Rescue the uninsured from sea of uncertainty


WASHINGTON -- In Manchester, N.H., a 6-year-old girl arrives at Catholic Medical Center unable to eat for several days because of medical complications from dental pain.

Why the wait? The little girl's family did not have health insurance.

This child, and so many others across the country, represent the crisis of vulnerability endured by 38 million Americans without any health insurance.

While the girl in Manchester was fortunate enough to live in proximity to a Catholic health facility with high quality emergency care, there are 22 million Americans who live in rural areas that the federal government calls "health profession shortage areas."

Many of these citizens are without health insurance and without access to medical care of any kind. They are at the apex of this health care crisis of vulnerability.

As we struggle to cope with burgeoning numbers of uninsured across the country, rural areas highlight a disturbing trend of funding "drift" -- a drift away from subsidized health care coverage for the poor, the unemployed and the disabled.

Rural hospitals were hit hard by the Balanced Budget Act of 1997. It has been estimated that of the $118 billion that the law directed to be cut over five years, $16.8 billion was cut from Medicare funds intended for rural areas. Legislation in the past two years has restored only about $3.8 billion of this money.

For skeptics who believe that rural health care may not be as vital as has been reported, a quick look at a sample state's mortality statistics may be convincing.

In Illinois, rural death rates from all causes from 1992 to 1996 were 1,106.7 deaths for every 100,000 people. This figure compares with 853.8 deaths in Illinois' urban areas.

Sadly, the rural patient base tends to be older, poorer and less medically privileged. For such patients, the small rural hospital is indeed a lifeline in need of preservation.

Whether in rural or urban areas, our cities have no shortage of uninsured and desperate families. In Des Moines, Iowa, a single Catholic hospital -- Mercy Medical Center -- operates a free clinic through its House of Mercy program. More than 600 people a month come in without insurance, many with acute illness.

In the South Bronx, the Dominican Sisters Family Health Services is a safety net provider in what has been designated the nation's poorest congressional district. Hospital admission rates in that community for children with asthma and pneumonia -- conditions that can be prevented with adequate primary care -- are five to seven times the rates in more affluent areas of New York City.

Emergency access to basic health care is a stopgap. The emergency room or free clinic is not a substitute for health insurance coverage for access to the same health-care services enjoyed by the more privileged in our society.

And such access is critical not only to ensuring quality of life but also term of life. The heart or cancer patient, treated early and with our best tools, can be offered a much different prospect than the critical care patient who arrives without benefit of early therapy.

During this congressional legislative session, it is increasingly important that we tackle the health care needs of our nation's uninsured. When Congress failed to adopt an economic stimulus package in February, the growing numbers of the recently unemployed and uninsured were dealt a dose of legislative paralysis.

Added to the diminishing set-asides for the "permanent" uninsured, the health care outlook for our nation's poor, uninsured, and under-served population is truly bleak.

We must and can do better.

American society must ensure that each person has access to affordable health care. At a crossroads moment, let us engage in a new national conversation on systemic health care reform, a dialogue from Main Street to Pennsylvania Avenue.

It is time for our nation's public and private leadership, health care providers and faith-based groups to come together and to join all Americans in a search for real and meaningful solutions to this health care challenge.

The Rev. Michael D. Place is president and chief executive officer of the Catholic Health Association of the United States.

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