Sliding Scales

In most instances of government or social service programs, sliding scales attempt to nail down the supposedly precise point where you fall in the topsy-turvy and nonsensically arbitrary world of socioeconomic status, and what that status qualifies you for or denies you of. In this realm, many who would not categorize themselves as poor are well below poverty line, and many who are deemed wealthy would have a bone to pick with you for the mere suggestion. One way or the other, an external force applies a framework within which all must maneuver to gain benefits.

Locally, Grady Health Systems provides a sliding scale fee schedule for health care services. Grady utilizes a formula based on the Federal Poverty Guidelines to determine the percentage patients must pay for services rendered. First you need to demonstrate you are a resident of Dekalb or Fulton county (all others get a lesser discount) by bringing three recent utility bills, business mail, or a government ID with an address on it. Y si no tienes documentos de estatus legal, no problema. Based on your income, or documented lack there of, Grady will determine what to bill you. If you earn $10,201 or less a year, the visit is free except for a three-dollar co-pay (if you are homeless with shelter documentation you are exempt from the co-pay). Someone who makes around $50,000 but doesn’t have insurance will receive a 50 percent discount off services rendered and a three-dollar co-pay. Grady looks at each case individually and has numerous brackets, depending on the percentage of federal poverty guidelines you earn, that determine your discount. If you don’t have anything except the co-pay, Grady will set up a payment plan.

Now that Grady is a not-for-profit entity and seems to have weathered its most recent financial storm, the new status will (fingers crossed) enable it to keep providing services for the poor (self-defined and otherwise) in Atlanta. Although some changes might be coming down the pipeline, the generous fee schedule is unlikely to change significantly. Non-profit status should help bring in lots of dollars to operate a system that in any other situation would be unsustainable.

Why don’t all clinics and hospitals use a sliding-scale? “From each according to their ability to each according to their need” just doesn’t pay.