Access to Health Care:
An Interview with Diane Larty

Aired June 9, 1999

David C. Barnett–The Clinton Administration rode into office with promises of reforming health care in the United States. Well, between then and now, a whole lot of politics got in the way. Diane Larty is the executive director of the Universal Health Care Action Network in Cleveland and she joins us on the phone. Good morning, Diane.

Diane Larty–Good morning.

DCB–What's your take on the closing of city hospitals and the increased reliance on community health centers?

DL–Well, I'm very concerned about what it does to people's access to care. As far as the closing of hospitals, it may be true that we have too many hospitals, that there has to be some addressing of the problem. What concerns me is the decisions are not being made in a whole, at a roundtable, with all the people who are affected at the table. The decisions are being made like business decisions, you know, we'll close this one because it's losing money, we'll close that one because it's losing money, and where are those who care about health care for all the people in the region?

DCB–So how do you propose to change that?

DL–Well, I would really like to see some, I mean it would be wonderful to have government take its rightful place as the crafter of social policy. Government, after all, is the only animal that is responsible for the common good by definition. If we leave it to the business interests, we're in big trouble. Many of the hospitals, in Cleveland especially, were started by religious groups who came with a mission. Our own public hospital, Metro, which you just had on, has that same mission, to serve people regardless of their ability to pay. But in today's world, unfortunately, we're seeing more and more market medicine, and so the petite, boutique hospitals, as Ted Board referred to them, the heart hospitals, are there to make money. They want to give the services that are to make money. We need somebody who says, "yes, we need people who have heart problems top be treated, but we need all people to have primary care as well." We need to have these other entities in place, and what can we do to have a comprehensive look at how people get health care?

DCB–You talk about the government, it would be nice if the government would take up this role. Do you see that likely as happening with the business interests?

DL–There has to be a partnership, obviously, I'm not talking about having Big Brother come in and run things. I'm talking about, there has to be the leadership there that says to local providers, "what can you do as a community to provide for all your people?" We have documented, especially in this town, the number of people, here in health care mecca, who cannot get health care. It's a crying shame, and when we have inner city hospitals closing and more facilities going up out in suburbs, we're just compounding the problem. If we're going to do that, if we're going to close down older buildings and so forth, we at the same time have to address the people who have been using those facilities.

DCB–Now you talk, in the course of your work, with welfare recipients regularly.

DL–Yes.

DCB–What do they think of Medicaid coverage at this point in time?

DL–Well, Medicaid coverage as a program is wonderful. I mean, it's comprehensive coverage, and it does include dental and eye care and so forth. The problem people have with Medicaid coverage is getting into the system, number one, it's a bureaucratic process that sometimes turns people off and some speak of not being treated with dignity, and I think rightfully so sometimes, so that is one part of the problem. But the biggest part of the problem, in terms of Medicaid, is that people don't know about it. There are many, many people eligible for some element of Medicaid coverage who are not accessing it,. and I speak specifically of those people who are leaving the welfare rolls and going to work in low-paying jobs that don't provide health care. They are entitled to transitional Medicaid, and sometimes they're not informed of that.

DCB–And what about issues of illiteracy, not even being able to deal with the complicated forms that are involved?

DL–This is true, the complications are unnecessary. I guess I'm cautiously optimistic, word of the day, that the state is going to come out with a simplified form. It said in discussion, it's certainly been supported by our own county to the state folks who govern this kind of thing, that we simplify these forms, and so that people-at one point, these forms were 33 pages long. We have now got it down to one page, but it still is a difficulty, as you say, for people who are illiterate. They do need help figuring it out, and sometimes the twists and turns of language are purposely, you know, goof them up. So I really think that the simplified way of doing things is a major improvement, and it's before the legislature now. I'm confident, somewhat confident that they're going to approve that. Hopefully that'll be one plus. Another thing I guess that's a plus, that people should be aware of, is the Healthy Start Program, which is actually Medicaid-funded and a comprehensive program, is now available by making a phone call. The form can be sent to your home, you don't have to go down and wait all day for an appointment and so forth, and that Healthy Start program applies to people earning up to 150% of the federal poverty level, which many, many people in Cleveland, Ohio, are in that category.

DCB–Diane Larty is executive director of the Universal Health Care Action Network in Cleveland. Thanks for joining us this morning.

DL–You're welcome.