North Kansas City Should Privatize Its Hospital
The number of government-owned and operated public hospitals in the United States has declined dramatically over the past three decades. There were almost 2,000 public hospitals in the U.S. in the 1970s. There were only 1,045 public hospitals by 2011, and the trend is continuing for many of the same reasons North Kansas City is considering selling its hospital. Like the post office, the model of a government-owned and operated public hospital facility is simply not nearly as effective as it used to be. All the public concern and political opposition that opponents can generate will not change the long-term economic outlook of public hospitals.
Local governments should provide services that government is best suited to provide and that the private sector cannot serve as effectively. This includes streets, police, fire protection, and neighborhood parks. The list does not include hospitals. The private sector, including both non-profit and for-profit hospitals, has long provided fantastic health services to our country. Indeed, to many Americans, the idea of a government hospital probably feels like a relic.
As with many privatization efforts, the fears of turning a beloved public asset over to the profit-mongering private sector are vastly overstated. The Kaiser Foundation found in a 1999 study of public hospital ownership changes that, “In most instances, access to care for low-income patients has been preserved after conversion and teaching programs have not been cut.”
A 2001 study for the National Bureau of Economic Research concluded: “In many respects, the empirical evidence from hospital conversions is reassuring. … On the whole, hospitals’ missions appear to be preserved post-conversion.” The studies note that the government should carefully negotiate the contracts and monitor the operations after the sale to ensure compliance with public goals and protect the public interest. Missouri law already requires the state attorney general to review any hospital sales, as it did when Sweet Springs, Mo., sold its hospital to a for-profit company in 2009. No more state regulation is needed, especially changes that outright prevent sales to for-profit companies.
Private hospitals, both non-profit and for-profit, are a cornerstone of our health care system. They treat the uninsured and poor as part of their mission, and they do it well. The idea that only a government hospital can take care of society’s needy is as ill-founded as the idea that government should make clothes and grow food for the poor because the private sector is not capable of doing those things, either.
There is nothing wrong with North Kansas City making money off the sale of the hospital if that is what it chooses to do. That money would not disappear in a sinkhole — it would be invested back in the city or returned to city taxpayers via lower tax rates. In particular, if a for-profit hospital took over operation, the tax base of the city would be greatly enhanced. The money from the sale or new taxes could allow the city to do many things, including investing in a lower-cost health care clinic if it chose. Clinics are a far more responsible long-term strategy for local governments than large hospitals. Such a change would not be new to Missouri. Saint Louis County now operates three clinics after closing its public hospital more than two decades ago.
North Kansas City officials deserve credit for launching a careful effort to investigate the best options for the city. They are not doing this as part of a fire sale. If city leaders determine that a sale of the hospital to a private company is best for the city and its residents, they should be allowed to do so without new state regulations blocking the way. Limiting the city’s options, which recent bills filed in the state legislature would do, has no real benefit. If residents and voters do not like North Kansas City officials’ ultimate decisions, they have numerous ways to send that message.
Privatizing the hospital will benefit North Kansas City. Health care services under private operation would continue just as they have for decades under public ownership. North Kansas City should not be expected to hold back against a nationwide trend toward converting public hospitals because of erroneous fears of private operation.
David Stokes is a policy analyst at the Show-Me Institute, which promotes market solutions for Missouri public policy.