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Bernie Sanders decries planned closing of Philadelphia hospital

Greenbeard

Greenbeard

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One of the challenges of finding savings in health care is that everyone (rightly!) wants to preserve jobs and access to health care services. There's a hospital in Philadelphia that lost $69 million last year providing jobs to thousands and services to tens of thousands. That clearly seems unsustainable but the unions and employees rallied in protest, the state and city officials did what they could to delay its closure, and now presidential candidates are weighing in.

Bernie Sanders decries planned closing of Philadelphia hospital
Sen. Bernie Sanders on Sunday assailed the planned closure of a hospital in the battleground state of Pennsylvania, saying it demonstrates the failures of the country's greedy health care system.
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"The situation in Philadelphia illustrates the entire problem: In a city with one of the highest poverty rates in the country, a major hospital serving low-income communities is on the verge of laying off 2,500 people, abandoning 500 medical residents, and closing its operations thanks to an investment firm looking to make as much money as possible in a corporate fire sale."

The Vermont senator added that he stood in solidarity with the nurses and others who are fighting to keep the hospital "from being destroyed by Joel Freedman and his investment firm" and reiterated his call for "Medicare for All."
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Using Medicare for All to pump additional money into failing hospitals to preserve jobs and public health infrastructure may or may not be a good idea, but it sure will make finding net savings more difficult.
 
Greenbeard said:
One of the challenges of finding savings in health care is that everyone (rightly!) wants to preserve jobs and access to health care services. There's a hospital in Philadelphia that lost $69 million last year providing jobs to thousands and services to tens of thousands. That clearly seems unsustainable but the unions and employees rallied in protest, the state and city officials did what they could to delay its closure, and now presidential candidates are weighing in.

Bernie Sanders decries planned closing of Philadelphia hospital



Using Medicare for All to pump additional money into failing hospitals to preserve jobs and public health infrastructure may or may not be a good idea, but it sure will make finding net savings more difficult.
Click to expand...

Unfortunately there are three aspects to health care.
Availability, Affordability and Quality.

If you're just a normal person with a middle class job, two of those three are there for the taking. But the third is always going to be elusive.

Sander's problem here is that his means do not meet up with his dreams and unfortunately. He doesn't know how we are going to support this system that he wants. Even taxing everyone in the top 15% upwards of 90% in their revenue. Would not be enough to fund such a massive change in our health care system.

We need another way.
 
Hahnemann University Hospital to Close, Leaving Thousands Out of Work - NBC 10 Philadelphia

Where was Bernie 5 years ago when Hahnemann University Hospital to Close, Leaving Thousands Out of Work - NBC 10 Philadelphia first went into Chapter 11? Where does he intend to find the desperately needed $200 mil the hospital needs for rebuilding 100 year old collapsing structures, and modernization of the buildings, not counting the costs of equipment?

Without constant rebuilding, sufficient maintenance, efficient fund raising, old private hospitals tend to die slow deaths. No community wants to lose their hospitals, no matter how poorly they function. Sometimes it is inevitable.

Bernie has stumbled on a political sound byte. Addressing lost jobs, the emotional plea of endangered health for local residents, selective outrage and no discourse about the underlying issues of crumbling old buildings, low quality morale, the shortage of quality healthcare personnel and management. One of the rating paradigms for hospitals is readmission rates for patients with the same maladies for which they were originally admitted. Patients at Hahnemann suffered a 67% repeat admission ratio, placing Hahnemann as one of the 50 worst hospitals in the nation.

Does Bernie have a plan beyond mere emergency funding to delay Hahnemann's closing, or does he have a longterm concrete plan for curing Hahnemann's ills?

The once single largest not for profit operator of hospitals in the US was the Salvation Army. They have either closed, sold off or repurposed all their hospitals and are no longer participants in the industry. No entity has replaced them. Hahnemann belongs to a for profit medical provider company. That company has determined the only recourse for recovering its investment and losses is to close the hospital and redevelop the property underneath. They bought the hospital hoping to turn it around. They found the task impossible. Professional hospital operators. Yet Bernie, with no industry experience, is coming to the rescue.

Bernie needs to do something about his breath, the stench is getting unbearable.
 
Keep half the personnel and population served, and decentralize.
 
OldFatGuy said:
The once single largest not for profit operator of hospitals in the US was the Salvation Army. They have either closed, sold off or repurposed all their hospitals and are no longer participants in the industry. No entity has replaced them.
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Links?
I searched and searched "Salvation Army Hospitals" "did the Salvation Army run hospitals" "former Salvation Army hospitals" and even "Salvation Army hospitals in the USA" and found nothing.
 
Checkerboard Strangler said:
Links?
I searched and searched "Salvation Army Hospitals" "did the Salvation Army run hospitals" "former Salvation Army hospitals" and even "Salvation Army hospitals in the USA" and found nothing.
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Starting during 1865 by evangelist William Booth and his wife, Catherine, reform methodists in the East End of London to help the poor save their souls, by charitable action, the Booths started with a health clinic for expectant mothers, particularly unmarried mothers. Within a decade they expanded throughout Britain, its colonies, and North America, establishing obstetrics clinics and later obstetrics hospitals. Booth Memorial Hospital on Main Street and Booth Memorial Avenue in Flushing, where my youngest sister and brother were born, was established in an old house, later replaced, repeatedly with more modern structures and facilities. It is now NY Cornell Presbyterian Hospital Center of Queens. Most of the Salvation Army hospitals closed in the 1960's and 70's. Booth Memorial in Queens lasted until 2015. The Rescue Center in the East End of London is still open and operating.

Not far away, on Bowne St., is Bowne House, home of the Quaker Remonstrance which laid the groundwork for American freedom of religion.

Our History - NewYork-Presbyterian Queens

NYP has only stated local SA history in NYC. The first US clinic was established in Philadelphia in 1879, the second in South Boston 2 years later. Both also later grew into hospitals. After WWI more than 200 clinics and hospitals run by the SA across the country were functioning. Most of the clinics evolved into hospitals. The SA did not have sufficient management skills, or sources of income to maintain their mission. Basically, more modern municipal and private hospitals put them out of business. Still they accomplished much good. The SA still operates obstetrics clinics in the slums of Brazil. Teaching basic prenatal and infant care, providing nutrition with RN led staffs.

Mae West was luring a young Gary Cooper from his love interest, a Salvation Army Captain, when she ad libbed "Is that a pickle in you pocket or are you just glad to see me, big boy?" Mae in real life was a generous donor and fund raiser for the SA, and War Bonds during WWII. The SA graciously forgave Mae her scandalous behavior. So did FDR who personally pinned a citation to Mae's chest, with a chuckle. :roll:
 
Greenbeard said:
One of the challenges of finding savings in health care is that everyone (rightly!) wants to preserve jobs and access to health care services. There's a hospital in Philadelphia that lost $69 million last year providing jobs to thousands and services to tens of thousands. That clearly seems unsustainable but the unions and employees rallied in protest, the state and city officials did what they could to delay its closure, and now presidential candidates are weighing in.

Bernie Sanders decries planned closing of Philadelphia hospital



Using Medicare for All to pump additional money into failing hospitals to preserve jobs and public health infrastructure may or may not be a good idea, but it sure will make finding net savings more difficult.
Click to expand...
As I understand it Medicare for All has lower payment rates the current plans - how will that help?
 
OldFatGuy said:
Starting during 1865 by evangelist William Booth and his wife, Catherine, reform methodists in the East End of London to help the poor save their souls, by charitable action, the Booths started with a health clinic for expectant mothers, particularly unmarried mothers. Within a decade they expanded throughout Britain, its colonies, and North America, establishing obstetrics clinics and later obstetrics hospitals.
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So, for the most part, back before even modern medical germ theory was universally accepted and "hysteria" was still regarded as a valid female disease to be cured by manipulation. :roll:
You might as well have included a few medieval bloodletting rooms, too :lamo

But I get the point.
PS: Mae West's chest, eh?
I bet he didn't need braces to stand up for that.
 
Greenbeard said:
One of the challenges of finding savings in health care is that everyone (rightly!) wants to preserve jobs and access to health care services. There's a hospital in Philadelphia that lost $69 million last year providing jobs to thousands and services to tens of thousands. That clearly seems unsustainable but the unions and employees rallied in protest, the state and city officials did what they could to delay its closure, and now presidential candidates are weighing in.

Bernie Sanders decries planned closing of Philadelphia hospital



Using Medicare for All to pump additional money into failing hospitals to preserve jobs and public health infrastructure may or may not be a good idea, but it sure will make finding net savings more difficult.
Click to expand...
As written, Sanders M4A bill doesn't "pump money" into unprofitable hospitals. At least, I don't see any provision within it that provides funds for unprofitable hospitals

The reason this hospital is unprofitable is unclear. According to some state legislators, it's due to "fiscal mismanagement. " According to the workers, the new owners bought the hospital and intentionally drove it into the ground because they believe that they can make more money redeveloping the property (I assume for high end housing)

If the hospital is losing money because it provides services for people who are uninsured, then M4A might help prevent similar closures by ensuring that hospitals get paid for the services they provide. However, if hospitals are being closed because investors can make more money using the land they sit on for some other purpose, then I don't see how M4A has anything to do with it
 
Checkerboard Strangler said:
So, for the most part, back before even modern medical germ theory was universally accepted and "hysteria" was still regarded as a valid female disease to be cured by manipulation. :roll:
You might as well have included a few medieval bloodletting rooms, too :lamo

But I get the point.
PS: Mae West's chest, eh?
I bet he didn't need braces to stand up for that.
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Consider the times, the place they started. For impoverished married and unmarried mothers, better some care than none.

Blood letting was Barbers' turf. As you laugh, blood letting is still a recommended therapy for reducing excessive iron in the blood, a rare cause of cardiac infarctions. More common among post menopause women than men, the former less aggressively examined for cardiac issues, suffering thereof.

FDR didn't have to stand, Mae accommodated him by leaning over, giving him a grand view of her magnificent décolletage. Mae lived in an 8 room apartment over a bar she owned on the corner of Jamaica Avenue and Woodhaven Blvd, above a bar she owned. Mae was a smart businesswoman, who invested well among the two story store and apartment above buildings that line that section of Jamaica Avenue, a main commercial thorofare running from downtown Brooklyn, through Queens to the east end of Long Island, renamed Jericho Turnpike, at the Queens Nassau border, a "Quality Road" following old Indian trails. The bar has been restored, a neighborhood watering hole and destination for Mae's fans today. Well decorated with Mae memorabilia, including one of the few photographs of FDR in his wheel chair, with Mae bent over for the citation pinning, and a huge smile on his face, cigarette holder barely hanging from between his lips at a very odd angle. :)

Mae's life should be an example and a source of learning for today's feminists. She started as a child actress in vaudeville skits, entered the talking film industry as both a performer and investor during her early 40's, launching herself as a national phenomenon, one of our early sex symbols that captured the nation and the world. Using her assets and quick wit to gain a vast following. Her celebrated verbal rivalry with WC Fields immortalized on celluloid. She was self educated, produced six successful Broadway plays, including "Sex" which was shut down by the morality police, reopened after a free speech in art case that was decided by the Supreme Court giving us the term "of redeeming value." In gratitude for her free performances for the men in white at Navy bases, The US Navy named a life vest after her, "The Mae West" which became an almost generic term for life vests. Mae never gave up, posing in Playboy magazine during her late 70's, surrounded by male body builders from the gym she owned on nearby Crossbay Blvd, now a Gold's Gym.
 
OldFatGuy said:
Consider the times, the place they started. For impoverished married and unmarried mothers, better some care than none.

Blood letting was Barbers' turf. As you laugh, blood letting is still a recommended therapy for reducing excessive iron in the blood, a rare cause of cardiac infarctions. More common among post menopause women than men, the former less aggressively examined for cardiac issues, suffering thereof.

FDR didn't have to stand, Mae accommodated him by leaning over, giving him a grand view of her magnificent décolletage. Mae lived in an 8 room apartment over a bar she owned on the corner of Jamaica Avenue and Woodhaven Blvd, above a bar she owned. Mae was a smart businesswoman, who invested well among the two story store and apartment above buildings that line that section of Jamaica Avenue, a main commercial thorofare running from downtown Brooklyn, through Queens to the east end of Long Island, renamed Jericho Turnpike, at the Queens Nassau border, a "Quality Road" following old Indian trails. The bar has been restored, a neighborhood watering hole and destination for Mae's fans today. Well decorated with Mae memorabilia, including one of the few photographs of FDR in his wheel chair, with Mae bent over for the citation pinning, and a huge smile on his face, cigarette holder barely hanging from between his lips at a very odd angle. :)

Mae's life should be an example and a source of learning for today's feminists. She started as a child actress in vaudeville skits, entered the talking film industry as both a performer and investor during her early 40's, launching herself as a national phenomenon, one of our early sex symbols that captured the nation and the world. Using her assets and quick wit to gain a vast following. Her celebrated verbal rivalry with WC Fields immortalized on celluloid. She was self educated, produced six successful Broadway plays, including "Sex" which was shut down by the morality police, reopened after a free speech in art case that was decided by the Supreme Court giving us the term "of redeeming value." In gratitude for her free performances for the men in white at Navy bases, The US Navy named a life vest after her, "The Mae West" which became an almost generic term for life vests. Mae never gave up, posing in Playboy magazine during her late 70's, surrounded by male body builders from the gym she owned on nearby Crossbay Blvd, now a Gold's Gym.
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You forgot to mention Richmond Hill, which was where my cousins used to live, and where I spent a significant portion of my childhood every summer until they all moved to Atlantic Beach, Long Island, where the rest of my cousins lived. :)

Very familiar with Jamaica Avenue and Queens in general.
 
Checkerboard Strangler said:
You forgot to mention Richmond Hill, which was where my cousins used to live, and where I spent a significant portion of my childhood every summer until they all moved to Atlantic Beach, Long Island, where the rest of my cousins lived. :)

Very familiar with Jamaica Avenue and Queens in general.
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Richmond Hill, which borders Woodhaven, and is much larger, wasn't Mae's bailiwick. Originally a Brooklyn gal, Mae preferred the western side of Woodhaven Blvd. Once a thriving white middle-class neighborhood, today Richmond Hill is a much more diverse and again thriving community. Houses that once sold for less than $5k now selling for more than $800k. At one time, the Richmond Hill Jamaica Ave bars were a second home for me. Seedy, low lit, hard drinking customers, always with an underlying presence of violence. A tough crowd. Bikers, wannabe made guys, made guys, and low life criminals, few actually living in Richmond Hill, with some exceptions, but mostly from Ozone Park and Brooklyn, later Howard Beach. Times and gentrification has changed things. Recently, a house in North Richmond Hill sold for $6.1 mil. Richmond Hill, once famous for its many Churches, now better known for its Hindi and Sikh Temples, revival Victorian mansions, and escapees from Manhattan to its tree lined streets, private schools, and proximity to Forest Park. One of the biker bars I used to frequent, now a high end family restaurant, bikers not welcome.

Few remember, pristine Jamaica Bay, before the construction of Idlewild Airport (now JFK) had a shoreline littered with the summer mansions of Manhattan's uber rich. Richmond Hill was founded as summer homes for those who were wealthy but couldn't afford the shorefront mansions. The neighborhood is still home to many of those smaller mansions, often subdivided into apartments, and surrounded by later developed blue collar homes. Today, as they hit the market, they are being restored as one family homes and grandeur. And many of those blue collar homes being rebuilt as mini-mansions. 30, 40 years ago, who would have thunk?
 
sangha said:
As written, Sanders M4A bill doesn't "pump money" into unprofitable hospitals. At least, I don't see any provision within it that provides funds for unprofitable hospitals

The reason this hospital is unprofitable is unclear. According to some state legislators, it's due to "fiscal mismanagement. " According to the workers, the new owners bought the hospital and intentionally drove it into the ground because they believe that they can make more money redeveloping the property (I assume for high end housing)

If the hospital is losing money because it provides services for people who are uninsured, then M4A might help prevent similar closures by ensuring that hospitals get paid for the services they provide. However, if hospitals are being closed because investors can make more money using the land they sit on for some other purpose, then I don't see how M4A has anything to do with it
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I don't particularly see how his proposal would save this hospital either, but that's the claim his campaign is making--see below. (Jayapal's bill at least has a mechanism for dialing up a particular hospital's revenue via its global budgets.)

"Medicare for All will not only save hospitals, but it will energize Pennsylvanians to vote and finally defeat Donald Trump," Faiz Shakir, Sanders' campaign manager, told POLITICO. "I think anyone pushing for less than Medicare for All needs to explain how their system would 'cost a hell of a lot less' if it's still going to be making life worse for too many Pennsylvanians."
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This seems more a symptom of the larger urge to make 'Medicare for All' mean all things to all people and present it as a panacea to whatever particular health care-related grievance anyone might have. But it does illustrate the political challenges to cost containment Medicare for All would face. (Of course, these impulses are not limited to self-described Medicare for All proposals; the Medicare for America bill, for instance, includes minimum nurse staffing ratios, which would push up health spending.)
 
Greenbeard said:
One of the challenges of finding savings in health care is that everyone (rightly!) wants to preserve jobs and access to health care services. There's a hospital in Philadelphia that lost $69 million last year providing jobs to thousands and services to tens of thousands. That clearly seems unsustainable but the unions and employees rallied in protest, the state and city officials did what they could to delay its closure, and now presidential candidates are weighing in.

Bernie Sanders decries planned closing of Philadelphia hospital



Using Medicare for All to pump additional money into failing hospitals to preserve jobs and public health infrastructure may or may not be a good idea, but it sure will make finding net savings more difficult.
Click to expand...

Medicare for all would NOT pump money into hospitals. Medicare reimbursement has been cut to the point that it barely covers the cost of providing care (and in many cases doesn't). Healthcare organizations are dependent on private insurance to fund much of the cost of healthcare, including maintenance / updating facilities, purchasing new euqiment, etc. Switching everyone to Medicare for all would remove this funding, and cause many smaller facilities to close.
 
From the article:

The Pennsylvania Association of Staff Nurses and Allied Professionals accused Freedman of having "basically plundered" the hospital, which dates to 1848, and having "driven it into the ground," according to a report.
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(Freeman is the health system president)

That's ironic because that union organized nurses and related personnel in 2016, "aggressively" negotiating higher wages, which doubtlessly is one of the major drivers of the hopital's losses.

Union organizing from PASNAP was highly successful throughout 2016. In January, PASNAP successfully led unionizing campaigns two major Philadelphia-are hospitals: Delaware County Memorial Hospital (DCMH) and Hahnemann University Hospital, for a total of 1200 organized nurses.[16][17]
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Pennsylvania Association of Staff Nurses and Allied Professionals - Wikipedia
 
dcsports said:
From the article:

(Freeman is the health system president)

That's ironic because that union organized nurses and related personnel in 2016, "aggressively" negotiating higher wages, which doubtlessly is one of the major drivers of the hopital's losses.


Pennsylvania Association of Staff Nurses and Allied Professionals - Wikipedia
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I suppose an alternate reading is that Medicare for All would use monopsony buying power to break the back of that union and relieve some of the labor costs currently on Freedman's books.
 
Greenbeard said:
I suppose an alternate reading is that Medicare for All would use monopsony buying power to break the back of that union and relieve some of the labor costs currently on Freedman's books.
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If you wanted to misuse the term. This hospital is obviously not the only employer in this city.

Unless, of course, you are advocating the government also directly take control of hospitals and set the wages for all hospitals in the area.
 
dcsports said:
If you wanted to misuse the term. This hospital is obviously not the only employer in this city.

Unless, of course, you are advocating the government also directly take control of hospitals and set the wages for all hospitals in the area.
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Misuse what term? And where have I "advocated" something?
 
Greenbeard said:
One of the challenges of finding savings in health care is that everyone (rightly!) wants to preserve jobs and access to health care services. There's a hospital in Philadelphia that lost $69 million last year providing jobs to thousands and services to tens of thousands. That clearly seems unsustainable but the unions and employees rallied in protest, the state and city officials did what they could to delay its closure, and now presidential candidates are weighing in.

Bernie Sanders decries planned closing of Philadelphia hospital



Using Medicare for All to pump additional money into failing hospitals to preserve jobs and public health infrastructure may or may not be a good idea, but it sure will make finding net savings more difficult.
Click to expand...



Balance the cost of saving the hospital with the cost of dealing with the consequences of low-income families not having access to healthcare. The longterm results of communities full of sick, impoverished and desperate people will be very costly. For example, take into account the crimes committed by desperate people -- the costs of policing, property loss, prison upgrades, welfare to families left without breadwinners, the effects of making generational poverty worse by incarcerating potential breadwinners instead of better by giving people health security.
 
So, some clarification on the argument being presented by Bernie.

The immediate response is to just give distressed hospitals money, which is obviously cost additive.

For his part, Sanders said he would introduce legislation to reserve $20 billion in emergency funds to help states buy hospitals in financial distress.
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The longer term response, moving to Medicare for all, is that safety net hospitals would benefit financially.

He used the podium to argue that if every American had Medicare, for-profit hospital closures would be less frequent because there would be fewer coverage gaps between the rich and poor. Hospitals in low-income city neighborhoods and rural areas would have more stable cash flow. Sanders has also stressed that with better coverage, patients would be healthier, driving down costly emergency room visits.
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There's potentially two pieces to that: 1) people with no revenue/payment attached to their visits now will have some, and 2) prices paid will shift.

Let's imagine a toy model looking at the status quo and two alternative universes: 1) M4A (i.e., all prices paid at Medicare rates but, very generously, the current uncompensated care patients paid in proportion to their contribution to operating costs, and 2) a "M4A+" model in which hospital revenue in the statewide aggregate is held constant, but the prices of various payers are re-balanced to some weighted average.

So for simplicity let's imagine all payers today are Medicare, Medicaid, and commercial payers. We'll set Medicare prices at 1.0. Then, per a MACPAC analysis of Medicaid hospital prices for 18 high-volume services across 40-odd states, we'll set Medicaid prices at 1.06. The relative value for commercial prices is tricky (one CBO analysis had it at 1.89, whereas a recent RAND study had it at 2.41) so let's just set it at 2.15 for illustrative purposes.

Let's lean on the latest report from the Pennsylvania Health Care Cost Containment Council, using FY18 numbers.

Based on Hahneman's payer mix (relative revenue contribution of Medicare, Medicaid, and commercial patients) and the corresponding statewide numbers our scenarios yield:

Hahnemann and Statewide Average Hospital Revenue, FY18 (in $ millions)
Hahnemann Now​
Hahnemann Under M4A​
Hahnemann under M4A+​
Statewide Avg Now​
Statewide Avg Under M4A​
Statewide AvgUnder M4A+​
Commercial$145.0$67.5$93.9$138.3$64.3$89.6
Medicare$149.3$149.3$207.8$94.2$94.2$49.2
Medicaid$118.7$112.0$155.9$37.5$35.4$49.2
Uncompensated Pickup-$10.7$10.7-$4.5-
Total$413.0$339.4$468.4$270.0$198.4$270.0
 
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A few observations on the previous post:

1) Straight M4A is a revenue loser across the board, for Hahnemann and for the average hospital statewide. That's because being paid at the Medicare price level in aggregate is invariably lower than whatever is happening today.

2) M4A+, the world in which no money is saved on hospital services in aggregate but a single-payer entity pays at some percentage of Medicare prices (~139% in our toy model) to maintain the status quo in aggregate, benefits hospitals like Hahnemann that disproportionately serve publicly insured patients today. Whereas hospitals with a favorable commercial payer mix are losers in such a world, payers with a high public payer mix benefit. So Hahnemann's revenue increases even as the statewide average remains the same as under the status quo. The total pie stays the same size but the sizes of the slices different hospitals get varies.

3) Even with the pickup under M4A+ (which saves the system no money), Hahnemann is in trouble. Its FY18 operating margin under the status quo is -29.7%. Its operating margin under our M4A+ scenario improves to -20.1%. Still wildly unsustainable. And that's because in no scenario does its revenue come close to approaching its FY18 operating expenses of $586M.

Even if you imagine a very optimistic scenario in which merely converting to single-payer eliminates 20% of Hahnemann's operating costs, those operating costs are still $468.8M--just a hair higher than the best-case scenario revenue, achieved under the M4A+ scenario. A scenario no one is actually proposing because, again, it saves the system no money.

So even favorable assumptions about the uncompensated care pickup for Hahnemann under M4A and favorable assumptions about a status-quo-spending M4A+ scenario don't get Hahnemann into the black.

So I'm a bit skeptical of this grandstanding.
 
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