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Privatizing insanity

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The same story is turning up over and over again these days: Public health concerns that are the result of the insane notion that private and public institutions can take care of the poorest, sickest among us and make money doing it. It's the story behind the disgusting treatment of soldiers at the Walter Reed Army Medical Center, the collapse of the mental health system in North Carolina, the corporatization of UNC Health Care, and obscene bonuses paid by Blue Cross and Blue Shield of North Carolina.

At Walter Reed, the mold, mouse-droppings and holes in the ceiling of now-infamous Building 18 are just the most graphic signs of a system that broke down under the weight of soldiers coming back from Iraq and Afghanistan. One cause, according to the U.S. House Committee on Oversight and Government Reform—citing a memo by the garrison commander—is "the Army's decision to privatize support services ... causing an exodus of 'highly skilled and experienced personnel.' As a result ... 'operations and patient care services are at risk of mission failure.'" Specifically, a $120 million contract was given to IAP Worldwide Services even though the Army had determined it was cheaper to do the work in-house. But IAP—led by Al Neffgen, a former Halliburton executive who previously had to testify about Halliburton's exorbitant overcharges in Iraq—protested and had the decision overturned. That's when conditions and health care went down the tubes.

Closer to home, story after story details the breakdown of North Carolina's mental health system after the so-called reform law of 2001, the centerpiece of which was privatization. Now, the state gets a D+ from the National Alliance for the Mentally Ill, private caregivers contracted by counties are going belly-up, state hospitals that were due to close (like Dorothea Dix) are filling up again, and thousands of sick people are suffering.

At UNC Hospitals, retired UNC medical school professor John Hammond chronicled in our pages on Jan. 17 the way pressure to increase profits led to staff cuts, higher fees, overly aggressive collections and reduced access for indigent patients—while administrators and doctors were rewarded with more than $2.5 million in bonuses for a job well done.

Those bonuses pale compared to the ones paid to top executives at BCBS—technically a nonprofit with a mission of serving the health-care needs of North Carolinians. As premiums rose 6 percent and the company's net income jumped 13 percent, CEO Bob Greczyn received a $2.2 million bonus—all by himself—on top of his $862,000 salary.

The problem is a system that is in chaos until we acknowledge that health care is a universal need and a public responsibility. Until then, execs will get richer, the poor will get sicker, and the rest of us will pay the price.

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