How does a local hospital dominate as a regional medical center in a generation without large community dollar donations? History (no longer taught in Idaho’s universities) might inform us. In1982 federal legislation — Tax Equity and Fiscal Responsibility Act (TEFRA) — was passed to balance the national budget. Quietly added were Medicare financial changes giving hospitals greater control of (and redistributing to themselves) income from some physician practices and in-hospital procedures. Hospital revenues surged, allowing purchases of more M.D. practices and community hospitals morphed into “nonprofit” medical centers. Other expenses such as East End/statewide real estate purchases or buying more M.D. practices were needed to offset profits and allow the “nonprofit” charade continuing. Their administrations changed from retired/semi-retired religious and community leaders to ever-growing aviaries of highly paid MHA/MBA administrators concerned with market share, efficiency and quality. Tempering health care costs never was mentioned during that part of the last City Council meeting I attended addressing St. Luke’s expansion. Vehicular traffic flow dominated discussions. Multiple federal administrative attempts to slow or stop rising health care costs have been decisively blocked by both the American Hospital Association (to which our local hospitals belong) and insurance lobbyists. This July Harper’s issue will further inform and infuriate.
Frederick W. Bauer, M.D., Boise