By Alan R. Davis
At
the founding of our country healthcare was provided by physicians in
individuals’ homes. A good reminder of
that is the scene from the HBO series “John Adams” in which his daughter underwent
breast surgery (for cancer) in an upstairs bedroom.
By
the mid 1700’s there was a growing sick homeless population in Philadelphia so Ben Franklin and
Dr. Thomas Bond worked to establish the first hospital in the colonies.
"
Faced with increasing numbers of the poor who were suffering from physical
illness and the increasing numbers of people from all classes suffering from
mental illness, civic-minded leaders sought a partial solution to the problem
by founding a hospital.”
The
use of hospitals for caring for the sick spread in Europe before it did in the
new country formed from the colonies. So
during the second half of the 1800’s groups from religious sects in Europe came
to the United States for the purpose religious freedom and caring for the
poor. This resulted in a significant
increase in the number of hospitals. The most common were Catholic based and run, staffed by nuns. SSM Healthcare (St.
Louis, MO) is just one of many Catholic Healthcare Systems that were established. Other religious groups followed suit.
Cities,
counties and states set up hospitals to care for the poor. They became known as “charity hospitals”. Two of the more famous are Cook County Hospital
in Chicago and Ben Taub General Hospital in Houston, but they were prevalent in many cities.
In
order to improve access to healthcare and allow hospitals access to funds for
construction Congress passed the Hill-Burton act. Those organizations using Hill-Burton funding
were required to give a “reasonable amount” of charity care.
As
charity care facilities became overwhelmed, Congress enacted “anti-dumping”
laws making it illegal to transfer emergency patients to county facilities
based on the patients lack of financial resources. Failure to comply with those restrictions was
grounds for exclusion from the Medicare and Medicaid programs.
Community
Health Centers have existed for some time.
Their primary purpose is to allow healthcare access to those who lack
insurance or have Medicaid coverage. The
Federal Government has acted multiple
times in the recent past to strengthen this system.
Under the previsions of the Medicare and Medicaid programs hospitals who accept patients from those programs must offer charity care and post their charity care guidelines. Failure to comply can result in organizations' exclusion from those programs.
So
access to healthcare for the poor has been a consideration since before our nation was founded.
And access has been improved over the centuries. The question has always been the type of
access and the ability of the Nation to support it.
While the rallying cry of those supporting universal healthcare is "the richest Nation in history can afford it" the truth might be that the "most indebted Nation in history" may have reached the limit on what it can afford?
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