By Adam Gaffney for The Nation

On Monday, Vermont Senator Bernie Sanders joined hospital staff, patients, and activists in a large protest outside the doors of Hahnemann University Hospital, a major safety-net hospital in northern Philadelphia. The demonstration came days after another rally at the hospital, attended by an estimated 800 protesters, last week. The crowds were not there to protest the hospital, but to save it. Hahnemann has been losing money, so Joel Freedman, president of the private-equity firm that owns the hospital, has decided that there is no choice but to shutter it for good—and possibly sell off its valuable real estate.

The closure of the hospital has already begun, and its effects are already palpable. A woman was recently struck by a car directly in front of Hahnemann but taken elsewhere, CBS reported, since the hospital relinquished its trauma center status last month. And last week Hahnemann stopped delivering babies. More than 800 pregnant patients received letters informing them that they would have to deliver elsewhere, according to a report by WHYY, despite worries about the lack of maternity facilities in Philadelphia. Meanwhile, hundreds of medical residents at the hospital are now rushing to find a new home where they can learn medicine.

“I am certain this is going to make waves in the health-care ecosystem of Philadelphia,” Kevin D’Mello, a physician who trained in medicine at Hahnemann and has worked there as an inpatient physician for six years since, told me. As D’Mello noted, the population of northern Philadelphia is already “one of the most underserved in the city.”

But things could get worse. After all, in the United States it is profitability—not the health-care needs of a community—that determines which hospitals stay open and flourish, and which wither and die. The story of Hahnemann is the story of not just a single urban hospital with a greedy owner but the dysfunctional and unjust way we finance health care across the nation.

Hahnemann was founded in 1848 as a center of homeopathy, but over the course of the 20th century it transformed into a major tertiary-care academic medical center with almost 500 beds. Designated the very first adult Level I Trauma Center in the city back in 1986, Hahnemann has long provided an array of specialty services, including organ transplantation. Today, the hospital cares for a predominantly low-income, publicly-insured, minority patient population. In 2017, some 17,000 patients were hospitalized there, and another 53,000 visited the emergency room, according to the Philadelphia Inquirer. But despite its public mission, Hahnemann has long been the property of for-profit corporations.

Tenet Health Corporation, a large national health-care company with a storied history of health-care fraud, purchased it in 1998. Just last year, Tenet sold it off to an affiliate of the private equity firm Paladin Healthcare. Now that company’s president Joel Freedman