Your Aug. 9 cover story, "Beginning of the end?" (p. 6), about one hospital system's decision to settle in the uninsured billing class-action litigation, should have included a description of the real issue-a broken healthcare financing system.
That self-pay patients are the only payers held to the highest level of accountability is the result of hospitals being forced to transfer the burden of the cost of caring for the uninsured and underpaid care of Medicare and Medicaid recipients to those who can pay more. I believe that as healthcare leaders we need to acknowledge this fact and use this current crisis as a basis to highlight the need for a more balanced financial model.
The first U.S. hospital, Pennsylvania Hospital in Philadelphia, began as a philanthropic effort by Benjamin Franklin and became the template for the mission of our early hospitals. It was built to care for the indigent. Tax-exempt status is a byproduct of our philanthropic culture, which started long before insurance and other healthcare reimbursement programs.
Then in 1946 came the Hill-Burton Act, which provided funds to build the hospitals that the government deemed necessary, but the funds came with the stipulation that communities receiving such funds provide charity care. The government's plan created many of the beds that were later described as unnecessary liabilities by the same government after costs became uncontrollable. More than 100,000 beds have been closed in the past 15 years.
Through court cases in the 1960s and 1970s, hospitals and their communities faced increasing demands for charity care that went well beyond the long-expired rules of Hill-Burton. It is apparent that our lawmakers, the press and the general public have forgotten that hospitals pioneered charity care.
We in the hospital industry have allowed others to control the debate and turn our efforts to stay in business by differentiating between those who can pay and those who can't into bad intentions.
The current litigation presents an opportunity for us not to fight to maintain a system of inequality, but to present what we know is true-the healthcare financing system is broken. The report, Building a Better Health Care System, by the National Coalition on Health Care, includes a recommendation to discontinue the cost-shifting found in the existing system.
We should embrace the report's recommendation and expound on the need for this change in order to return the healthcare system to a fair and equitable playing field.
Administrator Deckerville (Mich.) Community Hospital
Keep playing field level
I agree with David Burda that Florida's specialty hospital ban is the worst protectionist legislation ever enacted and the losers are the patients who deserve focused clinical treatment of their inpatient needs ("Raining on competition," July 12, p. 20). The law runs counter to the objective of improving the quality and access to healthcare while lowering costs.
We are a country founded on democracy and a system of free enterprise. So can someone tell me why adopting this same philosophy in healthcare is a bad idea? I can tell you why the hospitals and the lobbyists they employ don't want it: They like the playing field tilted in their favor. To hospitals, it's all right for them to hire specialists and inflict irreparable economic damage on the physicians who have provided those services in the community for years, but it's not OK for a group of physicians to develop a specialized inpatient facility.
For the past several years, specialists in my community of Stuart, Fla., have faced increasing competition from the community hospital. It's become clear that this hospital's mission is to control the delivery network of medicine in our community. As a matter of fact, a white paper produced by our local hospital in March makes it quite clear it has every intention of competing against the medical staff.
Last I checked, the mission of a community not-for-profit hospital was to ensure that adequate and appropriate care was available to their respective communities, not to use the benefits gained from its not-for-profit status to directly compete against its medical staff. Frankly, I'm a proponent of competition and would have absolutely no problem at all competing with the hospital, so long as the playing field was level.
Chief operating officer
South Florida Orthopaedics & Sports Medicine
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