In pediatric medicine, there is a condition among infants called “failure to thrive.” Premature birth, infections, and an inability to absorb nutrients are common causes for why some infants do not grow as well as they should. But inconsistent feeding and poverty can cause the condition too. Another important factor: The lack of an emotional bond between parent and child, the effect of which can last a lifetime.
In many ways, this is what has happened to America’s public hospitals and the communities they serve. The historic bond between these hospitals and the governments that gave them birth is being challenged in an era of fiscal austerity, political indifference toward the poor and an over-reliance on marketplace solutions to health care spending. Nowhere is that more apparent than here in Atlanta.
This city’s business leaders were instrumental in the birth of the Henry W. Grady Hospital in 1892. And, without the intervention of their more recent counterparts, there seems little question that the state’s oldest and largest public hospital might have perished just a few years ago when it was nearly insolvent.
The hospital’s troubled financial history includes equal parts dysfunctional local governance and a state political leadership that has been studiously indifferent to its mission.
Moreover, the social and policy issues Grady raises are complex and cut across all levels of government. They are infused with local politics and partisan ideology — rural versus urban, or frugal Republican suburbs versus tax-and-spend city Democrats. And then there’s the issue of race, always race, especially with Grady’s history of separate and not-always-equal treatment of the city’s large African-American population.
Yet it was the Atlanta business community that saved Grady in 2008, not the counties that are contractually obliged to maintain its mission, and certainly not the state that relies so heavily on it to train Georgia’s succeeding generations of physicians. Retired Georgia-Pacific executive Pete Correll and the Metro Atlanta Chamber of Commerce infused the aging hospital with new hope by changing how it was governed and bringing in new leadership. The financial picture improved within a few years and Grady started getting millions of dollars from foundations and philanthropies for long-deferred capital improvements.
Thus, with the passage of the 2010 Affordable Care Act to expand access to insurance for all Americans, Grady’s advocates saw even more cause for hope. Instead, several independent trends have coincided to challenge Grady and other hospitals like it around the country.
A federal court in 2010 found the state’s mental hospitals were understaffed, underfunded, and jeopardizing patient lives. The result was that many former patients treated by the state are now frequent flyers in Grady’s behavioral health unit.
Just as significantly, throughout urban areas of the South, and especially in Atlanta, the number of new HIV/AIDS cases among young males – most of whom had never been tested for the virus – has risen precipitously. Incredibly, this has happened at a time when Fulton County left more $8 million in federal funds for its HIV prevention program since 2012 unspent because of inept administration in the county’s public health department. Since many of the newly diagnosed are uninsured, they have turned to Grady’s Infectious Disease Program, one of the oldest and busiest in the country.
And, because illegal immigrants are specifically forbidden from coverage under the ACA, no hospital other than Grady routinely treats metro Atlanta’s substantial undocumented population.
Yet it is the political issue of Medicaid — and the state’s decision to refuse an estimated $9 million a day (more than $30 billion over 10 years) in federal funds available through the ACA to expand it — that has raised the prospect of breaking the bond with Grady once again. This singular act of public indifference means more mentally ill Georgians will wind up in Grady’s psych unit, on the street, or in jails. And the untreated HIV patients will continue to spread the disease, develop full-blown AIDS, and die. Tens of thousands of other Grady patients with more common, chronic diseases like hypertension and diabetes also remain blocked by the state’s indifference.
Public hospitals in Dallas, Miami, Tampa, Nashville, Birmingham, New Orleans, Memphis, Charleston, and other cities, mostly in the South — all operating in states that have refused to expand Medicaid — face similar challenges to provide costly, essential services not available to the poor anywhere. Public health advocates and business leaders in these cities understand that if the reverse were true — if the public hospitals were to be closed, and their poor and uninsured patients diverted to other hospitals — a sea of red ink could overwhelm even those private hospitals that are now more prosperous because more Americans than anytime in recent years have insurance.
But know this too: America’s public hospitals are remarkable at survival. Some of the best and brightest minds in medicine, management, and administration are committed to the cause of caring for the poor.
These hospitals are sentinels for the future of health care in America. State and local political leaders – and the people who elect them – should restore the historic bond with Grady. Our state’s most important hospital needs to thrive, not merely survive.
About the Author
