When Mayor Luke Ravenstahl announced a lawsuit challenging UPMC's tax-exempt status, it was yet another media shitstorm for the hospital giant. When you're claiming to be a charity, it's hard to imagine worse PR than a lawsuit accusing your CEO of hiring a private chef, chauffeur and jet. These days, even the new pope supposedly cooks for himself and takes the bus.
But Ravenstahl's press conference wasn't a complete disaster. The media completely ignored UPMC's most damning critic: Brookline resident Kendra Bowser.
While the politicians talked about CEO pay and the cost of UPMC's tax exemptions, Bowser was more succinct: "I'm no longer permitted to see the doctors who have been able to give me the ability to live my life," she told reporters.
Bowser, 33, says she suffers from crippling migraines, which UPMC doctors have controlled. But she has a new headache now: She carries a Highmark-issued Community Blue policy, which UPMC doesn't recognize. In fact, for UPMC, Community Blue may as well be the Scarlet Letter: It won't even allow Bowser to pay out of her own pocket — something she says she's willing to do, even though she figures a single office visit could cost $300.
"This is someone who was taking care of me for 10 years," she says. "It's a continuity-of-care thing."
Like many Community Blue subscribers, Bowser works for UPMC's biggest rival: the West Penn Allegheny Health System, which Highmark is merging with. So you could dismiss her as a competitor's employee, trying to make UPMC look bad. (Bowser also acknowledged a debt dispute with UPMC a decade before.) Except when it comes to looking bad, UPMC hardly needs help.
The fate of Community Blue subscribers was laid out earlier this month by the Pittsburgh Post-Gazette's Bill Toland. And on its own website, UPMC flatly acknowledges that Community Blue subscribers aren't welcome. Predictably, it claims that it's doing patients a favor by casting them out: "UPMC does not believe it is legally, ethically or medically appropriate to ... impose more onerous economic terms on those individuals," the site asserts.
But as Toland noted, while UPMC can legally deny treatment to patients like Bowser, "Cash is usually an accepted form of payment — [except] when it comes to Community Blue customers." If it's wrong to charge cash or out-of-network rates, are Community Blue patients — those insured by UPMC's sworn enemy — the only ones UPMC is treating morally?
I doubt it. The obvious conclusion here is that UPMC is simply trying to tarnish Community Blue — part of its loudly proclaimed belief in healthcare competition.
But consumer choice is supposed to play a role in competitive markets too. A few years ago, for example, UPMC tried to convince people to drop Highmark completely on a website called ... keepyourdoc.com. That's exactly what Bowser says she was trying to do. And if she wants to pay extra for that privilege, she says, "That should be my decision" — not UPMC's.
And when politicians like Ravenstahl fault UPMC for earning profits, UPMC says it has to make money to maintain its own financial health. But patients like Bowser could help it do so — by paying cash for services, without the discounts medical providers give insurers. Yet apparently, UPMC is neither charitable enough to let those patients see their doctors, nor mercenary enough to charge them a premium for doing so — strange behavior for a nonprofit that insists it has to make money.
Ravenstahl's court challenge will likely drag on for years, and before it's over, Harrisburg may already have rewritten the law governing nonprofits. (That would require a change to the constitution and a public referendum, which couldn't happen before 2015. But do you doubt UPMC could drag the lawsuit out? Or buy enough election-season advertising to make Karl Rove look like a gutter-shield salesman?) In the meantime, though, there's something UPMC needs to understand:
This is why people hate you. Because too often when they expect you to act like a charity, you claim you need to run like a business ... but when they want to tax you like a business, you insist you're actually a charity.
And even if you win this case, your headaches aren't going away either.