New Film Exposes The Big Business Of Nonprofit Healthcare—And The Patients Caught In The Crosshairs

When Vicki Arnett’s husband Maurice was identified with stage 4 colon most cancers, touring to Atlanta for therapy from their residence in Pittsburgh was hardly her first alternative. However the settlement between his native hospital and his well being insurer was about to finish. In the event that they didn’t attain a brand new settlement, his care could be disrupted midstream. 

The Arnetts had been like hundreds of sufferers caught within the crosshairs of an ongoing battle between UPMC, the dominant healthcare supplier within the Pittsburgh space that has drawn criticism through the pandemic, and Highmark, a Blue Cross Blue Protect-affiliated well being insurer dominant within the area. 

A five-year settlement to work collectively was set to run out in 2019. Because the deadline for a brand new settlement approached, sufferers insured by Highmark—a lot of whom had no different medical insurance possibility—had been liable to dropping entry to their suppliers at UPMC.

The battle between the 2 nonprofit behemoths—and the influence on sufferers—is chronicled in a brand new documentary, InHospitable, that premiered in New York Metropolis earlier this month and is exhibiting on-line at DOC NYC via November 28, 2021. 

“Everyone knows now we have an extremely damaged system,” mentioned Sandra Alvarez, the movie’s director, in an interview. “You hear quite a bit about insurance coverage, you hear quite a bit about pharma, you hear quite a bit about medical units. However within the public consciousness, there’s not lots of dialogue about hospitals.”

Alvarez and the workforce behind InHospitable got down to discover the function hospitals play within the U.S. healthcare system and wound up discovering a David and Goliath story during which underdog sufferers use their collective voices to create a grassroots motion. 

Beth McCracken was one of many sufferers liable to dropping entry to her medical doctors at UPMC in the event that they didn’t signal a brand new settlement with Highmark. A affected person with uncommon most cancers being handled at UPMC, McCracken couldn’t afford to change insurance coverage and feared for her well being with out her UPMC specialists.

“My combat to take care of my healthcare has robbed me of the power to look after my well being,” McCracken says within the movie. “I don’t wish to say on my deathbed, ‘Crap, I’m dying as a result of they wouldn’t let me see the physician.’”

The movie shines a lightweight on a grimy little secret of the healthcare trade: that nonprofit hospitals typically maintain monopolistic energy and make use of enterprise practices that search to maximise income slightly than group advantages. 

And plenty of nonprofit hospitals are wildly profitable in maximizing income. In 2020, UPMC earned $23 billion in revenue and $836 million in operating profit.  

“Nonprofit hospitals are like spending machines,” says Elisabeth Rosenthal, creator of American Illness and editor-in-chief of Kaiser Well being Information.

With out shareholders to return these income to, nonprofit hospitals as an alternative pour cash into buildings, affected person facilities, and the most recent tools—to not point out govt salaries.

“Does the affected person actually profit as a lot from the million-dollar piece of artwork and the marble flooring as they’d from not being caught with a $100,000 invoice that was marked up by 250%?” asks Dr. Pat Basu, president and CEO of Most cancers Remedy Facilities of America. “I feel in case you gave sufferers these selections, they’d select the latter.”

The movie highlights that few politicians are prepared to carry these organizations accountable for failing to adequately compensate the group for his or her nonprofit standing. Hospitals are sometimes beloved for the life-saving care they supply. Additionally they are usually the most important employers in a group—and huge political donors. 

That leaves customers weak, in accordance with Lisa Frank, govt vice chairman of strategic campaigns for SEIU Healthcare PA, Pennsylvania’s largest healthcare employee union.

“It is not unusual in the USA for individuals to take the insurance coverage that their employers give them,” Frank says. “I feel what makes the case of UPMC distinctive is that the identical entity units the value of the insurance coverage, units the value of the companies that the insurance coverage will then pay for, and units the employees’ wages.”

In line with the movie, 50% of UPMC employees are in medical debt to their employer, who can be their healthcare supplier and their well being insurer.

That’s simply certainly one of many wrinkles of U.S. healthcare that the filmmakers discover. 

“We, as a rustic, have determined that we’re going to have companies be in control of our well being and our healthcare,” Alvarez mentioned. “How can we be certain that the oldsters who’re working these hospitals and taking a look at their backside traces and attempting to save lots of each penny they’ll and making as a lot cash as they’ll—as a result of they’re working a enterprise—how can we stability that with ensuring that their essential objective is to assist sufferers and handle sufferers?”

The movie’s website gives coverage concepts that assist reply Alvarez’s query, together with assets for customers to teach themselves in regards to the group advantages offered by their very own native hospitals.

Alvarez says the Antitrust Subcommittees of the U.S. Home and Senate screened the film, which can assist policymakers higher perceive the influence on sufferers of hospital consolidation. She says Congress may additionally allocate extra enforcement assets to the Federal Commerce Fee, which enforces antitrust guidelines, and the IRS, which oversees the principles governing nonprofit organizations.

However Congress received’t give regulatory businesses more cash until they hear from constituents about how these points have an effect on them immediately. 

Within the movie, Rosenthal encourages customers to talk up about their wants.

“I need individuals to insurgent as a result of that is your and my tax {dollars} not at work,” Rosenthal says. “Everybody must vote their healthcare and we do want a affected person motion.”

Together with her husband’s life on the road, Vicki Arnett heeded that decision.

“A whole lot of occasions, individuals sit in silence…and say ‘Effectively, anyone wants to do that,’” she says. “Effectively, who’s the anyone? If we don’t arise and begin being that anyone for everyone, we’ll by no means develop as a state after which our state representatives won’t ever know what’s actually occurring in their very own neighborhoods.”