Force and Direction

Living close to Brooklyn, the news is filled with stories of hospital closings.  Long Island College Hospital (LICH) is fighting to close, and Interfaith Medical Center is following close behind.  Throw in the fact that Coney Island Hospital is still recovering from Hurricane Sandy, and future hospital care in Brooklyn looks pretty dismal.  All the news is focused on LICH and Interfaith, but I haven’t found a single article about how these closings are affecting (and will affect) the ones that are still open.  I suspect that they are over capacity and will burst at the seams once these two hospitals officially close.

So here is my step-by-step prediction… Other area hospitals will quickly see a significant increase in traffic to their doors.  With limits on beds, staff, supplies, and resources, wait times at the hospital will exponentially grow.  Hospital staff will have to start triaging patients – taking care of the sickest people first.  Even with triage, some of the sickest people will not get medical attention just based on the short supply of health services and the high demand for them.  At some point, a patient – or two or three – will die while waiting for medical attention.  The families of these patients will sue the hospital, doctors, and staff for neglect, manslaughter, and other acts.  Since most hospitals are not big profit centers, they will struggle to survive as the costs begin to outweigh revenue.

At this point, hospital administrators will have two choices.  First, they can turn patients away at the door and send them to other hospitals.  This choice may help them control costs but there is still a risk of litigation as patients may sue for being turned away.  Second, they can file for bankruptcy and close their doors as the costs to stay open, costs of pending litigation, and costs of probable payments to the families will be too much for the hospital to bear.  I suspect that many hospitals will fall into the second bucket – maybe not by choice but by pure economic forces of not being able to pay the costs of staying open.  My prediction is that more hospitals will close, and we will reach a breaking point in our healthcare system where hospitals as we know them will no longer exist.

Sounds pretty bleak, huh?  And the problem is that it’s not just Brooklyn.  The collapse of hospitals will occur all over the country.

But we were warned.  We knew that something like this would happen.  It’s an epidemic that we’ve been warned about for years.  Hillary Clinton fought for healthcare reform years ago.  President Obama started his first term pushing for healthcare reform.  Clayton Christensen wrote “The Innovator’s Prescription” in 2009 which lays out the problems that we have in our current system.  We’ve been given dates when Medicare and Medicaid will run out of money.  We can’t act like we didn’t know this would happen.  The warnings have been there for far too long.

So what do we do when we hit the breaking point?  The answer: We learn to adapt.  We learn to be Americans again – those tough, independent people that didn’t want a hand out and only wanted freedom and opportunity.  We have to.  Healthcare has become an entitlement in this country, and unfortunately, it’s an entitlement that we can’t afford.  We must start now in taking care of ourselves.  We must eat better and exercise more.  We must have annual checkups to find problems before they become big, and we must learn about diseases we have and how to help ourselves.

We must also make plans for our personal end-of-life decisions and think about the impact of those choices on our children and their children’s children.  Did you know that the last two months of a person’s life garners the most healthcare expenses over their entire lives?  And that most of those expenses are for life-saving actions that will only help for a few days or even a couple of hours?  We have to think about end of life and what that means.  We have to think about what we as individuals want in our last days.  So many actions that are currently taken are simply those of family members who are in denial about their loved one’s prognosis and are grasping at anything to keep their loved ones alive – even if those loved ones are in pain and ready to move on.  Ken Murray wrote an excellent article last year entitled “Why Doctors Die Differently”.  I hope you’ll take a moment to read it, think about what you want in your last days, and communicate those choices with family members.

What do you think?  Do you agree with my prediction on hospital closings or not?  What do you see happening in hospitals in your city?

The American Medical Association recently reclassified obesity as a disease instead of a major public health problem.  This change has been heavily discussed in my household over the past few weeks.

On the positive side, this reclassification can be a “wake-up call” to those people classified as obese.  By telling people that they have a disease, many will seek treatment for it.  Those who haven’t considered their weight to be a problem may decide that they need to make changes in their lives to reduce their weight.  This change will also make more treatments and procedures available to them.

On the negative side, how will our already-over-extended healthcare system handle more treatments and procedures?  Will some with the disease see themselves as victims and demand a higher level of care and consideration?  How will insurance companies handle the change in classification?  And as we transition into our new healthcare system, how will this new classification affect treatment plans and insurance rates?  Our household is curious to see how this decision plays out.  How about yours?