I read an article in the Boston Sunday Globe today that reminded me that the idea of health care being provided by hospitals as a "mission" seems to have been lost. The article talks about the "community benefit" local hospitals provide, and then compares that to the amount of tax savings they realize by being non-profit organizations. It concludes that in general the larger hospitals in Greater Boston save more money by not paying taxes than they provide to the community in benefits. By constantly referring to the hospitals as "companies", and briefly discussing the good being done by one for-profit hospital in Worcester, the article tries to convince us that non-profit hospitals don't deserve their tax exemptions, and that they shouldn't be receiving tax-deductible gifts from donors.The article describes the calculation of the community benefit and the calculation of the tax savings at some length, admitting that these calculations are complicated, but only in passing does it mention that these calculations may not take into account everything the hospitals do that could provide benefits to the community. Nearly all of the hospitals mentioned are major academic medical centers, which in addition to providing care for all (one of the arguments against them is that almost no one in Massachusetts is uninsured due recent changes in state law), also provide education to a new generation of physicians and on-going research that may lead to cures to some of the diseases being treated. Neither of these activities is "reimbursed" by insurance companies (an unfortunate term hospitals have been using for a number of years.)
One of the problems non-profit hospitals have these days is they have been talking like for-profit businesses for many years. They have also been merging into systems and acquiring medical practices and other ancillary businesses that help make them look too much like for-profit businesses. I would argue, however, that even with all that, non-profit medicine is still crucial to our communities, and that even if Congress manages to pass legislation providing for health insurance for everyone (by no means assured at the moment), non-profit hospitals still have an important mission of education, research, and patient care, and still deserve their tax exempt status. We should all try to remember that non-profit hospitals were created by communities - regional, ethnic, religious, and others - to care for their own because no one else would. They all assumed that good health care was a right that must be provided. As we have changed, and continue to change, the way we pay for our health care, we should keep in mind the history of non-profit health care and its on-going mission. And we should all consider giving to our local hospitals.
