September 21, 2007


By Steve Padilla

Right now somewhere in our community, as in our nation – a child and his or her family are walking into a hospital emergency room. They are there for medical care they can’t get anywhere else.

This is their visit to the family physician. Perhaps it’s the flu season, or a persistent pain or cough gotten bad enough to finally warrant going in after waiting and hoping it would just go away. Perhaps it’s nothing. Perhaps, it’s something much worse because they waited too long to seek care. Either way, their experience in the emergency room will largely be the same familiar and frustrating one we all see. Fill this out. Answer these questions. Sign here, and here and here. Have a seat over there. Wait.

If you have made an emergency room visit, or have visited in support of family or friends, you have seen “them” many times. They are among the millions who work hard full-time, and have no health insurance. In California alone, 6.7 million are without health insurance. According to the Urban Institute, 5.4 million children nation-wide are without insurance at some point, despite supposed access to coverage.

Seeking care even with insurance is often frustrating. Access is delayed, unavailable, sometimes denied. The costs of providing care are increasing, in large part due to the fact many who need and receive care are uninsured.

This chronically ill system is the biggest white-elephant in our nation’s dysfunctional living room, a disgrace in the most advanced and wealthy democracy in the world. Like many obvious but largely ignored problems, we can’t seem to get past the denial and arguing and find the will to act.

In local communities including parts of San Diego County, many doctors and specialists choose which hospitals to practice in based on their “patient mix” - that is, how much of the patient load have insurance. Because of this, many will practice in a hospital or a system where the mix is balanced, even if located away from their patients. This forces many from poorer communities with higher levels of uninsured to trek elsewhere to receive their treatment. Oh, and while this happens, those hospitals in communities with more uninsured have their situation made even worse.

While many fall ill and costs to all of us increase, what are leaders in Washington and Sacramento doing about it? Well, elephants are at home in the circus right? Let’s check-in under the big top.

In Washington, one of the few programs to show progress providing insurance to children without it is under-funded. President Bush promised to veto bipartisan bills passed in both the House and Senate to increase funding for the program. While Congress was in recess, the administration pushed through new rules restricting the ability of individual states like California and New York to increase eligibility to cover more children.

The Children’s Health Insurance Program (CHIP) is meant to be funded 70% by the federal government and 30% by the individual states, and target uninsured children in families living at up to twice the poverty level, which for a family of four is $41,300 dollars a year or less.

Many states are trying to increase coverage to include families making more than twice the poverty level, at three or four times that. But the administration won’t have it – sending letters to states during the recess like thieves in the night, demanding states show they have covered over 95% of all eligible families before they consider expanding. They also want states to show that no more than 2% of the children who currently have insurance became uninsured – in any given year. What? Are we supposed to assume mom and dad dropped their private coverage to run and join CHIP? What if they lost their job? Oh, I see, that makes sense. Under-fund the program to the point that 30% of families eligible don’t even know it, restrict states from expanding coverage and threaten to veto more funding. It is the circus after all.

The number of children under 18 without health insurance rose by 600,000 nationwide last year. According to the pentagon, we spend over 6.8 billion a month, excluding equipment, on the Iraq war.

In Sacramento, the Governor called the legislature into “extraordinary session.” No agreement during the regular session on a health care bill due to conflict on how to spread the costs. We’ll see how extraordinary it is. But they did get in some “legislative bingo” a game where silly phrases that don’t fit are slipped into speeches on the floor of both houses in the capitol. They also spent considerable time debating a ballot initiative expressing opposition to the war in Iraq. Oh, I forgot, the Legislature and an initiative have absolutely no authority to direct the course of the war in Iraq.

Meanwhile, a child and family are walking in. Fill this out. Have a seat over there. Wait.

Feeling ill yet? I am.

Padilla served as Chula VistaMayor from 2002-06 and on the California Coastal Commission from 2005-07. He is President/CEO of Aquarius Group, Inc. and can be contacted at:

Return to the Frontpage