Facing the Barriers

By Nancy Green

Nonprofit private and community-owned health centers focus on family and preventive medicine in Utah's underserved neighborhoods. KUED producer Nancy Green previews her documentary that airs October 22.
by Nancy Green
Seven years ago Yvonne King of Salt Lake City was diagnosed with colon cancer. She hopes she's beaten it, but she doesn't know for sure; she hasn't been tested since her surgery. A mother and grandmother who works full time without benefits, she struggles to afford health care.

For Yvonne King, for every Utahn, for every American, there is a stark question: Do I have a right to health care?

In the United States, an estimated 47 million people are without health care coverage. Every year 18,000 people die from diseases that could be prevented or cured, simply because they do not have access to the health care system.

In Utah, an estimated 305,000 to 420,000 people are uninsured-roughly twice the population of Salt Lake City. Nationally, the number of uninsured equals the populations of Utah, New Mexico, Wyoming, Montana, Idaho, Nevada and California combined. A 2001 Harvard study shows that among 1.4 million bankruptcies declared each year, 700,000 are due to medical debt.

Without insurance, finding a physician is a difficult task. "I really need some form of insurance to be able to get into the doctor," King says. "But I was so sick that I couldn't hold down a full-time job. I was just working part-time. There were no medical benefits and I thought, 'Boy, this is Catch 22.'" She spent a year looking for a surgeon who would take her on as a patient. While she was looking, her cancer progressed from stage one to stage three. The doctor removed the tumor and recommended chemotherapy to increase her chances of survival. Already worried about how she would pay the $87,000 she owed for her surgery, she declined chemotherapy. She could not afford it. If she didn't survive, she didn't want to burden her children with her debts.

Most of us know a neighbor, friend or family member grappling with this issue. "A health insurance premium today is almost the same as the mortgage payment on the median American home. Well, if you had to choose, would you rather have a home to live in, or would you rather have health insurance? Because that's the choice that we are coming to," says Brent James.

In Utah, dozens of clinics are trying to help the uninsured. While clinics provide an important safety net, that net is not big enough and is "pretty porous," says David Sundwall, MD, executive director of the Utah Department of Health.

"We catch a lot of people, we help them but a lot of people still fall through the holes in the net," says Marc Babitz, MD, University of Utah.

Mansoor Emam, MD, knows what can happen when chronic illnesses go untreated. That's why in 2004 he founded the Maliheh Free Clinic in Salt Lake City, offering care to the working poor with chronic illnesses. The clinic's name means comfort and beauty in Farsi. As a young boy in Southern Iran, the suffering Emam witnessed motivated his desire to become a physician and provide basic health care to people who otherwise don't have that privilege.

His clinic in Salt Lake, which supplies $20,000 a week in donated medicine, takes 600 to 800 calls a day from those needing care. Only about 60 to 80 of those calling  can become patients. "What happens to the other 600 to 700 patients?" he asks. "Where do they go? Where do they get their care?"

Local nonprofit community-owned health centers that focus on family and preventive medicine in underserved neighborhoods where language, culture, geography or poverty create barriers also attempt to fill the medical gap. Cobbled together through state, federal and private funds, these centers see a mix of patients, both insured and uninsured, who pay a sliding scale fee based on income. But the clinics often face financial crunches that put their services in jeopardy.

In rural towns, more than dollars, distance is the problem. "The vast majority of physicians choose to practice in urban or suburban communities, and only a very small proportion, about 5% of the total, are practicing in rural America; yet 20% of our population lives in rural America," says Babitz.

Over half a million people live in rural Utah, where health professionals are a scarce commodity. Some 90,000 of them are uninsured. Many work dangerous jobs. The Wayne Community Health Center in Bicknell is where some turn for their basic needs. With a population of 335, Bicknell is classified as one of Utah's remaining frontier towns. The closest hospital is three hours away. "You see and at least treat initially every infirmity known to man," says Jeffrey Chappell, MD, at the Health Center. "I think we're very good in this clinic at providing primary care and urgent care. Specialty care is a challenge for these people." A major problem in small rural clinics like his, he says, is finding physicians who will stay.

Language and culture can be as cruel as miles of separation from services. The Stephen D. Ratcliffe Community Health Center in Salt Lake City's Rose Park area deals with patients who, although predominantly Hispanic, come from diverse cultures and speak a variety of languages. The primary care physicians there are more like town doctors from a bygone era. Says Luz Sanamiego, "When you work in this type of clinic, of course you develop a relationship with the patients. You see them at church, you see them outside of the grocery store."

The health care crisis comes back to a very basic question, "Who has the right to health care?" It's a question that Utah's state legislature took up in 2007, a question driven by State Senator Scott McCoy's proposed amendment to the Utah Constitution. His proposal, SJR4, would amend the Utah Constitution to require the Legislature to establish and maintain a system to provide "affordable, medically necessary" health care for all Utah citizens.

"We know what the issues are, we know what the models are," says McCoy. "Let's put one together that will work for Utah, work for Utah citizens, so that the health care system will work for everyone."

McCoy's amendment was never put to a vote. The legislative session ended without further action. The question of how to find a health care system accessible to all Utahns remains. And people like Yvonne King will continue to ask how we-as a just and compassionate society-can continue limiting care to the people who most need it.

Nancy Green is a TV producer. Her hour-long documentary, "Health Care: Facing Barriers," investigating the realities of health care for the uninsured in Utah, airs this month on KUED.

Watch "Health Care: Facing Barriers" on KUED, Channel October 22, 8 p.m.

This article was originally published on September 29, 2007.