Crackpot realism and the West Penn debacle

It is hard to overstate the cruelty involved in the sad demise of West Penn Hospital as an acute care institution. This is the inevitable result of treating health care as a business.

Health care, by right in a civilized society, ought to be operated by the government as a public utility for the benefit of everyone, rather than treated as a series of corporations subject to profit-and-loss calculations and needlessly destructive "competition." But we saw last year that the vested interests in this industry are capable of stirring up nonsense about "government takeovers" and "socialism" (if only!) in response to even mild measures. The president never even dreamed of proposing something like what I have just proposed, and yet the industry-orchestrated outbursts of irrational stupidity that greeted Obama's piecemeal proposals eventually shaped the unappetizing National Romneycare that we now have.

Given this overarching national environment, plus the overwhelming facts about the local health care market, it is impossible to see how WPAHS officials had much of a choice, if their aim is to keep their health system alive as a going concern in that context. The share of WPAHS board and management in the blame is not a small one, beginning with the birth of the system in the wake of AHERF's thievery and continuing through to today, with the high six- and sometimes seven-figure salaries of its top management. But with the mountain of debt inherited from AHERF, the doctor-poaching of UPMC, and the steady year-to-year operating losses, this eventual decision was the outcome of a merciless logic. WPAHS management are going to tell you that this is not like Braddock, and they are right about that. UPMC could have afforded to keep Braddock open. It could have afforded to keep at least three or four Braddocks open, in fact, yet it chose instead to build a new hospital in Monroeville -- a mile from WPAHS's star suburban facility, Forbes -- to capture white suburban patients with insurance, rather than keep Braddock open to serve the poor of the Mon Valley. WPAHS by contrast could not have afforded to keep West Penn as it now is for much longer and still have money left over to pay the bills.

But saying that WPAHS as currently constituted could not afford this is not the same thing as saying that we, as a society, could not afford to keep services like this in place. West Penn may have had declining inpatient admissions and declining volumes in the more lucrative surgical procedures, but it still had plenty of city patients, including many who depended on its ER after the closure eight years ago of the former poor people's hospital of the East End, St. Francis. A major problem for West Penn was not so much that not enough people were coming to West Penn, but that too many of the "wrong" people were coming there. WPAHS management concluded -- and they are objectively correct -- that their health system could not continue to do this and still stay alive as a going concern, when their much-stronger competitor could afford to take on more of the burden.

So if we had a rational ordering of the health care system in this area and in this country, we could afford to have good health care for everyone. Instead we have these large institutions -- and WPAHS is a weak player in this, next to UPMC and Highmark -- that are supposed to be operated for the public good, but in fact have gotten out of control and relentlessly pursue institutional imperatives that are detrimental to the health and well-being of most of our people. All of us, in fact -- "in the final analysis," as we used to say. To treat these developments as forces of nature rather than the product of human-made decisions and human society, to accept as inevitable the dire results like the downsizing of West Penn, as if these were "acts of God" and we can do nothing about them -- all of this is an example of what C. Wright Mills called "crackpot realism," the notion that we should acquiesce to the rationality of a system that is fundamentally irrational.

We can do better than this, but only if we fight to make it better.