Workshop Talks: ER certainties: death and co-pays

September 23, 2011

by Htun Lin

A patient shows up in the emergency room, expecting care, and wanting to be seen by a doctor. But the gulf between the patient’s expectations and the reality of HMO practice is right out of “The Twilight Zone.”

Even before the patient gets to see the doctor, a healthcare worker like me walks in as part of a whole army of HMO personnel, setting in motion a battery of incomprehensible protocols–just doing our jobs as they were designed by the HMO bureaucracy. “Sir, we have a few questions…” the interview begins. Big questions before admittance are, “What other insurance do you carry? How are you going to pay for your co-payment?” The befuddled patient often asks, “Can’t you just bill me?” “No sir, our policy is that your co-pay is due at the time of service, which is now.”

No sooner than a whole gamut of admitting questionnaires is completed, in comes a discharge planner. “Sir, do you have a living trust?…If your heart stops or breathing stops, do you want us to resuscitate you?”

The patient, sometimes not even fully conscious, often looks bewildered, as if to ask, “Gee, I guess so. Doesn’t my coming to the emergency room speak for itself? Of course I want something done. And why am I being discharged before I’m even admitted?” We tell them this is just required protocol. That protocol puts discharge ahead of diagnosis and treatment.

Some days I’m not sure whether it is the patients, or those of us who have to impose these kinds of pressures on them, who are most troubled by that. Healthcare workers don’t like to be reduced to mere robots in an assembly line designed by the HMO. Both patients and workers feel dehumanized.

It is a natural human tendency to want to help heal those who are ill. In today’s HMOs, in “this economy,” that is not the bottom line. We rank and file in the ER feel a certain disquiet and apprehension, as well as indignation, as we see ourselves transformed into automatons, feeding the computer with useless information, just to earn a paycheck.

Everything we do at work is now dictated by the computer, turning healthcare workers into data entry appendages to the machine. Marx’s admonition about the factory taking “all the human interest out of work” with its deadly drone of endless repetition and speedup, is gradually permeating the healthcare assembly line.

The unions who are supposed to represent us are no help. Often their mantra is, we should be glad just to have a job “in this economy.” Why do we have to become something we don’t like in order to keep our job?


All the experts and labor “leaders” tell us daily there’s a serious recession out there. But I feel the real recession persists in our heads. It is more like a depression, a manacle on our collective thinking. Our society has made choices that dehumanize all of us. Those of us who still have a job feel scarcely more at ease than those who are chronically unemployed. Dehumanization is felt inside and outside the shop floor.

The HMO’s bottom line is not about how well the patient’s illness is treated, but how to minimize costs. They remind us employees daily that we’re a business. The corporate ethos is the survival of the business above all, over anyone else’s survival. The work is designed to efficiently get out of committing further resources to keep patients alive or get them well.

Human beings do not naturally conform to behaving like robots. In order to make this happen, the company now offers all kinds of bonuses and incentives. Managers and workers alike have to be bribed to act unnaturally. Company executives are all too happy to factor this kind of cost into the budget.

Managers get fat bonuses for keeping staffing as low as possible. The rank and file are also tantalized with the same carrot, if we achieve the goal of cost control according to the metrics prescribed by computers.

Metrics “in this economy,” is to enhance the business’s bottom line. It compels us to “downsize” our natural desire to care for others. We will not get out of this Twilight Zone unless we collectively deal with the recession inside our minds, reclaiming our own humanity in our everyday working lives.

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