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What is Work? Small Town Hospital Closing Opens Health-Care Debate

The closing of a cornerstone institution in the small but much talked about town of Braddock, PA, raises an important question: How should a community hospital work, really?
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In our last post on Work, we featured three experts about the changing nature of Work, from the Pop Tech conference in Camden, Maine.

One of those speakers, John Fetterman, the mayor of Braddock, PA, arrived in Maine with news that embodies America's health-care debate.

Braddock, population 2,700, is a rust-belt town on the verge of rebirth -- or collapse, depending on your glass half-full/empty position.

Per capita income is roughly $20,000 - less than the half the state average.

But where others see a rust-belt town, Fetterman sees sustainability-on-tap.

Since his election in 2005, Fetterman has embraced green businesses and the arts to start a more sustainable community model for Braddock's existing - and new - residents.

It's enough to make a person see blue sky beyond the smokestacks.

But on October 16, UPMC, the self-described "$8 billion integrated global health enterprise" that had purchased Braddock Hospital in 1996, announced it was closing the hospital on January 31, 2010.

The news stunned Fetterman, fellow politicians and UPMC Braddock employees.

The closing of UPMC Braddock embodies two core questions in America's health-care debate:

How should a community hospital work - really?

Is there a way to forge a productive conversation between now-opposing camps in the health-care debate?

Color me Cumbaya, but I believe one could emerge from the crisis in Braddock.

Despite is size, UPMC is a non-profit company - a 501(c)3 that gets tax considerations in exchange for its mission of serving the public, says Congressman Mike Doyle, D-PA.

Part of that mission is for the hospital to maintain health-care services in "under-served" areas like Braddock, he believes.

From UPMC's point of view, the Braddock hospital was financially non-viable. The company way be non-profit. But that's not the same as not-for profit, looking at things from a financial bottom-line.

"It was a difficult decision. But it was the necessary decision to make," says Paul Wood, UPMC Vice President, Public Relations. "It becomes awfully difficult to run a hospital that isn't being used."

But what is use?

Mayor Fetterman noted that a senior citizen residence being erected beside the hospital was predicated on its access to the hospital.

In a town where 90% of the buildings are empty, UPMC Braddock was used by residents as "a third place" - a public meeting place where bonds and rituals are conducted in ways that establish, cement and support community.

One of third-place uses of UPMC Braddock was as a restaurant in a town with no other sources of affordable hot meals for residents.

It's an eye-opening, even shocking way to look at use - one that says a lot about the town - and calls into question the role of a public building - in this case, the hospital.

"I very much empathized with them," Paul Wood said, about the 200 impassioned residents who recently attended a meeting about the Braddock hospital closing. 'What's really sad is - and I didn't know this - the only ATM in Braddock was inside our hospital."

For Fetterman, Doyle and residents, this aspect of the hospital was another reason for keeping it alive.

From Wood's point of view, however, the ATM situation highlighted the need for solutions beyond the hospital.

Weren't banks supposed to service under-served communities? he asked me.

And so it goes, from point-point, side-by-side:

There are other hospitals within five minutes of the Braddock hospital, UPMC's Wood notes.

But many residents of Braddock don't have cars, Fetterman points out.

Bus service will be boosted, Wood offers.

But what if you're an elderly resident having an emergency in the middle of the night - and can't afford an ambulance? Fetterman asks.

UPMC has poured millions into the Braddock community hospital and is reaping losses, Wood says.

For a net operating loss of 7%, Congressman Doyle notes. Which is equal to other hospitals that UPMC is keeping open.

These are the specifics of Braddock. But they apply to the American health-care debate at-large. Two sides, different view-points. Solutions urgent. Vital. Needed.

The need to find a common conversational ground brings me back to Pop Tech, which invites thinking past problems to shared needs and solutions.

In my talks with Mayor Fetterman, VP Wood and Representative Doyle, I noted a very hopeful common note:

All three men introduced themselves to me within minute as local sons and fathers who are deeply passionate about their families and towns.

Seeing oneself as a committed family member may sound like an odd place to find agreement on health-care.

But perhaps what Andrew Zolli calls "a new definition of our tribe" is just what the health-care conversation needs.

If we see ourselves as part of a tribe that includes the elderly and poor of Braddock - and towns like Braddock - and everyone else in the country, might we see insurance for all as a tool that could keep doctors in small communities, strengthening the community body - and the body politic?

Mayor Fetterman, Paul Wood and Mike Doyle are seeking ways to re-use the Braddock building and perhaps institute a scholarship to benefit the children of Braddock.

It's enough to give one hope. And a positive sense of urgency.

"It's too late to save our hospital," John Fetterman says. "But if this isn't enough to wake people up to the need for health-care reform, I don't know what is."