From Poder Magazine, Oct/Nov 2012
Life and Casualty
Ask not what your public hospitals can do for you but whether you have enough hospital days left for a life-saving procedure
By Kirk Nielsen
Your name is not Jim Kuhn but if it were you’d have died this past
August, after doctors and hospital administrators failed to provide you
with a heart pump, because your catastrophic coverage had expired.
We like to take comfort that America has “the best health care system in
the world,” and it does have astonishing ways, like heart pumps and
dialysis, to keep us alive. It also has astounding ways to kill us. In
2009, researchers from Harvard University and the Cambridge Health
Alliance determined that 45,000 Americans die each year because they
lack health insurance. That’s more than twice the number of American
troops killed during the deadliest year (1968) of the Vietnam War. “The
United States stands alone among industrialized nations in not
providing health coverage to all of its citizens,” the researchers
The kind of heart pump the 52-year-old Kuhn needed, according to Dr.
Steven Borzak, his cardiologist at JFK Medical Center in West Palm
Beach, is an amazing battery-powered gadget called a Left Ventricular
Assist Device. The pump part is implanted in one’s chest and wired to a
compact control unit worn like a shoulder holster.
As Miami Herald reporter John Dorschner wrote in the article that
broke Kuhn’s tragic story, LVADs “were made famous when former vice
president Dick Cheney received one as a temporary device before he
received a heart transplant.” But cardiologists are increasingly
prescribing the pumps in lieu of transplants. Dorschner quoted Duke
University physician Dr. Joseph Rogers as saying “80-to-90 percent of
patients with advanced heart failure die within a year without LVADs.”
With them, however, patients show a 63-to-75 percent chance of surviving
at least two more years, Rogers added.
The costs are daunting, of course. An LVAD sells for about $100,000. But
that wasn’t the obstacle in Kuhn’s case, according to his doctor. LVAD
manufacturer Thoratec agreed to donate one. The problem was that no
one donated hospital days to Kuhn, a former truck driver.
JFK Medical Center doesn’t do transplants, and when Borzak sought
transplant specialists at the University of Florida’s Shands Hospital
and at Miami-Dade’s Jackson Memorial Hospital, administrators at the two
hospitals refused to admit Kuhn. The rationale: He’d used up his
Medicare allotment of no more than five straight months in the hospital
and had no private health care insurance. Florida’s hospital limit for
Medicaid, for which he also qualified, is 45 days. “Borzak, the
cardiologist, said no hospital wanted to implant the LVAD in an
uninsured man,” Dorschner reported. In sum, Jackson and Sands left a
very sick man to die over concerns about money.
Like heart surgeries, LVAD installations are exorbitant. “The aggregate
costs of such treatments can potentially become high enough to have
adverse effects in other areas of social welfare,” bioengineer Kenneth
Foster and three colleagues from the University of Pennsylvania
concluded in a 2004 analysis. But they also wrote: “It is clearly
unacceptable to deny patients a lifesaving treatment (such as dialysis
The price of extending a life with an LVAD remains high, but is
decreasing. A Duke cardiology study published this year estimates the
average five-year cost for LVAD treatment to be $360,000. “If I were
dying from heart failure I would certainly want to have an LVAD,” Foster
told me recently.
Two days after Kuhn died Jackson Health Systems projected a $35 million
surplus for the fiscal year that started Oct. 1, after being deep in
the red in recent years.
And with the help of bond money, “Jackson leaders hope to plow $63
million into capital improvements,” the Miami Herald article noted.
A small fraction of that $98 million—or even tinier fractions of the
billion dollars in fraudulent Medicare payments that made their way to
South Florida in recent years, or the billion dollars sunk into a
baseball stadium—would have covered LVAD costs for Kuhn and many others.
JHS’s new budget also includes $1.5 million in marketing and
advertising. What a shame. Because no commercial could ever send a more
powerful message than a news story about surgeons defiantly giving Jim
Kuhn a heart pump regardless of his insurance coverage.