While I disagree with Rick Smith's conclusions, Rick's letter raises important issues regarding the American health care system. Rick might be interested to know that many doctors are already "forced to provide health care for those that ... cannot afford it." In order to qualify for reimbursement under Medicare, hospitals generally cannot turn away patients from their emergency rooms unless they're on diversion status.

Rather than receiving preventative care and routine physical exams, many uninsured Americans wait until they are gravely ill, and then go to the emergency room. Inner-city hospitals render millions of dollars worth of uncompensated care annually, often for conditions that could have been treated much more inexpensively at an earlier stage of progression. The cost of this "free" care is passed along to everyone else, in the form of higher fees and insurance premiums.

America offers a fragmented approach to caring for those who cannot pay. Some states offer public hospitals and community clinics. For many people, the emergency room is an option of last resort. Frequently, the challenge for inner-city health care providers is to assist patients in obtaining the reimbursement to which they're already entitled.

From a public health standpoint, we cannot entirely isolate ourselves from the health concerns of our poorest citizens. For example, failure to provide routine immunizations for communicable diseases threatens the health

of all of us, not just the poorest among us. And from a philosophical viewpoint, most communities of faith answer "yes" to the question, "Am I my brother's keeper?"