THE safety net that is supposed to provide medical care to the poor and the uninsured is tattered or broken in many communities across the nation but nowhere is last-resort help for the injured or sick worse off than in hurricane-ravaged New Orleans.
Since the storm called Katrina swept the Crescent City with wind and floods in late August, the plight of the poor in what is one of America's poorest cities has been painfully on display for all the world to see.
Low-income residents took the brunt of Katrina casualties. Many waited in vain for days for rescue from their flooded homes. In some cases, the bodies of those who died were left to rot. More recently, the overtime budget for the fire department ran out and the city announced that it no longer would search damaged homes for remains of those still missing.
In terms of medical care for the poor, the story six months later is no better.
Katrina closed eight of the city's 16 hospitals, notably including Charity Hospital. The 270-year-old institution, a public trauma center, reportedly was the only local medical facility that would accept the uninsured, critical for the well being of a city where at least a quarter of residents had no medical coverage.
In the aftermath of the storm, a bare facsimile of Charity Hospital was re-established in a collection of military tents, located most recently inside the city's downtown convention center.
Its small staff of doctors and nurses has coped the best it could with only rudimentary equipment but care is limited mostly to ailments that can be helped with medication. People with the most serious injuries are shuttled to outlying hospitals; those with less serious maladies, including broken bones, must wait for appointments at facilities as far away as a 90-minute drive.
Since many of the poor have no money, no cars, and public transportation is scant, a growing number are forced to live with their pain and let nature take its course. For those with long-term problems, the prognosis is even worse.
"If you have cancer, my advice is move," says Dr. Peter DeBlieux, who runs emergency services for Charity Hospital. "If you need dialysis, go. Get out of here. If you have any major illness and are uninsured, we cannot possibly accommodate your needs. You will die sooner if you stay here."
Such a sad state of affairs only serves to underscore how amazingly little has been done for those hurt the most by Hurricane Katrina, and it only magnifies the lack of concern in Washington as the disaster fades in memory.
The truth is that the nation's medical-care safety net is similarly tattered, not just in New Orleans but in many, more prosperous, communities as businesses cut or eliminate insurance for workers, and local, state, and federal governments continue to short-change programs that help the middle class as well as those in the most dire straits.
The broader health-care crisis that looms wasn't created by the destruction along the Gulf Coast, but the ineffective response to the crisis has laid bare the urgency with which we must decide what to do about it.