As a private equity firm reduces Hahnemann University Hospital to a mere real estate investment, the cracks in Philadelphia’s hospital system are widening. Soon, thousands will lose neighborhood access to emergency and hospital care.

Hahnemann’s closure threatens the tens of thousands of patients who come through its doors annually — as well as the around 2,500 professionals who care for them. According to Inquirer reporting, it seems that Hahnemann, one of the most centrally-located safety-net hospitals in Philadelphia, may be sold for parts by wealthy investors.

But the system doesn’t need to be vulnerable to the whims of investors. And the history of hospital closures shows that it would be senseless to let Philadelphia lose Hahnemann.

Until 1977, those who needed free care had a right to it at the city’s public hospital, Philadelphia General Hospital (PGH). PGH traced its roots to 1732. Over the centuries, it became a modern hospital that drew physicians from across the country. But its prestige was secondary to its legacy as a guarantor of care. In the absence of a national health-care system, municipal hospitals across the country, like PGH, were vital safety nets, admitting patients regardless of income or insurance. By the 1950s, PGH was also a center of care for black residents who faced discrimination elsewhere.

The 1960s were a turning point. Medicaid and Medicare, implemented in 1966, led some poor and working-class PGH patients to turn to private hospitals — institutions like Hahnemann. But thousands fell into the gap between employer-based private insurance and the poverty rate required for Medicaid. These uninsured patients continued to rely on public hospitals.

The Blockley Almshouse (top), which opened in 1732, was later renamed Philadelphia General Hospital. Its closure in 1977 dealt a blow to the city's safety net for health care, which some activists and historians worry will happen again after Hahnemann University Hospital shutters.
HANDOUT / DAVID SWANSON
The Blockley Almshouse (top), which opened in 1732, was later renamed Philadelphia General Hospital. Its closure in 1977 dealt a blow to the city's safety net for health care, which some activists and historians worry will happen again after Hahnemann University Hospital shutters.

Meanwhile, city contributions to PGH plummeted, and federal dollars were used to fill the shortfalls. Hospital conditions deteriorated.

Once some of the patient base dispersed to private hospitals, city leaders argued for PGH’s closure, but thousands still relied on the public hospital. Into the 1970s, there were more than 100,000 patient visits annually. At the same time, city government cut budgets as costs rose. Financial difficulties squeezed the institution and PGH’s reputation suffered.

By the early 1970s, Mayor James H.J. Tate had rejected proposals to fix PGH and signaled that the city should get out of the hospital business. The Inquirer agreed. On the eve of his reelection, November 4, 1975, Mayor Frank Rizzo was stuck in Hahnemann, recovering from a broken hip. He handily won the next day, as residents also voted to upgrade city infrastructure, including PGH. Despite elite disavowals of PGH’s continued relevance, the hospital retained public support.

Rizzo won out over popular opinion and soon began to shutter PGH. A coalition of hospital staff, unions, and community organizations protested. Despite their efforts, PGH closed in 1977. Its demise marked the beginning of a new chapter in the history of Philadelphia health care.

Private hospitals tried to fill the gaps with limited city support. Many had long offered some charity care, though not on the scale or with the same guarantee PGH offered. Some former PGH patients encountered difficulty getting care after it closed. The city at the time claimed that there were no negative public health impacts, but some scholars found that use of non-PGH hospitals did not climb after the public facility closed, signaling that many former patients fell through the cracks of this massive shift.

As the city’s only full-service public hospital, PGH was far from a complete health-care system. It often fell short on funding and of expectations. But its promise of publicly guaranteed and accountable care stands as a path not taken — and as a warning. Its closure lingered in a city whose hospital system could not, or would not, fill the resulting gaps.

Hahnemann’s closure would add another tear in Philadelphia’s frayed health-care safety net. Philadelphia trails peer cities in public health metrics and has shocking disparities in health outcomes and life expectancies across neighborhoods, race, and class, despite its renowned hospitals.

Safety-net hospitals like Hahnemann have provided affordable care to some of Philadelphia’s uninsured (approximately 9.7% of Philadelphians), publicly insured, and undocumented residents. If Hahnemann closes, remaining hospitals will struggle to keep up, ballooning wait times and leaving dangerous care gaps.

In the 1970s, city power brokers disassembled PGH, a beleaguered but crucial hospital. Today, as Philadelphians respond to the Hahnemann crisis, they should embrace the public hospital as a matter of human rights and fight for a legal right to care. This would go a long way to prevent the gaps created by safety-net hospital closures.

As PGH’s history attests, the city cannot do it alone. Philadelphia and communities like it will need a national system of universal health care alongside public and publicly accountable health-care institutions. This is an opportunity to reverse the city’s and country’s reliance on the profit motive to determine who lives and who dies.

Ian Gavigan is a Ph.D. student in history at Rutgers University where he researches 20th century U.S. politics and social movements. Amy Zanoni is a Ph.D. candidate in U.S. history at Rutgers University. Her dissertation examines struggles over Chicago’s public hospital in the late 20th century.