Opinion: IRS rule changes helped create a payment-focused hospital system

All three branches of the U.S. government — legislative, executive, and judicial — play important roles in shaping our health care system. Think of the passage of the Affordable Care Act, the Trump administration’s move to allow states to impose work requirements for Medicaid coverage, and Texas federal district court Judge Reed O’Connor’s ruling that the Affordable Care Act is unconstitutional. Often overlooked are small regulatory changes, such as adjustments to Internal Revenue Service codes over the past 70 years, that have allowed hospital care to evolve from a charitable mission into a profit-driven industry.

America’s original hospitals were . Funded by the public or charities, almshouses served primarily as places to quarantine the indigent who were stricken with maladies or dying. Individuals able to afford a physician’s fee bypassed these institutions, which Benjamin Rush, a physician and signer of the Declaration of Independence, once Separating the haves from the have-nots and protecting the better off from the burden of the less fortunate were not-so-thinly veiled purposes of these bygone institutions.