Shands makes a deal with enemy of health reform

May 11, 2009

Hospital closing will benefit promoter of cash-register medicine.

As part of closing Shands at AGH, Shands has made a deal with Solantic, a private, for-profit corporation, to open an urgent care center in Ayers Medical Plaza (720 SW 2nd Ave.) right across the street from what is now a busy hospital but in October is slated to become an empty hulk.

Shands claims it has capacity to handle the extra emergency room cases at its Shands at UF facilities on Archer Road. When asked if Shands at UF had the ability to handle the approximately 700 births at AGH every year, Shands CEO Tim Golfarb told the Gainesville Sun “There is capacity, but it will be tight.”

About 17,000 of the 73,000 emergency room cases AGH and Shands at UF see annually could be cared for in an urgent care center, Goldfarb told the Gainesville Sun. But there are already several urgent care centers in Gainesville, including one run by Solantic at NW 39th Ave. near 43rd St. Emergency room patients have already decided they need to go to an ER. So it is unclear whether Goldfarb expects these patients to self-diagnose and sort themselves out, or whether Shands will be sending the new influx of emergency room patients to the new urgent care center.

Assuming those patients can afford it, that is. After negotiations with Shands, Solantic agreed to take Medicaid patients (big of them, considering they can bill the government, which is easier to deal with than private insurance), but all others must pay up front for services or provide proof of insurance coverage. As Goldfarb told the Sun in a May 9 article, Solantic “Is used to true retail business,” and “in fact they post charges right on the wall of the waiting area.” Because as we all know, if you’ve smashed a finger, it’s nice to know what it’ll cost you to have it set, that way while you’re waiting you can decide whether you really need it or not.

Adding insult to injury, the chair of the Solantic chain is Richard L. Scott, the disgraced former CEO of Columbia/HCA. Under Scott’s leadership, Columbia/HCA bought up so many hospitals it became the largest hospital chain in the U.S. Also under his leadership, Columbia/HCA was found guilty of the largest Medicare fraud in history and fined $1.7 billion dollars. Scott was not charged criminally, but the board of directors relieved him of his duties after the fiasco was revealed.

It would perhaps be enough to give us pause that Scott oversaw Columbia/HCA while it was defrauding the government and that his new company is now benefiting from hospital closures like Shands’ closure of AGH. But Scott is also a major opponent of health care reform, and has ponied up $5 million to launch a group, Conservatives for Patients Rights, which promotes for-profit medicine and maligns national health care systems in which health care is regarded as a right. The group denounces any attempts to pass health care reform from the Obama plan to more thorough plans like HR 676. (Check out CPR’s website at http://www.conservativesforpatientsrights.org.)

Running a chain of urgent care centers in this economic climate can’t be easy. Health care is expensive and a lot of people are losing their jobs and insurance and can’t afford it. Others have insurance that won’t pay, or carry high deductibles. Around 17 percent of us have no insurance at all. So an urgent care center might have quite a few customers (uh, patients) who can’t pay.

But as it turns out, Solantic might consider providing care to these people, as long as it can get its hands on some public money. The money it has its eye on in Gainesville is that collected by Alachua County’s CHOICES to provide some coverage those who work but can’t afford insurance.

So Richard Scott, enemy of health care reform, wants money that came from Alachua County’s small CHOICES health care reform effort, to ensure profits at this private urgent care center. All the while he’s spending profits from his medical enterprises to denounce any expansion of the public safety net, and trying to make people think national health insurance would be a nightmare.

Yes, that might seem contradictory. But the real reason characters like Scott attack anything provided in the public sector is that every time a public program is starved or destroyed it opens up opportunities for the private sector to suck more money out of our wallets. The less we have guaranteed in the public sector the more we will be forced to purchase in the private sector, and the more profits Scott and his ilk can extract from us. The fact that some number of people will not be able to access health care at all just serves as a threat to everyone else to keep working harder in a never-ending race to buy health security. But health care should be a birthright, as it is in many other countries.

Shands currently has an average 5-hour wait in the emergency room. One reason is that a lot of people can’t access care any other way. Another is that emergency room staff are spread thin and overworked. The Richard Scotts of the world benefit from our overburdened system when patients show up at his urgent care centers, trying to avoid these long waits.

Solantic claims it’s saving people money because they can get care cheaper at an urgent care center than they can at an emergency room. That may be true for particular minor injuries, but as hospitals close and minor injury clinics are substituted, we will pay a much greater price as the community loses the beds and facilities necessary for coping with real emergencies.

Unlike AGH, Solantic has no mandate to provide care if you can’t pay, so it can be ‘profitable’ by cherrypicking ‘profitable’ customers with easy, lucrative problems and leave the ‘inefficient’ public sector to provide care to the ‘unprofitable,’ the uninsured and the serious, complicated emergency cases.
Shands and Alachua County should tell Richard Scott and his for-profit clinic to take a hike. Instead of subsidizing his profits, we should continue to spend our limited public money to support already-existing entities, for example the Health Department and the Shands Eastside clinic. That way we won’t be subsidizing Solantic’s profits, and we won’t be paying to have lies about health care reform shoved down our throats by its chairman.

As for Shands’ closure of AGH, Goldfarb told a meeting of the Alachua County Medical Society that Shands spends $116 million in “charity” care a year, according to Dr. Caroline Rains, head of the ACMS. So that makes the $12 million that Shands estimates it loses every year from AGH seem like a small slice of the overall pie.

Everyone (except perhaps Richard Scott) agrees that the problem is not that we don’t have enough people who need medical care, the problem is too few paying customers, a problem that could be solved if the U.S. adopted a national health insurance system like most other industrialized countries. That way the 30% of each health care dollar currently diverted to private insurance companies’ profit, paperwork and bureaucracy could go to health care and health care providers. Instead of losing hospitals (where care is provided) we’d see insurance company offices (where care is denied) closing up.

Goldfarb didn’t show up on May 5 for a long-planned public meeting of the County Commission to discuss the closing of the hospital. His absence angered county commissioners, who had been expecting to have a dialog. In a private meeting with Gainesville Sun editors on May 8 he said “the barn door is closed as far as the hospital is concerned.”
(Printed in the Gainesville Iguana, May/June 2009. Thanks to Jack Price for alerting us to this story.)

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Instead of pay, we got loans and credit cards

November 25, 2008

(An editorial the local paper wouldn’t print.)

The mainstream media says the cause of the economic crisis is that people can’t pay their home mortgages, with the implication that the crisis is their fault. But the basic reason for this crash, the worst since 1929, is that working people in the U.S. haven’t seen a real rise in wages since the 1960’s.

Meanwhile, everything from housing to healthcare to college has risen out of sight—much of it ignored by the official inflation rate. Families have coped by both spouses working where one used to before. We borrowed to go to school. We borrowed to buy a car. We borrowed to pay our health care bills. Many of us borrowed against our houses, because the value of housing seemed to be going ever upward. So, we were told, you can always refinance and get a lower rate.

When the housing bubble burst and prices began to go down, we could no longer refinance. And when the usurious interest rates on adjustable rate mortgages jumped, we couldn’t pay those either. Surprise! The banks were dependent on us, not the other way around.

But the basic question is, why are we not paid enough on the job to obtain the requirements of life without incurring huge debt? A big part of it is that the labor movement has been hemmed in and destroyed by employer hostility and anti-worker laws. Unions—the main mechanism that allows workers to get decent pay and benefits for their work—only represent 12% of workers now, down from 35% in the 1950s. When the union movement was strong, everyone’s wages were higher because employers knew their workers could leave and get better pay elsewhere.

This suppression of unions was so successful that our employers, especially the big corporations, were rolling in cash—money they no longer had to pay in wages—and they had to find a place to lend it. I once got an offer from a mortgage company to lend me $30,000 on a falling-down shed I own. It’s worth about $2,000, generously. These companies were desperate to loan us money. But lots of cash at the top leads to a bubble economy.

The real economy is not based on complex derivatives and investment vehicles, the economy is us, working people who make things go. If we’re not paid enough to buy what we need, the system will eventually grind to a halt. Pushing credit cards and home equity loans instead of a decent paycheck only works as long as we can make payments, and there are now enough people who can’t make payments—perhaps as many as 6 million families who may face foreclosure—to make the banks freeze up.

It’s good news that the government is stepping in to buy up parts of the banks—that might help the acute, “heart-attack” phase of the disaster. But the longer-term solution must include paying working people the wages we need for a decent living. That means passing pro-worker laws like the Employee Free Choice Act so we can get more power on the job and negotiate higher wages. On top of that, our government should keep some of those banks in the public sector, so when we do borrow money, it’s not from a profit-making corporations with lying advertisements and punishing interest rates. The rest should be regulated like utilities—for the good of all.

And the leading cause of personal bankruptcy is health care bills—so we need a health care system that is publicly financed and universal, like Medicare only starting at age zero. Other advanced countries do that and get more care per dollar and better life expectancies than we have here.

Anyone at risk of losing their only home needs the chance to negotiate a workable payment. People complain “Why should someone else get a break when I made my payments on time?” But foreclosures are bad for everyone, not just the family struggling to make payments. They destroy neighborhoods and further drive down the cost of housing. And anyone could get laid off—and lots will in this “recession”—there needs to be a real safety net with unemployment insurance that doesn’t run out.

The looting of the banks has already occurred through years of big payments and bonuses to already fabulously wealthy owners and managers. Rather than rescuing the rich, who don’t need rescuing, let’s get some of that stolen wealth back by taxing the rich and raising wages, to increase the working class’s share of our national wealth. No more bubble economy, let’s build working-class power instead.

Jenny Brown is co-chair of the Alachua County Labor Party in Gainesville, Florida.