Tuesday, August 18, 2009

More Gravy for the Healthcare Train

The brutal truth about America's healthcare

An extraordinary report from Guy Adams in Los Angeles
at the music arena that has been turned into a
makeshift medical centre

Saturday, 15 August 2009 The Independent [UK]

They came in their thousands, queuing through the night
to secure one of the coveted wristbands offering entry
into a strange parallel universe where medical care is
a free and basic right and not an expensive luxury.
Some of these Americans had walked miles simply to have
their blood pressure checked, some had slept in their
cars in the hope of getting an eye-test or a mammogram,
others had brought their children for immunisations
that could end up saving their life.

In the week that Britain's National Health Service was
held aloft by Republicans as an "evil and Orwellian"
example of everything that is wrong with free
healthcare, these extraordinary scenes in Inglewood,
California yesterday provided a sobering reminder of
exactly why President Barack Obama is trying to reform
the US system.

The LA Forum, the arena that once hosted sell-out
Madonna concerts, has been transformed - for eight days
only - into a vast field hospital. In America, the
offer of free healthcare is so rare, that news of the
magical medical kingdom spread rapidly and long lines
of prospective patients snaked around the venue for the
chance of getting everyday treatments that many British
people take for granted.

In the first two days, more than 1,500 men, women and
children received free treatments worth $503,000
(#304,000). Thirty dentists pulled 471 teeth; 320
people were given standard issue spectacles; 80 had
mammograms; dozens more had acupuncture, or saw kidney
specialists. By the time the makeshift medical centre
leaves town on Tuesday, staff expect to have dispensed
$2m worth of treatments to 10,000 patients.

The gritty district of Inglewood lies just a few miles
from the palm-lined streets of Beverly Hills and the
bright lights of Hollywood, but is a world away. And
the residents who had flocked for the free medical
care, courtesy of mobile charity Remote Area Medical,
bore testament to the human cost of the healthcare mess
that President Obama is attempting to fix.

Christine Smith arrived at 3am in the hope of seeing a
dentist for the first time since she turned 18. That
was almost eight years ago. Her need is obvious and
pressing: 17 of her teeth are rotten; some have large
visible holes in them. She is living in constant pain
and has been unable to eat solid food for several

"I had a gastric bypass in 2002, but it went wrong, and
stomach acid began rotting my teeth. I've had several
jobs since, but none with medical insurance, so I've
not been able to see a dentist to get it fixed," she
told The Independent. "I've not been able to chew food
for as long as I can remember. I've been living on
soup, and noodles, and blending meals in a food mixer.
I'm in constant pain. Normally, it would cost $5,000 to
fix it. So if I have to wait a week to get treated for
free, I'll do it. This will change my life."

Along the hall, Liz Cruise was one of scores of people
waiting for a free eye exam. She works for a major
supermarket chain but can't afford the $200 a month
that would be deducted from her salary for insurance.
"It's a simple choice: pay my rent, or pay my
healthcare. What am I supposed to do?" she asked. "I'm
one of the working poor: people who do work but can't
afford healthcare and are ineligible for any free
healthcare or assistance. I can't remember the last
time I saw a doctor."

Although the Americans spend more on medicine than any
nation on earth, there are an estimated 50 million with
no health insurance at all. Many of those who have jobs
can't afford coverage, and even those with standard
policies often find it doesn't cover commonplace
procedures. California's unemployed - who rely on
Medicaid - had their dental care axed last month.

Julie Shay was one of the many, waiting to slide into a
dentist's chair where teeth were being drilled in full
view of passers-by. For years, she has been crossing
over the Mexican border to get her teeth done on the
cheap in Tijuana. But recently, the US started
requiring citizens returning home from Mexico to
produce a passport (previously all you needed was a
driver's license), and so that route is now closed.
Today she has two abscesses and is in so much pain she
can barely sleep. "I don't have a passport, and I can't
afford one. So my husband and I slept in the car to
make sure we got seen by a dentist. It sounds pathetic,
but I really am that desperate."

"You'd think, with the money in this country, that we'd
be able to look after people's health properly," she
said. "But the truth is that the rich, and the
insurance firms, just don't realise what we are going
through, or simply don't care. Look around this room
and tell me that America's healthcare don't need

President Obama's healthcare plans had been a central
plank of his first-term programme, but his reform
package has taken a battering at the hands of
Republican opponents in recent weeks. As the Democrats
have failed to coalesce around a single,
straightforward proposal, their rivals have seized on
public hesitancy over "socialised medicine" and now the
chance of far-reaching reform is in doubt.

Most damaging of all has been the tide of vociferous
right-wing opponents whipping up scepticism at town
hall meetings that were supposed to soothe doubts. In
Pennsylvania this week, Senator Arlen Specter was
greeted by a crowd of 1,000 at a venue designed to
accommodate only 250, and of the 30 selected speakers
at the event, almost all were hostile.

The packed bleachers in the LA Forum tell a different
story. The mobile clinic has been organised by the
remarkable Remote Area Medical. The charity usually
focuses on the rural poor, although they worked in New
Orleans after Hurricane Katrina. Now they are moving
into more urban venues, this week's event in Los
Angeles is believed to be the largest free healthcare
operation in the country.

Doctors, dentists and therapists volunteer their time,
and resources to the organisation. To many US medical
professionals, it offers a rare opportunity to plug
into the public service ethos on which their trade was
supposedly founded. "People come here who haven't seen
a doctor for years. And we're able to say 'Hey, you
have this, you have this, you have this'," said Dr
Vincent Anthony, a kidney specialist volunteering five
days of his team's time. "It's hard work, but
incredibly rewarding. Healthcare needs reform,
obviously. There are so many people falling through the
cracks, who don't get care. That's why so many are

Ironically, given this week's transatlantic spat over
the NHS, Remote Area Medical was founded by an
Englishman: Stan Brock. The 72-year-old former public
schoolboy, Taekwondo black belt, and one-time presenter
of Wild Kingdom, one of America's most popular animal
TV shows, left the celebrity gravy train in 1985 to, as
he puts it, "make people better".

Today, Brock has no money, no income, and no bank
account. He spends 365 days a year at the charity
events, sleeping on a small rolled-up mat on the floor
and living on a diet made up entirely of porridge and
fresh fruit. In some quarters, he has been described,
without too much exaggeration, as a living saint.

Though anxious not to interfere in the potent
healthcare debate, Mr Brock said yesterday that he, and
many other professionals, believes the NHS should
provide a benchmark for the future of US healthcare.

"Back in 1944, the UK government knew there was a
serious problem with lack of healthcare for 49.7
million British citizens, of which I was one, so they
said 'Hey Mr Nye Bevan, you're the Minister for
Health... go fix it'. And so came the NHS. Well, fast
forward now 66 years, and we've got about the same
number of people, about 49 million people, here in the
US, who don't have access to healthcare."

"I've been very conservative in my outlook for the
whole of my life. I've been described as being about
90,000 miles to the right of Attila the Hun. But I
think one reaches the reality that something doesn't
work... In this country something has to be done. And
as a proud member of the US community but a loyal
British subject to the core, I would say that if
Britain could fix it in 1944, surely we could fix it
here in America.

Healthcare compared

Health spending as a share of GDP

US 16%

UK 8.4%

Public spending on healthcare (% of total spending on

US 45%

UK 82%

Health spending per head

US $7,290

UK $2,992

Practising physicians (per 1,000 people)

US 2.4

UK 2.5

Nurses (per 1,000 people)

US 10.6

UK 10.0

Acute care hospital beds (per 1,000 people)

US 2.7

UK 2.6

Life expectancy:

US 78

UK 80

Infant mortality (per 1,000 live births)

US 6.7

UK 4.8

Source: WHO/OECD Health Data 2009

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But Don't Jack My Genuis