The solution to our health crisis has vanished down a rabbit hole, and President Obama will need to pry an entire herd of bunnies out of his hat to salvage his reform proposals when he addresses the nation Wednesday evening.
Here at home, the health-care picture is equally fuzzy, what with the second round of layoffs unveiled this past week at Berkshire Health Systems, parent of Berkshire Medical Center -- the equivalent of 65 full-time positions, making the three-month total 130. That represents not quite 5 percent of the total work force; at more than 2,600, BHS remains the county's largest employer.
BHS faces what it calls "severe financial uncertainty" because more than 70 percent of its patients are on government programs. There's a sizable population of Berkshire seniors on Medicare; the working poor who depend on the state's subsidized health-care insurance program through MassHealth (a.k.a. Medicaid) and the once-uninsured folks now on Commonwealth Care. State reimbursements to BMC were slashed by $3 million last year; the combined reduction in federal and state aid next year could top $15 million.
Medicare and Medicaid payments to BMC account for more than two-thirds of the hospital's revenue. But those reimbursements cover only 70 to 80 percent of the costs of treatment, according to a new report from the Massachusetts Hospital Association. That's one reason people on private or employer-sponsored insurance have high premiums to make up the difference.
A further complication: Boston Medical Center, supplier of state-subsidized insurance in our area through its BMC HealthNet, is in financial distress and seeks a huge cut in reimbursements to providers here. At Berkshire Medical Center, that would amount to a $12 million loss, said Darlene Rodowicz, the chief financial officer, on WAMC Northeast Public Radio. Federal Medicaid payment cuts could cost BMC another $4.2 milllion. For next year, projected losses require "more work to be done," she added.
At Northern Berkshire Health Systems, which includes North Adams Regional Hospital, a proposed Boston Medical HealthNet cutback of 50 percent translates to $2 million, according to Richard Palmisano, NBH president and CEO. So far, layoffs have been avoided through "work-force restructuring." The Massachusetts Hospital Association reports one out of three hospitals are in the red statewide because of declining revenue.
Boston Medical projects a loss of $175 million in the year beginning Oct. 1, and it's blaming the state's insurance law, in part, for its plight. In early July, The hospital's CEO Elaine Ullian complained that the state is paying only 64 cents for every dollar of care to poor patients, "an untenable business model." Shortly thereafter, she announced her retirement.
Now, Boston Medical is suing the state, accusing officials of illegally cutting payments to the hospital. The complaint contends that Massachusetts has financed its health insurance reform, a potential model for the nation, on the backs of the poor by cutting funding to the hospital that cares for many of them. "This absolutely has implications for the national debate,'' said Larry Gage, president of the National Association of Public Hospitals.
Already, the fate of comprehensive national health-insurance reform hangs in the balance. The astute political observer Lawrence O'Donnell told MSNBC this past week that Obama's upcoming speech to a joint session of Congress smacks of defensive desperation and is unlikely to succeed in brightening the prospects of meaningful legislation.
O'Donnell was chief of staff for the Democrats on the Senate Finance Committee during President Clinton's failed attempt to push through health care reform 15 years ago. But O'Donnell thinks Obama is "actually in a much worse place" than Clinton was because Republicans are unwilling to negotiate and Americans are confused. "There's no one in any kitchen table around America who can explain to you what any of these bills are," he said.
Are we doomed to maintain the impossible status quo with the defeat or watering-down of meaningful, comprehensive health-care reform? I would never underestimate Obama, nor the right-wing's capacity for mischief and sabotage. It looks like a standoff, at best. And that standoff is not the prescription for America's desperate health-insurance ailments.
Clarence Fanto is a former managing editor for The Eagle.