February 2, 2006

I find it stunning that, in this promise-everything-to-everyone political climate, we have made medical care virtually unavailable to 20% of our citizens.

Unwilling to compromise the universality of Cat-Scans and $1,000 a day prescriptions, we have no basic medical care for poor mothers with sick children, other than emergency rooms at whatever might be their nearest hospital.

The rich are different than the poor and always have been. There’s no shame in that, it’s what being rich is all about. If there were no difference, why would anyone bother becoming wealthy? But because that reality doesn’t play well in the OZ world of American politics, we are destined to have the least effective health care for the highest costs in the world.

Forty to fifty million without care is despicable, a morally reprehensible state of American medicine that led the author, James Michener, to opt off the dialysis machine that kept him alive. Michener ultimately found it impossible to claim as his own that limited availability at an advanced age and to another renal patient's detriment. Unsaid, was that the other patient was not so well known and famous as himself. He died a week later, as he knew he would.

Emergency Rooms have become the doctors’ offices of last resort for the poor. ERs can’t turn people away or stop taking new patients, like a doctor’s office. Federal law requires hospital emergency rooms to treat all who seek admission, regardless of their ability to pay. People who can’t afford to see a doctor, or don’t have a doctor to see, take their problems to the emergency room and, even at that, there are continuing horror-stories of those turned away.

"The growth in ER use is a manifestation of a delivery system for primary care that’s breaking down," says Ken Rutledge, president of the Oregon Association of Hospitals and Health Systems. "People don’t have anywhere else to go."

Dr. Martin Tice, a veteran of 22 years in the Providence ER, puts it more succinctly. "The ER," Tice says, "is the clinic of last resort."

Okay, so what am I driving at? That we shouldn’t have some sort of contrived equity over health care? You bet. That’s exactly what I’m saying.

The rich, god bless ‘em, have always had it better than the poor. Somehow in this country, we never felt the need to make public housing equitable. The rich bought their own mansions and the poor got housing projects and no one even considered that unfair. We never refused to build low income housing because it was impossible to have have four bedrooms and three baths.

The rich drive new cars and the poor make do with used, wealthy kids go to Harvard and ghetto students go mostly to community-colleges and then maybe on to university.

Only in health care have we so wrecked our perspectives. If we recognized and accepted the fact that access to health care, like all other public access, is available unequally, then perhaps we could begin to provide it.

A nationwide system of clinics for the poor would drastically improve child health care, substantially alleviate the additional health problems that accrue to young adults as a result of this short-sightedness, while improving all other aspects of youth-opportunity.

Healthy kids do better in school and achieve more in all life goals than sick kids. Don’t fool yourself for even a moment that those 43 million Americans without health insurance are not mostly from the bottom slice of income.

It’s laudable that Jim Michener slid over a seat to give someone else a chance to live. He did it at the age of ninety-five, but he was altruistic nonetheless, having been stricken with renal failure very late in life. The irrefutable fact though, is that he made way for someone else who was richer than the average.

Bringing the same reality to health care that we regularly bring to housing and food stamps and the economic realities of American life, may finally set us on a path to providing fair and equal baseline standards. Everyone in this country needs access to decent clinical medicine. The rich, as they always have, can provide an additional layer of medical elegance for themselves.

Leaving millions of poor children to the vagaries of emergency rooms as the medical option of last resort is criminally shortsighted. This isn't some bleeding-heart liberal assault on medical insurance. It's common-sense realization that America is a nation of unequals and it's time we began to recognize that as a strength rather than a weakness.

Only then will we be able to afford the health care the nation deserves.

Get out of the Archives and read what Jim's writing today