Somewhere to turn for the uninsured

THE REMOTE Area Medical (RAM) flyer advertising free health care stated: "Free Clinic." "No Appointments!" "No Eligibility Requirements!" "First Come, First Served." It instructed patients to, "Please Arrive Early and Bring a Snack!"

RAM was coming to Chicago, the home city of Barack Obama--and to a state where 2 million are uninsured.

RAM Volunteer Corps is a nonprofit, all-volunteer organization of nurses, dentists and doctors that offers free medical, dental and vision care in remote areas of the world. A few years ago, RAM started serving rural and then urban areas in the U.S. In Chicago, RAM partnered with the local organization Collaborative Underserved Relief and Education Network (CURE). According to Josette Szalko, the executive director of CURE, 500 volunteers provided health care to 2,000 people over three days.

Word spread throughout the city that RAM and CURE would be setting up free clinics at Malcolm X College. Hundreds camped out with pillows and blankets on the sidewalks starting at 3 a.m. in the hope of getting care when the doors opened at 5:30 a.m.

Wherever RAM goes, the health care crisis is exposed, along with the incalculable human suffering and millions of disrupted lives is exposed.

RAM "expeditions," as they're called, raise fundamental questions about the nature of the health care system in the U.S.: In the richest country in the world, why are 50 million people uninsured? Why are thousands of people lining up for hours in the middle of the night and thousands are turned away in daylight when there's no shortage of hospitals and clinics, advanced diagnostic technology or health care providers?

IT WAS more than ironic that the RAM location, on Chicago's near West Side, is located just blocks from the Illinois Medical District (IMD), the nation's largest concentration of health care facilities, with an embarrassment of medical riches--but riches that are rationed by race, class and insurance status.

Within the IMD's four-block radius, the contradictions of the health care crisis, with its delays and denial of medical care for poor and working-class people, play out every day.

The Jesse Brown VA Medical Center is a government-run, single-payer health care system for veterans. Rush University Medical Center, a private, for-profit hospital (currently building a new hospital with public tax increment finance money), shuns the uninsured. The University of Illinois at Chicago (UIC) Medical Center is a state hospital, but does much the same as Rush. Both hospitals avoid or jettison the uninsured by requiring upfront payment, and by billing those without insurance at exorbitant rates.

Nearby is John H. Stroger Jr. Hospital of Cook County, a public facility and the only hospital in the IMD that accessible for those without coverage. Blacks, Latinos and ethnic minorities in general, as well as the undocumented, are disproportionately served by county health services. Most are poor. Rush, UIC and other hospitals in Chicago routinely dump uninsured patients on Stroger Hospital--both its ER and the Fantus Clinic, the county outpatient care center.

This "patient dumping" puts enormous stress on the city's underfunded public health safety net that has been ripped apart by years of chronic understaffing, budget cuts and elimination of services.

The wait times for appointments, surgeries and medical tests, or to be seen in the ER are as dangerous as they are outrageous. ER wait times can exceed 16 hours, a routine mammogram can take nine months, and patients can wait more than a year to see a specialist or for an operation.

THE SCENE outside Malcolm X College at Noon on the first day of the RAM clinic was busy and loud, with volunteers calling out numbers and instructions to patients waiting in line. Dozens sat on concrete benches to see if they could get a number, while volunteers in bright red T-shirts handed out fruit and bottled water.

Inside, there were rows of tables in a wide corridor where patients registered and met with a nurse. A dental suite was set up inside a large classroom on the first floor and, on the lower level, patients received medical and vision exams in classrooms.

Janice Kelly, a middle-aged African American woman arrived at Malcolm X College at 3 a.m. and joined 60 other people in line. Kelly's been uninsured since 1998 when she lost Medicaid because she started working part-time. For health care, Kelly goes to Fantus Clinic. But, she said, "It takes a long time, and they don't give you glasses, so I came here. I needed them really bad."

The right side of Kelly's face was swollen from having three teeth extracted. She had calculated that it cost $125 to have each tooth pulled, plus money for x-rays. It was money she didn't have. For a year, Kelly managed the tooth pain with Orajel and Advil.

When asked her if she thought health care was a human right, she replied, "Yes, I do. Just like they have in Canada and countries in Europe. It's not a communist or socialist thing. It's something everyone needs, because sooner or later, we're all going to get sick and need some help. No one should be denied."

Alphonso Garoy, an African American man, was determined to get in. He arrived at the college at 7:30 p.m. the night before the clinic opened and was number three in line. Garoy is hunched over and limps. He suffers from chronic pain in both ankles and has ulcers, too. But on the day of the clinic, he felt happy and lucky because his glasses were fixed, and his tooth was filled, not pulled.

Adella Gardner, who was sitting next to Garoy, smoking a cigarette, wasn't in such a great mood. She had hoped that President Barack Obama would fix health care. She doesn't think people should have to wait until 2014 for reform and added, laughing, "Come on, there are a lot of people out of work, and they can't afford health care."

Gardner also complained about the cost of medication. Her mother had a liver transplant and pays $600 a month for anti-rejection drugs. Gardner, her voice full of frustration and anger, said, "The reason medicine is so high is because of drug companies. We need it to live. People are out here starving to buy medication. We're supposed to be a superpower, but we can't house our people, and we can't get them medical treatment. So are we really a superpower?"

A Latina from Mexico who declined to give her name arrived at 4 a.m. to get glasses. The woman had seen an optometrist hours earlier and was waiting for new glasses. Her husband and three children didn't have health insurance, either, which worried her. "The economy is bad, there are no jobs," she said. "It's difficult."

RAM, despite its best intentions and the fact that it is staffed by committed volunteers who desperately want to relieve human suffering, can't make a dent in the American health care crisis.

It's not a problem of resources or personnel--it's the way medical care is organized in the world's wealthiest country. Rather than being seen as a right, health care is a commodity controlled by the insurance and pharmaceutical industries--whose number one priority is making profits for shareholders, not meeting patient needs. Health care can't become a human right as long as these powerful and greedy corporations are in business.

Tim Nam, a RAM volunteer, was sitting outside, taking a break in the cool shade. When asked why he volunteered, he said his brother was a dentist for RAM and had encouraged him to help out. The experience made Nam think more deeply about the health care crisis:

It's a travesty. People shouldn't go without health care because they can't afford it. I believe that health care is a human right. I think single-payer is the way to go. I was disappointed in Obama caving on that. It was a huge let-down. There was a huge opportunity to go in a new direction. With his trying to compromise all the time, he wasted an opportunity.