Dispensing Healthcare, Hope

The line begins in the chilly hours before dawn, when the doors are locked and the Los Angeles Free Clinic is empty. In the darkness, beneath a waning crescent moon, people who need care arrive by bus, car, taxi or on foot.

Chris Belfrage, an actor with sinusitis and no health insurance, arrived first at 5 a.m. Maria de los Angeles Rubalcava sat on a yellow milk crate a few feet back, nursing a 15-day-old toothache. Then came Sonia, with a throbbing headache, and farther back was Fred Turner, with swollen and infected gums.

People in this city are used to long waits -- for the best spot to view floats at the Rose Parade or a chance to buy concert tickets. This line, at Beverly Boulevard and Orlando Avenue, is for people who are ill and want to feel better.

For those who arrive early, it’s a chance to get a same-day appointment with a doctor who will provide free treatment to patients with no insurance and no money. Even prescriptions are free.

That possibility is enough to keep the line full -- bulging with sickness and hope -- four days a week, 52 weeks a year.

The scramble for healthcare is a reality for many of the estimated 6.5 million Californians who live without medical insurance. The uninsured are a mosaic: young and old, unemployed and working, citizens and illegal immigrants.

Of the state’s non-elderly uninsured, minorities -- who make up slightly more than half of the state’s population -- are disproportionately represented, accounting for at least 69% of Californians without health insurance, according to a survey by the nonprofit Henry J. Kaiser Foundation. The survey also found that 14% of California’s children age 18 and younger lack insurance; 23% of adults ages 19 to 64 are uninsured.

Although there are food pantries for the hungry and clothes giveaways, there is no easy way to fill the need for healthcare.

“You do what you have to do,” said Turner, who works part time as an office administrator at a magazine and has no health insurance. “You’re at the mercy of what you know.”

Turner expected more when he uprooted himself from Chicago and accepted a job as a project manager in Los Angeles. The job fell through. There was a time when all he had to do for healthcare was present a card and a co-payment. No predawn lines. No uncertainty about being seen.

“I didn’t realize how much of a luxury it is,” he said.

A friend referred him to the Los Angeles Free Clinic and told him to arrive early.

“And this is just to get into the door,” he said, surveying the line and his future. “It’s scary. The economy is bad. It’s a strange time.”

The dilemma confronting the underinsured and uninsured is part of the national debate. In California, Proposition 72 on the November ballot asks the electorate to vote yes or no on a state law passed last year that would require businesses with 50 or more employees to provide health insurance to workers or pay into a state-run plan for workers.

Opponents argue that requiring more businesses to provide insurance is the wrong solution. They say Proposition 72 will raise costs, driving small businesses into the ground and reducing the number of jobs in the state.

A recent Los Angeles Times Poll found that 46% of likely voters would approve the measure, while 29% opposed it and 25% were undecided. Whatever the outcome, the discussion has opened a view into a growing distinction riving American society: not wealth disparities or the digital divide but access to health coverage.

The Los Angeles Free Clinic has three locations serving 21,000 patients annually. The Beverly site, the busiest of the three, treats about 200 people a day, 13,000 a year.

By first light on this day, about two hours after forming, the line of more than two dozen extends around the building.

There is no grumbling about the wait, and the people in line are too sick or too sleepy for idle chatter. They are also unusually grateful, even at this hour, for a chance to avoid the huge medical bills that can throw a family deep into debt.

Sonia, the woman with the headache, is eligible for insurance through her employer but can’t afford it. She makes $9 an hour as a certified nurse’s assistant. Insurance would cost $80 a month.

“You can’t pay the rent in Los Angeles,” she said. “If I’m paying money for the doctor, now I don’t have money for the rent.”

A previous employer offered excellent, affordable health insurance, but she lost her coverage when the company moved to another state, she said. Now she must fend for herself. The day before, her blood pressure shot up to a dangerous 184/110. The next morning Sonia left her house near the Sports Arena at 4:45 a.m. and caught a bus to get a spot in line at the free clinic.

“I have a lot of stress,” she said. “I have gone many years without taking a vacation. Sometimes I feel frustrated. We work very hard for a little money.... I don’t need money from the [government], but I need insurance.”

Weak and bleary-eyed, Telma Martinez battles sickness and disappointment. Last month she saw a commercial for health insurance on Spanish-language TV and thought she’d found a solution. For a low premium and a few dollars each month, she could afford full coverage.

Martinez, who cleans apartments for a living, said she sent in $225, a week’s pay, and got nothing in return. Not even when she called again and threatened to report the company.

“I told them, ‘You took all the money I have,’ ” she said, her eyes welling with tears, but they told her to send more. “There are too many bad people here.”

With that money gone, there was even less available when she became ill this month. She tried treating herself with over-the-counter flu remedies, then finally came to the clinic.

“Sometimes you have to,” she said, almost apologetically.

In this era of medical advances, when people live longer and healthier, the uninsured experience a different reality.

Those in line at the clinic have many stories of the things people do to get better. They treat themselves with aspirin, herbal teas and willpower. Or they ignore the pain until it is too much to bear. They save for a doctor’s visit the way others might save up for a new sofa.

And some, like Anthony June de los Reyes, 22, travel long distances.

At a Los Angeles County hospital, he waited six hours, saw a doctor for 15 minutes, and was put on a six-month waiting list to have a cyst removed from his back, he said. The examination, he said, cost him $600.

Instead of waiting six months, he took a trip to the Philippines two years ago. At a regional hospital in Sindangan Zamboanga del Norte, the surgery cost 20,000 pesos, he said, or about $400.

But a recent episode of chest pains and sweats cannot wait for a trip to his homeland. So his mother and sister referred him to the free clinic.

“It’s hard these days,” he said. “If you don’t have a good job, it’s really hard to have insurance.”

De los Reyes is a nursing assistant who works part time at medical facilities and has a full-time job at a convalescent home, which will offer him insurance in about a month.

At the clinic, the worker with no insurance may be treated by volunteer doctors from nearby Cedars-Sinai Medical Center, a hospital known for the rich and famous among its clientele.

The clinic offers other services: dental care on Saturdays, mental health care, legal help, showers for the homeless.

Near the end of the line is a short, white-haired woman who declined to give her name. Once a clinic donor, she now waits to see a doctor for bronchitis. She said she lost her insurance after arthritis left her unable to work.

“They say, ‘You don’t have the coverage, you don’t have the money, but we’ll take care of you,’ ” she said. “ ‘We care about your health.’ If I ever get money again, I will come back and give them some more.”

The free clinic operates on money from foundations, corporations and individual donors, as well as some public funds. The facility opened in 1967, when most of the patients were young people hanging out on Sunset Boulevard.

Now most patients are people with jobs and no healthcare.

Because the demand is so high, services are usually limited to Los Angeles County residents. Immigration status is not a factor.

Not everyone seen at the clinic has to wait in the line. A call center schedules appointments, but the demand is high and the wait long. Unless the need was urgent, a person calling today would probably get an appointment sometime in December.

At 7:40 a.m. the line rustles with anticipation. The clinic’s security guard, Michael Hayes, moves down the line, handing out forms to each person. He stops at the 15th.

On this morning, the staff cannot see any more than that, he says, adding, “We just don’t have enough doctors.”

“That’s what I was afraid of,” says the former donor. She will not see a doctor. Nor will Turner, Martinez or De los Reyes.

The line divides. The fortunate 15 stream inside the clinic, and the others -- frustrated, disappointed and still sick -- head off in different directions. And the line is gone.

The next morning, fog obscures the moon and the stars. The line forms again. De los Reyes arrives at 5 a.m. So does Martinez. She sits on a purple milk crate. He sits on the curb.

On this day they are first.