The Uncovered

How New York’s Uninsured Really Survive

The fundraiser at Life on Bleecker Street is off to a slow start. The Verve's 'Bittersweet Symphony' all but echoes through the near-empty club. A few dozen guests stand by the bar, sipping beers, while the evening's volunteer entertainment, a karaoke punk band, waits for more people to arrive before beginning their set.

'I guess no one likes me,' says Dr. David Ores, the evening's host, as he surveys the abandoned dance floor. Or perhaps it's just that a party to raise cash for prescription drugs, as this one is meant to do for Ores's uninsured patients, can be a sad affair. What's more, the majority of guests at this early-winter gathering are the uninsured themselves, who can only manage to put a few bills in the coffee can at the entrance, so the cash-drawing potential is depressingly limited.

Still, Ores—or Dr. Dave, as his patients like to call him—is one of the bright spots in a city where more than one in four adults is uninsured (that's 50 percent higher than the national average). Without access to the daunting system that pays for health care, the uninsured are more likely to die, experience adverse health outcomes, and require more emergency hospitalization than insured Americans, according to a study just released by the American College of Physicians.

But the more than 1 million uninsured New Yorkers are not accepting their medical fates quietly. Instead they make their way in an alternative medical universe, where herbal apothecaries, advanced bill-dodging techniques, and low-cost community health centers take the place of claim forms and ID numbers.

There, in the realm of medical have-nots, Dr. Dave is liked very much—at least by the patients he treats regardless of their ability to pay. "He's great," says Ro, a 24-year-old who has never had her own health insurance. Just the other night, Ro went to him after a broken glass cut a gash in her side during her bartending shift. "I didn't want to go to the emergency hospital because I knew I would be paying at least $400," says the reed-thin woman, who wears a tiny stud in her nose and jeans ripped at each knee. "I've been to the hospitals for tonsilitis and things like that and they just charge you a ridiculous amount of money."

With the presidential election brewing, we're beginning to hear more about the ever-widening pool of uninsured—at least from the Democrats. Bill Bradley promises to build on the current employer-based insurance system by offering subsidies to the uninsured. Gore, who has criticized Bradley's plan as too expensive, says he would expand government insurance programs that already serve poor and elderly people. Bradley has called Gore's proposal "definitely timid."

Given that each of the two plans would likely leave more than 10 percent of the country still uninsured, it is safe to say they're both timid. Indeed, the problems of any system that falls short of universal coverage come into sharp relief with even a cursory look at the enormous obstacles people without insurance face in taking care of themselves.

Consider that, even as the candidates trade barbs about their plans, Betty Collins is staring down a $25,000 hospital bill. A 57-year-old beautician who lives in Bedford Stuyvesant, Collins was covered for much of her life through her husband's job with Brooklyn Steel. Since he stopped working for the company almost 10 years ago, though, she has been mostly uninsured. And so it was that Collins ended up getting emergency surgery when she came down with appendicitis almost six years ago—and forking over $100 a month toward the debt ever since.

Coming out of the $1000 or so she makes each month and the pittance her husband picks up "doing this and that," the payments leave little for food and rent, let alone private health insurance. Yet Collins and her husband, who is also uninsured, still make too much to qualify for medicaid, the government health program for the poor. They work, as almost 70 percent of uninsured New Yorkers do, but neither of their jobs provides benefits.

Without them, Betty Collins has taken to using herbs to cure her asthma and digestive troubles, which include an ulcer. "God has a made a plant for everything that can be wrong with you," she says, noting that herbal treatments are often cheaper than their pharmaceutical competition. "But I still have problems. I just pray that whatever I have will go away," says Collins, breaking into a laugh, as if the whole matter is hilarious. In eight years, she notes, she will qualify for medicare. "But, who knows," she says, laughing even harder. "I may not live that long."

For many others, the problem is not qualifying for medicaid, but getting it. Supporting three children on just over $600 per month, Vanessa Washington meets the financial requirements for the program. But, because she stopped reporting to her workfare assignment three years ago—a violation of the strict rules the Giuliani administration has applied to entitlements—she lost her welfare benefits and, along with them, her health coverage.

Without medicaid, Washington periodically goes to her local health center, which, because it receives government subsidies, is able to provide her with birth control pills at low cost. It's been four or five years since she's had "a real, real physical" though. "I just try not to get sick," she says.

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