Some of the discussion today has centered on the issue of competition, control, and profits.
New York City has been closing down hospitals that once enjoyed a hefty public subsidy but are now expected to pay for themselves or turn a profit. After these hospitals were turned over to private corporations, the pressure to make a profit brought about the closure of several major hospitals.
One of the hospitals slated for closure is Long Island College Hospital. Founded in 1858, the hospital serves several communities in Brooklyn. At some point in the not distant past, it was off-loaded to a for-profit corporation, which them passed it on to a state agency. But, unfortunately, the hospital doesn’t make any money, so its managers want to close it. Local politicians, including Bill de Blasio–who ran first in the Democratic primary for mayor–are fighting the closure of LICH.
Now, all this might seem arcane, but I have one important fact to share about LICH: It saved my life. In 1998, I felt very ill about 7 p.m., when it was impossible to reach a doctor, had a sharp pain in one leg, and walked to LICH. I was quickly diagnosed with deep-vein thrombosis and a pulmonary embolism. If I had not been able to get to the hospital that night, I would not have survived until morning. Both my lungs were rapidly filling up with blood. In a matter of hours, I would have died had I not had a neighborhood hospital. I stayed in the emergency room for a day, and in intensive care for two days, and was hospitalized for a week.
And soon this hospital will close. People will have to travel long distances in a city where traffic is often snarled to find emergency care. During Mayor Bloomberg’s nearly 12 years in office, about a dozen similar hospitals have closed, including the legendary St. Vincent’s in Greenwich Village, where AIDS patients found respite from their suffering at a time when no one wanted to treat them.
Here is the part I don’t understand: Why should hospitals be expected to make money? Doesn’t society have an obligation to keep them accessible to the public? In what sense does competition and the demand for profit improve hospitals? I don’t get it.
Diane Ravitch's blog 
In 1946, Congress passed a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area. The program stopped providing funds in 1997, but about 170 health care facilities nationwide are still obligated to provide free or reduced-cost care.
Since 1980, more than $6 billion in uncompensated services have been provided to eligible patients through Hill-Burton.
I’d say it is time we ask congress, “Why do you always find money for wars but you can’t find enough money to continue funding Hill Burton?” It was a good program that made sure there were enough hospital beds accessible where people needed them. We need to demand a return to the funding of Hill-Burton which would include the construction of facilities in areas of need. Thank God LICH was there for you, Diane. Thank you for bringing this issue to the blog.
Nixon was presented an idea of Health Maintenance Organizations (HMO) and he liked the idea of for-profit medicine. Up until then, medicine was the art of healing, not a business. Now it’s a business with little focus on actual healing, but on how to squeeze out the most profit….like everything else nowadays.
Yes. That is when things stated to go to hell in a hand basket. It was John Erlichman that talked Nixon into the HMO business.
Ehrlichman: “… the less care they give them, the more money they make.” (from a taped conversation between E. and N.)
I am grateful that LICH was there for you.
I hope it will continue to be there for others as well.
🙂
We have a national “disease” in this country and all the hospitals that can treat it “are closed”! This disease is a Darwinistic anti-community attitude fueled by the desire to profit above all else. Our nation needs to have a much healthier respect for the well being of all its citizens. The more Americans that are happy and self-sufficient in our country the stronger our country will be. When will the ever-richer megamillionaires getting richer every day learn this message???? I know that hospital which Diane references as I used to live close to it and had to do a walk-in visit once. Yes.. local hospitals provide important services to the local communities they serve… just as local public schools do. For profit competition promotes a win or lose game and there are many more losers than winners – not a winning situation at all for organizations that are supposed to be for the good of the public-at-large!
not Darwinistic at all. That’s a misreading of Darwin, who wrote passionately about the evolutionary value of cooperation
Malthusian, maybe.
It’s Social Darwinism, as first developed by Herbert Spencer, and intended to justify the harsh inequalities of industrialization during the the late Victorian era.
The more things change…
Spencer didn’t coin the term “Social Darwinism,” and his views were much more subtle than were the cartoon versions of it that got all the press. However, he was seduced by the adoration of the robber barons who gathered round him when he visited the US.
It’s not actually Malthusian at all. I just finished a presentation on Malthus for my AP Geography class. Darwin was also horrified by Social Darwinism, used at the end of the 19th and through at least half of the 20th to excuse all sorts of crimes against those who were “lesser.” This included the Holocaust, among other horrible crimes.
I do not know where you get your information about Darwin. If you read his own words, you will see that he would not have been horrified by “social Darwinism” at all. the following passage is from Descent of Man, Chapter Six: On the Affinities and Geneology of Man, On the Birthplace and Antiquity of Man.
“At some future period, not very distant as measured by centuries, the civilized races of man will almost certainly exterminate, and replace, the savage races throughout the world. At the same time the anthropomorphous apes, as Professor Schaaffhausen has remarked, will no doubt be exterminated. The break between man and his nearest allies will then be wider, for it will intervene between man in a more civilized state, as we may hope, even than the Caucasian, and some ape as low as a baboon, instead of as now between the negro or Australian and the gorilla.”
Darwin proposed in horrifying and explicit language that black Africans and Australian aborigines occupied a sub-species position between white Europeans and baboons. He not only stated this as his belief, but proposed that in the near future “as we may hope” according to his evolutionary theory, these “sub-races” of man will eventually be exterminated in a struggle for survival, along with the endangered mountain gorilla of Africa.
When it comes to healthcare, the traditional question of economics that asks who shall recieve the good or service also includes a decision about where they will recieve it. Are you willing to pay for a level 1 trauma center in my town? I should add there are only 3 in my state, but the city of New York has 15.
Let’s go put that question, TE, to the rest of the developed world, the countries with the lower costs and the better outcomes. We can find out how they answer it and continue refining their answers to it.
Is the market going to create that trauma center for you instead?
The political system will decide if my town has a level 1 trauma center, which is why I bring it up here. If LICH should remain open because of the difficulty negotiating traffic in NYC, should residents of my state be within, say, 200 miles of a level 1 trauma center? Should each resident be within 50 miles? Tiling my state with these centers would be very very expensive, but it could potentially save a life.
Libertarians (e.g., the Nozick of Anarchy, State, Utopia) often say that the only legitimate functions of the state are
a) to enforce contracts and
b) to provide for the common defense against violence, theft, etc.
Well, guess what? Disease and trauma have to be defended against.
But, climbing down from that theoretical posture, let me put forward a very practical observation:
Health care costs per capita:
US: $8,233 (Highest in the OECD)
Norway (the next highest): $5,288
Canada: $4,445
Germany: $4,395
France: $3,978
Iceland: $3,309
Japan: $3,035
New Zealand: $3,022
How does the US differ from these other countries?
From Wikipedia:
By 1941, New Zealand had created a near-universal health care system. On July 5, 1948, the United Kingdom implemented its universal National Health Service. Universal health care was next introduced in the Nordic countries of Sweden (1955), Iceland (1956), Norway (1956), Denmark (1961), and Finland (1964).
Universal health insurance was then implemented in Japan (1961), Saskatchewan (1962) followed by the rest of Canada (1968–1972), and twice in Australia (1974 and 1984). Universal national health services were then introduced in the Southern European countries of Italy (1978), Portugal (1979), Greece (1983), Spain (1986) and Brazil (1988), followed by the Asian countries of South Korea (1989), Taiwan (1995), and Israel (1995). From the 1970s to 1990s, the Western European countries of Austria, Belgium, France, Germany and Luxembourg expanded their social health insurance systems to provide universal or near-universal coverage, as did the Netherlands (1986 and 2006) and Switzerland (1996).
But our health outcomes are not better. In fact, in most cases, they are worse.
I try not to let ideology get in the way of facing the facts. This is impossible, of course, by it’s a goal.
Ms. Ravitch,
You know we all love you, but pointing out that you wouldn’t be here if it weren’t for the existence of the sort of hospital that the neoliberal profiteers are closing down is probably not going to do much to deter them from doing so.
In humor, of course,
– Ron P.
Our country owes a great debt to the LICH, then!
Heh…
http://en.wikipedia.org/wiki/Lich
lol
I believe, very deeply, in the value of competition.
And of cooperation.
And of social sanction.
Free markets, competition among alternative ideas, products, etc., is very, very productive and so very, very valuable. But competition should not become, as it has in the US, some sort of religion with the answer to every question. Sherwood Anderson said it best in the delightful parable with which he begins Winesburg, Ohio:
“It was the truths that made the people grotesques. The moment one of the people took one of the truths to himself, called it his truth, and tried to live his life by it, he became a grotesque and the truth he embraced became a falsehood.”
Other statements of the same idea:
“Give a small boy a hammer, and he will find that everything he encounters needs pounding.” –Abraham Kaplan, The Psychology of Science, 1964.
“Theology after breakfast sticks to the eye.” –Wallace Stevens, “Les Plus Belles Pages” (in other words, it blinds you)
Markets are a way to cooperate. Sometimes they are the best way, sometimes not. Have a look at what happens when a guy tries to make a toaster all on his own: http://www.ted.com/talks/thomas_thwaites_how_i_built_a_toaster_from_scratch.html
I agree, TE, emphatically.
And that’s one reason why I do not want to have some Centralized Curriculum Commissariat and Ministry of Truth mandating invariant education standards, curricula, high stakes tests, centralized depositories of student records, teacher and school evaluation schemes. Let people put forward their ideas, and let those ideas have to compete for hearts and minds, with the ideas of others.
It seems to me that traditional zoned schools are not compatible with your view of education. As long as the state tells parents that they must send their child to school C, not A, B, or D, the state (by which I mean the government at whatever level) will need to ensure that schools A,B, C, and D are not appreciably different from each other.
I want every school, every community, to be able to CHOOSE the materials from which to make its toaster(s). I don’t want them to have to use the toaster created by some plutocrat who has bought his wind-up toaster-suppliers in Washington and in state departments of education.
If a school chooses to become a Waldorf school, do you think every parent in the catchment area will be pleased? Would some want to send their children to the Montessori school in the next catchment zone next door? I don’t see how a system where the government assigns students to a school based on geography is comparable with school level diversification.
TE, we had site-managed public schools in this country for a long, long time. It was necessary for the feds to intervene to ensure protections of fundamental liberties in some places (Hillsborough, Co., Florida comes to mind), but to the extent we got state departments of education and the idiots in Washington into the business of telling educators what they had to do in the areas of standards and curricula, we got the consequences that distant, authoritarian, centralized planning always creates. Distant, centralized authorities are extremely stupid and corrupt.
So you think involved parents will allow school boards to tell them which school their students will attend when those schools offer significantly different curriculums? I live half a block from the middle school catchment line. The school board is going to decide that my child goes to a progressive school rather than the Montessori school my neighbor’s child is assigned to attend?
Schools do not have to be monolithic, TE. There can be schools within schools. Social sanction is a powerful force to shape, locally, what works in the local area, given the local ecology.
Co locating a traditional school and a Waldorf school in a building might make most of the residents of a catchment area happy. Would you have a regulation requiring the same choices be available in all catchment areas?
When you have site-managed schools, what you see is lots and lots of innovation–including the creation of small, alternative schools in fairly small communities. I grew up in Bloomington, Indiana, population 60,000 at the time. We had a public high school and a university laboratory school and a voc school and an alternative school, and these alternatives grew out of the public school in response to local demand. I think the alternative school couldn’t have had more than 40 kids in it, ones who were temperamentally unsuited to siting in desks all day.
My town has an alternative high school as well, but it is a charter school (the charter is held by the local school board). Most who post here would argue that it be shut down immediately.
The other schools you mention, were they traditional zoned schools or were students allowed to go to whichever school best matched their individual needs and talents?
The voc and alternative schools were by choice, though some kids ended up in the alternative school because their parents were told that they had to go there. I am not certain about the llab school. I think that enrollment was originally by choice but that the school became traditionally zoned. It was an amazing high school experience, BTW. We had a large campus with several separate building scattered about it, a lot of professors with doctorates, and fascinating classes in topics like wave motion and Russian history. These were great classes because a) the professor knew his or her subject and b) the professors had the autonomy to design classes that they cared to teach. And we got the windfall of their passion for what they were doing.
Greedy people, I guess.
My point was not that my life was saved, but that there are public services that are too important to a decent society to privatize: police, fire, air, beaches, parks, environmental protection, libraries, schools, and yes, hospitals. But it is happening.
amen to that!
They closed down the hospital in Chestertown, Maryland, on the Eastern Shore. Now when people get sick they have to be flown by helicopter across the Chesapeake Bay to Baltimore. The sick person or his or her heirs are then stuck with a $20,000 bill for the helicopter ride. I kid you not.
Open enrollment within a district is one way to send students to particular schools of choice, but there is a transportation expense that can be cost prohibitive. Depending on population size, transportation issues are a major expense. Our district is rural/suburban. It covers 2+ townships. We have 1 high school, 1 middle school, and 2 elementary schools. There is 1 parochial school. The vocational school is about 15 miles from the high school
To transport to schools of choice would require going 10-20 miles outside the school community. How does one justify that much transportation money being spent for a student?
I agree that transportation costs limit what can be done, especially in rural areas. I am optimistic that new communication technologies will be helpful.
There are, however, many places where transportation costs are less of a concern. The densely populated areas of the coasts come to mind. Even in my little town my children were not assigned to the closest middle or high school in an effort to achieve SES balance. If the town is willing to incur transportation expenses for that purpose, it might well be willing to do the same to offer a their children a more appropriate education based on their unique talents.
This vicious attack on all publicly financed public services stems from the perverted ideology pushed — as “market based” policy — by the disciples of Ayn Rand. One of the ironies of the past quarter century is that while most of us were busy with reality, the pushers of the “Atlas Shrugged” version of “economics” were busily winning converts to their crazy sociopathic theology. During the years we had to deal with Alan Greenspan’s meditations in his bathtub, it should have been seen as the sick joke that it was, but instead those prophecies and those prophets were hailed — and their public policies slowly spread like fertilizer across the land.
One of the many ironies of all this is that “Atlas Shrugged” is a very good case study in megalomania, paranoia, and outright falsehood. It had to be presented in boring fiction. Its version of the role of “markets” has nothing in common with the complex nuanced look at capitalist economics from Adam Smith’s Wealth of Nations through the classical economics of John Stewart Mill and Karl Marx and others of the 19th Century right down to today. Those who actually studied economics from the 16th and 17th centuries on knew its complexities. And men like Adam Smith not only wrote about the creativity of markets, but about the need for them to be carefully regulated (especially financial markets).
By the late 20th Century, however, those attempts to understand the history and realities of market and semi-market economies had been replace with dangerously ignorant religious rantings, the most amazing of which are the novels of Ayn Rand.
Ironically, that’s why every time there is a “bubble” and a bursting of the bubble, the disciples of Rand and their clones in positions of power don’t get it. They can’t explain what just happened because they never bothered to study the cyclical reality of capitalism, markets, demand, and all those complex things. And the need to reign in greed (sometimes with strong measures, as John Calvin and some of the early proponents of capitalism utilized in Geneva).
Instead, the late 20th Century and early 21st Century prophets of “markets” bathed themselves (and hence many others) in their dangerous fictitious oversimplifications.
Ten years ago, when my eldest son entered high school at Chicago’s Whitney Young, he came home and told me that as a 9th grade “honors” English student he could get “extra credit” by reading a very long novel. I was thinking Moby Dick, Anna Karenina, or The Brothers Karmarzov — any of the classics of the canon which were at that time beyond the classroom work of 9th graders. (But which I had taught in Chicago classrooms for years…).
No.
Danny came home with a copy of “Atlas Shrugged,” and his teacher hounded him not only to read it, but to enter the “essay contest” sponsored by the Ayn Randists, etc., etc.
With a little investigation, I learned that every high school in Chicago had boxes of “Atlas Shrugged” somewhere, and that some teachers, like that propagandist at Whitney Young, were force feeding it to ambitious youngsters. It turns out, this had been going on for years and years.
So…
Danny read all about John Galt and we talked about some of the crazier parts of the novel, from the sex to that endless sermon to the underlying viciousness of the plot itself.
A few years later, I was reporting on Chicago Public Schools and discovered the offices of “John Galt Associates” renting space on the 19th Floor of 125 S. Clark St. while Arne Duncan was CEO of CPS. A little more attentiveness, and the careful observer is likely to see the Ayn Rand books on display on the shelves of many of these crazies, but not anything resembling classical economics or serious literature. For a few years, I clipped those New York Times Business profiles of executives, especially when they cited, over and over, that their “favorite book” was “Atlas Shrugged.” After all, if its lurid depictions of a plutocracy in all its orgiastic strangeness could inspire Alan Greenspan in his bath tub, but more could anyone need?
My sister, a New York City nurse, was one of the first nurse practitioners to work in mid-town, and out of St. Vincent. She treated AIDS patients before the disease had a name. One of the reasons my brother, the artist Thomas Lanigan Schmidt, survived for his art to merit that recent (January to April 2013) retrospective at the MOMA Queens annex was that early on my sister the nurse knew enough about the biological realities of how AIDS was spreading among gay men — and pointedly warned him against certain practices.
As a result, he is still around all this time and still making his art. That is how he survived after he was one of those “working class kids” who were there at Stonewall (which he now does speaking gigs about).
And all that is partly thanks to the fact that in those days (the 1970s and 1980s), public health was viewed and paid for as a public good. Thousands were saved like Diane was. Public good — not as today as something that had to conform to the social sickness of “market” forces (and CEO pay scales).
It’s pretty dreadful fiction. Cliche-ridden purple prose, very Harlequin romance-like but a lot longer winded–she was a sort of very didactic Thomas Wolfe (not the later Tom). I forced myself through the Fountainhead but finally gave up on Atlas and skipped to the speech at the end which was rousing. Reading her gawdawfully badly written fiction was like having to read Volgon poetry. Her characters are comic book heroes and villains. She could have had a great career with Marvel comics, in fact.
She was a fascinating character but certainly no philosopher. Her overtly “philosophical” work is more readable than is the fiction but rarely rises above the intellectual caliber of, say, L. Ron Hubbard’s Dianetics: The Science of Mental Health. She loved freedom, as do I, so I really tried to like her work. I really did. But she hated people. I think that she was missing essential mental equipment, that she was clearly a sociopath.
In my experience, her stuff appeals a lot to 16 year olds, but they grow out of it, most of them. She was way over her head when she opened her mouth about the traditional problems of philosophy, which she couldn’t stop doing. Our Immanuel Cant, I call her.
Her stuff is more thoughtful than The Secret, to be sure, but I would definitely shelve it, along with the Hubbard book and The Secret and The Late, Great Planet Earth in the same section of the store, which one might charitably call “Alternative Visions.”
Thank you for that excellent rant against Ayn Rand and the people who sing her praises such as Alan Greenspan. They are not called out often enough. That is very interesting that Chicago public schools were pushing Ayn Rand.
“Why should hospitals be expected to make money?”
Because our Overclass, and the political brokers who represent it, is so devolved and degenerate that it’s intent on making money off human frailties and tragedies, and extracting rather than producing wealth.
Did I read correctly that Bill de Blasio is among those who want this hospital closed? That should be sounding alarm bells. Sounds like he’s yet another Obama – elected on a liberal platform only to pivot and govern neo-liberal. I think the voters should make it clear now that any future term depends on governing the way he ran, not the way his corporate overlords want.
“Local politicians, including Bill de Blasio–who ran first in the Democratic primary for mayor–are fighting the closure of LICH.”
Sick!
No, Dienne, de Blasio has been protesting against closing the hospital. He’s fighting to keep it open.
For those who may have missed it, Michael Moore’s SICKO says it all. Not a new film, but all the more relevant today. Clearly Moore sees the writing on the wall.
For all of American poopooing about the French, their health care system is one for us to look to for guidance. Then again, le citoyen has value and importance for the French society while our citizens are workers to fill the tax coffers for war that keeps corporate pockets moneyed. Our government has merely branched out into the education, health care and prison domains to funnel tax dollars to feed the 1%’s insatiable yearning for more.
As our schools become either for profit charters, or corporate ‘vendor’ controlled profit centers, this article will apply to schools as well. Closing neighborhood schools will make virtual learning easier to “sell”.
Follow the money.
Neither hospitals nor schools should operate for profit. What they “sell” is too valuable. Who can put a price tag on health or education?
That leaves us with the question of how much to spend on healthcare and education. Do you have a suggestion about how to decide this question?
This is such a key question you raise. Why indeed should hospitals, schools and other vital public services have to show a profit to exist? Everytime I mention the privitization movement in education to my friend, an M.D., she fills me in on why she could not practice medicine within the constrictions of the profit machine. She left a good practice in integrative medicine because she was forced to restrict her time with patients to 15 minutes while having to spend hours punching data into a computer. Great analogy to large classes/data driven education, right? It made it impossible to partner with her patients on an authentic level and left her feeling depleted and angry. Sound familiar, pedagogues? You are so right, Diane. It seems that unbridled profiteering is squeezing our birthright to life, liberty and the pursuit of happiness…as citizens and as professionals.
So what’s going to happen if the fat cats take policing and firefighting out of the public sector? You know somebody out there is crunching the numbers.
“So what’s going to happen if the fat cats take policing and firefighting out of the public sector? You know somebody out there is crunching the numbers.”
I posted something about this in a Yahoo article comment JUST yesterday!
When the neoliberal profiteers own the police, then the REAL fun can begin!
This hospital was never owned by a for-profit corporation. Continuum Health Partners is a nonprofit hospital network that was created to help three of New York’s smaller medical centers that are not directly affiliated with a medical school stay afloat. LICH’s financial woes (it has lost at least mid 7 to low 8 figures annually for 20+ years) threatened to jeopardize the entire network, and when it attempted to stop providing the services that were bleeding the most cash (emergency, OB/GYN, and neonatal care), the city’s Department of Health, under intense political pressure, said it could not.
To keep the hospital open and providing DOH-approved levels of service, SUNY Downstate took over ownership. After two years, its leadership has concluded that the hospital doesn’t attract enough patients to remain open with current staffing levels. No other agency or company, public or private, wants to take over the hospital, even if it didn’t cost them a penny to acquire it.
There’s probably a middle ground here somewhere. It costs a ton of money to keep an emergency room and surgical departments open, and the people who live in the neighborhood have overwhelmingly chosen to take their “business” elsewhere. I know we like to say that you can’t put a price on health or education, but as long as workers and vendors are expecting to be paid in cash, it turns out you can. There will be hardships for patients and employees, but paying a $100 million premium annually to keep this hospital open probably isn’t in the best interest of the public health of New York City.
LICH RECEIVED A bequest of $150 million from the Othmer family. Who ate it?
It looks like it was used to pay for operating expenses, especially those related to malpractice claims:
http://online.wsj.com/article/SB10001424127887324263404578614183479259720.html
It appears that the Othmers’ incredibly generous gift did help LICH remain open for far longer than it would have otherwise. I hope the DOH is correct in calculating that the closure won’t jeopardize the health of people living in the areas it served, and I’m certainly glad that they were there for you.
Sorry, place value fail: LICH has lost in mid 8 to very low 9 figures annually for 20 years, not mid 7 to low 8. Mea culpa.
TWO WORDS: GREED & POWER. This is to CONTROL the masses so they can do their evil deeds. Not to hard to figure out.
Both healthcare and education are devolving. What were services for the common good have become commodities. Healthcare and education are part of the infrastructure. Unfortunately the plutocrats look to these as investment opportunities. It is no surprise that poor neighborhoods are seeing both their schools and their hospitals shuttered.
A quick update on Long Island College Hospital: it is currently staffed by 1,400 employees who are caring for 12 inpatients. No, that’s not a typo. As it is running an estimated $250 million / year loss, SUNY will have to raise tuition and/or cut services at its universities and colleges.
http://www.capitalnewyork.com/article/politics/2013/11/8536069/cfo-long-island-college-hospital-has-1400-employees-caring-12-patie