Making tough decisions on charity care

As I read over the discussion on whether hospitals should ship medically-indigent immigrants back to their home countries, it occurs to me that most of the back-and-forth avoids discussing the central issue. And the issue, my friends, is this: Just which patients are covered by the tax break provided by the federal government to non-profits? We need to discuss that explicitly if we want to be honest about the choices we're making.

Look, on the one end, few would argue that a poor, sick, pregnant mom who'd been abandoned by a shiftless husband would deserve free care until she got on her feet. On the other, if a gunman came into a non-profit hospital's emergency department and demanded free care, nobody would feel he deserved it for one second longer than he needed it to survive the trip to a prison ward.

People who are uninsured but able-bodied, on the other hand, fall into a gray area of many people's compassion zone--and those who are uninsured, able-bodied undocumented immigrants even more so. While I'm not suggesting that any hospital administrator wants to see undocumented immigrants die or even be harmed, some may feel--personally as well as professionally--that such people are not their responsibility.

I'm not writing this column to take up a discussion of who's a more worthy recipient of free care, particularly given that immigration is a sensitive and personally charged matter for many. What I am suggesting, however, is that it's time we take the decisions we make regarding people's costly, uncompensated care--including, but not limited to brain-damaged immigrant workers--and make them more rational.

If such is where you stand, why not put it right out there and make the hard decision that you don't invest scarce charity dollars on foreign nationals beyond a certain point, define that point, and be consistent from case to case. Rather than turning such cases into political footballs over and over again, skip agonizing and politically-driven decisions from both pro- and anti-immigration forces. Then, you won't struggle over such patients any more than the other tough decisions you have to make.

Otherwise, if you aren't willing to decide, clearly and firmly, that an undocumented patient should be paid for by someone else, turn your focus to Congress and see if you can't force those wise men to pay for immigrants who are uninsured. Meanwhile, assume that you're going to be paying for such catastrophic cases and dig into how you can do so. I know it's extremely difficult, but at least you know what side of the fence you're on. Staying in the middle just gives you splinters. - Anne