FIFTY YEARS AGO the poor and uninsured were often charged the lowest prices for medical services. In a classic health economics article, Reuben Kessel explained in 1958 why it was rational for physicians to charge the wealthiest the most and to discount prices for the poor.¹ It included a quote from a “highly respected surgeon” that, according to Kessel, “presents the position of the medical profession”:

I don’t feel that I am robbing the rich because I charge them more when I know that they can well afford it; the sliding scale is just as democratic as the income tax. I operated today upon two people for the same surgical condition—one a widow whom I charged $50, the other a banker whom I charged $250. I let the widow set her own fee. I charged the banker an amount which he probably carries around in his wallet to entertain his business friends.²

Almost fifty years later, uninsured and other “self-pay” patients are often presented with bills by hospitals, doctors, and other health professionals with charges that are 2.5 times what most public and private health insurers actually pay…

Click here to read the full article.

From THE NEW YORK REVIEW:

The US is facing a major crisis in the cost of health care. Corrected for inflation, health expenditures in the public sector are nearly doubling each decade, and those in the private sector are increasing even more rapidly. According to virtually all economists, this financial burden, which is now consuming about 17 percent of our entire economic output (far more than in any other country), cannot be sustained much longer. The federal share, including payments for Medicare and Medicaid, was 23 percent of the national budget in 2009 and is a prime cause of the deficit.1..

However, today’s competitive health care market, with its private health insurance companies and fee-for-service payment system, severely limits the potential cost savings of a delivery system based on not-for-profit group practice. Private insurers contribute to high costs not only because of their profits and overhead, as already noted, but because doctors and hospitals have to pay the considerable costs of billing the insurance companies and collecting money from them. I favor a much less expensive single public payer system supported by a universal, progressive, designated health care tax. Fee-for-service payment gives doctors incentives to provide more services than needed and allows for fraudulent billing. It should be replaced by an advance payment to physicians for comprehensive care on a per capita basis…

Hospitals, as we have seen, are now hiring more physicians to work in groups. As hospital employees, these physicians inevitably feel pressure to protect their employers’ income by filling beds and using hospital facilities for tests and procedures. They are less likely to control costs than physicians in independent not-for-profit groups. It is not yet clear which type of group will dominate, but those owned by physicians would probably be more supportive of reform…

Click here to read the full article.

EDITOR: This is a thoughtful article and well worth reading.  Moreover, it has very specific implications for our local situation.

Lancaster General Hospital has spread it tentacles to virtually every aspect of health care in the county, not only virtually monopolizing hospital service but acquiring a large proportion of medical practices.  Medical practices and LGH have no financial incentives to further public health measures.  This is  contrary to other countries with Single Payer of nn-profit insurance systems that are far  superior to the USA in both care and cost.

The public pays for this in two ways:

1) Its health is jeopardized.  For example, LGH refused to help fund the establishment of a full scale syringe exchange and to devote proper capacity for the treatment of  addicts since there is no money to be made off of government funded Medicaid.  (LGH provides a part time ‘fig leaf’ of a clinic.) LGH does not take the lead in educating students,  the public and businesses on healthful practices.

2)  LGH can set its own prices with insurance companies.   The result is the public pays higher premiums.  Hence comes LGH extraordinary profits averaging around $100 million a year.

‘Public Charity’ LGH President Tom Beeman was paid his full salary of around $1,300,000 when he took a year off to serve in the Navy.  $1,300,000 would have funded a top notch syringe exchange for 13 years and led to a significant reduction of heroin addiction, overdose deaths, and the spread of social diseases including HIV / AIDs to the general public!!!  In any  case, how lawful is such an expenditure?   Just like  refusing to have public comment at their annual meeting, the self perpetuating board and leadership of LGH show their arrogance and isolation from public opinion and control.

Relman’s contention is that most young doctors prefer to be part of large practices and salaried.  This  growing trend lends itseslf to real reform of our health care system.

*Arnold Seymour Relman M.D. (b. 1923, New York City, New York) is a professor of medicine, social medicine and emeritus at Harvard Medical School, Boston, Massachusetts.[1] He is a former editor of the New England Journal of Medicine (1977–91) and writes extensively on medical publishing and reform of the U.S. health care system. In November 1988 Relman was awarded Honorary Fellowship by the New York University School of Medicine.[2]

From the DRUG WAR CHRONICLE:

For the past eight years, the San Francisco Department of Public Health has been handing out the opioid antagonist naloxone (Narcan) in a bid to reduce heroin overdose deaths. This week, the city marked what it said was the 600th life saved by using the overdose-reversal drug.

This drug stops heroin overdoses — 600 so far in San Francisco.

The city distributes naloxone through needle-exchange sites, nonprofit organizations, and community organizations that deal with injection drug users. The department also prescribes the drug to people in residential hotels and the friends and families of heroin users, and conducts training sessions in the county jail.

Not only have hundreds of overdose deaths been averted, but the department also reported that heroin-related visits to the city’s emergency rooms had declined by half between 2004 and 2009.

The lifesaving measure is funded by a department expenditure of $73,000 a year, which goes to the Oakland-based Drug Overdose and Prevention Education Project (DOPE Project). DOPE uses the money to buy and distribute the drug and train people on how to use it.

“San Francisco has always been a heroin town,” Alice Gleghorn, DPH’s head of Community Behavioral Health Services told the SF Weekly. “At one time, San Francisco had an overdose death every day, and that rate has really gone down. I hope our naloxone programs have contributed to that drop. But we don’t have the money to do the research.”

Eliza Wheeler, director of the DOPE Project, compared naloxone to insulin and said its use posed few problems for injection drug users. “The folks we see are pretty adept with administering drugs, so they’ll be okay. People are very capable and willing to save their friends’ lives… my experience is that people are really proud of themselves,” Wheeler said.

Harm reduction is saving lives in San Francisco. Perhaps other cities and counties should take heed.

EDITOR: Those in charge of health care in San Francisco care about the community at large unlike here in Lancaster.  The main concern here appears to be how much many can be made as part of the highly profitable but opaque so called public charity, Lancaster General Health.

LGH won’t help the Union League to establish a syringe exchange despite an estimated 5,000 to 10,000 heroin addicts countywide.

Thus in its sole meeting open to the public of the year, public charity LGH  prevented members of the public from addressing its board, officers, the medical community, and the local media should it be allowed by its editors to cover and write about the event.

About 125 people were in attendance. Former state senator Gib Armstrong is on the board. Former county commissioner  Pete Shaub was an audience member.

At the adjournment, NewsLanc reporter Christiaan Hart-Nibbrig approached board members and other LGH officials, introduced himself,  and said that NewsLanc’s publisher Robert Field was  out of the country but wanted Hart-Nibbrig to read a letter at the meeting during the public segment.  He handed a copy personally to Chair Alex Henderson, President Tom Beeman and Executive Vice President Jan Bergen.   Senator Armstrong received a letter as well.

There were NO PRINTED agendas to the meeting.  The reporter asked  Bergen for a printed copy.  She took him to Lines, who assured him he would forward an agenda on Thursday.  T he financial report — submitted by Dennis Getz — took all of 96 seconds of presentations.  In that report, Getz said LGH “was in good financial condition.” His report showed that the bond/credit rating of the hospital was very good.  He also pointed to other healthy financial indicators which are up.

The entire meeting had a perfunctory, boilerplate feel to it…  A ‘dog and pony show’.

Failure to permit public comment may have been a violation of federal regulations.  In any case, this is still another example of how LGH disdains public input and criticism, now taking the unprecedented and arrogant step of preventing  the well represented Lancaster  medical community in attendance from being exposed to views from the public.

Year after year, the evidence grows that Lancaster General Health system with all of the financial benefits of a “Public Charity” is largely run as a feeding trough for its top executives and physicians, to the neglect of the overall public health needs of the community.

Although LGH masks its operations, embargoing media from its committee and board meetings, it is required by law to publish its annual federal 990 Report and to allow the public access to its Annual Meeting.  (The Lancaster Newspapers did not cover the LGH annual meeting last year despite its abundant news content.)

Even as reputable a publication as the Sunday News either doesn’t have or is unwilling to dedicate financial analyst  resources to plumb the depth of the 990 Reports, so its report relies heavily on whatever spin it receives from LGH  through spokesperson John Lines.

As examples, below are quotes from the Sunday News article of May 22 followed by  NewsLanc comments:

SUNDAY NEWS: “Lancaster General employees have a defined-benefit pension, [Lines] said.  Actual salaries increased by just half of 1 percent across the board.”

NEWSLANC: Base salaries for the executives listed on the 990 Report went up 8.5% for those employed throughout both years.  (Without our appropriate adjustments, the figure would be 11%.)

SUNDAY NEWS: “Hospital CEO Tom Beeman — who has been a captain in the U.S. Naval Reserves for 27 years and began a military leave of absence Oct. 15 — was the hospital’s highest-paid employee in 2009-2010, with a total compensation of $1.323 million, including a base compensation of $649,037 and bonuses and incentives of $300,000. This actually represented a decrease from his 2008-2009 total compensation of $1.347 million.”

NEWSLANC: The drop in pay was only to offset the salary that Beeman received from the Navy.  The trustees were very patriotic with the charity’s money that should more appropriately have been used for the stated mission of LGH:  “To advance the health and well-being of the communities we serve.”

SUNDAY NEWS: Lancaster General provided $83.3 million in charity care, unreimbursed Medicaid expenses and other “community benefits” in 2009-2010, according to its tax form; that represented a major increase from previous year’s total of $71.2 million. Unreimbursed Medicare expenses alone totaled $63.6 million in 2009-2010 — 8.57 percent of all LGH expenses for the year.

NEWSLANC: “Unreimbursed Medicare expenses” are calculated as discounts from the inflated ‘retail’ price, not from what LGH actually charges insurance companies and the Amish Community.  It is as if General Motors treated auto discounts as public charity!  Anyone without insurance is charged the ‘retail’ rates that often lead to personal bankruptcy.

SUNDAY NEWS: “Lancaster General disbursed grants and other payments totaling $3.97 million in 2009-2010, a drop from the $6.66 given out in 2008-2009. The reason: In 2009-2010 LGH gave more than $2.6 million to SouthEast Lancaster Health Services so it could purchase the building for its Arch Street clinic.”

NEWSLANC: Over $2.65 million of the $3.97 million went to the City and the School District of Lancaster in lieu of real estate taxes.  While commendable, the contribution is far lower than would be the actual real estate taxes were LGH a for profit entity.   The County has no economic interest in accurately re-assessing tax exempt properties such as those owned by LGH and Franklin and Marshall College.

Items classified as “Lancaster Public Charity” of questionable appropriateness are: $135,000 to Franklin and Marshall College (“alms for the rich”); $14,980 in supplies for the Haiti Relief Funds; $150,000 for the James Street Improvement District; and $25,000 for the Lancaster Central Market.  Albeit worthy causes, they do not comply with LGH’s “Mission statement: To advance the health and well-being of the communities we serve.”

Conspicuously missing is LGH’s refusal to contribute one cent to the struggling syringe exchange sponsored by Bethel AME church.  Nor would LGH provide funding for the Urban League when it offered to take over and enlarge the exchange.  There likely is no greater pay back for public health than the funding of syringe exchanges, since they not only deter the spread of disease but they also are the entry point for addicts to be referred for counseling and treatment, and thus returned to society as productive members.

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LGH Chairman Alex Henderson and other members of the board have a distorted vision of the role for a “public charity” in a community.  Since the board appoints future members, it lacks public and government input.   Thus, there is nothing that members of the public can do to impact hospital policies and practices.

NewsLanc urges LGH to open their board meetings to media as do government agencies and to allow at least half of their trustees to be elected in the same manner as school district trustees.  Then there would be a greater alignment of the public charity with the public needs.

The ultimate solution would be either a merger with Geisinger Health System or the creation of LGH’s own health insurance company.   Then the economic emphasis would switch from ‘fee for service’ to how to promote good health and improve quality control in order to avoid the need for hospital and medical services and thus reduce costs.

As things now stand, the sicker the population, the more money LGH makes.  This is hardly in the public interest!

The OECD ranked Infant Mortality rates per thousand for 2005:   Sweden – 2.4; Japan – 2.8; Norway – 3.1; France -3.6; Germany – 3.9; Switzerland – 4.2; UK – 5.1; Canada – 5.3; Poland – 6.4; United Sates – 6.8.

The OECD ranked Health Expenditure as a Percentage of Gross Domestic Product 2005:  USA – 15.3; Switzerland – 11.6; France – 11.1; Germany – 10.7; Canada – 9.8; Sweden – 9.1; UK – 8.3; Japan- 8.0

“How many people go bankrupt because of medical ills?  In Britain, zero.  In France, zero.  In Japan, Germany, the Netherlands, Canada, Switzerland: zero.  In the United States, according to  a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.” *

“Here is a statistic to ponder: Among those nine rich nations, the per-capital rate of ‘Deaths Due to Surgical or Medical Mishaps’ was the highest by far in the USA.”*

“The profit-making health insurance giants in the United States generally spend about 20 percent of all premium income on administrative expenses; the French [rated first in the world] insurance plans routinely keep administrative costs below 5 percent.”*

France spends around $3,200 per person for health insurance which was rated the best in the world.  The USA spent more than $7,000 per capital, did not cover 45 million, and was rated 37^th.  “In the U. S. system, even with its built-in inefficiencies, that saving would meet the basic health care needs of all of the American who are currently uninsured.”

What has gone wrong with health care in the U. S. A?   In large part obvious reforms have been made difficult by special interest groups who are irrationally enriched by our current system.  But since the reforms that are necessary through a capitalistic system as in the case of France are apparent, we must look to the mistaken emotional devotion of a large segment of our population to a broken system.

We need not look further than the public’s blind eye to the causes and the use of the huge profits of our own Lancaster General Hospital to catch a glimpse of the larger national problem.   But how dare we question “mother” LGH in which we are borne, birth our children and form which we seek cure for our ills?

Can we rationally consider not-for-profit insurance companies, such is the case in France and elsewhere,  or government administration (Medicare / Veterans Administration) such as England and Canada that perform the same administrative  functions at a quarter of the administrative costs?

Make no mistake about it:  Health Care costs which are approaching 20% of Gross National Product will turn what was once the foremost economy into a ‘rust belt.’   There simply will be no funds available for investment.   The world our grand children will live in will not offer the opportunities and pride that did the world of our parents.

*“The healing of America” by T.R. Reid, 2009

Lancaster General Health has such a position in the Lancaster County market place, and through acquisitions and mergers is continuously expanding its control.   For example, just recently it acquired the Heart Group and has opened three Urgent Care clinics.

In other markets, insurance companies are able to negotiate competitive rates since they have a choice of two or three hospitals.  However, here in Lancaster, most need to contract with LGH in order to sell policies.

The higher prices they must pay are a major reason for LGH’s extraordinary profitability, continuously among the highest in the state.   In a typical year, LGH earns well over a $100 million dollars.

Consequently, those seeking health insurance in Lancaster County are charged more by the companies to compensate the insurer for the higher cost of providing care at LGH.  So the difference between what the cost of health care insurance would have been in a normal competitive situation and what we pay is comparable to a tax…   a tax imposed by and benefiting LGH.

Since LGH is a Public Charity, this would not necessarily be a bad thing were the excess earnings were distributed in a manner that would best serve the community.  But the community has no say whatsoever concerning how LGH spends its profits.  There is only one public meeting a year which is not widely publicized.  A LGH grants were only 1.5% of profits in 2007 and 6% in 2008.

Furthermore, the trustees are self perpetuating, with one board nominating and electing the next.

Compounding the situation is the propaganda and distortions that emanate through LGH’s public relations department and the stone wall erected by  LGH between itself  and the media…all media!

It is time for the county, city, school district and the local media to begin to hold LGH to account.  Instead of devoting the hospital’s resources to empire building and lavish compensations and perks, LGH should be directing a significant portion of its earnings towards benefiting the community at large, especially in matters of public health and education.

A place for LGH to start would be to approve the Urban League’s request for funds to operate a first rate syringe exchange in Lancaster.   In addition to reducing the spread of social diseases, syringe exchanges test clients for HIV / AIDS, provide counseling, and help those seriously addicted to obtain treatment.   They are as important in protecting our loved ones as are the police and fire fighters.

Another worthy cause would be to help support the libraries throughout the county.  They are underfunded, and yet serve several thousand visitors each day.

LGH is a ‘Public Charity.’    Yet the trustees and administrators treat it as their fiefdom.   By introducing transparency and a sense of responsibility towards the greater community, LGH can reach the same high level in Public Charity responsibility as it has achieved in health care.

In analyzing public charity Lancaster General Hospital’s 2008 Federal 990 report, entitled “Return of Organization Exempt From Income Tax,” NewsLanc notes the top ten LGH executives on average received a 60% increase in “Base Compensation.” When NewsLanc discards data concerning an executive who may have been part time in 2007, the percentage increase is 50%.

These increases by a ‘Public Charity’ took place during the severest year of recession since the Great Depression, a time according to national statistics when, there was virtually no increase in average wages.

LGH’s President Thomas Beeman’s “Total Compensation” package amounted to $1,347,309 for the year.  His “Base Compensation” increased from $530,298 to $605,676, an increase in “Base Compensation” of 14%.

Executive Vice President Jan Bergen’s “Total Compensation” package amounted to $681, 607 for the year.  Her “Base Compensation” increased from $256,333 to $351,046, an increase in “Base Compensation” of 37%.

Executive Vice President Marion McGowan’s “Total Compensation” package amounted to $726,027 for the year.  His “Base Compensation” increased from $205,043 to $423,990, an increase in “Base Compensation” of 107%.

Meanwhile, Lancaster General Hospital’s profit, defined on the form as “Revenue less expenses” dropped 30% from $113,326,709 in 2007 to $78,844,643.  Despite the decline, it is still one of the highest profits of any hospital in the state.

On the positive side, “Grants” increased from $1,183,464 or one percent of earnings in 2007 to $6,655,525 or 8%.

This still left LGH with $113,326,709 for 2007 and $78,844,643 for 2008 after grants and other expenses.

These huge profits in large part result from LGH’s market dominance and ability to charge insurance companies higher net rates.    In turn, the insurance companies charge county residents higher premiums than would be otherwise.

Since the media and public are banned from all Board of Trustee meetings except for the show case “Annual Meeting”, the self perpetuating trustees are shielded from transparency and public accountability.

(Editor’s note:   LGH’s Communication Department and president were provided this article a week ago and invited to suggest corrections or make comments.   There were none.)

The series next will address LGH’s recent purchase of the Heart Group.

Last year, the actual cost of providing healthcare to Medical Assistance (or Medicaid) patients was $49 million higher than what the government paid us for that care. The “Medical Assistance Unpaid Cost of Care” is based on the actual cost to provide that care. It is not based on charges.

We are not, as you say, “treating the difference between the seldom charged highest price and what they are actually paid as a “community benefit.” Again: That $49 million figure is based on the actual cost to provide care.

NEWSLANC: Thank you for finally responding to the question we posed a week before publication.  We will make appropriate revisions.   However the thrusts of our assertions remain the same..

The $49 million you claim as “community benefits” are the normal services and expenses borne by hospitals as part of their mandate.

Furthermore, they are ‘ordinary expenses’, so they do not come out of LGH’s $78 million in profits.

Moreover,  LGH provides a lower level of unpaid aid than most hospitals according to state reports.

The NewsLanc 2008 study based on State Health Department records established:

“Uncompensated Care (bad debt + charity) for LGH is 1.5% of Net Patient Revenue.   For the Region, 2.8%.   For the State, 2.3%.   The less bad debt, the greater profitability.”

“LGH’s Charitable Care in 2007 amounted to 0.5% of Net Patient Revenue. The State was 0.9% (Regional data was unavailable.) Note that LGH only provides about half as much charitable care as do hospitals throughout the state. The less Charitable Care, the greater profitability.”

LGH: Furthermore, all items we list as “community benefit” are based on categories, definitions and reporting guidelines outlined in “Guidelines and Standard Definitions for the Community” published by the Catholic Health Association of the United States and VHA Inc. Thank you

NEWSLANC: The terms were used to give the impression of an abundance of charity on the part of LGH which is contrary to fact, despite an improvement from the prior year.   We call that spin, obfuscation and propaganda.

Our contention is that LGH is earning exceptionally large profits as a result of its local market dominance. Since LGH is a ‘public charity’, the earnings which indirectly come from the public, a reasonable amount should be used for the public health, the social safety network, and education.  Instead, LGH’s contribution to worthy causes are relatively small.  Furthermore, its self perpetuating board of trustees does not permit the public to attend any meetings except one annually and shields from public its use of its vast earnings as it enhances its market dominence.

Below is the NewsLanc report from 2008 which was never challenged by LGH or others at the time or since:

Report #1: Reasons for LGH’s exceptional profits

Posted on July 30th, 2008

NewsLanc borrowed the services of Douglas McVay, Director of Research with an affiliated non-profit organization, to determine what circumstances have enabled Lancaster General Hospital (LGH) to earn the second highest profits in the State, amounting to $136 million in fiscal year 2007. Findings are not meant to detract from the efficiency and competence of LGH and the high quality service they provide.

McVay has examined and correlated information provided from Federal and State sources, LGH itself, and other publications deemed reliable. The research indicates special circumstances that are unique to our region plus LGH’s strong market position contribute substantially to LGH’s remarkable profitability.

Though LGH’s representative was cooperative at the outset, he became less forthcoming and then ceased to respond to inquiries as McVay’s inquiries became more knowledgeable and pertinent.

Therefore, the following factors for profitability are not a definitive list, but only those supported by current data on hand.

1) Proportion of LGH’s revenues from Medicare is 30%. For the region of which LGH is a part, 34%. For the state, 37%. Medicare pays a set fee which is considerably lower than private insurers and may not always cover the full costs of services. By law, Medicare rates are the lowest which hospitals are allowed to charge. The fewer Medicare patients, the greater profitability.

2) Proportion of LGH’s revenue from Medicaid is: 5%. For the region, 7%. For the State, 11%. Reports suggest that reimbursement for Medicaid is similar to Medicare. The fewer Medicaid patients, the greater profitability.

3) Uncompensated Care (bad debt + charity) for LGH is 1.5% of Net Patient Revenue. For the Region, 2.8%. For the State, 2.3%. The less bad debt, the greater profitability.

4) LGH’s Charitable Care in 2007 amounted to 0.5% of Net Patient Revenue. The State was 0.9% (Regional data was unavailable.) Note that LGH only provides about half as much charitable care as do hospitals throughout the state. The less Charitable Care, the greater profitability.

5) Percentage of “Charges” collected for LGH is: 50%; for the Region, 46%; for the State, 27%. Although available information is limited in this area, a comparison of LGH charges for ten medical procedures with a sample of hospitals from across the state indicated that LGH charges were about average. (Note: The “Charge” is a virtually mythical figure from which there are various discounts depending upon who is the payer.) The higher the proportion of Charges collected, the greater the profitability.

6) LGH’s program provides Amish and other cash payers with a standard 25% discount. According to the Wall Street Journal, Heart of Lancaster “agreed to discounts of up to 40% off its top rates” for the Amish. Lancaster County’s population is approximately 5% Amish. The less the discount to the Amish and cash paying patients, the greater the profitability.

Editor’s note.  The below has been slightly revised to take into consideration information requested from Lancaster General Hospital a week before publication but only provided in a letter after publication.

Accompanying the copy of Lancaster General Hospital’s Federal  990 Report for 2009 came a  news release entitled “Lancaster General Health Community Benefit Financial Summary, Fiscal Year 2009” that purports that “Total Community Benefit Support” amounted to “$73,645,000.”

However, according to its Federal 990 Report, “Description of Grants and Other Assistance to Individuals in the United States” amounted to $6,655,525, a respectable and welcome increase from the paltry $1,183,464 of 2008,and an increase in contributions from one percent of profits to about 8.5%.

(Profits in 2008 were $113,326,709 and in 2009 were $78,844,643, still among the highest in the state.  Not bad for a Public Charity during a recession year!)

So how does LGH justify exaggerating its “Community Benefits” eleven times?

They are claiming that $49,731,000 in “unpaid cost of care”, normal expenses borne by all hospitals as part of their mandate,  as a “benefit to the community.”

This is comparable to the airline industry treating free meals and baggage service  as “benefits to the community.” Or hoteliers, department stores and super markets claiming they are contributing “benefits to the community” every time they reduce a price or conduct a sale!

Another example is LGH’s treating $7,022,000 for “Un & Under insured Unpaid Cost of Care” also as “community benefit”.    Put simply, bad debt is treated as charity!    If this is proper, we should thank the owners of millions of non-performing home mortgages for their great philanthropy!

We ask ourselves “Why does LGH engage in such deception?” The answer may be they count on the reluctance of the local media to challenge such egregious propaganda, although a careful reading of the recent Sunday News article provides some hints.

Moreover, LGH has become so spoiled by the docility of the Lancaster community that they take affront and refuse to respond to media inquiries.  This isn’t just NewsLanc’s experience.

Next week:   Lavish pay increases for executives despite the Great Recession.