Explaining the state’s initial decision to accept the closing of Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer, Secretary of Health and Human Services Kate Walsh said in July, “The market has spoken.”
While the bluntness of that statement was shocking, the principle behind it is not. Whether they are for profit or technically nonprofit, hospitals are businesses. Like any business, they need customers — for hospitals, that means patients — and the revenue they generate for a healthy bottom line. Governor Maura Healey decided that five hospitals operated by Steward Health Care met that criteria. Steward has reached deals with other operators to run four of those hospitals. The state seeks to take control of another one — St. Elizabeth’s Medical Center in Brighton.
Without a rescuer, the two hospitals that did not make the cut will disappear. When the market speaks — and people listen to it — that’s what happens.
All kinds of businesses disappear. Convenience stores and hardware stores. Bakeries and coffee shops. Banks, supermarkets, drug stores — and hospitals.
Economies of scale — defined as the advantages that can happen when a business increases in size — are part of the big cultural shift that has occurred, one that moves away from local businesses and toward large operations that are supposed to provide more efficient service and savings for consumers.
There’s no more Jordan Marsh or Filene’s and no Bank of Boston. John Hancock Financial Services is owned by Toronto-based Manulife. Large hospital networks like Mass General Brigham and Beth Israel Lahey Health dominate the health care landscape. When the market spoke, it said bigger is better, the strong will survive, and the weak will not.
The collapse of the for-profit hospital network operated by Steward , driven by the extraordinary greed of its CEO, Ralph de la Torre, is an exceptionally ugly part of that big economic picture. Meanwhile, the state’s initial acquiescence to the closing of Carney Hospital in Dorchester as a result of that collapse represents an acceptance of a common outcome: Businesses that don’t survive are often the ones located in low-income areas, which means the poorest and most marginalized suffer the most.
“As a business model, it’s just not succeeding,” said Larry DiCara, a former Boston city councilor and longtime political observer who grew up in the Carney neighborhood. “The constituency for the hospital is now people on the margins of society. As a business, it’s just not lined up to succeed.”
If Carney Hospital closes, leaving what social justice advocates call a health care desert, it won’t be the only potential desert in the Dorchester, Roxbury, and Mattapan communities it serves.
As the Globe recently reported, after the fourth Walgreens shut down, there’s a growing drug store desert in the predominantly Black and Latino neighborhoods of Roxbury and Mattapan. That happens when a chain like Walgreens comes in, and through economies of scale, squeezes out small, independent pharmacies by offering more variety and lower prices. However, if Walgreens or another large chain decides it’s not making enough money in a specific location, it feels free to shut it down, leaving behind people who no longer have a place nearby to pick up prescriptions.
People in those communities must also fight for food access. According to a city report issued in 2021, when it comes to availability of food through supermarkets and convenience stores, sections of Dorchester, Roxbury, Mattapan, and Hyde Park are more than a half-mile from a grocery store — a distance that can be a barrier for elderly people or those with disabilities, and for those relying on public transportation.
Last April, it took a judge’s decision to put the Edgar P. Benjamin Healthcare Center, a Mission Hill nursing and rehabilitation home that has prioritized care for Black patients, into receivership to give it a chance to survive. A new administrator took over in May, after the previous administrator was ousted amid allegations of financial mismanagement. Whether it’s a winning business model is still unknown.
In Massachusetts, political leaders talk a lot about “health equity.” In January, the Healey administration announced what it said was a new approach to reducing health disparities across the state through “community-based interventions.” That was the same month that the Steward Health Care crisis began to publicly unfold, and when the Healey administration began to wrestle with the fallout.
In July, Boston Mayor Michelle Wu also announced a new health equity agenda aimed at improving life expectancy and reducing racial health disparities across the city of Boston
But when the market speaks, it does not demand equity. Unless political leaders intervene to make that happen, communities like the one served by Carney Hospital pay the price.
Joan Vennochi is a Globe columnist. She can be reached at joan.vennochi@globe.com. Follow her @joan_vennochi.
