Tuesday, January 16, 2018
Editorials

Editorial: The Legislature's free-market fantasy for hospitals

Access to quality health care is not just at risk in Washington. It also is at stake in Tallahassee, where Florida House Speaker Richard Corcoran relentlessly pursues a free-market fantasy that threatens the future of hospitals such as Tampa General, Bayfront Health in St. Petersburg and the BayCare network. This is a risky strategy that would undermine the financial viability of the venerable institutions Tampa Bay residents have long relied upon for top-flight care, and it fails to recognize that hospitals cannot be treated like fast-food franchises competing for customers on opposite street corners.

Corcoran declares he and his Republican allies are pushing "dynamic reform'' to health care aimed at empowering patients by increasing the supply of health care options, which they believe will bring down prices. They are promoting sweeping changes on multiple fronts, such as eliminating the state cap on the number of expensive but profitable trauma centers, repealing certificate of need requirements for building or expanding hospitals, and allowing standalone surgery centers to keep patients overnight. That would create a wild-west free market for health care where hospitals are treated no differently than auto dealers or furniture stores competing for customers by promising lower prices in the best neighborhoods and avoiding unprofitable sites in low-income communities.

The reality is that health care doesn't work that way unless you're Gov. Rick Scott, who got rich running the nation's largest for-profit hospital system — now HCA Healthcare — that is one of the key supporters of the changes. For example, the state's limits on the number of trauma centers already consider travel time and the volume of patients needed to maintain quality care in a variety of specialities often needed in medical emergencies. Bayfront president and CEO Kathryn Gillette, who oversees one of the two trauma hospitals allocated to Pinellas and Pasco counties, told the Times editorial board that lifting the limits would reduce the number of patients, make it harder to keep top-notch specialists, undermine Bayfront's finances and not result in cheaper hospital stays. Bayfront is mounting a legal challenge to the bid by HCA's Northside Hospital in St. Petersburg to open a competing trauma center. Two Level 2 trauma centers less than 15 minutes apart makes no sense, but Republican legislators want to replicate that competition everywhere.

The certificate of need system that requires the state to sign off on new hospitals or expansions is dismissed by state lawmakers as archaic in a 21st century economy. But eliminating that process would encourage HCA and other for-profit chains to cherry-pick the most lucrative health care services in the most affluent neighborhoods. That would result in fewer insured patients for Tampa General and other hospitals that already provide more than their fair share of uncompensated care. Allowing standalone surgical centers to keep patients for up to 24 hours may be less objectionable, and the top procedures at those centers are often routine colonoscopies, biopsies and cataract surgeries. But that also would reduce hospital revenues and potentially pose health risks to patients who won't have immediate access to emergency services on site if something goes wrong.

Corcoran, R-Land O'Lakes, argues a free market would empower patients to make their own informed decisions about health care and consider affordability, accessibility and quality. That is a viable goal, but does an unconscious auto accident victim want to go to the cheapest trauma center? The intentions of the governor and Republican lawmakers also appear less benign when their proposed budget cuts are considered.

Scott and legislative leaders plan to reduce Medicaid reimbursements to hospitals by hundreds of millions of dollars. Tampa General, for example, could lose more than $20 million. Johns Hopkins All Children's Hospital in St. Petersburg could lose more than $12 million in the proposed state budgets the House and Senate are expected to approve this week. Bayfront could lose more than $7 million, and BayCare's Morton Plant in Clearwater could lose more than $8 million. This is all about competing priorities for general tax dollars, and the governor and lawmakers would rather cut taxes and pursue other agendas than provide adequate medical treatment for the poor.

If there is any remaining doubt about Corcoran's health care mission, the House ordered hospitals to produce a list of all executives earning more than $200,000, lobbying fees and their market capitalization. The obvious goal is to suggest hospitals aren't hurting for money as lawmakers slash Medicaid spending and push free-market initiatives.

Hospitals are not just any business. Floridians are entitled to accessible, affordable health care — and hospitals have an obligation to treat anyone who comes through their emergency rooms regardless of their ability to pay. Yet state legislators want to impose the same free-market philosophy that would apply to hamburger stands, and they are putting longtime community institutions and the quality of health care at risk.

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