In Harris County, it's a reality (as for other places around the country). With 40 million in America unable to afford healthcare, this is quickly becoming a tragedy of mamouth proportions. <i>Medical emergency for 800,000 Survey maps out large areas of Harris County that lack basic health care services for the poor By STEVE BREWER Copyright 2002 Houston Chronicle Poor folks don't have sufficient access to medical care in a huge chunk of Harris County, a new report shows. The problem not only threatens the welfare of hundreds of thousands of people, it also strains the emergency rooms where these sick turn as a last resort, according to a coalition of health and government officials, medical care providers, civic activists and religious leaders that spent two years investigating. The situation described is not unfamiliar to politicians and others who monitor the state of health care -- too few clinics that provide basic and preventive care for the poor, too many doctors who turn away patients with empty wallets. But now there are numbers to match the anecdotes. Gateway to Care, a coalition representing more than 70 public and private entities, identified 18 geographic areas without enough basic health care. Some of those neighborhoods, most of which lie in a wide swath of Houston, include large numbers of residents who have doctors nearby, just not the kind who treat people on Medicaid or with little or no insurance. The group's study shows that more than 786,000 people in Harris County live in these neighborhoods. "This shows getting primary care for people at or below the federal poverty level is like playing football with one hand behind your back," said Ron Cookston, Gateway to Care's paid director. "Everyone is running, and everyone is working hard. But the resources just aren't there, and Houston is so big that maybe they never will be." Gateway to Care was formed, with that in mind, in May 2000 when city and county health department officials met with the Harris County Hospital District, Baylor College of Medicine and the University of Texas at Houston Medical School to discuss the crush of patients in local emergency rooms who should have gotten help sooner. The first challenge was to identify the problem. The report has already led the U.S. Department of Health and Human Services to declare 18 neighborhoods either medically underserved areas (MUAs) or dominated by medically underserved populations (MUPs). Cookston expects the same for five more areas now under study. The designation eventually could mean more federal dollars for primary care for the poor, provided that local officials and neighborhood activists rise to the challenge, he said. Success also hinges, Cookston said, on local and federal officials dismissing the notion that Harris County residents don't need federal help with primary care because they live in the shadow of the Texas Medical Center. That was one reason such a wide-ranging study had never been attempted before, said Cookston, whose group is funded by a mix of public and private money and supported by resources provided by the hospital district and other local governments. "People really didn't think we could qualify (for the designations) when they just looked at things on the surface, because we have so many physicians and so many health-care facilities," he said. But it was a problem health-care providers started seeing years ago, something Sister Rosanne Popp sees every day. She's a nun and family practice doctor who works at the Christus Southwest Community Health Center, 6441 High Star, a place in the Gulfton area that treats patients often turned away by other doctors. "If you can pay out of pocket for treatment, there are a lot of places you can go," she said. "But if you're someone who works out in the yard, cleans the pool or cleans a house, that's your rent money. Those people just don't know where to go." Popp, who said her clinic treats many illegal immigrants, sees a lot of patients suffering from chronic conditions such as diabetes or hypertension. They often ignore symptoms until they become debilitating. Many times, often because of language and cultural barriers, they haven't followed the regimens recommended by doctors. The same is the case in the East End area that encompasses Ripley and surrounding neighborhoods near Navigation, where Mary Jo May is part of a group trying to improve access to primary care. "Here, lots of people use an ambulance for transportation when they have a health problem," said May, who works at Centro de Corazon, a nonprofit health center that provides childhood intervention services and programs for the mentally ill. "These people are using the ER as their primary health care." She described the dilemma many of the poor face. "You take a sick kid to the bus on a day when it's 100 degrees so you can make it to the doctor, when you have three other kids to watch," she said. "You're just not going to do it." Despite what May and Popp see, it is perhaps understandable why things would look fine to outsiders, according to the study. There is one physician for every 524 residents in Harris County, compared with a statewide ratio of one per 699. The Medical Center houses two prestigious medical schools and the University of Texas M.D. Anderson Cancer Center. There are taxpayer-supported county and city health departments and psychiatric centers. There is the hospital district, which gets close to $400 million a year in support from local taxpayers. There are 68 clinics that offer different services to the insured, the uninsured, the poor, the middle class, the mentally ill, the elderly, children, people on Medicaid and illegal immigrants. In addition to hospital district facilities, some local nonprofit hospitals provided more charity care than they were required to in 2001. Private hospitals in Texas must provide the equivalent of 5 percent of their net revenues in charity care. Cookston's numbers show, for example, that St. Joseph's Hospital devoted 14 percent to charity care in 2001 and Memorial Hermann 20 percent. But even that does not tell the whole story. Many of the doctors factored into the local ratio are engaged in research and academic work; others don't see poor patients. Most of the local clinics -- ones run by public, private and nonprofit concerns -- are overwhelmed. And while there are lots of specialty clinics, only 12 focus on primary care -- the practice of treating a case of the sniffles, for instance, before it turns into a raging fever that leads someone to an emergency room. In many clinics it takes weeks to get an appointment, and when someone can find transportation, he or she usually will wait two to three hours to be seen. Among all the clinics in the county, only one is a designated "federally qualified health center," a primary care outlet for the poor supported by federal dollars and run, in large part, by the people who use it. That embarrasses some local officials. County Judge Robert Eckels said it presents an opportunity to create more of the federally qualified clinics and take other steps. "This is the only way we're going to reach many of these folks," said Eckels, who along with other members of the Commissioners Court is backing Gateway to Care and pushing for more of the centers. "And this makes sense because it's always good to have the users of these facilities involved in the decisions that dictate how they get treatment." Cookston estimates that private hospitals won't be able to sustain the level of charity care they have been giving. Public facilities are overwhelmed, too. Officials only now are hiring medical traffic cops for the poor -- telling them where to go and urging them not to clog emergency rooms, where 60 percent of the patients are seeking primary care and forcing doctors to routinely divert ambulances and make life-threatening delays in transferring critically injured patients to trauma centers. And, as Gateway to Care emphasizes, there are a lot of people in the county who need help. One of every 32 uninsured Americans lives in Harris County or a surrounding county, according to the report. Of the 3.4 million people in Harris County, officials estimate that at least 22 percent have no medical insurance. The proportion is roughly the same in the surrounding counties, and that plays into Houston's medical woes because those people come here for help. There are significant pockets of poverty here, places where families of four live on $18,000 or less a year. Gateway to Care estimates there are at least 650,000 people in the county who don't have what's called a "health home" -- a convenient place where they can get primary care. Despite the success in recent years of efforts to get children enrolled in state and federal plans that would provide them with insurance, there are still 100,000 children in the county without any kind of coverage, according to Gateway to Care. Cookston argues that many of their parents were probably moved off Medicaid rolls by welfare reforms in the 1990s that put them back to work in jobs where they earn too much to qualify for Medicaid but not enough to buy insurance. They also are in jobs where sick leave is scarce, he said. So if they or a child gets sick, they go to an emergency room at 10 p.m. and wait for hours, just so they don't miss work. The situation is frustrating to those in the neighborhoods. Popp said she is dismayed that there aren't more federally qualified centers here and that no one had done a large-scale study of MUPs and MUAs before. In the Near Northside, where residents are waiting for the downtown renaissance to benefit them, Vince Marquez is learning about the problem as executive director of the nonprofit Northside Redevelopment Center. It promotes economic development in an area near downtown roughly bordered by Interstates 10 and 45, Loop 610 and U.S. 59. "I've been doing community development work since 1993, and if anyone had asked me a year ago how much I knew about clinics and health care, I wouldn't think I'd be trying to get a clinic up and running here today," Marquez said. The area has been designated as an MUA, and Marquez's group has created a new nonprofit group to make application for a federally qualified center -- a step, encouraged by Cookston, that is being taken in about a dozen local neighborhoods, such as the Gulfton area where May works. There are other programs on tap, too: phone lines staffed by nurses who will direct callers to health care resources, workers called navigators placed in clinics and hospitals who will do the same, and other efforts in existing clinics to cut down on wait times. Cookston said there also are plans to put together a large health network -- an initiative to get at least 2,000 local physicians and 10 hospitals to agree to provide primary and specialty care to 24,000 uninsured people. In other words, the network would get them to essentially adopt a certain number of patients without insurance every year. Gateway to Care is also working on computerizing eligibility and appointment information and getting providers to share that data, Cookston said. But, he added, the problem is too complex for just one solution. "Harris County is just too big," Cookston said. "None of this will work in and of itself. We have to do more. We just keep have to keep doing more." </i>
baracade the hospital and take hostages, but make sure the gun is unloaded and have one bullet in your pocket for yourself, just in case. Oh yeah, and try to surround yourself with the company of a funny black man, a pregnant woman, a hot brunette, and a selfish yuppie from the "slappaho" tribe.
What to Do if You Can't Afford Healthcare? Make sure you have good credit, get several cards with high credit limits and hope you don't get sick. That's what I did before I had health insurance. I had like 6 credit cards that I did not ever use. They had credit limits of like 5000 - 7500 dollars!!! If I ever got sick I was going to use these as health insurance! And when I got health insurance, I cancelled all those cards.
ExcelLent story, Jeff. The rediculous thing is that Harris County is a great place for poor people to get health care compared to the surrounding counties where people without money can't get care at all. It is true that those counties may have an overall more affluent population, but if you lose your job and therefore health insurance in those counties you are in worse shape than in Harris County where you can at least go to Ben Taub and other facilities of the Harris County Hospital District. It is very discouraging that the voters could care less about such issues. Voters generally speaking have health insurance and those without can be damned. The insurance for profit lobby has been very successful in confusing people on the issue of national health insurance. It is very simple. Give everyone the right to medicare. Those that are happy with their private insurance can keep it. End of story.
My father in law is a neurologist. In order to keep his privileges to see HIS patients when they are hospitalized he has to spend one weekend a month on call. The other doctors in the group take turns with him. There is always somebody on call. When on call he HAS to see ANYBODY that comes in, regardless of financial condition. In fact most of the people he sees when he is on call never pay him. This situation has caused a lot of them to experience real business problems (but that's for a different thread). The point is that in hospitals doctors cannot turn people away when they are in dire need of care.
No health care solution is perfect, but the United States has produced the most innovative and effective system of medicine in the world. I have discussed this topic for hours with friends from Europe and Canada, where people wait months for simple procedures. Our system is the best because we have let market forces, the profit motive, and COMPETITION shape the way medical care is dispensed to our people. THE WORST ANSWER to our problem is some kind of socialized universal system which doles out mediocre care to all people equally. Check out the Libertarian Party reponse to this problem. The Libertarians aren't perfect, but they aren't hell bent on screwing up the greatest healthcare system in the world in pursuit of votes like the Republicans and Democrats are doing. ____________________________________________________ Health Care & Health Costs President Bill Clinton has brought the need for health care reform to the front of the political agenda. There is no doubt that our system is in crisis. Twenty years ago, health care was a $42 billon per year industry. Today, health care costs Americans more than $2 billion per day, more than 14% of our Gross Domestic Product. These soaring costs are putting enormous financial pressures on American businesses, forcing thousands of small businesses to reduce or drop benefits for their employees. Moreover, health care costs are an increasing burden to already strained family budgets. At the same time, nearly 35 million Americans lack health insurance. But President Clinton's proposals for socialized medicine are worse than the disease. The Clinton plan would increase costs, destroy jobs, impose broad new taxes on the American people, and lead to the rationing of care. The only health care reforms that are likely to have a significant impact on America's health care problems are those that draw on the strength of the free market. The Libertarian Party has developed a comprehensive proposal for health care reform that will reduce health care costs, while extending access to care. The Libertarian Party believes there is a better way. Our five-point plan is as follows: Establish Medical Savings Accounts. One key to controlling health care costs is strengthening the role of the individual health care consumer. As part of this process, an individual should be exempted from taxes on money deposited in a Medical Savings Account (MSA), in the same way that he currently pays no taxes on deposits to an IRA. Money could be withdrawn from an MSA without penalty to pay medical expenses. This would increase consumer responsibility, while increasing access and controlling costs. Restructure tax policy. As a second consumer-based reform, taxes should be restructured to establish equity in the treatment of employer-provided health insurance, individually purchased health insurance, and out-of-pocket medical expenses. All health care expenditures should be 100% tax deductible. This will add a measure of fairness to current tax policies that penalize the self-employed, part-time workers, and employees of small businesses, while subsidizing health care for the most affluent in our society. Deregulate the health care industry. There should be a thorough examination of the extent to which government policies are responsible for rising health costs and the unavailability of health care services. America can help lower health care costs and expand health care access by taking immediate steps to deregulate the health care industry, including elimination of mandated benefits, repeal of the Certificate-of-Need program, and expansion of the scope of practice for non-physician health professionals. Replace the FDA. The Food and Drug Administration is clearly an unnecessary burden on the American health care system. There is no evidence that agency offers Americans any real protection, but there is massive evidence that it is causing great harm -- driving up health care costs and depriving millions of Americans of the medical care they need. The agency should be abolished and replaced with voluntary certification by a private-sector organization, similar to the way Underwriters Laboratories certifies electrical appliances. Privatize Medicare and Medicaid.The current Medicare and Medicaid systems have clearly failed. Costs are skyrocketing. Patients are receiving second rate care. And, providers are being shortchanged. The time is ripe for drastic reform. The federal government should begin to restructure the system to give Medicaid and Medicare recipients more flexibility to purchase private health insurance.
The Libertarian Plan fails to address the fact that doctors are not paid timely or accurately by insurance companies. It also fails to resolve the inequities in the medical malpractice regime. These problems taken together have forced many doctors out of business. Check our the July 1 edition of US News and World Report. For instance, there are NO obstetricians left in West Virginia. They couldn't earn a living so they are all gone. The nation's largest trauma center was in Las Vegas. Due to these problems, it has been forced to shut its doors. Read the article...it should scare the hell out of you.
I actually agree with Refman on this one. The problem isn't the doctors. The problem is in the system. Let's assume for the moment we privatize EVERYTHING and give people medical savings accounts. What happens when you don't make enough to afford the private insurance? More and more, companies are dropping low-wage employees from benefits packages and offering to pay a portion of private healthcare. Since they can't afford the other portion, people are going without. When you have a country where 40 million people (in a country of 250+ million) or nearly 20 percent are without any insurance whatsoever and cannot afford it, you have a crisis. It is a crisis for those who cannot afford it. It is a crisis for doctors because they are having to practice medicine for free. The whole thing is a disaster and something has to be done. Solutions seem simple when your child has healthcare. But, when a family member gets cancer and their insurance company drops them or they don't have it in the first place, suddenly things get a little more real.
It's unbelievably expensive. I have very good coverage through my employer and every medical procedure I ever have ends up feeling like a proctological exam by the time I get the bill for my portion. I can't imagine what it would be like without the insurance companies picking up a large part of the tab. In fact, it's a little frustrating that I get a bill at all.
perhaps the most shocking assertion in this thread! This problem sucks...I don't have a good handle on how bad the problem really is. I don't think it's that people don't care about the issue...simply that they're not totally aware of the issue. It's not an issue that is really ever brought to the fore-front. I had a friend in law school who was previously a nurse...he said that if someone showed up to the hospital he worked at in Galveston, they treated him whether or not he could afford it or not.
Originally posted by glynch ...It is very discouraging that the voters could care less about such issues. Voters generally speaking have health insurance and those without can be damned. Our Federal and State Governments apend about $250 billion annually on Medicare and $200 billion annually on Medicaid. We all just don't give a damn, to the tune of $450 billion this year. And that just accounts for government support. Imbedded in almost all of our fees are part of the charitable costs borne by healthcare providers and facilities. And lets not forget direct contributions to healthcare charities. But if we don't believe in nationalized healthcare, we just don't care. The insurance for profit lobby has been very successful in confusing people on the issue of national health insurance. What's 'confused'? It is very simple. Give everyone the right to medicare. Those that are happy with their private insurance can keep it. End of story. Very simple, but, um...how do you pay for it? I am sure that there are no ramifications to increasing the Federal budget from $2 trillion to about $2.8 trillion. I guess little things like that are what you mean by 'confusing' people. We need to address the system's problems. The problems exist regardless of the payer (that includes Medicare). Since the government's management is weaker that the private sectors', moving all of those funds to the Feds will just screw the system up more.
I've got about 50 of them. What's your point? I think we all can recognize that, if you cannot afford healthcare and you get seriously ill, you probably should be worried. IMO, if you have a treatable disease and you die because of lack of money, the system failed. Period. As long as we place the value of money over the value of human life, the healthcare industry will be a mess. I don't know what the answer is, but the current state of the system ain't it.
Yeah, I don't think a book on holistic healing was gonna do me a lot of good when I nearly broke (actually severely sprained) my left elbow in March. Sorta needed an ER doc to look at that before I spit on it and said, "Good enough".
Last year in Houston, a security guard at my job ("Sgt." Kelly...people called her "Hooks," from Police Academy fame ["don't move, dirtbag!"] because that's who she resembled) had constant medical problems, was working ungodly hours at **** pay, couldn't afford to pay her electricity and certainly couldn't afford to get her medical problems looked at. I recently had $1100 worth in tests done, after insurance I paid $365; I can't imagine life w/o health insurance.
Most innovative, probably. Most effective for individuals who have coverage, quite possibly. Most effective for the population as a whole, not likely.
