Why Hospitals Never Have Enough Nurses: The Explanatory Power of “Prasad’s Law” of Wealth Concentration

The conclusion is harsh, but there’s a truth that merits a broader discussion. Medical healthcare delivery is expensive because the “market forces” determine the costs of payouts. There is no “fixed cost” to the procedures (emphasis mine)

Vinay Prasad, the hematologist-oncologist who, with Adam Cifu, wrote Ending Medical Reversal and who hosts the Plenary Sessionpodcasts, complains in those podcasts that there are a number of things patients really need that he is powerless to get for them (e.g. rides to his office); but, with no problem, he can order up marginally effective and super-expensive chemotherapy regimens.

My briefer version of Prasad’s Law (as I’m dubbing it) is: 

Prasad’s Law: Medical goods and services that concentrate wealth can be paid for; medical goods and services that disperse wealth are “unaffordable.” I think this is an enlightening law with broad explanatory power; and I imagine each reader can think of their own examples.

Because we would rather . . . and we will always, in healthcare, we will pay for interventions that consolidate or concentrate wealth in the hands of fewer parties than we would ever pay for interventions that disperse wealth, and one of the things that disperses wealth is if you have a labor force of people who would provide care, would go pick up my patients, and bring them here . . .and if we took all the money we spent on like marginal and useless and mediocre drugs, and we put all that money in that social system, you’re going to hire a lot of people and you’re going to spread wealth out, but you’re not going to concentrate wealth in the hands of a few investors and that kind of thing, and so that’s why – the way in which lobbying and pressure in the society work is always to push it the other way.

Wealth concentration is a strong and harsh comment.

Hospitals are sunk costs and investments. Apart from the running costs, there is constant pressure to “upgrade” machines to deliver healthcare. Nursing staffing patterns are challenging to manage effectively because of myriad reasons. Still, they never get the market value for their efforts because there is a constant steady pool of availability (immigration, anyone?). Doctors, meanwhile, are costly (and Radiation Oncologists, rarer still) but the healthcare administrators find it difficult to accept.

The US system is an extreme form of wealth capitalism that offers perverse incentives to milk medicare and for being unnecessarily complicated. The influx of insurance and consolidation of private players cannot be reversed. Despite numerous books, thesis and competitive pressures, little ever changes because the system is structured to aggravate bureaucracy and complexity.

I agree about the mediocre chemotherapy offering marginal benefits, but they are something better than nothing. The jury is still out for solid tumours but Prasad, as a haematologist, should know that it is the only thing which works in his sphere. Yes, if you factor in CAR-TCell and incendiary expenses with the promise of “durable response”, that’s playing with fire.

Radiation Oncology works and is the cheapest form of meaningful delivery. It is a bitter truth, especially for solid tumours, that many others will find it difficult to swallow.

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