On a sweltering July afternoon, the only thing hotter than Broad Street’s sun-baked sidewalk in front of 171-year-old Hahnemann University Hospital’s Gothic main building was a parade of furious nurses and politicians who hopped up on a wooden crate to denounce both the wealthy investment banker trying to close the Center City heath-care center and his alleged greed.

Joel Freedman is trying to make us roll over and die!” declared registered nurse Susan Bowes, who heads Hahnemann’s local chapter of the nurses’ union, referring to the head of American Academic Health System, which says it’s been bleeding cash since buying the for-profit hospital in 2018. She added: “We cannot let a rich hedge fund come in here and take this hospital from this city or this state!”

A few minutes earlier, Uhura “Free” Russ — an ER nurse and union activist at St. Christopher’s Hospital for Children, also owned by Freedman’s firm but not slated for closure — practically set Tuesday’s protest on fire with a withering assault on Freedman’s management and how “the damage of ‘for-profit’ has damaged both hospitals...These were world-class hospitals at one time, and they’ve been stripped to the bone....when you have a CEO pondering whether you can have an endocrine doctor.”

The speakers at a half-hour save-Hahnemann rally alternated between anger at the way Freedman and AAHS has managed Hahnemann and their passion for the work of an urban hospital where so many patients are disadvantaged and insured through Medicaid. They were also very much focused on the crisis at hand — the looming loss of more than 2,500 good-paying jobs, and the 11th-hour efforts by the state and city to keep Hahnemann open -- and thus no one stepped back to talk about the massive elephant standing in the corner of the emergency room.

Susan Bowes, registered nurse at Hahnemann University Hospital and president of its union local, addresses a rally aimed at keeping the hospital open, on July 2, 2019.
Will Bunch/Staff
Susan Bowes, registered nurse at Hahnemann University Hospital and president of its union local, addresses a rally aimed at keeping the hospital open, on July 2, 2019.

Few other developed nations in the world would even be having this debate — about closing a busy hospital not because the stream of patients isn’t sick enough but because they aren’t rich enough. Most other countries have national health systems that reduce or completely eliminate the kind of profit pressures that have forced Freedman’s AAHS to file for Chapter 11 bankruptcy.

In the short run, it’s completely understandable that the nurses and doctors of Hahnemann are looking to Harrisburg or to City Hall for a reversal of fortune. But in the long run, could the national debate — which has sat on the front burner of the 2020 presidential race — over the dramatic expansion of coverage through Medicare for All or something else closer to true universal health care keep struggling hospitals like Hahnemann open? Many experts offer a resounding “yes.”

It’s not only that Medicare for All — the currently most popular variation on progressives’ long-held dream of so-called single-payer health care in America — would both cover more people and help close gaps between the rich and poor. Some of the proposals now before Congress also include plans for “global budgeting” that would stabilize cash flow for the types of hospitals — rural, or in lower-income big-city neighborhoods that handle the poorest and sickest acute-care patients.

“Our motto is, patients before profits,” said Maureen May, the president of the Pennsylvania Association of Staff Nurses and Allied Professionals, or PASNAP, the union that represents 800 nurses and others at Hahnemann. PASNAP has officially endorsed Medicare for All as a way to eliminate profit-seeking middlemen from American health care and thus allowing more dollars to be spent on patient care. The statewide union has not only backed the bill proposed by Vermont Sen. Bernie Sanders, but in 2016 it had endorsed Sanders in his first presidential bid.

Uhura "Free" Russ, an ER nurse at St. Christopher's Hospital for Children, addresses a rally to keep Hahnemann University Hospital open on July 2, 2019.
Will Bunch/Staff
Uhura "Free" Russ, an ER nurse at St. Christopher's Hospital for Children, addresses a rally to keep Hahnemann University Hospital open on July 2, 2019.

These last weeks in Philadelphia have brought dramatic and at times painful reminders that all politics — including the big national debates — is ultimately local. Along the banks of the Schuylkill River, a dead of night refinery explosion — and a near catastrophe — brought home the debate over the trade-off between 1,000 blue-collar jobs and the fossil fuel exploitation that causes climate change and other environmental risks. Now the news that a major, historic city hospital is on the brink of closing is offering a real-life example of America’s broken health care system — also the topic that has dominated the early days of the Democratic presidential primaries.

American Academic Health System, which says that Hahnemann has been losing $3-5 million every month, filed for bankruptcy Sunday night and said the hospital, which opened on North Broad Street 13 years before the start of the Civil War, would close in early August, with efforts to steer trauma patients away from its emergency room already underway. But the city is currently challenging the Hahnemann shutdown plan in bankruptcy court.

Hahnemann’s planned closing also shines a bright light on systemic inequality — and inefficiency — in the U.S. health care system. The 8th-busiest emergency room in Philadelphia, Hahnemann, in tandem with its neighboring hospitals, has seen ER visits spike in recent years from patients who aren’t getting primary, or preventive, medical care at a doctor’s office. If the shutdown does go through, officials are worried about huge jump in ER wait times at nearby hospitals where the wait for traumatized patients is already longer than the national average.

Nurses and others protesting the shutdown insist the profit motive has already led to bad decision-making since Californian Freedman and his AAHS took over from another private firm in 2018. “They did waste a lot — they brought in a lot of consultants who were here and then gone,” Bowes, the nurse and union leader, told me, describing architects drawing up plans for changes that were never carried out. “I think it was just mismanaged from the get-go.”

Then there’s fact that the 2018 purchase by AAHS placed Hahnemann’s prime Broad Street real estate — some of the most valuable land in Philadelphia — under a separate subsidiary that’s not now in Chapter 11. To the shutdown’s opponents, this raises the specter of condos for wealthy buyers replacing a hospital where half the patients are on Medicaid and two-thirds are black or brown. That also sounds like an ad for a sweeping health overhaul, like Medicare for All.

While much of the national debate has focused on whether Medicare for All or its rival plans would replace private insurance companies (and the massive CEO paychecks that come with them), some of the proposals also take aim at other inefficiencies. One idea that’s created a lot of buzz in the world of health care policy — even if it’s unfamiliar to most average voters — is “global budgeting.”

The progressive American Prospect recently called global budgeting — a cornerstone of the Medicare for All bill sponsored by Washington state U.S. Rep. Pramila Jayapal — “the best part of Medicare for All that you haven’t heard of.” The idea is to give hospitals a yearly lump sum that isn’t tied to specific, and often overused, specific treatments, but instead gives more freedom to set spending priorities on what the local community needs most. (Banned would be political contributions, marketing, or employee bonuses.)

It’s already used in Australia, Belgium, Canada, Finland, France, Germany, the Netherlands, Sweden, Switzerland, and the United Kingdom — and an experiment in Maryland has looked promising. It’s past time for the rest of America to try ideas like this that, to borrow a phrase, are more focused on people than on profits and embrace the concept that health care is a human right.

Just like the South Philly refinery blast was a 4:22 a.m. wake-up call on the folly of our fossil-fuel addiction, once the dust settles at Hahnemann we should turn to the bigger discussion of the only-in-America Rube Goldberg devices of a health system that brought us to this precipice.

Russ, the St. Christopher’s ER nurse, said at Tuesday’s rally that she’s already dreading the day when she’s walking down Broad Street near the Pennsylvania Convention Center and “there’s a shiny new condo here” where a busy medical center used to be. “How does that make any sense?” The short answer is that — like so much else in America at this peculiar moment — it doesn’t.