This archive article is selected from The Cleveland Pages, the city's only weekly independent journal of politics and opinion on the Internet. Find out all about the Cleveland Pages here, or check out the current issue.
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The Cleveland Pages is a somewhat-weekly commentary on what's new and why it's all happening in Cleveland and Cuyahoga County. If what you read here is upsetting, you might prefer this simple-minded happy-talk instead.
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Ed Durden, a civil rights activist from East Cleveland, used to describe the statements of people in power by saying, "Don't you be SPITTING on me and telling me it's RAINING!" (Actually, Durden named a bodily fluid other than saliva. This is a family-oriented publication though.)
The corporate rhetoric over the Cleveland Clinic's canceled plans to close St. Michael's and Mt. Sinai East made me think of Ed Durden's favorite punchline. Apologists for the proposal referred to cash flow statements and studies showing that about half the hospital beds in Cuyahoga County are surplus. Representative Stephanie Tubbs-Jones organized public meetings around the need for "long term solutions" in terms and context that seemed to imply some kind of distancing from the immediate problems in her own Congressional district.
Nobody disagrees with the health care business experts when they explain that uninsured care costs are squeezing city hospitals, that highly profitable inpatient stays are being cut short by third-party payers, and that the trend towards better outpatient services is gnawing at the bottom line of all hospitals. Even advocates for more accessible health care services agree that we certainly don't need more inpatient facilities around the county, although they could definitely be better distributed.
To take up Ed Durden's expression, when it comes to small community-based hospitals, it really is raining out there. Whatever happens on Broadway or in a federal courthouse, it is still a marketplace out there in medicine, and a tough one.
The Clinic's proposal to buy and bury the two community hospitals reeked of insider trading, monopolistic intent, and reckless abuse of the organization's non-profit status. Their backing down under the glare of a Bankruptcy Court judge doesn't really clear the stench. It may have been raining outside, but absent any evidence to the contrary, the Clinic was still doing more than its share of spitting on us.
If it were really true that general market pressures constituted the whole reason for those planned hospital closings (as well as the actual closing of Mt. Sinai), the Clinic would not have made its infamous exclusive offer in the first place. The pattern suggests something more sinister.
Based on what is known about its derailed plan, the Clinic should still be subject to an antitrust investigation. Complaints about the organization's non-profit status should be pursued by the state Attorney General. These things are unlikely to happen now that the immediate crisis has passed--unfortunately giving a signal that institutions can attempt anticompetitive tactics and will not be punished if they're found out.
University Hospitals, now seen as the good guys, has committed to purchasing the two troubled hospitals and keeping them open as full-service institutions. That's great, but until all the documents become public we have to ask how durable and binding that commitment really is. Does UH have the right to close the community hospitals in a few years anyway if they become unprofitable? I don't know, and all the details of the purchase agreement aren't available yet.
So it's still hard to know exactly how much of a victory this really is.
It's clear that what people want is access to full-service hospitals within a reasonable distance of their home communities. Opposing that is the trend towards economies of scale, and the competitive urge of even the most honestly intentioned non-profits towards having the biggest facilities possible.
That's rain, and it's unlikely to change by itself or as a result of picket signs carried on Broadway. It's a systemic problem that needs a systemic solution. If nothing is done, the consolidation of hospital services will continue.
A systematic solution might include something as fundamental as a single-payer health care system, which might be structured in a way that sets up poor and working-class people as paying customers. Their normal inclination to spend, for example, medical voucher money locally would tend to support institutions like St. Michael.
Or more rigorous enforcement of statutes governing non-profit entities could simply preclude anti-competitive consolidation efforts. Greg Cole of the American Friends Service Committee has been the leading advocate of this approach. In requesting a quo warranto action to revoke the Cleveland Clinic Foundation's non-profit charter, Cole wrote recently to Ohio Attorney General Betty Montgomery, "By definition, a health care corporation has a duty to provide health care. Here, the Cleveland Clinic is attempting to limit health care."
There are a couple of possible solutions, and there are certainly many other more or less viable alternatives. While we're out trying to stop the rain or building a better shelter, however, we also have to enforce those existing rules against spitting.
This document's template was last modified on Wednesday, 09-Nov-2005 18:51:58 EST. There is a new Cleveland Pages more or less every weekend. The entire Cleveland Pages website is © 1997,1998,1999,2000,2001,2002,2003 by Mark W. Schumann, all rights reserved. Copyrights belonging to others on individual items are noted. Nobody else would take the credit or blame for these opinions anyway.
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