The question of who's responsible for charity care is a legitimate concern. However, it's not a question that can or should be answered by the private hospital community alone.
The charity-care debate within the private hospital community is not a high priority of patients in this rapidly changing healthcare environment. Who owns the hospital and where the profits go also are not really important questions for the average patient, insurance company or business.
Patients just want to get well and receive high-quality, caring services that meet their needs as close to home as possible. Their insurance carriers want competitively priced services, and government and businesses want to contain costs. Hospitals need to find the common ground, not the battleground, and focus on these common priorities.
While charity care and tax-exempt status are important issues, the argument among hospitals distracts from the larger and more important questions of who pays for the care of the poor, graduate medical education, and children's and rehabilitation services, and of how to fit mental health and long-term-care services into the new managed-care environment.
The debate between tax-exempt and tax-paying hospitals about their levels of charity care and tax status adds more heat than light to the current debate about the future of healthcare financing and delivery.
Hospitals no longer are competing with just each other. Insurance companies and a new array of alternative providers that want part of the pie are competing with them.
What responsibility do other healthcare providers, insurers, businesses, individuals and government have to assure that we all have equal access to the same level of quality and compassionate care? The marketplace itself cannot be trusted to take care of the medical have-nots. There is no competition for those who cannot pay.
Ultimately, federal, state and local governments will decide who pays for charity care, whether it is from explicit tax subsidies, tax exemptions, new taxes, private premiums, cost shifting or reduced healthcare services for everyone.
The federal government already has allowed Tennessee to privatize its Medicaid program for the poor and uninsured with TennCare, a private system of competing healthcare plans. Unfortunately, TennCare has not eliminated charity care as originally projected by state officials. Not everyone is covered by the innovative program, and hospitals are still picking up most of the slack and passing the cost along to paying patients.
Under TennCare, it is still very unclear who will be responsible for charity care if public hospitals, such as Regional Medical Center at Memphis, are unable to compete and survive without government support.
Today in Tennessee many rural local public hospitals are up for sale. Others certainly will close or consolidate with larger systems in order to survive.
Congress likely will allow even further experimentation with privatized healthcare alternatives for Medicare and Medicaid. The new system will pay one flat price for a patient's entire health and medical care across a broad spectrum of providers, but there must be enough money in the system to care for the uninsured and medically indigent.
More than ever, hospitals need to cooperate in the face of new competitors and government efforts to reduce the federal deficit. Instead of pointing fingers and swapping allegations, hospitals should be pulling together to make sure society decides who's going to pay for those who get the healthcare they need but cannot afford to pay the bills. Private hospitals, regardless of who owns, sponsors or operates them, cannot be the sole answer to this knotty problem.
There is room-even the need-for publicly traded private hospitals that are accountable to stockholders and private not-for-profit hospitals that are accountable to their church or community to continue their historic missions in new and unfamiliar ways. If both these segments of the private hospital community meet their goals, they will be successful.