Big charity in New Orleans.

In September 2005, Charity Hospital in New Orleans, the oldest continually operating hospital in the US and the safety net for the poorest patients in one of the poorest cities in America, was closed by a hurricane. It is closed for good. ‘Too far gone’ is the recurring phrase in the news. There is brave talk about rebuilding at another site, but the appetite in this country for public hospitals is non existent. The fantasy of the market solution to health problems is still strong. The likelihood of something like a Charity II is zero to nil. The era of the public hospital is over. When I was looking at internships in 1969, I drove with a classmate all over the US visiting public hospitals. Having done much of my training in the largest public hospital in the US, Cook County in Chicago, I knew I wanted to be at a public hospital for my residency. I visited New York, Los Angeles, San Francisco, Boston and then ended my trip at Charity in New Orleans. When the woman at the medical education office gave me a meal ticket for lunch, I was escorted to a doctor’s dining room that was unlike any I had ever seen before — a white tablecloth and silverware setting with black waiters in short white coats and bow ties and a choice of crawfish etouffee or gumbo with a dessert of warm bread pudding. But, other than the dining room, the hospital itself was not a white tablecloth place for either patients or doctors. It was in some ways, even then, an example of the racial and economic contrasts in the American South. Separate wards for black and white patients had been recently merged and the place was, indeed, what its name stated, a charity hospital, where anyone with means would only be caught dead by accident. In the US there has been a long-standing belief that if you get something for free it will weaken your resolve and sap your moral fibre. This attitude leaves large city public hospitals, like Charity, to serve an almost completely medically indigent populations, heavily black or Latino depending on the city.