John Livingston News

Deep Pockets – Triangular Financing

As we slowly emerge from the Covid pandemic of 2020 there will be plenty of “Monday morning quarterbacks” that will in retrospect imply that things were done wrong and that they could have done better. I am reminded of Teddy Roosevelt’s famous MAN IN THE ARENA QUOTE:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows, in the end, the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

Our President, our Governor, public health officials (especially in our state Dr. Hahn has been incredible) all carry battle scars. So in the months to come, I will let “the experts” opine about policy and decisions that were made that were right or wrong. When being critical we should all be understanding of context and circumstances under which decisions were made—many times without the information that has only recently come to light.

Today I do want to point out the differences in the processes that were used at the National level and in our own State specifically pointing out differences in leadership style and the upfront organizing of “crises management teams” and the differences in leadership between our President and his team—he conferred and they advised him, and our Governor—who deferred to the experts. Remember please that deferring only gives cover for an excuse.

The advisory group that Idaho deployed had no clinicians RN’s MD’s people who were actively taking care of sick patients. This fatal oversight grew out of a tight political alliance between our Governor and trade groups—the IMA, IACAI, IHA, that have continued even in the face of the pandemic, to leverage their influence at the expense of patient care. The one thing that can be said across the board is that after the 1st two weeks of the shutdown, the decisions that were made did not take care of the most vulnerable amongst us—the elderly and those with immune-compromised conditions. The Type 2 mitigation strategy that continues today diverts resources from the vulnerable to the young and healthy. The politicization of advisory boards across the country has led to decisions by public health officials that if made by individual practitioners would be considered negligence and malpractice. Virologists were given a back seat to Public Health Specialists in our State—not at the National level

Hospital and physician lobbyists groups that pour money into political campaigns of Governors and legislators and then receive funds controlled by Governors and legislators and who also have representation on the State advisory Boards, creates symbiotic and incestuous relationships that are ripe for abuse. In New York State Bill Hammond of the Empire Center has described a form of “triangular financing” by which the lobbies contribute to a campaign, the Governor or Legislature disperses Covid Cares Act monies to the hospitals and other special interests including physicians, who then recontribute monies from their profits back to the politicians. Having lobbyists on Covid advisory Boards representing these special interests and not having clinicians or virologists or even patients and business representatives to hold these special interests in check, creates suspicion in the public. When “stakeholders”—lobbyists are given a seat at the table and everyday citizens are no longer considered as “stakeholders” and they are the ultimate STAKEHOLDER, money becomes the goal and not patient care or the protection of the most vulnerable

Our President has recognized some of the flaws in the Covid-Cares Act and 8 weeks ago issued executive orders regarding supply chain abuses and overcharges, and the issue of “up coding” and the misuse of Covid diagnostic CPT-10 codes for billing purposes. Many practitioners—nurses, doctors, and even coders themselves have objected to this type of gaming of the system. Our Governor should issue similar Executive orders or our Legislature should pass similar legislation to codify the illegality of such abuses. Has the Covid Advisory Board in our State with its’ members representing IMA and IHA advised the Governor in this regard?

Finally, our President has demanded the representation of various clinical specialties on his team, including Public Health, Infectious Disease, and virology. He encourages descent. A consensus leadership style works poorly in a crisis—in business, in the military, or in government. Our President leads from the front. He confers with experts. There is no room in his world for “deferring”

In NY State the hospital association successfully lobbied to limit the malpractice liability for Covid patients to file suit against hospitals, nursing homes, and other providers. There is certainly a case to be made for crisis liability protection, but not at the expense of patient care and not when the most vulnerable amongst us were not protected. The negligence standard and standard of care standard will never be applied to politicians and those on “advisory boards”—and that is where the system breaks down. Those making the decisions impacting patient care and priorities had no personal skin in the game.

As part of the “out brief” that will occur when we emerge from this pandemic, we should at least look at the governance structure of the advisory boards and their make-up. At the very beginning, their actions were defined by who they represented and it wasn’t the most vulnerable, but those with the deepest pockets.

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