More than 1,000 people are expected to flood the halls of the Dallas Convention Center this Saturday seeking medical care at a one-day event sponsored by the National Association of Free and Charitable Clinics and other organizations.
Despite what Republican presidential nominee Mitt Romney seems to believe, this is a sign that uninsured and poor Americans lack reliable access to health care, not an indication that the system is working, said Nicole Lamoureux, executive director of the Alexandria, Va.-based free clinics group.
"There would be no need to take over convention centers to give people health care if there was not an access problem," Lamoureux said by telephone Tuesday from Dallas, where she's stationed preparing for the one-day event, which will cost as much as $300,000. The Dallas-Fort Worth-Arlington metro area has the third-highest uninsured rate in America, 22.3 percent.
During an interview on CBS News' "60 Minutes" that aired Sunday, Romney said people without health insurance in America don't have to go without medical care they need.
"We do provide care for people who don't have insurance. If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance and take them to the hospital and give them care," he said. "Different states have different ways of doing that. Some provide that care through clinics. Some provide the care through emergency rooms," he said. "I wouldn't take what we did in Massachusetts and say to Texas, 'You've got to take the Massachusetts model.'"
To Lamoureux, Romney's ignoring how overstretched the safety net is. "To say that emergency rooms and federally qualified health centers and free clinics or charitable clinics are the answer?" she said. "If there was no problem getting access, we wouldn't have to be in existence." Nationally, about 1,200 free clinics, which don't get federal money, treat 2.5 million people a year, she said.
There were 48.6 million Americans without health insurance in 2011, according to the most recent data from the U.S. Census Bureau. Many millions more have coverage but still can't afford medical care they need and go without. Put it together and you have a health care access problem that's been worsening for at least a decade.
Can safety net facilities compensate for the fact that so many Americans can't get health care? "No way. No, absolutely not," said Daniel Hawkins, senior vice president of the Bethesda, Md.-based National Association of Community Health Centers.
"Health centers are not insurance coverage. They don't have the ability to either provide or pay for specialty care, big diagnostic tests like CAT scans or MRIs, or for inpatient care," he said.
Romney used to agree that safety net health care facilities were no substitute for health insurance coverage. The health care reform law he enacted as governor of Massachusetts in 2006 is premised largely on this argument.
"It doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way," Romney said in 2010.
James Hunt saw firsthand the difference "Romneycare" has made in providing better health care for Bay Staters. Hunt is the president and CEO of the Boston-based Massachusetts League of Community Health Centers. "It's done a marvelous job," he said. "What I want for every man, woman and child in America is to have what I have," he said. "That's what we're striving for here and that's the example we're trying to show to the rest of the country."
Community health centers, also called federally qualified health centers, treat about 22 million patients a year at roughly 8,500 locations around the country, Hawkins said. About 8.5 million of those patients have no health insurance, he said.
"We can provide the visits, we can care for the diabetes and the high blood pressure and the asthma, and we can give kids their shots and do well-baby checks and prenatal care and we even [do] deliveries," Hawkins said. "But if the patient needs a specialist, if they need to see a cardiologist or a surgeon, we have to beg, wheedle and cajole."
Hospital emergency rooms are mandated by federal law to diagnose, treat and stabilize patients whether they can afford their care or not. In practice, emergency rooms have increasingly longer wait times for patients, or either divert patients to other hospitals or discourage them from seeking treatment.
Emergency departments are no substitute for getting people covered by health insurance, said David Seaberg, the dean of the University of Tennessee College of Medicine Chattanooga and president of the American College of Emergency Physicians.
"Emergency care is not health insurance," Seaberg said. "All patients need health insurance. That gives them access not only to quality emergency care but access to primary care doctors and medical specialists," he said.
Looking to emergency departments to make up for the lack of universal health insurance coverage also detracts from hospitals' ability to deal with true emergencies and threatens their viability. "If we continue to say that that is universal access, that health care safety net will fray and it won't be there when you absolutely need it," Seaberg said. "If emergency departments continue to have financial losses, they will not be able to survive."
That "free" care from hospital emergency rooms comes at a cost. Hospitals weren't paid for $39.3 billion worth of medical care they provided in 2010, according to the American Hospital Association. And patients aren't magically off the hook just because the hospital had to care for them. Unpaid medical bills can ruin credit, provoke harsh treatment from debt collectors and lead to bankruptcy.
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