Spring Training & Strange Days

On Tuesday of this past week, MLB officially opened its Spring Training 2024 when the Dodgers crushed the Padres 14-1. And yesterday all 30 teams in both the Cactus League and the Grapefruit League had games scheduled to really open the season. As I have mentioned, hope springs eternal and all you have to do is win enough games at the end of the long season and get a spot in the playoffs in order to make a run at the World Series and a chance at the title of Champion. Die hard fans year in and year out look forward to this time of year. We value competition in the US. It is part of our national fabric. There can be no denying that. It is seen in so many areas, including our in economic system. Startups, mom and pops, family businesses, retailers, manufacturers, large companies, and on and on. And in Healthcare.

In ancient, and later reinforced in medieval times, a handshake was a gesture of peace. The ancients raised an open hand (and then extended it for the hands to grasp) to show that they held no weapon and meant no harm to the approaching personage. Later knights might reach for the forearm to ensure no knives were hidden under the leather gauntlet and would shake the hand to dislodge any that were still hidden somewhere. Later still the handshake evolved into a symbolic gesture of mutual commitment to an oath or promise: two hands clasping each other representing the sealing of a bond. A gentlemen's agreement, albeit informal, but for many years it was seen as good as gold. Jimmy Hoffa, the infamous labor organizer, later said, when dealing with management, "In the old days all you needed was a handshake. Nowadays you need forty lawyers."

Hoffa probably underestimated how many lawyers would be needed to establish commitments in 2024, much less how many would be needed to unwind those same agreements. Of course, since he went missing (presumably) from the Machus Red Fox restaurant on the afternoon of July 30th, 1975, he also did not get to stick around long enough to see how many MLB player-labor-management disagreements (inclusive of walkouts and strikes) would occur in the coming decades. But he would have seen the re-location/re-naming of 10 MLB teams between 1952-1971, the most famous of which were the move of the Giants and the Dodgers from NYC to the West Coast. To this day, people still cannot believe that the Dodgers left Brooklyn.

We are seeing the exact same things rumbling in healthcare. Not just the organized labor efforts, but the dismantling of major healthcare institutions, namely hospitals.

MLB consolidated in 1903 when the AL and NL came together. The AHA came together a few years earlier in 1898. Both organizations are about 120 years old, but what the MLB can withstand is not at all the same as the threat to the public health and safety when hospitals close/merge/re-locate services. Some argue that Hill-Burton spawned too many hospitals and as innovation and transportation has altered the role of so many things, including local hospitals, that maybe some reductions in hospital quantity may be a "good thing." Some even insert "competition" into the dialogue when asked why. As though, hospitals that cannot survive are just examples of Darwinian economics. Except tell that to those communities who depend on them for care and as a bedrock of employment given the loss of other industries that use to drive the economy of the community.

I just returned from a meeting where a large number of Hospital CMOs and CNOs gathered to discuss the top priorities that they face every day when dealing with their facilities. The conversations were rich. Enlightening. Supportive. Invigorating. If there was one thing clear, the folks in attendance were NOT complaining. There was an adopted Stoicism that everyone was doing their absolute best with what they had no matter where they were. And everyone was eager to share stories and potential solutions in an effort to collectively problem solve. If there was one thing that we all agreed upon was that there was absolutely NO national conversation on the need to re-design the structural forces that exist today. The ones that are forcing SO MANY difficult conversations. Sure we talked together, the AHA talks to itself and others, the AMA does, too, and so on and so one. BUT like Jimmy Hoffa, the national discourse is MISSING.

Where is the social contract? Where is the Grand Design? Where is the PUBLIC HEALTH re-design? Why aren't public Hospitals run as public utilities? Why aren't we moving toward a Bismark model for access? Do we love our competitive fabric that much?

AS far as I can tell, you can move an MLB team (the A's are headed to Las Vegas ICYMI) if you have enough money and enough lawyers. And, while 35 (!!!) states require a Certificate of NEED to open a hospital, as far as I can tell ZERO require a CERTIFICATE OF CLOSURE. Yes, there are many requirements involved in closing a hospital. But they are mostly communications to the various agencies of the state/federal governments, but there are no functional STOP signs when closing a hospital. I am not even sure how many lawyers you need (other than to mitigate against any liability that may occur). As far as I can tell you don't need "approval" to close, so long as you give everyone involved a decent heads up.

Thomas Phillip "Tip" O'Neill Jr. reportedly earned the nickname "Tip" from Canada's Babe Ruth, a fella otherwise known as James Edward "Tip" O'Neill. The ballplayer played his last game for the Cincinnati Reds in 1892, about a decade before the MLB and about 80 years before Hoffa went missing and the Reds won the world series the same year (1975). The politician "Tip" O'Neill Jr. hailed from Massachusetts and served as the 47th speaker of the United States House of Representatives from 1977 to 1987, the third-longest tenure in history and the longest uninterrupted tenure. He is widely remembered for the comment, "All politics is local."

Well, all healthcare is local, too. And while so many great folks are out there every day trying to hit a base hit or maybe a double, and doing everything in their power to keep their local hospitals from collapsing, they aren't trying to win any World Series. And there is no off season during which they can prepare for the fun and excitement of a new pennant race. All of them as leaders (in my book anyway) are breathing oxygen into hope. Otherwise, I am not sure where their hope springs from. They are not counting on any fans to cheer them on. Rather, they bring their "A game" as often as they can muster to cheer their own teams. Nobody told them that there would be days like these....

John Lennon said it best, "Well, everybody's talking and no one says a word....

Always something happening and nothing going on....

Nobody told me there'd be days like these

Nobody told me there'd be days like these

Nobody told me there'd be days like these

Strange days indeed

Strange days indeed"