Rachettattating Nurses Physicians and Others Who Deliver the Care

The corporate takeover of health care is more obvious with each passing day. The power goes with the trillions of health care dollars. Insurance corporations, drug corporations, and largest systems dominate. They can dictate the disposition of dollars. They can effectively prevent reforms, They can design legislation and programs that favor their interests. Generally this marginalizes dollars for patient care, dollars for the support of those who deliver the care, dollars for basic services, and dollars for most Americans most in need of care. In other words, health care has been redirected to care of the corporation.

Sadly much of the rhetoric that guides this transition claims to be focused on the patient and on better outcomes. This is clearly not the case. Journalists are often engaged in some new innovative intervention that has great promise - but that mostly requires more dollars for same or less outcomes. This is can even be termed value-based even when the outcomes stay the same and the cost is more. For the patient and those providing the care, there is clearly no improvement and no value.

Tracking the dollars clearly shows who benefits and who is left behind by the innovative designs. The spin is always progress but the designs and innovations are actually regressive with regard to what is most important.






Innovative Language Is Required to Address Regressive Innovation in Health Care

Rachetatat is a word derived from rachet and from the sound of automatic weapons.

Rachet - mechanical device consisting of a toothed wheel or rack engaged with a pawl that permits it to move in only one direction

Rachet in Urban Dictionary - An annoying very rude person

Racheting is to operate by means of a rachet or to cause something to rise (or fall) as a step in what is perceived as a steady and irreversible process

The word rachettattat is designed specifically to indicate the continual erosion regarding the support of physicians, nurses, and other team members. Interestingly as the consequences are more evident to patients in various outcomes, there is an even greater call to micromanage those who deliver the care. The result is burnout, turnover, lower productivity, and less satisfaction for all except those who micromanage.

Examples of ratchetatat include:

  • Privatizing laundry, maintenance, and other support personnel with the result of lower pay, less desirable employers, and worsening benefits. 
  • Dividing personnel into subclasses with lesser benefits, often creating a new division.
  • Studying or researching "the market" and bringing salaries and benefits to the 50% level, which of course results in minimization of salary and any remaining overtime or bonus or benefits. The changes usually result in more duties added
  • One intervention is a reduction or elimination of overtime as the means to the end of looking better as a manager - even in situations that tend to be short of team members due to seasonal or other changes. There are also requirements to work overtime without being paid at overtime rates. As team members are driven off, the cycle is progressive as more must do more for less...
  • There can be a failure to replace personnel lost because they were fed up and their duties are added to remaining team members.
  • Major changes such as divisions, lost overtime, or increased responsibilities may have been worked out in various back rooms, but are often thrust upon those who deliver the care in last minute versions. Often these require changes as they are so poorly thought out because two way communication is lacking. 
Those doing the care are constantly put in a position of defending themselves, patient care, patient family needs, and the ability to care.


Every once in a while the abuses are made apparent. Studies have exposed the special funding that goes to insurance companies, the various kickbacks involving drugs, and special discounts for those largest with those smaller having to make up the gap. Clearly payments favor those largest and most specialized with those smaller, basic, and less organized falling further behind.

Sometimes systems are caught red-handed as seen in antitrust cases. Sometimes there are whistleblowers. These are few and far between. The opioid situation has many origins but one problem is that those charged with investigating problem areas have been hired away from government to help corporate lawyers defend corporations and CEOs from prosecution. Profits matter more than people or punishment.  Corporations can risk the fines and prosecution because health care is so lucrative.

The foundation of health care has been a focus on health and a focus on care and caring. 

Health care has been refocused upon the financial health 
of the corporations, stockholders, and leaders doing well already. 


Recognize Rachetatat to return the focus of health care to those who need care and to those who deliver the care.


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