OPINION: Hospitals and the Great Depression: What was different?
In the last few months, as readers of this paper know, SUNY Downstate has been trying in all sorts of ways to either close or seriously downsize Long Island College Hospital, which SUNY’s board members see as a financial drain. Brooklyn Heights and Cobble Hill residents once hailed SUNY as having “saved” LICH from its previous parent firm, Continuum Health Partners, but it now looks like SUNY may have “saved” LICH in the same way that Russia “saved” Poland, Czechoslovakia and Hungary after World War II. SUNY Downstate itself is in serious trouble – according to an audit in January by state comptroller Thomas DiNapoli’s office, it was losing $3 million a week at the time.
As for Interfaith Hospital, it’s been in and out of trouble so many times over the years that it’s not funny. And looking beyond Brooklyn into Manhattan, many of the political “powers that be” approved the sale of eight buildings of St. Vincent’s Hospital to the Rudin family of real estate developers in hopes that they would at least include an urgent care center in their plans. Well, the transformation of those buildings has begun, but where’s the urgent care center?
Now, I’m well aware that all this is occurring during a recession, the greatest financial downturn since the 1930s. But this begs the question: How did hospitals fare during the Great Depression?
Wikipedia has a list of hospitals past and present in New York City, and it seems that very few closed during that era. Indeed, the current trend of hospital closures and mergers didn’t begin until the 1970s, picking up more steam in the ’80s and ’90s. According to other accounts online, private hospitals indeed did reduce admissions during the ’30s and also were forced to institute measures like cutting nurses’ salaries and shortening vacations.
One difference is that in those years, communities pulled together to support the hospitals. An online account of one hospital, Lakeside Hospital in Kendalville, Indiana, recounts that during the 1930s, concerned citizens donated food to the hospital’s kitchen. After cafeteria workers were cut, nurses stayed late to prepare food for their patients. “Dedicated employees with a teamwork philosophy, continued Lakeside Hospital during these tough years,” according to the account.
The business community also pitched in to do its part. In the mid-1930s, concerned business leaders in Chicago pooled their savings and launched a company known as Hospital Service Corporation, which offered a pre-paid hospital insurance plan – a new concept at the time. The idea caught on across the country and eventually evolved into Blue Cross and Blue Shield.
Where private and voluntary not-for-profit hospitals couldn’t keep up with the rising tide of patients and their own fiscal shortfall, the government stepped in. During the Depression, there was a huge growth in public hospitals. Nurses who were “excessed” from private hospitals were eager to work for public institutions. These hospitals, at the time, were well-staffed, affiliated with major medical schools, and supported by the tax base. Pilgrim State, a still-functioning state psychiatric hospital on Long Island, was actually built during the depths of the Depression, The original campus included not only a hospital, but doctors’ and nurses’ homes, a theater, a bakery, a laundry, a power plant and a firehouse.
What was different back then? Many things. Medical equipment was less expensive and less elaborate. But perhaps most importantly, people were willing to sacrifice and still had a sense of the common good.