Reform pits city hospitals vs. rural

The Boston Globe reports:

Large, urban teaching hospitals - including hospitals that are the biggest engines in the Boston economy - are facing the possible loss of hundreds of millions of dollars under national healthcare reform as rural lawmakers on Capitol Hill wage a fight to win more federal cash for their local institutions.

Big hospitals affiliated with medical schools around the country receive heftier reimbursements for treating elderly patients covered by Medicare, part of a government policy that rewards them for maintaining things such as trauma centers and burn units, as well as for training future generations of doctors.

Rural members of Congress, however, angry at what they see as an unfair advantage to glitzier facilities in cities, are demanding a bigger share of the pie for smaller hospitals, which serve remote populations and often struggle to survive.

The intense competition is among the key political subplots in the debate over expanding healthcare coverage to more than 46 million Ameri cans with no insurance. Although Republicans have stronger representation in the nation’s heartland, it’s not simply a red state-blue state divide. Plenty of rural Democrats think the current system - which favors facilities such as Massachusetts General Hospital in Boston and Mount Sinai in New York - is unfair.

“This is a very urban bill,’’ fumed Representative Earl Pomeroy, a North Dakota Democrat on the House Ways and Means Committee, which passed the healthcare overhaul bill Friday. “Could it be improved? Could it be more rational? Of course.’’

This is all part of Obama's urban focus.