Community hospitals make up the vast majority (86%) of hospitals in the US and account for more than a half trillion dollars in national health expenditures.  There are 4,897 of them, and they largely are a product of the 1946 Hospital Survey and Construction Act. This legislation was part of the political struggle in Congress over national health insurance. Indeed, more hospitals-where the federal government put up the money, but was specifically forbidden to have any regulatory role in hospital policy-was a substitute for national health insurance.

Because so many community hospital associations formed as not-for-profit organization and raised matching funds for the federal appropriations, they were able to win the case for property tax exemption.  That exemption brought the expectation that the community hospital would absorb an undetermined amount of charity care-partly taking over the responsibility of the old county alms houses.  The community hospital, however, was not expected to be a major force in the economic health of a community, even if it became a significant local employer.

Many of the stories Tagline winnows-particularly telemedicine, “smart” environments, wearable-wireless sensors, technology-enabled nursing for home health, et al-suggest that the community hospital can become a hospital-without-walls, allowing elders to live independently in their own homes, disabled people to hold jobs without giving up medical security, and mortgage-holders to hang on to their homes and their health. Actually, this is a sea change in American life.