Dead Certain

comes to medicine.”
    “What makes you so sure it’s meaningless?” I demanded.
    “Because in health care what is ultimately at stake is lives, not dollars.”
    “A business is a business,” I countered, not at all happy with the direction this conversation was taking. “It doesn’t matter whether it delivers bagels or babies.“
    “Tell that to Adam’s patient, the one whose baby was born with a heart defect last night. Her insurance company refuses to cover the cost of a new, less invasive surgery to correct it because it costs too much.”
    “Okay, I grant you the difference between babies and bagels, but that still doesn’t mean that health care isn’t a business.”
    “Then I guess it’s time for quiz question number two. In one sentence or less, describe the mission of Prescott Memorial Hospital.”
    “To deliver high-quality health care to patients in need, regardless of their ability to pay,” I answered, repeating the catechism without hesitation.
    “Very good. So now tell me, what’s HCC’s mission? „
    “I don’t know,” I replied, growing weary of this interrogation. “To deliver cost-effective health care to people who can pay?”
    “Wrong answer. You just said it a minute ago. A business is a business. HCC’s mission is to maximize profits for their shareholders. Period.”
    “So?”
    “So that’s what makes them evil,” declared Joan passionately. “Medicine may be a business, but it’s not like any other business. If you walk into Saks to buy a dress and you don’t like the way they treat you, you can always walk down the street to Neiman Marcus. But when you’re sick and helpless, you’re in no position to go down the street. That’s why, whether you can pay for it or not, you pray you’re in a place like Prescott Memorial where everyone is working their butt off to give you the best possible care instead of an HCC hospital where all they’re worried about is squeezing the maximum profit out of you in the shortest amount of time.”
    Suddenly I thought about Claudia, who attacked her job with a selfless dedication approaching mania.
    “The doctors I know wouldn’t have anything to do with a place that treated patients like that,” I protested. I “You’d be surprised,” said Joan in a tone of voice that told me she’d long ago been stripped of such illusions. “Doctors have their price just like anybody else. If they didn’t, HCC wouldn’t have been able to do what they’ve done. Everywhere they’ve gone, the company has made it worthwhile for the docs to roll over for them.”
    “In what way worth their while?”
    “Kickbacks and insider contracts. Everyone knows that HCC gives bonuses to the doctors who perform more of the procedures that provide the highest profit margins and to the administrators who have the fewest empty beds. I That’s why HCC hospitals take more X-rays, do more MRIs, and perform more hysterectomies on average than other hospitals. Conversely, they see fewer emergency patients and have a policy of shunting off the indigent to noncompany facilities.”
    “Then what on earth could they possibly want with Prescott Memorial?” I demanded. “All they have is indigent patients.”
    “Oh, HCC isn’t looking to make money from Prescott Memorial,” answered Joan, “at least not in the short run.”
    “Okay, now you’ve really got me confused,” I protested, “Just a second ago you had me convinced that all HCC was interested in was making money.”
    “They are. You’re just not looking at the big picture. Don’t you see? Acquiring Prescott Memorial is just the ) first part of a much larger plan.”
    “Which is?”
    “To buy the company a foothold in Chicago. Think about it. HCC may be a $16 billion company, but they’re doing all their business in places like Omaha and Dubuque. By buying Prescott Memorial, HCC is making their first move into a major metropolitan market.”
    “Why? What does it matter where they make their money?”
    “You want to know why? Because Gerald Packman is an arrogant son of a bitch who actually believes that he’s found a better way, and like every other arrogant son of a bitch who’s come before him, he wants to shove it down everybody else’s throat whether they like it or not.”
     
    After lunch I took the long way back to the office, pausing to admire the Chagall mural on the First National Bank Building as I tried to sift through everything that Joan Bornstein had just told me.