Friday, October 2, 2009

Show me the money

Here’s the lead in a recent New York Times article: If Grady Memorial Hospital succeeds in closing its outpatient dialysis clinic, Tadesse A. Amdago, a 69-year-old immigrant from Ethiopia, said he would begin “counting the days until I die.”

It’s meant to tug at your heartstrings, and it does. There’s a bit of reflexive anger, too. Closing a facility that provides life-saving healthcare simply doesn’t register in our national psyche. After all, this is the United States, not Ethiopia.
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Nine paragraphs later the reader learns that Grady Memorial Hospital lost more than $33 million last year — about 40% of its patients are uninsured and 25% are on Medicaid. Grady is on the frontlines, serving the neediest. But compassion alone can’t stem that kind of red-ink hemorrhaging; it takes money, lots of it. Where’s it going to come from?

Our current healthcare debate sorely lacks honest discussion about the true costs of delivering medical services. If the economy were booming, it would be an easier time to talk about reform. But it’s not. We’re approaching double-digit unemployment and people are jittery about money.

I once asked Harold Freeman, the head of Ralph Lauren Cancer Center in Harlem, what the main barriers to cancer screening and care in Harlem were. He gave a world-weary sigh and said, “Money. The lack of it. That’s the biggest barrier.”

In 1965, out-of-pocket expenses made up 44% of healthcare spending; today it’s 12%. Of course we get better care today; we’re also more shielded from the actual costs. But hospitals and clinics that serve poor patients aren’t shielded. They struggle on, and some, like Grady Memorial, have to close because they can no longer dish out up to $50,000 a year per dialysis patient, some of whom have availed themselves of the thrice-weekly treatments for years.

So when politicians talk about healthcare reform, our first response should be: Show me the money.

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