Washington Sometimes there is just no shame, when there should at least be silence.  The medical establishment represented by the American Hospital Association indicated that it is going to fight aggressively against a requirement that non-profit hospitals provide a set and accountable level of charity care as part of the new health care legislative reform.  Both Senator Bachus (D-MT) and Senator Grassley (R-IA) have indicated they want this in, and they are 100% right about this.

The hospital argument is that they essentially do so much good for the community simply by existing, that they should not have to provide anything for the poor.  Poppycock!  Since the struggles dating back to the enforcement of the Hill-Burton act that paid for a lot of hospital construction it has been a constant battle to get many hospitals to do right on this requirement even when it was a fully understood condition for their original receipt of the funding.

An article in the New Yorker by Atul Gawande called “The Cost Conundrum,” brings all of these matters into bold relief.  He compares the McAllen, Texas medical market, which is rates as the most expensive in the country with other ways of doing business.  I know McAllen and that area along the Rio Grande Valley in South Texas.  For years Orell Fitzsimmons and I used to make a “fence mending” tour in the area annually when we represented school workers in these counties and had an office in Harlingen.  The area is among the poorest in the country rivaling the Delta south.

To make the summary short Gawande found a couple of things that go to the heart of a demand for charity, since the incentives for greed seem huge and unchecked.  Doctors need minders or the systems evolve towards little more than financial maximization with patient needs a forgotten commodity since it can’t be converted to cash.  Gawande found the McAllen health professionals surprised to find they were so expensive, which goes past irony, but adds up when one recognizes as he did that there is simply no systemic accountability anywhere.  Physicians are not going to heal themselves.  It will take a concerted community effort of health professionals and citizens structured into law.

Charity should start in that home and be mandated in all communities or it will not be a part of any health care system either.