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1 Pay Caps in Healthcare Stephanie D. O’Neal Arizona State University Professor Kane Sociology 352: Social Change

PAY CAPS IN HEALTHCARE 2 Cutting off salaries in healthcare It is no secret that the medical industry has sustainable income with the never-ending increasing diseases, growing illnesses, changing lifestyles of people, rapid growth of technology advancements and demand for faster, more efficient delivery of healthcare. The US Bureau of Labor Statistics projects that employment in healthcare is expected to grow at about 16% in the next decade and that doctors and surgeons make an average of $208,000 per year (bls.gov, 2021) Physicians and surgeons, especially those who have specialties, diagnose, and treat injuries or illnesses that seem to be ever-growing. Health maintenance has become very common, and it seems everyone that you know has some form of a diagnosable disease. No wonder why it has become a profitable industry for pharmaceutical companies over the last few decades. Pharmaceutical companies, or Big Pharma, as often referred to makes tons of money. One of the ways they make so much is that their drugs, are targeted at what could make them the most money. So, they target specific patients that are seemed to be profitable, meaning they will use the drugs the longest and have a chronic condition that will require a repeated prescription. I fear calling them medications, because in my opinion, medications treat something and the way these drugs are pushed don’t deserve that type of acknowledgement. We’ve seen this though in cases where opioids are highly addictive and pharmaceutical companies are pushing prescribing doctors to prescribe their drug, knowing that they falsely advertise the medication and lie about its benefits. This was the case in the OxyContin federal case which was just settled in 2020 (Isidore, 2020) Pharmaceutical companies also patent everything, in which that causes a monopoly over drugs that they own rights too. This is often seen with common medications like insulin, and EpiPen’s. The maker of EpiPen’s, which is a company called Mylan that acquired them in 2007 and quickly controlled 85% of the market since another competitor of a similar

PAY CAPS IN HEALTHCARE 3 injection pen backed out after faulty issues with their product, and Mylan’s development of a school program that places EpiPen’s in more than 65,000 schools and even a partnership with Walt Disney Parks (LaMotta, 2016) With all of this control, it doesn’t make sense that health care hasn’t faced caps on salaries as of yet. Our capital industry in healthcare is running ramped. Furthermore, things like vaccines are considered non-profitable because they are a one- time use product and doesn’t keep a large market pursing them, at least until COVID came around. With the turn of COVID in healthcare, we have seen how further expensive healthcare can get. ICUs became quickly full, hospitals with no beds, medical staff overworked and exhausted. Companies couldn’t make equipment fast enough. Suddenly emergency funding to staff hospitals and care for the sick and ill became available under former President Trumps emergency coronavirus spending bills. Then came questions of where was this funding going to? Nurses and staff who make an average of $75,330 with a bachelor’s degree, although only an associate degree is required to become a nurse, found that they could partake in the pandemic funding by joining a traveling company and making three times as much for the same if not better workload (bls.gov, 2021) Nurses and hospital staff weren’t seeing it in anything other than overtime pay and call out pay for shift coverages. In our country of private market options for healthcare funding was most likely to going into mitigating economic costs of the pandemic. So, nurses who could leave and move to a traveling company to make more money for the largely increased workload did just that. Once social media caught the attention of that, I began hearing a stir of capping salaries for not only nurses but healthcare in general. Why wouldn’t that be a good idea? Not just for nurses but for healthcare in general, pharmaceutical companies, hospitalist, and anyone else involved. If we don’t stop it at funding and pay, where does it stop? It seems that the only people

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PAY CAPS IN HEALTHCARE 4 that suffer in the expenses of the rising cost of healthcare and its’ workers are the patients, particularly the elderly and those much more vulnerable to having healthcare become a necessity. There are not many, in fact, I couldn’t find any, peer reviewed articles related to the effects of capping pay, because it’s not something that has ever been done in our country in healthcare. Pay caps are often seen in sporting leagues to keep teams in healthy competition with each other. Yet, if we could standardize a way to pay people in the healthcare industry, we might just be able to provide better care without all the hurdles that stand in the way currently. This would lead us towards a universal healthcare system, much like in Canada and other countries and I did find peer reviewed articles on that. Universal healthcare provides several advantages such as increasing health care preventative initiatives and addressing the chronic diseases that plague most people like diabetes, cardiovascular disease and hopefully improve people’s overall health (Zieff et al., 2020)

PAY CAPS IN HEALTHCARE 5 Not cutting off salaries in healthcare Healthcare is a solid industry that provides security because it’s always going to be there. Jobs are always going to be available because we as a species will continue to get ill, need aid in getting better, advances in technology will continue to grow and disease processes will continue to change. Just look at the latest with COVID and how many variants there were from this one virus. Healthcare is an arguable topic in the United States. The US has many different populations of people and all with different healthcare needs. During COVID it is understandable that so much money was spent on healthcare. This was a major pandemic that effected every part of the world. The American Hospital Association reports that hospitals nationwide lost an estimated $54 billion in net income in 2021 and this was even with taking into account the coronavirus aid and relief provided by the CARES act (aha.org, 2021) Factors that contribute to the rising costs that we faced amid the pandemic were sicker patients, higher expenses and fewer outpatient visits because hospitals remained depressed of care with higher patient ratios (aha.org, 2021) Still it is estimated that more than a third of US hospitals are going to re main in a deficit throughout this year (aha.org, 2021) Any funding away from healthcare is never a good idea. What most people don’t understand is how much funding goes into your care. You need at least an associate degree to become a nurse and depending upon the facility, a bachelors to be able to work in a specialized ICU or critical care setting. This meant a lack of staff was available and hospital staff were also getting sick meaning they couldn’t come to work. So, there was an increase in labor costs, along with personal protective equipment needed for a higher acuity of patients (aha.org, 2021) All of these things add up into an extended cost that was not budgeted.

PAY CAPS IN HEALTHCARE 6 Being overwhelmed with the current conditions, some nurses, aids, respiratory therapist began reaping the benefits of travel assignments that would lead to an increase of pay for a higher workload. Travel nursing became a profitable position filling the gaps that hospitals were left in short, staffed schedules (Eschner, 2021) While this led to nursing agencies being accused of exploding the pandemic, what wasn’t known was that about 18% of healthcare workers quit between February 2020 and September 2021, even further disrupting the healthcare workforce (Vesoulis & Abrams, 2022) There has been such a rapid turnover in which contract nursing has increased its pay to accommodate. Travel nurses at most facilities rose to 164% in the fourth quarter in 2021 (Vesoulis & Abrams, 2021) If there were government involvement or capping on salaries for these workers, it is likely we wouldn’t have been able to sustain care during this situation. That is already the case at many long-term care facilities who are governed by Medicaid and Medicare (Vesoulis & Abrams, 2021) Decreasing funding and providing pay caps doesn’t help anyone provide better care. When funding is cut, it isn’t usually the CEO who takes a cut, it is the staff and workers who are expected to do more with less. Capping salaries and funds would mean inadequate care and insufficient staff.

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PAY CAPS IN HEALTHCARE 7 Reveal So, in my actual opinion, is I don’t care for capping healthcare at all in our current healthcare situation. I am in support of a more universal health care system. The road to that system becoming in place in the United States doesn’t seem to be getting worked on anytime soon. It would be a careful navigated path we would have to take to ensure that healthcare could be provided, monopolies of medications would have to stop and providing preventative care to reduce chronic disease and ensure the better quality of health of our overall population. In a peer reviewed article, I found discussing universal healthcare, it notes that there are logistic challenges and upfront cost that are going to be cut by large corporations of pharmaceuticals but in the long term would lead to a healthier populace. The diabetic population alone is responsible for about 55% of emergency room visits (Zieff, 2020) In other countries with this model already in place, things like diabetes are better controlled. The downfall would be the involvement of government into people’s care, but the uninsured community would benefit as well, and I think that would lead to an overall positive care of people by our nation.

PAY CAPS IN HEALTHCARE 8 References Eschner, K. (2021, December 21). As covid surges, 'travel nurses' are in more demand than ever and can make $5,000 per week . Fortune. Retrieved March 2, 2022, from https://fortune.com/2021/12/21/travel-nursing-jobs-careers-salary-covid-omicron-surge/ Financial effects of covid-19: Hospital outlook for the remainder of 2021: AHA . American Hospital Association. (n.d.). Retrieved March 2, 2022, from https://www.aha.org/guidesreports/2021-09-21-financial-effects-covid-19-hospital- outlook-remainder-2021 Isidore, C. (2020, October 22). Oxycontin Maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company . CNN. Retrieved March 2, 2022, from https://edition.cnn.com/2020/10/21/business/purdue-pharma-guilty-plea/index.html LaMotta, L. (2016, August 24). How mylan ended up with an EpiPen monopoly . BioPharma Dive. Retrieved March 2, 2022, from https://www.biopharmadive.com/news/how-mylan- ended-up-with-an-epipen-monopoly/425050/ U.S. Bureau of Labor Statistics. (2021, September 8). Healthcare occupations: Occupational outlook handbook . U.S. Bureau of Labor Statistics. Retrieved March 2, 2022, from https://www.bls.gov/ooh/healthcare/home.htm Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of America: A Healthy Debate. Medicina (Kaunas, Lithuania) , 56 (11), 580. https://doi.org/10.3390/medicina56110580 Vesoulis, A., & Abrams, A. (2022, February 23). Hospitals say nursing agencies are 'exploiting' the pandemic . Time. Retrieved March 2, 2022, from https://time.com/6149467/congress- travel-nurse-pay/

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