Letter: Fixing healthcare without tearing it down

Letter to the editor

I think most people, both on the right and the left, agree on at least one thing: healthcare costs are out of control. We may disagree on how to fix it, but the fact that almost everyone recognizes the same problem should give us hope that honest discussion might help us correct course.

For years, I blamed pharmaceutical companies and insurance carriers for the rising cost of care. They play their part, but what surprised me was discovering that the largest driver of America’s healthcare spending is not Big Pharma or the insurers. It is the hospitals.

Over the past several decades, hospitals have been allowed to consolidate into large regional systems that operate much like monopolies. If you live in Gainesville, you have probably noticed how far and wide Shands has expanded. When a dominant system buys up the independent clinics and outpatient centers that used to compete on price, the free-market effect disappears, whether the lawyers call it a monopoly or not.

All of this has taken place during a period when the cost of healthcare has risen far faster than wages. Since the mid-1980s, real household income has increased by only about thirty to forty percent. In that same period, real per-person healthcare spending has increased almost fourfold. That gap is a major reason families feel squeezed.

Here is the part most people never hear about: the majority of these large hospital systems operate as “nonprofits.” That means they pay no corporate income tax and no property tax, and they receive other significant financial advantages. What they give back in charity care varies widely from place to place, but it is highly doubtful that any major system returns an amount equivalent to the value of the tax breaks it receives. The exemption is large, and communities deserve proof that it is being earned.

Why did this happen? The short answer is that our laws allowed it to happen. Over time, legislation was written in ways that gave hospitals more room to consolidate, and the rules that once limited their reach were weakened or ignored. It was easier for elected officials to avoid the political pushback that meaningful oversight would have required.

None of this came from one party or the other. Both sides played a part in creating the conditions that allowed large hospital systems to grow unchecked. And while hospitals did exactly what the law allowed them to do, the responsibility for the results still rests with the people we elected. We are here because government allowed it and because few in Washington wanted to admit the system was drifting off course.

So, how do we change direction? The cure is almost always harder than the cause, but in a case like this, the remedy comes from the same mechanism that caused the problem. Legislation and weak oversight let the system drift, and legislation with real oversight is what will steady it again.

We must remain a free-market nation, and despite a growing belief that privatization is always harmful, we should not discourage private providers or risk undermining our constitutional framework. The goal is not to punish success or limit growth. Instead, legislation could be written that brings costs back within reach without restricting a hospital’s ability to operate profitably. We can create incentives that help new providers enter the market, which encourages competition, and competition naturally drives prices down.

The nonprofit issue is more difficult. Ending nonprofit status outright would not undo the damage already done, and trying to reverse thirty years of consolidation would be like trying to put toothpaste back in the tube. But we can stop wasting what is left in the tube. We can require nonprofit systems to earn that status going forward by reinvesting a meaningful portion of their surplus back into the communities they serve, especially in areas where these large systems control the market.

And let me be clear about one thing: your doctors, nurses, and medical staff are not the ones to blame. They may work inside a system that has grown far too costly, and some may benefit from the structure around them, but they did not create it. They are doing the best they can within the rules that government and large institutions put in place. The problem is the system itself, not the people who take care of us.

At the end of the day, we may never see the universal healthcare system that some Americans hope for. But short of that, and just as worth fighting for, is the goal of bringing these enormous costs back under control and making care more affordable. That will never happen if we stay locked in partisan fights with one another. It will only happen if we start acting like a nation again.

That unification begins at the ballot box. We need future leaders who are committed to fixing the piping rather than demolishing the structure. We do not need more political showmanship or promises that go nowhere. We need practical reforms, honest oversight, and elected officials who understand that the system can be repaired without tearing it down.

Healthcare should not be a battlefield between Americans. It should be a place where common sense prevails and where we choose leaders who are serious about solving problems instead of creating new ones.

David Wallace, Newberry

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