Elwell: Profit-driven health care hurts community hospitals, patients and workers

Important recent news stories about hospitals during the COVID-19 crisis highlight the inadequacy of our fractured health system during the pandemic and the need for a comprehensive, equitable, high quality system which is less expensive and covers all residents.

San José Spotlight reported that San Jose-based Valley Medical Center Foundation, the nonprofit arm of the Santa Clara Valley Medical Center hospital system, is having to beg for charitable donations in the valley to respond to the pandemic.

Cash donations are needed to buy essential hospital supplies such as ventilators, personal protective equipment, and portable X-ray and EKG machines. The Santa Clara County-run hospital system includes O’Connor and St. Louise hospitals and many clinics as well as Santa Clara Valley Medical Center, the county’s main trauma center. They serve most of the uninsured and the county’s poorest patients.

National Nurses United reported in their recent study “Fleecing Patients” that hospitals jack up charges by as much as 18 times over their costs, a substantial contributor to the growing health care crisis for patients and families.

Of the 100 hospitals with the highest charges over their costs, for-profit corporations own or operate 95 of them, led by HCA Healthcare, the largest hospital system in the United States, which owns or operates 53 of the top 100. Two hospitals in San Jose, Regional Medical Center and Good Samaritan, are owned by HCA Healthcare.

The report says high and unpayable charges are a calamity because too many patients avoid needed treatment due to high cost, medical debt, bill collectors, and bankruptcy. It cites surveys which found 78% of adults have avoided hospital visits or medical care because of the cost.  About 30% reported having to make a choice between paying for medical bills or other basic necessities, such as housing and food.  An astounding 137.1 million people in the United States said that they struggle with medical debt.

HCA Healthcare Corporation

During the pandemic, important issues have been raised about both HCA hospitals in this county.  In May, San Jose Regional Medical Center, which serves central and eastern San Jose and Milpitas, closed its maternity and newborn units).

The primarily low-income women served by HCA, many of color, now have to travel to the westside Good Samaritan Hospital for their perinatal care and to give birth — quite a trek, whether by car or public transportation.

Women who present themselves at RMC when birth is imminent have to go to an emergency room lacking specialized staff and facilities and where COVID-19 patients may be present.

In addition, healthcare workers in those HCA  hospitals have had to fight to get the staffing and personal protection equipment they need.

HCA has received $700 million in bailouts from the CARES Act as well as $4 billion in Medicare loans. They can well afford to safely serve the families of East Santa Clara County and provide the necessary staffing and PPE to keep the patients and workers safe during the pandemic.

Public, small and rural hospitals

An NPR Report in September highlighted the issues that safety net urban hospitals face because they treat the uninsured, who often can’t pay bills, and Medicaid (MediCal in California) recipients, because the reimbursement rate for Medicaid doesn’t cover costs.

Better-equipped hospitals in more affluent city areas are luring the best-insured patients away from the safety net hospitals. The pandemic has exacerbated the problem because the core patients of safety net hospitals, the poor and people of color, are being hit hardest by COVID-19.

A Nov. 21 article from The Conversation reports how hard COVID-19 is hitting rural America’s hospitals: “North Dakota has so many cases, it’s allowing asymptomatic COVID-19-positive nurses to continue caring for patients to keep the hospitals staffed. Iowa and South Dakota have teetered on the edge of running out of hospital capacity,  it states.

Rural health care systems were already on the brink because of lower revenue, changing demographics and higher operating expenses. With the pandemic, elective procedures, which brought in revenue, were stopped in order to slow the coronavirus spread, and rural hospitals have also faced price gouging for supplies.

It doesn’t have to be this way

There is an alternative to this grossly unequal health care system.

Medicare for All, popularized by Senator Bernie Sanders, was introduced by Congresswoman Pramila Jayapal in February 2019 as HR 1384 and would go a long way towards resolving these problems.

This proposal would guarantee comprehensive, equitable, high quality care, which is less expensive, covers all residents, and allows free choice of healthcare providers. It would improve on the current Medicare by covering dental, hearing, glasses and long-term care and by ending the need for supplemental insurance.

Also, it is politically feasible: an exit poll by Fox News during the last election found 72% of respondents would be in favor of a “government-run healthcare plan.”

A public, nationwide single-payer plan would save money for both patients and struggling hospitals.  There would be no co-pays or deductibles due at the point of service.

By eliminating private insurance companies and allowing Medicare to bargain reasonable prices for hospital and provider services and pharmaceuticals, the money that currently pays for outrageously high overhead for insurance companies can be used to expand full services to all residents of the United States.

Since better health, not profit, is the goal, Medicare could give special attention to keeping open the hospitals serving needy urban and rural areas, by allocating a greater proportion of resources there.

Medicare for All would also end medical bankruptcies, medical debt lawsuits, and the health insecurity of those who currently have to make choices between getting the care they need and other necessities.

Encourage your representatives and senators to support Medicare for All, especially Rep. Anna Eshoo, who is the only South Bay member of Congress who doesn’t support HR 1384.

Peggy Elwell works with the Santa Clara County Single Payer Health Care Coalition, which fights for Medicare for All.