Public Forums - Healthcare

Earlier this past week I was informed by the infamous Sister Mary Ellen (my site supervisor) that there was a Public Forum being held at the Cadillac Place which was appropriately titled "Attorney General's Community Forum on the Proposed Sale of the Detroit Medical Center (DMC) to Vangaurd Health Systems (VHS), Inc."

The DMC is an eight-hospital system that includes a number of other subsidaires and affliliates. The hospitals that are part of the DMC are: Children's Hospital of Michigan, Detroit Receiving Hospital, DMC Surgery Hospital, Haper University Hospital, Huron Valley-Sinai Hospital, Hutzel Women's Hospital, Sinai-Grace Hospital, University Labs. The entire system is non-profit/charitable business.

The Vangaurd strategy (pulled from their website) is to embrace the prinicples of a non-profit ran hospital and marry those principles with that of a for-profit business. Sensitive to a hospitals needs they collaborate with the current staff remain deticated to the community and invest in the hospital by providing resources and technology that improvethe overall care patients receive.

At this point in time the DMC is bankrupt. They do not have the finances to support themselves, but have the most deticated staff that I have ever come across. They are working with equipment that is so out of date that the parts no longer exits when a machine breaks. DMC is desperate and in desperate times comes desperate measure. After attending this forum it was made clear to me that the DMC is basically give handing itself over to Vanguard for free. Vanguard is going to take the DMC and invest 1.5 billion dollars into the hospitals there however the DMC will not be making the desicions with that investment VHS will and they will be investing in their own asset; Detroit and its citizens are not receiving anything for the superb system it has built; based on non-profit and charitable values. The Attorney General's Office informed the forum that the DMC had not even been priced out. They are making it seem that there is no other option than VHS but the fact is that DMC Administration has not explored other options; another flaw is that the DMC is ran by lawyers who have no idea how to manage healthcare.

Some of the Key Terms of the proposed sale are as follows:
DMC will receive
- relief from outstanding bond debt ($417,000,000)
- '' '' net pension liability ($190,000,000)
- Expansion to the DMC Hospitals adding up to $850,000,000
- VHS promise to maintain each hospital as a licensed acute care or rehabilitation hospital
- VHS promise to meet or exceed DMC's existing charity care policy
- VHS promise to provide the following essential core services for a minimum of 10 yrs at one or more hospitals: Neonatal Intensive Care Unit, Obstetrics, Emergency Deptarmental Services, Trauma-Designated Emergency Deptarment, Intensive Care Services General Medical Services.
VHS will receive
- will acquire substantially all assests held by DMC and its subsidairies, including all DMC hospitals and the DMC name.
DMC will retain
- will continue as a charitable Michigan nonprofit corporation and will retain control of charitable funds that are subject to restrictions imposed by donors of about $140,000,000. These funds will be safeguarded for their intended charitable uses.

This is the cliff note version of the FAQ's sheet that was handed out to us at the forum. So now you have an overview of both the DMC, VHS, and what the sale proposal is I would like to share with you how the community responded at the forum.

Margie Mitchell of MiUCAN: She had three main points "1) the mission of a nonprofit company is to give back and limit its profits. If we are to except this agreement Blackstone the hedgefund of VHS will act as a vaccum and suck all of the money out of DMC and send it to Wall Street. 2) Who will have the power to make decisions? Instead of the power remaining in Detroit, it will transfer to Tennessee and there they will have a Regional Manager make the decisions for the DMC. This presents a problem because when the power remains in local hands the appropriate and understood decisions can be made. What sort of proper decision making can you do from TN? 3) VHS limited commitment to keeping the DMC a charitable company. After 10 yrs will the keep delivering affordable services that the people of Detroit desperately need.

Dr. Reggie St. Xavier of DMC: "We are a struggling system, struggling simply to breath, to provide for our patients. This is the worst position we have ever been in and VHS is our answer".

John Trivia Nurse Union: "The DMC has provided a safety net for over 1,000 of Detroits citizens and by giving our hospitals up the VHS we are putting the desperately needed net at risk. In a forprofit atmosphere the patient never comes first the share holders do".

Sharon Madison: "This sale will primarily employ detroiters and we need to consider the fact that this is a big deal and here in Detroit we deserve to be a big deal".

What was interesting to me is that this room was filled with three piece suit businessmen who all made a significant amount of money and have the means to pay the premiums and deductables of the health insurance that is offered to them. Out of all of those people in the room there were only 2 women their to represent the actual citizens of Detroit that benefit from the nonprofit system. These women represented the proverty stricken working class of Detroit who have no insurance. It made me sick to my stomach when they approached the mic and their main concern was that they did not understand this transaction and what it would mean to them. But isn't that how it goes to keep the decisions at the top and not let the actual people who will benefit or struggle in the unknown so you can stay at the top. My question is how much Mr. Duggan (DMC CEO) will be making after this sale and where he will land. They both asked for the forum to be advertised to the people of the city in free newspapers and on non cable channels.

The two people that had the most effect on me was Sister Mary Ellen's address and a man who laid out the simplicity of a forprofit -> first reduce wages, second reduce services, third increase charges, fourth externalize cost (eliminate the taxes and put those costs on the citizens), fifth the profits don't remain in the city they are shipped to TN to the hedge fund.

Sister Mary Ellen: "The DMC is a Detroit community asset, a nonprofit health care system whose mission is to serve the community. it is governed by a local board whose responsibility is to guard that asset for the community. Hence, I find it incredible that Mr. Duggan and the board are considering handing over this community resource to a for profit corporation. VHS, whose corporate offices are located in Nashville, TN.

My understanding is that the community will not receive any payment from VHS. This is highly unusual. When most nonprofit corporations convert to for profit use, their value is transferred to another entity, such as a foundation, which carries out the charitable purpose for which the original corporation was founded. VHS is doing nothing like this for the city of Detroit. Instead VHS promises to invest $800 million in the DMC which they will own.

The DMC is the closest thine have to a public hospital in Detroit. It is where those who are poor and uninsured turn for care. Will this mission continue under VHS? They have made a ten-year commitment, but will they own the DMC for ten years? We don't know,and we have no guarantees. With no local government board, how will the community hold VHS accountable for all the promises they have made?

Let's be honest. VHS is a for profit corporation whose primary purpose is to maximize return to its owner which is the Blackstone Group, the world's largest buyout firm. What will happen when the interests of this for profit corporation conflict with the well-being of DMC patients, staff, and the surrounding community? Will vital, but unprofitable services such as OB and ER be discontinued in order to pay larger dividends? Or will they put people before profits? I doubt it very much.

On a deeper level, the VHS/DMC issue is yet another example of a dangerous trend in our country and throughout the world today. More and more, we are seeing public goods turned into private commodities, access to which depends on one's ability to pay. This push to privatization has had a devastating impact on access to vital services such as water, education, and housing, as well as health care.

What is at stake here is nothing less than our humanity. When health care is looked upon as just another commodity to be bought and sold in the marketplace, priorities become skewed and people suffer. We only have to think of the millions in our country who do not have access to adequate health care, especially unprofitable primary care and preventive services.

We desperately need to recover a sense of the common good. We are living in a world that puts a price on everything and values nothing - where everything is for sale to the highest bidder, including the DMC. I don't want to see this happen to health care in Detroit".

After the forum I had not decided if I was for or against this sale. It seemed to me that what Vanguard had to offer was ideal they were going to save this health system. However, I was challenged to look deeper into the ethics and consequences of this sale. What will happen in a year will the VHS sell the DMC to another bidder in a year, will they come through with their so called promises, are we making the right decision? I am still conflicted with this issue and want to trust that the VHS has Detroit's best interests in mind, but they are a corporation practicing similar tactics to the Real Estate business buy up the cheap and desperate and do with what they desire after they have full control.

Mary Ellen had posted about the forum on her facebook wall and got a response from a pharmacist in Phoenix, "I am very familiar with some Vanguard owned hospitals in Phoenix and they DO operate like a for profit in every sense of the word. From what I've seen here they are light years behind what the DMC already has in technology so their "technology" will likely be a step back and involve layoffs".

This response definitely pushed me in one direction however I would like to know your comments and concerns about going from nonprofit to for profit. It is a never ending battle in the health care field and it is un-nerving that health care, which I believe is a basic human right, has become a political football.