Reif: How do we measure health in Cleveland?

Jordan Reif, Staff Writer

Cleveland is overwhelmingly known for its healthcare sector. The Cleveland Clinic (CC) and University Hospitals (UH) are playing a never-ending chess game as they sprawl across the city and suburbs. Yet perhaps the mere presence of these award-winning, internationally recognized health systems is not a sufficient means to measure the quality of health in Cleveland for local Clevelanders. For every Case Western Reserve University pre-health student running around collecting extracurricular activities and shadowing hours, there are countless more residents unable to access care at CC and UH because of insufficient private insurance policies, the lack thereof said policies or other administrative barriers. It is critical as members of this community that we must understand the disparity between buildings and access, and how these are inherently tied to race and class. Moreover, we’re long overdue to consider the strength of the “community commitments” of these large health care corporations. 

Let’s start by considering the information disclosed by CC as part of their community commitments. They start their page boldly, “[CC] is much more than a healthcare organization. We are part of the social fabric of the community, creating opportunities for those around us and making the communities we serve healthier.” They quickly follow with information about how social determinants of health are the most consequential factors contributing to health—including education, food security, housing and so forth. 

They are absolutely correct. Unfortunately, it seems some of CC’s policies contradict their idealized commitment to comprehensive health. 

In addition to ranking No. 1 in the country for cardiology, CC also ranks No. 1 with the largest fair share deficit. In other words, of over 3600 major hospitals in the U.S., CC spends the least on community investment in comparison to their tax exemptions—which they receive due to designation as a non-profit and “charitable hospital.” CC had a negative $261 million fair share deficit, spending only 1.4% of total expenses on community spending. 

Suppose CC is serious about their community commitments. In that case, the first step is prioritizing them—including making sure that the professionals who work in community investment offices are local residents, not people who drive in from the suburbs—and ensuring at least equal, if not greater, support for the community as is provided for high-profile surgeries for people from around the world, to say nothing of excessive executive salaries. 

There are three clear areas where CC could bolster this community support: changing their hiring process, removing discriminatory obstacles and funding city-wide public transit. 

First, consider their hiring process and employment standards. What percentage of employees live in Cleveland compared to the suburbs? What percentage relies on Greater Cleveland Regional Transit Authority (RTA) or some form of transportation other than single-occupancy vehicles? And what are the racial makeup and socioeconomic status of employers and directors? 

At MetroHealth—Cleveland’s public hospital, located on the city’s west side—managers cannot hire new employees unless 40% of the candidates are racially diverse, and they have agreed that experience should carry equal weight to education. These are steps toward ensuring that “non-traditional” people are still considered qualified candidates in the hiring process.

Conversely, CC has promoted other policies that create obstacles in their employment process. Since 2007, CC has mandated that all employees must be tobacco and nicotine-free and pass drug testing proving as such. Anyone who has taken Sociology 101 surely can explain how these policies are discriminatory, particularly toward low-income individuals. Many people will not even consider applying for a CC job because they do not believe they can or have the resources to quit smoking, and as public health expert Michael Siegel said, “Unemployment is also bad for health.” 

Finally, patients who are late or unable to make an appointment with less than a 24-hour notice can be charged a $25 fee. If these behaviors are repeated, they can be dismissed from CC as a patient. Hypothetically, if a babysitter or daycare center cancels because of an emergency, leaving you without childcare and forcing you to change an appointment, you are charged $25. Let’s remember how expensive it is to be poor. You make your following few appointments, but then the RTA is delayed, making you miss your connecting bus, which only arrives once an hour. Should these be grounds for dismissal? 

CC should consider Cleveland Scene writer Sam Allard’s proposal for CC to subsidize the RTA; at just $40 million a year, this would make RTA free for everyone. It would surely help their employers and patients, saving CC millions of dollars that would otherwise go toward building more parking garages and aggressively revolutionizing access to comprehensive health care—this is without addressing the larger impact of making transit accessible. Subsidizing RTA is undoubtedly a better alternative to supporting the Opportunity Corridor, the glorified highway that brings people in their single-occupancy vehicles from the west side to work at CC or in University Circle while displacing residents of Slavic Village, Buckeye, Kinsman and Fairfax. What kind of opportunities is this providing? 

These criticisms should not be taken to suggest that CC does not provide high-quality healthcare. My grandmother’s life was extended by nearly five years because CC physicians provided her an option when clinicians at other hospitals sent her home to die. However, she was able to receive treatment first and foremost because the tens of thousands of dollars in treatment were covered by her insurance, and she had a support network that helped her make it to appointments regularly and on time. I will forever be grateful for the extra time that CC affords the people we love. However, that can’t and shouldn’t just be an option for people with specific insurance policies, accessible transportation and support networks that know the right questions to ask. 

We all deserve better, and we all deserve the fundamental human right of healthcare. Our ability to receive preventative check-ups, cancer treatment, or even just a pair of glasses or routine dental cleaning cannot be dependent on our socioeconomic status, the ID number listed on a little plastic insurance card or the timeliness of the RTA.