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Who Are the Uninsured?

September 04, 2004

Re "What Health Insurance Crisis?" Commentary, Aug. 29: Dr. David Gratzer asks, "Who and where are the 45 million Americans that the Census Bureau found without health insurance?" I think he will find the majority of them in California and the other states where illegal immigrants collect.

These people form the bulk of the uninsured because they are undocumented workers. They often earn less than minimum wage and have jobs with no benefits.

Furthermore, what money most of these people have left over from basic living expenses, they send to families still living in their country of origin. The problem is even worse than it appears because many undocumented workers and their family members exist below the radar of the Census Bureau.

Though the BlueCross/BlueShield study cited by Gratzer found that roughly a third of those lacking insurance earned over $50,000, that finding is skewed unless it analyzed data only from the states where most of the uninsured live. I think he will find that of the millions of undocumented workers in this country, very few earn over $50,000.

Gratzer does have it right, though, when he states that even the uninsured can find care in emergency rooms. And I do like his suggestion that Washington should offer block funding for coverage options to states in return for welfare reform. But that suggestion would affect only legal residents, or at least it should; it wouldn't help the insured get care in emergency rooms when ERs are forced to close because of funding deficiencies caused by caring for so many uninsured illegals.

Joanne Law



Gratzer writes that even the uninsured can find care in emergency rooms and that such care is "very likely free; the expenses are written off or, perhaps, buried in the bills of those with insurance." A decade or so ago, healthcare reform was shot down by a scare campaign warning that the Clinton administration proposal would lead to "socialized medicine" in the U.S. Real socialized medicine would have been funded according to means and allocated according to need. Having been frightened out of our wits by the specter of such a thing, we now instead have lottery-style healthcare funded by stealth and allocated by chance. Anyone for a second go at the Clinton plan?

Margaret Daugherty

Los Angeles


It's interesting to hear a bit of the other side of the "uninsured" dilemma. As a retired physician, I could write a long article about patients uninsured by choice rather than necessity. One uninsured patient upon whom I'd operated at no charge (the assistant surgeon and anesthesiologist also donated their services at my request) subsequently informed me that she and her husband had decided to use the $350-a-month health insurance premium toward their yearly "vacation fund."

Another, on Medi-Cal, invited me out into my office parking lot to show me her new Cadillac. A pregnant patient, wearing a mink coat and dropped off at the hospital by a new Mercedes, came up to the delivery suite and handed the admitting nurse her Medi-Cal card (with an address in Rolling Hills, then the wealthiest community, per capita, in the United States). There was the Medi-Cal patient who came in one day with a fresh, $5,000 "boob job," not covered by Medi-Cal, that she paid for herself. Or the pregnant Medi-Cal patient who was flying to Bali and wanted a note from me to upgrade her to first class because the long flight would be hard on her back. I could go on and on.

John Elfmont MD



The Los Angeles Free Clinic staff knows there are millions of people in L.A. without health insurance, and the recent U.S. Census Bureau's report only confirms our fears that the number of Californians with no health coverage has increased to 6.5 million people. Since 1967, we have put into practice our belief that access to health and human services is a right, not a privilege. Although the Census Bureau's report on the increased numbers of people without health insurance has piqued the interest of the media, elected officials and the public, every day the Los Angeles Free Clinic experiences this increase firsthand at its three sites in L.A. County. Between fiscal year 2002-03 and fiscal year 2003-04, we saw an 11% increase in our patient visits -- up from 68,254 in 2003 to 75,949 in 2004. Numbers that we know, from our years of experience and from the Census Bureau's report, will continue to rise.

Without a nationwide solution for the uninsured, the Los Angeles Free Clinic has created its own community of care; thousands of supporters have come together to build a safety net for those without access to affordable healthcare. Just as the number of uninsured is impressive, so is the outpouring of support and spirit of hope that a community can create.

Abbe Land, Jeff Bujer

Co-Chief Executive Officers

Los Angeles Free Clinic

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