Delivery of Care

Why not a nurse?

Instead of naming a male surgeon to lead the new nonprofit being set up to redefine health care for their employees, would it make more sense for Warren Buffett, Jamie Dimon and Jeff Bezos to have chosen a nurse to manage the enterprise?

Image courtesy of STAT Facebook page

The image from a recent STAT story posted on Facebook, in which the publication said it asked some of the leading experts in health care how Atul Gawande could create a new model in an imperfect industry.

By Richard Asinof
Posted 6/25/18
The impertinent question: Instead of naming surgeon Atul Gawande to lead the new nonprofit enterprise in Boston being established by Jeff Bezos, Warren Buffet and Jamie Dimon, would it have made more sense to have named a nurse?
Will Bezos, Buffett and Dimon stand up and say no to the efforts by the Trump administration to revive the practice of pre-existing conditions? When will candidates running for statewide office in 2018 in Rhode Island be asked if they can answer what a health equity zone is or a neighborhood health station is? Where are the voices promoting the importance of safe drinking water in Rhode Island as a public health issue? When will CommerceRI lead a tour of the Neighborhood Health Station now under construction in Central Falls? When will those conducting polls of likely voters in the 2018 ask questions about health care?
When I was 10 years old, I decided it was time to test whether or not I had outgrown my allergies to shellfish, enabling me to join my family for a lobster dinner. Big mistake. I had a severe allergic reaction, breaking out in hives, resulting in a family physician making a visit to my house at 2 a.m. to give me two shots of adrenalin, one in each arm, to counteract the reaction. The doctor told my mother that if I turned blue and stopped breathing, it meant that I had developed a hive in my windpipe and to call an ambulance. She later said that she stayed up all night watching me breathe while I slept, just in case.
Eighteen years later, that same family physician saved my father’s life, diagnosing him with a ruptured spleen following a tragic car accident in which my mother had been killed, a condition that the hospital doctors had somehow failed to pick up on. We were able to rush him to have emergency surgery. We buried my mother while my father was under the knife.
When I write about health care these days and reflect about the missing ingredients to the stew, I often think back to the fact that a family doctor made a house call to save my life, and then two decades later, intervened to save my father’s life, responding in the early morning hours. Today, that kind of relationship and response does not seem to be possible.

BOSTON – The big news in health care last week was that Atul Gawande, 52, a professor at Harvard Medical School, a surgeon at Brigham and Womens Hospital in Boston, and a staff writer for the New Yorker magazine, has been named the CEO of the new nonprofit health care organization being created by Warren Buffett, Jamie Dimon and Jeff Bezos to manage the health care of their more than 1 million combined employees.

The only apparent compromise in Gawande’s busy schedule is his decision to step down as executive director of Ariadne Labs, a research center he founded, but maintain his position as board chair.

The selection of Gawande, who will assume his new role on July 9, has left numerous health care pundits to puzzle over what will be his approach to control health care costs.

For ConvergenceRI, the impertinent question, in the best tradition of Studs Terkel, is to ask: why not name a nurse to take the helm rather than a male surgeon?

Anyone who is deeply involved in the delivery of health care recognizes that nurses run the day-to-day operations of most hospitals, not doctors. The future of health care will be rooted in primary care and prevention in community-based health care, not in surgery or in the preservation of the financial health of hospitals.

If women hold up more than half the sky, as the Chinese adage goes, nurses hold up more than two-thirds of the health care delivery system.

Another impertinent question: given that the current health care delivery system is only responsible for, at best, about 15-20 percent of all health outcomes, will the new nonprofit be willing to make investments outside of the current health care delivery system model, which some have called a wealth extraction system?

For example, investments in Rhode Island innovations such as health equity zones, or community-based Neighborhood Health Stations in Central Falls and Scituate, organized around providing integrated primary care that serves the needs of the residents, not the providers.

[The disliked fact is that most politicians and health care reporters in Rhode Island cannot describe what a health equity zone or a neighborhood health station is, or, for that matter, what an accountable entity is.]

A third impertinent question: will the new, as yet unnamed nonprofit enterprise adopt the primary care model developed by Iora Health, created by Dr. Rushika Fernandopulle, co-founder and CEO, which markets its approach as “restoring humanity to health care,” putting people first?

That model, as Fernandopulle described it during at talk at the Warren Alpert Medical School in September of 2017, is dependent on deploying a network of community health workers focused on better management of employer health benefits.

A fourth impertinent question: how invested in the politics of health care are Dimon, Bezos and Buffett willing to become? This trio of very wealthy white men defines the top tier of the U.S. economic system, the top 1 percent.

Pre-existing conditions, once a health insurance company barrier to securing coverage that was ended by the Affordable Care Act, are now back in play, as the Trump administration seeks to make that policy the law of the land again.

The estimate by some researchers is that more than half of women and girls nationwide – some 67 million – have pre-existing conditions. There are approximately 6 million pregnancies each year, once a commonly cited reason for denying insurance coverage before the Affordable Care Act.

Any attempt to control medical costs as part of the new nonprofit enterprise will be threatened by the Trump administration’s efforts to revive pre-existing conditions as a potential barrier to health care insurance coverage. Will Dimon, Bezos and Buffett intervene legally and politically?

How onerous can be the way that pre-existing conditions are applied? Let me share a personal story: In 1989, my wife had to refuse a job she had been offered by a major health care agency in Providence, because, newly pregnant, she was told by the health insurance carrier for the agency’s employees that her pregnancy was a “pre-existing” condition, and the estimated medical costs of up to $20,000 of health care during pregnancy and birth would not be covered.

Times and policies have changed; there are far more egregious examples, many for cancer patients, related to health insurance policies related to pre-existing conditions.

Finally, there is the reality that to combat the ever-escalating medical costs, we must confront the need to change the way we think about disease, particularly chronic disease, putting the focus on prevention, public health and environmental protection.


No comments on this story | Please log in to comment by clicking here
Please log in or register to add your comment

© | subscribe | contact us | report problem | About | Advertise

powered by creative circle media solutions

Join the conversation

Want to get ConvergenceRI
in your inbox every Monday?

Type of subscription (choose one):

We will contact you with subscription details.

Thank you for subscribing!

We will contact you shortly with subscription details.