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BY JORDAN RAU
KAISERHEALTHNEWS.ORG
WESTWOOD — The last thing New Jersey needs is more hospitals, given that there aren't enough patients to fill all the existing beds, a prestigious state commission declared last year. So why is there now a campaign to build a new one just a few miles from others?
Money and popular demand are behind it. Hackensack University Medical Center sees an opportunity to grow by constructing a for-profit facility in this middle-class suburb of about 11,000 people near New York City. Borough leaders covet a big new employer to bolster sagging tax rolls and boost local businesses. And residents like Lee Tremble take solace in the thought that if they took ill, an ambulance could whisk them to a hospital in just a few minutes.
"I'm 58, my blood pressure is high, my cholesterol is out of whack," said Tremble, a local restaurant owner. "I know if I have a heart attack, I'm not making it" to a hospital farther away. He and many other Westwood residents are championing the 128-bed proposed hospital against opposition from two regional hospitals that fear a new competitor nearby.
The campaign is a case study of the formidable obstacles confronting President Barack Obama and Congress as they try to mine savings from the $2.5 trillion health care system. Tens of billions of dollars must be found to keep health care spending from gobbling up an increasing share of the economy and thwarting efforts to insure all Americans. But standing in the way are strong financial incentives and public enthusiasm for the latest and often most expensive facilities, technologies and procedures. There's also powerful resistance to making do with less.This is especially true in New Jersey, whose residents receive some of the most extensive and costly medical care in the nation. It's not only that there are too many hospitals scrambling for patients to fill their high-priced beds. Compared to most other states, elderly patients here are more likely to end up in intensive care units and undergo extra testing.
In the last two years of their lives, New Jersey patients on Medicare see specialists an average of 50 times — twice as often as those in Connecticut and more than four times as often as those in Minnesota, according to the Dartmouth Institute for Health Policy and Clinical Practice.
But there's no clear benefit to the populace's overall health: New Jersey ranked 26th among states in a comparison of health care indicators by the Commonwealth Fund, a private foundation. Experts have found other high-cost areas of the country also don't deliver exceptional care.
"Substantial opportunities appear to exist to reduce health care costs without impairing quality of care or outcomes," Obama's budget director, Peter Orszag, told a Senate panel earlier this year.
But sharply cutting back on Medicare payments to high-expense areas, as congressional leaders are considering, could undermine hospitals' ability to treat the poor and uninsured, pay off their ambitious building upgrades and expansions or compete with stand-alone surgery centers that cherry-pick many of their most lucrative patients.
"If we went into New Jersey and said, ‘New Jersey, you've got two years to look like Rochester, Minn., which does perfectly well with less,' essentially health care systems all across New Jersey would go bankrupt," said Dr. David Goodman, a professor at the Dartmouth Institute.
Steep cuts to hospitals, among the most powerful political and economic players in any community, also would inflict substantial collateral damage. New Jersey's hospitals spent more than $18 billion in 2007 and employed more than 145,000 people, according to the New Jersey Hospital Association.
"They have an important role in the economy: they hire lawyers, they hire accountants, they have their events to raise money at the local hotel," said David Knowlton, president of the New Jersey Health Care Quality Institute. "It creates a big sucking sound as jobs go down the drain when they leave."
