Corporate Ownership in Healthcare

Finance: Consolidation and Corporate Ownership in Health Care: Trends and Impacts on Access, Quality, and Costs, June 8, 2023

The turn of the Millennium saw the destruction of public hospitals and their consolidation into conglomerates. This has hit the DC area hard. INOVA has taken over most of Northern Virginia, Montgomery General has been absorbed into MedStar and DC General has closed. In rural areas, Catholic Health Association hospitals have taken on almost monopoly status, which as the appendix underlines, has a major impact on reproductive health.

With the decrease in vocations, CHA hospitals have had to resort to executive management, with all of its flaws. In other words, they have been corporatized in all but name.This is a shame, but that is a problem for the Church, not Congress.

While we could seize for-profit hospitals under eminent domain, that would merely reward bad actors.  As the Minority points out, the best way to fix the economy is competition. For both rural and urban areas, this competition must be from a renewal of public hospitals. 

In the past, these hospitals were the responsibility of religious orders or city governments To renew the public and charitable systems, federal funding is needed. State governments simply do not have the resources to otherwise compete - nor do they have the moral courage to disregard corporate campaign donations to keep public hospitals out.

Please see the second attachment for more on dealing with the demand side of medicine through single-payer. A single-payer scheme, either through Medicare for All or a Public Option (which is favored by the President and would be enacted given the votes), will not help the supply side. There are other options, however. 

Public hospitals can be built with either grants to the states or by establishing hospitals within the U.S. Public Health Service (or expanding the Veterans’ Health System. That is a detail that can be worked out on a state by state basis, provided the funding is there. 

The actual buildings are the easy part. Staffing is a bigger concern, although not at all insurmountable. Simply expand the Uniformed Public Health Service, both in terms of numbers and in providing training. There are certainly more people who are qualified to go into medicine than there are medical school slots. Funding these slots so that schools can expand or creating a UPHS medical school(s), where the price of tuition is made up with the requirements of residency in urban and rural areas, solves that problem - especially if overseas doctors are given an easier path toward licensing. 

The biggest problem is political will - or rather - political ill-will by some who would put ideology ahead of the availability of adequate rural medicine options. Making that point would help with passage, as well as coming up with the kind of national compromise on abortion that would actually encourage support by Catholic Health USA members (who would balk at providing fetal hospice but secretly support it).

Finally, allow me to remind the Committee of our position on controlling drug prices while providing for enhanced research.

A significant driver of drug prices is the question of funding orphan drugs. The answer is easy. Keep control of orphan drug intellectual property in the hands of the National Institutes of Health. Let them, and other agencies such as the National Science Foundation, fund grants and research contracts to generate breakthroughs, as well as to manage clinical trials for FDA approval (if appropriate for the population that needs the drug). When the drug is approved, NIH can then contract for its manufacture and distribution. 

This methodology will get more done faster, without relying on profiteering to do what is necessary to help our most vulnerable patients.

Attachment: Tax Exempt Hospitals Rural Healthcare

Attachment: Single Payer discussion from HHS Budget FY 2022