Health Care Reform: Vision or Hallucination?

Has anything in health care improved for the better for us patients… for anyone?

Over 10 years ago as we approached the new millennium I was finishing an intensive Health Policy Fellowship.  As a synthesis of all I had seen and learned from an insider’s perspective, I penned a vision of what I thought healthcare should look like in the next century.  It was more a statement of some twenty principles and directions rather than specifics. We are now more than a full decade into the 21st century so it seems a good time to take a look at my old roadmap.   Perhaps it is a measure of my current pessimistic state of mind, but I am not immediately able to declare progress towards any of the goals I envisioned.  In fact, it seems at first blush that despite all the money and best efforts of public and private interests, that most of the items on my wish list are getting worse.

What do you think?  Please prove me wrong.  Help me indentify something good that has happened to us as collective patients.  Is anyone better off?   If so, who?    Convince me that we are not irreversibly lost in a status quo of decreasing access to healthcare of uncontrollable cost, and of unknowable quality.

Add a comment below.  I will not spam you, I promise.

Peter Hasselbacher

New Suburban Veteran’s Hospital for Louisville

On Veterans Day, 11-11-11, the Courier-Journal reported on the status of plans to build a new Veterans Hospital for the region of Louisville Kentucky.   The community has been waiting with decreasing patience for the results of all the promises and hearings.  The update did not, however, announce that a final site had been decided, nor that financing was in hand, nor that a start date was known.  Instead, the big news was that the site selection process had decided against leaving the hospital where it is on Zorn Ave, and against moving to the downtown medical center of metropolitan Louisville.   Subsequent notice of new road work near the intersection of the Watterson Expressway and Route 42 suggested that the new VA would be located there.  On Dec 14, we received further official verification from United States Secretary of Veterans Affairs, Eric Shinseki, that indeed the 4906 Brownsboro Rd  address is the first choice for the new medical center.  The second choice site is the one Factory Lane near the Gene Snyder Expressway.  It was estimated that from the time financing is secured, construction will take a little more than three years.  The letter from the Secretary appears to be in response to a request from Sen. McConnell for a realistic timeline for the project.  The Veterans’ Day update quoted 5 veterans, 4 of whom expressed disappointment and a preference for staying at Zorn, one of whom was relieved that at least it would not go downtown. Continue reading “New Suburban Veteran’s Hospital for Louisville”

Open Letter to Governor Steve Beshear Concerning Acquisition of University of Louisville Hospital

Last week I submitted the following letter to the Governor’s Office.

Governor Steve Beshear
700 Capitol Avenue, Suite 100
Frankfort, Kentucky 40601

Re: Premature approval of hospital acquisition in Louisville.

Dear Governor Beshear,

You have been asked to consider approving a merger/acquisition involving the University of Louisville and University Hospital, Jewish Hospital & St. Mary’s, and the St. Joseph’s Hospital System under the auspices of Catholic Health Initiatives.   Individuals and Organizations (including women’s organizations) in the Louisville Community who have written or spoken about this matter are overwhelmingly against this merger, save for employees of the University, or its business partners.   The opposition continues unabated despite several public and private briefings.  This is in great measure because of the puzzling refusal of the proposal advocates to disclose relevant details supporting the real public or indigent-care need for the merger, or the implementation of its most controversial elements– especially those revolving around church and state issues. Continue reading “Open Letter to Governor Steve Beshear Concerning Acquisition of University of Louisville Hospital”

Let Them Eat Cake! (In somebody else’s hospital.)

I have been reviewing all of the letters sent to the Courier-Journal by members of the community.  So far, without exception, all have been employees, faculty, or associated with one of one of the proposed partner institutions, or capital venture company that benefits from the University’s commercial research program.  One of these letters is particularly painful to me.

It was written by a medical student who has not yet even begun his clinical training.  It begins by parroting an assortment of the arguments that have been made by the University and Jewish Hospital & St. Mary’s almost as if the letter were from a University official.    Nonetheless, even a medical student deserves to have their voice heard, and perhaps especially a medical student, whose training will be very much affected by the proposed change in business structure.  The last sentence however broke my heart.  When speaking about the women’s health policy regarding tubal ligations, the writer concludes, “patients who don’t want to deal with it can always choose to go elsewhere.”  This is one of the most unfeeling  comments I have seen with respect to this proposed merger/acquisition.  I hope someone has taken the student aside and counseled them. Alas, perhaps not the two faculty leaders who also wrote regarding end-of life care, “When the stipulations of the Catholic Church make it difficult to follow the patients’s and families wishes, the patient can be transferred to another facility where the desires of the patient and family can be met.”

I hope the student above can bring more sympathy to the patients he may have the privilege of attending to in the future.  Perhaps as he learns to take a medical and social history from those patients he will learn that in fact these patients do not have a choice of going elsewhere.  That is the whole point!  Shame on the University of Louisville School of Medicine, its leadership, and its faculty for creating an environment where such a statement is thought justifiable by your student.  The privilege of caring for the indigent must be earned.  In past months, the University of Louisville has in my opinion abused that privilege.  The majority of the patients, students, trainees, and employees of the proposed merged entity are not Roman Catholic, yet their most intimate personal decisions are now subject to review by somebody else’s bishop.   How can that stand?

Peter Hasselbacher, MD
Dec 5, 2011