Taming the beast in state's healthcare
MASSACHUSETTS HOSPITALS face the same harsh reality as Massachusetts citizens: a gap between rich and poor, which grows wider every day.
And, when it comes to healthcare, you can't talk about the gap between the haves and have-nots without talking about King Kong.
That would be Partners HealthCare, the parent company overseeing 11 hospitals and medical facilities. Partners' jewels -- Massachusetts General Hospital and Brigham and Women's Hospital -- posted double-digit profit increases in fiscal 2005. MGH's profit soared 22 percent to $188 million; Brigham and Women's achieved a bigger increase, 75 percent, to $74.8 million. (The industry calls this surplus, not profit, since under Massachusetts law these are nonprofit, charitable organizations.)
These two Harvard-affiliated teaching hospitals joined forces a decade ago, consolidating a powerful brand that commands worldwide respect. They save lives, employ many of the best doctors, and engage in medical research that may change the world. Yet, there is a price everyone else pays for their excellence and market share. Like
At the other end of the spectrum, hospitals struggle for survival. The poorer ones tend to serve poorer communities and people who do not have the luxury of calling a Partners' board member for a doctor referral.
Nine hospitals in Massachusetts lost money in 2005. They are North Shore Medical Center, which is part of the Partners' network; Cambridge Health Alliance; North Adams Regional Hospital; Lawrence General Hospital; Noble Hospital in Westfield; Anna Jacques Hospital in Newburyport; MetroWest Medical Center; Clinton Hospital; and Beth Israel Deaconess Hospital-Needham. Many others with slim profit margins are forced to cut back on nursing staff, lack basic equipment, and can't invest in technology that would ultimately reduce costs.
And then, there is Partners, rolling in profit -- OK, surplus -- which is reinvested, according to board chairman Jack Connors, into information technology systems, bricks and mortar, generous salaries, and new medical research. Connors freely admits the Partners' surplus is not used to reduce cost to the patient/consumer. He also acknowledges the obvious gap between rich and poor hospitals. His response: To some extent, ''That's life. That's classic market forces. There's Chanel and the guy who sells bags on the street corner that say, 'Channel.' "
The other side has another view. ''What you see in Partners' behavior is healthcare anarchy, in which the powerful thrive financially because they are not restrained by either free-market competition or sensible government price regulations," says Alan Sager, a director of the Health Reform Program at Boston University's School of Public Health.
Healthcare is a vital piece of the state's economic engine. Because of that, Partners is probably the most influential business and political player in town today, no small feat for a ''nonprofit." On Beacon Hill, Partners is driving the healthcare reform debate. The overall agenda includes a quest to increase Medicaid reimbursement and extend health insurance coverage. Who bears the ultimate cost is still unclear. The likely suspect is the consumer, via higher insurance premiums and copayments. There is no constituency for slowing the growth in overall healthcare cost. ''I don't think healthcare reform should address it," says Connors. That is, after all, how Partners ends up with surpluses.
This is not an evil empire. It does great things and embraces its nonprofit mission. For example, Connors insists Partners would never shut down North Shore Medical Center in Salem and Lynn, which lost $29 million in 2005. ''Absolutely not," he says. He says he is fighting for more Medicaid money for all hospitals because, ''We want them to stay alive. We want them to be healthy. We are not Pacman. We are not interested in being the sole survivor."
A healthy Partners is good for Massachusetts. But Partners' success cannot come at the expense of others who serve people in dire need, or with health insurance premiums we cannot afford. True healthcare reform should distribute wealth better. Partners does not need the hike in state-funded support that others do. The disparity between haves and have-nots should be discussed more openly, especially as state legislators hammer out details of a proposal that is expected to reach the governor's desk in January.
King Kong may have the noblest of intentions, but they do not change the nature of the beast.
Joan Vennochi's e-mail address is vennochi@globe.com. 
