They sit in the waiting rooms of D.C. General Hospital, New York's Bellevue Hospital, Boston City Hospital: the sick poor, the neglected, the ailing second class in America's two-class medical system.
Despite public protestations to the contrary, the United States has quietly accepted this inequitable arrangement.
To some extent, there is two-class care in even the most socialist of countries, where the affluent manage to get a little "extra." But in recent years the gap here has widened:
From 35 to 37 million Americans lack any health insurance, meaning they must either seek free or low-cost or welfare-type care or go without, as many do until they are carried into an emergency room.
Two thirds of these millions are actually employed (or dependents of the employed), yet meagerly self-employed or working at low wages for employers who provide no health insurance.
Medicare, the supposed medical safety net for the elderly, now covers just 65 percent of all medical costs.
Medicaid, the intended safety net for the poor, now mainly pays bills for the elderly poor. Fewer than 40 percent of the poverty population under 65 get any Medicaid coverage; assistance goes mainly to low-income families with children, the disabled and, in some states, the pregnant.
In 1984, 13 percent of the population was medically indigent (by a late 1987 federal calculation). In 1978, the figure was 11 percent.
All of those statistics add up to an American health care system that fails in many important areas and doesn't come close to providing equity. Among its failings:
Nineteen nations, including Canada, Japan and France, have lower rates of infant deaths than does the United States. In poor, urban neighborhoods, including some in Washington, 25 to 30 babies die for every 1,000 live births, almost three times those who die in the nation as a whole.
More than 1.3 million women a year get little or no medical care before childbirth.
Twice as many women who lack care before delivery have premature and low birth-weight babies. A quarter of a million babies a year are born so dangerously underweight that there is a 1 in 10 chance they will not survive their first year.
"Right now," sums up Carol McCarthy, president of the American Hospital Association, the medical safety net is "more than a little bit frayed."
How has this happened?
In part it has happened as a result of cuts or restrictions on federal spending. These include limits on Medicare payments to hospitals. This is part of a trend that has state and local governments, businesses and insurers also limiting payments and shopping among hospitals for cut rates.
Hospitals, which are pressed to stay solvent, have become increasingly tough about refusing to admit or keep patients who cannot pay. The result has been premature discharges or transfers of patients to overcrowded, understaffed public facilities, the practice known as "dumping."
The old and "very old," those above 85, are fast increasing in number and consuming so costly a share of care that ethicist Daniel Callahan has concluded they must accept the end of life when care costs too much.
Answers? They largely fall into two categories.
A growing number of people, like Dr. Robert Butler, former head of the National Institute on Aging, are speaking of the need for "a comprehensive national health policy." Some point to the fact that the United States is the only industrialized nation except South Africa that lacks a national plan to give everyone care.
Doing so would require radical changes in American health care delivery. People like Robert Helms, a health economist who is assistant secretary of health and human services for planning and evaluation, see no need for such a "radical restructuring," while they concede the need for many improvements.
Carol McCarthy, for example, calls for "many bold private and public sector initiatives," both expanding the numbers covered by private insurance -- in part by new requirements on employers -- and extending public programs "to finance care for the rest."
Both houses of Congress last year passed a measure that would at least chip away at one class of problems -- the costs of catastrophic illness. It still must emerge from conference committee, and it does nothing about larger problems, such as long-term care. Some members of Congress are urging, with uncertain prospects, that more small employers indeed be required to provide health insurance.
There are no signs at all of a comprehensive national health policy.