Battles rage in West Ashley and Mount Pleasant and on James Island, where hospitals build new clinics and buy up doctors' practices in part to boost their influence and referring power. The fiercest battle, however, involves two Berkeley County hospitals that haven't been built. For the past three years, two local hospital systems have sparred over which should build a 50-bed hospital in the growing community. The duel draws parallels to a spat in neighboring Charleston County, where two new hospitals compete for too few patients. Healthcare systems vie for business in an industry where referrals and reputations, rather than low costs, direct patient spending. The Berkeley competitors purchased land near where developers planned to build tens of thousands of homes before the recession hit and growth stalled.
Early each morning, private ambulances charged toward a leafy Tomball subdivision where, for a hefty price to taxpayers, patients are dispatched to psychiatric "therapy" in a brown brick house where two portable potties are perched in the driveway. The ambulances are but specks among hundreds of emergency medical vehicles across Harris County making millions of dollars off the poor, the sick and the mentally vulnerable, whether they need a costly EMS lift or not. Medicare and the American public pay for the ride - dubiously and often - billed to the U.S. government as trips of medical necessity to "clinics" or "hospitals," a Houston Chronicle investigation has found. Much of it is fueled by the daily trafficking of the mentally ill and fragile to so-called therapy programs in aging strip malls, mid-rises and residential neighborhoods.
Joe and Teresa Graedon give lots of healthcare advice in their syndicated column, "The People's Pharmacy," and on their National Public Radio show by the same name. He's a pharmacologist, and she's a medical anthropologist. The Durham, NC, residents have written more than 14 books on topics from herbal remedies to deadly drug interactions. They should know how to get the best medical care. But in 1996, Joe's 92-year-old mother, Helen, died as the result of errors made at Duke Hospital. Joe Graedon thought he had been a good advocate. He stayed by his mother's bedside and repeatedly told her caregivers that she couldn't tolerate morphine and other narcotics. But in the end, he said, "You have to trust the doctor." He felt guilty about not being able to protect her. But soon that guilt turned to action. He and his wife reconstructed the steps leading to Helen Graedon's death, and that story opens their new book.
As far as health-reform boosters go, Oregon Gov. John Kitzhaber is among the most stalwart. "We want to show that health reform is something real, that it actually works," he said. "Oregon is a place that can actually make it happen." His state has aggressively implemented the health overhaul Congress passed last year, taking more than $100 million in federal funding to do so. But at the same time, the healthcare law puts Kitzhaber (D) in a bind. This year, Oregon passed its own plan, which starts with changing how it pays doctors and eventually ends with allowing public employees to enroll in Medicaid, the federal insurance program for low-income Americans. There's just one big obstacle: What Oregon wants to do would require the Obama administration to waive integral pillars of its signature legislative accomplishment.
Seniors who choose to enroll in Medicare plans provided by private insurers rather than the original, government-run Medicare now will have access to the same preventive care services. The question is whether they will use them. Starting Saturday, Medicare beneficiaries began to choose from nearly 40 plans and original Medicare to take care of their health needs in 2012. The focus on preventive services began this year for beneficiaries of original Medicare. In January, everyone with Medicare will be eligible for free or low-cost flu shots, mammograms, smoking cessation counseling and another 15 services. In 2011, 20.5 million people with Medicare took advantage of one or more preventive services available with no deductible or co-pay. But officials with the Centers for Medicare & Medicaid Services are hoping that many more will use the services in 2012. "People are not understanding that this is available to them and are not taking advantage of it," said Renard Murray, CMS administrator for the region that includes Florida.
U.S. Sen. Chuck Grassley said his skepticism about the nonprofit hospital industry is heightened by the large salaries some executives make running purported charities. National reports show some nonprofit hospital executives' pay approaching $10 million per year. No one in Iowa is close to that, but IRS reports show some million-dollar-plus salaries related to nonprofit hospitals here. Bill Leaver, CEO of Iowa Health System, made $1.6 million in 2009. Kevin Lofton made $2.3 million as CEO of Catholic Health Initiatives, a nonprofit hospital group based in Colorado whose systems include Mercy in Des Moines. Joseph Swedish made $3.8 million as head of Trinity Health, a Michigan-based system whose Iowa hospitals include Mercy hospitals in Clinton, Dubuque, Dyersville, Mason City, New Hampton and Sioux City. Industry supporters say nonprofit hospitals must pay enough to compete with private industry for top executives to run their complicated organizations.