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David Ansell diagnoses U.S. medical care in County, an examination of the notorious Chicago public hospital

 Most new medical interns aspire to nothing more than survival, but the idealistic David Ansell showed up at Chicago's Cook County Hospital "to join the union, to fight racism, to improve health care for poor people and to learn medicine."
"County: Life, Death and Politics at Chicago's Public Hospital" is his attempt to filter the larger story of U.S. health care through the sooty prism of his three decades practicing medicine at the Old Lady on Harrison Street.
Ansell's experiences were as extraordinary as his ambitions. The standard fatigue, frustrations and exhilaration of medical training are all here, but this definitely was not the hospital that made George Clooney famous on the fictional "ER."
County started in 1914 as "Poor House," a place for indigents to receive care. When Ansell arrived in 1978, the hospital lacked proper sanitation and heat. It fell to medical students to keep flies away from the cavities opened in patients during surgery. And a corrupt political machine operated the institution in a way that seemed intent on maintaining its decidedly separate but unequal nature.
The level to which Ansell dedicates himself to reform is humbling. Not only did he treat people who couldn't get medical care anywhere else, he worked and lived alongside them.
A white man, Ansell marched with African-American physicians to protest racist policies. He helped a colleague open an HIV clinic at a time when many physicians were afraid to be in the same room as patients with AIDS, and then watched as his friend succumbed to the disease. In his private and professional lives, Ansell confronts the lethality of bigotry, allowing him to put a very human face on the suffering that often gets obscured in policy debates.
The Emergency Medical Treatment and Active Labor Act of 1986 -- based in part upon Ansell's research at County -- made it illegal to dump critically ill patients at public hospitals because of their inability to pay. However, as Ansell points out, the residue of such dispiriting practices clings to our health care system to this day.
You can see it in overcrowded emergency rooms and shuttered free clinics; in entire communities of undocumented people sharing one Medicaid ID card; in neighbors and family members who skip the care they need because they have lost the insurance that once went with their jobs.
While pertinent to issues affecting us today, the book is most interesting as a portrait of Chicago politics in the 1970s and '80 s. Ansell effectively ties the Dickensian squalor of County to the political corruption and racial tensions of the era, providing a detailed look into how the Democratic Machine used a complex system of patronage to maintain and exert its power.
Ansell and many colleagues fought back, and from the book's dedication -- "to those individuals who, because of their race, income, immigrant status or lack of health insurance, have been denied the most basic health services that should have been available to them as a simple condition of their humanity"-- he makes it clear that this volume is a continuation of the fight.
Unfortunately, his vehemence clouds a story that is more complicated than he allows.
Today Ansell wears a suit to work as chief medical officer and vice president of clinical affairs at Rush University Medical Center in Chicago.
His call for a single-payer system and critique of the recent health-reform legislation may well resonate with some activists, but others will be turned off by the preachiness and his description of U.S. health care as "murder." Indignation has its uses, but it contains no solutions.
In 2002, Cook County Hospital was finally closed and replaced by the gleaming new John H. Stroger Jr. Hospital of Cook County. The struggle to replace County had been won, but the victory was bittersweet.
While uninsured patients finally escaped the indignities of County's roach-infested wards, Ansell knows that they're still at the mercy of the same underlying social, economic and cultural forces that have always hurt the underprivileged.
After three decades in the trenches, David Ansell discovered that replacing bricks and mortar was the easy part. 

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