On a Friday morning at 8, patients were already lined up at St. Anthony’s Free Clinic in San Francisco’s Tenderloin district when the three doctors showed up. There is always a line. A cabdriver with liver disease. A first-grader with
On a Friday morning at 8, patients were already lined up at St. Anthony’s Free Clinic in San Francisco’s Tenderloin district when the three doctors showed up. There is always a line. A cabdriver with liver disease. A first-grader with asthma. A waitress with abdominal pains. None of them with health insurance.
During the lunch hour, Dr. Katie Broner remembers the story of the teenage girl who came in with sore legs. The doctors are giving me a glimpse of the 45 million Americans who have no health insurance. It is the highest number ever, according to a U.S. Census Bureau report that landed on front pages across the country recently.
“She came from a working family that had no insurance,” Broner says of the teenage girl. “She was in here getting a physical and was complaining about pain in both legs. I said, ‘Let’s get an X-ray.’ It turned out she had been in a car accident awhile back and had hurt both legs. Her family didn’t want to go to San Francisco General because they had gone there once and got a $1,000 bill that they were still paying off.
“When the X-rays came back, I couldn’t believe it – both legs were fractured. This girl was walking around somehow on two broken legs.”
Then there was the guy a couple Mondays ago with an acute infection in the throat that can close off the airway.
“He waited through the weekend to come in here on Monday because he has no insurance and didn’t want to face a bill from the (San Francisco) General,” Broner says. His condition was so dire by the time he arrived at St. Anthony’s that Broner had to call 911.
“I’m surprised he didn’t die,” she says. The man ended up at S.F. General after all, courtesy of a pricey ambulance. His throat was drained and his airways cleared. Now, because he delayed treatment for fear of the medical bill, he faces an even higher one.
“This kind of thing happens every single day,” says Dr. Sonia Bledsoe, who has been working at St. Anthony’s for 10 years. She has a thousand stories, as does her colleague sitting next to her, Dr. David Lown, a young man with an ear studded with small hoops.
The number of Americans without health insurance climbed in 2003 for a third straight year, according to the Census Bureau report. It would be unfair, though, to place all the blame on employers.
Insurance premiums rose 14 percent last year, six times the rate of inflation. Experts say that health premiums have become a bigger financial burden for businesses than energy. Employers have responded by hiring fewer full-time workers, cutting health benefits, or shifting more of the insurance costs to employees.
Thus, some people face a choice that is no choice: Paying high insurance premiums or feeding their families. Government insurance programs have filled some gaps. Most low-income children are covered through federal and state programs, but adults often fall through the cracks.
In 19 states, parents who make as little as $9,300 per year earn too much to qualify for Medicaid. In most states, Medicaid isn’t available at all to adults who are neither parents nor disabled.
In the St. Anthony’s waiting room, Lown flips through his charts and finds a patient who fits that profile. Here, he says, is a 50ish man who has reduced his cab-driving shifts to two a week because he has cirrhosis of the liver from alcoholism and hepatitis C. He doesn’t have health insurance from the cab company, and he doesn’t qualify for Medi-Cal, California’s version of Medicaid. But he doesn’t make enough money to pay for his medications.
“His condition is life-threatening,” Lown says. “But he’s in that nowhere land of health care.”
The doctors tell me about the barriers to medication for those without insurance, even when the government is picking up the tab.
St. Anthony’s, one of several free clinics in San Francisco, handles 14,000 patient visits a year. This is its 48th year. The folks here say they would like to be out of business before they finish another 48.
So how do we solve the health care crisis so their wish comes true? I don’t know. But we won’t get very far if our presidential candidates and media spend this valuable pre-election period obsessing about who did what in a war that ended 30 years ago.
The lunch hour is now almost over. The doctors still have paperwork to finish and sandwiches to eat before the doors are opened again. Health care issues are pretty boring. Insurance is even more boring. But the cabdrivers and laborers and bookkeepers waiting outside might have a different point of view.
Broner stands to return to her office. “The personal price they pay,” she says, “is horrendous.”
Joan Ryan is a columnist for the San Francisco Chronicle. Send comments to her in care of this newspaper or send her e-mail at joanryan@sfchronicle.com.
