What’s on your corner? Trends in ‘progress’

Back in the 60’s and 70’s corners were covered with gas stations. Walking to elementary school there were three in a row- all were real gas stations, not the mini-marts of today, with repair bays, and guys who would not only pump your gas (it wasn’t legal to do self-serve) but also knew how to change your oil or do a tune-up.

In the 80’s and early 90’s it was drug stores moving in. Not, the mom-n-pop of old, but national chains. Each with an almost identical selection of the same sundries to go with your script.

Although it started on the West Coast in the 80’s- it didn’t hit the Midwest until almost 2000- the coffee shop made a bid for storefront dominance. Now, water over beans was going for as much as overpriced gas and OPEC didn’t set the price of beans.

The new trend seems to be medical facilities. No longer are we hosting the local general practitioner (who has almost gone the way of the local mechanic) but mini-hospitals. These are wildly expensive buildings holding a plethora of the latest medical technology. So, as our cars got too complicated to fix at a local garage, apparently our bodies did too. Common sense preventive general medicine has been replaced with temples of technology, ready to peer at you with every kind of gamma ray/knife/scan/test possible. Doctors have become  dependent on these tools not just to make their diagnosis, but to protect themselves from lawsuits. Never mind the fact they are paid more for running more tests, instead of for actually taking care of people.

The really strange thing about capitalistic medicine is that these institutions advertise like crazy to establish some sort of branded pecking order in the community. They can’t actually say they are better than the competition, so they pay “independent” review companies to give them grades- adding even more cost to the delivery of services. Remember, you can’t have the same heart attack twice to do a double blind test on outcomes, but, for some reason, these testing firms are more than happy to pronounce anyone who pays their fee as one of the “Top 100” whatever.

The doppelganger on the advertising is that no one really wants to go to a hospital. In fact, most people want to avoid going to the hospital at all costs (partially because the cost of doing so is enough to kill all but the healthiest bank accounts). All those millions spent on reviews and on advertising- are millions not spent on improving care or lowering prices. When was the last time you heard of a hospital offering a “Sale” or even mentioning price as a competitive price point?

One last observation in the shift from independent doctors to the network, is that small medical offices pay property taxes. Large “not-for-profit” hospitals do not. Claiming they have some great value to the community, even while building themselves into a price structure few can afford, hospitals get a free pass on property tax, so while they may bring income taxes to a community and jobs, they cut property tax receipts with each new facility.

Looking to an America with health care that is accessible to all, we’ve built a system that is exactly the opposite of what we’ll need. Instead of local proactive health maintenance offices close to each community, we’ve got Goliaths of high-tech that were built for reactive care at high costs.

They call this progress?

Before we build any more hospitals, maybe we should be considering how to deliver health care centered on the patient, instead of the system.

See these stories in the Dayton Daily News for the details of the local hospital race:

The economy may be in the doldrums but at least one sector is flying high in the Dayton region: hospital construction.

All told, 22 projects totaling more than $1 billion were either completed in the last year or are in the works. They include two hospital replacements (Middletown and Springfield), one major modernization (Greenville), three major heart treatment centers (Dayton and Kettering) and 10 hospital satellite facilities aimed at competing for private pay patients in the suburbs.

Hospitals keep building in hard times ^[1].

But under the current system of pay, hospitals have no incentive to improve their efficiency, only to expand their capacity to deliver more care to more people, consumer advocates say. Hospitals and doctors are rewarded for performing procedures and hospitalizing patients — not for finding ways of keeping them healthy and out of the hospital.

“More care is not always better care,” said Bill Hayes, president of the Ohio Health Insurance Institute in Columbus. A growing amount of data from think tanks like The Dartmouth Institute show that “areas that spend more on patient care don’t necessarily produce good outcomes, and may sometimes produce less good outcomes,” Hayes said.

Is hospital construction boom good for area? ^[2].