Hill-Burton Enforcement: A Proposed Remedy to Cure Hospital Inertia;Note

OF THE UNITED STATES: 1986, at 109 (106th ed. 1985). 11. Health expenditures amounted to $1,721 per person in 1985, with 59 percent coming from the private sector, mostly through private health insurance and from consumers and their families. The remaining 41 percent was funded through government programs, principally Medicare and Medicaid. See Levit, Lazenby & Waldo, National Health Expenditures, 1985, 8 HEALTH CARE FINANCING REV. 1 (1986) [hereinafter cited as National Health Expenditures]. 12. The amount spent on health care in 1985 equalled 10.7 percent of the Gross National Product. Id. at 8. 13. Federal payments amounted to $124.4 billion, and $50.4 billion came from state and local governments. Public programs financed 39.7 percent of all personal health care expenditures, including 53.8 percent of all hospital care, 29.1 percent of all physician services, and 46.9 percent of all nursing home care. See id. at 13-17. 14. All third parties combined-private health insurers, government, private charities and industries-financed 71.6 percent of the $371.4 billion spent for personal health care in 1985, covering 90.7 percent of hospital care services, 73.7 percent of physicians' services, and 42.1 percent of the remainder, which consists of those personal health care expenditures other than those for hospital care, physicians' services and nursing home care. See id. at 16-18. 15. See K. DAVIS & C. SCHOEN, HEALTH AND THE WAR ON POVERTY: A TEN-YEAR APPRAISAL 9 (1978) (group insurance policies provided by employers have lowered premiums and increased access to insurance for those in lower income brackets, but many indigents have no jobs, and thus do not have this access to low-cost insurance). 19871 Hill-Burton Reform had been shut out of the medical market. 16 Private insurance companies, however, are reluctant to write comprehensive health insurance policies for the poor, who, because of their multiple health problems, are considered a bad risk.17 Even for those who can afford it, the typical medical insurance policy provides only limited coverage. 1" Since Medicare and Medicaid came into being in 1966,' 9 access to medical care for the people eligible to receive it has markedly improved. Eligibility standards for Medicaid, however, exclude a great number of people. 1 Because of Medicaid's multiple criteria for eligibility, about 12 million people with income below the federal poverty 16. Unlike other goods or services for which the consumer pays the provider directly, health care payments are often handled by a financial agent, a third party. Insurance has increased access to care, resulting in the increase of care for those who usually could not afford it. See Gibson, Levit, Lazenby & Waldo, National Health Expenditures, 1983, 6 HEALTH CARE FINANCING REV. 11 (1984). 17. The poor bear many social costs imposed upon them by a negligent society. These result in poor health, which the indigent are largely unable to avoid. The poor suffer from the high risks of injury, sickness, or poor health they incur in risky and physically demanding jobs or through industrial pollution and waste in the communities in which they live. Additionally, poor health prevents the disadvantaged from competing equally in the marketplace. Oftentimes the disadvantaged are handicapped from birth, off to a slow start because of inadequate care and nutrition during pregnancy. Poor health care during childhood and adulthood is recognized as causing a rapid loss of functional ability, and this loss becomes even more apparent as people move into middle and old age. Because of the poor health from which the indigent suffer, insurance policies for the poor are usually limited in benefits and require the payment of a premium far in excess of the expected benefits. Often riders attached to policies give companies the option of dropping coverage should the beneficiary become a poor risk. For the disabled poor or those with obviously identifiable poor health, companies are unwilling to provide any coverage at all. K. DAvIs & C. SCHOEN, supra note 15, at 810. 18. For an informative discussion of the nature and extent of private health insurance coverage, See A. SCHNEDER, AN ADVOCATE'S GUIDE To HEALTH CARE FINANCING 138-83 (1980). 19. Medicare is the popular name for Title XVIII of the Social Security Act, 42 U.S.C. §§ 13951395pp (Supp. 1975). It was enacted as part of the Social Security Amendments of 1965 to provide health care benefits to eligible aged persons, and became effective on July 1, 1966. Medicaid is the popular name for Title XIX of the Social Security Act, 42 U.S.C. §§ 1396-1396i (1974). Like Medicare, Medicaid was enacted as part of the Social Security Amendments of 1965 to provide health care benefits to eligible low-income and lower-middle-