Health Care Isn't Capitalistic

Letter to the Editor

Health Care Isn't Capitalistic:

But it's in Sarasota taxpayers' best interests to act capitalistic and patronize their tax-supported hospital.

Dear Editor:

On Aug. 12, your editorial, "The Cost of Compassion," challenged some statements I made in a recent guest column in the Sarasota Herald Tribune. In that column, I attempted to explain how decisions by for-profit hospitals to scale back or eliminate essential but money-losing services, such as obstetrics and psychiatric care, is making it harder for not-for-profit hospitals such as Sarasota Memorial to remain profitable.

Your editorial objected to my commentary on the practice of "cherry-picking," presented a robust defense of capitalism and the right of for-profit hospitals to let not-for-profits absorb the extra case load and costs associated with uncompensated care and concluded by blaming Sarasota Memorial and taxpayer subsidies for the rise in charity care.

I respectfully disagree on all counts. Your editorial is based on the premise that the U.S. health care system is capitalistic. I contend it is not.

• The prices of most hospital services are not determined by market competition but rather set by government dictate - often at levels well below cost.

• Because of federal laws like the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals are obligated to provide service even when they know they will not be paid.

• Government regulators control competition through Certificates of Need, which ration health care based on proximity to what the government believes is an over-utilized alternative service.

• Seriously ill patients cannot comparison shop or accurately judge the quality of services they may need.

The result is that hospitals are selling their services at a loss, or giving them away, in markets with high barriers to entry and in which only a few organizations make up an industry. Whatever you call it, that isn't capitalism, and it is incorrect to suggest that the U.S. hospital system is simply an industry like any other.

Although Americans are the world's foremost capitalists, we also are the world's foremost idealists, and in this dichotomy lies the problem of trying to create a purely capitalistic solution for the nation's health care needs.

Basic health care is a fundamental right, not a privilege, and we believe it is a moral and ethical responsibility for hospitals to care for all people, not just those with financial means. The rise in charity care is no greater in our community than in others across the nation. Sarasota County is home to an estimated 18,000 indigent people and 45,000 uninsured - most of whom are members of working-class families.

Simply shuttering maternity and psychiatric wards won't solve the problem - it just moves it to a new location. Case in point: In 2002, when a local for-profit hospital's obstetrical unit closed (leaving Sarasota Memorial the only hospital left in the county delivering babies), it was reported that closing the department saved the for-profit hospital about $1 million per year.

From 2002 to 2004, the number of women delivering babies at Sarasota Memorial jumped from roughly 2,500 to 3,500 per year. In addition to the for-profit's annual savings becoming our annual losses, such volume increase is well beyond our facility's physical capacity, necessitating the relocation of our mother-baby units to a new facility - with a multi-million dollar price tag.

Today, the tax subsidy that Sarasota Memorial receives covers only half of our cost to provide uncompensated care. Yet we continue to invest in not only money-losing services for-profits drop but also a wide range of primary and preventive programs and services for those most at-risk: primary care centers and affordable insurance plans for low-income people who earn too much money to qualify for Medicaid but not enough to afford private insurance; specialized clinics for local AIDS patients; acute and outpatient care for people with mental illness; neonatal care for babies born prematurely, to name just a few.

Why? Without that safety net, the cost would be counted in human lives. More babies would be born in emergency rooms or die in pre-term labor; more people with mental illness would be walking homeless on the streets; more people with chronic diseases, like diabetes, would suffer from irreversible systemic infections and lose their limbs, or worse, their lives.

Just as the CEO of a for-profit hospital has a responsibility to protect the interests of its shareholders, I as CEO of a public hospital have a responsibility to work in the interests of mine ... the resident taxpayers of Sarasota County. It is in their best interests to protect and preserve the breadth and quality of medical care that Sarasota Memorial provides. We are not merely a safety net hospital, we are a nationally recognized medical center that ranks among the best medical and academic institutions in the nation. Among other achievements, we rank in U.S. News & World Report's 50 "Best Hospitals" in the nation and in HealthGrades' top 3% of the nation's hospitals for patient safety. We also are the only hospital in the region with "Magnet" status - the nation's highest honor for nursing excellence. No other hospital in the region comes close to matching our measures of excellence.

We can continue to protect this community asset through tax increases - or as I mentioned in the guest column that raised this debate, by residents actively choosing to invest their health care dollars in Sarasota Memorial.

If the heart of capitalism is self-interest, as championed by the "father of economics" Adam Smith, then how is my suggestion that Sarasota taxpayers patronize the hospital that they own, anything but capitalistic? They minimize their tax burden while preserving the breadth, scope and quality of their community's medical services. I doubt even Smith himself would disagree.

Gwen MacKenzie

Chief executive officer

Sarasota Memorial Hospital

While showing how our health-care system isn't capitalistic and is controlled by the government, Gwen MacKenzie helps buttress one of our main contentions last week: Those very controls, subsidies and socialistic programs have created the problems we now have. - Editor