Medicare Part D Policy: The Cost to the Republican Party

Medicare Part D Policy: The Cost to the Republican Party
by Gary M. Votour, MHCA
UPDATED 04/27/2015

As a nation politically divided approaches another presidential election, health care policy will again move to the front burner of public opinion. The Democrats passed the Affordable Care Act (ACA) early in President Obama’s term, and there will be the inevitable Republican presidential candidate promising to repeal it if elected this fall. I’ll be writing more on the ACA soon, but right now I wanted to share some history from twelve years ago to show how the Republican party has a past record of using health care to win elections.

Medicare Part D was passed in 2003 in a political climate that used it as a tool to ensure the re-election of a President facing a huge deficit. It is representative of the power of lobbying forces to dictate and control public health care policy. Most importantly, it is a cautionary tale on the result of allowing the abuse of political power.


Medicare began covering the cost of some of the precription drugs that are taken at home on January 1, 2006. Known as the Medicare Part D Benefit (Part D), this benefit is administered through private insurance companies that offer Medicare approved prescription plans (PDPs) and through Medicare Advantage managed care plans that include a Part D drug benefit (MA-PDs). Part D replaced the coverage formerly provided by Medigap plans, Medicare drug discount cards and many managed care plans. (Matthews, 2006)

For many benefit recipients, Part D reduces their out of pocket expenses for prescription drugs. Patients with very high annual expenses for prescription medication generally realize a significant reduction. For patients with low incomes, however, Part D actually costs them more than they paid prior to its adoption when they were covered by state Medicaid programs. Also, because the legislation that established Part D prohibits Medicare from negotiating lower prices with drug manufacturers, the increases in costs of prescription medications are often passed on to the benefit recipients. (Matthews, 2006)

Much of this situation is due to the nature of how the Part D legislation came into being, and how this happened is a fascinating look at public health policy and how it is influenced by political agendas and profit motives from lobbying forces.

I’m going to focus on two key aspects, the first being the actual passage of Part D in the House by the Republicans in 2003. Second to this, and likely more important in terms of policy impacts is the fact that it profited the pharmaceutical industry more than anyone else by preventing Medicare from using their buying power to negotiate lower prices. I think these two examples show how public policy is often misused for both political and financial gain.

Congress in 2003

Part D has been called many things since its passage, but I believe the most accurate description is that of Comptroller General David Walker, who called it “the most fiscally irresponsible piece of legislation since the 1960s.” In 2003, the Bush administration was projecting the largest deficit in American history. The July 2003 mid-session Congressional budget review projected the fiscal year 2004 deficit would be $475 billion. With an election looming the next year, Bush and the Republican Party decided to gain the votes of America’s seniors by giving them a new program that appeared to be designed to pay for their prescription drugs. (Bartlett, 2009)

This occurred at a time when every fiscal projection pointed to a looming deficit ahead for Medicare. The 2003 Medicare trustees report projected spending was going to rise more rapidly than the payroll tax as baby boomers began to retire. Republican leaders had access to the actual costs of Part D and suppressed them before it was passed, and exerted undue influence on fellow Republicans to get the legislation enacted. The estimated cost stated to Congress was that Part D in its first ten years would incur was $395 billion.

The Bush administration knew this was not accurate. Medicare’s chief actuary, Richard Foster, had previously concluded the cost would be in excess of $535 billion. A Republican appointee at the Department of Health and Human Services, Thomas Scully, actually threatened to fire him if he made his report public before the 2003 vote. (Singer, 2007)

This was because a congressional budget resolution had already placed a cap on the projected cost at $400 billion. If the official estimate from Medicare had been made public, then it would only have taken a single member of the House or Senate to kill it by raising a point of order. (Bartlett, 2009)

There was also an unprecedented move to apply pressure on members of congress to get the law passed. Despite the fact that the Republicans held the majority in the House of Representatives, when the legislation came up for a final vote it was failing by 216 to 218. Then, even though the fifteen minutes allowed for voting came to an end, the vote was kept open for three more hours while pressure was put on republicans to change their votes.

What happened during those three hours was unseen by America, as the C-SPAN cameras were frozen by the republican leadership. House Majority Leader Tom DeLay was later ‘admonished’ by the House Ethics Committee, specifically for attempting to bribe fellow Republican Nick Smith to change his vote by promising he would ensure his son got his house seat when he retired if he voted in favor of the bill. These strong arm tactics eventually got enough Republicans to change sides, and the final vote was 220 to 215 in favor of Medicare Part D. (Bartlett, 2009)

Pharmaceutical Lobbying

In addition to a massive political gain to the Republican Party in the next election, the passage of Part D yielded tremendous financial rewards to several of its key proponents.

Thomas Scully, the man who threatened to fire Richard Foster if he disclosed the projected costs of Part D prior to the vote, was actively pursuing a job as a lobbyist at the time. In fact, when Bush appointed him to his position to run Medicare, he was a hospital industry lobbyist. Scully had already received a special ethics waiver allowing him to negotiate for future jobs with lobbying firms while he was in public office.

He left Medicare ten days after Part D was signed by Bush, and became a lobbyist again, working for pharmaceutical companies. Many of the key figures involved in passing Part D left for positions working with lobbying firms after it was passed, all with substantially higher salaries than they had before. Representative Bill Tauzin, one of the bill’s leading supporters, also left Congress shortly after the bill was passed to become president of the Pharmaceutical Research and Manufacturers of America. (Krugman, 2006)

In retrospect, it seems obvious that the political agendas of many of these key figures were influenced by their goal of pleasing their future employers. The result of these hidden agendas left behind a political mess that has cost the country billions of dollars and created a system that was flawed in several critical ways. (Krugman, 2006)

The Problem with Medicare D

The most lasting effect of Part D’s passage was to fragment the potential purchasing power of Medicare into dozens of smaller entities.

Because none of them have the power to negotiate with pharmaceutical companies to the degree that Medicare would have had, this has given the pharmaceutical industry near complete control of pricing. This is one of the main reasons why the price of prescription drugs in this country is among the highest in the world. (Bartelett, 2009)

Democrats attempted to continue to modify Part D after its passage by amendment, but they did not have the political power to do so. Attempts to extend deadlines for enrollment where met with adamant refusal by the Bush administration, most likely because deals had been made and political favors needed to be paid for. No consideration was given to the actual needs of the beneficiaries. To do so would have given Medicare the ability to control costs by negotiating prices. (Zwillich, 2006)

The ACA Solves Some Part D Problems

It was not until the passage of the Affordable Care Act (ACA) in 2010 that some these issues were finally addressed. A 55% discount was negotiated for Medicare Part D recipients with the pharmaceutical providers that includes most medications.  The infamous “donut hole” where recipients are required to pay high prices for medications until huge annual deductibles are reached is being closed and will be gone by 2020. (The ACA and Medicare, 2015). In the meantime, the “Extra Help” program was implemented as part of the ACA to provide financial assistance for those Medicare recipients making less than $13,000 a year, and provides up to $4,000 of help anually in purchasing medications. (Extra Help, 2015)


The passage and implementation of Part D was clearly a part of a larger political agenda. The one stakeholder group that most needed this law, Medicare beneficiaries, actually gained the least from it. The law ended up being written by lobbyists and entrenched the industry’s control over drug prices in the United States. It became a partisan issue, and helped assure the re-election of a president. These were the stakeholders who influenced Part D the most.

Part D was marked by an unprecedented use of lobbying power in congress coupled with a political agenda. Direct control of information by the Bush administration and strong arm tactics on the House floor accounted for a final vote that barely passed. Political payoffs in the form of future employment for those who advocated for Part D’s passage helped guarantee control over drug pricing for the drug industry.

I find that it is ironic that many Republicans who now vehemently opposed the ACA on the grounds that it will add to the national deficit are ones who voted for Part D. While Part D has already incurred a cost of $1 trillion dollars, the ACA only has an estimated cost of $900 billion.

It is also worth noting that Part D simply added to the deficit. It had no dedicated financing, no offsets to cost and no attempt to raise revenues to pay for it. The current health care law is likely to be paid for with a combination of spending cuts and tax increases, and is not likely to add to the national deficit. According to Medicare’s trustees the unfunded drug benefit added $15 trillion (in present value terms) to our national deficit.

In closing his article in Forbes, Bartlett (2009) clearly states the impact the passage of Part D had and continues to have on the credibility of Republican members of Congress: “The national debt belongs to both parties. But at least the Democrats don’t go on Fox News day after day proclaiming how fiscally conservative they are, and organize tea parties to rant about deficits, without ever putting forward any plan for reducing them. Nor do they pretend that they have no responsibility whatsoever for projected deficits, at least half of which can be traced directly to Republican policies, according to Office of Management and Budget Director Peter Orszag. It astonishes me that a party enacting anything like the drug benefit would have the chutzpah to view itself as fiscally responsible in any sense of the term. As far as I am concerned, any Republican who voted for the Medicare drug benefit has no right to criticize anything the Democrats have done in terms of adding to the national debt.” (Bartlett, 2009)

That opinion summarizes my own. It expresses the long term cost to the Republican Party of winning one election… a cost I doubt they planned for, because it was concealed from the party as a whole by members who had much to gain personally by doing so. In the political arena of public policy it is all about paying the price for what you gain, and often that cost is hidden and has very long term consequences.


Bartlett, Bruce. (2009). Republican deficit hypocrisy. 11.20.09.

Extra Help With Medicare Prescription Drug Plan Costs, Social Security Administration, (2015).

Krugman, Paul. (2006). The K street prescription. New York Times. January 20, 2006.

Matthews, Joseph. (2006). Medicare: Part D. Social Security, Medicare & Government Pensions. pp. 11/37-11/40. Berkeley, CA: Nolo Books.

Singer, Michelle. (2007). Under the influence. 60 Minutes, CBS News. April 1, 2007.

The ACA and Medicare, The Official US Government Site for Medicare, (2015).

Zwillich, Todd. (2006). Medicare Part D deadline debate heats up. The National Ledger. Apr 21, 2006.

Medical Air-rogance

Medical Air-rogance
by Gary M. Votour, MHCA

In the middle of February, 2006, I had been living in the neurosurgical ICU for the last few weeks hoping for my wife, Lyn, to wake up from a coma following a massive stroke. The stroke was a result of a high risk surgery to remove a cancerous vertebrae from her neck. Her surgeon had told us that the stroke had occurred becaus_dsc0213_475x316e Lyn had a congenital defect in her heart that had allowed a clot to reach her brain during the surgery. There was no evidence that this was the cause, and despite many tests in the coming weeks, there never was.

An expert neurosurgeon from another hospital had been flown in to consult on Lyn’s case. He had agreed with Lyn’s surgeon that the theory about her heart was valid and suggested some follow-up tests. While he was there he presented several of his cases to the surgical team of the hospital and, strangely, I had been invited to attend the presentation. I sat through a three hour presentation and watched with horror as he showed slides of his patients surgeries. I was the only person in the room not wearing a white coat. At the end he presented what he said was his most successful case.

He told us he couldn’t show pictures of the patient because the patient had not given consent, but that he had decided he could show what had been removed during the surgery. On screen was a female body, from the lower abdomen down, lying on a stainless steel table. The patient had a spinal cancer that was very advanced, and he had removed her hips and legs in order to save her life. He went on to tell the room how well she had done following the surgery, even recovering to the point where she was able to return to work as a secretary, although she had to sit in a bucket instead of a chair.

Then he explained that despite all he had done for her, she had let him down because years later she died from lung cancer. He said it was because she had so little respect for herself that she did not quit smoking. While many of the older doctors laughed along with him at that comment, most of the younger residents did not. I felt like I was in a room surrounded by humans who had fallen from God’s grace.

At the end of the presentation, I was waiting for the elevator when Lyn’s surgeon and the expert approached me. He said how much he respected me for staying by Lyn’s side, and reassured me that her surgeon had not caused the stroke. Then he asked me if I wanted to go to lunch with them. I turned away, and with a mouth tasting of bile, I said words I will forever remember… “No thank you. There would never be a restaurant large enough go hold both of your egos and still have room for me to sit in.” Foregoing the elevator, I walked down the nearby stairs, back to Lyn’s side.

Years later, I read what Max Lucado has written about air-rogance. He used the term to compare arrogance to climbing a mountain and breathing thin air.

“You can climb to high for your own good. It’s possible to ascend too far, stand to tall, and elevate too much. Linger too long at high altitudes, and two of your senses suffer. Your hearing dulls. It’s hard to hear when you are higher than they. Voices grow distant. Sentences seem muffled. And when you are up there, your eyesight dims. It’s hard to focus on people when you are so far above them. They appear so small. Little figures with no faces. You can hardly distinguish one from another. They all look alike. You don’t hear them. You don’t see them. You are above them.”

I realized that on that day I had briefly visited that mountain. What I saw there scared me so much that and I quickly climbed back down to reality. Many of the doctors in that room had been there so long they actually saw nothing wrong about their laughter regarding that patients death. They saw nothing disrespectful about that image of a discarded life, burned now into ca93bb6d5753fcf422bb810e3866a0e9my memory. Worse than all of that, they acknowledged they felt the visiting surgeon had the right to be angry and disappointed that his patient had shown HIM such disrespect. Only the newer ones, hoping to find acceptance amongst their seniors but not fully acclimated to the thin air, remained silent.

I believes God hates human air-rogance. It must make him very sad when people, especially doctors that he has gifted with great life-saving skill, decide to live on that mountain. I believe God hates to see his children fall from His grace. The Bible has much to say about pride and arrogance, many of which we have all heard before: “When pride comes, then comes disgrace, but with humility comes wisdom…. Do not keep talking so proudly or let your mouth speak such arrogance, for the Lord is a God who knows, and by him deeds are weighed… Pride only breeds quarrels, but wisdom is found in those who take advice… The eyes of the arrogant man will be humbled and the pride of men brought low… Pride goes before destruction, a haughty spirit before a fall.”

The most relevant quote is in Obadiah 1:3 “The pride of your heart has deceived you, you who live in the clefts of the rocks and make your home on the heights, you who say to yourself, ‘Who can bring me down to the ground?’ ” Isn’t it amazing that words written so long ago continue to have such relevant meaning? “The pride of your heart” is the arrogance that comes from unbalanced egotism. I say “unbalanced” because egotism is not necessarily a terrible thing- it is much like self-confidence, and it can come from a sense of self-pride that is well deserved images (5)amongst those who have great skills bestowed upon them. Yet egotism must be balanced by great compassion and humility, for to be uncaring of those who have lifted you up to that mountain is to risk a great fall from God’s grace.

The cure to medical air-rogance is humility. C.S. Lewis once wrote “Humility is not thinking less of yourself, it’s thinking of yourself less.” It means you think of others more than yourself… and is that not why most of you chose a career in medicine in the first place? “Do nothing from rivalry or conceit, but in humility count others more significant than yourselves.” (Philippians 2:3-4)

To those on that mountain, please… Come back down.

The thin air of air-rogance will not sustain you.
You can be forgiven you for being there, but only if you come back down.
When you find yourself breathing that thin air, look for the stairs.Mountain-Stairs-485x728 (1)


Do No Harm, or at Least Make No Profit From It When You Do.

Do No Harm, or at Least Make No Profit From It When You Do.
by Gary M. Votour, MHCA
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There is a really big reason why most Health Care Organizations (HCOs) do not support the changes to our health care system being driven by the Affordable Care Act… and that is that it will cut into their profits. It is time for us, as their consumers, to understand why so we can demand change. Health care in the United States is big business. As costs have been driven upward for the last fifty years, so have profits. Contrary to what many politicians like to say, the health care industry in the United States is not a free market,an economic system in which prices and wages are determined by unrestricted competition between businesses, without government regulation or fear of monopolies. In reality, the health care industry in our country has become a seller’s market,a system in which goods and services are scarce and prices relatively high. (Davis, 2013)
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ImageI am not referring to the occasional emergency room visit for a broken arm or the trip to your primary care provider for antibiotics during a relatively mild illness. In major urban and suburban areas, choices exist for those with more routine medical issues. The proliferation of “Doc in a Box” health care services, which are often franchised out like fast food restaurants, are options for those with insurance or who can self pay, and add value to their service by allowing the convenience of drop-in appointments with little or no waiting time. It is when you or someone in your life is hit with a major illness or a complicated life threatening condition that your options become narrowed to the nearby specialized care providers, and that’s where free market competition ends. When it comes to specialized care it is a seller’s market, and what they are selling for profit is life itself.
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It is all about the profit. We have “for-profit” hospitals and “non-profit” hospitals in this country. Study after study shows hospitals whose decisions are controlled by shareholders seeking profit do not offer services that do not make as much money, which in itself is hardly surprising. Instead, they specialize into the areas where the maximum profit from investment can be made. Hospitals which do not make a profit are more likely to offer the services most people need, like emergency rooms, preventative programs and home care based services. In fact, studies have shown that patient mortality rates increase when nonprofit hospitals switched to become profit-making, and their staff levels declined. Many politicians, sponsored by health care organizations making profit, argue that we need less government involvement, less regulation and more competition. American consumers hear arguments that more privatization and less governmental control will lead to lower costs and higher quality when it comes to the medical care we need. Unfortunately, a lot of people do not understand enough about the economy and what drives it to realize that these arguments are self-serving and spurious. (Porter, 2013)
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ImageThe reality is that HCOs make money providing treatment to patients, and there is money to be made whether the problem being treated is from an illness or from a complication cause by an error. This problem is even more of a concern when the patient has private insurance. A recent study published in the Journal of the American Medical Association (JAMA) found that when patients with private insurance had complications following surgery, hospitals made nearly $40,000 more profit than when there were no complications. For patients insured by Medicare, that profit is reduced to less than $1,800 for the same surgery with the same complications. The profit difference is because Medicare does not reimburse for overhead and fixed costs, it only pays for the items and services directly involved in a patient’s care. Atul Gawande, one of the studies’ co-authors and a Professor of Surgery at Harvard Medical School, said ” The magnitude of the numbers was eye-popping… That’s an indication of the level of perversity here. Having a complication was profitable, and fighting complications was highly unprofitable.”(Shute, 2013)
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The JAMA study indicates that this the case in 90% of the hospitals in this country. The reason is that there is no financial incentive to hospitals to reduce errors. The Affordable Care Act includes changes that will make changes to the system, including reductions in payments for complication related care. A major step forward are changes to Medicare that include bundled payments, where the hospital is paid the same amount for a procedure, with or without complications. They still have to provide the care, they simply will not be reimbursed for it. Even this solution is not going to solve the problem, for hospitals will simply shift the uncharged costs to their patients with private insurance. What needs to happen is reform system wide, an adoption of a consumer driven standard that takes control of the system that is running out of control. Mark Lester, executive vice President of Texas Health Resources, was another of the JAMA studies’ co-authors. “It’s just more evidence that payment reform is key to health care reform. We’ve unmasked some hidden perverse incentives that are just part of our system…. We’re all moving toward payment reform. It’s happening incrementally, because it’s very complex.” he said. (Shute, 2013)
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ImageI am not trying to build a case against a health care system based on profitability. In fact, profit is essential in health care as it can be used to drive innovation, research and ultimately improved levels of care.  If there was no profitability in health care, there would be no doctors, no nurses and no hospitals. In order for them to defend their right to make a decent living, there must be an ethical decision about when and how that profit is made. Amesh Adja summarized this belief in his recent opposing editorial in Forbes magazine. He wrote, “For those who want to preserve and extend the advances in the standard of living that have been made possible by innovations in medicine, the moral defense of profit–against those who view profit as an evil to be banished–is a crucial and necessary step.” His explanation is thorough and thought provoking. “…physicians are often considered by the public to be part of an exalted class who labor tirelessly with no thought other than serving their fellow man and are, for the most part, paid well for their sacrifice. To ascribe profit-seeking to a profession that is heralded as an embodiment of self-sacrifice would offend the sensibilities of the public and many physicians”, he wrote. He is correct, and that is where the thinking needs to change. Consumers and providers both need to acknowledge that health care is built around the concept of profitability. Once we do that, we can begin to decide where it is morally acceptable to  make that profit, and how much profit is enough. I am proposing that we declare complications that are caused by errors are not ethically profitable. (Adja, 2013)
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Can these changes be made without reducing the overall profitability of the health care system?
Of course they can, but not without the cooperation of HCOs
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At The Brigham and Women’s Hospital (The Brigham) in Boston, MA an innovative approach to reducing errors has been introduced and we should all be watching how this unfolds. Since 2011, a monthly newsletter to its 16,000 employees called “Safety Matters” has included anonymous yet detailed accounts of patient errors and descriptions of the steps they have taken to remedy them. By providing the narrative details of specific cases where errors have been made, the leadership of The Brigham are trying to make the steps needed to solve this problem. Dr. Elizabeth Nabel, The Brigham’s chief executive has said that one of her goals is to create a more open culture around medical errors, in which staff can report them and seek help without shame. She even describes the occasion when, years ago at a different hospital, she was repairing a patient’s heart valve when she accidentally punctured a ventricle of the heart with a wire. This caused bleeding and required the patient to undergo surgery.  She did disclose the error to the patient but felt she had no one else she could discuss it with besides her husband. She said, “I felt very insecure and my confidence was shaken… Think about how much easier it would have been if I could have talked to my colleagues rather than living in fear I would get stabbed in the back because I made this mistake.”  (Kowalczyk, 2013)
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Janet Barnes, The Brigham’s executive director of compliance, was at first hesitant about the project.  Concerned that disclosing errors in a public forum could give lawyers grounds for lawsuits, her staff review each newsletter to make sure the event is related factually and without editorializing. “There’s definitely a balance,’’ she said. “We want people to know we are working to improve. But you want them to come here and feel safe and not come in the door and worry.’’ Their goal is to tell of the problems they encounter in a more memorable way than a simple statistical report, so that the staff retain a greater understanding of the importance of the changes being introduced as a result. (Kowalczyk, 2013).
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ImagePhysicians take an oath, to do no harm. At it core is the belief that every patient has a right to complete autonomy, and that it is unethical for a physician to withhold information from a patient concerning any aspects of their condition or the potential positive or negative outcomes of a recommended treatment. This is in direct opposition to the traditional paternalistic views held by physicians in the past. Practitioners of medicine long considered themselves as the the givers of life saving treatment and patients as the recipients. This has its origins in the core of values defined by Hippocrates that relied on the fact that physicians had more information in the form of advanced knowledge about medicine than patients. This perspective gave them the right to make the decisions on the behalf of their less knowledgeable patients. His original precepts of medicine, which included ‘do no harm’, established the strongly paternalistic view that a patient had no need to know their current diagnosis. It was a cultural belief, not far removed from religion. Hippocrates lived in the 5th century BC, and his version of the physicians oath guided medicine (with many modifications designed to keep it in contemporary terms) until this century, when a sense of ethics began to change medicine and challenge the paternalistic physician view. (Garrett, 2010)
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In 1964, Louis Lasagna (while serving as the Academic Dean of the School of Medicine at Tufts University) wrote a new oath for doctors that is used in many medical schools today. Lasgana’s oath, in part, states “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death.  If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.  I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” (Tyson, 2001)
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Prevention is preferable to cure.  As medicine has become more and more complex, the quality of the health care services we receive as patients continues to increase. Yet with that increased complexity inevitably comes errors. The standard that we, as consumers of a very profitable segment of our economy, must insist on is a standard of excellence based on transparency. Errors must be examined to prevent them from recurring. To the 90% of hospitals still operating under the concept of profitability above all else, I challenge you… adapt to the new standards. Embrace changes being mandated regarding errors. Do not delay, do not hesitate, for your patients require it now. Our lives are the ones impacted by errors you choose to ignore and repeat.
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The Oath above contains strong words that I believe sum up the ethical principles of most doctors, and they bear repeating. “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” It is not just the oath a doctor swears to uphold, it is the ethical principle we insist that every HCO must uphold. We want them all to be like The Brigham, and embrace the changes that are coming. We are fine with them making a profit, they deserve to do so in exchange for the services they provide and the financial risks they take in doing so. At the same time, we are becoming more educated about the choices they make in pursuing that profit, and we can not and do not have to tolerate profit from errors.
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Do no harm, or at least make no profit from it when you do.
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Adlja, Amesh. 2012. “Why are profits in the healthcare sector so demonized?” Forbes OP/ED, November 01, 2012
Davis, Paula. 2013. “Learn about obscene profits of health care industry.” Standard Examiner. March 06, 2013.
Garrett, B. (2010). Health Care Ethics Principles and Problems.  5th  Ed. Boston, MA: Prentice Hall.
Kowalczyk, Liz. 2013. “Brigham and Women’s airing medical mistakes:Hospital reports errors to staff in drive for improvement”. The Boston Globe. April 09, 2013.
Porter, Eduardo. 2013. “Health Care and Profits, a Poor Mix.” New York Times, January 08, 2013
Shute, Nancy. 2013. “Quality Conundrum: Complications Boost Hospital Profits.” National Public Radio, April 16, 2013.
Tyson, P. 2001. The Hippocratic Oath Today. NOVA, PBS. March 27, 2001.