Where Will The Sick Go Now?

Alec Dubro

April 12, 2007

Alec Dubro is senior editor for TomPaine.com.

The striking characteristic of American health care is not its cost—which is, admittedly, very high—but its disparity . You can watch the care gap widen right now in the Washington area.

On Wednesday, officials of the Prince George's County hospital network announced that the system was on the verge of shutting down. Majority African-American Prince George’s County in suburban Maryland is short on medical facilities and long on uninsured and indigent patients. Closing the county hospitals is not a negligible act. As The Washington Post said :

The Prince George's system treats 180,000 patients a year—many of them uninsured. Where would they go? What would happen to the 3,100 trauma patients a year taken to Prince George's Hospital Center's busy emergency room in Cheverly? And what about the 3,500 babies born each year at the hospital?

Although Prince George’s is not poor overall, it ranks high in accidents, homicides, infant mortality and diabetes, and, for the Washington Metro region, low in educational attainment.

What effect  would the closure of its primary trauma and neonatal center have on this troubled community? We can get an idea by simply crossing the border into Washington, D.C. There, in 2001, Washington’s budget-conscious mayor, Anthony Williams, decided to close D.C. General Hospital, the city’s first and only public hospital, after two centuries of service to the community. Williams announced that a new financially self-sustaining hospital complex would be built on the site of D.C. General to “provide first-class trauma care to some of the city's poorest neighborhoods while offering high-quality specialty services to patients of all income levels.”  Williams has come and gone and there’s nothing much on the site but the jail complex next door.

And the patients? Dispersed, burdening other facilities unprepared for an increase of uninsured and often desperately unhealthy residents. Emergency admissions to nearby Washington Hospital Center increased from 13,000 to 19,000. “The safety net is at its breaking point,” said the Center’s president, James F. Caldas.

A year after D.C. General was closed, The George Washington University Medical Center on the other side of town proudly opened its new, $100 million, 400,000 square-foot facility, with nearly a thousand physicians and a level-one trauma center. Some of the indigent abandoned by the closure of D.C. General manage to make it to GWU or one of the other hospitals in the region, but not all.

But it’s not the emergency care that’s most critical. African-American men not only suffer from a high rate of trauma, but also have much higher rates of untreated, or badly treated, chronic diseases than other groups. For instance, Prince George’s County has a diabetes rate 50 percent higher than the regional average. Clinics at D.C. General and Prince George’s County managed to provide care that often made the difference between life and death.

The same goes for the unusually high rate of infant mortality in the black community. Moving the source of care even farther away dooms many more infants to a death that need not have happened. The Post quoted one official:

“If the hospital closes ... I don't know what in the name of God we'll do. It's the only show in town,” said Mary Jelacic, executive director of the Pregnancy Aid Center in College Park, which provides prenatal care to about 600 poor and uninsured women a year.

This same scenario is played out across the country in rural counties, on Indian reservations, in communities abandoned by sustaining industries and in communities of color. While the health care industry overall is, well, healthy, public health facilities are shrinking. America can keep its top-level care for the insured and well-to-do. But is it too much to ask that states and municipal governments, with help from the feds, sustain and improve health care for those whose need is greatest?

Changing this health care disparity is no easy task, as many reformers have discovered. It is rooted in all the myriad and distorted bonds between black and white that go back as far as the slave trade. But that’s no excuse. This country is moving inexorably, if haltingly, toward a true integration, but first stumbling blocks, like inequitable health care, must be fixed—no matter what the cost.

That affects us all, not just those at the bottom of the economic pyramid. As Yale professor Jacob Hacker, who has been promoting a health-care-for-all plan  in conjunction with the Campaign for America’s Future, said in a post on TPMCafé earlier this week:

The problem of health insecurity is not a problem experienced only by those on the fringes of American society; it is a problem increasingly affecting all Americans, both directly and indirectly. And the implication of this core argument is equally simple and profound: Any real solution will have to address the problems faced by us all—rapidly rising costs, widespread gaps in coverage for the insured as well as the uninsured, health care that's not producing a healthy society as well as it could. We can no longer content ourselves with yet another round of gap-filling half-measures aimed at correcting the most egregious failures of our rickety financing structure.