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Politicians Know the Problem, but What is Their Solution?

Before St. Vincent’s Hospital closed, many community activists and local politicians objected. Afterwards, every politician representing the community, with the notable exception of Mayor Bloomberg, decried its loss. This same scenario seems to be playing out in Brooklyn hospitals, especially the Long Island College Hospital (LICH). Politicians realized that the closing of hospitals effects communities greatly, even if that realization sometimes comes too late. Yet, what is their solution to avoid these closings?

A typical example of this situation is an interview of Comptroller Scott Stringer in the Brooklyn Daily Eagle (February 28, 2014). He states strongly that what happened to St. Vincent’s shouldn’t happen to LICH and that the attempts to save St. Vincent’s came “Too little and too late…” He also, correctly, attacks the theory that Brooklyn has too many hospital beds and closing more will somehow improve medical care and save money. This failed theory is one of the causes of the steady loss of community hospitals across the country and city (Closing Hospitals Saves Money: A Failed Theory, Westview News, March 2014).

One approach is to fight each hospital closing on a case by case basis depending on the political support, community resistance, and other local factors resisting the cutbacks. This tactic didn’t work with St. Vincent’s, but may work with LICH, at least temporarily. Other times, the hospitals can save themselves by affiliating with larger hospital systems. However, a more comprehensive solution is needed, is possible, and actually existed at one time.

It comes down to money. When St. Vincent’s closed, Mayor Bloomberg said words to the effect that “all communities want their own hospital, but how can we afford it?” Free market advocates say that the rules of the private market should be used and that hospitals which are financially self-sufficient should live, and those which aren’t should die. This approach treats a hospital the same way as a corner donut shop, and takes into account financial issues, but ignores community health care needs. Unfortunately, this is the philosophy of many health policy analysts and the politicians who listen to them. Instead of determining the healthcare needs of communities and then figuring out how to pay for them, this approach determines the finances of an institution and then determines what healthcare will be provided.

It wasn’t always like this. Until the administration of Governor Pataki, New York State set reimbursement rates for all hospitals and so had a way of readjusting income so that weak hospitals could still survive. When this system was eliminated, healthcare advocates predicted, correctly, that there would be many financially weak, but locally needed, hospitals closing. A return to this system would provide an overall approach to hospital financing and the Department of Health could take healthcare needs, and not just market share, into account. This system would not be perfect, and there would still be struggling small hospitals and voracious politically connected big hospitals, but at least there would be a framework for a global approach, and an opportunity for communities to appeal to their elected representatives before hospitals ran out of money and not after they closed. Otherwise, expect to see a lot more hospital closings.

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