During the years that we served as pastors of congregations, we received medical and surgical insurance as part of our compensation package. Because my role in the church included the preparation of budgets, I was aware of how significant the cost of health care was for churches. Throughout my career the cost of health care increased at a pace far beyond that of inflation. That cost has meant that many small, rural, and isolated congregations can no longer afford pastoral leadership. Those congregations, long the training ground for new and inexperienced pastors were forced to reduce pastoral leadership to part-time positions and were unable to attract the kind of leadership they once had taken for granted.

We been our careers serving two congregations in southwest North Dakota. The total membership of both congregations was less than 200 people, but they managed to offer us a living wage, a parsonage in which to live with utilities paid, health insurance, and a reasonable investment in our retirement. Those congregations managed to keep up that practice for one more pastor, but after that pastorate they had to shift to a variety of different leadership solutions. Neither of those congregations was able to remain in business for the span of our careers. They have both closed their doors after a century of service.

While I paid attention to health care costs as a pastor, there were a lot of other issues that had to be managed in my service. Now that I am retired and we are paying the premiums for part of our insurance, I no longer have the luxury of ignoring health care costs. Susan and I are both covered by medicare, the federal program that provides health care coverage to all seniors. However, we have a supplemental insurance policy that covers items not covered by medicare. That policy is provided through the church. As was the case throughout our careers, we participate in the program offered by the denomination we served. Each month, part of our annuity is deducted to cover health insurance costs. That cost exceeds the amount of our total pay package when we began serving the church.

People in the United States pay some of the highest costs in the world for health care. Our system provides some incredible levels of life-saving and life-enhancing care, but that care comes at a very high price. Increasingly, people are unable to afford the costs of care. Health statistics in our country do not fare well when compared with other industrial nations. We pay more and receive less than our neighbors around the globe.

As is the case with many things in life, spending more money does not always result in a higher quality of life.

Part of our problem in this country is the strange mix of for-profit and non-profit corporations involved in health care. And when it comes to health care the definition of non-profit is especially murky. Seven of the 10 most highly paid nonprofit CEOs in the United States are the head of hospitals. Nonprofit hospitals pay millions, sometimes tens of millions to their executives. While the corporation may be non-profit, they offer very profitable compensation to those in executive positions.

We like to think of hospitals as charitable organizations that provide life-saving care to all regardless of ability to pay. But the level of free and unpaid medical care is surprisingly low. Everyone knows the story of someone who was forced to go to the emergency room for treatment and emerged with debt that exceeded their ability to pay. Health care debt is the leading cause of personal bankruptcy in our country.

Hospitals that are nonprofit by the rules of the IRS continue to own for-profit companies. A patient treated in a nonprofit hospital will likely receive anesthesia services form a for-profit company and the doctor may be part of a for-profit practice fully owned by the hospital.

Nonprofit hospitals in the US own for-profit insurance companies, venture capital companies and for-profit hospitals in other countries. A nonprofit hospital co-invests with private equity firms. Hospitals are diversified businesses and have multiple revenue streams.

Hospitals are part of the complex pattern of funding for ventures that are not directly health care. At Stanford University, 62% of operating revenue in fiscal 2023 was from health services. The University of Chicago patient services brought in 49% of operating revenue in fiscal 2022.

The result is that no one can explain the charges for health care. A recent out-patient procedure for a member of our family cost tens of thousands of dollars for a procedure that took less than half a day and that was after our insurance provider negotiated thousands of dollars of price reductions, something that does not happen for those who do not have supplemental insurance. There is no one at the hospital or in the medical practice that can give a clear explanation of why the charges were what they were. They cite the cost of comparable procedures at other US hospitals, not a clear breakdown of fees for services. Because we have small co pays, we see the number of different companies that are involved in medical billing. A simple surgery results in bills from the surgeon, the hospital, the anesthesiology services, the infusion services, the medical imaging services, a separate company that interprets the medical images, and more.

We are very fortunate. We have excellent health care provided by medicare and the church we served. Our out of pocket costs for health care are affordable. In consuming health care the way we do we participate in a system that funnels millions of dollars into the pockets of already wealthy individuals and corporations.

In the four years that we have been retired we have seen multiple mergers of giant non-profit hospital and health care corporations in our area. The number of providers continues to shrink as hospital corporations become larger and larger. At least two major hospital corporations in our state have operating budgets in the tens of billions of dollars. I’m sure that they do provide a certain level of charitable care, but I’m pretty sure that the amount of charity is pretty small in the big picture of their corporate fiscal pictures.

Big hospital systems do perform lifesaving care. But their systems are being richly paid for their services. Perhaps it is time to take a look at what is mostly a charade of community benefit and consider having these mega corporations pay some taxes. Local governments are already providing services that directly benefit residents’ health through services to homeless people, by providing mental health services, and meeting other community needs. A bit of property tax collected from a hospital might help fund more charitable health care than the hospital now provides.