For months now, opponents of health care reform spread rumors that the proposals simmering in Congress would establish death panels, leaving medical bureaucrats to make life-and-death decisions.
It was a lie about death panels. But life-and-death decisions are becoming a stark reality of the very health care system enemies of reform are fighting to preserve.
"Absolutely. That is what we have now in public hospitals," said law professor Paul J. Zwier II of Emory University in Atlanta, who watched, aghast, as that city's struggling public hospital, Grady Memorial, announced in October that it could no longer afford to fund kidney dialysis for poor end-stage renal disease patients.
Lest anyone think that the Grady Memorial crisis was an aberration, last week Miami's Jackson Memorial Hospital adopted the same unhappy tactic.
Both hospitals, strapped with treating the uninsured urban poor, struggle with massive operating deficits. Jackson is expected lose $168 million in 2010. Grady's losses will be close to $200 million.
The financial crisis has forced both hospitals to adopt a kind of brutal triage. Dialysis clinics devour a disproportionate chunk of the hospital budgets to keep a relatively few end-stage renal disease patients alive. Jackson, for example, calculates that out-patient treatment of some 175 uninsured kidney disease patients costs about $4.2 million a year.
Without dialysis, they can survive maybe two weeks. Of course, the strategy here isn't to actually kill these burdensome patients but to funnel them into the emergency rooms, where hospitals can pass much of the costs onto the federal and state governments.
It's considerably more expensive to postpone dialysis and then pay for it when the patient descends into the medical crisis required for emergency room care -- three to four times more expensive -- but the Kafkaesque calculation here is that the costs are shifted away from those overwrought hospital budgets.
Both Grady and Jackson have worked out temporary solutions to fund kidney dialysis treatment for the uninsured -- mostly undocumented immigrants -- until February. After that, who knows?
Meanwhile, Grady has offered to fly kidney-diseased immigrants back to their home country. The New York Times, however, found that the treatment received by Grady's repatriated immigrants was fraught with difficulties.
"We're sending them back to their home countries to die," said Professor Zwier, who has tried to rally Atlanta around a community-based solution. He talked about appealing to "core religious values, ideals and principles."
Zwier said Miami and Atlanta supported scores of private kidney-dialysis clinics, enough to cover uninsured patients turned out of public hospitals if each clinic agreed to take just one patient as a charity case.
A SOLUTION OFFERED
The U.S. House of Representatives version of the health reform bill offers a solution, allowing undocumented immigrants to buy a basic medical insurance policy.
The insurance option would be cheaper than treating uninsured immigrants at the ER, but the proposal faces the wrath of the same critics who worry about death panels -- mythical death panels mind you, not the actual death panels created by the very real financial crises facing public hospitals.