That's the lesson from the scathing article last week in Bloomberg News about New York's Mount Sinai Hospital whose headline screamed, "A Heart Surgery Factory With 'Obscene Levels' of Pay."
According to the Bloomberg account, Mount Sinai climbed out of a multi-million dollar financial hole in part by ramping up the volume of cardiac stent procedures, doubling the number performed during the 2000s to become New York's top stent factory.
Mount Sinai has had a troubled financial history. Its ill-fated merger with New York University Hospital that began in 1998 and resulted in a divorce five years later yielded junk-bond status credit ratings and combined debt of $670 million. It's hard to imagine, or perhaps not, that this would happen to a hospital whose board of trustees is comprised of Wall Street financiers and whose address is Gustave Levy Place, named for the founder of Goldman-Sachs.
Mount Sinai is not alone in ramping up surgery volume to pump up the bottom line. The health care system is perfectly designed to be abused.
High priced hospital consulting groups like the Advisory Board Company tout volume growth as a "ticket" to profitability and advise clients on how to "grow" profitable procedures.
Profitable, indeed. The director of Sinai's interventional cardiology, who oversaw the growth in stent procedures, was paid $4.8 million by the hospital in 2012, more than the CEOs of Microsoft and Amazon, according to Bloomberg.
The health care industry has created its own aristocracy with multimillion-dollar lifestyles at public expense.
Far away in Yorkshire, England, home to the wildly popular, made-for-TV "Downton Abbey," the aristocratic Crawley family has had a similar share of financial distress, also of its own making.
A few seasons ago, the Earl of Grantham, lord of the abbey, invested the family fortune -- which came from the dowry of his wife, Lady Cora -- in an ill-fated Canadian railway venture that went belly-up. The family laid out a plan to eliminate the servants' jobs and downsize. At the last minute, they are saved by the largess from an inheritance.
In the post-World War I era setting of the PBS series, many large estates in England were in financial tatters. Downton Abbey is forging a new path to sustainability, thanks to the sensible proclivities of the Crawley family's former chauffeur and now son-in-law, Tom Branson, the anti-aristocrat who married Sybil, daughter of Lord and Lady Grantham, who died during childbirth.
Under Branson's sober stewardship, the lands of the estate are now home to a herd of pigs that will bring home the bacon. For post-war England suffering from a food shortage, Downton is feeding its sausage-loving compatriots while putting itself on the path to self-sufficiency, at no one's expense, except that of the pigs.
No surprise that Branson came from the world of real work for a day's wage, never dreaming of having reams of other peoples' money to blow up.
Palatial buildings and lavish lifestyles are rarely sustainable over generations, whether in a fictional aristocratic Yorkshire family or in a hospital along Manhattan's Fifth Avenue.
Downton Abbey's Crawley family is portrayed as having a sense of duty to its ancestral Yorkshire home. Likewise, hospitals feel a duty to keep a vital community resource intact.
Neither is an excuse for profligacy. At least the Crawleys were blowing up the money of their rich relatives.
Too-big-to-fail hospitals blow up the money of the working men and women of America, the people who work "downstairs" -- the tireless Mrs. Patmores and Mrs. Hughes' of the world.
Dependence on other peoples' money becomes an addiction.
Rather than pare back the excessive paychecks and eliminate wasteful spending that keep the peace among fractious fiefdoms, the health care aristocrats impose their own kind of "tax" on the little people, those forced to fork over an ever-growing share of their paychecks to pay for the modern-day steel castles and the lords who preside over them.
The scary part is how shamelessly unsuspecting patients are reeled in, tests and surgeries done on them, to fill in a financial ditch and reap obscenely high pay.
Even the Downtown Abbey aristocrats would recoil from such a prospect.
It's time for the health care aristocracy in the United States to fade into the sunset. The fiefdoms and their misplaced sense of entitlement to the public's money need to be gone with the wind.