Opinion: Medicare for All can put Georgia hospitals on solid financial footing

Credit: Steve Schaefer

Credit: Steve Schaefer

Closing of the Atlanta Medical Center is largely a cost-reimbursement issue that can be fixed.

Georgia has the third-highest rate of uninsured people in the nation, 16% for the non-elderly, a travesty for a state as affluent as ours. Expanding Medicaid would cover almost half of the nearly 1.4 million Georgians without coverage. Georgia could easily come up with the 10% state match (the feds put in 90%). But Gov. Brian Kemp would rather play politics and send rebate checks out to voters in an election year.

However, there is an even better national solution that would cover all 1.4 million of our fellow Georgians while preserving patients’ freedom to choose providers - Medicare for All. Both the Atlanta City Council and the Georgia Democratic Party have endorsed Medicare for All in the last 2 months. Dr. Belinda McIntosh, a dedicated local physician, made the resolution to the Atlanta City Council. I personally made the proposal to the Democrats’ Platform and Resolutions committees.

Credit: contributed

Credit: contributed

Advocacy for full coverage of all Americans is not new for me. I have been dealing with the coverage issue for many years, going back to when I was the first Director of Health Planning for Georgia. Also, I have been long involved with Physicians for a National Healthcare Program (PNHP, Georgia), the nation’s premier physician-led Medicare for All advocacy group.

The looming closing of the Atlanta Medical Center (AMC) has motivated me to bring up the topic once again. Payer mix (health insurance terminology for who pays the hospital bill) is clearly a major factor -- likely the biggest factor -- in the Atlanta Medical Center’s closing.

I should know. Before it became AMC under Tenet (a national, for-profit hospital corporation), the hospital was Georgia Baptist. Baptist was a shareholder in Premier Inc., a national healthcare company that I helped start. I spoke with the Baptist CEO repeatedly about their many challenges, including heavy indigent care and Medicaid.

Plus, well before I helped create Premier, I was a vice president of acquisitions for NME (now Tenet). Per corporate policy, we acquired hospitals with high private pay insurance, low indigent care and minimal Medicaid. That’s because those were the hospitals most likely to make a profit in a turnaround situation.

Much later, after my departure, Tenet acquired Baptist. I questioned the wisdom of the purchase at the time. Obviously, significantly improving the bottom line of a facility with a high indigent care and Medicaid mix would be very difficult, even for a “take no prisoners” for-profit healthcare company.

Tenet was unsuccessful in turning AMC around, selling the hospital to Wellstar Health Systems, a Cobb nonprofit chain. After heavy loses, Wellstar is now closing the AMC facility. AMC’s closure will mean dumping more Medicaid and indigent care patients onto already financially strapped Grady.

Clearly, Medicare for All would benefit both Grady’s clients/patients and that facility’s financial picture. In fact, implementing that program would have a greater financial impact on Grady than any other facility in Georgia.

If all patients were covered 100% by expanded universal Medicare as their insurer, it would eliminate that payer mix issue. Then, all facilities could then compete on a level playing field. This versus urban and rural facilities which serve low-income populations having their hands tied behind their backs by a lack of adequate third-party reimbursement -- as is currently the case.

Frankly, the AMC closure could have been avoided if we had true national Medicare for All with no co-pays or deductibles, as they do in Canada and other nations. Under Medicare for All, Canada not only covers all citizens, it does so at less than half the per-capita cost -- $5,370 for Canada versus $11,945 here.

If we really are serious about saving Grady and other vital hospitals serving the less fortunate, the state should expand Medicaid short-term. And both parties should support national Medicare for All.

Jack Bernard is a retired healthcare executive who worked extensively with some of America’s largest healthcare systems; he is currently chair of the Fayette County Board of Health. He was the first director of health planning for Georgia. Bernard is a former chairman of the Jasper County Commission.