Todays #hcr Moment: Hospital Failures in Massachusetts

Crossposted from DemConWatch.

The Massachusetts health care experiment has been up and running for five years now. As I and others have been writing for years, it was a bad idea then, it's a bad idea now, and it's only going to get worse over time.

Today's problem? Hospitals. In the 1980's there were 95 hospitals in the state. Now, there are 65, and 16 of them lost money last year. In June, two of them (both over 120 years old) filed for bankruptcy. Ouch. There are currently about 6.5 million people in the state, up from 5.7 million in 1980. More people, less access.

The problem for hospitals, in Massachusetts and elsewhere, is trifold. First, reimbursement rates keep falling across the board, but especially as relates to Medicare and Medicaid. Related to that, hospital costs keep rising. Second, there is a huge difference between rich and poor hospitals, setting things up (like across America) where the rich get richer at the expense of the poor. Finally, there is the issue of “the deal”. 

Hospital costs are somewhat fixed. Labour is a huge one, and then there are the costs of things like drugs, medical equipment, supplies, food. We can talk economies of scale, and that prices are too high, but the bottom line is that when you're sick, you need care, and care costs.

More after the jump.

Then we come to the issue of rich and poor hospitals. Rich hospitals are mostly, but not always, private and for-profit. They're in “better” neighborhoods. They have the newest equipment, higher percentage of private-insurance pay patients, as well as things like private suites, on-site chefs, and in some cases 4 star hotel-like accommodations. These hospitals often work in groups: a first tier teaching hospital in a city, with tertiary feeders in richer suburbs. At the other end of the spectrum are community-based hospitals, in poorer neighborhoods, or the only game in town for 200 miles in a rural area. They have x-ray machines and maybe CT scanners, but doubtful MRIs and for sure no PET or BEAM scanners. No robotic surgery equipment, no electronic records. Often licensed professionals are replaced with aides, or “technical partners“. 

This second issue of rich and poor hospitals is exacerbated by “The Deal”. When I wrote about this back in 2009, I opened with: 

“The Deal” refers to the relationship that a large insurance company has with all of the hospitals in a geographic area. With the exception of military bases, prisons, and Indian Reservations, virtually every other acre in America has one insurance company with “The Deal.”

You can see the full article here, complete with US map showing insurance company market share. In 2009, with the exception of Florida, Oklahoma and New York, one or two insurance companies controlled more than 50% of the market. Indubitably, it's gotten worse since then.

In Massachusetts, this all comes together (to the great detriment of patients) with Partners, a very large conglomerate of hospitals that cut a deal with the Blues in 2000, driving up both hospital and insurance costs across the state, decreasing quality care across the board, and fully showing the damage The Deal will do. In this case, not just losing money, but the bankruptcies of Quincy Medical Center and North Adams Regional Hospital.

The political ramifications are far-reaching. Not just because of the parallels of the Massachusetts plan and the Federal plan. But because when Medicaid and Medicare funds are cut as part of the debt ceiling deal, more people suffer. Massachusetts is the case that proves the point that single payer is the way to go for every single rational reason there ever has been, or could be. 

Health care is not a matter of “if”, but of “when”. Everyone gets sick, or has an accident, at some point in time. The worse one's economic situation, the higher the probability of needing MORE care. I could go on for tomes about what's wrong with health care in America, and what we need to do to fix it. (Wait, I HAVE….if you put “health care” in as a tag in DCW, you'll see more than 300 articles over the past few years.) But for today, CALL. And while you're on the phone, mention that “raising taxes” is the wrong phrase, it should be “making tax cheats pay what they've owed for decades.” We need to stand up as one and do everything we can to prevent the wacko right in charge of DC from killing even more poor people. And yes, every hospital that closes leads to deaths. Just looking at emergency rooms, more than 25% have closed:

In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent. – NY Times.

So do something today. Call the White House and your reps and let them know how important it is to keep Medicare and Medicaid (and the rest of the safety net while you're at it) out of the debt ceiling deal. In case you don't have the numbers on speed dial:

White House Switchboard: 202.456.1111.
Full list of Senate numbers here.
Full list of House numbers here.

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