The Gristle

Monopoly

Wednesday, March 15, 2017

MONOPOLY: For seven years, the Republican Party vowed they would repeal Obamacare, the Patient Protection and Affordable Care Act of 2010. Some in the national party were content with just that and only that, and the massive tax cut that would deliver to an economically advantaged class of billionaires for whom rising healthcare costs are but a trivial personal concern. Other Republicans believed the ACA should be replaced with something, and in February they unveiled a proposed American Health Care Act (AHCA) amid a great deal of chaos and secrecy.

The scoring of the impacts of AHCA was released this week by the Congressional Budget Office, creating shock at how bad the proposal was for the Republican congressional leaders to whom CBO reports. The estimated healthcare coverage losses of 14 million in the first year alone and 24 million within ten years were astonishing, and worse than many believed possible. Still, the promised tax cuts continue to charm a lobbying donor class that can practically buy their own private hospitals, and a plan that would ordinarily be slaughtered by its poor CBO score may continue to thrum in national discussion.

Much of the healthcare debate in the United States revolves around questions of demand—the numbers of people in the risk pool; and the incentives and subsidies necessary to keep healthy people in the risk pool to lower delivery costs and insurance premiums. But we’ll suggest issues of supply also yield clues to the solution of the healthcare debate. There’s something about the delivery of medical care in the United States that pressures for monopoly—a standardization of methods and practice, a consolidation of facilities in the form of medical campuses, and the regulation of the whole in the manner of a utility—and that means the standard capitalist model of many providers and many insurers, all financed through investment profits, is likely inadequate to provide permanent, stable, affordable health care for millions of Americans. In other words, we probably should give up on the taxonomy of health care as some free-market, many-limbed creature and begin to consider the beast more in the sense of a regulated, monolithic utility.

Most communities have only one hospital, one centralized campus for the delivery of medical care; and Bellingham is no exception.

For years PeaceHealth has grown, and in its growth acquired other medical service providers and laboratories. The nonprofit organization’s remarkable growth and consolidation caused the City of Bellingham in 2014 to revise its tax code as PeaceHealth acquired for-profit ventures and brought them under its tax- exempt umbrella, successively starving the city of considerable business revenues with each acquisition.

Having effectively eliminated competition in local laboratory services, in February PeaceHealth announced the sale of its laboratory services to Quest Diagnostics. Under the agreement, Quest Diagnostics will manage 11 laboratories PeaceHealth operates in hospitals in Washington, Alaska, and Oregon. PeaceHealth will maintain ownership of those labs, including the one at St. Joseph hospital in Bellingham. Quest Diagnostics also will purchase eight patient centers throughout Whatcom County. The patient centers are typically places where people can go to get blood tests and other services.

In a news release, PeaceHealth President and CEO Elizabeth Dunne said the agreement was made to keep its commitment to care that is both accessible and sustainable in an environment of increasing cost and complexity in the delivery of health services.

“In our current healthcare landscape, that sometimes means collaborating with organizations that offer the data, tools and resources necessary to stay ahead of the curve in specialized services,” Dunne said. “After thorough and thoughtful consideration, it became clear that Quest Diagnostics offers the expertise to enhance our services and increase convenient access to care in our communities.”

PeaceHealth has yielded to the pressures of a capital-driven healthcare market.

The agreement has unsettled a community of patients and health service providers concerned the outsourcing of laboratory services will weaken local control in the delivery of medical services and eliminate good-paying jobs for a professional class of technicians, analysts and practitioners.

According to numbers from SEIU Healthcare 1199NW union that represents these professionals, PeaceHealth employs about 100 lab assistants and 45 technologists in Whatcom County, with about 50 of those combined positions being eliminated. Last month, PeaceHealth sent a notification to the state, announcing 142 employees will be let go in various locations in Washington beginning in April.

Organized emergency medical service providers weighed in on the agreement this week, announcing “the more than 205 firefighters that serve Whatcom County are calling on PeaceHealth to walk away from its misguided plan to sell its currently locally run, not-for-profit labs to an out-of-state, for-profit operator.  As firefighters, the safety of our community is our top priority and we fear public health and patient needs will suffer after the sale.”

“These labs serve our community with quick, reliable data provided by community-based lab staff,” said Robert Glorioso, president of the Bellingham Whatcom County Firefighters Local 106.  “After the sale, the new owner will be shipping specimens out of state for testing, slowing results and possibly sacrificing the integrity of the testing.  This can’t be good for public health.”

Firefighters also pointed to the loss of living-wage jobs in the community.  PeaceHealth Labs staff are currently union members with a contract guaranteeing wage increases and affordable health benefits. The replacement workers, who may not even be from our community, are unlikely to have the kind of stability the union lab jobs offer.

“Bellingham thrives when workers thrive,” said Dave Pethick, Firefighters L106 vice president. “The loss of 100 good jobs in our community will hurt us all.”

The quality of medical care in the United States outshines the world. Its costs and delivery, baked into a broken capitalist model that demands outsourcing and wage suppression, is misaligned to that quality. The game of Monopoly always ends with a bankruptcy. That’s no way to deliver medical care.

BTown
Past Columns
The Missing Middle

August 16, 2017

The Last, Best Solution

August 9, 2017

Fire and Water III

August 2, 2017

Fire and Water II

July 26, 2017

Fire and Water

July 19, 2017

Some Assembly Required

July 12, 2017

Good, Bad, Ugly

July 5, 2017

Zero Hour

June 28, 2017

Standoff

June 21, 2017

An Existential Triangle

June 14, 2017

Divided Decisions

June 7, 2017

Breached and Beached

May 10, 2017

The Calm Before the Storm

April 26, 2017

April Showers 2

April 19, 2017

April Showers

April 12, 2017

The Fix Flops

April 5, 2017

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