"I was just in the Emergency Department. His family said, 'Get a one way ticket to New York,' so they could get him his dialysis."
Dr Thomas Santucci is the Chairman of Medicine at Jamaica Hospital Medical Center and he has his "worried" look on today. As the chair of the hospital's largest department, he has the responsibility to balance the microcosmos of the care of the individual patient with the macrocosmos of the financial health of the hospital. For most of the rest of the hospital's employees, "Healthcare Reform" is still an abstraction, political theatre, generally "good" or generally "ill-advised." For Dr. Santucci, the tension between taking care of a single person and making sure the hospital does not go out of business expresses itself in a physiology of increased pressure visible on his face, in much the same way the rest of us might wince at a horror movie too sympathetically felt.
"How are we supposed to pay for all this?" he asks, and he winces so tightly the emotion comes across the Chairman's office like a lemon peel. Dialysis costs at minimum $70,000 per person per year, and there are HUNDREDS of thousands of people already on it (US Renal Data System: Annual Report).
By calling, and by law, no person with an emergency can be turned away.
Including a man from South Africa with a one way ticket to New York City.
Jamaica hospital has the unique honor (burden?) of being geographically closest to JFK airport. It is a private institution. How is a private institution to take care of a person with NO insurance but who MUST be cared for?
By hard work, talent, and luck, I suppose.
Ignorance is bliss.
How are private institutions to pay for this? They are mandated by law to turn no one away, even someone coming to the door in kidney failure who has been in the country for less than an hour.
I have a surprise for you. Dialysis, it turns out, with a total cost including medications that can approach $80,000 a year, was the FIRST federally funded, automatically insured disease. In the 1960's, by legislation, everyone was GUARANTEED dialysis. Everyone. Automatic insurance. The joke is, we have been doing it for forty years with this disease, and now we are about to do it for ALL diseases.
Don't worry.
When the country led with "What is the right thing to do?" as a matter of national policy in the 1960's, for dialysis two things happened.
1. A lot of sick people got excellent care.
2. We did NOT go out of business as a country.
And you know what? As we approach universal coverage those same two things will happen.
Our only question is: Will it happen fast enough to save private institutions like Jamaica Hospital? Or will we go the way of Cabrini Hospital and Mary Immaculate and St. Clare's Hospital which shut their doors in NYC these past two years?
Would you like to tell me what other private business has a mandate to provide FREE services to EVERYONE besides hospitals?
If you are making the hard-hearted mental decision or "stance" at this moment of "Forget them! Tell the guy to get back on his plane and go home!" you are missing the point.
Jamaica Hospital is exactly like what I love about New York City. Tough, vigorous, worried, and generous. The lesson today is: Decades ago we found a way to take care of ALL the dialysis patients with kidney failure. They are okay and the country is okay.
That is nobility.
We have recently seen the same event happen in Washington, D.C. We will find a way. We are a Nobler America this week because of healthcare reform.
Even though Dr Santucci may be a little more worried.
