To the Editor:
Re “Nonprofit Hospitals Are Focused More on Dollars Than on People,” by Amol S. Navathe (Opinion guest essay, Dec. 4):
Dr. Navathe says nonprofit hospital boards need to focus on mission, communities and patients more than profits, “replace some financially minded members with community-minded ones,” and become more accountable to the I.R.S. and local governments.
His message also applies to nonprofit colleges/universities, many of which operate hospitals. These largest and most influential public charities will pay greater attention to those who consume and provide their services when their boards increase their representation of women and people of color to more closely reflect the demographic makeup of stakeholders — patients, students, employees and surrounding communities.
Interviewees in a national report we wrote said gender and racial board diversity increases effectiveness in serving consumers and prompts boards to pay greater attention to quality and patient safety, to look beyond numbers and finances to patient experience and satisfaction, and to pay more attention to the welfare of students and employees.
To hasten change, the Women’s Nonprofit Leadership Initiative joined with leading organizations and individuals across the United States to petition the I.R.S. in June to require large public charities to report the demographic makeup of their boards on their annual Form 990 tax return. Adding one simple question to that form would give stakeholders the information they need to hold these boards more accountable.
Vicki W. Kramer
Carolyn T. Adams
Philadelphia
The writers are co-chairs of the Women’s Nonprofit Leadership Initiative.
To the Editor:
Hospitals of all types provide unparalleled benefits to their communities. Yet the author of this guest essay ignores these benefits in an unconvincing effort to claim that hospitals are not living up to their mission.
Cherry-picking statistics and weaving together unrelated issues to try to build a false narrative undermines the hard work and societal contributions of the hospital field that provides 24/7 medical care (which is often uncompensated or undercompensated), and other essential services, including emergency care.
In a report prepared for the American Hospital Association, an industry group, the accounting firm EY, previously Ernst & Young, estimates that every dollar invested in nonprofit hospitals results in $9 in benefits delivered back to the community. Tax-exempt hospitals provided $129 billion in total benefits to their communities in 2020, an increase from prepandemic levels and an extraordinary feat given the extreme stress Covid-19 created for America’s health system.
Hospitals provide far more than medical care; they provide social services, food insecurity programs, maternal and prenatal education, transportation, housing and economic opportunities. They are the heart of their communities and deserve our support, not false narratives.
Rick Pollack
Washington
The writer is president and C.E.O. of the American Hospital Association.
To the Editor:
Dr. Amol S. Navathe’s essay describes clearly both the excess profit that nonprofit hospitals make and the inadequate care they often provide. However, it offers only an imperfect solution: to focus on the actions of their boards of directors.
A better solution? Tax the hospitals. N.Y.U. Langone has enjoyed tax-exempt status since 1998. In 2022, its revenue was $7.4 billion; its expenses, $6.8 billion. It paid no taxes. In 2022, I, as a semiretired physician, paid 9.1 percent of my gross income as federal tax.
The Supreme Court, in Citizens United v. Federal Elections Commission, has, in effect, declared that corporations are people. Why are they not subjected to a progressive income tax?
Marc H. Lavietes
New York
The writer is a pulmonary and critical care doctor and the secretary of the New York Metro chapter of Physicians for a National Health Program.
To the Editor:
Dr. Amol S. Navathe’s essay is disturbing because many years of research show that nonprofit hospitals provide better care than for-profit ones. The trend he describes suggests that result may be at risk and that nonprofits may turn out to be no better than investor-owned facilities.
His proposal that boards be reconstituted and reward community service instead of financial performance is a necessary but an insufficient response.
Why do these institutions behave as they do? Unless we understand and address those reasons, his recommendations can be no more than a limited-impact Band-Aid.
We need to look at the entire U.S. health care system. Why is our system the most expensive in the world yet produces mediocre aggregate results? Why do hospitals, nursing homes and insurance companies believe they need to be larger and larger? Just to eliminate the competition? So the managers (and shareholders in the case of for-profit firms) can enrich themselves?
When we get the answers to those and other questions, we can identify reasonable changes that guarantee that everyone has access to the care they need. Those reforms will be hard to achieve, though, because the organizations that drive the trends he describes have the political power to resist fundamental change.
Stephen M. Davidson
Philadelphia
The writer is professor emeritus of health care policy and management at Boston University.
A Disgraced Rudy Giuliani
To the Editor:
Re “Giuliani Finds Price of Lying Is $148 Million” (front page, Dec. 16):
This was not how Rudy Giuliani imagined the last years of his life. Once the law and order boss of New York City, followed by a dalliance with the Republican nomination for president. Now but a punchline, disgraced and, to the outside world, broke and broken.
Just another piece of collateral damage in the orbit of Donald Trump. Mr. Giuliani, trying desperately to keep his 15 minutes of fame going a few more seconds, acted with clear calculation and no moral restriction, doing anything and everything to please his boss.
The image of Mr. Giuliani walking resolute through the rubble of 9/11, defiant and determined, has long ago faded from sight. The glory days are forever gone. Now all that remains is a sad, pathetic, hollowed-out shell of a man.
Robert S. Nussbaum
Fort Lee, N.J.
To the Editor:
Rudy Giuliani’s lawyer claimed that the monetary damages awarded to the two Georgia election workers whom he defamed so egregiously “would be the end of Mr. Giuliani.”
It would be interesting to learn whether the jurors awarded as much as they did because they didn’t believe what the lawyer said or because they did.
Steven P. Grossman
Baltimore
The writer is professor emeritus at the University of Baltimore School of Law.
Why the Pessimism?
To the Editor:
Re “It’s No Surprise That America Is Pessimistic,” by David Wallace-Wells (Opinion, Dec. 10):
It should be no surprise that traditional economic theories based on data and computer modeling fail to connect fundamental economic indicators (now up) to consumer sentiment (now down). The economists are barking up the wrong, albeit traditional, tree.
Look to the sway of social media, rife with unsubstantiated information and conspiracy theories, 24/7. One need only compare the number of subscribers to traditional media (The New York Times, The Washington Post) and the number of subscribers to social media (Facebook, X) to find the answer.
Mary Frankel
Bryn Mawr, Pa.