Counterpoint

If Rip Van Winkle were a blogger, he might feel like I do today. After penning “Lost in D.C. with the Dartmouth Atlas” in 2009 with my friend John Morrow, I decided to take a break while the federal government implemented a $35B “incentive” program to encourage the widespread adoption of billing systems disguised as clinical documentation systems. Having decided to re-enter the blogosphere, I see that the market-distorting effects of the EMR industry’s successful lobbying effort have evaporated, hospitals are once again faced with the reality that times are tough. 

The healthcare policy wonks are crowing about President Trump’s comment that healthcare is “an unbelievably complex subject” and mocking his statement that “nobody knew health care could be so complicated”. Of course, many of those people are part of the modern-day illuminati who thought that the federal government should stake CMS with $10B to incubate innovation in healthcare delivery and who advocated for a program that allowed two people to become billionaires by creating clinical data tombs. I agree with President Reagan that “the nine most terrifying words in the English language are: ‘I’m from the Government, and I’m here to help.'”

Hospitals are the lifeblood of vibrant communities and serve as a core economic engine for growth, even in the 2007-2009 recession. In fact, hospital employment expands even faster when general business conditions are weak (https://www.bls.gov/opub/mlr/2011/04/art2full.pdf). I have seen dynamic communities with strong health systems, like Nashville and Boston and Austin; I have worked with communities that lost hospitals like Destin, Florida, and Clarksville, Texas; and I have risked my job to keep hospitals open in towns like Haverhill, Massachusetts. The difference between communities with strong hospitals and weak hospitals is stark.

Peter Drucker said that “the hospital is the most complex human organization ever devised”, and his statement is likely to stand the test of time. And yet, the solution to the myriad challenges faced by hospitals is quite simple: increased market share of commercially insured patients. “Revenue solves all problems” is a cliche, and cliches are cliches because they are true. This cliche is especially poignant for hospitals, because revenue is the only solution for hospitals in today’s environment.

Even so, competition for commercially insured patients is a negative-sum game. Everyone knows about the “silver tsunami” of 10,000 people becoming Medicare-eligible every day. Fewer people know that 10,899 babies are born in the U.S. every day, almost 50% of which are paid by Medicaid (The Kaiser Family Foundation / Births Financed by Medicaid). Every single day, the commercially insured population declines.

A strong hospital is the foundation of a strong community, and our sole purpose is to make hospitals stronger. We believe that is a noble purpose.