Old San Francisco General Hospital

How many times have you heard liberal politicians and pundits declare that millions of Americans –perhaps 40 million – have no health care, when what they should say is that these people have no health insurance. I leave it to you to decide whether this mistaken message is inadvertent, or whether the politicians and pundits are intentionally conveying a false message – that is, lying – in order to convince Americans that they need to give the government complete control of health care.
But whatever the motivation, the message is false. Even worse, it is an insult to the hundreds of thousands of health-care professionals, including me, who devoted their lives to providing health care to the uninsured, the indigent, and the unemployed – including immigrants, regardless of whether or not they are here legally.
Conversely, insurance does not guarantee care. In the Soviet Union, Communist Party bigwigs were cared for in Western-style clinics, while common people begged their American relatives to send them antibiotics. In British National Health Service hospitals, patients are 45% more likely to die than patients in American hospitals. Swedes are buying their own insurance to avoid long waits in the government-run system. One Swede explained, “It’s quicker to get a colleague back to work if you have an operation in two weeks’ time rather than having to wait for a year.”
“Universal coverage” means insurance coverage, not necessarily health-care coverage. If you doubt this, look at the delays in care – sometimes with fatal results – that our veterans are subjected to. They already have “single payer” – but what if it won’t pay? They already have “universal coverage” – but what if it means six feet of dirt?
My image of a doctor was my father. He served the people of Lisbon, North Dakota, a town of 2000. He began his practice in the later years of the Depression, when few people had health insurance. Some patients paid with a sack of potatoes or a chicken. For the truly indigent, the county paid my father a few dollars. But everyone got care, sometimes in the midst of a blizzard. On one occasion, my father’s car got stuck in a snowdrift, and he came home with the early stages of frostbite. To claim that the uninsured have no access to care is an insult to his memory, as well as to the thousands of doctors, nurses, and technicians who practice in rural areas or inner cities today.
I attended the University of California School of Medicine in San Francisco. Our third year was at the old San Francisco General Hospital, shown above. Later I spent the second year of my residency there as well.
Watch the movie “Bullitt” and you will see what still is the best car chase ever filmed. You will also see scenes of the old hospital. You will see nurses in white uniforms and caps – remember them? You will see crowded wards and dingy surroundings. You will see a dimly lighted basement corridor, where I had to walk in the middle of the night. But back then, the hospital needed no security officers, only a night watchman.
But if you use your imagination, you will see other things. You will see doctors, nurses, and other personnel working tirelessly to care for very sick patients under suboptimal conditions.
● There I learned how to find a vein and start an IV mainly by feel, because many of the light bulbs were burned out.
● There I learned how to use an EKG machine that had fallen on the floor and was held together with adhesive tape, as if it had broken a rib.
● There I learned to steal essential materials from other wards, contrary to regulations, when we ran out on nights and weekends.
● There I learned to ditch “mandatory” conferences when my patients needed me.
● There I learned to put on two scrub shirts under my white jacket, to keep warm in the drafty wards at night.
● There I learned to function when I was sleep deprived, cold, and hungry.
● There I learned to respect our full-time Catholic chaplain, Father Feder, who appeared in the emergency room in the middle of the night to give Last Rites to the seriously ill or injured, then stamp the chart in purple ink with “IHS.”
● There I learned to sit up all night with an indigent patient, get him through a severe heart attack and stroke, and see him walk out of the hospital – and the pride was just as intense as if he had been a millionaire or a celebrity. I still remember his name.
True, I learned other things too. I learned that what I had thought of as peaceful San Francisco held meetings of the “knife and gun club” every Friday and Saturday night. I learned what a cut throat and a close-range shotgun wound look like. I learned that violent psychotics have to be physically restrained by police before they could be hospitalized and medicated. I learned that civilization is like pie crust – thin and delicate, but just barely covering hot, bubbling material that can really burn you.
In short, I learned to be a doctor by watching dedicated doctors and nurses caring for uninsured, mainly indigent patients. No, it wasn’t Cadillac care. It was Chevy care, sometimes used Chevy care. But it was care.
Since then, the old brick buildings, dating from the 1920s, were replaced with a new building. But fortunately, the old administration building was left as a memento.

Old Los Angeles County General Hospital

Then I did a fellowship in medical oncology at Los Angeles County General Hospital. Later it was renamed Los Angeles County-USC Medical Center, to emphasize its university affiliation. It was built in the 1930s and in 2008 was replaced with a newer building that has 25% fewer beds. More indigent citizens, more indigent non-citizens, more patients because of ObamaCare – but 25% fewer beds? This is called “political leadership.”
As a fellow in training, I found that the building was newer and better equipped that its San Francisco counterpart. Better still, there were full-time professors stationed there. I vividly remember going up the stairs late in the evening, and coming down the stairs was Dr.Telfer B. Reynolds, an internationally known authority on liver disease. My boss was Dr. Jesse L. Steinfeld, who went on to become U.S. Surgeon General and a medical-school dean. These and many other distinguished physicians devoted their full time to the medical center.
During my fellowship and subsequent career at “big county,” most of my patients were uninsured, and many were indigent. Some were not. Among others, I cared for an aerospace engineer at Jet Propulsion Laboratory, the brother of my medical-school professor, and the wife of a foreign diplomat. They all got equal treatment.
To say that the uninsured have no access to health care is to spit in the face of all those dedicated health-care professionals who spend their careers caring for the uninsured, the under-insured, the working poor, the unemployed, the indigent, the undocumented, and the unwanted.
Could the care of these people be improved? Absolutely.
● Medicaid could be improved and strengthened.
● Additional federal dollars could be spent on neighborhood clinics, where the physically and mentally ill could be treated before their conditions become acute and dangerous to themselves or others.
● Subsidies could enable these people to afford adequate health insurance.
● High-risk pools could be subsidized by the government, as is done for automobile insurance. Those who lacked funds or had pre-existing conditions could be insured by this low-cost pool.
But, you see, all these possible solutions do not serve the hidden purpose of increasing government control of our health care, and our very lives, to the point that we are reduced from citizens to subjects – that is, to undo the American Revolution.
Still, even King George III would have found it unacceptable – as well as beneath his dignity – to tell his elderly subjects that they should forego surgery and just take a painkiller. But President Obama did not find it unacceptable, or beneath his dignity – so he said it. One need not be a prophet to predict what this will mean for American health care, especially for the elderly.
Before this happens, we need to stop using – or tolerating – muddled language, which leads to muddled thinking, which leads to muddled actions, which leads to where we find ourselves today. As a first step, I strongly recommend that we stop equating health care with health insurance. They are closely related, but they are not the same.
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