For-profit hospital systems are destroying healthcare
5,000 healthcare workers are set to strike in Oregon
Roughly 5,000 hospitalists, nurses, and other healthcare workers will go on strike a week from today in Oregon. According to OBGYN, Dr Jennifer Lincoln, the Oregon Nurses Association has been bargaining with Providence Health & Services for over a year, with no meaningful changes ever put on the table.
Among the requests, palliative care hospitalists asked not to be forced to travel all over the state to provide care—or at the very least, be compensated for travel expenses and time. According to Lincoln, Providence rejected this request, among a host of others.
The association also asked for signing bonuses on par with those offered to other hospitalists, but were rejected. Lincoln pointed out the OB Hospitalist staff is all-female. Coincidence, given American healthcare’s longstanding dismissal of women?
In her latest update, Lincoln points out that Oregon Public Broadcasting published a story claiming Providence wants to bargain, yet never talked to hospitalists or other care providers (they do offer quotes from a union spokesperson). The claim is laughable because, as Lincoln notes, they’ve been trying to bargain for over a year.
Similar problems are occurring elsewhere. Roughly 1,000 doctors in New York City are planning to strike just three days later. Like their counterparts in Oregon, they’re overworked, understaffed, and underpaid, all conditions which they say means they can’t provide proper care to their patients.
A major reason for both of these strikes is what you’d expect in a for-profit, shareholder-driven healthcare system :
A national shortage of doctors has led to a market where physicians working in the public healthcare system are often drawn to the private sector for dramatically higher pay, a union spokesperson said.
In October, I discussed the implications of driving billions of dollars into biotech startups focused on maximizing profits instead of using that money to invest in our public health and healthcare infrastructures. A month earlier, I detailed my own family’s struggle with our insurer, United Healthcare, and Providence (which happens to be our hospital system) when I tried to get a simple flu shot and Covid booster.
As I pointed out on Monday, there are four major types of healthcare systems in the world. America utilizes aspects of all four. This unnecessary complexity creates a cloud of confusion with which executives can hide behind—a stark reminder that it’s not only patients who lose in this system, but millions of doctors and healthcare providers across the country.
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Providence is notoriously profit-driven—ironic, given that it’s a nonprofit Catholic hospital system, which you’d think would be less bottom line-driven and more charitable. Yet you’d be wrong.
In 2022, The Oregon Department of Justice opened an investigation into their shady billing practices, following multiple lawsuits filed by the Washington state attorney for similar reasons.
The NY Times published a lengthy investigation into Providence that year as well, noting:
More than half the nation’s roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.
But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.
It’s not surprising that Providence is now using their PR machine to try to split doctors and nurses in Oregon, as Dr Lincoln noted last night. Like many other patients, I remain with Providence due to their incredible staff, as well as the fact that finding care providers that will work with my family insurance can be challenging. Of course, the latter isn’t necessarily a good reason, given that Aetna dropped Providence earlier this week, leaving thousands of patients in the dark when it comes to healthcare.
That means patients of Providence hospitals, clinics and doctors who are insured with Aetna’s employer-based and Medicare Advantage plans will now have to pay steep out-of-network fees — driving up their out-of-pocket costs — or seek care from a different provider.
Providence said about 9,000 patients with Aetna plans across Oregon would be impacted.
The only shining light this week might be the work of Health Care For All Oregon. In 2022, Oregon became the first US state to codify healthcare as a fundamental right in our state constitution. A task force is currently working to implement the first universal healthcare program in the country.
If such a program gets implemented—it’s not a given, yet—this could mimic what Tommy Douglas did for Canadian healthcare in the nineteen-fifties. By focusing solely on the province of Saskatchewan, Douglas helped implement the continent’s first single-payer, universal healthcare program. When the program—Medicare—became a success, all other provinces wanted in.
By 1961, all 10 provinces declared participation in the program. In 1984, the Canada Health Act made this system a reality for every Canadian, updating the 1968 implementation of the Medical Care Insurance Act.
America, by way of Oregon, is poised to follow in Douglas’s footsteps. We’ve already done it once, when President Lyndon Johnson implemented our own version of Medicare in 1966. Of course, American Medicare predominantly covers individuals 65 and over (there is some other criteria eligibility). We’re way past due in making such a program accessible to everyone.
That means caring for all healthcare practitioners and citizens. If the strike begins in a week, I plan on covering it on the ground here in Portland. Hopefully, Providence will come to its senses by then, but I’m certainly not holding my breath.