Wednesday Jan 26

The Paradox of USA Hospitals Today

In the public health and hospital world, a global and national pandemic presents the challenge and opportunity of a lifetime, justifying years of training and preparation. Like almost everything, it depends on who is counting, but frequently the 1918 flu pandemic gets the most comparisons to our current Covid-19 crisis.

We have all become mini-healthcare-statisticians, able to pour over the charts and graphs of outbreaks, here and there. We celebrate healthcare workers as essential, and it breaks our hearts to read about the 1800 nurse death rate and counting, the 2000 doctors in India, the uncounted dead among nursing home staff. Everyone seems able to cite the number of ICU and other hospital beds outstanding in this state or that one, as the delta variant surges throughout the country. We listen closely to reports from hospitals about the number of ventilators available, testing locations, and vaccination availability. Those that pray, pray. Those that hope, hope. All of us worry about our families, friends, neighbors, communities, and more, for what good that might do.

At the same time, I have this nagging problem. I can’t get my head around the contradictions that abound in our hospital system, which is such a fundamental part of our healthcare infrastructure. Too much of the time, I feel like I want to root for them and stand and applaud the job they are doing, and, god knows, the workers deserve any support we can offer, but the institutions themselves seem to be rouge, even while they are claiming to be righteous.

ACORN with our partners, Local 100 United Labor Unions and the Labor Neighborhood Research & Training Center, have been involved in a series of ongoing joint research projects focusing on hospitals in recent years. (See Social Policy v.50#3, Hospitals Believe in Charity for Themselves, Not Their Patients)

First, we looked deeply at all of the nonprofit hospitals in Arkansas, Texas, and Louisiana, and whether or not they met the requirements set in the Affordable Care Act to provide a sufficient, though unspecified, among of charity care. We were disappointed to find that another $1 billion would be available for healthcare, if nonprofits in these three states even hit the miserly national average of around 4%. Remember, this is for hospitals with a 501c3 tax exemption worth millions, because in no small part they provide charity care. I can’t read about the pandemic and the fact that now with the end of various stimulus and “cares” packages ending, they might be trying to charge an average of $40,000 for each coronavirus patient fighting for their life. Oh, and, yes, for testing and vaccines as well, if the government isn’t paying the bill.

Since we’re talking about prices, that raises the issue of the second research project we have been working on with our volunteer army of interns: hospital pricing transparency. The American Hospital Association finally dropped its lawsuit and faced the music with one of the few solid reforms of the Trump administration requiring all hospitals, profit and nonprofit, big or small with at least twenty beds, to post hundreds of prices for basic procedures with a good number of them mandatory. They required the posting to be on the hospitals website and to be “machinesearchable” to ease comparisons. As of January 1, 2021, all hospitals were required to put their prices up.

Hospitals were scofflaws. Many were anti-transparent, even to the extent of trying to require you to be a patient and surrender your information before you could access the price list. The Wall Street Journal, undertaking similar research, found that some tagged the requests to prevent their numbers from being machine readable, therefore blocking comparative shopping.

We looked at our same three states once again. In Louisiana, 47% did not comply. In Texas, 45% didn’t do right. In Arkansas, 38.7% didn’t bother. This isn’t a local problem either. DHS has now indicated that it will begin affixing fines for noncompliance that, if repeated, could mean millions. In coming months, we will issue a report that names and, hopefully, shames the recalcitrant hospitals. We are currently in the process of preparing complaints within the DHS procedure for all of the hospitals we have found to be regulation deniers.

On another front, hospitals are digging in their heels to keep from disclosing the special deals that they are making with insurance companies. News reports indicate that in many cases lower income families without insurance are charged more than many hospitals charge the insured.

See why I have mixed feelings about the hospital paradox? I want to thank them for stepping up in the pandemic, but every time I try to join the clapping, I can’t get past the fact that they are biting these same hands, kicking families to the curb, foreclosing on houses and debtors, while shunning charity and transparency, along with fair and equitable pricing. We have a predatory healthcare business model hiding in sheep’s clothing. What happened to “do no harm?”

Wade Rathke is the Chief Organizer of ACORN International, Founder and Chief Organizer of ACORN (1970-2008), and Founder and Chief Organizer of Local 100, United Labor Unions (ULU).



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