It’s 8 AM, and though the health fair doesn’t begin for another hour, there is already a long line of people standing outside the pavilion. The air is filled with chatter, mostly in Spanish and Vietnamese. Everyone is waiting for the chance to get a flu shot and check their heart health. Many haven’t been to a doctor in years; some have never gone before in their lives. And even though the services at the health fair were eagerly received, none was provided by a physician. The volunteers that day were local nursing students, working under the supervision of a handful of clinical instructors. 

This is the way that many people in this country get health care. It’s wrong. It’s wrong that some people have to depend on charity care for routine health checks. It’s wrong that the health care that some people do get is often not from a licensed physician or occurs in an inadequately-resourced setting. It’s wrong for us to patch together a safety net so that we can procrastinate on fixing the horrendously unjust status quo. Now that I’m on winter break, I’ve been able to catch up somewhat with current events, and it’s been both frightening and heartbreaking to hear that states are cutting back on Medicaid and other essential health care services (mental health, anyone?). 

In this country there is a vast network of safety net health care centers that provide routine medical care primarily to patients who are uninsured or on a publicly-funded insurance program like Medicaid. These centers can include clinics and hospital systems run by local governments, such as the Santa Clara County Valley Medical Center, which is owned and operated by the County and actually provides pretty comprehensive services, including some specialty care. The VMC is on the high end of the quality spectrum for public medical centers. It is even a training site for some of the residency programs at Stanford University. Places like Planned Parenthood or the Berkeley Free Clinic can also be considered part of the safety net system. These clinics, depending on their legal status, survive by a combination of federal and state grants, foundation grants, private donations, and revenues from services (probably mostly from reimbursements from public insurance schemes like Medicaid). And sometimes, health care professionals volunteer to provide care to the uninsured at massive events such as the annual seven-day clinic in LA or the annual Open Air Health Fair right here in San Jose.

Sometime last year, it struck me just how unjust it was that we have this whole other microcosm of health care services for the poor/uninsured. In some ways, the safety net helps perpetuate the current flawed system because it masks the worst problems and allows people to think that things really aren’t so bad. 

Forget about the various structural problems of our health care system. Forget that we pay a lot of money as a country for too many services that we don’t need and that actually probably cause more harm than good. Forget all of that and focus on the simple fact that we have a health care system in which large numbers of people are completely shut out, and those who have access get very different levels of care. Even with the expanded coverage made possible by the Patient Protection and Affordable Care Act, we are not yet absolved of our responsibility to each other and to the poor. And just to be clear: I’m not against community clinics or free health fairs. I helped make possible the scene I described above, and I’m now on the board of our student-run clinic at school. Such organizations clearly fulfill unmet needs, but sometimes I wonder if they really only help us all to procrastinate on making the necessary, fundamental changes to the system. 

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