STATE REPRESENTATIVE
PAUL C. CASEY

Room 473-B
State House
Boston, MA 02133
Telephone: (617) 722-2230
District Office
585A Main St.
Winchester, MA 01890
Telephone: (617) 721-7285 or (617) 438-7185

A View from the Hill

FOR IMMEDIATE RELEASE: December 29, 2000
CONTACT: Michael Auerbach (617) 722-2240

A TOAST TO YOUR HEALTH, AND A PROMISE TO KEEP IT

Well, the new millennium officially began on Monday. On Sunday evening we gathered with friends and family, reflected on the last year and looked forward to the new one. After all, the month of January is named for the two-faced Roman god Janus, who looks back at the last year with one face and ahead to the upcoming year with the other. Many people made a resolution to improve their health, promising to eat healthier, exercise more and reduce their daily stress. It is no wonder why memberships at gyms and health clubs increase exponentially in January and February!

Health care is one of the most salient political issues to Americans today. In fact, health care has been a high-priority issue for most Americans throughout most of the 20th century. In 1946 the federal government saw the need for large geographic regions to have a facility that can tend to a wide range of medical needs. Congress decided that it would do two things: first, it would evaluate the medical care facilities that already existed to determine whether they could provide adequate care to a large number of patients; second, in the absence of such adequate care the government would sponsor the construction of new hospitals. The "Hospital Survey and Construction Act" (or the "Hill-Burton Act" so nicknamed after the two legislators who authored it) provided funds necessary to ensure that every citizen had access to medical care if he or she needed it. The "Hill-Burton Act" helped build hospitals across the country, spending an incredible amount of taxpayer money in the process. Since that time many hospitals built under "Hill-Burton" have closed their doors for a myriad of reasons. Still, "Hill-Burton" symbolized an extensive show of government support for hospitals.

A sad truth is that a large number of Massachusetts residents (and people all over the country) do not even have health insurance or health care programs. Some are unemployed, others homeless and still others are simply not financially stable enough to enter a program. The government does have safety nets, such as Medicaid, for those who cannot afford health care. These safety nets do not just cover emergency care, though. Many Massachusetts programs funded by Medicaid are considered "preventative" medical care, advising people of dangers like lead paint and poor nutrition. Then again, some patients only utilize Medicaid when they have taken ill. Knowing that it is unlikely that they will be turned away , many patients use the emergency room (ER) the same way others use a primary care physician.

Two problems arise as a result of this course of action. First, the high population in an ER can be an overwhelming strain on a hospital. After all, there are only so many doctors and nurses in each hospital. When there is simply no room for patients, ERs close. This problem is not exclusive to smaller hospitals, either. One of the most prominent hospitals in the nation, Massachusetts General Hospital, closed its ER for a total of 871 hours during the first nine months of 2000. The Brigham and Women's Hospital and the New England Medical Center have had similar problems. An ambulance must either wait for the ER to reopen or divert to another hospital. Either way, precious time is wasted.

Diverting may prevent further strain on a major metropolitan hospital, but it adds strains on the hospitals to which ambulances are rerouted. When patients are rerouted from MGH or other Boston hospitals, they are sometimes sent to the Whidden Memorial Hospital in Everett and may even be diverted to Winchester Hospital.

Another problem arises from the medical insurance programs themselves. Medicaid operates on the principle of reimbursement; a hospital that administers to a Medicaid-eligible patient receives reimbursement from the federal government through the Health Care Financing Administration (HCFA). However, this reimbursement does not completely cover the cost of care. The government only reimburses medical providers in part. The hospital is expected to cover a percentage of the costs of care as well. In Massachusetts, hospitals are reimbursed anywhere between 77 and 80 cents on the dollar. In 1998, HCFA reports that the Commonwealth received a total of $4.6 billion in Medicaid reimbursements. While this sounds like a lot of money, a hospital system like the one in eastern Massachusetts requires considerably more. Hospitals are forced to dip into their own resources.

When resources are exhausted a hospital can lose the ability to offer a wide range of services to patients. Some facilities close down specialized surgery departments or even emergency departments. Other hospitals can close down altogether. A recent study by the American Hospital Association shows that in the last 20 years or so the number of public hospitals has declined over 30 percent, and the number of community hospitals has declined almost 15 percent. Most major private and teaching hospitals in the Bay State such as Massachusetts General, Beth Israel-Deaconess and the Brigham and Women's do show fiscal solvency (mainly because they see a larger number of patients covered by private insurance vendors). However, many of the other hospitals in our area have posted considerable losses this past year, raising the specter of closure. In Everett, this fear has come close to reality. Just two weeks ago the Board of Trustees of Hallmark Health System (the organization that manages Whidden Memorial as well as Lawrence Memorial Hospital in Medford) reviewed Whidden's financial situation to determine whether the hospital should close its doors. Fortunately, the Trustees decided to keep the hospital's doors open for now. The implications of closure are frightening, indeed. If Whidden does close its doors, other hospitals in the area would pick up its "business," including Winchester Hospital. However, what if the hospital to which this "business" is diverted is already operating at full capacity? What if these additional patients are covered through Medicaid? The hospital could deny services, lose money, or both. Put simply, diverting patients from one hospital to another does not solve the problem; it merely shifts it elsewhere.

Thus, one hospital's closure of services (if not all services) has a ripple effect on other hospitals. Compounding the problem created by an increase in Medicaid patients is the fact that an increase in patients needing certain services means longer waits for those services for all. If Whidden's emergency services close, for example, its ER population would be diverted to Winchester. That means the long wait for care would become even longer.

The problems facing our area are manifest nationwide. The federal and state governments are working to infuse more funds into hospitals. Two weeks ago I sponsored bills to obtain greater funding for our area's hospitals and bolster their internal resources, so that hospitals can cover the difficult task of administering to patients. I have also been in close contact with officials and legislators throughout the greater Boston area, gathering information about distressed hospitals and what is needed to keep them up and running. The problem to date has been serious. However, as we enter the flu season, we can expect the number of patients going to the hospital to increase significantly, worsening the situation. We all hope that we never have to go the hospital, least of all during the holiday season. But accidents and unexpected illnesses do occur, and for this reason we have a number of excellent hospitals in the area.

Hospitals provide an invaluable service to the communities in which they operate. Congress understood this point all too well in 1946. Now, the hospitals that remain are faced with astronomical debt, and in many cases, inadequate resources. We must work with zeal to help solve this problem. In this New Year, we reflect on the past and look ahead to what the New Year will hold for us. We hold our glasses high to one another and wish our friends and family all the best in the coming year. In Gaelic one might say "Slainte!" (meaning, "To your health!"). I wish all of us great health in the New Year and the continued means to stay healthy!

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