Irony lives. Many pundits declared it dead after last fall's terrorist attacks as the mood of the country turned somber. But time went by, the numbness subsided, and we discovered life was still the same old story of foibles and incongruities. The Enron/Andersen debacle reminded us of that early this year.
Healthcare offers a mother lode of contradictions and unintended humor. Consider these recent developments:
* Only a couple of years ago, providers were rubbing their hands and dreaming of how they would spend the federal budget surpluses. Lawmakers approved relief from much of the 1997 Balanced Budget Act Medicare restrictions, and the good times really began to roll.
Then the dot-com bubble burst, sending the stock market and the economy on a financial slalom. We elected a president who served up tax cuts as a remedy for everything from the recession to the common cold. Sept. 11 sent the economy on an even steeper slide, and federal spending escalated. Not surprisingly, the surpluses dwindled just as Congress and the administration developed an appetite for prescription drug benefits.
In short, we find ourselves pretty close to where we started: Money is tight once more.
Then Congress directed HHS Secretary Tommy Thompson and White House Budget Director Mitchell Daniels to come up with a plan to shift the Medicare money around. They finally decided hospitals should lose to physicians in the zero-sum game of reimbursement, setting up a provider vs. provider struggle.
So much for progress and the champagne wishes of hospital lobbyists and executives.
* And why did the Bush administration target hospitals? As Washington Bureau Chief Ed Lovern reported (March 25, p. 25), Thomas Scully, administrator of the Centers for Medicare and Medicaid Services, apparently believes hospitals are faring well financially.
This is the same Thomas Scully who once headed the Federation of American Hospitals. We remember because he objected to an editorial on this page almost two years ago. At that time, we suggested that an investment analyst's upbeat assessment of for-profit companies was correct and could apply to much of the not-for-profit sector. The report put hospital representatives in an awkward spot. They were pleading for more government money while an industry observer said many institutions are financially healthy. But in the end, Mr. Scully proved that Einstein was right: The universe does appear different depending on the position of the observer. The evidence indicates he now believes hospitals enjoy smooth financial sailing.
We cannot wait to see what he believes in his next position.
* When the nonrich and nonfamous die as a result of medical errors, the story often ends in silence and maybe a small settlement. Journalists for the most part are a low-paid lot, but when they or their close relatives die, questions are asked very publicly. Sometimes corrective action is taken.
After the daughter of a prominent New York journalist died in an incident alleged to have been worsened by inadequate care, the state began regulating resident hours. When a chemotherapy overdose killed a Boston Globe health columnist, the incident prompted reprimands, an overhaul of the Dana-Farber Cancer Institute's procedures and a renewed debate on medical errors.
In the latest case, the state health department fined Mount Sinai Medical Center in New York $48,000 for the death of a patient under what can loosely be described as its postoperative care. Michael Hurewitz, a reporter for the Times Union of Albany, died three days after surgery as a living liver donor for his brother. State officials cited the hospital for 18 violations and have expanded their probe. Perhaps if enough journalists are killed, the hospital industry will fix the problems that lead to patient deaths. So far, it seems content mainly to form committees and shoot down proposals from safety experts and payer groups. Some statistical whiz or enterprising health administration student could calculate just how many scribes have to die to achieve reform. The study could be useful to journalism schools and life insurance companies.
In the meantime, keep laughing at the irony. Unless you prefer to cry.