Published by: Bruce Siegel on 11/19/2010 3:12:13 PM
Around the time I joined NAPH, a number of people asked me the same question: Will we still need public hospitals in the future? After all, given health reform and expanded coverage, why would we still need this safety net? Everyone would have insurance, could go anywhere, and of course they would vote with their feet and head to the fancier private hospital across town. We could declare victory and say goodbye to the safety net.
I didn’t just hear this from a few friends; some very esteemed, thoughtful faculty colleagues of mine opined that the safety net hospital was a thing of the past. These pundits will of course remain unnamed.
Last week, I had the privilege of visiting our three members in Massachusetts. I went there early because they have already gone through health reform that looks a lot like what we plan to do as a nation. Coverage for almost everyone, dramatically reduced payments to the safety net, people expected to have choices they did not have before. As a matter of fact, their reform has covered a far higher proportion of the population than the Affordable Care Act will do for the nation. Following this logic, our members in Massachusetts should have emptied out by now.
That wasn’t the picture that greeted me at any of our hospitals there. Two of our members - Boston Medical Center and Cambridge Health Alliance - have seen volumes increase since reform, while payments were slashed dramatically. All of them have seen emergency department visits rise as the newly insured found they couldn’t get in to see a doctor. If anything, in the current economy, need for the state’s safety net seems to have surged despite fewer uninsured.
If this is a harbinger of the future, then we know two things: Safety net hospitals around the country will be as needed as ever, but we could easily undermine them with the false hope that just giving people insurance cards is the cure-all to America’s health care woes.
One evening in Boston, I talked to an old friend. He too wondered why we would need the safety net in the bright new day of health reform. My response? There wasn’t any miracle in Massachusetts.