Democrats Diagnose Health Care Ills : Politics: Members of Congress return to their districts to hear constituents’ views on cost and barriers to medical treatment as part of a plan to highlight reform.

Carolina Prudencio smiled at Rep. Henry A. Waxman (D-Los Angeles) from a dental chair at the Los Angeles Free Clinic. One tooth extraction and eight fillings, she told him, was the toll of a lifetime without dental care.

Prudencio has never worked for an employer who provided health insurance or dental coverage. Then, last August, she was laid off from her job as a warehouse worker, making the $300 price quoted to her by a private dental office out of reach.

“I do not have such money,” the 23-year-old single mother told Waxman on Tuesday as he toured the clinic at 8405 Beverly Blvd.

The 24th District congressman was one of nearly 200 House Democrats who returned to their districts Tuesday to hear constituents talk about cost and access barriers to medical treatment. Waxman chose to visit clinics patronized by the poor and uninsured. Other representatives, including 12 from California, held “town meetings” to collect testimony on problems and possible solutions.

Similar hearings were held last month in selected cities by Senate Democrats, part of an overall Democratic strategy to highlight health care reform in this presidential election year.

Numerous reform proposals already before Congress are aimed at putting medical care in reach of about 35 million Americans without health insurance.

Some call for scrapping the current patchwork system of private and public insurance, replacing it with a single, government-run, tax-supported plan similar to Canada’s. Others, including one sponsored by Waxman, propose “pay or play” arrangements, in which employers either provide health insurance or pay a special tax to buy coverage for workers who cannot get employment-based insurance.

Democratic congressional leaders have seized on the theme of health care reform in the wake of what they contend has been gross neglect of health care problems by the Reagan and Bush administrations. But as President Bush puts the final touches to a federal budget proposal highlighting his own health reform package, Democratic congressional leaders are pushing colleagues to unite behind a specific plan.

“We can’t just keep saying we are for health care reform,” said Waxman, chairman of the influential House Subcommittee on Health and the Environment. “The Democrats have to get together behind some proposal.”

Testifying at Rep. Robert T. Matsui’s (D-Sacramento) town meeting in Sacramento, Jo-Linda Thompson, senior director of government affairs for the California Restaurant Assn., said health care costs are out of reach for most small businesses.

Thompson was one of about 200 health care providers, advocates, state officials and patients who filled an auditorium at the Sacramento Community Center Tuesday to air their concerns.

“We want to provide health care, (but) we can’t do it,” she said. “There isn’t any money out there, and we can’t pass these costs along.”

Restaurants, which typically operate on a 1% to 2% profit margin, cannot afford the average annual cost of about $3,000 to provide health insurance for each employee, she said.

In the meantime, the combination of rising health care costs and California’s severe economic downturn is jeopardizing California’s health care system, the director of the Assembly Office of Research, Steve Thompson (no relation to Jo-Linda Thompson), told Matsui.

Employers essentially help subsidize emergency room and other health services for an estimated 6 million uninsured Californians through private health insurance premiums. These private plans pay doctors and hospitals enough money to partially offset losses incurred in treating those who cannot pay.

But as more people lose their jobs and health insurance, that pool of paying patients shrinks, while the group of patients who cannot pay grows. This, in turn, drives up health insurance costs to business, Thompson said, reaching a point where it is “an impossible cost burden” for employers.

As Matsui listened to Thompson describe the strained state health care system, Waxman wound up his conversations with those on the front line of care at the Los Angeles Free Clinic and the county-run Hollywood Wilshire Community Health Center on Melrose Avenue.

Prudencio’s story had become a familiar one by then: essential health care delayed by lack of money or health insurance coverage.

Pain finally drove Prudencio to the Free Clinic, a 24-year-old facility that depends mostly on private funding and a volunteer medical staff to provide free medical and dental care.

But the clinic is falling far short of the demand for such services, according to Mimi West, a member of the clinic’s board of directors, even as it projects nearly double the number of patient visits this year as two years ago. “The needs are just enormous out there,” West said.

To address such needs, the White House plan would use tax credits to encourage workers whose employers don’t provide it to buy health insurance on their own. It would finance the tax breaks with new levies on Americans who make more than $90,000 a year and get generous health insurance benefits from their employers, and on people over 65 who make more than $100,000 annually yet pay the same rate for the government’s Medicare health plan as the impoverished elderly.

Democrats say Bush’s plan doesn’t go far enough. In particular, Waxman said, it fails to address the problems of people who are unemployed or whose dependents are not covered by employer-based insurance benefits.

Major questions remain, especially in these recessionary times, about how to finance expansion of a health care system that costs Americans $700 billion a year.

Wielawski reported from Los Angeles and Ellis from Sacramento.