While we watch NH go to the polls and elect the next candidates for President, let's keep in mind where this country is, and what's happening to us in our day to day lives, for those are the things that will decide the election.

Health care is an illustrative issue. Health care is important to Americans. In surveys, health care routinely comes up as an item of importance just after Iraq and the economy.
graph from Kaiser Family Foundation (.pdf)

But there's more to health care than universal coverage, important though that is.

For example, our health system itself is on life support. For all the individual issues with health care coverage, the health system itself is in trouble, and any realistic review needs to consider not just insurance coverage, but health care access and health care quality as well as health care financing. Of those three, access is often the one left out or taken for granted because our teaching hospitals and emergency rooms take up the slack.

Is that a stable situation? Not at all, as this article from the NY Times shows.

Once admired for its skill in treating a population afflicted by both social and physical ills, Grady, a teaching hospital, now faces the prospect of losing its accreditation. Only short-term financial transfusions have kept it from closing its doors, as Martin Luther King Jr.-Harbor Hospital in Los Angeles County did last year. That scenario would flood the region’s other hospitals with uninsured patients and eliminate the training ground for one of every four Georgia doctors.

To put it more starkly:

But Grady’s value is more than sentimental — it is essential to the region’s health. With 675 beds and 16 operating rooms, the hospital handles more than 850,000 outpatient visits a year and admits more than 30,000 inpatients. It is home to the only Level 1 trauma center in north Georgia and the city’s only emergency ambulance fleet. It has one of the country’s largest AIDS clinics, a dialysis unit and a 24-hour emergency center for sickle cell anemia.

All are now at risk.

The prospects that Grady could close, and that Atlanta’s health infrastructure could crumble, have forced a civic re-examination of the region’s commitment to its least fortunate, a reckoning that has revived old antagonisms over race, power and class.

Health infrastructure... that's a term we've heard before. I've written about it when we examine our country's ability to respond to a health crisis like the next pandemic. You see it strained to the max every time we get another seasonal flu epidemic.

Sure, that's just health. We're not forgetting the public works infrastructure (our bridges and roads) and the civic infrastructure (our Constitution and the Rule of Law). There's the government infrastructure (and the undoing of the 30 something political minders Bush planted everywhere). Our schools could use some work, too.

But some things are immediate and potentially catastrophic. Here's ABC's look at Parkland Hospital in Dallas:

"I've brought people back that have been in the waiting room 24 hours," says nurse Bunni Mayfield as she scans the hallway for precious bed space. "It's pretty sad. People who come to county know it's going to happen."

Ninety percent of Parkland's ER patients can't afford a family doctor or health insurance, so people like Tyler Sholz ignore the pain until they can't. He brought a friend and cooler of food to pass the time, hoping someone would eventually look at the painful abscess on his arm. He realizes that he would be better off getting care from a primary physician, but when he dropped out of college, he didn't realize he would be dropped from his father's insurance.

"I'm used to going to the doctors and being seen within like 45 minutes at the max," he says. Twelve hours after walking in, he is treated.

In fact, the system has been broken for a while:

Is There A Crisis in Emergency Medicine?

Q. Is there a crisis in the nation’s emergency departments?

A. Yes. Emergency department visits in 2003 rose to 114 million, up from 89.8 million in 1992. At the same time, the number of emergency departments decreased by 15 percent, resulting in dramatic increases in patient volumes and waiting times at the remaining facilities.
Q. What is the impact of overcrowding on patient care?

A. According to the U.S. General Accounting Office, overcrowding causes prolonged pain and suffering for patients, long emergency department waits, and increased transport times for ambulance patients.
Q. What is causing the crisis?

A. A lack of hospital inpatient beds; a shortage of on-call medical specialists; an increasing elderly population; and nationwide shortages of nurses, physicians, and support staff.

Put it on the list of things this administration has neglected in favor of stifling information on global warming and chasing after WMD in Iraq that never existed.

Health care reform is a GOP weakness. Americans prefer Democratic health care solutions by a ratio of 2:1. But regardless of voter preference, when the next President is elected, there's going to be years of neglect to tackle. We want to be patient and help to tackle this sensibly. Let's hope we have time. The evidence is that we have less than we realize.

Originally posted to Daily Kos on Tue Jan 08, 2008 at 06:53 AM PST.

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