Friday, Jul 4, 2008
For the great numbers of uninsured, the care may not be bad -- but the wait is.
Oct 21, 1999 | Pablo Benitez's health-care saga began with a small ulcer on his foot. When it broke open and started oozing pus, he guessed it was related to his diabetes so he went to a local hospital for treatment. Once there, he was refused for lack of coverage. Go to County, they told him -- meaning Los Angeles County-USC Medical Center, a 30-mile bus ride from home.
He arrived at County-USC's walk-in emergency room at about 9 p.m. Several hours passed before he saw a doctor in the minor trauma unit; he finally left at 4 a.m. Had he waited much longer for treatment, his foot might not be there.
On a Tuesday afternoon a few days later, Benitez -- a 54-year-old Mexican immigrant -- leans on his cane and walks gingerly down a hallway toward a crowded walk-in clinic. His left foot is freshly wrapped in white gauze. He has come to Los Angeles County-USC Medical Center, one of the nation's busiest hospitals, to make sure that the injury on his foot is healing properly.
Benitez shares his story more with gratitude than frustration. "The process is slow, but I felt that I got excellent treatment," he says through a translator. Unchecked diabetes often leads to amputation, and his blood sugar level had soared to five times normal. But on this follow-up visit, a check-up shows his blood sugar back in the normal range and his foot healing nicely. Benitez is also happy that he can afford this health care. Under County-USC's "ability-to-pay" program, he received hundreds of dollars worth of care for $60 up front. For some, ability-to-pay amounts to no payment at all; the shortfall is ultimately absorbed by the system and thus borne by the public.
At county, nobody gets turned away. Perhaps this is one of the reasons why it has long been a refuge for a growing class of workers, immigrants, seniors and just about anybody who doesn't have health insurance. According to a recent census report, 44.3 million people in the United States are now uninsured -- the highest number in a decade.
"It is very difficult, particularly when funding is being cut back," says Steve Moskey, spokesman for the National Association of Public Hospitals & Health Systems. "It's a time of increasing demand with uncertainty about the level of government funding for Medicare and Medicaid."
Located a few miles northeast of downtown Los Angeles, County-USC is the sprawling flagship of the nation's second largest public health system. This teaching hospital is one of America's biggest "safety net" hospitals. In 1998, it handled more than 700,000 emergency and outpatient visits, most involving uninsured patients.
On any given day, about 500 people come to County-USC's emergency units, for everything from upset stomachs to multiple gunshot wounds. The major trauma unit is so busy with urban violence that Army doctors train here to stay sharp for wartime.
The day-by-day plight of the uninsured, however, is better illustrated by the drab, utilitarian environs of the department's minor trauma and walk-in clinics. "When you're not feeling good and have no place to go," a clerk explains, "this is where you go."
Where you go -- the waiting rooms -- has linoleum floors, fluorescent lights, stale air and about 100 hard blue plastic chairs, most of them occupied from early morning until late at night. At this moment, all but a few seats are taken. Many people have been here since 8 a.m. and now it's noon.
A few patients hold crutches, some are visibly ill, most just look bored. The crowd is mostly Latino, including many immigrants from Mexico and Central America. A few faces are white, a few are black. There are a few other immigrants, too -- a man from Armenia, a family from Korea, a couple from Bangladesh. Hospital statistics suggest that only one in four in this crowd has any form of health coverage -- and only then because they're old enough for Medicare or poor enough for Medicaid (or MediCal, as its California variation is known.) The uninsured, for the most part, are the working poor.
But now they are not working, they are watching a TV that hangs from the ceiling, audible above the quiet conversations in Spanish and English. Some people chat quietly, some read, some listen to headsets with their eyes closed. Everybody waits for the loudspeaker to crackle with their name.
For the uninsured, the worst part about being treated at a place like county isn't the care itself, it's the hours and hours it takes to get the care. As one guy in the waiting room, complaining of a stomach virus, puts it: "It's got to be something real serious for them to take you in front of everybody. You've got to be cryin', half-dead."
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