Private Equity Is Harming Healthcare -- and Owns Memorial Medical Center

I first visited Memorial Hospital in Las Cruces in 1969, when it was still a small, city/county owned hospital downtown. A Hill-Burton public hospital. This two-part column is my warning to the City and County that maybe we aren’t well-served by Memorial Medical Center, under private equity ownership, and that things will very likely get worse, particularly if we are not vigilant.

Neither what I hear on the ground in Las Cruces nor increasing national scrutiny of hospitals owned by private-equity firms bodes well. Two senior U.S. Senators recently launched an investigation of Apollo Global Management, which owns Lifepoint Health, which owns MMC. Locals say they experienced a stronger “profits over patients” attitude after Apollo’s purchase.

Sophisticated private-equity firms acquire hospitals or other medical-service entities and go to extremes to milk whatever funds they can from the hospitals, while minimizing services and jacking up costs. Often they fund the acquisition by burdening the hospital companies with huge debts. That can bankrupt hospitals. Owners may cut expenses by firing people and closing important departments that aren’t highly profitable. They also find ways to increase costs or make money by doing unnecessary procedures.

Such firms have bought out more than two hundred hospitals. Experts estimate that 40% of hospital emergency departments in the U.S. are managed by entities such firms own.

Senate Budget Committee Ranking Member Chuck Grassley and Chair Sheldon Whitehouse are investigating how private equity ownership impacts our nation’s hospitals. They wrote Apollo regarding “the horrific events” in a Lifepoint health center in 2021-2022 “where at least nine female patients were sexually assaulted while sedated by a now-deceased nurse practitioner who overdosed and died at the facility.” They inquired about a dizzying series of “questionable” mergers, acquisitions, and transactions by Apollo.

Studies had long shown that senior living facilities owned by private equity firms have higher death rates and inferior patient well-being.

A recent study compared Medicare claims for patients at 51 acute-care hospitals owned by private-equity firms with data at 259 similar-sized hospitals in the same areas that weren’t owned by such firms. 

They  studied a period from three years before a hospital’s acquisition by private equity to three years after, between 2010 and 2017. Soon after private equity firms took over, patients experienced about a 25% increase in infections, falls, and other hospital–acquired conditions, compared with patients elsewhere. Although overall numbers of surgeries declined, patients also got twice the previous rate of infections from surgery, even though numbers of surgeries declined.

The FTC recently sued a private-equity firm for allegedly plotting for ten years to gain a monopoly on anesthesia practices in Texas, then use it to charge patients unreasonably high prices.

Grassley has said that, with hospitals, "a business model that prioritizes profits over patient care and safety is unacceptable.” A Berkeley study concluded, “The private equity business model is fundamentally incompatible with sound healthcare that serves patients.”

Some local sources suggest that MMC may be proving that.

Interviews with present and former MMC personnel paint a sad picture. Non-public hospitals need to make profits; but observers say that MMC management, since Apollo took over, has even more extremely prioritized maximum profits over everything else, including patient safety, collegial oversight, and avoiding medicare fraud. They say that’s cost us some wonderful doctors, a hospital culture of cooperating to manage the best possible patient care and safety, and probably lives.

Part II will explore the local situation.

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[The above column appeared Sunday, 28 January, 2024, in the Las Cruces Sun-News and [should soon be] on the newspaper's website, as well as on KRWG’s website under Local Viewpoints.] A shortened and sharpened radio commentary version will air during the week on KRWG (90.1 FM) and on KTAL-LP (101.5 FM, streaming at http://www.lccommunityradio.org/).]

[Locally, I began to hear concerns from the medical community about certain events, situations, decisions, and incidents at MMC, some tying the problems to Apollo’s acquisition of Lifepoint, MMC’s parent company; meanwhile, a marvelous Pulitzer Prize-winning journalist, Gretchen Morgenson, was publishing excellent articles on the national situation discussed above: private equity firms, as a group, are making huge profits by doing tremendous harm to our health centers and hospitals. As some had told me happened here, the usual tension between maximizing profits and optimizing patient care, an inherent problem in non-public hospitals, was getting way out of whack. Next week’s column will opine on the local situation. I am hoping to hear the MMC administration’s views in the meantime. Previously public aspects of the problem include MMC’s violation of its contract with city and county regarding mental health services and allegations by Yoli Diaz and others that MMC is also out of contract [and inhumane] with regard to indigent cancer patients and others. My opinion is as stated above. Other sources worth consulting are: Senators Probe Private Equity on Health Care , White House, Senate Take Aim at "Corporate Greed in Healthcare and perhaps https://www.nytimes.com/2018/02/28/business/jared-kushner-apollo-citigroup-loans.html.]

[Gotta say more about Gretchen Morgenson: first, from what I know, her articles are incisive, well-written, and right-on; second, I’d read good reviews of her latest book, These Are the Plunderers, co-written with Joshua Rosner, and have started reading it; and, third, part of the reason [for me] to read it soon is that she’ll be here in February, speaking as well as visiting with a long-time friend of hers here. Since she’s kindly agreed to gab with us for an hour on our radio show, “Speak Up, Las Cruces!” on KTAL, [either 8:30-9 or 9-10 on 21 February], I’d better start preparing to ask halfway sensible questions and pretend I know stuff. We’re looking forward to her visit! (Here’s the Publisher's Weekly bit on Plunderers, and if you google her name plus Apollo or health, you’ll acquire links to a bunch of interviews she’s done, or she and her co-author have done, with NPR and anyone else who’s paying attention.)

As you might sense, part of our problem is a national shift [not only in healthcare] from the local, human, and reasonable to everything being run by some financial people sufficiently far away not to give a shit about your or me. It’s like the change that surprised Americans in the late 19^th Century, and led to a strong progressive effort to control trusts and monopolies and force ‘em to pay at least lip service to human health, purity, and honesty. J.P. Morgan and Harriman and Rockefeller were wealthy to a degree [when compared to the average citizen] unimaginable to Jefferson and Madison. Now out billionaires and even, recently, trillionaires are obscenely wealthy compared to any of us, and probably the difference is way more outlandish than at any earlier moment.  (Interestingly, Blogger's spell-check had no problem with "billionaires" but is advising me that "trillionaires" is a non-word or misspelling.  So maybe I was wrong, and we're about to have our first trillionaires.)

Result? McDonalds doesn’t much care how its meat affects you, unless something happens that’s so bad it’ll impact a significant portion of customers. It’s particularly sad to see health care go that route. I can read stuff and avoid particular food vendors, but I likely have no meaningful alternative to my local hospital; and whereas I know the folks who make my clothes, tools, furniture, and other things are doing it for the money, and not for my health except as the law may require, I tend to imagine my doctors and nurses feel differently. Fact is, they mostly do; but those they work for are squeezing them inhumanely, and in effect punishing them for taking extra time and care with me – or pushing them to con me into some lucrative but unnecessary step they can overbill Medicare and me for. And even punishing them for doing the kinds of quality control efforts that used to be standard.  We're a long ways from the post-WWII era when the nation thought having non-profit hospitals in areas like ours made sense, and the Hill-Burton Act made that happen.  (Yep, our city/county-owned Memorial Hospital was one.)  Big picture? We have one of the world’s most costliest health care systems and one of the developed world’s worst! Why should Switzerland, Sweden, Germany, Japan, Norway, Singapore, Australia, and the Netherlands – and others – have such better systems than we do, when our country (or, at least, its wealthy citizens) have so much more wealth than most countries?]

[PS: Greg Lennes just responded to the column by sending me a link to a group that keeps a watch on private equity health care ownership, and I noticed this piece on "News Coverage of Apollo's Stranglehold on Hospitals". Thanks, Greg! Thanks, Gretchen! Thanks, CL!]

Thanks to our U.S. Senators for Daring to Vote for Peace

I’m raising my coffee cup to salute New Mexico’s two U.S. Senators, Martin Heinrich and Ben Ray Lujan, for a sane yet somewhat courageous vote for peace.

The Biden Administration’s unflinching unconditional support for Israel appalls me.

What Hamas did on October 7 was an ugly, indefensible massacre of civilians – nearly 1200 killed and others taken hostage.

Israel’s excessive response, bringing death to 25,000 people, the vast majority of whom are civilians, and destroying hospitals, is appalling.

It shows no moral compass.

It ignores international law.

It ignores the dangers of a wider war. Already we’ve seen expanded violence between Israel and Hezbollah, and tension between Israel and Egypt. Iran and Pakistan have exchanged strikes.

It ignores the complicity of Israeli President Benajmin Netanyahu. For years, he and Hamas have needed each other. Both oppose any peaceful solution, such as two states. Hamas’s credibility with the Palestinian people arises mostly from Israeli harshness, including the West Bank “settlements,” a slow-motion invasion, while the corrupt, dictatorial Netanyahu, loathed by many Israelis, can return to power, and hold it, largely because of Hamas. Netanyahu approved Qatari funding of Hamas. He weakened Palestinian alternatives to Hamas. On his watch, with the military and everyone distracted by fears of his dictatorial move against the Israeli Supreme Court, that intelligence failed to prevent the Hamas attack, although Israeli Intelligence had long known of the plan .

People around the world are disgusted. The Hague is hearing South Africa’s complaint that Israel is committing genocidal acts.

The Biden Administration (and Republicans) refuses to qualify its support for Israel’s activities. The Administration has attacked Yemen, a country we have collaborated with Saudi Arabia, the Emirates, and Iran to destroy by supporting a proxy civil war.

Tuesday’s vote tabled Sen. Bernie Sanders’s motion to invoke the Foreign Assistance Act to require the State Department to assess publicly whether or not Israel is using U.S.-provided weapons to violate Palestinian human rights. While Mitch McConnell calls this “performative leftwing politics,” we must begin to temper our national support of Israel’s slaughter of Palestinians with some mercy, judgment, and compassion. Tuesday’s vote was 79-11. Our senators were among the 11. That won’t please Joe, and could decrease donations from folks who fervently support Israel.

Sanders’s motion would merely require the public report. If Israel is violating the law, Congress could vote to continue the aid anyway.

The disproportionate numbers echo U.S. troops killing hundreds of native tribe members after a small band burned a couple of farms, killing a dozen whites; or the British killing huge numbers in India or Burma, and disproportionate retaliations by occupiers Spain in Mexico or Peru, French in Algeria, Japanese in China, Chinese in Tibet, Nazis in France, or us in Viet Nam. “Our” lives matter much more than “theirs.” Our hearts goes out to the little blond settler girl being kidnapped, but we know nothing of the Apache kid’s humanity. Unsurprisingly, polls here reportedly show that significantly more nonwhites than whites feel Israel has gone too far.

None of this excuses mistreating Jews or Palestinians, here or anywhere. An Israeli friend described feeling “torn,” because “my analytical mind isn’t comfortable with my emotional mind.” He, too, thinks someone should pressure both sides toward peace.

We must stop the carnage! I fear not only widening war but that Biden’s support for war could keep progressive voters home November 5^th, helping to elect some unthinkable alternative.

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[The above column appeared Sunday, 21 January, 2024, in the Las Cruces Sun-News and on the newspaper's website, as well as on KRWG’s website under Local Viewpoints.] A shortened and sharpened radio commentary version will air during the week on KRWG (90.1 FM) and on KTAL-LP (101.5 FM, streaming at http://www.lccommunityradio.org/).]

[Of course, I dislike thinking too much about Israel and Gaza and Palestinians and Jews. It is too painful, too saddening; and (for me, at least), although I can certainly identify some villains and/or some villainous acts on each side, mostly I feel a confused sort of grief and empathy. I understand everyone’s pain, and while individuals are victims of other individuals, everyone seems also a victim of others’ greed or hatred, Europeans’ greed and hatred: the nations, of which Nazi Germany was only the ugliest and most methodical, that persecuted, killed, and reviled Jews; and the white western European – and “American” – assumption that only European civilizations matter. Not Arabs, Indian, Chinese, Vietnamese, Latin American, or African cultures and lives. Too, there was a time here in Las Cruces when my closest friends were an Israeli couple and several Kuwaitis. So, it’s personal.]

[At the same time, unlike so many other public issues in my life [Segregation should be dismantled, we should stop the massacre of Vietnamese folks, rapidly widening income gaps ain’t good for our economy or our polity, we shouldn’t persecute gays, neutrals, pregnant women, or any religious or ethnic minorities], the solution isn’t clear; and with what solutions folks mention, it’s hard to know what chance they have of working. The live people on both sides have an excess of pain they don’t deserve.]

 

Honor Dr. King but Don't Forget How the U.S. Treated hIm and so Many Others

Martin Luther King Day? A national holiday?

I couldn’t have imagined such a thing on the April evening when I walked numbly along Manhattan’s 3^rd Street, processing the fact that Dr. King had just been shot. He was a leader in the movement I was a foot soldier in. Selma had inspired me to do some civil rights work in the rural county east of Memphis. Many Negro families lived in shacks. A huge sign at the county line celebrated a state championship won by the Fayette County High School girls’ basketball team. Black kids didn’t go there. They went to the Fayette County Training School. King was a leader in a movement in which I was a foot soldier.

Stumbling along 3^rd Street, I made eye contact with some Black guys standing around. I probably gave a helpless, sad shrug, thinking of King. One guy reached out to hand me something. Suddenly I thought he was poking a lighted cigarette into my palm. (I was, after all, a white guy.) As I snatched my hand away, I saw, and still see clearly, the marijuana joint he’d been handing me, falling toward the sidewalk. I picked it up and took a hit, reflecting on how the moment had gotten inside me.

Our country has changed greatly, but not enough that we should forget or ignore “racism.”

In our small suburban village, when my mother started a neighborhood cub scout den, it included Jewish kids, Protestant kids, the mix I was, and two Black kids. It was nothing we thought about. (I guess she did. One project we did for a gathering of dens celebrated George Washington Carver. Long afterward, she told me that some mothers hadn’t liked seeing a den with Black kids in it.)

In high school, if a white girl hung out with a black guy, the school called to inform the girl’s family. As a new kid, recently kicked out of prep school, I saw the ethnic tension between blacks and Italian kids. I was friends with both, of course. But they didn’t mix so much. Later, working with kids in Harlem, we had long talks. Being white, I was as strange to them as I was long afterward to Tibetan Khampas, who reached out in amazement to touch the hair growing from the back of my hand.

Once in Tennessee three of us took a local kid out for lunch to celebrate something with him. When we asked where we should go, he named the diner his brother had once been knifed for tying to integrate. We went. Our hamburgers had such an excess of unordered hot sauce that we could not have eaten them except to show the owner she couldn’t drive us away. When I tried to pay, she kept waving the bill at the kid, shouting “The [N-word] pays! The [N-word] pays.”

King grew up in that South. Slavery was gone, but whites tried their best to replicate it. At six, he and a white friend were sent to different schools. The white boy’s parents forbade him to see Martin. They told Martin, “We’re white. You’re colored.” When Martin’s parents explained, Martin said he would hate all white people, always. His parents said he had a Christian duty to love them.

The oppression that killed King had permeated every moment of his life. The nation honoring him shouldn’t forget how it treated him.

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[The above column appeared Sunday, 14 January, 2024, in the Las Cruces Sun-News and on the newspaper's website, as well as on KRWG’s website under Local Viewpoints.] A shortened and sharpened radio commentary version will air during the week on KRWG (90.1 FM) and on KTAL-LP (101.5 FM, streaming at http://www.lccommunityradio.org/).]

[Again, too, welcome to the new year! So far, it’s been a particularly good start to mine, and I hope it has for yours too.]

[ On MLK, there’s just so much to say. The key is that although the U.S. has much improved with regard to inclusivity, the prjudice problem isn’t like smallpox – we haven’t nearly eradicated it.\

[Interestingly, the column couldn’t be printed in the newspaper precisely as written. I used “Negro” a couple of times, because I was recounting events from when that word was in general use. (No, I didn’t do the same with “the N-Word,” or try to utter “Nigger” on radio.) All fine. Yet part of me worries that as we “pretty up” the past to avoid hurting folks, we might lose some of our vigilance about repulsing “racism” wherever and however it rears its ugly head.]

[“Race” is a weird word. It describes a distinction that doesn’t exist. There’s a human race, and many other races. “Black,” “White,” and “Yellow” folks are not a different race. We’re different ethnicities; and our skin-colors and hair colors vary; but we’re one race. “Negro race” was invented, I think, because while slavery, particularly of captives or those defeated in battle, was common in the ancient world, the African Slave Trade arose late in the game, when we were already beginning to have more enlightened views on many things, and we hadn’t beaten African tribes in some war, so supposed Christians needed some excuse for enslaving fellow human beings. They created it: there were different races, and God had made caucasians the smartest, the elite, so they could do as they liked with the others, and the contact would teach those others.”

So I’m careful not to use “race” in that way; but, ironically, “racism” is a real force in our society, even if “ethnic prejudice” would be a more accurate but less ugly phrase for it.]

[Two things are particularly worth noting; that although the column focuses mostly on the South, racism was (and, to some degree, still is) alive and well in the North, though mostly in milder forms; and that all the horrors are not so far in the past as racists would like us to think.]

 

 

Minnesota Enacts Sensible and Compassionate Laws to Protect Citizens' Rights and Wellbeing

In November 2022, when Minnesota Democrats elected a governor, gained narrow majorities in both state legislative offices, and had a Democratic attorney-general, they became a laboratory for how to effectively use that power to achieve progressive policy priorities.

Our imminent legislative session, plus the return from Minnesota of a friend who’s a seasonal Las Crucen, prompts this look at all that Minnesota has done – including things we did before them and others where we lag.

As soon as the 2023 legislative session started, Minnesota protected abortion rights by encoding Roe v. Wade, expanded background checks on gun purchasers and passed a “red flag” measure through which officials can take guns away from people deemed to be threats to themselves or others, legalized recreational marijuana, and enacted major protections of voting rights. (They instituted automatic registration, pre-registering 16- and 17-year-olds, and cut the use of “dark money” in state and local races).

Minnesota has also increased school funding (including providing universal breakfast and lunch for every student in the state); expanded public child care support; increased paid family and sick leave to 12 weeks; provided legal refuge to trans youths from states that restrict gender-affirming and other medical care; set minimum wages for Uber and Lyft drivers; enacted “green” energy goals such as requiring utility companies to offer carbon-free electricity by 2040; and expanded public child care support programs. Governor Tim Walz says he wants Minnesota to be the best state in the union to raise a child in.

As U.S. Sen. Tina Smith said, these policies “have a direct and clear impact on improving people’s lives;” but Minnesota enacted them with a slim majority and while also maintaining a robust economy and keeping crime rates low, the criteria by which conservatives judge progressive local governments. The narrow majorities might have suggested caution; but Minnesotans, deciding that doing good beats doing nothing, took massive steps to improve the lives of real people and protect citizens’ rights. Some say there’s a lesson here for the national Democratic Party.

People call Minnesota a laboratory for progressive policy and a model for what the states can accomplish. Such a laboratory reassures other states that enacting laws to protect people and the environment can be done; and that such pro-people steps can succeed in a state that’s relatively moderate, socially.

I recall a very different episode in Kansas, where Republican Governor Sam Brownback and his Republican-controlled Legislature abused their unhindered power so extensively and created such a huge deficit that people wondered if the state could keep funding basic needs like public education. That seared the conservative state (where Republicans outnumber Democrats nearly two to one) so badly that Democrats have held the governorship ever since.

It’s essential to maintain basic services and help the state’s economy; but let’s also compare Minnesota and New Mexico with neighboring states where close-mindedness, intolerance, and hatred of folks who are different rule the day. States that try to erase slavery and racism from history, minimize assistance to poor folks, suppress minority voting, beat gay kids into submission with cruel “therapies,” and jail not only pregnant women seeking abortion but the bus driver who takes them to the Minnesota or New Mexico border to get medical care. Abortion-rights advocates note that Minnesota’s new law is especially crucial for pregnant women in neighboring states, where abortion remains illegal since the Supreme Court vaporized Roe v. Wade. That sounds quite familiar. 

-- 30 -- 

 

[The above column appeared Sunday, 7 January, 2024 December, in the Las Cruces Sun-News and on the newspaper’s website, sub nom What Minnesota Did Can Inform New Mexico's Work, as well as on KRWG’s website under Local Viewpoints.] A shortened and sharpened radio commentary version will air during the week on KRWG (90.1 FM) and on KTAL-LP (101.5).]

[Welcome to the new year! So far, it’s been a particularly good start to mine, and I hope it has for yours too.]

[Obviously, I applaud what Minnesota has done. At the same time, some of these steps (abortion protection, free breakfasts/lunches for schoolchildren, “red flag” law, for examples) New Mexicans also took at roughly the same time, or even earlier. What seems to differentiate Minnesota (other than “Who cares about New Mexico?” attitudes around the country) is the governor’s determination to think big and do maximum good for folks with a really slim legislative minority. Minnesota leaders seem to have said, “We can do these things, they’re good for our people, and so we’ll do them,” more plainly and firmly than progressives in many other states.]

[Minnesota has a long progressive tradition, starting with the Minnesota Farmers and Labor Party in the Progressive Era a century ago, and continuing with great Farm and Labor senators from before my time or enduring my youth such as Hubert Humphrey (before his disastrous vice-presidency), Eugene McCarthy, and Walter Mondale. Farmers and laborers? They have some common interests. Both get hosed by our economic system and its outsized trusts and corporations, and always have been. But our politicians cleverly pit them against each other (as southern whites did the Negroes and “white trash”). Currently, the rural folk getting fleeced by corporations that buy their agricultural products at unfairly low prices, add various poisons, and charge others excessively for those, are convinced that their true enemies are (1) loose women who have abortions, (2) people who don’t consistently act as men and women (should), (3) unbelievers, and (4) them intellectuals and journalists who ask too many questions. Nothing new there. But if I get the chance I’ll ask Governor Walz how Minnesota gets around that. ]