Universality: a call for compassion

Abstract

Acyclist is struck by a car and lands on the pavement, motionless. Paramedics arrive within minutes and determine that he has multiple fractures, a head injury and possible intra-abdominal trauma. Barely conscious, the victim whispers, “I have no insurance!” This poses a dilemma. The nearest hospital, St. Avarice, has an excellent reputation but high co-payment charges. Riffraff General is farther away and often has long waits, but the care is free. To complicate matters, St. Avarice is known to “dump” uninsured patients. The paramedics head for Riffraff, where the patient later dies of treatable injuries while waiting for an operating room. Farfetched? Hardly. Dumping, defined as “denial of or limitation of emergency care, and referral elsewhere, usually for financial reasons,” was, until recently, a widespread practice in the US. Economically motivated transfers led to significant unnecessary mortality, 1 and “dumped” patients were predominantly young, male, uninsured, minority members, therefore provoking the observation that dumping is a practice “which appears to reinforce racial and class inequities of access to medical care.” 2