Doctors’ Essay Details Ways to Heal the Poor

With an article in today’s Journal of the American Medical Assn., three UC Irvine doctors and a Costa Mesa health advocate have written a primer on strategies for helping the poor to get medical care.

Their essay describes the history of a 4 1/2-year-old, 50-member group, the Orange County Task Force on Indigent Care, and its battles with local bureaucrats to make medical care available to some of about 400,000 county residents who have no health insurance.

Although their article details the efforts of one local group, the authors--Howard Waitzkin, F. Allan Hubbell and Lloyd Rucker, all UCI internists, and Vicki Mayster, a health advocate with the SOS Free Medical Clinic in Costa Mesa--say some of their tactics could be used around the nation.

“Every community is different, but there are some things that transfer,” said Mayster, a former seminary student who, with Waitzkin, heads the health group.

According to the article--titled “Legal Advocacy for the Medically Indigent: Strategies and Accomplishments in One County”--the doctors, medical residents, lawyers, clergy and civic volunteers in the group have used a three-pronged approach toward making “modest improvements” in medical programs for the poor.

Members have written medical journal reports documenting the difficulties that poor residents face in finding basic medical care in one of the nation’s wealthiest counties. They have taken political action, testifying before county and state officials. And sometimes, the article said, they have turned to lawyers to argue their case.

In all, “they have been a thorn in the side of bureaucrats,” noted Chauncey Alexander, chairman of United Way of Orange County’s Health Care Task Force, who has worked alongside the group’s members.

But several county officials who saw an advance copy of the article said it overstates the group’s gains.

“I’m not even sure who they are,” said Marianne Maxwell, special projects director of the county Health Care Agency, who started the county’s Indigent Medical Services health insurance program.

Cautioning that she had only briefly reviewed the article, Maxwell said she believes that other community groups such as United Way deserve more credit for changing county policies toward the indigent than Waitzkin’s and Mayster’s.

Mayster responded: “I don’t want to claim we’re taking credit for things other people were involved in.”

She added that the article repeatedly describes her group’s members as working with other community groups.

For instance, the article notes, her group contributed to well-publicized and highly critical reports on local health care by the League of Women Voters and United Way.

The group also conducted studies of its own. One, published in the 1989 American Journal of Medical Science, showed that 94 patients, or 5% of one UCI clinic’s caseload, did not receive such needed care as surgery, medication or ultrasound studies because they could not afford them.

The article also credits the Task Force on Indigent Care with helping persuade county officials to sharply increase prenatal services to poor women and to streamline eligibility requirements for the county’s Indigent Medical Services (IMS) program.

It also says the group’s members took part in “targeting health-care institutions.” In 1985 and 1986, they helped “organize a broad coalition” that successfully opposed the sale of UC Irvine Medical Center to a for-profit corporation.

Also, the article says that the group lobbied to prevent medical center administrators from closing satellite and pediatric clinics and has used “limited” legal actions. An attorney for the group recently persuaded county officials to make a major policy change in the IMS program, for the first time allowing immigrants approved for amnesty to be covered by that health insurance. That change, the article says, “makes health care available to thousands of immigrants in the county.”

For all the pluses, the article also concludes that each tactic has some weaknesses. For example, political activity “remains basically defensive. . . . Efforts to maintain services at a minimum level do not lead to more creative and proactive programs” that would improve overall health care.

In the end, the article says, organized advocacy is a “piecemeal approach” that will not produce a well-organized health care system. Only a national health care system can do that, the authors say, and in the meantime, “we and other health advocates can only continue to hold the line.”

Actually, Waitzkin and Mayster said, since the article was accepted by the medical journal, health care for Orange County’s poor has deteriorated. One of the county’s four trauma centers closed in December, poor women still have few places they can go to deliver their babies and, Waitzkin said, “There’s been a whole bunch of commissions and task forces, and the only thing that has happened is an exchange of words.”

He and Mayster said their group is so upset with county officials, especially county supervisors, that they are thinking of changing strategy and becoming more “confrontational.”

What do they intend to do? Both declined to say.