St. Vincent's: first of many?

New York magazine reports that although the closure of giant St. Vincent's hospital earlier this year shocked New Yorkers, the pain isn't over yet -- because the majority of the city's hospitals teeter on the edge of financial collapse. With 2% profit margins considered enviable, and losses the norm for most institutions, the city's hospitals leave the article's author searching for the why. What's killing the city's hospitals?

The author does identify some reasons specific to New York: the stranglehold that unions have on hospital labor drives up costs, the high percentage of uninsured and Medicaid- or Medicare-insured patients, the older buildings that many hospitals are forced to maintain.

But what he doesn't say is how all of these things tie together with the pressures that hospitals nationwide are facing: It's government intervention, stupid.

If hospitals weren't forced by city government to deal with unions, they could contract privately with workers willing to accept lower wages than unions demand. If the government didn't insure the poor and seniors, and if hospitals weren't forced to accept all comers (in NYC, it's not just emergency departments that have to do this; according to the article, the nonprofit status of the city's hospitals subjects them to a complex web of regulations forcing them to accept patients regardless of ability to pay), hospitals could choose to deal with patients who can pay (and accept charity patients voluntarily, if they could afford to do so). If New York weren't landmarked to death, with a ridiculous number of historical committees, neighborhood groups, and bureaucrats to please if you so much as want to change the windows on your townhouse, hospitals could build newer facilities when it makes financial sense for them to do so.

All this, on top of the pressures that hospitals all over the country face -- emergency rooms that can't turn away patients, even those who are clearly faking an illness to get a free bed for the night and who will never pay a red cent for the expensive medical care they receive; malpractice lawsuits that force enormous, often undeserved, payouts; private insurers (who would likely play a much smaller role in a fully free market) driving down reimbursement rates -- and it's no wonder New York's hospitals are in the toilet.

Add ObamaCare to the mix, and there will be even more patients clamoring for care, straining a system already at the brink of collapse.

I was fortunate, four days ago, to have a New York City hospital to go to when I had a medical emergency. I certainly hope I don't have one again for the rest of my life. Unless we turn toward a free market in health care, who knows what will be there the next time?