If Hillary Rodham Clinton ever wanted a panorama of what is good and bad about American health care, she has chosen the right place.
This evening, she is scheduled to pitch her proposals for universal health care during a town meeting at the Johns Hopkins Medical Institutions, home to a hospital and graduate schools of medicine and public health that rank among the nation's finest.
But within blocks of the grand Victorian dome that anchors the complex, the first lady could see an East Baltimore neighborhood that is ailing.
It's a community where one-fifth of the residents lack health coverage, less than a third have private insurance and nearly half qualify for medical assistance -- the name for Medicaid, a program of free medical care for the poor.
In the parlance of the health care debate, medical assistance provides "access to care" for thousands of neighborhood residents, covering a wide range of preventive and emergency medical services at clinics as well as at the venerable hospital itself.
Nonetheless, this proud community of brick and Formstone rowhouses -- buoyed by its myriad churches, beset by drug traffic -- has some of the highest disease rates in the state. By itself, health coverage doesn't protect people from the hazards of dilapidated housing, homicide, drug abuse, AIDS and diseases such as hypertension and diabetes.
Residents in the five-ZIP-code area have the state's highest rate of stroke deaths, the second highest rate of amputations due to diabetes, and the second-highest rates of lung and breast cancer, according to the state health department. It also ranks second in infant mortality, teen births and underweight babies.
The comparisons are based on statistics for an area that includes the neighborhood surrounding Hopkins, as well as the east side of downtown, Fells Point and a slender arm reaching northeast to Herring Run Park.
Researchers with the world-renowned Wilmer Eye Institute reported three years ago that 8 percent of East Baltimore residents over 80 were blind. Across all age groups, half the cases of blindness could have been averted with preventive care, according to the study.
Reporters for The Sun asked more than 40 neighborhood residents to comment about their family health care needs. They had much to say, but few said they were aware of tonight's town meeting or had seen postcards mailed by Democratic Rep. Kweisi Mfume of Baltimore, the organizer.
Most navigate a dizzying labyrinth of health programs during their lifetimes, falling in and out of coverage as their circumstances change.
'I was sicker than sick'
In her 37 years, Claudette McColl knows how dangerous the voyage can be.
Pushing her baby grandson in a stroller down East Madison Street the other day, she said she got free Medicaid coverage for many years because she was a single parent who was poor. Like many young mothers, she received welfare through Aid to Families with Dependent Children and, with it, medical assistance.
Two years ago, when her daughter turned 18, Ms. McColl fell into a safety net designed for poor, single people without dependent children. But she soon lost that coverage when the state eliminated the program to trim skyrocketing Medicaid costs.
"I had no medical coverage," said Ms. McColl, who lives in the Lafayette Courts housing project. "I was not seeing a doctor. I had known for three years that I had high blood pressure, but I was just treating myself."
Sometimes when she felt bad, she would take illicit drugs to calm herself, she said.
One frigid February evening this year, she was overcome by weakness, fatigue and a crushing pain in her chest. She said she managed to call an ambulance and crawl out of the door to wait for it, but an alarmed friend drove her to the Hopkins emergency room.
There, she was treated for a heart attack and hospitalized for 10 days.
"I was sicker than sick," she said. "I nearly saw my life go."
Like all Maryland hospitals, Hopkins has a policy of accepting patients regardless of whether they have insurance.
But Hopkins works hard to find coverage for the uninsured who walk in its doors.
In her case, the hospital succeeded, proving that Ms. McColl was permanently disabled. She qualified for Medicaid under a provision for single people without dependents who are too sick to work.
Now, she carries a medical assistance card, which entitles her to see a private doctor at a nearby health maintenance organization. It also covers prescriptions for chronic hypertension and kidney problems.
She said her blood pressure is now under control, thanks to regular medication and a low-fat, low-salt diet that's carefully spelled out in a Hopkins brochure that she likens to a restaurant menu.
"Johns Hopkins really helped me out a lot," she said. "They stuck by me all the way."
Emergency room lines