American Hospital Association’s Fake News Strategy
In what has become its predictable knee jerk fashion, the American Hospital Association has reacted to the Health Affairs study showing that bottom line deficits at 10 large nonprofit hospitals were caused by investment losses and, by implication, not by increases in charity care. AHA has a very fined tuned radar, detecting and reacting to even the slightest public suggestion that maybe nonprofit hospitals don’t do enough to justify their tax exemption. The thing is, AHA is an otherwise respected organization and might even be correct that nonprofit hospitals easily deserve tax exemption. But they are too busy using the “fake news” strategy.
I would actually like to read AHA’s serious responses to studies questioning hospitals’ tax exemption/nonprofit bona fides. I assume they have enough expertise, or access to it, to provide thoughtful nuanced responses to these studies. And that their PR department can easily produce serious scholars to dispute conclusions if that is their purpose. For example, in response to the Kaiser Foundation report, the AHA might have legitimately confirmed [or disputed, as the case may be] the data showing the $28 billion dollars worth of state and federal tax exemption, and then attempted to justify the underlying notion that community benefit is more than charity care, and why that is appropriate. And then maybe it could have offered a way to better quantify community benefit to dispute the implication that nonprofit hospitals get almost twice as much value from tax exemption than they provide in charity care (which is only a small part of community benefit). In fairness, AHA cited to a reputable study, but the study addresses a broader question. Kaiser limited its report to a comparison of the cost of tax exemption and charity care, admitting that community benefit is broader than that, but still raising the questions whether nonprofit hospitals provide enough charity care in any event. Or whether anything other than providing health care without regard to ability to pay even justifies tax exemption at all.
And instead of answering whether the raw data was correct in the Health Affairs study, and then explaining why the implication that hospitals are sacrificing charity care to subsidize investment losses — a task that hardly seems insurmountable given that the entire industry suffered relative losses during Covid and beyond — the AHA said the following in a release titled “Irresponsible Rhetoric Should Not Drive Public Policy:”
The AHA has previously noted the third party observers who demonstrate a tenuous grasp of the data and rules regarding federal hospital transparency requirements. Now, some of those same entities with deep pockets and an apparent vendetta against hospitals and health systems have turned their attention toward the broader financial challenges facing the field. The results, as described in a recent Health Affairs blog, are as expected — a complete misunderstanding of current economic realities. The three most egregious suggestions in this piece are that hospitals are seeking some kind of bailout from the federal government, employers and patients; that investment losses are the most problematic aspect of hospital financing; and that hospitals’ analyses of their financial situation are dishonest. We debunk these in turn.
See, now I want to hear more about this vendetta. But judging the rest of the argument in the light most favorable to AHA forces me to concede that the argument scores some rhetorical points suggesting substantive merit. But the swiftness with which the AHA responds, typically within 48 hours of a study’s publication (too soon to consider the quantifiable points or present a valid critique of the study to which AHA takes invariable offense), and the overall “this is all fake news” tone is just off-putting. Not because I am sensitive. I can still play the dozens with the best of them, I think. I just want to hear both sides of the substantive arguments without the AHA claiming that the researchers are stupid or have a “vendetta.” I mean, these are Ph.D. researchers at RAND, Johns Hopkins, and George Mason University; Health Affairs is a reputable scholarly publication, not the National Enquirer. “Irresponsible rhetoric?” I just kinda doubt it. The implications those tenure and promotion seeking associate professors raise might ultimately prove incorrect, but AHA’s response doesn’t help anybody know. AHA would have more credibility if it argued more by reason and less by shouting “fake news.”
darryll jones