Poor health: Modern medicine has a hard time serving the needy

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The complicated inconsistencies of the nation’s health care system come as no surprise to American consumers who have tried to navigate it. The way the forces conspire against the country’s poorest residents is less obvious, except to those caught in the spiral of poverty and ill health that multiplies the impact of both.

In a nine-month investigation led by the Post-Gazette’s Lillian Thomas, a team of journalists from the Milwaukee Journal Sentinel and students from Marquette University unraveled the history that has played out in Pittsburgh, Wisconsin and across the country. The series “Poor Health” details a medical care model that began in many cases as a mission of charitable organizations, offering treatment to those who were least able to pay for it. The present-day reality looks nothing like its predecessors, as Pittsburgh is aware with its powerful health care conglomerations.

The new methods offer premium research and high-quality care, but the growth of large hospital systems and the loss of smaller, community facilities has come at a cost to low-income people, creating health care deserts where treatment is elusive or unattainable. There is a dearth of primary care doctors as well as specialists in poor neighborhoods.

The federal government’s role is a powerful undercurrent, through tax incentives to employers and benefit plans aimed at specific groups — Medicare and Medicaid among them. Because those programs — particularly Medicaid, which covers poor and elderly people — typically don’t pay hospitals as much as private insurers do, the government in effect encourages and rewards the hospitals for pursuing and treating privately covered patients.

None of which makes much difference to an unemployed, unskilled, uneducated man from Milwaukee. John Patton Jr., featured in last week’s editions, struggles to obtain necessary care at a bare-bones clinic housed in what previously was a full-scale hospital. His story is just one example of how a system considered the best in the world remains out of reach.

The series raises anew questions of whether the existing medical providers are offering their fair share of care for the poor and whether they deserve the tax exemptions that have flowed from their establishment long ago as charities. It is not surprising that there are no easy answers, but the questions are at the core of the American health care system.

Next month, this important series will focus on Pittsburgh, where a war between health care giant UPMC and health insurance behemoth Highmark is playing out at the highest levels of state government and threatening upheaval come Jan. 1. Sadly, though, when it comes to facing the overarching challenges of the medical care system, the region is not alone.

Meet the Editorial Board.

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