It is no great mystery that Los Angeles contains an immense homeless population. On the relatively short drive from the University of Southern California’s campus to downtown Los Angeles, one can spot the tents and shopping carts that mark sections of sidewalk homeless individuals have claimed as theirs. As people walk or drive through Los Angeles and observe the multitude of homeless seeking shelter beneath an underpass or in a tent, they rarely give them a second glance. There are, however, those who have devoted their time and energy to creating better lives for the homeless through homeless shelters and soup kitchens. They face a much more difficult issue when it comes to providing healthcare for the homeless. Some physicians dedicate time to assisting the homeless populations of Los Angeles, but healthcare for the homeless remains a significant challenge.
The most obvious issue is the sheer number of homeless. According to an LA Times article by Gale Holland, there could be anywhere between 36,000 and 54,000 homeless in Los Angeles county. The second issue can be inferred from the first: It is very difficult to locate all of the homeless. These two primary problems do not even touch on administering health care to the vast population of homeless people.
The actual healthcare that the homeless require could range anywhere from routine vaccinations to organ transplants (liver failure due to alcohol abuse or Hepatitis C is extremely common). The former being much simpler than the latter. Many of the homeless would be able to give a name or some other identifying information from which physicians could find a medical history. Others may not have medical histories due to a variety of circumstances. With no medical histories, physicians would have no idea where to even begin medical care. They would have no knowledge of allergies or whether or not somebody was at risk for certain diseases.
Currently, the only medical attention available to the homeless is to seek help in emergency rooms. The Emergency Medical Treatment and Labor Act (EMTALA) requires emergency rooms to treat those who require aid regardless of ability to pay. Since the homeless generally do not have insurance, nor money with which to pay for medical services, the emergency room is their only option. Unfortunately, the emergency department is one of the more expensive means of treatment and the costs are then transferred to other patients who are capable of paying. I am not saying that we shouldn’t treat those who can’t pay – I am saying that the most affordable means of providing healthcare is unavailable to the homeless. Preventative care is far gentler on the finances, but the homeless have no way of obtaining preventative medications.
Payment would be another issue altogether. It’s one thing for physicians to donate their time, but quite another to get hospitals on board with giving out many potentially expensive medications. Performing comprehensive exams and providing certain treatments would also require the use of hospitals rooms, adding another complication to the already complicated issue. Hopefully somebody has a vision and a plan to solve the issue of healthcare for the homeless, but it seems to have too many layers to address it efficiently, particularly with healthcare still undergoing drastic changes.
The idea of providing healthcare to everybody is a noble goal, but there are numerous challenges that must first be overcome in order to make it a reality. It is morally unethical to leave out the homeless from consideration in universal healthcare, but it is logistically nightmarish to provide for them as well. Perhaps we should focus on the more important step: getting the homeless into homes. That issue alone is plenty complicated.