The plight of the uninsured

Despite political progress on healthcare reform, business is booming at clinics catering to America's uninsured, writes Dr Patrick Neustatter, a former UK GP now working in Fredericksburg, Virginia

Indigent care is booming in America despite healthcare reform. And there is no indication that members of Congress are uncomfortable about it, even when it is happening in their own back yard.

Nationwide 15.4% of the population is uninsured – 57,200 of them in Washington DC, despite the fact that there is better coverage and less unemployment there than in many other cities in the US.

So, the National Associations of Free Clinics (NAFC) found it necessary to hold its first-ever one day free event on August 4, where 800 doctors, nurses and support staff saw hundreds of patients in the cavernous DC Convention Center.

Despite the potential embarrassment of this event taking place in Congress' own back yard, of all the members of Congress and their staff who were invited, only one (Rep. Donna Edwards, Democratic congresswoman for Maryland) came.

Up close and personal

Having just retired from general practice and taken over as the medical director of the local Moss Free Clinic, which provides indigent care to the uninsured and poor in Fredericksburg, Virginia, just 50 miles south of DC, I get a close-up view of the plight of the uninsured. They come in desperate droves, with their lawn chairs because they have to wait so long, and even then not a few are turned away.

Of those lucky enough to be seen, Mr A is worried that the pain radiating from his left hand to his chest is coming from his heart. And it seems quite likely the anxiety of having no health insurance, and the potential out-of-pocket cost, could be aggravating the situation

It is reminiscent of the episode of the Simpsons where Homer is told he needs a triple bypass, but when told the cost, has another heart attack and needs a quadruple bypass.

Mr A is one of many who have no health insurance because so often health insurance is tied to employment, but the printing company he worked for closed in the recession.

Mrs B fell off a ladder and hurt her back, and her orthopedic surgeon advised her to quit work. Which is, of course, when she needs her insurance the most.

Business is booming at the Moss Clinic. There was a 25% increase in patient visits in 2009 - a number likely to go on rising as many of the features of the healthcare reform act don't come into effect for several years.

'Although it has been a historic year with the passage of federal healthcare reform legislation,' noted Nicole Lamoreux, NAFC's executive director at the one day event in Washington, 'uninsured people throughout the country still need free medical resources now.'