Here:
Uninsured dialysis patients who could be cut off from their life-sustaining care lost a court challenge on Friday when a judge ruled that Grady Memorial Hospital could close its outpatient dialysis clinic. But the hospital gave the patients a temporary reprieve.
Ruling largely on technical grounds, a state court judge dissolved the restraining order that prevented last weekend’s scheduled closing of the clinic at Grady, the Atlanta region’s safety net hospital. The hospital, which is deeply in debt, quickly announced it would close the clinic within a week. It agreed, however, to pay for up to three months of dialysis at private clinics for the 51 patients who will be dislocated.
The simple refusal to admit that we already ration care in the United States is maddening. We ration all the time- poor people don’t get it, or if they do, it is in the most costly and inefficient way possible.
jon
Those patients could always go to prison. Inmates have access to dialysis treatment. Maybe not the best medical care in the world, but it is provided.
It’s sickening that the poor in our country can get better medical coverage if they commit felonies than if they’re merely poor.
Healthcare: it’s a right for those who work for government, are spouses or children of those who work for government, old people, select handicapped and disabled people, some children, and people in jails and prisons. For just regular people? What are you, a socialist?
someguy
Hey, look over there! Terrorist arrests! And check out these Iranians! Is there a blonde white girl missing somewhere? Want some pie?
What were you saying about health care again? President Dialysis wants to kill us and take our medicare rationing or something?
Riggsveda
What is more troubling is this:
Because the case involved at least some illegal immigrants, it’s unclear whether the judge thinks it’s they that lack a constitutional right to health care, or whether it’s everyone. In any case, I wonder what kind of health insurance he has?
estamm
My mother needed dialysis 3 days a week for the last 3 years of her life. Any time the location of her clinic changed it was a huge deal in dealing with transportation, scheduling, payments, in-home health care changes among many other things. I can to some degree imagine the fear that these people are going through. We have GOT to get a public option.
The Grand Panjandrum
Of course, having no health insurance just means you aren’t trying hard enough or you’re here illegally.
I don’t blame her death on her Congressman House Minority Leader John Boehner. But that disingenuous prick should be reminded of this unnecessary death every time he and his comrades stall the legislation working its way through Congress now.
The GOP … sheesh, I have so many nasty things to write about them I think I’ll save it for my own blog later today. I am now going to try and enjoy my cup of hot coffee.
Maude
So, they have three months. They must feel like they are under a death sentence.
OT: Mark Levin had heart trouble at one point. Rush Limbaugh paid for his medical care.
Has he ranted against the public option?
The Grand Panjandrum
@Maude: Not OT at all. It points out that you are NOT subject to rationing if you have money or your friends have money.
Dave S.
I don’t need dialysis, so I see no problem with this outcome. /kyl
Bootlegger
To be fair, Our Lady of Perpetual Outrage admits we ration care. She just sneers at the redistribution of health care. It’s unmurkan to take someone’s health care at the point of a gun and give it to some undeserving schlep who should be indenturing themselves to our corporations so they have the Best Health Care In the World. If you won’t indenture yourself for health care you deserve to die.
The Raven
More food for corvids!
Folks, I can only make so many corvid jokes. These people are probably going to die, because life-sustaining care will be withdrawn. Can we call ourselves civilized in any meaningful sense if we do this?
kay
@The Grand Panjandrum:
Sad. Poor baby went to a doc in the box for emergency care, and that’s a cheaper option than the emergency room, so she probably was worried about how she was going to pay.
She’s a 2008 graduate of Miami University in Ohio. It’s a selective public university, a “public ivy”, which is probably why this is newsworthy locally.
linda
perhaps if congress and the media magpies had personal experience with fighting their insurers, there might be more recognition of the true state of healthcare in this country. i was actually surprised that the column written by one of their own — georgie ann geyer — describing her experiences with her insurance company after a diagnosis of tongue cancer didn’t get more play.
Bootlegger
@The Raven: Civilized is what we say it is! Go join the savages in commie Sweden and see what kind of death care you get there. Also.
El Cid
Grady’s not just ‘the region’s safety net hospital,’ it’s “the only level I trauma center within 100 miles of metro Atlanta”. Not to mention burn centers, the South’s largest infectious disease centers, and one of the main teaching hospitals of the region.
And two years ago it was nearly shut down with $100 million in debt It was since reorganized into a non-profit with a cash infusion of donations from major foundations and raised funds.
******************************
After years of fiscal desperation and management turmoil at Grady, Atlanta business leaders stepped in last year to force a restructuring, from a quasi-governmental authority to a nonprofit corporate board. In response, the Robert W. Woodruff Foundation pledged $200 million over four years to replace dilapidated beds and modernize computers. A $20 million gift from Bernie Marcus, a founder of Home Depot, is helping to update the emergency department, which provides regional trauma services.
But the hospital’s operating deficits have continued. Grady’s senior vice president, Matt Gove, estimated that its uncompensated care would grow by $50 million this year, up 25 percent. The new nonprofit board eliminated 150 jobs this year, closed an underused primary care clinic and began charging higher fees to patients who live outside of the two counties that support Grady with direct appropriations.
The closing of the outpatient dialysis clinic was recommended by consultants in 2007, who said that equipment was outmoded, that most hospitals did not provide outpatient dialysis and that Atlanta had scores of commercial dialysis centers. When the hospital’s chief executive at the time tried to shut it down, the resulting firestorm helped prompt his dismissal.
******************************
Our metro area has increasing rates of the uninsured, too:
******************************
“At Grady, about four in 10 patients are uninsured, and an additional 25 percent are insured by Medicaid, which reimburses at rates so low they often do not cover actual costs. As a result, the hospital lost $33.5 million last year, with the dialysis clinic accounting for about $2 million of that total, said Denise R. Williams, the hospital’s executive vice president.”
******************************
This is somehow all ACORN’s fault.
Farmer_Jones
You make the wrong choices, you pay the piper. These folks didn’t make the right life choices way back when, did they? Could have got themselves established, could have gone into something lucrative like law or banking. But they chose career paths that didn’t pay the bills (teachers, social workers, nurses, construction workers, busdrivers etc.) and now they reap what they sow, or didn’t sow. Why should those of us who’ve worked hard to get ourselves into a good situation pay for the lazy slobs who didn’t?
Signed
R. Kent Twickenham-Fopper IV
Harvard, class of ’51
Heir to Twickenham fortune
U.S. Army officer (ret.) recipient of TriCare
Current Medicare beneficiary
Craig
Also touches on another topic near and dear to my heart–how state governments screw city governments left, right and center. It’s Georgia and Atlanta in this case, but you can hum the same song anywhere in this great nation of ours and someone will know the words. The Grady health care system provides indigent and trauma care to the entire North Georgia region. But does the entire region pick up its fair share of the tab? Of course not. Atlanta, Fulton and Dekalb Counties are left holding the bag. And so there are budget problems. Who would have guessed?
I’ve thought about forming an organization whose purpose would be to fund billboards on all the major highways as they enter Atlanta that would say, “Atlanta welcomes you! We pay X million dollars every year to provide medical care to your county at Grady Memorial Hospital. You’re welcome.”
And the funny thing is, in spite of this, and in spite of slicing our neighborhoods up with Interstate highways, and in spite of underfunding every aspect of our infrastructure with respect to the rural counties, cities are _still_ vibrant, exciting, attractive places to live. In spite of every state house in the country doing their damndest to throttle the life out of every large city, here we are in something of an urban renaissance.
Which is lucky, because where else would the suburbanites go for their trauma care?
Bootlegger
@El Cid:
Obviously they didn’t do a good enough job organizing the community into paying for their own community hospital.
Violet
@The Grand Panjandrum: Oh, jeez, that’s sad. And scary. At various times in my life I’ve been just like that young woman – refusing to see a doctor because I didn’t have coverage.
kay
@El Cid:
I would think that single phrase “uncompensated care”, would be part of the health care debate. Because that’s the bottom line.
At some point someone somewhere has to pay for health care that is delivered and then not paid for. In this instance, the people who are going to “pay” are those who need treatment, but this idea that no one is paying for our wreck of a health care “system” is just ridiculous.
The whole premise of the discussion over costs is just wrong. Conservatives have gotten away with pretending that we’re not paying for the current system, and that any attempt at reform is an additional cost. That simply isn’t true, but that’s the basis of the debate. It’s who pays, and what they pay with, money or life. “Not paying” was never an option.
If I hear that one trillion number one more time I am going to scream. It’s a completely false number. We should start with what we’re paying now. Is it one trillion? 700 billion? Who the hell knows, but it might be important to find out, don’t you think, if we’re talking about total cost?
kay
@Craig:
It’s true. I live in a rural area with a single private hospital. They patch up the people with an inability to pay and send them 80 miles down the road to the nearest public (urban) hospital.
See ya! Good luck!
cmorenc
How can natural selection aka evolution work its proper course if those of us who are healthy, wealthy, and swell have to pick up the tab via subsidised health insurance to cover treatment to keep inferior protoplasm alive? Ayn Rand proved beyond any shadow of a reasonable doubt that selfish individualism IS actually the most humane, moral course of action for society, and the most morally righteous stand is for those who got theirs to say a big “F.U” to those who don’t.
I of course wrote the above in parody, but unfortunately there’s a sizeable minority in this country who actually think that way, and cheer when Glenn Beck is on the teevee.
Svensker
@Farmer_Jones:
.
Teachers and social workers are usually government employees and hence have fantastic health care benefits. Don’t know about the other ones.
Now if you had said “artist, writer, entrepreneur, small business owner” (what used to be considered the backbone of America, in other words), that would be true.
The rest is on the nose.
henqiguai
re” Svensker #23
While both groups may be government employees, not all ‘government employees’ are equal. Teachers’ medical coverage is generally due to union negotiated contractual trade-offs; relatively cheaper medical insurance in return for (on average) almost criminally low pay. And those health care benefits are not all that fantastic.
mclaren
Jon nailed it. The solution is simple: these patients need to dump some flour in a baggie, walk up to a police officer, and offer to sell him some coke.
Within 30 seconds you’ll see more SWAT teams, more sniffer dogs, more guns, more tasers, more mobile command vans, more body-armored assault teams than you’ve ever imagined.
And when the police find out it’s just flour? Don’t worry, trying to sell pretend drugs is just as much of a felony as actually selling drugs, unless I mistake our drug laws. So once they wind up in prison for whatever the mandatory minimum is now, 40 years or whatever, they’ll get their dialysis on time and on schedule.
henqiguai
Great. I proof read the (my) stupid entry at #24 and hit the [Submit] button; then I see the colon at “re:” masquerading as double quotes. And lo!, no magick edit function…
Evil b@stard software.
Chad N Freude
@cmorenc:
Evolution is an atheistic, soc_ialistic, homosexual, non-white, illegal immigrant, non-Christian conspiracy to deny the truth of Intelligent Design. The truth is that the Intelligent Designer designed the people who can’t pay for coverage not to have coverage. To provide them with an affordable means of obtaining health care would be an affront to the Intelligent Designer and would delay the Rapture, forcing people with coverage to pay ever-increasing rates as they lived longer.
QED.
Mental Lint
Dialysis is the one treatment where there really is “Medicare-for-all” – regardless of age. Medicare covers virtually all patients for these treatments. It’s the one example in the US of single-payer coverage.
Except if you are an undocumented worker – no coverage for you. In some states, these folks get covered (and the clinics that treat them) by Medicaid. Except if you are an undocumented worker in Georgia – no coverage for you. Lou Dobbs must be proud.
Bill H
I lived in Atlanta for more than fifteen years and was in AA for eight of those years. A lot of the people in AA were, as you might imagine, people who used Grady Hospital, and I came to love that huge pile of bricks in downtown Atlanta which was, at the time, a county institution. It was crowded and a dump, and far from the cleanest or most attractive place you ever saw, but it provided good care. It treated the crummiest homeless person with all of the dignity and care as if that person was the inhabitant of Trump Towers. The people in that place were among the most caring people in the world. To me it was something for Atlanta to take pride in, as even then civic hospitals were becoming extinct.
I moved away from Atlanta in ’89, and I’m saddened by what has become of that noble effort in civic responsibility.
r€nato
@Farmer_Jones:
Um, I have a family member (to whom I no longer speak because he’s a monster on multiple counts) who would say pretty much the same thing.
“It’s their fault for not going to college and getting themselves a nice six-figure job like everyone else.”
And there are a number of ‘Merkins who would agree with that.
These people are a cancer on our society. If there were a god who truly believed in love and mercy and justice, he’d put these people on their knees until they learned some humility and empathy.
But, there is no such deity so we are on our own to make this world a little better than the brutal, nasty and short life our ancestors lived.
Steeplejack
@henqiguai:
When you want to reply to, or just reference, a previous comment, click the gray arrow to the right of the time stamp on that message. It will put you in the text-entry box and give you a nice hyperlink that others can use to refer back to what you are writing about, instead of them having to scroll up or do a search for the previous comment, then scroll back down or do a search for your message because they can’t remember the number on that. [cough]
Also, sometimes comment numbers can change–I think–if a comment comes out of moderation upthread of the comment to which you are referring. The beauty of the hyperlink is that it will always refer to the exact message you want. Readers can click the hyperlink to go to that message, then press the backspace key to come back to your comment. Nice and easy. And, God knows, there are few enough things that we do nice and easy around here.
/pedantic
ThatLeftTurnInABQ
@cmorenc:
Well said.
I think we also have to deal with a sizable minority who don’t rationalize our existing system as explicitly or ruthlesssly as in your parody but rather they just assume that no other system is possible and live with the cognitive dissonance which comes along for the ride with that Panglossian package. No doubt some of them cry at the end of the school play based on Charles Dickens ‘A Christmas Carol’ every year and then go in to work the next day to cancel some more health insurance policies. It’s all in a day’s work after all, and if no ghosts come by to disturb my nightime rest, then it’s all good.
Jonathon Glover wrote a really good book ‘Humanity: A Moral History of the Twentieth Century ‘ in which he examines the psychological mechanisms whereby people involved in various 20th Cen. massacres and atrocities were able to do what they did, and he found that one of the most effective techniques for subverting and suppressing people’s moral sense was to divide up the ‘work’ involved into many little pieces so as to diffuse the ethical responsibility for the ultimate outcome to the point where individuals at different links in the chain could more easily rationalize what they were doing. It seems to me that our current system of health care rationing via private insurance suffers from a bad case of this moral disease.
tc125231
45,000 people die every year, due to lack of insurance, per Harvard.
http://www.southernstudies.org/2009/09/uninsured-die-every-year.html
You have to love they way the current all Christian all the time crowd have fixed their faith, by getting rid of the teachings of Jesus.
Nonetheless, Mathew 25:41-43 ought to worry these clowns a bit:
‘Depart from me, you cursed, into the everlasting fire prepared for the devil and his angels: for I was hungry and you gave me no food; I was thirsty and you gave me no drink; I was a stranger and you did not take me in, naked and you did not clothe me, sick and in prison and you did not visit me.’
Chad N Freude
@ThatLeftTurnInABQ:
I looked this up on Amazon and read some of the reader reviews. One reader who didn’t like the book said it was OK philosophy but the history was all wrong. Another who didn’t like the book said that the history was good but the philosophy was all wrong. I suppose I’ll have to read it and try to judge for myself. Damn!
ThatLeftTurnInABQ
@Chad N Freude:
Being something of a 20th Cen. history freak, I’ll vouch for Glover’s history being reasonably accurate. His philosophy is interesting since he takes a fair chunk of the western tradition of moral philosophy and turns it around by arguing from horrifying consequences backwards into the flawed systems of morality and ethics which made those consequences possible rather than starting from first principles and trying to argue forward based on reason and logic.
He writes a sort of forensic pathology of western moral philosophy and his ultimate conclusion is that any system of ethics which, no matter how well constructed or well intended it might be, if it still allows us to end up in a place like Treblinka or the Kolyma or Hiroshima then it is unacceptable, and that instead of constructing elaborate systems of ethics based on logical reasoning we would be better off guarding against the specific psychological mechanisms which have tended to recur in the horrible events of past and which can be readily spotted once you know what to look for (example: the ‘Cold Joke’ which uses humor to dehumanize potential victims by subjecting them to verbal violence which reframes them as animals or non-living objects). His approach to approach to moral philosophy is fundamentally pragmatic and empirical rather than ideological. Overall a very good book which I can’t reccommend strongly enough to do it justice.
Brachiator
@El Cid:
Thanks very much for the background on Grady. I was wondering what the NYT article was referring to in the throwaway line, “The hospital, which is deeply in debt…”
There are some hard realities in this sad, story.
The health care plan being considered by Congress would not necessarily provide relief for all of these patients since some of them are illegal aliens.
The health care plan would not necessarily solve any of the problems faced by hospitals like Grady.
Grady became a non-profit, the new holy grail for some seeking easy solutions to difficult economic problems, and still could not maintain its outpatient dialysis unit.
Even with a $250 million cash infusion from a foundation and an evil corporate benefactor, Grady’s costs continued to rise and they could not deliver quality medical care.
I greatly appreciate Grady’s sense of mission: “In the Atlanta region, that has made Grady, which accepts all patients regardless of immigration status or ability to pay, the provider of last resort for many illegal and uninsured patients. ”
However, once you get past the reasonable outrage over this issue, you still have to answer the practical questions: how will you deliver quality care to all people, and how are you going to pay for it.
And anyone who simplistically responds, “Single Payer,” deserves a kick in the junk.
different church-lady
I’ve said this already: you’ve got it backwards — rationing is when you don’t have enough and you measure it out fairly so that everyone gets some.
What we have is the OPPOSITE of rationing — we have COMMODIFICATION of healthcare, where only the highest bidders get the commodity.
Chad N Freude
@ThatLeftTurnInABQ: Thanks. I’ve added it to my excruciatingly long list of books that I really want to read if I can only find the time, which I can’t because I spend so much of it commenting on BJ.
Chad N Freude
@ThatLeftTurnInABQ:
Pragmatic? Empirical? Non-ideological? Well, then it can’t possibly be right.
The Sanity Inspector
Grady Memorial Hospital was never intended to be a charity hospital. But, because of the recession, its inner city clientele, and piss-poor management, that’s what it’s turning into.
Miriam
@Steeplejack: Thanks for those tips! I’ve been coming by for quite awhile (well, over a year anyway) and didn’t know that about the grey arrow. I wish there was a manual for the site along with the dictionary.
Chad N Freude
@Miriam: Well, first you have to drink blood from a skull . . .
Steeplejack
@Miriam:
No worries. You’ll pick it up in dribs and drabs; that’s how I did it. And, really, there’s not a lot to it. Just a few little details that make it easier.
Now, commenting, and picking your way through the personalities around here, that’s a whole other thing. I can’t help you there. I’m new in these parts myself.