Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what’s happening to the venerable institution is gut-wrenching to read.
I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002. A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:
Boston Medical Center is almost broke, perilously close to what its accountants euphemistically refer to as the “zone of insolvency.” It did not get here — $175 million in the red for the fiscal year ending September 30 — because it bought too many MRI machines or banked on cosmetic surgery being a big income generator. It landed in this hole because the folks on Beacon Hill like the sound of universal healthcare a whole lot more than they like the cost of it.
The piece is a powerful indictment against the Massachusetts government. And completely on the money.
I wrote previously in a CNN.com op-ed that expanding coverage without considering costs is a recipe for disaster. It’s true that Massachusetts has the highest rate of insured patients in the country. It makes for good headlines for the governing party. But doing so without addressing costs was a grave mistake:
Massachusetts is finding out just how difficult it is to fiscally maintain universal coverage. In part due to soaring health costs, the state Legislature has proposed reducing health benefits for 30,000 legal immigrants and cutting funding to inner-city hospitals like Boston Medical Center, which, according to the Boston Globe, may “force it to slash programs and jeopardize care for thousands of poverty-stricken families.”
Those dependent on the care supported by Government reimbursement — the Medicare and Medicaid demographic, namely — are going to be penalized as health reform takes hold. Consider BMC’s admirable mission to serving the poor:
To preserve Boston City Hospital’s long-standing mission to serve the poor, lawmakers wrote that obligation into legislation that created the new quasi-public hospital. Boston Medical Center, the statute stipulates, must “consistently provide excellent and accessible health care services to all in need of care, regardless of status or ability to pay.” The state, in turn, must compensate BMC for treating a disproportionate share of low-income patients by paying “rates that equal the financial requirements of providing care to recipients of medical assistance.”
BMC has kept its part of the bargain. Seventy percent of its patients are poor, elderly, disabled, or members of ethnic and racial minorities. More than 50 percent rely on free care, Medicaid, or state-subsidized insurance plans like Commonwealth Care. Many live in Boston’s most impoverished neighborhoods, and more than 30 percent speak a primary language other than English.
Massachusetts politicians are under heavy pressure to cut the state’s budget, and Medicaid costs are among the most inviting targets. And this places the hospital in an impossible situation. Yes, they can stop taking Medicaid patients. But first, where else would these patients go? The area’s high profile hospitals seen recently on ABC’s reality television show Boston Med, like Brigham and Women’s? Unlikely. And second, the state requires BMC to accept all comers.
A no-win situation, indeed.
Health reformers like to say that, in response to decreasing hospital payments, medical institutions need to “cut costs,” and “curb waste.”
But, as the article noted, “Demanding that BMC simply cut its way to solvency is as glib as promising that every government budget can be balanced by eliminating ‘waste, fraud, and abuse.’ Of course programs should be reviewed for inefficiencies, but there is no getting around reality: It is more expensive to treat the patients who come to BMC.”
Boston Medical Center is where I got my start out of medical school, and has played a defining role in making me the doctor I am today. Its impending financial insolvency is heartbreaking, and is a situation that will echo across the country as Massachusetts-style reforms take hold nationally.
Universal coverage makes great headlines, helps get politicians elected, and, to be fair, is something that needed happen. But doing so without adequately addressing its cost is going to bankrupt hospitals, especially inner-city ones like BMC. That will hurt the Medicaid and Medicare patients dependent on them.
And that’s a goddamn shame.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.
