Healthcare For All … Even Homeless
March 29th, 2010by Laurel
This past week health care reform took root after more than a year of struggle and debate. As the bill now goes on the be signed into law after passing the Senate in December and last week passing by 7 votes in the House of Representatives, many are wondering what the implications will be for clinics like our own St. Anthony Free Medical Clinic, which offers health care options to the poor and uninsured. The number of statewide uninsured has jumped 28% in the past three years, according to a study from UCLA – that’s more than 8 million who lack insurance in California alone – so, many are hoping for tremendous impact.
Channel 2 News was on site here at St. Anthony Free Medical Clinic last week to discuss possible changes and hear the reactions of healthcare professionals in the community. One item they touched on was how health care reform would affect Healthy San Francisco, the city’s access to healthcare program. St. Anthony Free Medical Clinic Director Dr. Ana Valdés spoke on clinic hopes for nationwide universal healthcare—for one, that Healthy San Francisco will eventually no longer be the only option for those without coverage.
Post-news-interview, I sat down with Dr. Valdés to discuss come of the finer points of health care reform. She pointed out that this initial movement towards universal care is a great step, but there is still a lot more we could stand to gain.
“It was a great first step,” she said, “I don’t think we got everything we wanted but I think we got a lot. Health care reform isn’t going to change in this country overnight.”
“A lot of these things are great, but they don’t happen for many years, and the problem is the economy is in the tubes now and the uninsured are now. So what we really need is for these things to happen now, especially for seniors.”
A little more than half of our patients at St. Anthony Free Medical Clinic are covered by Healthy San Francisco, and even though health care reform would mean many of these people would be eligible for alternative coverage we won’t see enrollment drop until at least 2014 when healthcare changes are fully implemented. The first change we would see would be in the young adult population because they will be able to stay on their parent’s insurance, Dr. Valdés points out, but even so most of our young adults that won’t really benefit from healthcare reform because their parents are uninsured and won’t be eligible.
“We are a sanctuary clinic, San Francisco is a sanctuary city. The majority of our patients would not be eligible for any of the new healthcare benefits because of immigration status,” says Dr. Valdés. These patients often work several jobs but because of their status are unable to get coverage.
What’s more, changes may not be entirely effective eve n for those who will qualify for public healthcare. Even with the upcoming advance in MediCare/Caid, San Francisco will still see quite a few people who are the working poor and make enough to survive in the city but not to afford health care on top of food and shelter for their families. Dr. Valdés and her peers would like to see more expansive changes that include more people in a timelier manner than in 4 years from now. Immediate changes to the healthcare system would greatly benefit many struggling Californians, such as faster Medicaid expansion, faster elimination of pre-existing conditions insurance denial for adults, a standardized and comprehensive set of Medicaid benefits (including dental), and eliminating the state option of offer restricted benefit packages.
Dr. Valdés makes the point that Channel 2’s news piece talks about healthcare reform impacting HSF as if this is potentially negative. The truth is, Healthy San Francisco was conceived only to serve as a temporary solution to an ongoing problem. It is the hope of the program to see people move on to full health care coverage.
“San Francisco took the initiative to say ‘well, we’re gonna deal with our uninsured problem’ [by creating this program]” says Dr.Valdés, “but it’s not the end all-be all, it’s not insurance, and the government is finally taking a step to insure people – HSF is a stopgap, HSF should really even exists, so the more a federal program comes in and insures everybody the better. It’s just a temporary solution. HSF was created to address the issue of the uninsured when nobody else was.”
March 29th, 2010 at 11:48 pm
This blog is very much to the point about recent health care reforms in DC. Unfortunately, as stated, it isn’t likely politicians in Washington (or anywhere else, for that matter) will solve the massive healthcare “Gordian Knot”. Health care reform as envisioned by our political leaders may improve coverage for some (perhaps many)… but it does not address the overwhelming, crushing costs of our “disease management” healthcare system. Currently, we really don’t provide health status improvement – our incentive is to treat disease as it arises. Our community could provide a $500 air conditioner to an asthmatic who decompensates during a heat wave, but instead we pay (through Medicare or Medicaid, or private insurance) to treat an acute attack in the hospital emergency department for thousands more. Our nonprofit hospitals could send out teams to install stair railings and remove slippery throw rugs from a 90 year old’s home – but instead, we treat the resulting hip fracture, to the tune of $40,000 or more. Until our communities recognize that true health maintenance saves our scarce resources we will continue to pay hospitals to treat congestive heart failure patients, instead of working with them to keep diet, weight and blood sugar in control. So, the solution involves re-engineering the incentives so health care providers, hospitals and community leaders wake up and take the lead in keeping our population healthy! Robert Bentley, MD