reported in 2005 that cancer treatment in the United States accounted for an estimated $72.1 billion in 2004, just under 5 percent of total U.S. spending for medical treatment, and an increase of 75 percent from 1995. The institute predicted that cancer costs would grow at a faster rate than overall medical expenditures.
In the health-care business, however, large investments were often made on predictions that turned out to be wrong. A few years earlier, Maimonides had spent more than $1 million each on two robots that could do complex surgery. The robots generated far more press than patients, and their costs weren’t expected to be amortized anytime soon, probably never.
The cancer center required a much larger investment, about $12 million to build plus an additional $40 million commitment on a twenty-year lease. While Brier talked earnestly about the 2.5 million people in the borough of Brooklyn who didn’t have a comprehensive cancer center, she knew that the numbers that really mattered were the people who lived in the zip codes surrounding the hospital. These weren’t the hipsters of Williamsburg, the artists and musicians who could no longer afford the East Village, nor were they the aspiring burghers of Brooklyn Heights and Park Slope. Maimonides tended to treat new immigrants and the working middle class—except when they had cancer. The finance people had conducted a study and found that only 26 percent of the people in the surrounding area came to Maimonides doctors when they had cancer. Where did they go? Most of them went across the bridge to Manhattan.
The statistics were worse, from a financial viewpoint, when you broke them down. “As many as fifty percent of people who get cancer diagnosis in Brooklyn receive some part of treatment in Manhattan—and those tend to be the people with private insurance,” said Kopel, the medical director. “If you’re a woman in Park Slope or Brooklyn Heights and find a lump on your breast, chances are you’re going to Manhattan for treatment. If you live somewhere else in Brooklyn and are from Bangladesh, you’re more likely to come to us.”
Like the Brooklyn clerk played by John Travolta in Saturday Night Fever, the hospital administrators understood that they were perceived as something less because they sat on the wrong side of the East River. Proving that the care at Maimonides was as good as that of the Manhattan hospitals was an institutional obsession. It wasn’t unusual for people to cross the bridge for radiation treatments and chemotherapy but then end up in the Maimonides emergency room when it was time to die. The cancer center was created to convince enough people—especially those with good insurance—to stay in Brooklyn for treatment as well as death, and to trust that for most types of cancer Maimonides could offer results comparable to Memorial Sloan-Kettering or Columbia Presbyterian, leading lights in the field. None of the administrators at Maimonides believed they could keep everyone close to home, but they figured they could do better than 26 percent. They didn’t need 75 percent for the finances to make sense, only 45 percent.
The cancer-center strategy was as much a dream as a plan, but that was enough. No one understood better than Brier that plans were mutable and that change could be slow and maddening or quick and catastrophic. She was almost sixty years old and had been maneuvering through the hospital world for twenty-five of those years. Compromise was part of the terrain. She also knew from personal experience that one misstep—in an operating room or in life—could destroy confidence and threaten everything she cared about in an instant.
More than almost anything, Brier believed in the rules of propriety. She tried to charm the Orthodox Hatzolah wives with her designer clothes, which she made sure were cut modestly, and with her willingness to come to their numerous luncheons honoring somebody or other. She accepted
In the health-care business, however, large investments were often made on predictions that turned out to be wrong. A few years earlier, Maimonides had spent more than $1 million each on two robots that could do complex surgery. The robots generated far more press than patients, and their costs weren’t expected to be amortized anytime soon, probably never.
The cancer center required a much larger investment, about $12 million to build plus an additional $40 million commitment on a twenty-year lease. While Brier talked earnestly about the 2.5 million people in the borough of Brooklyn who didn’t have a comprehensive cancer center, she knew that the numbers that really mattered were the people who lived in the zip codes surrounding the hospital. These weren’t the hipsters of Williamsburg, the artists and musicians who could no longer afford the East Village, nor were they the aspiring burghers of Brooklyn Heights and Park Slope. Maimonides tended to treat new immigrants and the working middle class—except when they had cancer. The finance people had conducted a study and found that only 26 percent of the people in the surrounding area came to Maimonides doctors when they had cancer. Where did they go? Most of them went across the bridge to Manhattan.
The statistics were worse, from a financial viewpoint, when you broke them down. “As many as fifty percent of people who get cancer diagnosis in Brooklyn receive some part of treatment in Manhattan—and those tend to be the people with private insurance,” said Kopel, the medical director. “If you’re a woman in Park Slope or Brooklyn Heights and find a lump on your breast, chances are you’re going to Manhattan for treatment. If you live somewhere else in Brooklyn and are from Bangladesh, you’re more likely to come to us.”
Like the Brooklyn clerk played by John Travolta in Saturday Night Fever, the hospital administrators understood that they were perceived as something less because they sat on the wrong side of the East River. Proving that the care at Maimonides was as good as that of the Manhattan hospitals was an institutional obsession. It wasn’t unusual for people to cross the bridge for radiation treatments and chemotherapy but then end up in the Maimonides emergency room when it was time to die. The cancer center was created to convince enough people—especially those with good insurance—to stay in Brooklyn for treatment as well as death, and to trust that for most types of cancer Maimonides could offer results comparable to Memorial Sloan-Kettering or Columbia Presbyterian, leading lights in the field. None of the administrators at Maimonides believed they could keep everyone close to home, but they figured they could do better than 26 percent. They didn’t need 75 percent for the finances to make sense, only 45 percent.
The cancer-center strategy was as much a dream as a plan, but that was enough. No one understood better than Brier that plans were mutable and that change could be slow and maddening or quick and catastrophic. She was almost sixty years old and had been maneuvering through the hospital world for twenty-five of those years. Compromise was part of the terrain. She also knew from personal experience that one misstep—in an operating room or in life—could destroy confidence and threaten everything she cared about in an instant.
More than almost anything, Brier believed in the rules of propriety. She tried to charm the Orthodox Hatzolah wives with her designer clothes, which she made sure were cut modestly, and with her willingness to come to their numerous luncheons honoring somebody or other. She accepted
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