We were a vivid group 100 strong, demonstrators waving signs on a street corner across from the 1,035-bed Grady Memorial Hospital, the only public hospital in the Atlanta metropolitan area. Overnight, the price of a prescription for indigent patients had risen from as low as 50 cents to $10, and the hospital pharmacy would take cash only. An internal Grady document projected that without access to discounted medications, 6,500 people would suffer or die within thirty to sixty days. We were chanting, singing civil rights songs and calling through our bullhorn for compassion for the disabled, the elderly, "the poorest of the poor." We were preachers, doctors, labor leaders, the homeless, the blind, students, business people--gay, lesbian and straight. We marched across the street into the towering marble-faced building and made our way to the hospital boardroom. Behind mahogany tables, the trustees were holding their regularly scheduled meeting.
Point by point, we made our arguments: More than 26,000 patients would be affected, many on life-sustaining medicines. People on fixed incomes who had been paying $4 for eight medicines each month would now face bills of $80. Already, cancer patients were not showing up at clinics for vital therapy. Old people were quietly telling their doctors not to worry; Jesus would take care of them. Emergency rooms could expect to be flooded. A homeless man in a wheelchair explained how he'd been discharged from the hospital with no medication for heart failure, how his shortness of breath reappeared after a few days, how he was rushed to the emergency room drowning from the backup of fluid into his lungs.
The chairman of the board banged his gavel. The protests and prayers continued. The chairman explained that the hospital had a $26.4 million deficit and that the price increase was essential to maintain its fiscal viability. It was as though a bomb had exploded. Furious protesters confronted the board. Guards were quickly called in, and the trustees escaped through the back door.
Grady's pharmaceuticals policy is America's healthcare crisis in microcosm. Throughout the country, hundreds of thousands of people are suffering or dying every year because they can't pay for medications. Of late, the matter of prescription costs has surfaced as Congress considers changes in the Medicare program, with politicians sensing a galvanizing issue for the 2000 elections. That debate is focused on the serious problems of the elderly; ignored are the younger-aged "medically indigent"--the many others who cannot afford the medicines they need, whether they are employed or unemployed, low- or middle-income, with poor insurance or no insurance. The opposition that has been brought to bear in Atlanta against Grady's policy is also a microcosm--but a microcosm of what could be, rather than of what is. For nowhere else in the country has such a broad-based coalition of community activists rallied around people facing medical catastrophe and won--at least for now.
The confrontation with Grady's trustees, which took place on March 22, was only the opening shot in a battle that, at least temporarily, reinstated the minimal prescription fees and, by June 8, secured $4.6 million in public money. But the fundamental problem remains what it is everywhere. Access to medication is often the ultimate bottleneck in the healthcare system. Even if doctors, clinics or hospitals donate their services, patients are helpless unless they can afford the medications prescribed by the doctor. Since the United States is the only industrialized country that places no ceiling on the price of drugs, prescription prices are out of reach for millions of Americans. So what is a typical scenario? As shown by a 1960s study, one-third of untreated patients with extremely high blood pressure will develop kidney failure, heart disease, other heart- or kidney-related problems, have a stroke or die within twenty-six months. A minimum-wage worker faced with a $200 monthly bill for blood pressure medicine has to spend a quarter of his or her income to cover it. Many patients in this circumstance receive no assistance for medication until their kidneys fail and they need dialysis, which costs the government at least $45,000 a year per patient, or their damaged hearts require surgery, or they become paralyzed, requiring nursing-home care at tens of thousands of dollars a year.
The holes in the supposed safety net are growing bigger by the minute. Medicaid often does not provide coverage for the working poor, and it too frequently does not kick in with essential treatment until the patient develops an irreversible disability. So the waitress with heart problems is told that she is not disabled and can work if she just takes her medicines and gets a job where she can sit. Of course, companies are reluctant to hire her because of her illness and the burden of underwriting her healthcare. Because she can't afford her drugs, her condition worsens to an irreversible stage; then she becomes eligible for Medicaid. Such cases provide a continual flow of clients for attorneys specializing in disability law. Retroactive payments from Medicaid settlements feed the lawyers.
Medicare reimburses for medication only while the elderly patient is in the hospital. Carol Dembe, an emergency-room doctor working at a Philadelphia hospital, repeatedly treats the same patients with recurrent crises such as asthma attacks and seizures. Medicare pays for the emergency-room visit. Patients who cannot afford their medicines go home without their prescriptions filled and bounce right back to the emergency room a few days later. The cycle continues at a higher cost to the system than if medications were provided at a nominal fee.