A Health Care Disaster - New York Times
The New York Times

September 25, 2005
A Health Care Disaster
By
NICHOLAS D. KRISTOF

KILN, Miss.

In the richest country in the world, a man named Eugene Johnson is going
blind in a homeless shelter, because his eye medicine washed away in
Hurricane
Katrina and he can't afford to buy more.

At one level, that's an indictment of the official rescue effort: the
authorities were sufficiently concerned about hurricanes that last year they
pre-positioned
10,000 body bags in New Orleans, but they dozed as Katrina approached.

Yet at a deeper level, Mr. Johnson's plight is a window into our broken
health care system. Sure, we need to think about how to rebuild New Orleans,
but
we also need to reconstruct a sensible health care system. And that task is
urgent, for one study suggests that more than 18,000 Americans will die this
year as a consequence of not having health insurance.

Barbara Bush thought that Hurricane Katrina worked out pretty well for the
poor. ("Many of the people in the arena here, you know, were underprivileged
anyway," she said after touring the Astrodome, "so this is working very well
for them.") I'd like her to come here to the rural Mississippi town of Kiln,
near the Louisiana line, and meet Mr. Johnson. A barrel-chested retired
plumber, a white man of 57, Mr. Johnson suffers from diabetes that has
already
cost him two toes. Complications also threaten his eyesight, and so he must
take nine prescription medicines, including two to preserve his vision.

But the hurricane destroyed Mr. Johnson's house. Since then, he has been
bouncing from one shelter to the next and is now sleeping on a cot in a
school
gymnasium, along with his wife and four of his five children (one is grown
and has left home).

Once Mr. Johnson found a pharmacy that was open and had one of the medicines
he needs. But it charged $119 for it, and he couldn't afford that. So Mr.
Johnson
is slowly going blind.

"My eyes are starting to mess up," Mr. Johnson explained. "I see little
spots. And then sometimes they all move around, like a TV picture that's
gone bad."

Finally, a first-rate aid group, Children's Health Fund, brought doctors and
a mobile clinic to Mr. Johnson's shelter. One of the doctors, David Krol,
examined
Mr. Johnson, was horrified, and is working on obtaining the medications he
needs. But as Dr. Krol described the mobile clinic: "We're a stopgap.
Nothing
more."

If Mr. Johnson were more mobile, more adept at working the system, and more
of a complainer, he might have gotten help earlier. But the poor tend to be
stuck in shelters, without vehicles, and many are busy looking after small
children. And many, like Mr. Johnson, are disastrously polite, patient,
deferential
and even cheerful. Around here, if you have the patience of Job, you suffer
like Job.

Nearly every medical worker I spoke to warned that there would be a surge in
deaths from heart disease, strokes and other ailments, concentrated among
the
poor, because of the interruption in medicines. Dr. Jay Lemery told of
treating a single mother in a shelter whose three children were bouncing off
the
walls because they had attention-deficit disorder and hadn't had their
medication. The mother herself was prone to depression and had run out of
her own
medicine as well - in an environment that would make Pangloss suicidal.

The shelter was hot and tempers were so frayed that two women were having a
fistfight. Dr. Lemery added: "Even the Red Cross people, who have the
patience
of Mother Teresa, were in tears."

Yet the reality is that our medical system failed this region long before
Katrina arrived. One of the Children's Health Fund doctors discovered a
previously
undetected hole in a 4-year-old boy's heart. The mother said nobody had ever
listened to the boy's chest before.

In both Mississippi and Louisiana, infant mortality is worse (for every
1,000 babies born, 10 die in their first year of life) than in Costa Rica (8
die
per 1,000). For black babies in either state, the picture is still more
horrifying: 15 die per 1,000. In poor, war-torn Sri Lanka, where per capita
medical
spending is only $131, babies have better odds, with 13 dying per 1,000.

So let's rebuild the levees, but let's also construct a health care system
that works. A dozen years after the last, failed attempt to reform health
care,
the system is more broken than ever. For the sake of Mr. Johnson, and for
our children, it's time to try again.

Posted by Miriam V.