A Spirit of Charity

In the spirit of investigative journalism, this assessment of public hospitals paints a grim picture of health care for the poor in America.

Debut author King, a former newspaper reporter, focuses primarily on Atlanta’s Grady Memorial Hospital, showing that the public hospital in general has become “the symbol of how the poor are cared for in the United States.” This book traces Grady’s history and compares it to the evolution of four other public hospitals, demonstrating the challenges such centers face in serving their communities. Grady’s story is deftly interwoven with the advents of Medicare and Medicaid and, more recently, the Affordable Care Act. Perhaps most disturbing is King’s insightful exploration of the intersection of race, poverty, and health care, particularly in the South. Grady, for example, which started as “White Grady” and “Black Grady,” was desegregated after the 1964 Civil Rights Act; still, “remnants of Grady’s segregated past lingered for years.” The larger issue, however, was Grady’s compensation for taking impoverished patients. Grady’s Emergency Room, like those of other public hospitals, couldn’t turn away patients with life-threatening ailments. King notes, however, that nonprofit and private hospitals routinely “send patients without life-threatening conditions who come to their ERs to a public hospital for what they deem to be nonemergency care.” Public hospitals typically receive payment for these poor patients via Medicaid—but in the South, “state Medicaid programs have been unusually restrictive.” In fact, the author reports, “by refusing to expand Medicaid, Georgia was leaving about $9 million a day on the table, unclaimed for use by the neediest people in the state and the hospitals that treat them.” Grady survived, writes King, because of the efforts of local business leaders rather than county or state governments. In this important book, the author more briefly recounts similar stories of the other four public hospitals: Parkland Memorial Hospital in Dallas, Jackson Memorial Hospital in Miami, the John H. Stroger Hospital of Cook County in Chicago, and Charity Hospital in New Orleans. Carefully documented, journalistically crafted, and artfully told, this account illuminates the myriad struggles of public hospitals to effectively treat the indigent. King bluntly asks: “Have we reached the point where public officials, particularly those in the South, are frozen in the ice of their own indifference when it comes to the government’s responsibility in caring for the poor?”

A searing and sobering indictment of the public health care system that highlights the inequality of treatment.