In healthcare, economic and fiscal circumstances make it clear that hospitals and other healthcare providers serving as true "safety nets" are increasingly endangered under the weight of community service demands from uninsured and low-income patients. Does anyone really believe that all of the coverage expansions provided for in the federal healthcare reform law will be implemented or sustainable given the current state of federal and state government finances?
In order to demonstrate true leadership in community benefit, those hospitals doing relatively less should do more by reaching out to their community's safety net providers, offering monetary and/or in-kind support (e.g., managerial, clinical) to enable the safety nets to carry out their vital missions.
If the "haves" don't help the "have nots," then the "haves" will ultimately bear the burden, one way or another, that the "have nots" are carrying. It may not happen today, but it will happen.
One possible scenario, which does not seem out of the realm of possibility, is that policymakers will seek to use hospital tax-exemption requirements to leverage greater support by the "haves" to the safety nets. Here's the progression: