Do Wisconsin hospitals provide enough free “charity” care to compensate for their tax breaks? This was the topic of a three-part series in the Wisconsin State Journal last week.
The debate centered on whether hospitals are “fat cats” that could give away more free services. Every dollar spent on facility additions, improvements, advertising and attracting top-notch physicians was viewed as suspect since this money could have been used to provide free care. As one health care consultant put it, “There’s a fine line [hospitals] must walk. If they function too much like a charity they go out of business. If they function too much like a business, they’re accused of violating their charitable purpose.”
And therein lies the contradiction. Providing top-notch medical care, attracting the best physicians, building modern, up-to-date facilities, etc. requires making a profit. It requires production not sacrifice, improvement not stagnation, and trade not handouts. Regardless of one’s endeavor, being successful in life requires achieving values, not giving them away.
But morally, our culture condemns this. Good is regarded as giving up values in the name of those who lack them. Giving up a posh hospital addition to serve someone in need is considered morally right; building new facilities to attract doctors and patients who value them is considered morally tainted.
St. Mary’s Hospital in Madison, in contrast, has partnered with doctors’ groups to save costs, had the foresight and planning to expand its facilities without borrowing money, increased operating and emergency room capacity to keep up with growing demand and attracted top doctors to its facilities. For this they are denounced. We need to “prevent empire building,” said one critic. We should prevent hospitals from expanding without permission from the state, said another.
As these examples show, the more hospitals give away, the more they struggle and suffer, the more they sacrifice for those who cannot offer anything in return, the greater their moral stature. A hospital that makes a substantial profit, builds the latest facilities, attracts the best doctors and CEOs and provides top-notch care is condemned for its achievements. After all, this wealth could have gone toward providing free care. And do they really need these improvements anyway?
This moral code sets up an impossible contradiction between doing what is in the interest of living and what is considered moral. It demands sacrificing values, yet life requires achieving them. It demands hospitals give their services away, yet their livelihoods depend on profit. This is the anti-life morality of altruism, and its true nature is consistently obscured, evaded and distorted.
Referring to hospitals as charitable organizations, for example, distorts both the meaning of charity and the nature of what is being demanded from them.
Charity is voluntary goodwill between people. It is a gift and an act of supporting one’s own values, not a moral obligation or duty to others.
Let’s concretize what so-called hospital “charity” actually consists of. Suppose a man (from the IRS, perhaps) takes $1,000 from the hospital. He then offers them a “deal.” He will return $500 of the hospital’s money if it agrees to provide free care.
The hospital is given the choice between losing $500 of its money directly or by providing free services. The hospital and its employees are expected to sacrifice part of their livelihoods in service to others, and it will be extracted from them one way or another. Far from promoting charity, this is a policy of extortion.
Earlier this week, UW Health was lambasted for suggesting that “increased revenue” was a factor in deciding to offer late-term abortions. That UW Health should profit from providing a highly valued surgical procedure was regarded as — in the words of one writer — “unethical” and “downright revolting.”
The physicians themselves offered self-effacing assurances that they desire nothing but the satisfaction of serving others. “We hope to break even, but the physicians believe there is a service in the community that needs to be filled,” a UW Health spokesperson said.
Altruism is not charity, benevolence or goodwill. It is the doctrine that enshrines sacrifice and service to others while condemning achievement, self-interest and profit. If we are to live in a world of success and prosperity, we must reject the anti-life code of altruism and adopt the life supporting code of self-interest.
Jim Allard ([email protected]) is a graduate student in biological science.