Starved for funding, public healthcare is collapsing

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Nothing is more powerful than an idea whose time has come, and no idea is pressing more insistently on people's consciousness than national health insurance. For all but the wealthiest segment of our society, this is literally a question of life or death.

From the comfortable middle class, who can be devastated by medical bills of thousands of dollars, to the poorest citizens who must wait eight hours to get a fiveminute session with an exhausted intern, everyone knows there is something terribly wrong with the American system of healthcare.

Almost daily, the newspapers publish horror stories. On April 11, the New York Times showed its readers how the Medicaid system works in a run-down Chicago neighborhood.

Medicaid is the system that supposedly guarantees our poorest citizens good medical treatment. Twenty million people, including 13 million children, depend on Medicaid to keep them healthy.

Doctors are paid by the state and federal governments to treat these patients who cannot afford private health insurance. Doctors are also paid under another program, Medicare, to serve patients over 65.

The fees paid doctors for Medicare patients are low, but the elderly patients are expected make up the shortfall out of their own pockets. This is the dreaded "medigap" that impoverishes so many retired people.

Doctors who treat the poor under Medicaid are paid even less: 48 percent to 69 percent of Medicare payments-and there is no opportunity to collect anything from their impoverished patients. As a result, physicians are quitting the Medicaid program in droves.

"Writing off the poor' The result can be seen in the city-operated Neighborhood Health Center on Chicago's North Side. Dr. Claudia M. Fegan will not take any new Medicaid patients.

She loses money on nearly every one. But she wrestles with her conscience, she says. She puts the blame on federal and state governments who won't fund the program adequately. "Now they are writing off the poor with new budget cuts." she says.

The "written-off" poor can be observed five days a week at the North Side clinic. They line up outside the door long before the 9 a.m. opening hour. Between 500 and 700 patients a day try to see a doctor. There used to be seven internists; now there are only four.

One patient said she had to wait an hour to see a nurse and three more hours to reach a doctor. All she wanted was a routine shot for her baby.

Doctors are also kept waiting—waiting for the small stipend the government pays for each patient treated. Often a claim has to be submitted three times while the bureaucracy checks for fraud. Final payment is often delayed three months or more. This is additional incentive for doctors to quit the system.

A liberal physician, Dr. Quentin Young calls his policy of limiting Medicaid patients a mix of "reality and shame;" reality that he cannot stay in practice on Medicaid income, and shame that he has to turn away sick people.

"The health status for people represented by Medicaid is declining," he said. "It is a reflection of the powerlessness of the poor, and the hardening of the heart of America that is ominous."

Cutbacks worsen the misery Meanwhile, Californians are seeing their hospitals close for lack of public funds. "Health agencies face the worst cuts in memory," proclaims a San Francisco Chronicle headline on April 15. Moreover, the paper reports, more than half the Los Angeles County hospitals will be forced to close this year unless they get increased funding.

In Alameda County, Calif., where patients already wait three months to see a dentist and two years to get in a drug treatment program, a further $7 million cut is proposed. Pediatric services have already been cut back to the point where babies must wait a month for a checkup. Adults must wait seven months.

A health worker in Los Angeles commented, "You can't cut any more out of our budget and still call it a health sysmillionaires.

A much smaller story below concentrated on Gorbachev's warning to "secessionists," and only mentioned in passing that he made it on the same day that 50 million workers struck in the Russian Federation. Neil Sears, Alto, Calif. liver healthcare under these circumstances was summed up by an observer: "I see t00 many practitioners whose eyes reflect hopelessness and despair."

Such despair might be expected among rescue workers confronting famine in Africa, but this health crisis is taking place in the richest country in the world. Unlike Africa, the resources to treat every sick person in America already exist. Hospitals are standing idle, wards are being closed, and workers are being laid off, while sick people are begging for treatment The Bush administration has no interest in a national health plan. Bush wants to push the whole problem onto the states. State governments push the burden onto the counties, where authorities give up entirely and close the county hospitals. This leaves the poor with absolutely nowhere to go.

American working people will not tolerate this situation forever. Many are looking next door to Canada, where a national health plan serves every citizen. "If the Canadians can do it, why can't we?" Americans are asking. Why should we be the only major industrial nation (besides South Africa) without a national health plan?

As the scandal of poor Americans dying needlessly spreads, the pressure for adequate healthcare will become an irresistible force. The immovable object in this case is the profit-motivated health industry and their political agents in Washington. They can and must be pushed aside by the power of aroused people determined to save the health of the nation.