Commentary: Health Care Separate and Unequal

Chicago

AT 4 A.M., the ambulance rushed the driver in a single-car accident to the emergency room where I was the attending physician. The victim, a man in his late 20s, had been knocked unconscious when his head slammed into the windshield. The paramedics handed me two-thirds of his scalp in a plastic bag.

That sounds horrible, of course, but modern medicine can do a lot in such cases -- if it has the chance. Our team worked to stabilize the patient and save his scalp. Human tissue can die in a just few hours if it's cut off from its blood supply. So to avoid a disfiguring injury, our patient would need the care of a specialist who could reattach his scalp's blood vessels. Unfortunately, my hospital didn't have such a surgeon; the closest one worked at a sibling hospital in a more affluent neighborhood 15 miles away.

We raced against time to avoid permanent tissue damage. I called and called and called, searching for a physician willing to take care of our patient. But no one would accept him. After 40 minutes, we flew him -- and his dying scalp -- by helicopter to a hospital 45 minutes away.

The patient should have been recuperating after a close call. Instead, by the time he was whisked away from me, he was facing lifelong disfigurement. This is the reality I see every day as an ER doctor: Large groups of people -- mainly those from communities of color, and those who are poor and uninsured -- are not receiving basic care that can make all the difference.

Many Americans have been talking more about health care these days because of the buzz around Michael Moore's new documentary, "Sicko," a polemical look at unfairness in the nation's health care industry. But the types of communities I care for are barely addressed.

Moore says upfront in the movie that he is not focusing on the nearly 50 million people who have no access to care at all. His decision to concentrate instead on the substandard care given to the working and insured is an understandable attempt to touch the heartstrings of Middle America.

Unfortunately, by giving cursory treatment to race and class, he avoided tackling the most intractable problems in this country's health care system.

Here's the view from the front lines: hospital waiting times of 10, 12 hours. Emergency rooms so packed that ambulances must be turned away. People suffering from ailments ranging from organ failure to psychotic breakdowns, all preventable.

These issues affect not only individuals but also whole communities and the health outlets serving them. I sympathize with those who are unhappy about the quality of their insured care, but I'm more worried about those with no care at all. The bigger problem is that we all want the finest of health care, and as a result, many of us -- largely black and brown -- are left with nothing.

One scene in "Sicko" does deal directly with race: A white woman questions whether her husband, who is black, would receive better care if he were white. My experience is that the influence of race and racism on health care is rarely that obvious. But it is unmistakable, nonetheless.

For instance, the young driver in the car accident essentially had the misfortune of getting hurt in the wrong part of town. I was working in a community hospital system in the Midwest that consisted of two very different hospitals. Hospital A (where the patient started) served a blighted, post-industrial city of about 100,000 residents, about 85 percent of whom are black and largely poor and uninsured. Hospital B (the one we couldn't get him into) is 15 miles away, in a more affluent community of about 30,000 people, about 70 percent of whom are white.

Although technically the two comprised a single hospital system, physicians were allowed to choose to work at one or both of the locations. Most chose Hospital B, leaving few specialists on call for emergencies at Hospital A.