Waiting room

All emergency rooms have their war stories, but County-USC's are better than most. Inside the minor trauma unit's "stretcher" hall, Dr. Gail V. Anderson, chief of emergency medicine, points to the spot where a suicidal man who had leapt from the 12th-story roof crashed through the ceiling, landing on a gurney. He suffered remarkably few injuries, and was treated on the scene. Six months later, Anderson says, the man jumped from the opposite side of the roof, avoiding the emergency room, and completing his objective.

After 41 years at County-USC, Anderson has witnessed more than his share -- and aside from the odd suicide mission or hostage stand-off, he has also seen two generations of social change in health care. Before becoming founding chairman of the Department of Emergency Medicine in 1971, he oversaw the obstetrics and gynecology department for many years. He remembers the frustration of being unable to save women who came in suffering infections from illegal abortions -- horrors that helped fuel a movement that reversed society's attitude toward abortion. Now he wonders if rising anger over managed care and the increasing numbers of the uninsured will prompt more dramatic change.

To be uninsured and face huge hospital bills is to risk financial ruin. But what if American health care has changed so much that the uninsured, after all that waiting, receive superior care?

The medical culture of a public teaching hospital such as County-USC, trauma unit doc Orlinsky suggests, is more conducive to proper treatment than the business culture of the HMO. "I've got a tremendous amount of pride that we will do what's right for the patient," he says. "When medicine becomes a business, there's a real problem. At a hospital like this, patient care is patient care ... Nobody says to me, Orlinsky, you can only spend this amount of money on a patient."

Even if the phrase "socialized medicine" sends the American Medical Association into toxic shock, the managed-care mess is making many doctors reconsider a national health program. "I feel we have our priorities wrong," Anderson says. "I think the money we spend going to the moon is not that important -- not when we have people on the streets and people in need of care. We need a plan where everyone has access to care. But I'd like to see it run efficiently. I guess that's an idealistic world."

Today, incremental approaches to expand Medicaid and Medicare are the focus of most initiatives addressing the uninsured. A recent study by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured last summer found that of 11 million uninsured children, 43 percent were believed to be eligible for Medicaid but not enrolled, and another 27 percent may be eligible under the Child Health Insurance Program (launched in 1997); that adds up to 7.7 million children. "Finding improved ways to make families aware of these benefits, to simplify the enrollment process and to reduce barriers and stigma, are critical to reducing the number of uninsured children," the report concluded.

To some, however, such stats are only proof that incremental approaches don't work. For health care to be regarded as a right, Physicians for a National Health Program's Hellander says, it may require a social movement akin to women's suffrage or the civil rights movement of the 1960s. The uninsured, she says, are "stoic" when they should be angry. After all, public money underwrote the training of every doctor and the construction of most hospitals. A wisely administered national plan would make for a healthier population at lower public cost.

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Inside the walk-in clinic at County-USC, it's hard to tell the stoic from the glum. Now it's nighttime and the TV is tuned to "Buffy the Vampire Slayer." It is just as crowded as it was at noon, though a few seats have opened up around a disheveled, sad-looking soul who looks as though he hasn't bathed in weeks. There's something oddly beautiful about this, just to know that, here, even bums don't get the bum's rush.

As before, the mood appears calm. But sitting in the front row, Donald Feagin admits that his patience is wearing thin. This is his sixth hour of waiting. His head hurts, his allergies are a nightmare and he has a stomach virus. He isn't grumbling about the state of American health care, but the quality of the room's speaker system. When Feagin complained to a clerk about the delay, he was told that his name had been called a half-hour earlier -- he just didn't hear it. Now Feagin worries that he wouldn't be seen before midnight -- and he has to get up at 4 a.m. for work.

In this waiting room, most of the faces are unfamiliar. But Jason Funk is still here in his backward baseball cap, his visit approaching 12 hours, just as he had predicted. It might have been shorter, he says, but the first doctor sent him upstairs to a specialist. Now he's waiting for his prescription to be filled.

Funk says he is a recovering drug addict who is now in a church "discipleship program" that provides him lodging and meals. Even now, after the long wait, Funk's mood seems buoyant beyond reason. But then he explains why.

"I talk to people," he says. "I get to share Jesus with them."

After decades at County-USC, Anderson doesn't see any change happening until there are more doctors. In the meantime, he empathizes with those in the waiting room. "I'm amazed by their patience," he says.

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