In my November 28, 2011, post, All Hospitals Should Be Physician Controlled, I discussed the fact that, as a result of society’s current communal tide, the trend toward a “we” society, healthcare is becoming increasingly hospital-centric with looming negative impact.
Keeping that in mind, consider now that people, not institutions, are capable of morality. At best, institutions are amoral. At worst, they are immoral.
This doesn’t necessarily mean that hospital executives are amoral or immoral in the conduct of their personal lives, or whether they don’t have good intentions in their work lives. What it does mean is that institutions—corporations and other entities, whether their tax status is for profit or nonprofit—must make a profit or otherwise meet financial targets in order to continue to survive. The executives get significant salaries and great bonuses if they deliver profit and, at worst, lose bonuses or (sometimes) their jobs if they fail.
But in no case does a hospital executive go truly at risk…at no point does he or she have to dip into his or her personal funds, or declare bankruptcy, if their decisions lead to loss. This is true in terms of the overall push to make a profit and in terms of the impact of withholding care, of cutting corners, of doing just enough but no more.
Individuals, physicians in this discussion, are capable of morality and my experience is that most are highly moral. Sure, there are some bad apples, there are in any subset of society. But no matter where Dr. X lies on the moral scale, he or she is ultimately liable for his or her decisions, for his or her actions.
Who would you rather empower to make decisions affecting your personal health: An individual truly at risk, someone with “skin in the game,” or an institution that one way or another restricts its employees’ actions, led by executives whose chances of suffering from bad decisions are seldom negative at all, and whose most likely ultimate risk is capped at the loss of a bonus?
There are several solutions. One is make hospital executives and administrators personally liable for their decisions. Another is to shift control of healthcare to physicians, putting hospitals back into the position they occupied when hospitals first came into being.
Care to weigh in on this?