When health care is wealth fare.

• Author: Gearino, G.D.
• Position: FINEPRINT

There are times, and they are many, when I think of the American healthcare system in the same way England's Henry II thought of "this turbulent priest" Thomas Becket--which is to say, I wonder why no one will rid us of fee-gouging hospitals and price-fixing insurers. But when I give voice to that frustration, nothing happens. When Henry II expressed his frustration, his henchmen immediately set off to slay the cause of his majesty's annoyance. It's good to be the king.

[ILLUSTRATION OMITTED]

It's beginning to feel that health care is the American domestic equivalent to the Israeli-Palestinian conflict: an intractable problem that was long in the making, spreads suffering mostly among the innocent, exposes differing world views that cannot be reconciled and thus makes zealots out of virtually anyone who joins the discussion. Worse yet (and to change metaphors in midrant), any attempt to change the way health care is paid for is akin to trying to reduce the size of a balloon by squeezing it. The cost of health care is never reduced. It just moves around to the place where there's less squeeze-back. That place is us, the consumer.

That reality was made clear recently by reporting from three newspapers. Two of them, the Raleigh News & Observer and The Charlotte Observer, are one-time rivals now owned by the same company that team up occasionally. A series of stories by their staffs showed that North Carolina's major hospitals, most of which are structured as nonprofit institutions, make a mockery of the phrase "nonprofit." To cite just one example: Duke University Health System, which comprises three hospitals, posted an operating profit of $190 million in 2011. It also has a $1.5 billion investment portfolio, which helped the company invest in lavish, patient-attracting touches such as "waiting rooms that rival lobbies at four-star hotels," as the newspapers described them. (And, yes, those stories you hear about huge markups for things such as an aspirin are true.)

Health-care systems have that kind of money, in part, because their urge to grow and dominate their markets was given almost free rein by the Affordable Care Act, which encourages consolidation and doctorhospital networks. The idea, I suppose, was that economies of scale could be passed along to patients. In practice, it works the other way around. As the newspapers reported, revenue of North Carolina hospitals "has risen faster than the cost of treating patients--and much faster...