ABSTRACT
“Medical care,” the surgeon Robert M. Sade approvingly noted in the pages of the New England Journal of Medicine in 1971, “is neither a right nor a privilege: it is a service that is provided by doctors and others to people who wish to purchase it.” 1 As a description of the status quo, the sentence was partially correct: despite progress—for instance, the broad expansion of healthcare access achieved by the creation of Medicare—there was no universal right to healthcare in the United States in that era (or indeed, today). And at that point, hospitals and doctors could even more or less turn dying people away from their doors, charitably shuttling them to public institutions with the expectation (one hopes) that they wouldn’t die en route. Such so-called “patient dumping” apparently become more prevalent during the 1980s. 2 Consider this example from that decade, as described in the Journal of the American Medical Association:
[A] patient transferred to Cook County Hospital in Chicago was a 41-year-old man with gunshot wounds to his head, chest, and abdomen. He was in a coma and on a respirator. The reason for the transfer was that he had no insurance. 3
