But when Ms. Sarandon announced she wouldn’t bring her children to St. Vincent’s, she was merely corroborating what was already spelled out in hospital statistics: In 2008, only 14 percent of the hospital’s inpatients were residents of surrounding ZIP codes. And though the inpatient admissions—the revenue that greased the wheels of the operation—dropped by 10 percent, the emergency-room volume surpassed the citywide rate, largely made up of patients from Brooklyn, Queens and Manhattan’s few remaining working-class enclaves, such as neighboring Chinatown.
The preservationists’ chants of “Save the Village!” were perhaps a little late. To a long-departed isle of bohemian misfits, St. Vincent’s had been a stalwart: It gave Edna St. Vincent Millay her name and Dylan Thomas his last breath. Innumerable artists, alcoholics, addicts and exiles passed through its unremarkable rooms. But that Village didn’t exist anymore, except maybe as a patchouli-redolent pantomime on Bleecker Street. Members of the modern-day Village set were equipped to pay their way into the city’s state-of-the-art medical havens. In the way that health care always seems to, it came down to a question of access, which is really a question about money.
THE REQUIEMS FOR St. Vincent’s, composed even before the last siren wound its way through lower Manhattan, recalled its historic junctions with the narrative of New York: The 1849 cholera epidemic! The sinking of the Titanic! In a compulsively reinventing metropolis, where the blocks barely hint at themselves before receding and the skyline never sticks to its own story, the 160-year lifespan of St. Vincent’s was practically biblical.
But, in truth, the hospital’s most lasting legacy has more to do with the complex financial and social algorithms we employ to care for our sick. Like all hospitals, St. Vincent’s was a place of odd and jarring extremes-magnetic resonance imaging cut through the sludge of flesh with molecular grace, the intimate geographies of bodies collided with the bluntness of impersonal enterprise. The hospital’s linoleum arteries, crowded with institutional smells and the intractable meter of bed-management, witnessed moments of quiet wonder. Patients who couldn’t afford health insurance spilled out of its emergency room, while down the hall medical machinery worth millions of dollars whirred to life.
The modern dialectic of cost-shifting perhaps belies the fact that hospitals, in one way or another, have long depended on the rich to subsidize the poor. The four Sisters of Charity who founded St. Vincent’s—a 30-bed operation in a brick townhouse—were among the legions of 19th-century Catholic nuns who viewed the vast American landscape, untempered with social institutions, as a great civilizing mission. By 1853, just four years after the hospital opened its doors, demand for St. Vincent’s beds outpaced the sisters’ reserves, according to Bernadette McCauley’s Who Shall Take Care of Our Sick? Roman Catholic Sisters and Development of Catholic Hospitals in New York City.
As one early steward of the hospital somewhat prophetically observed, “Building … in New York is expensive.”
With that dictum in mind, the sisters dreamed up an early version of modern-day cost-shifting: Essentially, they took one hospital and made it into two. In the original St. Vincent’s, things stayed much the same; down the block, patients entered a St. Vincent’s with plushly furnished rooms, ample privacy, and all but mini-chardonnay bottles. It may have been the first concerted effort to turn the rich into hospital patients. (Until then, they preferred to die in private.) At the turn of the century, even the generously endowed New York Hospital, considered the city’s locus of technologically advanced care, had only six private rooms.
FOR MUCH OF their existence, private nonprofit hospitals like St. Vincent’s shared the burden of caring for the uninsured with the public hospital system. But that changed in the late 1980s, as a number of forces—diminished faith in the public sector, deflating state and municipal budgets, an upsurge in the ranks of the uninsured—converged to form the beginnings of a national health care crisis.