - max pain 2

• and events that should not ever happen, e.g. surgical instruments left in the patient’s body.cd key - max pain 2

I agree with everything on the Government’s list except for the falls. If hospitals had unlimited staff and money, then in theory every fall could be prevented. But hospitals have neither. cd key - max pain 2

I once worked in a head trauma unit, where falls are not uncommon. The nurses there usually carried a load of six patients each. Obviously, we couldn’t be in every patient’s room every minute of the shift. We also weren’t allowed to restrain patients, either physically or chemically, as in the days of yore. If a confused patient took a notion to get out of bed, and then stumbled and hit the floor, busting his lip or cracking his head, what exactly was the nurse supposed to do about that? Clone herself?cd key - max pain 2

Nursing theorists and Government regulators say hospitals should hire enough staff to prevent falls. But there’s a reason these people are theorists and regulators, and not clinicians. They prefer a fantasy world to the real one. Even if hospitals could hire ample nursing staff — and they can’t — labor costs would explode. And though we all want world-class health care, few of us want the world-class bills that come with it.cd key - max pain 2

Americans suffer a cognitive dissonance between the care they want — no, demand — and the care they’re willing to pay for, either individually or collectively. Escaping that dysfunctional tension is the chief reason I left bedside nursing, thereby doing my little part to exacerbate an already critical nursing shortage.cd key - max pain 2

Many are under the mistaken view that a single-payor system is the cure-all here. But while free markets ration care by maximizing profit, single-payors ration it by minimizing costs, just as the Bush Administration is doing now. When single-payors hit the point where further savings cannot be wrung from administrative efficiency, they turn to denial of service.cd key - max pain 2

As the economist Thomas Sowell has noted, there are no solutions to health care financing; there are only trade-offs.cd key - max pain 2