Regarding the May 15 editorial “The wrong way to pay for health care’’: Community hospitals in Massachusetts are being undermined through an unfair market dynamic, a dangerous cycle that is the larger issue beyond the specific rates that hospitals are paid.

Steward Health Care’s support of reforms to the hospital payment system is not about increased rates. Steward benefits, at best, a negligible amount under the proposed ballot initiative. Right now, hospitals that get paid significantly more are able to extend their hours, improve their facilities, build remote surgicenters and imaging centers, and subsidize specialists. This biased market dynamic attracts patients to these facilities. When these facilities, such as Boston teaching hospitals, are miles away, they disproportionately draw the younger, employed, mobile sector that is covered by commercial insurance. The result is the continuing shift of commercial insurance to high-priced hospitals with no appreciable quality difference.

The result is that we are creating a two-tier system. The emergency, elderly, frail, and poor patients will stay local. Their facilities will be lacking, their specialists will have fewer hours, and their waits will be longer. Also, as commercial volume continues to gravitate to higher-priced markets, the multiplicative effect of more employees seeking care at ever-increasing prices will devastate businesses. And, of course, since the commercial market is not staying at local hospitals, the taxpayer will pick up the bill or face the health care crisis of widespread community hospital closures.

Neither a ballot initiative nor a behind-the-scenes deal is the best way to deal with this problem. But after a decade of documenting this evolving tragedy, even a flawed solution is better than no solution.

David Morales

Chief strategy officer

Steward Health Care System

Boston