Bad Medicine

The Patrick administration likes the notion of universal health coverage. It just doesn’t want to pay for it.

IN THE EMERGENCY ROOM, a doctor is trying to save a 39-year-old man with multiple gunshot wounds. In the nursery, nurses are weaning a newborn from opiates transmitted during pregnancy. In pediatrics, what initially looks like a simple case of bed-wetting will require the intervention of hospital lawyers and social workers to relocate the traumatized child and mother from a violent public housing project.

It’s just another Tuesday at Boston Medical Center, and the afternoon is playing out here the way it does most days — with a mix of the hopeful and the horrific. The hospital’s food pantry, which serves 7,000 people a month, is crowded with patients clutching doctors’ “prescriptions” for free groceries. A substance abuse team is back from court, having secured a commitment for alcohol treatment for a woman who has been regularly showing up drunk in the ER. The pharmacy is filling a prescription written at a rival Boston hospital that would not honor its own script — because the patient could not pay. Pharmacists fill so many of these that they are unfazed when patients hand over discharge instructions from a wealthier hospital that include directions to BMC.

This place is not to be confused with Boston Med, the “reality” TV show about the city’s private Harvard-affiliated hospitals, which recently ended eight weeks of entertaining melodrama on ABC. There is nothing entertaining or mellow about the drama at BMC, which has provided life-sustaining medical care to the most vulnerable residents of Boston for 146 years. But this much longer-running show is also poised to end its run.

Boston Medical Center is almost broke, perilously close to what its accountants euphemistically refer to as the “zone of insolvency.” It did not get here — $175 million in the red for the fiscal year ending September 30 — because it bought too many MRI machines or banked on cosmetic surgery being a big income generator. It landed in this hole because the folks on Beacon Hill like the sound of universal healthcare a whole lot more than they like the cost of it.

BMC is locked in a battle with the Patrick administration over dramatic cuts in how the state pays for treating the poor. Barring a last-minute settlement, a Suffolk Superior Court hearing on September 29 will consider the state’s motion to dismiss a BMC lawsuit that challenges Massachusetts’ reimbursement rate. (The state currently pays the hospital 64 cents for every dollar it spends on patients with Medicaid.)

BMC says the new reimbursement formula violates state and federal law, and will sound the death knell for the state’s largest safety-net hospital. The commonwealth says it has the power to set any rate it wants; if BMC finds the payments inadequate, it can simply stop taking Medicaid patients. The state’s argument might have some merit in the case of doctors being free to choose their patients, but it’s a ludicrous posture to adopt toward an inner-city hospital that is required — by state law — to serve all comers.

  • sri

    It seems a shame that the Brigham and Mass general doesn’t step up to absorb some of the difficulty of caring for the poor.

  • Michael

    Why is it a shame? The state isn’t living up to its deal with the BMC and is showing why health care isn’t as cut-and-dry as everyone likes to make it out to be.