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Beware of the Great Leveller

Theodore Roszak
Tuesday November 27, 2001

Governor Davis’ cuts from the state budget for 2002 include $150 million gained by postponing the expansion of the Healthy Families health insurance program to cover low income parents as well as their children. 

If you are among those blessed with good health insurance, you may feel this cut has nothing to do with you. Wrong. Uninsured families are those who rely on the Emergency Room for care when they need it – which is often after they have delayed as long as possible. Their costs then wind up being clandestinely shifted to those who are insured. 

The ER is a unique institution in our society. It is the great leveller. When you enter those doors, it doesn’t matter if you are rich and famous, you will be subject to triage. Meaning doctors and nurses will put you on the list in order of urgency. You may be Julia Roberts or Michael Jackson. You may be head of a Fortune 500 company. Doesn’t matter. Those who need to have their hearts restarted, no matter how poor, take precedence. 

In this life-and-death respect, the ER is as far from market values as we get in the United States. Makes you wonder why the Bush administration tolerates it at all. Why hasn’t Tommy Thompson our secretary of Health and Human Services proposed a new VIP ER plan that jumps CEOs, Republican campaign contributors, members of Congress, and of course cabinet secretaries to the head of the triage list? 

As it is, the only thing remotely like entering the ER is being aboard a hi-jacked airplanes where first class suffers the same fate as the economy. Which raises a timely point. If we are destined to experience more terrorism, biological, nuclear, or plain old explosive, the ER is our first line of defense. Regardless of your social status, the only thing that insures prompt care is if your local ER is well-staffed and well-equipped. Otherwise you will wait ... and wait. 

Last month I escorted a neighbor to the ER at Alta Bates, which is one of the best. She had a broken arm and was hurting bad. She had health insurance; she was from the Berkeley Hills; she was solid upper-middle class. Made no difference. She waited a good long time until those laid out on gurneys could be cared for. At Highland Hospital, she might have waited longer. Highland ER, so a doctor tells me, is so overcrowded it now tracks admissions by the day not the hour! 

Money for Healthy Families, like all health care money, doesn’t go to those eligible. It is an infusion of funds into the overburdened health care system we all share. It pays doctors who might be able to head off a trip to the ER by people who would otherwise be ahead of you on the list. Or if those patients do need ER care, it pays for that care so the ER can afford to treat you more efficiently. 

Cutting Healthy Families while bioterrorism is in our midst is penny wise and pound foolish, though you may not think about that until you wake up in the ER. People can afford to wait for almost anything. They can even afford to wait for better schools, though they shouldn’t have to. But nobody can afford to wait to stop the bleeding. 


Theodore Roszak’s most recent book is “Longevity Revolution: As Boomers Become Elders,” Berkeley Hills Books.