Commentary : Why Health Care Crisis Deprives the Needy of a Human Right

Is the access to health care a human right or a privilege?

During the late 1960s and early 1970s, while I was in my early medical training, this question was addressed as a moral issue rather than a financial one. It was widely believed that everyone should have free access to health care.

This view was enhanced by the belief that poverty, race and lack of financial or political power should not be an obstacle to obtaining a healthy mind and body. A people with a healthy mind and body will enhance a healthy society.

This sound moral logic resulted in the development of many extensive and compassionate medical delivery systems, improving the health care of the poor, indigent and needy. In the 1960s, California led the way with the Medi-Cal system. This system had a rather liberal eligibility requirement and allowed recipients to seek medical care from any physician or medical institution.

A decline in cardiovascular deaths and infant mortality was accomplished, and the mentally ill received professional assistance rather than being forced to live on the streets. We were making progress to overcome the stigma of being the only major industrialized country without a comprehensive medical care system for all of its citizens. Then came the era of double-digit inflation, unemployment, huge budget deficits and, finally, “fiscal responsibility.” This caused severe psychological trauma for Americans. We began to vote for more “fiscally responsible” political officials and demanded that government spending be curbed.

The first substantial reductions took place in the areas that affected the citizens with little or no political influence--the poor, the indigent, blacks, Latinos and the elderly. Health care was no longer treated as a human right, but a privilege for the financially and politically influential. The abuses that existed within the system were used to justify the callous and inhumane underfunding of the health-care system designed to care for the poor and indigent.

This underfunding has resulting in the system being subsidized by physicians and medical institutions, leading to the current crisis with health care for the poor and indigent. The “fiscally responsible” atmosphere has led to fiscal neglect of medical care for the less fortunate.

Instead of exhibiting fiscal responsibility and adequately funding health care for the needy, legislation has been passed to force hospitals and physicians to treat all emergency patients regardless of their financial status. I believe this is a good law, but it should have included adequate financial reimbursement for these patients; then an institution would not want to transfer them. Many physicians, including myself, have always treated the poor and indigent without concern for financial reward. However, I do not want to see this human expression of kindness being abused.

The poor and indigent now have severe problems with access to medical care. This population suffers a higher medical acuity and seeks medical treatment only when disease advanced. The result is more-expensive emergency-room visits and more-expensive hospital stays. The chronic underfunding of the state Medi-Cal and county CMS programs has caused medical institutions and physicians to close or stop seeing patients in this category.

San Diego Physicians & Surgeons Hospital is a microcosm of the current crisis in health care of the poor and indigent in San Diego County. This institution is on the verge of closure or a sale to an entity that will not continue to serve the health care needs of the needy. San Diego Physicians & Surgeons Hospital is situated in an area with 200,000-plus citizens.

Without this hospital, many of these citizens will suffer a further restriction in

their already limited access to care. Many of the disabled, poor and elderly lack transportation to other hospitals. It has been accurately predicted that other hospitals would be overindulged with the closure of Physicians & Surgeons Hospital. This would result in the closure of other facilities, or, at a minimum, the closure of their emergency rooms.

The cost to the county, state and federal governments would be much higher, with an even higher acuity of medical care because of lack of earlier treatment. And, it is less expensive to treat patients locally rather than at teaching institutions such as University Hospital or Mercy Hospital, where a large part of them would be forced to be treated.

Does anyone care what happens to San Diego Physicians & Surgeons Hospital? In the past two years, I have met with many local and state officials who have made gallant attempts to resolve some of the bureaucratic and financial crises at the hospital. Supervisor Leon Williams, ex-City Councilman William Jones, state officials Pete Chacon and Wadie Deddeh and Rep. Jim Bates have all attempted to help, with Williams leading the way.

The way to keep the hospital open is simple--a just and appropriate redistribution of health-care dollars to all medical institutions taking care of large populations of the poor and indigent. This will only happen if the residents of our community demand that our elected officials reveal their humanism and show financial responsibility with adequate funding of these programs.

If we fail to succeed in seeing that access to health care is a human-rights issue and not just a financial issue, we will leave our children with a moral dilemma that will make it difficult for the President of the United States to negotiate human-rights issues with foreign governments that have succeeded in the delivery of health care to all of their citizens.