I’ve been giving a lot of thought about my experiences in grad school and about the 25 years working in the health care industry. And I want to say something I’ve needed to for a very long time. You see, I didn’t go to grad school for hospital administration because I loved the idea of being in health care. My parents pushed me to because they didn’t think I could make a living following my long-held dream of being a writer. Why that’s so is a story for another time.
These facts may be 57 years old. But, I was there, bore witness and remember them clearly.
In 1967, I enrolled in the master’s program in Hospital and Health Administration at the University of Iowa. It was a structured program; the first two 15-hour semesters led to a summer “internship,” followed by another two-semester-15-hour stint. The final semester was focused on the masters thesis. It was lock-step. The program sought to turn out administrative practitioners and doctoral graduates who would enter the field as either researchers and/or academicians.
The Iowa program was headed by an academician credited as one of the founders of the field of health care administration, the late Gerhard Hartman. Hartman was a Prussian to the core. And a tyrant. A dishonest tyrant. And, a petty tyrant at that. I will never forget Hartman referring to the doctoral student who was my thesis “supervisor” as a “martinet” in front of my entire class. So, what, in addition to his mean spirit, what else did students learn under Hartman’s tutelage?
Modeling behavior is an effective way to teach, to instill values and mold character. What did Hartman model? That it was acceptable to engage in private consulting services using the university’s resources for copying, typing and charging other expenses to the university funds. That it was acceptable to pass off the students’ research and writing as his own in a consulting report. And, that it was acceptable to exploit people; he required the students’ parts of the consulting report to be professionally typed — and paid for by the students.
Even with Hartman gone, the program put him on a pedestal with self-serving puffery and egregious dishonesty. One of Hartman’s “pets,” the late Sam Levey, wrote a monograph about the program’s history incorporating information about Hartman and his legacy. That monograph failed to address the realities of how Hartman ran the program. In short, it was a cover-up. A snow job. And worse, people at the university and in the program who knew the truth about Hartman let the publication stand as is. What does that mean for the credibility of such academic research? As an editor and publisher, the story would have been fact-checked; and finding these flaws, I would have spiked the story and fired the reporter. I am sure in another time and place, Hartman and Trump would have been great chums.
Finally, although Hartman and his henchmen claimed to train leaders in health management and policy, I have no memory of any Iowa graduate take a strong stand for fixing the health care system. And, from the time I enrolled in the program in 1967 until I left the field and subsequently severed ties with Iowa and the industry, I was never aware of an Iowa leader taking a stand on the radical steps needed to reshape the United States’ medical-health-industrial complex. In fact, strong stands were discouraged.
Meanwhile, in the almost 60 years since my time in the health care system, little of the industry's core has changed. As a nation, we tolerate the capitalist medical-industrial complex. Despite what politicians and others would have you believe, adding drugs to Medicare benefits and passing the Affordable Care Act needed major concessions to BigPharma, BigInsurance and BigEquipment. So while politicians and BigMedia propagandized by touting the benefits of these measures, the truth was buried and the umpteen-year-old so-called health care cost “crisis” continued.
How long have these observations festered? Probably since 1968, when I saw “The Graduate” and failed to understand the message: Live your life as you wish it. But, wait, Don Pardo, “There’s more.” During my second year, I enrolled in a photography course offered through the student union and almost washed my master’s thesis down the darkroom drain. How I wish I had.
After 25 mostly miserable years in the field, I had enough. I took a part-time job and went back to school. It took one journalism course before landing an internship covering the Colorado Legislature’s 1996 session and, then, my first job as a cub reporter. My drive to do investigative reporting scratched my anger itch and fueled my desire to hold to account those who need to be held responsible. I am proud of the work I did in journalism. I cherish the friends, the memories and the awards.
Few would dispute that the health and medical care system is deeply flawed and needs radical repair. “Medicare for All” would be a good start since we know that, despite swipes at government bureaucracy, the Centers for Medicare & Medicaid Services is far more efficient than BigInsurance. We need to de-fang the BigPharma, BigInsurance and BigEquipment lobbies. Pundits are only partly right when they lash out at physicians and hospital systems for the exorbitant health care costs. The inflation is driven by the choices forced into legislation by these lobbies. Failure to institute negotiation to lower drug prices for Medicare’s Part D is one example. “Saint” Ronald Reagan’s destruction of “Certificate of Need” and other measures to staunch duplication of services leading to unhealthy competition and inefficiency is another. And the propaganda that “free market” competition was good for health care and medicine? That was another “big lie,” and as false as “trickle down” economics. Joseph Goebbels would have been proud.
Which brings me back to the leadership in the hospital space. Graduate programs like Iowa’s have ceded their legitimacy to call the policy shots. Training administrators to game the system under the guise of fiduciary responsibilities is a cover and the perfect example of Albert Einstein’s definition of crazy. You can’t keep doing the same thing and expect a different result; unless of course this is all a kabuki dance with dancers who don’t want to change the tune.
It’s time for the clinicians seize control of the health care system. The leadership of hospitals and hospital systems should lie with physicians and other clinicians. One example of this successful paradigm is the Houston Methodist Hospital system. Those who come through the hospital management programs can be secondary players serving, as Ward Churchill said, “Little Eichmanns.” They and the other specialties like accounting and IT will have their proper roles. But the ship needs navigation by those who most understand what’s really going on at the patient level.
I didn’t have the courage in 1968 to walk out of the program and become a whistleblower. But in 1995 I took the steps that let me do more good than a lifetime of professional cowardice. The 22 years of comforting the afflicted and afflicting the comfortable were the most fulfilling of my work life. For those of you who have dreams to follow, do so. Now.
