Ho Jo Health Care 101

Health care administrators and those who teach them try to fathom the low esteem they are held in without much success. “I was talking to one health care CEO and he said, ‘We no longer want to be the Ritz Carlton of health care,’” Harvard’s David A. Shore said at the Cato Institute last month. “He said, ‘We just got a look at our balance sheet and now we want to be the Holiday Inn.’”

Georgetown Law Professor Heidi Feldman questions even the more exalted of these metaphoric hosteling goals. “Ritz Carlton has been most well known lately for bankrupt properties,” she said at the Cato forum that Dr. Shore also addressed.

With the view the public takes of health care providers, they would be lucky to be compared to Howard Johnson’s, the ubiquitous hotel chain of the 1970s whose orange-roofed entrances are nearly impossible to find today. Nearly half of the people Dr. Shore surveyed thought that health insurers should be more regulated.

As it happens, many hospitals have scaled back their imaging goals accordingly. Two that Dr. Shore hears were: “We’re better than tobacco” and “All we’re trying to be is the prettiest pig on the truck.”

Dr. Shore is the director of the Trust Initiative and Associate Dean at the Harvard School of Public Health. “Trust tops the list of what people find important in health care in every poll,” he notes.

“Trust is an empty vessel and could be for better or for worse,” Dr. Feldman argued. She avers that the effective delivery of goods and services is of paramount concern to patients.

The usual answer to heath care woes is to seek government interference. The Nixon Commission on malpractice, for example, recommended some form of nationalized health care, Dr. Feldman points out.

Even though that has not happened officially, the federal government’s role in providing health care has grown dramatically over the past four decades, particularly with the introduction of Medicare for the elderly and Medicaid for the poor. “My grandfather 40 years ago was a country doctor,” Sigrid Fry-Revere of Cato remembered. “He had many patients for whom he had no paperwork and no government oversight.”

“People would tip their hat to him and sometimes we would find cakes on the doorstep when we got home.” Fry-Revere serves as director of Bioethics Studies at Cato.

Malcolm A. Kline is the executive director of Accuracy in Academia.