The health care injustices that Dr. King spoke about are still here. And growing.
How Long, Oh Lord, How Long?
The top story in yesterday’s Los Angeles Times brought to mind one of the most-cited Martin Luther King, Jr. quotes about health (and health care) in the United States. It is usually this version–slightly but significantly altered by someone who must have thought his exact words might offend some folks–that we see and hear:
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
Before quoting Dr. King precisely below, here’s the headline of the Times story:
‘This can only go on so long.’ Patients needing routine care pack MLK emergency department
I encourage you to read the whole story, but here are the first paragraphs:
In the emergency department at MLK Community Hospital, masked patients lay in wheeled stretchers lining the hallways.
Others slumped in chairs where nurses attended to them. Amid the crush of people on a recent day in December, only the sickest or most severely injured got one of the 29 rooms.
The rise of flu, RSV, COVID, and other winter viruses has exacerbated overcrowding that existed even before the pandemic, hospital officials said–the result of stark shortages in medical care in a low-income South Los Angeles neighborhood where most residents are Black or Latino.
Patients come to MLK’s emergency department with minor ailments they haven’t been able to get treated elsewhere, or more serious conditions that have become dire in the absence of care to prevent or manage them, said Dr. Elaine Batchlor, chief executive of MLK Community Healthcare.
Shortchanging Doctors to Reward Private Insurers
The story noted that when the hospital opened in South Los Angeles seven and a half years ago, the emergency department was expected to handle 110 patients a day, or 40,000 a year. But last year, it was not unusual for more than 400 patients to arrive seeking care in a single day. By the end of 2022, the hospital’s emergency department had treated more than 112,000, nearly three times the expected capacity.
The Times went on to point out that because California’s Medicaid program (called Medi-Cal) pays doctors and hospitals so little compared to what Medicare and private insurers pay, MLK had a net loss of almost $43 million for care provided in the hospital’s emergency department last year. Only 4% of its patients have private insurance. The cost of private coverage is now far beyond the ability of most of the area’s residents to even consider.
Almost 30% of California’s population of nearly 40 million (59% of whom are nonwhite) are enrolled in Medicaid, but the state ranks 40th in the nation in terms of provider reimbursement. As a consequence, finding a physician or clinic willing and able to treat Medicaid enrollees for routine care in California is nearly impossible for many residents, especially those who live in predominantly Black and Latino neighborhoods.
Meanwhile, hospitals in more prosperous zip codes in Los Angeles and across the country–including the ones that are exempt from paying taxes–are sitting on mountains of cash and spending relatively paltry sums to fulfill their “community benefit” obligations.
I became all too aware of that while helping to produce a documentary entitled “American Hospitals: Healing a Broken System,” which will premiere in Washington and nationally this spring. Hospitals that get most of their revenue from people who can still afford private insurance are increasingly concentrated in rich suburbs, while hospitals in rural areas and poor neighborhoods of our cities are closing.
Newspapers in just about every other big American city could have reported stories similar to the one in yesterday’s L.A. Times. Not only are most urban emergency departments overwhelmed on a daily basis, but many cities are also losing their “safety net” hospitals, Atlanta being one of the most recent. Here in Philadelphia, Hahnemann Hospital, founded in 1848, was shuttered by its private equity owners in 2019.
But while more and more people in rural communities are forced to travel long distances for care and poor residents of our cities push the emergency departments of our remaining safety net hospitals to the breaking point, big insurers continue to report record profits, thanks largely to how they are stealing our tax dollars to reward their shareholders. Just last Friday, UnitedHealth Group, the largest health insurer, said it made $28.4 billion in operating profits last year alone.
The Medicaid program was just a few months old when Dr. King spoke those famous words about health in America at a Chicago press conference on March 25, 1966. Fifty-seven years later, nearly 91 million of us are enrolled in Medicaid or the Children’s Health Insurance Program. But far too many can’t find a doctor willing to treat them, and an untold number of them are dying prematurely as a result.
So what exactly did Dr. King say?
“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”
As Dr. Charlene Galarneau wrote in the Journal of Health Care for the Poor and Underserved a few years ago, there are three significant distinctions between what he said and what someone changed, perhaps to be more palatable. Note that he used the word health, not health care. And inhuman, not inhumane. And that he made a point of saying that this most shocking form of inequality and injustice kills people every day in this country.
Let’s recommit on this day of remembering and honoring Dr. King to telling the whole truth–not mincing words and leaving out important facts–and doing something about it.