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SPEAKER: Dr. Thompson, would you tell us what some of the background of your paper is? What do you base your judgments on?

DR. THOMPSON: I think the judgments in the paper dealing with some effects the US health system on the poor is based, basically, upon an observation and sort of an historical case analysis of what has happened to minority groups and, say, to Blacks over the last 5 to 10 years as it relates to the development of health care legislation, as it relates to the purchasing power and ability of Blacks to purchase health care, and also looking at how the different institutions and organizations affect the availability and accessibility to health care for Blacks.

SPEAKER: Well, you're saying that Blacks can't afford health care. I think there are a lot of whites that are saying the same. What's different?

DR. THOMPSON: Well, this is true. Now, if you will notice, the title of my paper says "Some Effects of the Health Care System on the Poor." And my definition of the poor includes anyone with a family income of $5,000 or less. That includes white poor, Black poor, Puerto Rican, any kind of poor people. And especially, it includes the aged, most of whom have incomes less than $5,000.

SPEAKER: What do you see as the problems right now? What's the matter?

DR. THOMPSON: Well, the problems are numerous. And I think it's very difficult to say what they are. And as always, we can say money is a major problem.

And we can observe this by looking at the latest reports from the US Census Bureau, which indicates that the income level for Blacks, the median income level, is somewhere like $7,000. As for whites, that level is about pretty close to $12,000 a year, median income.

And just looking at that figure, we can tend to make some inference as to the purchasing power, purchasing ability of minority groups and the poor to purchase health care as compared to the whites.

SPEAKER: Well, don't we have Medicaid that helps poor people with their health care costs?

DR. THOMPSON: Medicaid is an interesting kind of program, simply because it's set up on a grant basis from the states. And here you find different, varying eligibility criteria in different states. We find, for example, in several states that Medicaid-- there's a group called the medically indigent, which means those individuals who have income enough to take care of their basic necessities for day-to-day survival, but they do not have enough income left to take care of medical and health cost needs.

So that group, in certain states, are covered. In other states, they are not covered. So we have a working-class poor who, say, may be at the minimum, minimum maximum range, if you will, of a poverty scale who cannot afford to purchase health care.

SPEAKER: And they're wiped out when they have even a fairly minor problem of health care.

DR. THOMPSON: There are other additional problems with Medicaid where doctors and hospitals are refusing to accept patients who have Medicaid cards.

SPEAKER: Well, why are they refusing to accept payments-- accept patients who have Medicaid cards?

DR. THOMPSON: Well, there are people who believe that-- I suppose the whole working ethic issue gets involved once again. They don't believe in charity medicine. Now, some doctors have written, especially in some of the Southern states, that, well, we don't want to demean or degrade our patients by offering them charity medical care.