This blog cross-posted at Huffington Post

It's time for the health care aristocracy to fade into the sunset.

That's the lesson from the scathing article last week in Bloomberg News about New York's Mount Sinai Hospital whose headline screamed, "A Heart Surgery Factory With 'Obscene Levels' of Pay."

According to the Bloomberg account, Mount Sinai climbed out of a multi-million dollar financial hole in part by ramping up the volume of cardiac stent procedures, doubling the number performed during the 2000s to become New York's top stent factory.

Mount Sinai has had a troubled financial history. Its ill-fated merger with New York University Hospital that began in 1998 and resulted in a divorce five years later yielded junk-bond status credit ratings and combined debt of $670 million. It's hard to imagine, or perhaps not, that this would happen to a hospital whose board of trustees is comprised of Wall Street financiers and whose address is Gustave Levy Place, named for the founder of Goldman-Sachs.

Mount Sinai is not alone in ramping up surgery volume to pump up the bottom line. The health care system is perfectly designed to be abused.

High priced hospital consulting groups like the Advisory Board Company tout volume growth as a "ticket" to profitability and advise clients on how to "grow" profitable procedures.

Profitable, indeed. The director of Sinai's interventional cardiology, who oversaw the growth in stent procedures, was paid $4.8 million by the hospital in 2012, more than the CEOs of Microsoft and Amazon, according to Bloomberg.

The health care industry has created its own aristocracy with multimillion-dollar lifestyles at public expense.

Far away in Yorkshire, England, home to the wildly popular, made-for-TV "Downton Abbey," the aristocratic Crawley family has had a similar share of financial distress, also of its own making.

A few seasons ago, the Earl of Grantham, lord of the abbey, invested the family fortune -- which came from the dowry of his wife, Lady Cora -- in an ill-fated Canadian railway venture that went belly-up. The family laid out a plan to eliminate the servants' jobs and downsize. At the last minute, they are saved by the largess from an inheritance.

In the post-World War I era setting of the PBS series, many large estates in England were in financial tatters. Downton Abbey is forging a new path to sustainability, thanks to the sensible proclivities of the Crawley family's former chauffeur and now son-in-law, Tom Branson, the anti-aristocrat who married Sybil, daughter of Lord and Lady Grantham, who died during childbirth.

Under Branson's sober stewardship, the lands of the estate are now home to a herd of pigs that will bring home the bacon. For post-war England suffering from a food shortage, Downton is feeding its sausage-loving compatriots while putting itself on the path to self-sufficiency, at no one's expense, except that of the pigs.

No surprise that Branson came from the world of real work for a day's wage, never dreaming of having reams of other peoples' money to blow up.

Palatial buildings and lavish lifestyles are rarely sustainable over generations, whether in a fictional aristocratic Yorkshire family or in a hospital along Manhattan's Fifth Avenue.

Downton Abbey's Crawley family is portrayed as having a sense of duty to its ancestral Yorkshire home. Likewise, hospitals feel a duty to keep a vital community resource intact.

Neither is an excuse for profligacy. At least the Crawleys were blowing up the money of their rich relatives.

Too-big-to-fail hospitals blow up the money of the working men and women of America, the people who work "downstairs" -- the tireless Mrs. Patmores and Mrs. Hughes' of the world.

Dependence on other peoples' money becomes an addiction.

Rather than pare back the excessive paychecks and eliminate wasteful spending that keep the peace among fractious fiefdoms, the health care aristocrats impose their own kind of "tax" on the little people, those forced to fork over an ever-growing share of their paychecks to pay for the modern-day steel castles and the lords who preside over them.

The scary part is how shamelessly unsuspecting patients are reeled in, tests and surgeries done on them, to fill in a financial ditch and reap obscenely high pay.

Even the Downtown Abbey aristocrats would recoil from such a prospect.

It's time for the health care aristocracy in the United States to fade into the sunset. The fiefdoms and their misplaced sense of entitlement to the public's money need to be gone with the wind.

This blog cross-posted at Huffington Post

The military counts its dead and wounded even though politicians would prefer to hide the truth.

Public health officials count the deceased and injured from drunk driving. The alcohol industry might prefer to hide the mayhem by slashing public health funding, but wiser, compassionate minds prevail.

Counting the dead is a way that society says a life matters. It honors the deceased, a mother, father, sister or brother, son or daughter.

Failing to count them is to dishonor them.

In hospitals, nursing homes and other health care facilities, no one counts those who die or are injured because of preventable mistakes and infections.

In 1999, the Institute of Medicine of the National Academy of Sciences estimated 44,000 to 98,000 deaths from preventable health care harm. Courageous doctors and others took a stand. It was perhaps the first time in the history of medicine that the public was told the truth.

The 98,000 figure is more than the number of soldiers killed in the Korean and Vietnam war theaters combined, as reported in the Wall of Silence.

Still, the death toll has not compelled the government to routinely count mortality from iatrogenesis.

Parents fill the void. One of them is John James, Ph.D., a NASA toxicologist. His 19-year-old son, John Alexander James, died because of uninformed and careless medical care at a Texas hospital, according to a website Dr. James created in his son's memory. 

Dr. James conducted a study published this month in the Journal of Patient Safety in which he meticulously examines more recent studies. He estimates the number of premature deaths from preventable harm to be more than 400,000 Americans per year.

The jaw-dropping estimate means that a new Arlington National Cemetery is needed every nine months to bury the dead.

Why should the people of the United States rely on an extraordinary, dedicated private citizen to calculate estimates of a leading cause of morality in our country?

Powerful vested interests don't want we, the people, to know.

President John F. Kennedy warned the country about the dangers of secrecy in a 1961 speech, saying, "Secrecy is repugnant in a free and open society; and we are as a people inherently and historically opposed to (it) ... We decided long ago that the dangers of excessive and unwarranted concealment of pertinent facts far outweighed the dangers which are cited to justify it." 

Secrecy is unraveling the fabric of the health care system. The dishonor of the deceased is taking its toll. There is only one way out. Count the dead and the injured. Honor them as we would all wish to be honored.

This blog cross-posted at Center for Health Media and Policy

Hospital budget cuts became viscerally visible earlier this month when Vanderbilt Medical Center announced that nurses must now perform housekeeping duties — cleaning patients’ rooms and bathrooms.

In case you missed the video of the internal announcement secretly recorded by a nurse that aired on  Nashville’s WSMV television station, here it is.

http://www.wsmv.com/story/23364976/vanderbilt-medical-center-to-have-nurses-cleaning-up?auto&topVideoCatNo=default&clipId=9280584

It is hard to think of a worse way to demoralize professionals who want to practice at the top of their license.  Invoking Florence Nightingale’s name as a spoonful of sugar to help the budget medicine go down is no salve for deep wounds of disrespect.

For patients, they are at greater risk, an inevitable outcome as nurses spend less time at the bedside.

All of this begs the question, “Where does all the money go in hospitals, who is getting it, and what are they really doing with it?”

The direction of the budget axe is being determined by an unspoken battle between labor and capital.

Nurses, pharmacists, housekeepers and increasingly, doctors, are employed labor.

Medical equipment and supplies, medical devices, drugs, computers and information technology are the products of capital investment.  Companies that manufacture these products need constantly increasing revenue to keep stock prices and earnings per share headed north.  Stockholders and other investors – their unforgiving owners – demand bigger, better, quicker returns.

Consequently, companies are programmed to take more money for themselves, which leaves less for everyone else, especially nurses.  I wrote about the uncanny parallels between the health care industry and the banking sector in Battle Over Health Care: What Obama’s Reform Means for America’s Future.  Both have price bubbles, toxic assets, too-big-to-fail syndrome, and privatized gains and socialized losses.

Implicit tradeoffs between labor and capital are made every day.

Companies have to create a stream of so-called new, innovative products every year to pump up earnings per share.  As nurses know, new is not always better.  It might be worse.  A steady torrent of new stuff: equipment, technology and a bevy of consultants causes money to trickle up.

Meanwhile, hospitals are not exactly shopping at the equivalent of Costco and getting a competitive price.  And they buy too much that ends up in landfills.  A hospital supply chain executive at a large public teaching hospital estimates that at least 10 percent of hospital purchases in inventory are expired.  Good for Wall Street investors.  Bad for people taking care of patients.

To correct the misallocation of the public’s money, transparency of billion-dollar hospital budgets would shed light on where all the money is really going.

In the meantime, we cannot let the material abundance of a few create a chasm of indifference to the plight of many.