Just a few days ago, the owners of our community’s hospital announced that they will probably be closing … again. The hospital has been hanging on by its toenails for years, and traded two or three times by big owners. The owners had also taken on a hospital to our north. This year, both closed in March, suspending 175 workers, then reopened in June, then closed again in September. With each trade, the media has reported appalling amounts of debt; so much that we were surprised when a new buyer surfaced. For patients, care went steadily downhill due to shortages and broken equipment. At the hospital closest to me, state inspectors said conditions were “endangering” patients.
Trade among corporate buyers is a new scheme for hospital ownership. Ambar La Forgia, a Columbia University assistant professor who studies private equity and health care, said the business model, is “all about creating short-term returns for shareholders.” The emphasis on profit, as she said, is “not necessarily great for the patient.” Then she asks, “Is a bad hospital better than no hospital?”
Stories from staff of my county hospital and the other are horrific. In a pattern familiar to many farm families where health insurance is an impossible expense, some workers were in their jobs only to get their family insurance. Deductions came out of their checks, and the workers received insurance cards, but the insurance companies were never paid. So when the hospital workers needed treatment, they presented their cards and the treating physician applied for payments that never came. Weeks later, a bill was sent and the unsuspecting worker would find they owed hundreds or thousands that they thought was paid by insurance.
This kind of fraud, performed on their own workers, was part of the hospital owner’s scheme in all its relationships. Another scheme was separating the hospital ownership from the land ownership so that the landowner received rental income while the hospital struggled to make ends meet.
So, the hospital failures are due to many complicated reasons. Add to this the fact of Missouri’s stubborn refusal to allow federal Medicaid dollars to pay on the bills created by treating the most dependent members of our community. With Medicaid, about 60% of a bill would be paid by the Feds for someone in poverty. One advocate for Medicaid expansion, manager of another hospital, reported that he couldn’t believe he was asking for reimbursement for 60% of costs, but 60% is better than nothing. And nothing is what they’ve been getting.
Many residents use hospitals as their go-to health providers, and hospitals are required to treat folks that turn up at the emergency room. For a while, our hospital had emergency-only care, stabilizing patients and sending them to another hospital for in-depth diagnosis. Now, of course, emergencies have to wait until the patient can get to the next place, losing precious moments. Experts call the 60 minutes after an accident, heart attack or stroke the “golden hour,” and say that early treatment can make the difference between success and failure. As the rural population ages, of course, the loss of that treatment is more tragic.
Missouri has lost 10 rural hospitals in less than a decade. And five urban ones. Loss of the hospital has obvious community ramifications: Longer ambulance rides as emergency patients are carted farther away for care; more inconvenience for friends and family when visiting a loved-one in the hospital; a greater tendency for folks to put off getting care. In addition, chronic conditions that need regular treatment are put off due to longer travel times. And, a community’s potential new employers, seeing the hole in infrastructure, may decide to go elsewhere.
Those are obvious negative outcomes, but there are more subtle losses also.
Rural communities have long depended on health care providers to lead the way in advocating for reasonable policies on all sorts of things. We often ask our doctors and nurses to speak out on health impacts of environmental changes like the addition of a polluting industry or the impacts of minimized services.
There are work-arounds, of course, and tele-health is often held up as the next best thing. Indeed, my family has used telephone visits with our doctors and had good results. I’ve sent pictures of particularly bad poison ivy to a doctor and received, quite promptly, a prescription for relief. Another friend reports she visits her physical therapist via an internet connection and is grateful to be saved a trip to town. Mental health care, now called “Behavioral health,” is particularly impacted as patients can visit a provider from the privacy of their own home.
Still, as we see our community institutions disappear or starving for attention—schools, libraries, post offices and other shared non-profits—we feel the loss deeply. The community institutions provide more than health care. They are our anchors in good times and bad.
Margot Ford McMillen farms near Fulton, Mo., and co-hosts “Farm and Fiddle” on sustainable ag issues on KOPN 89.5 FM in Columbia, Mo. She also is a co-founder of CAFOZone.com, a website for people who are affected by concentrated animal feeding operations. Her latest book is “The Golden Lane: How Missouri Women Gained the Vote and Changed History.” Email: margotmcmillen@gmail.com.
From The Progressive Populist, November 1, 2022
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