David Ansell is an intense man. He believes that accessibility to quality healthcare is a moral issue and he ties the inequities of the multi-tiered American system to racism, poverty and lack of medical insurance. I found him a refreshing antidote to the conservative posturing that dominates the current discussions of health initiatives. I didn’t expect his book to be about the need for a single-payer health care system but once it’s clear what has shaped Ansell’s thinking, you can see that he could hardly have arrived at a different conclusion.
His recently released book, County: Life, Death and Politics at Chicago’s Public Hospital, is a memoir of the events that shaped him as a physician. He and a group of medical school friends at Syracuse University, swayed by the work of Quentin Young at Cook County Hospital, came there to do their residencies. They were idealistic and anxious to fundamentally change the way health care was delivered.
Ansell, an Oak Park resident, appeared at the Main Library on June 29th. He read from the book and provided chilling stories of how inexperienced and largely unsupervised new doctors learned on their patients. While they became uniquely knowledgeable from their experiences and typically went on to lucrative jobs elsewhere, patients died as they learned their craft. Adequate patient care was further thwarted by a system that put political patronage before people and which played brinkmanship with funding for supplies and medication. Filth, vermin and the lack of access to such basics as sinks and soap further compromised patient safety. Desperately ill people suffered bone-chilling cold in the winter and suffocating heat in the summer. And frankly, very few of us gave a damn.
I met Ansell for coffee and found him passionate and articulate about the need for health care for all. After a long and distinguished career in internal medicine at three Chicago hospitals, Cook County, Mount Sinai and now Rush, Ansell still burns with the injustice of what happens to those who have no medical insurance and who have the misfortune to be born poor, black or Hispanic in this city.
He writes that, “The conditions at Cook County Hospital were so appalling and the suffering of such magnitude that we often felt that if the outside world knew about it, there would be more outcry to end or improve it.” Later in the book he said, “We were practicing Third World medicine in Chicago, one of the largest cities in the U.S. I shudder to think how many patients I may have harmed or killed because we could not diagnose or treat them quickly enough—and this, because they were County patients and lacked access to the most basic services.”
When we talked he compared the conditions at County to those he found in Haiti after the recent earthquake. That the richest country in the world accepts health care for its citizens that is no better than what the poorest country in the Western Hemisphere can provide after a natural disaster is profoundly disturbing. Ansell asserts that we accept a certain “level of dying,” which in Chicago is about 9 people a day, in order to maintain the current status quo.
Shocking but not an exaggeration. I have spent a considerable part of my teaching career in poor neighborhoods like West Englewood, Auburn-Gresham, Cabrini-Green and North Lawndale. Per census data figures, life expectancy for adults in North Lawndale used to be age 62 but is falling and is lower than that of Mexico. In contrast, in wealthier parts of the city it is roughly age 78. My students have alarming rates of asthma, heart disease and obesity. And they often die from gun violence. They die, but we all pay—in money, lost productivity, and diminished lives. What happens to the poor stunts everyone’s life.
I asked him if he thought it would ever change. After all, what the book so painfully details is that unequal care for the indigent has been going on in County Hospital for over 160 years. Even though medical residents have fought for program changes and better access to preventative health programs, the lines for service, the long waits for medical care still exist today. “It can’t be done incrementally,” Ansell says. “It requires a fundamental change.” Yet, he believes that it will happen. He quoted Winston Churchill who said, “Americans will always do what’s right—after they have exhausted all other possibilities.”
“A single payer system like Canada’s or like Medicare will solve a lot of these problems,” Ansell continues. “There are no perfect systems, but at least the problems in a single payer system are wait times for services not access to life-saving procedures like the current one we have.” He pointed out that there are also millions of Americans who are under-insured and who avoid medical care for preventable illnesses because of the cost of the copays. He believes that this will increase under Obama’s plan because it favors the insurance companies at the expense of patients.
The book is well-written and engrossing. There are unsettling stories and depressing details about what it meant to be a young doctor in the system but Ansell does not waste time on extraneous verbiage. He told me that he went through the book and tried to make it as clear and straight-forward as possible and he has achieved that. But let the reader beware: there is frequent usage of high-octane words such as myriad, cacophony, raucous and obsidian. Many contemporary books use carefully edited prose and I haven’t encountered so many polysyllabic words outside of the dictionary in a long time. It was refreshing.
Whether you agree or disagree with Ansell’s argument about health care, you will find his narrative riveting. He offers a compelling argument that the current system is broken beyond repair and needs to be replaced. As Americans, as believers in justice for all, we cannot continue to support health and wellness only for the fortunate few.
Further information about the book and Dr. Ansell is available at the website: www.countythebook.com. County: Life, Death and Politics at Chicago’s Public Hospital is available at the Book Table.