Dr. David Ansell on lessons from Chicago

By Ellen R. Hale
Louisville (Ky.) Medicine, April 2012

David A. Ansell, MD, MPH, visited Louisville in January to offer evidence from his long career as an internist in Chicago for a one-card national health program. Author of the recently published book “County: Life, Death and Politics at Chicago’s Public Hospital,” Dr. Ansell delivered a lecture to University of Louisville medical students and another to the general public. He also spoke at Grand Rounds for the Department of Family and Geriatric Medicine and the Annual Meeting of Physicians for a National Health Program-Kentucky.

Dr. Ansell criticized what he called the “death gap” in the United States – the difference in life expectancy of the insured versus the uninsured. “You can’t explain this by biological differences. The death gap is an issue of poverty, race and lack of insurance,” he said. “As a doctor, it’s completely unacceptable that people should die early simply because they’re poor.”

Dr. Ansell arrived at Cook County Hospital in 1978 for training and worked there 17 years. He then worked at Mount Sinai Hospital, a private safety-net hospital, before his current position as chief medical officer at Rush University Medical Center.

In 1986, he and several colleagues published an article in The New England Journal of Medicine titled “Transfers to a Public Hospital” documenting that 87 percent of patients transferred to County from other emergency departments lacked insurance. Many were unstable at the time of transfer. The article on “patient dumping” drew national media attention and led to Dr. Ansell’s testimony before Congress.

“We were doctors by day learning medicine but at nighttime saying, ‘OK, what are we going to do to keep the hospital open?’” he said. “It’s one thing to be all high and mighty about policy, but when you have a patient in front of you who needs something and you need to overcome the hurdles to get that patient treated, you can’t help but be moved.”

Through a breast cancer screening program he started, Dr. Ansell has found that mortality rates have decreased for white women while staying the same for black women. The Metropolitan Chicago Breast Cancer Task Force is seeking to decrease the disparity by improving the quality of breast cancer screening and care for minority women.

“We have a system that’s completely dependent on whether you have a card or not and what your card says,” Dr. Ansell said. His solution is a one-card “Medicare for all” system, which would be completely private with low administrative costs. He was critical of the Affordable Care Act for expanding Medicaid, which “doesn’t pay doctors,” while failing to address the inequalities in health care coverage that affect the ability to access services.

Asked about the debate in Louisville surrounding University Hospital, Dr. Ansell said that without a national solution, there will need to be a state or local solution. He suggested a hospital tax based on the amount of charity care performed, with revenues going to providers of indigent care. “Many hospitals that serve poor people are struggling to stay open not because of the capability of the administrators, the doctors or the nurses, but because of the design of our health care system and the way that it’s funded,” he said.

Dr. Ansell recognizes that the right to health care remains a political issue among the American people. Until it’s a right, and not a mandate and not a privilege, he said, inequality will persist.

Ellen R. Hale is the communications associate for the Greater Louisville Medical Society. Louisville Medicine is one of the society's publications.