IMAGINE PAYING A hospital a fixed amount and saying "cure me."
You now have a ridiculously simplified explanation of the change to "managed health care" proposed by President Bill Clinton.
Some people are rejoicing and others cowering. But Richard Mark is the only one I know who reacts with a chuckle.
Not that there is so much to chuckle about down at St. Mary's Hospital in East St. Louis. It lost something like $6.5 million in 1990, the year Richard came to work as chief operating officer.
It's just that Richard knows St. Mary's has been in the "managed care" business for years. Not by choice. But when almost all your patients either have no insurance or are covered by Medicaid or Medicare - with strict payment limits - well, managed care is what it is.
This is not another down-and-out in East St. Louis story, loaded with gloom and despair. Nope. St. Mary's is doing much better these days.
It lost only $20,000 last year, and may finish 1993 in the black. It scraped together enough to replace a $400,000 CAT scanner. Heck, it even has tentative plans to build a clinic for 15 doctors and dentists next door.
I wandered down to the hospital Thursday to hear Richard's angle on Clinton's big health care reform speech the night before.
It turns out that Richard heard it, and also studied one of the 245-page Clinton health plan synopses that leaked out earlier.
"Something is going to change, that's for sure," he said. "It could help us a lot, or it could hurt us a lot. We don't know yet."
Before moving on, I've got to fill in a little history here.
The fortunes of St. Mary's, once the medical powerhouse of Metro East, fell with the fortunes of the town that surrounds it. Most patients, like most residents of the 70,000 people in its immediate area, are poor.
The emergency room teems with a mix of sick people who failed to get early care, people shot in street wars and accident victims from busy highways plied by commuters who usually don't give St. Mary's a second thought.
It's a busy place, filling about 90 of its 115 beds each day. It handles 1,100 trauma cases a year. There are 65 doctors on staff, 484 employees in all. The budget is about $28 million a year.
An order of Roman Catholic nuns from Indiana operates the hospital on a non-profit basis. Not expecting a profit is very appropriate when about 92 of every 100 patients either have no means whatsoever to pay or are covered only by Medicare (for the old) or Medicaid (for the poor). …