Letters.

Providing Medical Care for the Elderly

Professor's Smith's article, "The Elderly and Patient Dumping" (October), reflects a critical omission: Who pays for this exercise in "fairness" and "respect"--and how do they pay? Near as I can tell from his article, Professor Smith would impose this obligation on the individual physician and hospital, who would be denied medical licenses unless they agree to allow "moral and ethical" obligations to take priority over "consumerist" proclivities.

Would Professor Smith extend this obligation to grocery stores? After all, the elderly must eat. How about clothing stores? Surely decent raiment is something that our respect for the elderly should make "controlling." Maybe even university education, although that probably gets to the category of "luxury" which a profitmaking organization can deny.

If physicians and hospitals are required to bear this cost, they will have to increase the cost to other patients to make up the shortfall. If the professor has been paying attention for the last 20 years, he has probably noticed that has happened: It is called Medicare, and it has so distorted the cost of medical care in this country that it has priced that care out of the reach of many lower and middle income patients who were formerly able to afford it (or who received it from physicians who could afford to provide it at less than market rates).

The problem as Professor Smith sees it lies with allowing health care providers to operate from the profit motive. Is that really the answer: socialized medicine? The American public has looked at that option over the years--and has found nothing in the experience of England, or the Soviet Union, or even Canada--to persuade them of its superiority.

Not a simple prolem, but not solved by exhorting us to make "the ethic of fairness" the determinant for-how we provide medical care to our citizens, or how we license our doctors.

BARRY AUGENBRAUN St. Petersburg

Professor Smith inadequately quotes the statutory and regulatory status of EMTALA and utilizes outdated statistics. Professor Smith suggests that EMTALA has been ineffective on preventing patient dumping and that "judicial enforcement is waning." To support his position, he cited the alleged number of fines between 1986-1992, quoting a 1993 article from the Chicago SunTimes. On the contrary, as of June 1997, there were over 60 investigations throughout the country that resulted in imposed penalties upon hospitals and...

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