Correspondence

Our Ailing Public Hospitals

N Engl J Med 1996; 334:597February 29, 1996

Article

To the Editor:

Having had the privilege of being trained in one of the best-organized public hospitals in America (Bexar County Hospital in San Antonio, Texas) I cannot but deplore the prospects you describe in your thoughtful editorial.1 Helping an underserved indigent population with the best of medical technology is a highly challenging and rewarding experience that should be available to all physicians in training. It is only by treating the sickest and most needy patients that one will fully appreciate the curative potential and the curative limits of the tools of modern medicine. And only by being forced to use limited medical resources selectively on an unlimited number of very ill patients will a physician acquire the discriminatory decision-making capabilities that are at the core of competent and cost-effective care. In my experience there is no conceivable substitute for this unique learning environment. . . .

Sebastian R. Fetscher, M.D.
Freiburg University Medical Center, 79106 Freiburg, Germany

1 References

1
Kassirer JP. Our ailing public hospitals -- cure them or close them? N Engl J Med 1995;333:1348-1349
Full Text | Web of Science | Medline

To the Editor:

You state, “All of us should be ashamed of our national about-face.” This statement echoes what so many of us on the front lines feel as we watch in disbelief the turnabout in attitudes toward service to communities. Three years ago I was also surprised when finally there were substantial discussions on health care as a right and a renewed vision of a society not driven by the profit motive but by a sense of fairness and moral obligation. In the past year, under the onslaught of Republican rhetoric on balancing the budget, all the talk of universal health care coverage appears to have gone with the wind. . . .

What is happening in health care is but a reflection of our society, a society that has not yet committed itself to long-term solutions to social problems in general or to those that directly affect the public health.

Danielle Laraque, M.D.
Harlem Hospital Center, New York, NY 10037

To the Editor:

. . . Public hospitals should be supported and strengthened to the extent that they provide the necessary resources for comprehensive health care in given communities. By definition, such communities are likely to be largely urban, with high densities of uninsured or underinsured people. Preserving resources for tertiary care, even as we emphasize the need for primary care and prevention, is what is clearly needed. The United States spends a smaller portion of its gross national product (GNP) in allocations of public funds to health care than any other Westernized nation, although its overall health care spending represents a large percentage of the GNP (14 percent, including 6 percent from public funds).1 Moreover, even as the number of uninsured Americans approaches 42 million, the percentage of health spending that flows into corporate coffers rises apace. We must re-address our national priorities, looking for the moral and ethical imperatives that ought to drive our search for direction in addition to searching for practical solutions.2

L. Julian Haywood, M.D.
Los Angeles County–University of Southern California Medical Center, Los Angeles, CA 90033

2 References