11 February—Yale New Haven Health, Connecticut’s biggest healthcare conglomerate, a nonprofit on paper, wants to buy three currently for-profit hospitals from Prospect Medical Holdings, including Waterbury Hospital, to make it even bigger by about a quarter. The only downside, according to Waterbury’s mayor, is that the hospital’s return to nonprofit status will deprive the city of some $4.6 million in tax revenue. If my memory serves me, Waterbury already has given Prospect Medical some tax breaks. And if the state approves the deal, it’ll probably come up with a payment in lieu of taxes (PILOT) worth a few million.

It’s pretty certain that Prospect Medical Holdings had bought Waterbury Hospital and other nonprofit hospitals and medical practices a few years ago with a view to adding to its bottom line. Because that’s what capitalism is all about. And I suspect that Prospect approached Yale and/or Hartford Healthcare with an offer to sell because, for whatever reasons, it just couldn’t make the three hospitals profitable enough. But what do I know?

Given what I do know about Prospect and its principals, however, the communities served by the three hospitals—Waterbury, Manchester, and Rockville—are bound to be much better off with Yale. Or at least without Prospect Medical Holdings.

The second largest healthcare conglomerate in Connecticut is Hartford Healthcare, which owns Torrington’s friendly little Charlotte Hungerford Hospital as well as lots of formerly independent medical practices. Unfortunately, that’s what healthcare has come to. Solo practitioners and independent group practices are a dying breed. Because, sad to say, they can’t compete and can’t handle all the insurance paperwork, among other requirements of modern medicine.

Compete? Do physicians really have to compete? What a silly question. Nonprofit hospitals compete, so why shouldn’t for-profit physicians. Certainly, many physicians still practice medicine for the right—if old-fashioned—reasons, but they have to make ends meet. And, in all events, healthcare has become a business first and foremost.

If we’re lucky, we may have an old-fashioned doctor-patient relationship with a physician or two, usually a general or family practitioner who may often be or call himself an internist, sometimes with a specialist. But, all things considered, patients are a thing of the past. It’s a luxury these days to have a doctor make a house call to you. And even if you pay a premium for a so-called boutique doctor, you’d be lucky to get him every time you need him.

Like it or not, what used to be patients are now customers. Just like with plumbers, electricians, and auto mechanics.

The CEOs of the biggest for-profit healthcare conglomerates are paid around $20 million a year. But so are the CEOs of the biggest nonprofit healthcare conglomerates. The difference between for-profits and nonprofits is mostly in bookkeeping and lawful tax avoidance. In theory, the nonprofits are in the game for the public good, while the for-profits are in it to make money. But the care you get from either species is a crap-shoot no matter where you get it or how much you and/or your insurers pay.

And how long before Hartford Healthcare merges with Yale New Haven Health System to become a gargantuan monopoly in Connecticut’s health business? Then what?