The man smelled of vomit and fungi. At fifty years old, he stood a foot above me at 6’2’’ and must have weighed 300 pounds—of fat, just to be clear. At Bellevue, the best known NYC public health hospital, the majority of people I see in the emergency room are homeless, uninsured, undocumented, or a combination of the three. Yet, this man easily took the spot as the bottom of the “wretched refuse.”
He had yet to be admitted, when he asked me an innocent question, “can you get me a pair of socks?”
Just one of the many services that Bellevue provides its patients is a load of fresh socks in thin plastic bags that occupy a bottom drawer in the storage closet. Bellevue also provides one-size-fits-all shoes that resemble Crocs, balanced meals for the hungry, clothing services, showers, free metrocards, and social workers on site.
Mr. Socks Man epitomizes the reason for much of the backlash against public healthcare. I have seen him stroll into the emergency room on many occasions, spend a couple hours using the hospital’s resources, discharge out of Bellevue, and move onto King’s County or another NYC public hospital (as shown by a research article that tracked the movement of homeless people). As I reviewed his record, a piece of private health information I am privy to when volunteering in the ER, I saw more than a thousand visits to the hospital in his lifetime. Most people can count the number of times they have visited the hospital on both hands, but the homeless population presents a more complicated healthcare usage. For example, the records I look at only show his visits to Bellevue, and do not even include the other public health hospitals the man has visited.
I gave him a fresh pair of socks when Mr. Socks Man asked me another more humiliating question: “Can you change my socks for me?” Take my word for it, the only thing that smelled worse than this man with his socks on, was this man with his socks off. But his leg injury genuinely prevented him from the ability to change his own socks, and so I helped him, holding my breath the entire time. People like Mr. Socks Man, people down on their luck, find a place in the emergency room while waiting for treatment. From individuals like the blind, half deaf man who barely spoke English to families like the one from Puerto Rico, who lost everything in the natural disaster, most homeless people are just individuals who find themselves down on their luck, trying to treat their health and the constant medical struggles that homelessness presents.
Firstly, homelessness presents unique problems for maintaining treatment plans. For some, it may be difficult holding medications while on the streets. For an alcoholic trying to stay sober, the street presents too many opportunities for drinking. For some disorders like schizophrenia, medication might make a homeless person too drowsy to handle the challenges of living in their dangerous environment.
In addition, the homeless population has a higher proportion of those who abuse alcohol and drugs, which causes the homeless to abuse the emergency room for rehabilitation needs. The homeless also disaffiliate themselves from networks outside their immediate circle, which limits support from individuals in times of need, making the emergency center a last resort. The homeless population often feels distrust for the healthcare system, as they do with most people, which causes the homeless to be weary of consistent checkups and overall medical advice.
Public health care emergency centers have many positive usages, but acting as a shelter or public hangout spot for the homeless has never been one of them. At Bellevue, Medicaid bears the cost of emergency room visits, usually between $1,000 to $2,000 per admission, depending on the treatment necessary. Nothing can prevent the homeless population from entering hospitals. They have real chronic health concerns which entitle them to admission to the emergency center by law. And Medicaid is necessary to treat those who lack employment. We also cannot deny homeless people from using Medicaid; without it, contagious diseases would be rampant on the streets.
But we cannot allow homeless people to continue abusing the healthcare system as they have been doing. For every time that a homeless person is admitted to the emergency room, the government and therefore taxpayers must pay a minimum of $1,000. During the course of a lifetime, people like Mr. Socks Man, who has been admitted to the Bellevue emergency center more than 1000 times in his lifetime, cost taxpayers a minimum of $1,000,000. No citizen wants Medicaid to bear such ridiculous costs for a relatively useless cause. I say useless since the homeless will not benefit from emergency care, but instead need regular treatment for their chronic diseases.
So what now? Kick them out of emergency rooms? End treatment of any diseases the homeless may have? Leave disease rampant on the streets? Great idea! Let’s see how that works out. Do not blame me when half of NYC catches the transmittable diseases so prevalent in homeless populations like tuberculosis, scabies, body lice, bartonella quintana, and rickettsia prowazekii. Or when a schizophrenic man on the street attacks a midtown pedestrian during a hallucinogenic episode.
A better solution is necessary, and it can only come with focused strong intervention to fix the root of the problem–homelessness, a public health issue. Homelessness affects you and me: monetarily due to medicaid, medically due to contagious diseases, and morally every time you or I pass a homeless person on the street and realize we are doing nothing to help. I am suggesting a policy change: instead of treating the symptoms of homelessness, let us cure the root of the problem and fix homelessness in New York City. The Coalition for Homelessness and several research articles have proved that providing secure housing for homeless people not only reduces homelessness, but is also significantly less expensive than emergency rooms, shelters, and other institutionalized care.
The Coalition for Homelessness has developed a method in NYC to reduce health issues among the homeless–the “housing first” approach. Providing long-term subsidized housing and support systems to long term homeless people with severe health problems, the housing first approach stably houses the homeless and significantly lowered their health problems. The best part is that the “housing first” option is a significantly lesser burden to taxpayers than emergency or institutionalized care. It has proven so effective, that is has spread to other parts of the nation.
I do not mean to push a political ideology onto people. I only write about what I see at the emergency center every week: homeless people lowering their dignity by abusing a health care emergency center while causing taxpayers to bear the burden. A simple policy change, providing homes to sick homeless people, could not only save taxpayers money, but also create a better society by providing the chance for people down on their luck to pick themselves back up.