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Hospitals: The new villains in the story of American healthcare? (What Slate has to say)

Online magazine Slate is known for its contrarian and strongly worded headlines.

"Fat People Might be Better Off Staying Fat Than Trying to Lose Weight"
"Thank Aldi for Sending British Supermarkets Into a Death Spiral"
"Update: The Job Market for Academics is Still Terrifying"

If you're like me, a shocking headline doesn't make you blink twice anymore. You're even less tempted to click on it. Yet, when browsing Slate yesterday, one headline made me do a double take:

"Hospitals Are Robbing Us Blind."

Forget Obamacare, read the deck. The real villains in the American health care system are greedy hospitals and the politicians who protect them.

With fewer than 2,000 words, Slate columnist Reihan Salam simply skewers hospitals in this piece. "Whether you're for Obamacare or against it, you can't afford to ignore the fact that America's hospitals have become predatory monopolies," he writes. "We have to break them before they break us."

Mr. Salam touches on many issues, including consolidation, contract disputes with private payers and Medicare's payments to hospitals as they compare to other sites of care. "As for why hospitals charge such high prices, it's fairly simple: They do it because they can," he writes.

When someone or something tries to tame a hospital, lawmakers or local politicians run to the rescue. Politicians see the value in having hospitals on their side, he says. The health sector employs more than a tenth of all U.S. workers, and hospitals hold the key to any meaningful change in the industry. As Mr. Salam writes: "One of the reasons President Clinton's 1993 health reform effort failed is that he never won over the hospital lobby." When it was his turn, President Barack Obama knew better.

Despite all of the arguments he made, what struck me most about Mr. Salam's piece was the word villain. Or crooks. The phrase bleeding us dry. Such terms are not unusual to a magazine like Slate, yet in the broader narrative of American healthcare, these words aren't often used to describe hospitals. The piece is the latest in what has been a series of scrutiny, following Steven Brill's book "America's Bitter Pill" about healthcare and, specifically, hospital prices and profits. It's an expansion of his TIME story, which won the 2014 National Magazine Award for Public Service.

In speeches meant to inspire, I've heard the phrase, "We're rewriting American healthcare." If healthcare is changing, maybe the villains are, too. For so many years, the insurance and pharmaceutical companies were painted as the antagonists in the Great American Healthcare Story. In 2009, then House Speaker Nancy Pelosi said payers were villains and the health insurance industry was "immoral all along." That same year, 13 percent of Americans ranked the biggest problem in healthcare as insurance company greed (3 percent said it was hospital or physician greed). 

In the early 2000s, drugmakers were cast as the bad guys. A Kaiser Family Foundation poll found 70 percent of people thought pharmaceutical companies prioritized profits over the development of new drugs. "Rightly or wrongly, drug companies are now the number one villain in the public's eye when it comes to rising health care costs," KFF President and CEO Drew E. Altman said in 2005.

It's too simplistic to say hospitals were ever heroes in this story, but they held a certain place in our collective conscious. Drugmakers and insurers — distant and faceless — were somewhat easy to paint as villains. But most people know someone who works in a hospital, or they have donated money to one or spent time there as a volunteer. After all, for most of us, life really began the day we were brought home from where? A hospital.

A professor in health policy recently told me, "There are no villains here." He is like the many writers and authors who sit in the camp that there's no such thing as villains at all. Snidely Whiplash was a cartoon for a reason, they say. You don't meet people who rub their hands together, twirl their mustaches and set out to do evil. At their core, villains are no more than flawed people with problems on their hands.

While authors and professors are fortunate to have such a textured appreciation of good and bad, it seems many Americans would really appreciate a healthcare villain right now — especially a new one.

Pharmaceutical companies and insurers had their day. (Mr. Salam's piece doesn't mention big pharma, and his writing about insurers actually makes them seem sympathetic.) President Obama was cast as a villain by many, for a long time, still is. Critics rebranded the law as Obamacare to make it sound like the joke it was to them, only for him to embrace the nickname and for it to become part of our vernacular. In 2013, more (36 percent) Americans said the healthcare reform law was his greatest failure rather than achievement (22 percent).

Our broken Congress was, and to some extent still is, villainous. Americans consistently rank members of Congress as having the lowest standards of honesty and ethics (they rank physicians and nurses as having the highest standards, on the other hand).  Regardless of your political party, it's tough to say Congress was anything but despicable during the government shutdown of 2013. On the bright side, perhaps there is slightly more reason to believe they are working better together, given the recent doc fix legislation.

Is it hospitals' time for the hot seat?

There's a conversation-starter.

"The hospital and health system arena is multifaceted," says Scott Becker, publisher of Becker's Healthcare. "They are a critical piece and building block with nurses and doctors of the healthcare system. They are working through a rapid set of changes as to how they get paid — this makes running a system or any kind of entity very, very challenging."

Mr. Becker says larger systems are, for the most part, faring better than anticipated at this moment, although many smaller hospitals are barely surviving. "The extent of financial risk most hospitals are now forced to take is immense, and — as has been said many times — if there is no margin, they cannot provide care."

We'd like to know your thoughts. Please email mgamble@beckershealthcare.com.

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