AHA and CHA Respond to HRW Report on US Healthcare System
I am biased in favor of research showing the failures of the nonprofit healthcare system. How can one not be biased when health care poverty is a continuing fact of life. I am not naïve enough to think the HRW Report we blogged about yesterday — the report concluding that the United States is violating the human right of health care through its market-based health care system — is not to some extent a political product. Besides, everything is politics. I am not even sure there is an objective reality to discover anymore.
But my bias doesn’t mean I am against nonprofit hospitals. It just means we need to do a better job subsidizing health care. The same way we subsidize death and destruction through the military budget, or maybe a bigger percentage of what we spend on death and destruction. If providing more subsidy to nonprofit hospitals would make them do a better job, I am all for it. So I think that instead of condemning every new report by knee-jerk reactions, the nonprofit hospital trade groups should shift the focus. Inequities in health care, as the HRW report argues, result from health care profit makers. That nonprofit hospitals can’t solve the problem themselves doesn’t mean nonprofit hospitals are themselves the problem. It is more likely that allocating health care to all bidders above a certain floor requires and inevitably results in health care “have nots.” And just to put the hospital Top Hats at rest, I doubt that if we eliminated every nonprofit hospital CEO’s multi-million dollar salary we would have very much more to spend on charity care. Too many are making “eye-popping salaries” but I doubt those those salaries are the cause of health care poverty. They just make for good news print and indignation in the face of continuing health care poverty. They make villainizing nonprofit health care easier.
Instead of reacting defensively and condemning any research suggesting that nonprofits aren’t achieving the goal they are subsidized to achieve, the American Hospital Association should admit the root problem — health care poverty persists despite their fair efforts — and then tell Congress and the rest of us what we can do to make them better at doing what we want them to do. Do we need direct appropriations to nonprofit hospitals — allocated via grants, maybe — the funds from which must be segregated and used solely for indigent care? The AHA should get over its own biases and tell us something useful from its review of negative research. Otherwise, its quick inevitable responses accusing researchers of bias and political agendas sounds like turf protection. Here are some excerpts from an unhelpful script the AHA keeps rehearsing. They are from a joint statement issued by the American Hospital and Catholic Health Association:
America’s hospitals and health systems, regardless of size, location, or type, are committed to treating all patients with respect and dignity while providing high quality, accessible care, regardless of ability to pay or health insurance status. The report released today from Human Rights Watch — based in part on research funded by an organization with a track record for bias — conspicuously focuses on tax-exempt hospitals, largely in the absence of other sectors of health care, such as commercial insurers, drug, or device companies that contribute to hospital expenses as well as consumer debt. It all but ignores that the root cause of medical debt is inadequate commercial health care coverage.
Importantly, the report does not even attempt to present a comprehensive understanding of the community benefits tax-exempt hospitals provide or the IRS regulations they are subject to. For example, tax-exempt hospitals are required to report to the IRS Medicaid shortfalls for the low-income patients they treat, which is the difference between the actual costs of caring for a patient versus what the Medicaid programs covers. The report gives these shortfalls, which for some hospitals make up more than 60 percent of community benefit work, short shrift.
How about responding to health care poverty, nonprofit hospitals’ inability to solve that problem under current circumstances, and telling us what more nonprofit hospitals need? Nonprofit hospitals are only to blame when they deny the problem even exists.
darryll k. jones