The shift in decision making to insurance companies means that it is no longer the physicians and medical staff who determine treatment but insurance company bookkeepers and bureaucrats. Their decisions are based on profit, not patient needs. This struggle has had disastrous consequences for health care workers and consumers. Hospital workers are seeing the facilities where they work gobbled up by huge corporations. Community ties are broken.
Hospitals become cogs in the machine of the powerful HMOs.
In the scramble to provide care at the least possible cost hospitals have implemented widespread restructuring, largely by shrinking their staffs and replacing high-skilled workers like Registered Nurses with unskilled, unlicensed personnel. These changes have serious effects on the quality of care. Jobs are being lost. Wages are falling. Jobs are being redefined as workers are told to do more work for less money.