Saturday, September 03, 2011

Why Universal Coverage is so Hard

On the face of it, the idea that everyone ought to have health insurance seems to be such a good one that it makes one wonder why getting it accepted is so hard.

A clue is provided by an obscure story that appears on page 12 of the September 2 issue of the New York Times.

It seems that for some time now, Grady Memorial, Atlanta’s safety-net hospital, has been providing dialysis care to a number of indigent patients, many of them illegal immigrants. Faced with financial losses, the hospital shut down its outpatient dialysis program. Of the 38 charity patients receiving care, 13 were accepted by other providers and Grady, under pressure, contracted with Fresenius, a private company that advertises itself as the largest dialysis services provider in the world, to care for the remaining 25. The contract was for one year, ultimately extended to two.

Now Grady wants out and when the patients involved recently appeared for their three-times-per-week treatment, Fresenius turned them down, told them to wait until their condition became acute, and then go to the Grady Emergency Room, which would have to accept them for treatment.

It is a nasty story and it is a shame that anyone gets treated that way, but the interesting point is that the provider system, in this case Grady Memorial, has been funding expensive care for illegal immigrants for two years and their refusal to do it any more is an important enough story to make the New York Times.

The story illustrates the extent to which the uninsured get care; albeit not always conveniently or in pleasant circumstances. The fact that they get care prevents the kind of heart-rending stories about patients unable to get care that might get people excited about the issue.

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