Big Smoke

'cause it's hard to see from where I'm standin'

Things That Deserve More than a Storefront

TAGS: None

I’ve grown up watching neighborhoods change character – ethnic succession and urban renewal and yuppies, oh my – but noticed that some things simply don’t leave: Irish bars. It doesn’t matter if it hasn’t been an Irish neighborhood for sixty years; those bars don’t die. When I lived in Flushing, Queens, surrounded by Taiwanese cafes and Korean bakeries, there the Irish bars would remain, nestled in holes in the wall with aged, well-pickled patrons who apparently never got the memo. In my time in Washington Heights in upper Manhattan, Irish bars sat happily next to mangu huts and Cuban-Chinese joints. They’re like urban hangnails.

Up in Inwood, which has historically had the most bars per capita in any neighborhood in the country after Hoboken, New Jersey, they were there pretty much every block: Cheap bottle bars with wood paneling and green paint, seemingly brazenly defying the gentrification of the neighborhood with their ubiquity. However, lately they’ve begun to disappear. If this wasn’t odd enough – bars were, I’ve always assumed, the quintessential recession-proof business – they’ve all been replaced by the same type of establishment: Three former Irish bars on Broadway in a ten block stretch of Inwood have been replaced by for-profit branded medical clinics such as LabCorp, which specializes in diagnostic tests.

I didn’t think much of it at the time: Washington Heights and Inwood have always had a large number of private medical practices taking up small storefronts. Most of them, however, were dentists or family doctors or the like. It wasn’t until I had noticed a spate of them near the former St Vincent’s Hospital complex in Greenwich Village did I recognize a shift. The New York Times surmised that it was difficult to tell just how much of a strain this put on public health in the area, but did note that residents didn’t like it much:

Many doctors and some Village residents were dismayed when St. Vincent’s went bankrupt and closed, and consider the new health care choices in the area to be less than adequate.

Each time a hospital closes in New York City – largely because it cannot recoup costs – the demand on the emergency rooms of other hospitals, as well as for general care, rises. To capitalize on this demand, walk-in emergency clinics and private diagnostic clinics have come in. It should come as no surprise to anybody that these options end up costing more, as they are more fragmented, accept less insurance, and are under less oversight and regulation. Advocates argue that they are supplementary to and taken the burden off “primary care centers,” but considering how New York has lost no less than nineteen hospitals in the last fifteen years, they may not be supplementing but replacing primary care. It reminds me of, well, a Dilbert cartoon.

In a way, it makes me wax a bit nostalgic for the dirty 90s: When twenty bucks got you quite further than it does now, there were more than just pink-collar jobs available and, while your chances at getting stabbed were higher, so were your chances at seeing a doctor at the emergency room in an acceptable amount of time. It would drive a man to drink, but sadly they replaced most of the bars.

That said, I can think of no better illustration as to how America views health care: As a commercial service, not a universal right. Even as we’re right on the cusp of a (barebones, woefully insufficient) reform on health care, there is yet another barrier to access. We need to approach the idea that hospitals are a public good and therefore need public administration. This piecemeal approach to health care is pretty damn frightening in its prospects.

© 2009 Big Smoke. All Rights Reserved.

This blog is powered by Wordpress and Magatheme by Bryan Helmig.