35 Years Later

I have been asked, what does a 35 year old exposé mean today? Other than the story about Dr. Bergman and his nursing home empire, most of the characters in Tender Loving Greed weren't the stuff of national news, and some of the incidents reported were old. Of course being out-of-date was often cited against the book. The relevance then, as now, lies in the patterns of deceit, fraud, and poor care, and the efforts of government to regulate, prevent fraud, and improve care.

In 1974, comments about HMOs feel on deaf ears; although now we are considering ACOs. Fraud had been little talked about then; since then it has been officially called “management inefficiencies” by HHS; and buried in lists of “health care cost drivers” between excessive paper work and poor communications. Ownership was a mystery, and despite three decades of efforts it remains a mystery. It is in these areas, and others, that Tender Loving Greed was remarkably prescient and remain relevant.

The New York Times wrote that “Private equity firms have been rapidly buying up nursing homes in the last few years, sometimes using complex ownership structures to shield them from lawsuits. Now they have attracted attention in Washington” NYT, 10.18.07, http://tinyurl.com/yeard6j . The first comment on the NYT web site was, “Unfortunatley the greed that is being illicited by Private Equity firms that own nursing homes is nothing new. The book “Tender Loving Greed” addressed this problem in the 1970’s. The only problem, 30 years later, is the lack of accountablity of caring for the most valued resource in America is not sufficient,” Margo Tucker.