The Hospital: Life, Death, and Dollars in a Small American Town

by Brian Alexander

While small community hospitals tried to stay afloat, big hospital systems had truckloads of money to ride out the crisis. The richest figured out how to take government money anyway. By the end of June, ProMedica had taken $240 million, though it sat atop a hoard of $2.2 billion in cash and investments. For the quarter ending June 30, the “nonprofit” made a 10.8 percent operating margin. UPMC, the University of Pittsburgh Medical Center organization—the “nonprofit” that built hospitals in Italy and started its own venture capital outfit—swept up about $1 billion in government payments and loans by the beginning of summer, though it had an investment portfolio of about $6.6 billion. The for-profit Hospital Corporation of America (HCA), which once paid its CEO $109 million, received about $1 billion. Private-equity-owned businesses like EmCare borrowed about $1.5 billion from the taxpayers. Such generosity, though, did not stop the operators from slashing jobs. Beaumont, the Michigan system that went into the real estate development business with a shopping mall and hotel project, laid off 2,475 people and permanently eliminated 450 jobs. HCA threatened layoffs if staff did not agree to wage freezes.