Coming Soon: The Unfinished Business of Health Care Reform

Failure to Thrive: Hope and Reality at Grady Memorial and America’s Great Public Hospitals

Expected publication: Early 2016

Henry W. Grady Memorial Hospital is a fixture in Atlanta, built and chartered by the city in 1892 to provide care to anyone who needs it. Over the years Georgia’s largest public hospital has earned a reputation as one of the nation’s best teaching hospitals. But it also was a place so rife with political mismanagement that it nearly had to close its doors in 2007.

Many of Grady’s counterparts around the country – iconic places we know by their first names like County in Chicago, Parkland in Dallas, Jackson in Miami – have been through similar turning points and survived. Yet how these hospitals operate, who pays for them and how they fit into the nation’s $3 trillion-a-year health care system, is a mystery to most of us.

Through the prism of Grady, Failure to Thrive explains the unique history of America’s large public hospitals, as well as their continuing challenge. More importantly, it is story about how the poor are cared for in the United States.

In a country that has yet to determine whether access to basic medical care is a right or an earned privilege, these hospitals bear the burden of that indecision. Indeed, their very existence makes it easy to avoid the discussion altogether.

That’s because the people who show up in the emergency rooms and clinics of America’s public hospitals represent the gaping holes, the ill-conceived compromises and the unintended consequences resulting from decades of attempts to reform health care in our country.

Even now. Even after the Affordable Care Act, the latest contentious effort to make health insurance more available to Americans without it. The 2010 law – subject to so much litigation at the federal level and ideological obstruction at the state level – still leaves millions of Americans behind when it comes to getting the health care they need, especially among residents of the South, where state leaders have a history of eschewing federal programs aimed at helping the poor. These patients will continue to turn to Grady and Parkland and County and Jackson and dozens of other beleaguered last-resort providers for the care they need and deserve.

Failure to Thrive makes the case that these hospitals represent more than a frayed safety net for the poor; they have become a safety valve for the nation’s highly profitable health industrial complex.

They exist, not just to take care of the poor but to relieve others from the challenge to profits that poor people represent. And because they exist – indeed, many, like Grady, have been around for more than a century – we seem content to take them, and the essential services they provide, for granted.

Public indifference toward large public hospitals can be understandable for nearly all of them have had years where they failed badly in their mission. Many, like Grady, have had to overcome financial improprieties and political interference. Others have been scandalized by horrific treatment of the very patients they were chartered to help.

But know this too – America’s public hospitals are remarkable at survival. Some of the best and brightest minds in medicine, public health and administration are committed to the cause of caring for the poor. And, despite the financial constraints under which they are forced to function, many of them are providing state-of-the-art services for indigent and paying patients alike.

These hospitals are sentinels to the future of health care in America and, ultimately, how our country treats the poor. Knowing more about them will improve the ongoing discussion of health care reform as we move forward.


Mike King, the author, is a retired health policy reporter, editor and columnist for The Atlanta Journal-Constitution.

Secant Publishing, Salisbury MD, expects “Failure to Thrive” to be available in early 2016.