Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, June 5, 1990 TAG: 9006050442
SECTION: EDITORIAL PAGE: A-7 EDITION: METRO
SOURCE: Bob Willis Associate Editor
DATELINE: LENGTH: Medium
Until last month. I went to Atlanta to visit relatives and discovered some of those 37 million right in my own family circle.
Audrey, 35, a niece, is married to David. They have two lively and handsome little boys. The couple is buying a nice home in an Atlanta suburb; they are solidly middle-class.
David made a good living as a long-distance truck driver until his company, caught in the fierce competition among trucking firms, had to retrench. As the most recently hired, David was the first to be laid off.
He was able to catch on with another company. Then a man who'd been working in the trucking firm's lot decided he wanted to go back on the road. David was bumped again. He was offered the lot job, but that didn't pay enough to support his family.
Next came an offer from another trucker who said he needed full-time drivers. But it was only a few days before the boss admitted those he'd taken on, including David, were meant to be only temporary hires.
David couldn't wait around to see what might happen. He took a job with still another company where the prospects of latching on permanently looked better. He's driving long-distance again, not making as much as he had before, but hoping things will improve.
He's a hard worker with a good record. But at 40, his job prospects are not what they used to be. He can't moonlight at other work because a driver's hours are so irregular. And until he has a permanent job, he, his wife and their children have no health insurance. Like most middle-class people, they can't afford to buy it if their employer doesn't furnish it for them.
No special pathos or drama to this little story. They've been lucky so far: They and their youngsters are healthy. They've had no serious illnesses, no accidents for which they'd need hospitalization and other costly care.
But if their luck doesn't hold, their world could turn upside down. They could be faced with tremendous bills, compelled to accept charity care or assume burdensome debt - perhaps even give up their home. They're among the 37 million periodically out in the cold in a country that offers most of its citizens the best health care in the world, while the rest get whatever is left over.
An earlier article on health care brought a thoughtful letter from Dr. Wayne B. Wheeler, director of emergency services of U.S. Health Corp. of Southern Ohio in Portsmouth, Ohio. He said in part:
"Many of us in the field believe that the United States does enjoy the finest health-care delivery system in the world. Certainly issues such as infant mortality, longevity and the like can be raised to dispute that belief, but many believe those figures relate to the overall standards of living and society at large, rather than the health-care system itself.
"As an emergency-room physician, I work in the part of the hospital that has become the last safety net for the 37 million Americans unable to afford health insurance. Nearly one-third of my patients make no payment on their health care, are not funded by federal insurance of any sort, and have little hesitation about presenting to the Emergency Department . . . a wide variety of trivial complaints for which clinic care would be appropriate and for which clinic care is available, but requires waiting for the care to be delivered.
" . . . [U]nder the Comprehensive Omnibus Budget Reconciliation Act of 1988, no emergency department can turn any patients away without stabilization and arranging of appropriate transfer and care. This necessitates our seeing every patient who presents to the department, when they present. . . . Certainly nursing triage helps channel this flow, but it can only go so far.
"I, like you, do support pressing the individual consumer into more responsibility for medical bills. Certainly the tendency on the part of our politicians to oversell their constituents on all the benefits the government can provide them has, in part, helped us to the current crisis."
I did not know of the provision Dr. Wheeler mentions in the 1988 law. Such a safeguard for the patient - especially in a time when so many cannot guarantee payment for urgently needed care - makes sense to me.
But while that may prevent hospitals from simply turning people away, it surely places a large burden on the front-line providers such as emergency-room physicians and nurses. It is easy for lawmakers to mandate care, but unrealistic unless the means of care and the funds to pay for it are unlimited. They are not and never will be.
by CNB