In Utah more than 300,000 people have no health insurace. This week on Utah Now, we are asking why...just who are these people? What are the strategies they use to care for themselves and their families? And what are the costs to them...and you?
Editorialist Mark Alvarez, a writer and lawyer in Salt Lake City, speaks out on what makes a healthy lifestyle.
If you have health insurance – you don't understand what it means to worry about even the most minor of illnesses. The fact is – there is a growing number of Utah families who do. They face inconsistent medical care, excessive drug costs, and constant anxiety.
Tonight on Utah NOW we're asking who are these people…it may surprise you…how are they getting their health care and what are the costs?
Hello, and welcome to Utah NOW. I'm Doug Fabrizio…Everyday throughout the state – thousands of families have to decide whether the simple act of seeking medical attention for a loved one is worth the risk. The choice often goes something like this - do you wait to see if a nasty cough or a nagging pain will work itself out – or do you play it safe and call a doctor…
If you have health insurance there really is no risk - it's a pretty easy choice to make. If you're like the more than 300-thousand Utahns who don't, these decisions are complicated and at times incredibly stressful.
Families without insurance have to find a way to maneuver within a system that hasn't taken them into account. What if you don't qualify for Medicaid or Medicare – but still can't afford insurance premiums. For many families it means putting off preventive care – or settling for attention in an emergency room.
There are options - both public and private - that have moved to fill this vacuum - but they still haven't answered the critical questions – questions we'll get at tonight. Are safety-net programs like free clinics an answer, or a diversion – just who are the uninsured and what does their experience tell us about the country's health care system…
In Focus: Primary Care
[Susan Julian, Salt Lake]:
It's awful, I have a son that's ten years old and I have no medical coverage for him and it's awful just to have to not know incase something happens that you can't take care of your family and yourself, and if I don't take care of myself, I certainly can't take care of my family.
Susan Julian joined the ranks of Utah 's uninsured when she lost her job – and Medicare was out of reach. She's just one of about 14,000 patients who have come to the Maliheh free clinic since it first opened last year.
Of course, the clinic serves a fraction of the 300,000 Utahns without health insurance. Jane Powers, a co-director of Maliheh understands the scale of the problem and the limits of her clinic, but she says they're committed to making health care accessible to all.
[Jane Powers, R.N., Co-clinical Director, Maliheh Free Clinic]:
I feel the Maliheh Free Clinic is just a piece of the greater pie and what we can do here is that we can offer people the chance to reach resources that they are not aware of.
Our clientele at the Maliheh Free Clinic come from as far as Tooele, Ogden , Provo , the majority of our clients are from this immediate area.
I've worked at the Cottonwood Emergency Room for over 20 years, and that is how I met Mansoor Emam who runs this clinic and it was part of his vision and he's captured a lot of the people that in the emergency room work with him and they also volunteer here.
Working as a nurse in an emergency room, Jane Powers encountered Dr. Monsoor Emam, and both were struck by what they were seeing day after day. The place was constantly overcrowded with people who, deprived of any other option, were enduring long waits for medical attention. Some of these were drastic procedures that could have been managed with a little primary care.
The experience prompted Emam to open the Maliheh Clinic…and today it relies on the volunteer efforts of translators, mental health specialists, even dentists to serve between 60 and 80 people a day.
[Dr. Mansoor Emam, Medical Director, Maliheh Free Clinic]:
I'm an ER physician and that's one of the reasons that motivated me to do this, is when I took care of folks that came in that could have simply not ended up there had they taken medication for $5.00 a month and not end up with an expensive visit in the ER, plus the ER is not the answer because we would see them there take care of them or admit them or they would go home, they still didn't have anyone to follow up with.
Mele Kanongataa is one of Maliheh's patients who has found herself caught in the middle of the American health care system. She doesn't qualify for Medicaid but she's also unable to afford a regular physician. Sisilia is Mele's granddaughter.
[Sisilia Kanongataa, Kearns]:& Grandmother [Mele Kanongataa, Holladay ]:
We would take her into the hospital and stuff just to check up everything her kidneys were really in pain and stuff and so it was a lot of money and she would just sit home in pain until my grandpa drove by and saw the sign.
The majority of the patients have chronic illnesses such as diabetes hypertension coronary artery disease, arthritis etc. and these folks like Mele follow here until they get other resources, but we take care of them just as their primary care physician would.
It's a big help for us and we're thankful for this clinic, because if it wasn't for this clinic we would not be sure about her kidneys or her diabetes because it got so high it was over 300, ever since we came everything has leveled out and she is in good health now and so we can live longer, she can see my kids one day.
Most of the patients actually come in, ya know these are folks who work, and they're working poor, they basically can't afford the healthcare so they would go to work and not feel well of course they are not as productive, our goal is usually to see them and get them feeling better get them controlled so they are much more productive and happy, and that's what we try to accomplish. We try to accommodate patients who don't have any other resources, and for example, Brenda brought her little son, 5 months old son who has been ill for the past few days.
[Brenda Padilla, Taylorsville ]:
I don't have any Medicare or CHIP insurance, I don't have anything, so yeah I am really sad about I don't know where I can go because in the hospital the really expensive the bill. So my sister told me about this clinic.
So I find the doctor and he tell me about oh come Tuesday and I can check the baby and you can pay anything if you don't have the money and I said oh that's great.
I need to find anything for my baby when he is sick.
Clinic works as a bridge for most patients, our mission and our goal is not to take care of these patients on long term basis, because otherwise the clinic will be full and we can't really serve anybody else.
For the people at Maliheh, the old adage rings true: an ounce of prevention being worth a pound of cure. But their efforts are playing into a growing debate…should the clinic be a necessary component of the health care system, or a temporary fix?
The reason we focus on prevention is if we can stop the fire before it begins it's much easier, less cost, and also the patient has a much higher quality of life.
I don't think this is the solution. The health care system is broke, there is no reason that people should not get medical care, the way the system is it seems like getting medical care is a privilege rather than a right and that people with chronic illnesses I think have the right to get care. This doesn't solve the problem, but sitting back and saying the system is broke, therefore I can't fix it and do nothing is just as wrong.
The people who are joining us now understand the choices you have to make when you're uninsured.
Steve and Jill Romo own and operate two small businesses- Landscape Curb and Clean Reflections. Steve works does cement landscape curbing and decorative concrete.
Jill runs a carpet and window cleaning service out of their home… all of this while tending to their two kids…
Welcome to you both..
Jill and Steve, I want to start with a story. Your daughter, seven years old, was bitten by a dog. And I want you to sort of tell how you handled it, because it seems to illustrate the predicament you're in.
OK. I just remember right after it happened both Steve and I looked at each other and very few words were said, and we knew we needed to go to the emergency room. And so off we went. And about nine hours later we waited for a plastic surgeon to show up and he said that all they could do was wash it and put the glue adhesive that would close it, rather than stitches. For just those three minutes of his time was about $800. Our total bill was almost $3,000 that day, which we are still continuing to pay on. That and among other medical bills as well.
So, what does that say about your predicament that most people who are, Steve, you know, have health insurance, they don't have to worry about that sort of thing, so I expect this thing is on your mind all the time.
Certainly. As a father, as a husband, it's up to me to provide good health care, food on the table, and we have sought insurance, you know. We do want to be insured. However, the cost of it is anywhere from $800 to $1,500 a month. That's equivalent to my house payment, you know, so things need to change.
Where do you figure you are in terms of this sort of economic scale? It seems to me you're sort of somewhere in the middle, I guess. Is that how you see yourselves?
We're relatively a new company, our companies are pretty new. We're aspiring, you know. In a lot of ways we feel that we can't afford it, but we need it. So we're kind of like a Catch-22.
You find yourself squeezed somehow, in the middle?
For sure, absolutely, absolutely.
So what are the strategies that people who are in your situation? What…do you have to sort of come up with a way to find health care, to deal with the costs? What do you do?
You know, I think we've just…you only go to the doctor if you absolutely have to. There's not a lot of preventative care there. We have resorted in the past to going to some of the community health care centers and some of the other clinics that are available. But, you know, just having that benefit that those have, of having insurance under their belt is, you know, it's a blessing in a sense and it's almost as if we are being penalized for being self-employed and not working underneath someone else. We wanted to build equity in ourselves and therefore that's a risk we have to take.
So immunizations for your kids, prevention care, that's tough to come by, you have to sort of figure out how to do that?
Most of it comes out of pocket. You just, you have to pay those prices.
Yeah. How are you treated, do you think, when people find out you have no health insurance?
It's humbling for me to be her today. I mean, I don't…I wish I was insured, you know. And it is stressful, you know. When you take your kids to the playground, it…you make sure there's no rocks around, make sure…you have to have awareness, and, you know, it's just always in the subconscious, just be extra careful.
Have you thought of solutions? Have you sort of figured out what you think should happen? Have you gone that far to sort out of work it all out?
Well, we know the more money we make the more we'll get closer, you know, to being able to afford that. However, you know, there should be…I know there's a bill public employee heath plan that's on the table. People need to notice that, that it's a deal where we can all kind of join together and pull together and have insurance together, you know.
Let me ask you this, finally, both of you. Is health insurance a right? Do you have a right to health insurance? Should you?
Absolutely. We are hard working individuals and we deserve health care just like anybody else. Health coverage. Absolutely.
I agree. I create revenue; I put revenue back into my city. You know, we provide service to a lot of people and we do a great job. And by that same token, you know, we feel that we deserve just our fair share, you know.
Steve, Jill, thanks. Thanks for being with us.
[Steve and Jill Romo]:
For this week's VOX POPULI we ask people to offer their own solutions for fixing the country's ailing health care system….
I don't know the answer necessarily to solve it but I think that access either through government programs or whatever is pretty necessary to maintaining the quality of life.
If the populous is willing to accept a higher tax structure then I believe the government can offer better health insurance.
Ya know, we all deserve a better quality of life, so I think that if there's a system, or some way of having that, I think it would only benefit the whole community.
The problem with healthcare is broader than just Utah , it's really more of a national problem. Access and the cost of healthcare is pretty outrageous.
No one in this country should be without. There are people that die on the streets diseases that could have been treated had they had healthcare coverage.
Joining us now are two people who have spent their careers working out the problems and solutions of health-care access in Utah .
Judi Hilman is here – she's the Executive Director of the Utah Health Policy Project. Her organization does health policy research and advocacy for the uninsured.
And Cynthia Boshard is also with us – she's the Director of Community Health Partnerships for Intermountain Healthcare. She leads their support of non profit health care clinics across the state. Welcome to you both.
I want to ask you first why we should care about the dilemma of Steve and Jill. Judi?
[Judi Hilman, Executive Director, Utah Health Policy Project]:
Well, first and foremost, we should care about these families. You know, they said it best themselves. They're doing everything they can. They're working hard, they're building companies for our state. They're raising two beautiful children. That's the first reason to care. We should also care because they're going to delay care that would be obviously least expensive to deal with if they had coverage up front. We should also care for the sake of economic development. Our small businesses can't afford anymore to cover their workers. Our uninsured rate has increased seven times the rate that the U.S. Rate increased over the last year, and that's because we have a lot of small businesses. So we should care for all those reasons. If we want true economic development, we will take care of this problem in a financially sustainable way and we think that's the small business to buy in to the Public Employee Health Plan.
[Cynthia Boshard, Director, Intermountain Healthcare Community Health Partnership]:
First, I want to thank you for giving me credit for running our clinics. That's not That's not my job, I have colleagues who do that. But we should care because they're part of our community. They're working, as Judi said, they have children. When people delay care we know that their illness is more complicated, the expense and the complications that come with delayed care is considerable as opposed to getting care at the appropriate time when it is most accessible and most treatable.
What are the strategies that people like Steve and Jill have to sort of come up with to maneuver their way around this system?
Well, I go around and interview a lot of people who are insured and I'm struck by the extent to which, like Steve mentioned, they will not live life to the fullest. They may not let their child play freely in the playground, get all the exercise that they need. And truly you are at…if you want to ski a black diamond and you're a young male or a young person, you probably shouldn't do that if you're uninsured quite frankly. So that's one thing. I have seen a lot of uninsured folks do a lot of home remedies and stuff and try to self-medicate and try to recycle medications, even antibiotics, and really put themselves at tremendous risk, even more risk than they're already at. I've seen them go without other needed essentials like food. So these are all things for us to be concerned about.
Cynthia, I want to ask you, it seems tome you acknowledge the fact that there are too many uninsured.
It seems to me you think there's a kind of myth that people don't actually have access to health care.
It's the rest of the sentence, that there are over 300,000 people do not get health care. Certainly the safety net system that we have in the state, and we have many volunteer and sliding fee scale clinics from Cache Valley to Washington County , I believe there are 47 such clinics that exist especially to care for uninsured and underserved populations. There is access and the safety net is being stretched and there are serious capacity issue sin our state, but one of the most important things we can do is as advocates and people who care about those in our communities that are underserved is to make sure we've got current, good information. We look at really interesting collaborative models of people who will volunteer their time, physicians and nurses. We look at the story of the Maliheh Clinic. Doctor Emam was an emergency room physician for many years, so he is very aware of that complex of serving the needs of people who can only seek health care in emergency rooms, which as Judi said is a very expensive and often too-far-down-the-road way to get health care.
Is the problem that people are seeing these clinics, these safety net programs, as a solution when they should be regarded more as a sort of a temporary fix?
Yes. I think that this is kind of where we are right now in the moment in policy where a lot of people don't know, but our former Governor Leavitt has put out a so-called expansion for the working adults called the Primary Care Network which offers a basic prevention-only primary care package for uninsured working adults under 150% of the poverty level, and then it says that for the rest of the care, the specialty care, the in-patient hospital, they're on their own. They have like one case manager for the entire state to help them get the charity care for the rest. Someone has said that this is acceptable because this is the only solution that's out there right now for working families. And what's really bothered us in our organization and all around the state, I think, is that the current governor's uninsured work group seems like is saying that that group is taken care. So there's a lot of wishful thinking that the safety net, as sophisticated as it, and don't get me wrong, I value it more than anyone and I know we'll need it even when we figure out systemic health reform and we have a sustainable solution. I want the community health centers and the clinic to play a huge role. They are the model for a true medical home, but we've got to have financially sustainable coverage from cradle to grave, and that's where we're failing our families.
Is that realistic?
Well, we believe that those clinics, as you said, they're not a permanent solution. They are a temporary solution. And the whole issue, and very bright minds for a very long time have been looking at solutions to that, that whole coverage question. And we just, as we work together, Judi and I and the community and with others is what can percolate up that is new and innovative but really does address those needs of the uninsured and the issue of accessibility as well as affordability.
I'm wondering, what are the obstacles? Judy, you said that political options are limited, there's….there are social and political limitations, obstacles to getting it ot where you think the state ought to be, the country ought to be. What is making lawmakers, what is keeping industry from transforming the way we think about health care, sort of getting to the next point, do you think?
Well, I think that a lot of the money interests, and there's a lot of corporations that are invested in the very expensive status quo and I think we have got to take the politics and take the money interests out of the question, maybe some of the other questions too, but I'd like us to take it out of this question because, as I see it, luckily, we have a governor and I think we have a populous that is really committed to economic development. And we want to be the number one state in economic development. So do I. You really want to do that. You will take that leap with us and take care of the uninsured crisis in a way that's going to be sustainable. And that means, that means lower your administrative overhead, that means probably nonprofit administration, public financing of all medically necessary care and private health care delivery. That can be done, and I think it can be done in Utah , uniquely in Utah . People think we have to wait for the federal government to figure this out. Forget it. It's going to be up to the State.
Cynthia, less than a minute. Is it going to require kind of new thinking, creativity to deal with this?
I don't know what it's going to require. I have a colleague that's been working on this since 1971. There are many interests, and it's complicated, but if we try to simply identify with the human interest, what are we doing for one another, what are we doing to make our community safer, what are we doing to make them healthy, to make health care affordable and accessible, but there are a lot of people who have a stake in the system working as it is because it works for them. And where is the public to satr to look at something that is going to be a little bit different, toward something more permanent?
Cynthia, Judi, thanks.
[Cynthia Boshard and Judi Hilman]:
In our Speak Out segment, a new voice - immigration attorney Mark Alvarez says when you're talking about prevention – sometimes the simplest methods work the best.
Speak Out Utah
I have a triathlon partner – Jim Demet. At seventy-two, Jim swims, bikes and runs almost every day. He says that exercise has helped make all of his years golden.
Jim is enthusiastic, encouraging and inspiring. Though his example is tough to follow, Jim shows us the value of being active.
In 2000, scientists designed a program called Healthy People 2010 to get people in communities across the country thinking about their health. And physical activity is the leading health indicator. The program makes it clear - we are less active than we should be. And the consequences are also clear - increased costs on businesses , families and individuals.
Take the example of diabetes. Experts tell us one in three people born in the United States in the 21 st Century will develop diabetes. The rate for Latinos is one in two. And its frequency in children is increasing.
The challenge need not overwhelm us, but we must address it. Emphasizing better nutrition and activity can help reduce the incidence and severity of diabetes and other diseases.
Walking is the most common exercise. Marvelous and inexpensive, walking provides the additional benefit of bringing families, friends and communities together. Liberty Park , the Jordan River Parkway and the Rose Park neighborhood are all wonderful places for activity. You probably have or will find your own favorite spots.
Ideally, we should exercise at least thirty minutes a day on most days, but that can be broken into smaller segments, say ten or fifteen minutes at a time. All forms of activity count. Try to exercise with others for motivation and enjoyment.
Physical activity helps us feel better, inspire others and save money. In working for better health care, some of the most important steps to take are our own.
I am Mark Alvarez. Thank you.
That's Utah NOW for this evening - if you're interested in exploring more issues surrounding health care in Utah , join KUED Tuesday night, October 17, in the auditorium of the Huntsman Cancer Institute.
KUED is going to be screening “The Stealth Epidemic,” the third episode in the series “Remaking American Medicine”.
The event is free and open to all – it will be followed by a discussion with guest speaker Dr. David Sundwall, Executive Director with the Utah Department of Health.
For information visit our website – kued.org. While you're at it you can comment on tonight's program and make suggestions for future show topics.
In the meantime – We'll be back next Friday with another edition of Utah now…until then, I'm Doug Fabrizio.
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