America's healthcare is often delivered with a mean streak

U.S. healthcare delivery is different from most of the rest of the world for a variety of reasons, but perhaps the most significant one is the fact that ours is often marbled with a mean streak.

That doesn't mean that there isn't compassion in the care that is being delivered in this country--there is a ton of it, and for the most part it obscures the mean streak. But the profit-driven, bottom-line and ideologically obsessed manner in which some organizations deliver care feeds that streak nevertheless. It can sometimes make hospitals appear more like a New York City moving company holding furniture hostage than community-based charitable institutions.

That explains "Leave No Money on The Table," a report just issued by the Washington Go Action Network. It detailed the financial operations of regional hospital system MultiCare Health System. Despite having annual revenue approaching $2 billion a year, the report concluded MultiCare didn't hesitate to snap at every patient dollar, even if it meant stressing out critically ill patients and their families by asking for payments upfront. Executives were also compensated partly out of how much was collected from patients. And if that didn't work, MultiCare also didn't hesitate to refer patients to a collections process that heaped fee after fee on top of their already significant bills. In one case illustrated by the report, a patient owed double his original bill four years after garnishments began.

I'd like to think that MultiCare is an anomaly- but then I'd have to disregard the practices of the Carolinas HealthCare System, the Mosaic of Life system and the dynamic duo of Accretive Health and Fairview Health Services, all of which have been discussed in this space multiple times in recent years. And there are many more examples.

Meanwhile, there are still 20 states that have declined to expand Medicaid eligibility, despite multiple studies suggesting doing so would create jobs, stimulate economic activity and cut costs at the state level. Florida Gov. Rick Scott has cynically flip-flopped so much on this issue for the sake of political gain as opposed to helping out his poorest constituents, PolitiFact finally called him out for it. 

I can think of a lot of things that the U.S. has turned its back on due to ideological grounds. However, Medicaid expansion may be the first that demonstrated it could stimulate economic activity and help people, and yet still be roundly rejected by a significant proportion of the populace.

So, say what you will, there is a mean streak in our nation's delivery of healthcare. And I doubt it will be removed or disappear anytime soon. - Ron (@FierceHealth)

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