My voice mail is beginning to sound like an episode of ''ER.'' Doctors, nurses and patients are telling me stories of drama, frustration, anger and despair.
They're not talking about some exotic disease. The crippling condition they're worried about is managed care.
Two weeks ago I quoted nurses who said they would not feel safe as patients in their own hospital; staffing and care have been dangerously reduced as hospitals compete for patients in a survival-of-the-fittest struggle for HMO contracts. Health care by lowest bidder.
Since those nurses spoke out, dozens more calls and letters have backed them up, describing conditions as bad or worse at other local hospitals. Some people were willing to have their names printed; others said they'd be fired.
''Some of the people are just absolutely afraid to speak out,'' said Barbara Schare, professor of nursing at University of Cincinnati. Based on what she knows and hears from the working nurses she teaches, she said, ''I'd rather stay at home and die than go in the hospital.''
The patient:
Bob Rack says what happened to him is ''unbelievable.''
Mr. Rack has a condition that causes excruciating pain during treatments. ''I end up groveling, moaning on the floor, making noises I can't control.'' For six months he endured the agony. ''Then one day, this nurse told me I shouldn't have to put up with this.''
She told him what his doctor and insurance company had not mentioned: Visit a pain management clinic.
''This had been available, but they don't tell you about it to keep costs down,'' Mr. Rack said. Now his pain is gone. But he's sick about health care. ''Doctors have lost their individuality. They're like mechanics.''
The nurse:
As she described 16-hour shifts, staff shortages that threaten patient lives daily and constant pressure to do more with less, a nurse who has worked 25 years at a local private hospital began to cry. ''An angel sees me through,'' she said. ''So many of us have quit, we're like a revolving door.''
''You have to be extremely dedicated, watch each others' backs. ... It's not like laying pipe, where if you don't get there it doesn't get done. People's lives depend on us. We can't turn our backs, and the hospital counts on that. ... Hospitals are cutting each others' throats and the insurance companies like it.''
The doctors:
A specialist who works at two local hospitals said, ''It never matters what's important to the patient. The only thing that matters is money.''
''Since 1990, the biggest thing I notice is that it is next to impossible to get patients admitted to a hospital. I'm talking about very sick people.''
And that may be the good news. ''If I'm ever admitted, I've already told my personal physician to make sure of every person who takes care of me. They're giving custodial workers a few hours of training and expecting them to do what nurses should do.''
Mr. Rack's case was no surprise. ''We were told insurance companies don't pay for pain management anymore,'' the doctor said. ''You will see a whole lot of people suffer with chronic pain in coming years.''
He's bitter about the $250 million sale of local ChoiceCare to giant Humana, netting millions for ChoiceCare bosses: ''The whole thing was just to make all the executives rich,'' he said.
Dr. Susan Weinberg said it's not just one HMO or one hospital. ''It's happening at every hospital in the city,'' she said. ''The money has been shuffled and dealt to people who have nothing to do with direct providers of health care.''
The managed care executive:
Jim Massie, former vice president for operations of ChoiceCare, is now general manager of CIGNA in Columbus.
He was there when physicians sued ChoiceCare, accusing top executives of taking over to enrich themselves. ''The whole thrust of what ChoiceCare said was they had to, quote, preserve this valuable community resource. Who's kidding whom? It's all about money.''
''We all have shareholders. We all have a bottom line. But at what price? ...
''We'd better start listening to those nurses,'' he said. ''If we have pushed hospital administrators to the point where they compromise patient care - and, quite frankly, their own integrity - then we have a problem. Then we're all hypocrites for saying we provide quality, affordable care. Gag.''
It took some fed-up nurses to pry the cap off bottled-up frustration. They don't speak for everyone. But a lot of people who work in hospitals say it's the painful truth, and it's been covered up too long.
I don't have an answer, but it's not higher salaries for the pirates and bean counters who have hijacked health care. The most recent reports from the state of Ohio show: In 1994-95, when ChoiceCare went from non-profit to for-profit, enrollment climbed 15 percent; but administrative costs rose 77 percent, executive compensation climbed 50 percent and bonuses went up 186 percent.
The average increase in compensation for Ohio managed care executives in 1995 was 52 percent.
The patient who endured months of torture to provide the ''savings'' that pay for those bonuses wondered: ''Have they sold their souls?''
Maybe. Or maybe the problem with managed care is that the people who manage it don't care.
Peter Bronson is editorial page editor of The Enquirer. Call 768-8301, or write to 312 Elm Street, Cincinnati, Ohio 45202.
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