How do we reimagine what opportunity looks like for all…and who is accountable for doing that? In May, the Federal Reserve Bank of New York held a hybrid event with finance experts, public health practitioners, and hospital leaders to address this question. Watch the video recording or read an overview below.
The event kicked off with a discussion about incentives and accountability in healthcare. Earlier this year, panelist and healthcare expert Dr. Don Berwick published “Salve Lucrum: The Existential Threat of Greed in US Health Care” in JAMA, making waves in his unabashed critique of health sector greed. This unchecked greed, he argues, has an immense impact on entire communities.”We have worked very hard to…have a single effort to try and improve the upstream determinants of health, and to be honest with you, we’ve failed miserably at that,” Dr. Berwick told the audience. “We’ve been working at it for a very long time and we have some good examples [of effective changes], but it should be much bigger.” Panelists at this NY Fed Event agreed, emphasizing the dissonance between workers’ dedication and profit-driven policies.
“Our healthcare workforce does noble and often heroic work, but the system has given in to greed and the pursuit of excess profits. I think we can start to change this if we aggressively assert that hospitals have a responsibility to their communities that goes beyond the provision of healthcare.”
– Dr. Patty Gabow, Chair of the Lown Institute
Transparency is a key part of accountability. Dr. Patty Gabow, a panelist and Chair of the Lown Institute, pointed out that large nonprofit hospitals have tremendous taxpayer support. This support comes with the condition that these hospitals give back an equivalent value in community investment and support. Our “Fair Share” spending research at the Lown Institute suggests that this condition is not being met.
The 2023 Fair Share Spending Report revealed a $14.2 billion dollar national fair share deficit, meaning that the value of nonprofit hospital tax exemptions is far more than the value of investments communities receive in return. This gap in value, juxtaposed with the fact that many hospital workers earn below the federal poverty line while some hospital CEOs make millions each year, demonstrates just how off balance the current system is. We need social responsibility, but we have a profit-driven system.
As the panelists note, if hospitals did just two basic things; take care of their own and gave community investments equal in value to their tax breaks, they could pivot from excess profitability to become anchors for communities. “This should be the baseline,” said Tyler Norris, Visiting Scholar at the Federal Reserve Bank of New York.
“We treat vulnerability as some sort of exotic thing we don’t know how to solve for. But we’re not at a loss on how to build healthy, productive communities with children who thrive—many of us live in them. We don’t have an innovation problem, we have a distribution problem.”
Jason Purnell, President of the James S. McDonnell Foundation
For hospitals to become anchors for their communities, they need to collaborate with community members themselves. “We need radical inclusion of people’s voices,” said Dr. Leslie Walker-Harding, Senior Vice President and Chief Academic Officer at Seattle Children’s Hospital, “If you live in a particular community, you are an expert on that community, you know what you need and you know how it can be done.”
Watch the video recording to view the full event and panelist discussion.