Testing patients’ patience

Stop the clock: Deadlines are fairly arbitrary markers when used by government. And if this column had actually gotten to Bites’ editor by its deadline, you’d probably be hearing even more righteous indignation in its tone. But let’s not let my hypocrisy spoil an otherwise good point, ’kay?

If the state’s self-set deadlines had been strictly observed, you’d see a lot more electric cars on California highways, those that still burned gasoline wouldn’t have MTBE in their tanks, and the strawberry industry would no longer be eating away at the ozone layer with methyl bromide.

But deadlines come and go in officialdom, sounding great and strong-minded on the front end, although they’re sometimes a pain in the political patootee to actually implement. The state budget, with its oft-missed deadline, stands as a stark annual illustration of how ineffective deadlines actually are at forcing action.

And so it was with this week’s announcement of the new patient-to-nurse ratios that the state will require of hospitals, ratios that were supposed to be in place by the start of this year, but which will now go into effect a few months from now after a public comment period.

Yet the California Nurses Association (CNA)—which sponsored the legislation creating the ratios, Assembly Bill 394—wasn’t quibbling with the timeline this week, a sure sign that they like the state’s numbers and want to play nice in making them a reality.

Beyond ratios: CNA has been making a lot of noise on this issue over the last year as the nurses sparred with hospitals over the numbers. And while SN&R and other pubs have spilled some ink over the ratios, Bites couldn’t imagine a bigger snoozer of a story than this one, on its surface at least.

Yet when you dig down, even just a little, the question of whether we want a 3-to-1 ratio in the emergency rooms or a 2-to-1 standard is actually about the failures of the managed-care systems: those we’ve seen and those still hovering on the horizon.

Designed to hold down skyrocketing health-care costs without forcing more fundamental and politically risky decisions—such as whether to limit care on patients approaching death—the managed-care system tries to ration the care we receive. And that means fewer nurses per patient.

The discussion of nurse ratios is sort of a backdoor way into the larger questions of what standard of care we should expect, what sacrifices are we willing to make to get it and what role should government play in implementing those decisions?

Because even though constant efforts are being undertaken to put Band-aids on the problems—such as nurse ratios, or a Patients Bill of Rights—the assessment of health-care experts across the political spectrum says the current system is a house of cards ready to fall.

Seniority counts: When will we see the fall? It could be sooner than you think. Just consider a seemingly obscure rule change in the Medicare+Choice program that Congress approved five years ago, which just went into effect January 1.

Luring seniors into Health Maintenance Organizations (HMOs) was supposed to cure the runaway health-care costs of the most expensive demographic—seniors. But instead, this politically influential group has experienced the same problems that the rest of us have had with HMOs, while many of the senior HMOs have been destroyed by the rising cost of care.

So to stabilize the system and prevent seniors from repeatedly jumping ship from sub-par HMOs, new Medicare rules mandate that only one such change is allowed for the next year, trapping seniors who have already made a change.

And this is a group that won’t silently suffer captivity. One Sacramento-area industry insider predicted to Bites that this change, designed to save the senior HMO market, will instead sound the death knell of managed care, as pissed-off old people start demanding reform.

It’s one thing when some young laborer complains, but quite another when it’s the Greatest Generation.