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'California's Medical Crisis'

February 24, 1987

In Robert Steinbrook's article (Feb. 9), "Cost of Treating Uninsured Strains Trauma Program," financial hardships are described as the bottom line rationale for several hospitals dropping out of Los Angeles County's trauma center network. The basic problem being that a significant number of the patients who receive treatment are uninsured. I believe that the current acronym for those people who cannot afford private health insurance, or who do not qualify for Medicare coverage, is MIAs (medically indigent Americans).

A fact that is too often not brought to light in discussions of what to do, where to get the funding, and who is ultimately responsible for the medical care of MIAs is that their numbers are increasing. The most current estimates number MIAs between 35 million and 37 million. Fortunately, as has been pointed out by Robert Cunningham Jr., a member of the American Hospital Assn.'s Special Advisory Committee on Biomedical Ethics, "Even in a country as vast and rich as ours, 35 million people without access to medical care cannot get out of sight . . . so the problem is now getting deserved public attention."

While the "financial hardships" cited by administrators of the hospitals in Los Angeles County are certainly worthy of consideration when legislators meet to discuss what to do, it should not be forgotten that federal legislation, the Consolidated Omnibus Reconciliation Act of 1985, makes it illegal--a federal offense, in fact--to refuse emergency treatment to uninsured patients.

A more fundamental question than "who should pay," or "should we take on a 10% surcharge for moving traffic violations" (a consideration under review that would provide an estimated $25 million pooled fund for trauma care reimbursement), is "Which comes first--the mission or the money?" The medical profession and hospitals that are established to serve the patient community might do well by the patient community by undergoing much needed "internal scrutiny" of their motivation for existence. Is their reason for being to turn a profit, or is it to serve those in need of health care? Particularly, emergency health care.

Any hospital's administration is to be commended for subscribing to a network that provides such emergency care as is needed. However, to illustrate the need for "internal scrutiny" of motivation, an administration that subscribes to such a network because they anticipate increased profits and/or prestige (as was cited in Steinbrook's article) is not, by anyone's standards, commendable.


Managing Editor

Administrative Radiology Journal


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