It was almost surreal to read about Cone Health's CEO prevailing upon local elected officials in various parts of the Triad to adopt an approach that would partially shut down their local economies; force the closure of businesses and churches; and effectively put citizens under house arrest.
But this approach advocated by Cone Health crushed the hopes and aspirations of our many unemployed, and numerous small business owners throughout the Triad. It trampled on constitutional rights. Many people were already living on the edge economically, and these moves drove them to bread lines akin to the Great Depression. The fact is that Cone Health used its enormous influence as one of the region's largest employers to push things in this direction.
The ancillary staff and doctors and nurses at Cone Health on the job-- and in other health care settings-- have demonstrated courage in the face of the potential COVID-19 threat. My comments are not intended to diminish their efforts. But they are not the decision-makers.
We need to review the history. The Cone health system, which began with Cone Hospital, sequentially acquired and/or incorporated Women's Hospital in Greensboro; Wesley Long Hospital; Annie Penn Hospital in Reidsville; and Alamance Regional Medical Center in Burlington. This expansion took place between 1995 and 2013.
These were very astute moves by Cone's executive team. What was the motivation? By providing a lock on hospital services in a wide region, they would be able to command from insurance companies much higher contractual reimbursements. This leads to higher health insurance costs for individuals and for businesses. When we wonder why health insurance is so high, one of the factors we must consider is the monopoly-like conditions created by hospital systems.
When Cone Health went running to local elected officials, it was indicative of panic and hysteria. The organization possesses no particular public health credentials because that is a discrete skill set that involves practicing medicine on wider populations in accordance with a long-established approaches and ethical principles. Cone Health's expertise consists of delivering health care to individual patients-- not devising public health policy. The approach to COVID-19 was developed on an ad hoc basis, on the fly, in marked contradistinction to traditional public health approaches. It was improvised with no concern for proper boundaries.
Part of the reason for Cone Health's response was an ugly reality. The organization did not feel ready for this epidemic. Indeed, many hospitals across the country did not feel that they had sufficient supplies of PPE, or adequate numbers of ventilators. But this is a management failure. The organization should have been ready. It should have maintained adequate stockpiles. With the enormous cash flows that enable massive construction projects and the gobbling up of massive portions of the regional health care market, they had the resources to be ready. But they were not. The Triad Business Journal explains further.
They were trying to make their own situations more comfortable and manageable. They were trying to avoid the PR implications of being unprepared.
And as a result, they advocated putting thousands of people out of work, and shutting down businesses and churches. And killing the economy.
Never mind that the approaches advocated defied logic and rationality. Quarantine the young and health, and effectively place them under house arrest. Allow the medically vulnerable and the elderly to work if they are within essential businesses. Decimate the economy in a region that has very different conditions than New York-- a warmer climate with earlier spring, much less density, and minimal mass transit. We knew from the experience in Italy that it was the elderly and the medically vulnerable who were primarily at risk for complications and death. And remember how Fauci wrote back in March that the fatality rate would be considerably less than one percent.
But what happened? Soon thereafter, Cone reopened the old Women's Hospital, which had recently closed, and diverted nearly all of its COVID-19 cases there. It therefore did not need hardly ANY of the ICU capacity in its other hospitals, except for limited cases. The huge surge did not even come close to materializing.
The approach Cone Health had advocated was very similar to what we saw at various levels of government. And it was pure poppycock.
At the same time, we saw hospital systems across the country closing many of their clinics, furloughing staff, and reducing the hours of line employees. The same panic and hysteria led to a governmental suspension of non-urgent surgeries. People were terrorized by the media and other entities; and would no longer present for health care. Hospital systems therefore faced huge economic losses; and are now consequently being bailed out by both the federal and state governments to the tune of tens of billions of dollars. But Cone Health helped create the conditions that led to these huge economic losses "justifying" hospital bailouts.
More information is now being published around the country about many people experiencing major issues because of not receiving proper, in-person medical care in a timely manner. This will be very difficult to quantify. And of course, there will be serious medical and health consequences due to the recession (or depression) that was deliberately engineered.
The leaders of modern hospital systems are akin to the robber barons of the Gilded Age. Abner Doon had previously published about how Cone Health's CEO has received in excess of $1.5 million in annual compensation. There is an extensive, well-paid executive/managerial class within health systems, most of whom produce nothing.
And hospital systems are sometimes akin to the monopolies or "trusts" that the trust-busters used to break up. Cone Health is one of them.
The organization has a lock on emergent hospital care in a wide geographic region that includes much of Guilford County; the northern and western parts of Alamance County; the southern part of Rockingham County; and the southern part of Caswell County. People within these areas have to drive very long distances to seek hospital alternatives. For emergent situations, there is virtually no choice. This is an area shaped like a rectangle that measures approximately 35 miles x 25 miles; or 875 total square miles.
And there are two unique attributes of our area that warrant concern. First, our area has a very high degree of "sprawl". In fact, we have among the highest amount of sprawl in the country. That means we have to drive long distances to get places. That is of grave significance when choosing which hospital to use during an emergency.
And second, the city of Greensboro has the fourth highest degree of hospital market concentration in the entire country. Translated: Greensboro has the fourth worst hospital monopoly conditions in the United States.
This is also very bad for employees in the health care industry. They must stay with the one monopoly system closest to home; or venture many miles with a long commute for alternative employment.
The people of the eastern Triad deserve better than this. We need to break up this monopoly.
And there are two potential vehicles to make this happen.
First, the Federal Trade Commission deals with hospital monopolies. This document explains further. Another page at the FTC website explains how to report an antitrust violation.
Second, the State Attorney General's office has authority under state law to initiate antitrust suits. (Private individuals and concerns can do so also.) Josh Stein has previously targeted the Atrium Health System based in Charlotte.
A very thoughtful, comprehensive, well-reasoned case can potentially yield positive results.
But it is clear something is terribly wrong in the eastern Triad. We don't have nearly enough hospital choice and competition. And the biggest player-- Cone Health-- has recently advocated against the rights and economic well-being of thousands of local citizens. The organization did this after having spent many years building its empire assuring that people would have to pay much more for health insurance.
Break up the Yankees
Posted by: Fred Gregory | 05/06/2020 at 07:41 PM
That's right, Fred.
Posted by: Triad Conservative | 05/06/2020 at 08:43 PM