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Ayala: The health care system isn’t broken, it’s working as designed

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Ayala: The health care system isn’t broken, it’s working as designed

Picture of Laura Garcia
An empty wheelchair is seen in the hallway at Texas Vista Medical Center in San Antonio, Texas, on Oct. 26, 2021.
An empty wheelchair is seen in the hallway at Texas Vista Medical Center in San Antonio, Texas, on Oct. 26, 2021.
Josie Norris / San Antonio Express-News
San Antonio Express-News
Monday, May 9, 2022

By Elaine Ayala

“Access Denied” is the perfect name for San Antonio Express-News reporter Laura Garcia’s ongoing series on health disparities in the southernmost third of the county.

The area encompasses what we consider the city’s South Side, the historic West Side and parts of the East Side, where Mexican Americans make up big swaths of the population.

What they also have in common is poverty, poor educational outcomes, lower income levels and lack of transportation.

Fewer have insurance coverage, thus aren’t accustomed to the ridiculous complexities of the nation’s health care system.

They lacked good coronavirus information in English and Spanish, weren’t as rapidly tested or vaccinated and couldn’t help flatten the curve.

More of these residents were on the front lines and couldn’t work remotely. They were exposed to the virus and suffered more than people from the county’s richer northern sectors.

Garcia’s investigative journalism has made an impact.

Bexar County, for example, is using maps created for the series to change its approach.

“To me, these two maps are a sort of visual mission statement for this new department that I’m forming,” said Bexar County Manager David Smith last week when he announced an initiative to revamp health care in outlying areas. “It is to try and make these healthcare outcomes more evenly distributed throughout our community.”

Bexar County will reorganize about 16 health-related county functions, put them under one structure and hire a county public health director for a new initiative that will cost $2 million a year in pandemic relief funds.

Garcia’s first piece was published April 24, the second on Sunday. A third and final installment will be published May 22.

Born in Pearsall, because her hometown of Cotulla had no hospital, Garcia grew up on the Southwest Side of San Antonio, was trained by the mighty San Antonio College journalism department and ultimately graduated from Texas State University, another great producer of Texas journalists.

She collaborated with data reporter Libby Seline, with support from the University of Southern California Annenberg Center for Health Journalism, where Garcia was a 2021 national fellow.

USC will be a partner in an “Access Denied” community engagement health fair from 9 a.m. to 1 p.m. May 28 at the Wesley Health and Wellness Center, 1406 Fitch St.

“Access Denied” describes an inadequate, broken health care system that ravaged areas where poor people of color already suffered from chronic conditions exacerbated by COVID, including obesity, diabetes and heart disease.

In one ZIP code on the South Side, “Access Denied” found a death rate 16 times higher compared to a zip code on the North Side.

Garcia told the Texas Standard the COVID mortality rate in parts of the South Side is double that of Bexar County, the state of Texas and the nation.

Mass vaccination sites were set up downtown and on the North Side — none on the southern end of the county. One of Garcia’s most powerful sentences: “It didn’t matter that they were free.”

Today, in one North Side ZIP code, 99 percent of its eligible residents are fully vaccinated against COVID-19 compared to ZIP codes on the South Side, where about 50 percent of residents are fully vaccinated against the virus.

It’s not an accident, but the result of more than a century of segregation followed by decades of redlining.

Many politicians, public servants and medical experts referred to the health care system as broken, and that the pandemic highlighted those problems.

At the time, I agreed that the crisis landed on top of an existing one, and as one doctor said, “making a broken system worse.”

But if there’s an epilogue to this series, it’s this:

The health care system isn’t broken. It’s working exactly as intended, said political scientist Alicia Reyes-Barrientez, an assistant professor in the Department of Social Sciences at Texas A&M University-San Antonio.

“It wasn’t designed to care for the sickest or poorest,” she said. “The health care system was designed to provide optimal care to certain people. It’s a racialized institution. We have to think of the health care system in that way.

“Money and connections,” plus healthcare insurance, “those give you the best odds of getting you optimal healthcare in this country. Years of research shows this,” Reyes-Barrientez said.

So, it’s not about reforming the health care system, though those in it are likely to protest.

“Health care needs to be completely redone,” she said. “It has never cared about black and brown people.”

This is a part of a much larger system in which we live, and why the president changes but the status quo remains.

“That’s why so many people who are frustrated don’t vote,” Reyes-Barrientez said. “They don’t believe voting will change anything.

“Do I vote?” she said. “Religiously. Do I think voting will create the radical change we need? Absolutely not.”

At least 5,320 people in Bexar County have died because of COVID-19. In the United States, the number of deaths recently reached 1 million.

It’s estimated each death affected nine close relatives, the Washington Post reported, thus 9 million in mourning.

That’s an awfully conservative number.

[This article was originally published by San Antonio Express-News.]

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