Medicine used to be all about healing

Today's medical-industrial giants seem more interested in market share

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Hindsight may be 20/20, but foresight often has cataracts. Take the case of The Wall Street Journal.

Some of the newspaper's former owners, members of the Bancroft family, said last week they regret having sold the publication to Rupert Murdoch's News International now that they have learned about the company's nefarious phone-hacking practices.

"If I had known what I know now, I would have pushed harder against" the Murdoch bid, Christopher Bancroft said in a story co-published Wednesday by ProPublica and The Guardian. Other family members expressed similar sentiments.

Their regrets are a little hard to swallow -- the family sold to the deepest pockets they could find, knowing full well that Mr. Murdoch's billion-dollar empire was a sleaze machine -- but even so, the Bancrofts got me thinking about another story closer to home.

How many of the hospitals that have joined up with the University of Pittsburgh Medical Center over the years regret that affiliation -- however necessary and unavoidable it may have been -- knowing that their services may become prohibitively expensive for long-time patients?

That's what's on the horizon, as UPMC seeks to punish the region's largest insurer, Highmark, for the sin of saving the West Penn/Allegheny Health System from bankruptcy. Rather than tolerating a little bit of competition from WPAHS, the monopoly-seeking UPMC is trying to drive subscribers away from Highmark by refusing to renew its contract.

Nobody can say that UPMC President Jeffrey "Darth" Romoff lacked foresight. He envisioned making UPMC the dominant health care provider in the region, then set about making it happen, swallowing up other hospitals and building competing facilities in places that already had one. Smaller hospitals either saw the advantages of throwing in with the biggest player, or felt they had little choice.

Looking at the corporatized medical-industrial complex that exists today across the country, it's hard to remember that many nonprofit hospitals began as charitable institutions whose mission was to heal the sick. For all the advances of modern medicine, caring for the sick sometimes seems to take a back seat to the corporate agenda that makes doctors see too many patients in too little time, that overworks the nursing staff, that closes less profitable facilities in hard-hit communities that need them the most.

Then there is the whole rat's nest of private insurance coverage that determines which patients will be covered at which hospitals, essentially putting some doctors out of reach for those with the wrong policies -- or no policies. This problem could have been solved with a single-payer insurance system, but we all know what happened with that.

If the hospital founders of an earlier age could see what's become of their institutions today, they'd no doubt marvel at all the medical advances while lamenting the ruthless business practices. They would certainly disdain the penthouse suites and costly ad campaigns. Most of all, they'd be appalled by the gigantic egos that want to corner the market on a community's health care system.

I am thinking of Montefiore Hospital, with its venerable history of serving all comers. Established by Pittsburgh's Jewish community in the early 1900s, Montefiore was financed by the tireless fundraising of the Hebrew Ladies Hospital Aid Society.

As described in a history by Alan L. Otten, the hospital's initial purpose was to treat the growing population of Jewish immigrants who were going without care and to give Jewish doctors a place to train and practice in an era of discrimination that shut them out of other hospitals. Over the years Montefiore grew in size and scope, providing first-rate care to patients without regard to religion, race or income.

Upheaval in the health care industry made it harder for independent hospitals to survive. In the 1980s, facing empty beds and costly modernization of its aging building, the Montefiore board agreed to sell the hospital to the University of Pittsburgh Health Center. The 1990 sale brought $75 million, which went to form a new charitable organization, the Jewish Healthcare Foundation.

In hindsight, it was a good move -- as part of UPMC, Montefiore is still standing and still meeting the health care needs of the community. St. Francis Hospital, on the other hand, tried to remain independent but failed. Instead, it was demolished to make room for the new Children's Hospital -- of UPMC.

Alvin Rogal was a former president of Montefiore and a long-time board member who also served as the Jewish Healthcare Foundation's first president. He died in 2007, but I couldn't help wondering what he'd have thought about the UPMC move to put Montefiore and its doctors out of financial reach for people insured by Highmark, which covers 65 percent of the local market. So I called his son, Jim Rogal, and asked.

Jim didn't think his father would be very happy with the situation.

"I'm reluctant to speak for my father, but I have pretty good idea of how he'd feel given our conversations over the years.

"He believed in being inclusive, and that good, affordable health care should be available to everybody. With that in mind, and the history of Montefiore that reflected that same belief, I have to say he'd be very disappointed by what's going on."

Jim Rogal, president of a communications consulting firm, also happens to be chairman of the board of Gateway Rehabilitation Services.

"As chairman of an organization founded on the principle that anyone who needs help for addictive diseases will get it at Gateway one way or another, that philosophy of health care is something I believe in strongly and I know Al did as well.

"I'm not necessarily blaming either party over the other," he said of the battle between UPMC and Highmark. "Each needs to move beyond its comfort zone to reach an agreement."

And like thousands of other county residents, Jim Rogal has a personal interest in the outcome.

"I have Highmark insurance and doctors at UPMC," he said.

Correction/Clarification: (Published July 19, 2011) Stanley Gumberg was president of Montefiore Hospital when it was sold to the University of Pittsburgh Health Center in 1990 -- not Alvin Rogal, as mistakenly reported in Sally Kalson's Sunday column. Mr. Rogal was a former president of Montefiore and a longtime board member who also served as the Jewish Healthcare Foundation's first president.

Sally Kalson is a staff writer and columnist for the Post-Gazette ( , 412 263-1610).


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