COVID has put a spotlight on disparities in American healthcare and the large urban hospitals hit hardest by the pandemic.
But many of these “safety net” hospitals, whose primary mission is to serve low-income, working-class communities, have been in crisis for years.
This month, “The Healthcare Divide,” an investigation from FRONTLINE, NPR and American University’s Investigative Reporting Workshop, examines the market forces and government failures that are deepening the healthcare divide, with profits at some hospitals booming, while many safety nets struggle to stay afloat.
“I think we’re on the brink of a precipice,” Dr. Bruce Siegel, president of America’s Essential Hospitals, says in the investigation. “Even before the pandemic, many of these [safety-net] hospitals were losing money and the pandemic is only going to make that worse.”
“Unless there’s a substantive change in the way safety nets are funded, things are simply going to keep going in the direction they are, which is a great disparity in how patients are taken care of,” says Dr. Chris Young, chief of the medical staff at Erlanger, the safety-net hospital in Chattanooga, Tennessee. “That divide is only going to grow.”
“The Healthcare Divide,” a documentary from FRONTLINE producers Rick Young, Emma Schwartz and Fritz Kramer and NPR correspondent Laura Sullivan, premieres Tuesday, May 18, on PBS (check local listings) and online. NPR will air a story from the investigation that same day (see stations and local broadcast times at NPR.org/stations).
FRONTLINE, NPR and the Investigative Reporting Workshop have previously collaborated on numerous projects — most recently in Plastic Wars, an investigation of how the plastics industry publicly promoted recycling as the solution to the waste crisis despite internal industry doubts, from almost the beginning, that widespread plastic recycling could ever be economically viable. Other collaborative projects have included an in-depth look at Trump’s Trade War with China and investigations of Hurricane Maria and Hurricane Sandy relief efforts (Blackout in Puerto Rico and Business of Disaster), and America’s affordable housing crisis (Poverty, Politics and Profit).
Now, in The Healthcare Divide, this award-winning team probes why some hospitals are thriving and others are in dire shape.
“It’s a little unfathomable to me how a hospital system could be making a huge profit in the middle of a COVID pandemic,” says Dr. Brad Spellberg, chief medical officer at the safety-net hospital, LAC-USC Medical Center, where the documentary shows the heavy burden COVID took during the winter surge earlier this year. “This system itself makes no sense and when you have a system that makes no sense, there are going to be some winners and there are going to be some losers. Is that how you want your health care to be delivered?”
The documentary traces the story of safety-net hospital Erlanger, whose struggle to stay afloat led it to focus on more profitable aspects of healthcare rather than its core mission — with deadly consequences for patient care.
“We were seeing patients in hallways and in the waiting room,” says Dr. Sudave Mendiratta, chief of emergency medicine at Erlanger. “It became very clear that spending money as an organization to gain market share and to increase volume was not effective to deliver quality care.”
The film also takes viewers to the hub of the healthcare industry: Nashville, where more than 50 years ago for-profit hospitals chains took root, most prominently Hospital Corporation of America, HCA. As the investigation shows, the growth of these hospital chains and the subsequent consolidation of the industry, both for-profits and nonprofits, has created a progressively competitive environment that has made it harder for safety-net hospitals to live up to their mission and stay afloat.
“So that dynamic you have today in American healthcare is that wealthy hospital systems are able to invest in [profitable business lines],” says Siegel. “They’re able to attract more commercial, privately insured patients. It makes it even more profitable and then they can invest even more. So you have the situation where, really you have two tiers in a way rich hospitals are getting richer and the poor hospitals are getting poorer.”
Says Jeff Goldsmith, a long time healthcare consultant,“The real problem is the inequities in the society as a whole have reached the point where we really need to address them. The disparities in the circumstances of the hospitals are an outgrowth of a failure of social policy and politics. That’s what I believe. I’m not going to blame the hospitals.”
The documentary also explores how the fact that Medicaid’s reimbursements to hospitals are lower than those made by private insurers have made it more difficult for safety nets to cover their costs. To help offset losses on Medicaid and care for the uninsured, the government gives many hospitals additional funding, called supplemental payments. The team uncovers how in Tennessee this program isn’t keeping up with the increasing costs safety-net hospitals face caring for people who are uninsured or on Medicaid.
“Your findings really show that in Tennessee, there’s obviously something worth examining going on,” says Diane Rowland, a former top adviser to Congress on Medicaid. “I suspect that one would find similar differences among other states.“
At the end of the day, the fact that Medicaid pays hospitals less than private insurers “is completely a result of the structural racism baked into the fabric of how we pay for healthcare and how the Medicaid program has been underfunded over time,” Siegel says.
The Healthcare Divide premieres Tues., May 18, at 10 p.m. ET, 9 CT on PBS stations and will also be available to stream on FRONTLINE’s website, YouTube and the PBS Video App. NPR will air a story from the investigation that same day on All Things Considered (see stations and local broadcast times at NPR.org/stations), with additional radio pieces airing in the coming weeks.
The Healthcare Divide is a FRONTLINE production with American University School of Communication’s Investigative Reporting Workshop in collaboration with NPR. The writer and director is Rick Young. The producers are Emma Schwartz and Fritz Kramer. The correspondent is Laura Sullivan. The senior producer is Frank Koughan. The executive producer for FRONTLINE is Raney Aronson-Rath.