There is a great deal more to this than most people realize. Bottom line is most hospitals make money in almost all their units except for emergency rooms and ICUs. This is what I have been told by physicians who work these units. Emergency rooms in particular, but also most ICUs (I near neonatal ICUs are an exception) always lose money. There are two reasons for this. First, for both emergency rooms and ICUs, these are where the top, most expensive and personnel intensive care takes place. To save lives a great deal is expended in terms of cost.

Second, applying only to emergency rooms, is the fact that people who are uninsured (an increasing number thanks to Republicans) have absolutely no recourse for medical care other than emergency rooms. So, with our current crappy, Republican dictated healthcare system, an increasing number of people have to use emergency rooms for routine care because they are given no other option. This means the most expensive unit of a hospital gets increasingly overused the more uninsured people there are.

When emergency rooms get overused, hospitals can't keep up with the cost. This sends them into bankruptcy unless the government intervenes. This is happening to hospital after hospital in the US, because a.) we structure the whole system wrong (so-called "Socialized" medicine in Sweden, Canada, etc do much better, keeping costs down and care better), and b.) we force people to rely on emergency rooms for routine care because we refuse to insure them.

Once a hospital gets into this hole they are almost destined to close. Once they close, the emergency room coverage they once covered now gets shifted to nearby hospitals...forcing them into the same hole. When they inevitably in turn close, the next hospital down the line has to pick up the slack in their emergency room...forcing them into bankruptcy.

Simply put our current healthcare system is stupid, pretty much the most expensive in the world, give care equivalent to Slovenia and Albania's care (which they do much cheaper), and has pretty much all our hospitals that aren't bailed out by government on the path to bankruptcy.

Even some of the best hospitals in the country (e.g. Cedars-Sinai in Los Angeles) have gone way, way down hill in terms of quality of care in the last decade thanks to Republican ideas of healthcare. My family has watched this decline in Cedars-Sinai from a magnificent hospital to crap.

The first time I brought my now wife to Los Angeles, we had to take my mother to the hospital for somewhat random reasons (that's another story). We took her to the hospital that my family always used (and which had saved my life when I got creamed by a car), Cedars-Sinai. This was Joy's introduction to Los Angeles and she was amazed at the quality of care. It blew her away. This was some 12 years ago.

Now Cedars Sinai has messed up so many times I wouldn't trust them to remove a hangnail. They have messed up my mother's care several times in the past few years. We have been trying to switch away from Cedars-Sinai doctors to UCLA doctors because the former suck so badly while the latter remain good so far. But there have also been high profile cases where famous patients have gotten criminally bad care (infants getting an adult dose of heparin, for example).

Why this decline? The Republican business model for healthcare. Personnel are cut and costs are cut until people die and lawsuits get too expensive. That is how it works.

The closing of St. Vincent's (a wonderful hospital, the ONLY one in NYC friendly to midwives and the one where my son Jacob was born) is just one small part of this nationwide, pretty much deliberate destruction of our hospitals by Republican fanatics. I don't see it getting better until we get even more extensive healthcare reform.