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

by Brian Alexander

Acton finally had enough and resigned. By the end of July, forty-nine health officials in twenty-three states had either resigned or been fired, often after threats, harassment, or having property vandalized.

By June, Watkins was receiving emails like “YOU ARE A FUCKING ASSHOLE, YOU SON OF A JACKASS!!!!!!!!!!” The mayor of Pioneer, Ed Kidston, seemed to think Covid-19 was an enemy coming over the hill to attack a fort. “Americans are not do-nothings!” he wrote to the Bryan Times. “We never sat silent and let the enemy creep in, regardless of the casualties.” It was the “regardless of the casualties” part that worried Watkins. When attending a meeting to discuss the cancellation of much of the county fair, the president of the Williams County fair board wore a “Don’t Tread on Me” baseball cap (the slogan used on the so-called Gadsden flag, featuring a coiled snake, which had been adopted by the Tea Party and white nationalist groups) and a white mask on which he inked a sarcastic, and grammatically incorrect, whine: “IT’S FOR THE KID’S!!”

The answer to that racist question was no, just as it had been way back when Frederick Hoffman suggested that African Americans were less healthy because of personal moral failings, and just as it was in Bryan when people suggested the poor and the sick had only themselves to blame. African Americans were more likely to be poor, to live in crowded households, to be “essential workers” (grocery store clerks, truck drivers, delivery people, nursing assistants), to suffer from obesity or diabetes or high blood pressure, to have lousy health insurance or no insurance at all, to have crummy access to medical care—all like their poor white counterparts in Williams County.

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.

Consolidation within the medical equipment industry now seemed to have been a bad idea, too. For example, in 2012, Covidien—the Tyco spin-off that was purchased by Medtronic several years later—bought a maker of ventilators called Newport Medical Instruments. Regulators suspected Covidien bought Newport because Newport had designed a cheaper vent that threatened to compete with Covidien’s expensive one. Covidien, they thought, wanted to squash the cheaper design. Two years before the buyout, Newport had signed a deal with the federal government in which Newport would make thousands of vents at a cost to the government of $3,000 per unit, as a way to bulk up the national stockpile in case of an epidemic. Covidien backed out of the government deal after it bought Newport, and the ventilators were never made. As a result, states found themselves competing against each other to obtain ventilators to treat Covid-19 victims, and paying ransom-level prices to companies when they found some. New York paid about $59,000 per unit.