Straight Talk: A Parable Revisited

By Spencer B. King, III, MD

Every few weeks I hear about one or another hospital facing severe financial problems. Many of these are hospitals with a large population of uninsured patients, such as our iconic Grady Hospital in Atlanta, but they also include many rural hospitals and others serving the underserved. Is there no way to help these hospitals survive? Perhaps reenacting a 2,000 year-old parable will help.

Do you remember the Good Samaritan story of the poor man who was sick and lying beside the road? A wealthy man stopped and offered to pay for the sick man's health care. Well, this has happened again, but when the Good Samaritan (Good Sam) tried to pay for the poor man who was sick, a local authority said, "Hold on, this is my territory, and if you pay for the poor man, he may get used to it, feel entitled, or worse! And then I might have to chip in and help pay for him after several years!"

Since the authority was in charge of this particular region, he blocked Good Sam from helping. Finally, the poor sick man crawled to the hospital, which was obliged by law to treat him even though he had no money. Treatment was given, but it was too late. The poor man died, but not before a lot of medicine and bandages had been bought and used by the hospital. Because of patients like the poor man, the hospital began to run out of money. Then, the time came when the hospital had no money to care for any patients and began to beg the local village to tax the people in order to keep the hospital open.

I hope the authority is thinking about this. The poor people and the hospitals are becoming desperate. The players in this parable are:

  • Poor Man: Those citizens who need, but cannot currently get, Medicaid support
  • Good Sam: The Affordable Care Act, which pays 100% of Medicare extension for 3 years and 90% thereafter
  • The Authority: Politicians who value politics over serving their constituents
  • The Hospital: Hospitals that are in the red because of a heavy uninsured-patient census
  • The Local Village: All the municipal and county governments that are being asked to pick up the hospitals' losses because of the state's unwillingness to allow Medicaid expansion

Of course, some states have welcomed Good Sam and have accepted his money. They are happy to support their patients and hospitals with funds provided from the states that refuse Medicaid expansion.

The surprising thing to me is the relative silence from the potential beneficiaries of Good Sam's offer. From the politicians who demonize Good Sam as being "Uncle Sam," or the poor who have little voice, the quiet is not so surprising. However, from the hospitals and local governments who could well use the money, it is baffling.

Spencer B. King, III, MD, is president of the Saint Joseph's Heart and Vascular Institute and Professor of Medicine Emeritus at Emory University School of Medicine in Atlanta. He is also editor-in-chief of JACC Cardiovascular Interventions. He has been a pioneer in interventional cardiology, directing the first trial of angioplasty versus surgery.

Keywords: Financial Management, Medically Uninsured, Medicaid, Politics, Hospitals, Rural, Medicare, Patient Protection and Affordable Care Act, Local Government

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