Deadly Cuts: Grady Hospital and the National Health Care Crisis

By Murphy Davis

Vol. 21, No. 3, 1999 pp. 3-5

The county commissioner looked perplexed. "You understand, don't you, that we're the bottom of the food chain here. You're coming to us because you know who and where we are. But we're not the real cause of this crisis at Grady Hospital. It's much bigger than DeKalb and Fulton Counties."

The commissioner is absolutely right and she is absolutely wrong. Grady, Atlanta's public hospital since 1892, is facing a $26.4 million deficit for the 1999 calendar year. To cut costs, the administration recommended to the Hospital Board that they begin to charge even the poorest of the poor a five dollar charge for each clinic visit and a ten dollar co-payment for each prescription and medical supply. This policy attempted to lay the budget problems on the backs of the city's poor. If enacted, it would amount to a death sentence for some Grady patients, especially the poorest many of whom are elderly and/or with chronic illnesses that require several medications to sustain life and health.

The situation at Grady is a local problem with local causes. It is also a symptom of a national crisis with national causes. Local governments are responsible for the problem; local governments are victims of the problem. The health care crisis is a particular place where the national drama is being played out on a local level. Perhaps it might also be the place where we come together nationally and bring about significant change.

Over the past twenty years, the United States has undergone massive and sweeping changes that have increasingly consolidated resources into fewer and fewer hands. According to the U.S. Census Bureau, between 1980 and 1997, the mean household income of the lowest quintile (20 percent) rose a mere 1.45 percent ($129). The wealthiest quintile, on the other hand, enjoyed a mean household income increase of 26.9 percent ($32,952). A significant number of people near the top have accumulated more money and possessions than anybody could ever need in one lifetime. The middle class is more vulnerable. The working class is close to falling over the edge. The poor have sunk more and more deeply into the misery of substandard housing, homelessness, prison, and limited access to good schools, proper nutrition, and health care.

Health care has not all of a sudden become an issue of privatization. Much to the detriment of the common good, health care has long been understood as a commodity in the United States. It has more often than not been a problem for poor people to find adequate care. But we have had at least some sense of the obligation of government to care for the public health. It has, for several generations, for instance, seemed imperative that we sustain the agencies that monitor, test for, and treat infectious diseases. It has been an acceptable notion that all children, regardless of economic circumstances, should be immunized to protect them from preventable illness. We have even supported programs like Medicaid and Medicare to insure at least minimal care for the very poor,


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people with disabilities, and the elderly.

But now even this minimal level of care provided from public resources in the United States is under fire. Since the early 1980s, a steady and persistent legislative and judicial program has given advantages to wealthy individuals, corporations, and institutions and increasing disadvantages to working class and poor people. Public institutions and services have been opened up to the forces of privatization for the purpose of increasing profits for the already-wealthy and destabilizing the lives of workers. All services and institutions are becoming fair game for the market and all space is becoming commercial space. Prisons and jails are being constructed and managed by corporations whose stocks are soaring. And while Corporate America bites off larger and larger chunks of the public funds, the strident resistance to government "interference" by planning or regulation is a steady theme.

The values and language of the market have come so to dominate our common life that ethical discussion, or religious or moral discourse have begun to seem quaint if not completely irrelevant. The bottom line is everything. Those who matter are consumers. But poor people (by definition, those without capital) are not consumers, so they, literally, don't count. In fact, they don't even exist except as commodities in the prison industrial complex.

At the same time, on national, state, and local levels, we have cut programs that help the poor and vulnerable among us. The results are increasingly disastrous for individuals, families, public institutions, and the common good. The Grady crisis represents this unfolding drama.

As a single example of the national trend and its local impact, two pieces of federal legislation, the Welfare Reform Act of 1996, and the Balanced Budget Act of 1997, have meant a loss of $28 million for Grady Hospital in 1998 -more than this year's projected deficit. As people have been moved "from welfare to work," they have often moved into low-wage, dead-end jobs that almost never provide health insurance. Without access to Medicaid, these families continue to depend on Grady for medical services, but the patients cannot pay for services and medication, and the hospital can no longer be reimbursed by Medicaid. Grady's plight is one that is also affecting teaching hospitals across the country.

The state of Georgia has taken the federal cuts and made even deeper cuts in Medicaid and Medicare. The DeKalb and Fulton County Commissions, which are legally responsible for Grady have voted for less and less county support for the hospital since 1992. Simply put, the emergency that Grady faces has been created by specific policy decisions at every level of government over a period of years. Some folks knew doggone well what was happening, a few people protested in vain, and the rest seemed to be watching television and shopping at the mall. But as the cuts continue to trickle down to the local level, they are deadly for the poor, the sick, and the vulnerable.

The crisis is local, so the organizing has to begin locally. The elected officials closest to home are those who must first take the heat for this multi-level assault on public institutions and poor people. They are responsible for their own malicious policy decisions. And they are responsible for not raising cain with state and federal decision-makers who helped them to craft this disaster.

For us, the Grady Coalition, there is a rich privilege in being part of a diverse and growing coalition that is confronting the local health care emergency and crying out for those who cannot cry out for themselves. When we forced a discussion with the Grady Board, they voted to temporarily rescind the co-payments. We made a commitment to work with them and help advocate for additional funding to meet the deficit. We knocked first on the door of the Fulton County Commission and were received by those commissioners who are friends of the poor and advocates for Grady. They allocated an additional $3.5 million. When we went to the DeKalb County Commission and CEO with the same appeal, we were met with a stone wall.

On May 11, thirty members of our coalition of activists were arrested for praying and singing when the DeKalb Commission once again refused to discuss the hospital. It was, without a doubt, the largest and most diverse group arrested for an act of civil disobedience in Atlanta since the Movement activities of the 1960s. We were clergy and laypeople, Christians, Jews, and Buddhists, women and men, gay and straight, Black, white, and Asian, students and retirees (the oldest were seventy-nine and eighty-one), medical professionals in white uniforms and members of organized labor taking the day off. While we were loaded onto the police bus and taken to jail, two hundred or more supporters sang and prayed. Then they moved the vigil to the DeKalb County jail.

On June 8, the DeKalb Commission approved $1.1 million for the Grady Pharmacy.

We are continuing this struggle on several fronts. We are appealing to Governor Roy Barnes to get involved to make state resources available to move past this crisis toward long-term resolution of Grady's support as a regional and state resource. We understand that this must include discussion and action for public hospitals in every area of Georgia.

We are also looking toward public dialogue about the responsibility of the private institutions that have a role in Grady's long-term health. Emory University made its international reputation as a medical school and research center at Grady Hospital. The medical school has been a major source of Emory's growing wealth and power. With


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an endowment of eight billion dollars, Emory's is the fastest-growing endowment of any private university in the nation. It is time for the wealth to be shared to endow Grady's future as a resource for health care for the poor and the excellent teaching context that it continues to be.

Other private sources that must be called to accountability are the many for-profit hospitals in the Atlanta area who sometimes send their patients to Grady when insurance monies have run out. We understand that some cities or regions levy a tax on for-profit hospitals to help support public hospitals. Drug companies and insurance companies must be called to account for their massive profits and pricing based on market feasibility rather than their own costs. And finally, Morehouse Medical School and other smaller teaching institutions and programs must be called into the discussions to explore shared responsibility for this precious resource in our community.

With our local partners, we must seek new ways to work together to advocate in Washington. The Balanced Budget Act will bring deeper cuts in the coming years. Our health care system is in serious trouble. We must stop the damage and move toward a national health insurance plan.

We in the United States, spend some four thousand dollars per person per year for health care, more than any other people in the world. This is a cost nearly twice any other country and a much higher figure than other industrialized countries like Canada and Great Britain. And their expenditure pays for a health care system that provides access to care for everyone.

The diverse and lively coalition that has formed around the Grady crisis is a long-haul group of committed activists. We are working and planning together with clarity that we have a long road ahead. We look forward to learning more of how this struggle has taken shape in other cities and regions. And we hope to be part of a growing movement that will struggle for not only a guarantee of decent health care for all God's children, but justice, housing, freedom, and peace for every woman, man, and child.

Reverend Murphy Davis is a partner at the Open Door Community, Inc., an Atlanta community of Christians who minister with the homeless and prisoners, particularly those on death row. Davis is the coordinator of the Southern Prison Ministry.