The demolition of the Atlanta Medical Center brings to an end the legacy of one of Atlanta’s oldest hospitals.
The five-bed hospital that opened in 1901 was the idea of physician-turned-Baptist preacher, Leonard G. Broughton, who was known to exhort his congregation and the whole city to do more than just feed and clothe the needy. By the time his Tabernacle Infirmary opened a new facility 20 years later, the 75-bed newly named Georgia Baptist Hospital served rich and poor alike.
In big cities around the country, smaller, church-based hospitals worked in coordination with large, publicly owned and operated hospitals, like Grady Memorial in Atlanta, creating a loose safety net for the poor.
Sociologists had a name for the practice: “Scientific charity,” a concept that emphasized private charity coordinated occasionally with government help. (A modern-day version of this is how caring for the unhoused is handled now in Atlanta.)
U.S. health care system structure has resulted hospital closures
When the new Georgia Baptist opened in 1921, Presbyterians had a hospital in Atlanta. So did Seventh Day Adventists. The city’s oldest hospital, St. Joseph’s — founded by the Roman Catholic Sisters of Mercy — had already been around for two decades.
Most of these church-founded institutions are gone now, the result of a highly competitive health care marketplace where hospitals must control the amount of free care they can provide in order to stay solvent.
More than a few Atlantans have decried the decision to shutter the Atlanta Medical Center, the new name given to Georgia Baptist when it was sold in 1997 to Tenet Healthcare, a national chain of for-profit hospitals. Count me among those who were most disappointed.
Still, it is important to know this is how our nation’s $5 trillion-a-year health care system is structured. The debate rages anew as Congress voted to inject even more turmoil in the system by cutting off millions of Americans from government programs like Medicaid, Medicare and Obamacare through the recently passed budget bill.
‘Patient pay mix’ influences level and quality of health care in a community
Time and again the United States has avoided answering the question that other countries dealt with decades ago: Is there a right to health care, and if so, how should we pay for those who can’t afford it?
American hospitals are the fulcrum of this indecisiveness.
Ideally, a hospital takes in enough commercially insured patients and patients on Medicare to be able to offset the money it loses from caring for indigent patients and those on Medicaid. It’s called “patient pay mix.”
Hospitals in rural areas have the hardest time with this, which is why they are constantly in danger of closing. Often, there just aren’t enough insured patients out there. And in Georgia it is hard, by design, for low-income adults to qualify for Medicaid in the first place.
Metro hospitals have their own set of challenges, especially those located in impoverished areas of the city. Affluent patients with good insurance or on Medicare have numerous choices when they need hospital care. Wellstar Health System, the last owner of AMC, caters to these patients in the Atlanta suburbs, where most of its hospitals are located.
This trend actually began in the 1970s when nonprofit hospitals in cities around the country packed up and reopened in the nation’s booming suburbs. For this and other reasons, Atlanta’s oldest hospital, St. Joseph’s, moved from downtown to a new facility in Dunwoody in 1978, eventually to become part of Emory Healthcare.
Other advanced nations don’t face the same challenges as America
Still, it wasn’t as if Wellstar and Tenet didn’t try to make a go of it at the downtown Atlanta Medical Center. Tenet reopened the hospital’s Level 1 trauma center, hoping to attract new patients impressed by the hospital’s dedication to this vital community service. Wellstar sunk a lot of money into renovating the facility and modernizing its equipment.
In the end, this peculiarly, only-in-America hospital business model simply failed at AMC. It hung around longer than many expected.
Hospitals in other economically advanced nations don’t face the issue of patient pay mix. All their patients are covered by universal health insurance plans paid for through government taxes.
This is a pathway the United States has refused to take, preferring instead to sustain a commercial health insurance industry. And hospitals have had to adapt.
Georgia Baptist couldn’t. The Reverend Dr. Broughton would probably have condemned the failure from his pulpit. But his era of scientific charity is long gone.
Mike King is a retired Atlanta journalist and author of “A Spirit of Charity: Restoring the Bond between America and Its Public Hospitals.” He previously worked at the AJC as a science and medicine reporter, executive metro editor and editorial board member.
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