Last week while physicians were performing three successive heart transplants -- one of them using an unauthorized man-made pump -- on a Tucson man who subsequently died, The Wall Street Journal ran a report on the increasing number of hospitals that are "dumping" seriously ill patients unable to pay their bills. Can this be a sensible -- and moral -- way for the country to distribute its health resources?
Writing in the Princeton Alumni Weekly, Professor Uwe Reinhardt observes that patient dumping is a perhaps predictable progression from this country's traditional way of dealing (or not dealing) with people whose budgets don't meet their medical needs. Under the old system, the costs of caring for the uninsured were shifted from pocket to pocket -- first to hspitals, then to insured patients' bills, from there to insurance companies and finally to employers, who pay for most insurance.
Now two things have changed. A rise in the number of poor and long-term unemployed and continuing cutbacks in federal-state Medicaid programs (which never covered most of the poor and near-poor anyway) have increased the number of uninsured. New pressure from the government and from employers to cut hospital costs has made hospitals and doctors less willing to run the risk of being stuck with uncollectable bills. So, Mr. Reinhardt notes, the type of shifting is changing. Now it is not simply costs that are passed along; instead, "the uninsured poor themselves become the hot potatoes one hospital seeks to dump into the lap of another."
The pressures producing this shift are not necessarily bad. In the pursuit of the best possible care with the least possible restraints on patients or doctors, this country has let its health bill consume a larger share of the GNP than have other countries with far more comprehensive health systems. The problem is that policy-makers and the public have not faced up to the inevitable consequences of squeezing a system that, at its most expansive, never adequately served millions of people.
And so, while media-conscious doctors race to produce still more exotic treatments, a desperately ill baby sometimes dies after waiting for hours in the emergency room of a regional medical center because a pediatrician will not admit an indigent patient. A woman in labor is moved to a county hospital when doctors finally decide she needs a Caesarian section and the hospital she is in won't accept her husband's promise of installment payments. If stories like these keep getting reported, Mr. Reinhardt notes, the United States runs the risk of losing its membership in the "club of civilized nations."