Today we had a class on access to healthcare. It was a policy class, which usually equals snooze, but this one was interesting. There was a lot of discussion about the fact that there are people in america who have poor access to health care and that those with the poorest access tend to be poor and minorities. The lecturer was good, but it was clear that she had a) never been poor (save for those bitter cold days when she was a doctoral student and her stipend was still probably above poverty level) and b) not a minority. She talked about access to healthcare in terms of all people who are poor must have medicare and then just have to deal with finding medicare providers. (for my foreign friends, the us government does pay for healthcare for our poor, disabled and elderly, but it is very difficult to qualify for this service and even when one does qualify there are problems finding practitioners who will accept patients covered by the service.) And she talked about the rest of the population as though everyone has insurance that pays for their medical expenses.

It was interesting to hear how our policy-makers think the system works. During the class she asked us to think of all the reasons why Americans pay 3x's what other countries do out of pocket for health care. People responded with answers like: insurance doesn't cover medications (often true). Deductables are very high. (true, but maybe not what is the real cause for high out of pocket costs.) But when I mentioned how we are forced to use the emergency room for basic primary care because we can't get appointments with out health care providers, and then those emergency room visits aren't covered by the insurance, she waved me off like this was insignificant.

I disagree. Maybe I am basing things too closely on my own experience. When I was poor poor and homeless and living in San Francisco, I had to use free clinics and the department of public health for health care. I could go to a free clinic during their drop-in hours, but they often didn't have drop-in hours at night or on the weekends. So the few times I needed attention, I had to go to the emergency room. Once was for a UTI (ow! like I'm going to wait for monday to take care of that!) and the other was when I had systemic poison oak and was having trouble breathing. I was covered by my father's insurance, but they refused to pay for both those visits because they were considered basic and could have been taken care of by a primary care clinic. Well, duh. But my insurance didn't cover primary care. And I didn't have a clinic that was open on weekends. And I had serious problems that were messing with my ability to work. What would you do? Those bills ended up going to a bill collection company and it took me YEARS to pay them off.

I'm pretty good at finding free healthcare. I've spent most of my life getting free healthcare from the Indian Health Service. While the IHS has issues, I wouldn't trade it in for many other systems because I know I can be treated by IHS wherever there is an IHS clinic. same for my kids. I may have to wait eight hours for the doctor to finish his shift at the white hospital downtown before he sets my broken arm (which happened when I was eight) but I will be seen.

The worst deal is with the truly indigent in San Francisco and the public health department. Back when I was poor and homeless, my boyfriend woke up one morning with a very alarming and personal issue. One that needed immediate medical care. I won't go into what that issue was, just for the sake of his privacy, but it was serious enough that he needed to be seen immediately. We asked around and heard that the public health department would see patients same day. The deal was, you had to go down there that morning and stand in line for a number. Then you had to leave the public health office and return when your number was due to be called. We went there, stood in line and got a number. Then we spent the day wandering around nervously. We returned that afternoon when his number was due and we waited.

The waiting room was stinky. Many of the patients there were homeless bums who smelled like drink and piss and sweat. When we got there, we noticed this guy sitting there with a bloody rag in his mouth. He just sat there, bleeding. We waited in the waiting room with him. My boyfriend's number was finally called after at least an hour of waiting. He went in, leaving me in the waiting room with all the other patients. And with the guy with the bleeding mouth. People came and went and came and went. Hours ticked by. Bleeding mouth sat there, barely moving. His bloody rag got bloodier and bloodier. The blood started to saturate his shirt.

Eventually it was five o'clock and the staff wanted to clear out the waiting room so they could go home. I was still waiting for my boyfriend to return from the abyss, so I just sat there. One of the receptionists came around the corner to see if I was the only one there and saw bloody mouth man. She called out and some guy in scrubs came out to check on her. He looked at bloody mouth, at the puddle of blood on the floor, at the blood saturated shirt, and back at bloody mouth. He walked up to bloody mouth and pulled the rag away to look at his mouth. The man had bitten his tongue off, and had been waiting in that waiting room all afternoon. Without his tongue he couldn't really ask politely for help, so he had just waited quietly for someone to ask after him. I spupose he figured having a bleeding rag hanging out of his mouth was an indicator that he needed help. The guy in scrubs rushed him back into the abyss right as my boyfriend was walking out.

After spending essentially an entire day waiting to be seen, My boyfriend was told that they had no clue what his problem was, that the problem probably wasn't serious, and that he should go home. If it got worse he should return. It did go away and I never went back to that clinic. I don't know what we would have done if it had gotten worse.

I will never forget that day. I know what people who are poor go through to try to get health care. I know about the uncaring system and how it ignores all but the squeakiest of wheels. I promise you that paying for prescription medications is only a teeny wedge of our country's screwed up healthcare system.