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Life Health > Health Insurance

Better Hospitals for a Sick City

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Some years ago, I worked as a freelance writer for a publisher in Detroit, Michigan, and every year, I’d be invited out to the home office for a few days to have a little face time and to hang with my virtual colleagues. This was the first time I ever got to witness firsthand the depressing squalor that defines the Motor City.

This is how Detroit would like to see itself.
Unfortunately, this is how much of Detroit actually looks.

Now, I hail from the Lehigh Valley, Pennsylvania. For the length of my childhood, I got to witness the slow, sad decline of Bethlehem Steel. I remember the day the plant finally shut down. I remember driving past the rusting facility. And I remember more recently how depressed I was that the only redevelopment the old industrial site could gain was a new casino. Believe me, a gambling institution is the last thing the people of any economically depressed community need. I don’t care what the PR flacks of the gaming industry say otherwise.

So I know what it’s like to see a city’s fortunes fall, but even for me, Detroit was shocking. There is a scene in the action movie The Crow, where gangs participate in an annual ritual of citywide arson called Devil’s Night. Turns out, the tradition got its start in Detroit, where there are entire neighborhoods of abandoned, dilapidated homes just waiting to be torched. The urban race riots of the 1960s caused such bad white flight that the city suffered a bizarre death spiral that has left it with half the population it had in 1950. Very few other urban centers in the country can claim such a dubious distinction.

According to my old publisher, the Detroit housing situation was so bad that in the worst neighborhoods of town – many of which have a haunted, bombed-out look you typically find in war zones—that it was not uncommon for people to buy a run-down home for a few thousand dollars in cash and then simply abandon it when it needed repairs. And this is before the city became Ground Zero in the subprime mortgage fiasco. While the rest of the country continues to struggle with bad housing numbers that leave some worried a second recession is on the horizon, it’s nothing compared to what Detroit faces. The average home price in the city is down to around $7,000. Last year, it was over $13,000. At this point, owning a car is a better investment than owning real estate in Detroit, but not even the Big Three automakers can get behind those numbers.

Which brings me to the real topic of this story: health care.

According to the Detroit News, there are some $1.3 billion in new hospital building projects in the works, including a $850 million upgrade to the Detroit Medical Center’s hospitals and a $500 million development plan for land south of Henry Ford Health’s Detroit hospital. But all of isn’t necessarily a good thing, the News reports. On the one hand, all that redevelopment money would be a welcome addition to the city’s foundering economy. But according to a report released by the National Institute for Health Care Reform, shiny new hospitals would likely drive up the cost of health care in terms of a greater cost burden on area employers and higher premiums.

It’s an interesting paradox: by increasing the quality of health care, might Detroit have access to less of it? Yes and no.

On one hand, the report notes a number of factors that portray a health care system that, despite environmental conditions, is working pretty well. The Detroit health market is a competitive one, but also one dominated by Blue Cross Blue Shield of Michigan, which has 70% market share, and Priority Health and Health Alliance Plan splitting the rest. Doctors are being  paid less, but also getting rewarded for working more efficiently, and Detroit doesn’t seem to have an unusually high problem with chronic illness.

Then again, the group that penned the report is funded directly by the United Auto Workers and the Big Three automakers, who have historically opposed anything that will drive up their healthcare costs. So it figures they would find the downside to new health care spending.

To some degree, the argument is moot, as health care costs are going up in Detroit anyway, thanks to chronic illness and unhealthy lifestyle behaviors. The NIHCR report may suggest Detroit is just like any other city in America when it comes to chronic illness, and maybe that’s true. But America is an increasingly unhealthy country, and Detroiters are becoming less and less able to afford the medical care that stems from long-term sickness. Couple that with the poor economy in the area and you’ve got a vicious cycle for a city already in decline. The people are poor because the local economy is horrible. The poor tend to eat poorly and engage in low-level vices such as smoking at higher than average levels, which contributes to chronic illness. Those without jobs have no insurance to pay for their inevitable heart disease or diabetes or even minor illnesses, which then become major ones. Sidelined by medical problems, families earn less, and so the cycle renews itself.

Building new hospitals may not be the answer to Detroit’s problems, but it hardly seems like an addition to them, either. And while I can appreciate the languishing automakers’ unwillingness to take on any more operational costs…come one. These companies have traditionally prided themselves as being part of the heart and soul of Detroit. If ever there was a time to dig deep and support a city’s effort to heal itself, that time is now.


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