New Orleans       ACORN and the Labor Neighbor Research & Training Center for years piled through tax data from nonprofit hospitals in our joint Hospital Accountability Project.  We issued a number of reports about the paucity of charity care these hospitals were providing, despite requirements in the Affordable Care Act that they do so and failing in that area would threaten their tax-exemptions.  The IRS was supposed to enforce these requirements, but we are almost more popular to the Republican Congress and administration than the Internal Revenue System, which they have starved of appropriations even when such collections would fuel the federal budget.  Getting sufficient supervision of charity care is perhaps lower on their list than tilting at windmills.

We may have been beating the wrong drum, even if it was in service to our membership and constituency desperate for such care and relief.  A recent op-ed joins the fight demanding more hospital accountability on a number of grounds, but primarily makes the case that hospitals and their increasing de facto monopolies in many US markets are the greatest driver of health care costs now and are forcing health insurance increases.

The key points in this indictment are the following:

• Hospital prices are the leading driver of the 320 percent increase in insurance premiums that Americans have experienced over the past 25 years.
• Since 2000, prices at hospitals have grown faster than prices in virtually any other sector of the economy. Hospital prices have grown three times as fast as inflation and twice as fast as prescription drugs and doctor visits.
• Since 2000, there have been more than 1,300 hospital mergers among the nation’s approximately 5,000 hospitals. When hospitals that were once competitors merge, prices go up, often by double-digit percentages, with no measurable improvement in patient outcomes.
• Even though we rely on competition to determine hospital prices, 21 percent of hospitals are effectively monopolies — they have no competitor within a 30-minute drive — and an additional 24 percent face only one competitor.
• Hospital mergers destroy more jobs than they create, and those they create pay lower wages.
• The price distortions are huge. Hospitals in the United States earn $29,000 on average for a hip replacement covered by private insurance and $16,000 for one covered by Medicare. In Germany, the public system of nonprofit insurers, which covers 90 percent of the population, pays hospitals $9,400.

So, how do they get away with it?  This Yale professor of public health argues that a big part of it is politics.  Hospitals are often the largest, or among the largest, employers where they are.  They spent $100-million for federal lobbying and that doesn’t count what they spend on local and state lobbying.  They also benefit from soft spots we have in our hearts for their legacy contributions to our communities and our families from our beginnings to our ends.  All of this has made them bulletproof from normal anti-monopoly protections on restraint of trade and competition.

What’s the medicine we would need to apply to hospitals to rein in their avarice and make health care more affordable?  Sadly, Dr. Zach Cooper argues that he only sees federal regulation as the answer, and he’s probably right.  Fat chance of that now, but it ought to be near the top of the list if we get some changes in Congress and the administration in the future.