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November 4, 1992

America's Safety NetThe Wrong Place at the Wrong Time?

Author Affiliations

From the Division of General Internal Medicine, San Francisco (Calif) General Hospital (Dr Bindman), and the Department of Family and Community Medicine (Dr Grumbach), and the Institute for Health Policy Studies (Drs Bindman and Grumbach), University of California, San Francisco.

JAMA. 1992;268(17):2426-2427. doi:10.1001/jama.1992.03490170098033

THE PLIGHT of Americans without adequate access to health care captures public attention when vivid instances of human suffering occur. In the 1980s, there was public outcry over "patient dumping" in response to numerous reports about uninsured patients dying after being refused care at private hospital emergency departments.1,2 Congress and many state legislatures responded by enacting strict sanctions against the transfer of patients in unstable condition. Absent media stories about patients "dying in the streets," the sense of urgency about problems of access to care tends to dissipate. It becomes easy to believe that a safety net is in place and that care is available for all Americans, even the poor and uninsured, when they really need it.

The article by Weissman et al3 in this issue of JAMA confirms the presence of a health care "safety net" for the poor, but suggests that low-income patients may not