We Can’t Afford to Keep Everybody Alive

One of the best ways for a newspaper to make money is to give a conference. Everybody from the Times on down does it. However, perhaps one of the most profitable are those given by Crain’s Health Pulse, a publication aimed at the business of medicine. I attended one in Brooklyn and it was packed; every table was taken. The keynote speaker was the diminutive, feisty, acerbic stock broker turned medical expert, Stephen Berger of the Berger commission whose mission was to close hospitals. (The commission is no more, but Burger has become as infamous as the hospital closings so that no hospital conference is possible without him.)

Berger just didn’t come up with the idea of closing hospitals on his own. The state has been pouring billions into hospitals to provide primary health care for people who can’t afford it.You can walk into any hospital and be treated, by law, without the ability to pay for it, and poor people know this. This is the way the system worked for decades and still does; the state subsidizes poor hospitals in poor neighborhoods but delivering medicine has become more and more expensive and the current lingering recession finds the state less and less able to pay.

How can this be fixed? The traditional plant to deliver medicine from a cinder in the eye to a heart attack has been the hospital. However, you don’t need a hospital for a cinder and so the medical business experts hit on closing hospitals and encourage cheaper physical plants to deliver medicine such as store front doctor offices and even doctors in drug stores (makes it easy to get a prescription); Berger became the spokesperson for this effort.

To help the argument, small local hospitals were and are going broke – so the dictum was close the losers and let the stronger richer ones take over – as Bloomberg intimated in his argument with de Blasio (survival of the fittest).

Now, in Crain’s Health Pulse October 24 there is talk of a billion dollar hospital to replace University, Brookdale and Kingsbrook Jewish hospitals in Brooklyn. They have been arguing for and closing more than a dozen hospitals like our St. Vincent’s and now somebody wants to build a billion dollar hospital to replace University, Brookdale and Kingsbrook in Brooklyn – what goes on here?

What does Stephan Burger think about this proposed billion dollar Brooklyn hospital? “It could make sense as a part of a ten-year plan,” but only after “a primary and urgent care infrastructure is in place.”

If you need to monitor a diabetic condition, that’s primary care; if you fall off a ladder and crack a rib, that’s urgent care; but if you have a stroke, that’s emergency care and the doctor in the booth at Rite Aid is not going to be able to help you. You need a real hospital with an operating room, surgeons, and a bed. You can’t wait 10 years before the “infrastructure is in place.”

At the Thursday health conference, Mr. Berger spoke bluntly and asked de Blasio to accept the fact “that some hospitals must close” referring of course to de Blasio’s arrest in his effort to keep open a Brooklyn hospital.

As I write this, a store front medical office paid for by Beth Israel hospital is opening up on 14^th Street and they have hung a sign over the Phillips Ambulatory on 14^{th Street} and Park Avenue South center that is now the Beth Israel center. So yes, primary and urgent care will be delivered in less expensive facilities but for us here in the West Village and all of the Lower West side, we need that real emergency room; we need those beds and I, with your help, will keep trying.