PITTSBURGH, Pa. — Camille Scott-Ford had no health-care insurance — and no way to pay for medical care — until she went to the new Catholic Charities Free Health Care Center in downtown Pittsburgh, Pa., last March.

Scott-Ford, a divorced mother of two who lost her family’s medical insurance four years ago when her ex-husband left the military, fits the profile of many Americans who lack insurance.

She works as a nanny, and consequently, isn’t eligible for Medicaid. But she can’t afford to buy medical insurance on her limited income.

“I make an income, but you’re making choices between: Do I eat, do I pay my rent, or do I have health care?” said Scott-Ford, who has multiple sclerosis. “Unfortunately, the thing that tends to go is the health care.”

Helping ease the plight of the uninsured is a key goal of virtually everyone involved in the ongoing debate over how to reform America’s health-care system, including Dr. Nancy Nielsen, president of the American Medical Association (AMA). Nielsen, who is Catholic, has said she intends to make helping the uninsured the key goal of her term as AMA president.

“Forty-six million Americans are uninsured,” Nielsen told the Register in an e-mail interview. “That’s not just a statistic — it’s a tragedy.”

A 2004 study by the Kaiser Institute quantifies the inequities that millions of uninsured Americans experience in terms of getting medical care. Although U.S. law mandates that no individual can be denied necessary medical treatment because they can’t afford to pay for it, the uninsured nevertheless receive far fewer medical services on average than other Americans.

The Kaiser Institute study found that per capita medical spending for uninsured persons in 2004 was $1,629 — almost 50% less than the $2,975 spent annually for persons with insurance.

And, the study reported, compared to those with health insurance, the uninsured “receive less preventive care, are diagnosed at more advanced disease states, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates.”

At the same time, according to an analysis released in August by the National Center for Policy Analysis, the magnitude of the uninsured problem is often overstated.

The analysis noted that the number of uninsured actually decreased in 2007, from 47 million to 45.7 million. Of those, 18 million lived in households with annual incomes above $50,000 and could likely afford health insurance, the study said. And up to 14 million more uninsured adults and children qualified for government programs in 2004 but had not enrolled.

But even if the National Center for Policy Analysis assessment is accurate, there are still a huge number of people — more than 13 million Americans — who can’t afford medical insurance, but earn too much to qualify for government programs.

Sister Carol Keehan, president of the Catholic Health Association, said that as well as unjustly depriving people of vital medical services, the current insurance system doesn’t make sense economically.

That’s because uninsured people commonly skip visits to doctors’ offices, since they are expected to pay out-of-pocket for treatments they receive there.

Instead, they wait until their medical problems are so severe that they must seek help at hospitals.

“They still get sick, and they show up at the least-efficient and most-expensive venue for care — often too late to be as effective as it could be, or sometimes just too late period,” Sister Carol said in an interview with the Register in July. “What we’re talking about is: No. 1, make the system efficient,” she said. “Don’t make people wait until they’re so sick they’ve got to show up at an emergency room.”

While there is broad consensus that something must be done to help the uninsured, there is less agreement about the best way to deal with the problem.

Some Catholic groups agree with those who believe the best approach is to extend insurance coverage through the expansion of government-driven initiatives.

Catholic Charities USA — whose local affiliates often deal with individuals facing hardships as a result of a lack of health insurance — advocates several measures to assist the uninsured.

These include preserving Medicaid and ensuring health coverage for all eligible children through the State Children’s Health Insurance Program, restoration of benefits to legal immigrants, expanding mental-health coverage for the poor and the vulnerable, and easing documentation requirements for eligible populations.

The American Medical Association takes a different approach. It advocates increased subsidies for lower-income Americans through vouchers or tax subsidies directed to health-insurance payments.

The AMA also advocates providing vouchers or subsidies available to higher-income people so they can purchase insurance on the open market, thereby shifting the system away from the current dominance of employer-based private health-care insurance plans.

“If enough people have enough purchasing power — and enough say over how that purchasing power is used — insurers will be compelled to offer better, more affordable coverage options,” the AMA states on its VoiceForTheUninsured.org website.

In its 2004 document “Health Care in America: A Catholic Proposal for Renewal,” the Catholic Medical Association supported a similar approach of making refundable tax credits to purchase medical services or health coverage available to everyone who files a tax return.

Lower-income working Americans who lack insurance would use the tax credit to help pay for coverage. And like the AMA, the Catholic Medical Association supports free choice in the insurance market.

Doing so would facilitate the creation of new forms of health plans that, according to one study, could provide coverage for up to 8.5 million workers and their dependents who are currently uninsured.

While the debate over health-care reform continues, Pittsburgh’s Catholic Charities is already helping the uninsured at its health-care center. Located in the organization’s administrative building, the center opened in November 2007.

The free center is staffed by a team of volunteer professional staff that includes doctors, dentists, nurses, dental assistants and dental hygienists. By the time it ends its first year of operation, the center expects to have served more than 4,000 patients.

Bishop David Zubik of Pittsburgh visited the center on March 18, when the 1,000th patient, Camille Scott-Ford, was treated. “This is a wonderful beginning, yet we must ensure that many more people are able obtain the health and dental services they desperately need, but cannot afford,” Bishop Zubik said in a press statement about his visit.

Scott–Ford is delighted with the quality of the care she has received since she came to the center that day.

And she’s especially grateful, as a non-Catholic, to be allowed to participate in the Catholic Charities’ initiative. Said Scott-Ford, “I think it’s phenomenal.”

Tom McFeely is based

in Victoria, British Columbia.