COLUMN ONE : Uninsured Children Pay a Price : Millions are not covered because their parents cannot afford policies. Simple medical problems go untreated and often lead to serious illness and tax the health care system.

Of all the suffering brought on by the nation’s health care crisis, nowhere is the pain--or the system’s failures--more apparent than among the millions of children in America who are sick and uninsured.

Because their parents cannot afford to buy medical insurance for them, growing numbers of uninsured children are deprived of basic medical care. They arrive in hospital emergency rooms, public health clinics and the school nurse’s office with acute illnesses and debilitating fevers that could have been prevented, health experts say.

“Basic care is increasingly beyond the reach of millions of American children,” said Sara Rosenbaum of the Children’s Defense Fund. “Children have definitely borne the brunt of the breakdown in our (health) insurance system.”

Children without insurance are nearly 50% more likely to suffer health problems than those in families who do have it, according to Children Now, a statewide nonprofit advocacy group. Uninsured children are much more likely to forgo treatment of medical problems and develop complications that require costly hospitalization.

At the Venice Family Clinic, doctors recalled examining three children during a four-month period last year who were suffering from ear infections that had raged untreated, rupturing the eardrums and, in one case, spreading infection into the mastoid bone near the brain.

These children were referred for surgery to public hospitals, where their care cost taxpayers about $25,000. Yet the medication that could have prevented the problems costs less than $20.

“There is a gaping wound in our health care system when it comes to children,” said Dr. J. Donald Thomas, an emergency physician at Huntington Memorial Hospital in Pasadena.

Dr. Laurence Wellikson, former chairman of the Orange County Medical Assn.’s Access to Care Committee, said that during the recession both children and adults, in many cases, are failing to get preventative care for lack of insurance or cash.

“I think there are a lot of people ignoring their health needs and not getting things taken care of,” he said. Ultimately, he added, they may wind up in hospital emergency rooms.

A study comparing hospitalization rates of children throughout Los Angeles County shows that poor children living in East Los Angeles are more than five times more likely to need hospitalization for middle-ear infections than children living in Malibu. Countywide, poor children are seven times more likely to be hospitalized for bronchitis, asthma or gastroenteritis, and 15 times more likely to be hospitalized for pneumonia.

In California, the number of uninsured children increased 62% from 1983 to 1989. About 2.1 million children--more than 25%--had no health insurance in 1989, ranking California among the 10 worst states in the nation, according to Children Now. About 300,000 were younger than 6.

Nationally, between 8 million and 12 million children younger than 18 had no health insurance in 1989. Their number rose almost twice as fast during the 1980s as the number of uninsured adults.

The recession--not reflected in the statistics--is believed to have given the figures a cruel boost, with more children losing their health insurance as their parents lose employment or see their earnings reduced.

“It is working, moderate-income families--whom we think of as providing a strong safety net for their children--whose children proportionately have been hit the most,” according to a report this year by the Children’s Defense Fund.

In the vast majority of cases, studies show, uninsured children live in families where at least one parent works. But either the employer does not offer health insurance as a benefit, or the employee’s share of the cost makes the health plan not affordable.

Like millions of Americans, Kenneth Lloyd, a single father of three girls, has no health insurance available through his job and cannot afford to purchase it privately. So Lloyd, who works as a custodian in a Pasadena church, says he has to “wing it” when it comes to paying medical bills, like the $500 tab for his 11-year-old daughter, whom he took to an emergency room recently for treatment of a 106-degree fever. Another daughter, he said, needs oral surgery for an impacted tooth, but the dentists he has called all require insurance or payment in advance.

Rosa Soto of Los Angeles said her husband--who works as a cook and has no health insurance--makes enough money to pay for food and rent, “but I can’t afford the doctor’s bills.”

Until she found free medical care for her three daughters at the nonprofit Venice Family Clinic, Soto said she had no place but the emergency room to take them when they were sick. The hospital “charged me $400 that I just couldn’t pay,” she said.

Victoria Veloz of Granada Hills, a single mother of three with no job or health insurance, said paramedics rushed her 10-month-old baby to the emergency room when she stopped breathing during a seizure.

“I thought she had died in my arms,” Veloz said.

The baby spent two days on a ventilator at Holy Cross Medical Center and ran up a bill that Veloz said she cannot pay. Nor can she pay for follow-up doctor visits the baby may need.

Increasingly, even those employers who offer health insurance are requiring workers to pay considerably higher premiums and deductibles to cover their spouses and children--or they are not covering dependents at all. The upshot is that nearly 25% of the uninsured children in the United States live in families where the parents are insured.

Gene Thompson of San Francisco and his wife, Ellen, have health insurance, but their 8-year-old child does not. The private school where Ellen teaches provides health insurance for her only. Gene is an instructor at City College of San Francisco and gets health insurance through his job, with the option of paying an additional $170 per month to cover his daughter.

But the additional expense of covering her “would stretch the budget considerably,” he said.

“We’re moving out of our one-bedroom apartment, and we’re going to be paying that much more in rent for a two-bedroom place,” he said.

So for now, the Thompsons have decided to continue paying their daughter’s health care bills out-of-pocket and “hope for the best,” Gene Thompson said. “But I can’t stress enough my discomfort with the situation.”

At Stanford University, there is growing concern about the plight of employees who need health coverage for their families. A recent study of Stanford’s costs concluded that if changes are not made, Stanford families will be paying $400 a month for coverage by 1994. University officials are trying to revamp their health coverage because of concerns that families might increasingly choose to go without insurance.

By decade’s end, more than half the children in America will not have health insurance through a parent’s employer, the Children’s Defense Fund forecast in a recent report.

It said that the government-sponsored Medicaid program, which is supposed to provide care for the poor, is not a big enough safety net to catch growing numbers of youngsters whose families cannot afford private health insurance.

Health experts point out that children have relatively modest medical needs and, compared to other age groups, are less expensive to keep healthy provided they receive proper preventive care and timely medical attention.

“They’re basically cheap, if you care for them up front and you don’t delay treating problems,” said Susan Bales with the National Assn. of Children’s Hospitals and Related Institutions.

A study of low-income 18-year-olds who had been rejected by the U.S. Selective Service found that about 33% of the problems could have been prevented or corrected if they had been treated before the age of 9; if treated before the age of 15, 62% could have been avoided.

But as the number of children without health insurance soars, preventive health care is taking a back seat to costly crisis care.

Increasingly, poor health is interfering with classroom learning, teachers say. According to the National Survey of Teachers by the Carnegie Foundation in 1990, 60% of 22,000 teachers interviewed described poor health as a “major problem” for their students.

Schools are obliged by law to ensure that children are properly immunized against major diseases and screened for scoliosis, hearing and vision problems. But in reality, school nurses deal with a vast array of major ailments and injuries.

Although their ranks are thin--with one school nurse for about every 3,000 pupils--students and families have come to view these nurses as their only medical lifeline, because appointments are not required and visits are not billed.

“On Monday morning, the nurse finds at her doorstep a child with a broken wrist that occurred on Saturday,” said Patricia Lachelt, coordinator of health programs for the Pasadena School District, where about 30% of the children have no health insurance. Infections, bone fractures, nutritional problems, seizures, respiratory problems, rashes and severe tooth decay are typical, she said.

“We see kids with stubs for teeth,” said Susan Lordi, school health program consultant for the Los Angeles County Office of Education.

“We are overwhelmed here,” said Sharon Goodrich, coordinator of health services for the Pomona Unified School District, burdened by a very high proportion of low-income children with no health insurance.

“As they assess minor problems, our nurses come across big ones. They put a stethoscope to the chest and discover missing heartbeats. They find enlarged livers and kidney problems, undescended testicles, horrible bladder infections, and kids with growth so stunted that a fifth-grader looks like a preschooler,” Goodrich said. “Nobody has picked up on these things because these kids have not had a physical before.”

Pomona school nurse practitioner Nitzi Fikel said she typically refers children for treatment to a local public health clinic. But the place is so crowded that “it takes a week and a half to get an appointment for a child with a raging ear infection and a bulging ear drum.”

Children with complicated problems need to be treated by experts at the County-USC Medical Center’s Pediatrics Pavilion, where the waiting list is so long that doctors try to see the highest-priority cases first. To get children an appointment there, Fikel said she has written long, pleading letters pointing out life-threatening symptoms and begging doctors “not to pass up this child. . . . It’s like composing an entry for a contest.”

Getting an appointment does not necessarily resolve the matter, Fikel said, because many parents do not have cars to take children to the medical center 30 miles away or they cannot afford to miss work and lose a day’s wages.

Furthermore, the fees, though lower than those in the private sector, nevertheless discourage many parents.

Fikel recalled the case of a 9-year-old boy with a severe fracture whom she referred to County-USC Medical Center. The parents were distraught because a $40 bill was going to be tripled if they did not pay within 24 hours. “So I just took out my own checkbook and paid it for them,” she said.

The emergency room is where many uninsured children wind up.

“What happens is that we have a child come in by ambulance with a seizure, and it turns out he’s had three or four of these before,” said Dr. Nancy Schonfeld, director of emergency medicine at Childrens Hospital Los Angeles.

“We can stop the seizure, but this child needs tests and follow-up care to evaluate his reaction to medication and adjust the dosage. But the reality is that he doesn’t get it. So, he goes home and runs out of medicine and has another seizure and comes back to the emergency room. . . . We have to treat the symptom rather than the problem.”

She said fewer than 50% of the parents who bring their children to the hospital have money to pay for their children’s prescriptions.

Dr. Robert St. Peter, a pediatrician at the UC San Francisco School of Medicine, said many parents are so strapped that “they have asked me whether they can wait until they get their paycheck to buy antibiotics for their child.”

Across the country, pediatricians recounted stories of uninsured children suffering from delayed care.

Dr. Joseph Zanga, professor of pediatrics at Children’s Medical Center at the Medical College of Virginia in Richmond, said during an interview last month that he hospitalized a 7-month-old baby who had developed meningitis from an untreated ear infection.

“This baby is now at risk of brain damage, seizure, hearing loss and death,” Zanga said. “What could have been treated with a $50 doctor visit and $20 bottle of medicine resulted in a $100 emergency room visit, plus another couple hundred dollars in tests, and hospitalization that will probably run seven to 10 days and cost about $8,000.”

The United States is the only country in the industrialized world, except for South Africa, that does not guarantee basic health care for its children.

Many experts decry the logic of a health care system that spends more than seven times as much money on the elderly--half of it during the final 45 days of life--as on children.

The annual per capita health expenditure for children nationwide was about $745 in 1987, compared to a yearly per capita cost of $1,535 for adults ages 20 to 64, and $5,350 for people older than 65, according to federal health officials.

Robert Sweeney, president of the National Assn. of Children’s Hospitals and Related Institutions, said the average cost of providing medical care for a child is about $900 per year.

Yet a study by Sweeney’s organization of all uninsured children treated during a one-month period at 22 children’s hospitals across the nation showed the average charge per admission was $13,383, which Sweeney said suggests the seriousness of the children’s illnesses. About 70% of the children were under 5, and 65% of the cases were life-threatening emergencies.

Uninsured Children

In California, the percentage of children under age 18 who have no health insurance rose steadily from 1983 to 1989:

The vast majority of children without health insurance live in families where at least one parent works, but either the employer does not offer health insurance or the policy is unaffordable.

At least one parent is employed full time: 67% Parents are jobless: 20% At least one parent is employed part time: 13%

Source: National Commission on Children

Source: Valdez, Morgenstern, Brown et al., “Insuring Latinos Against the cost of Illness.”