I broke my arm last week and went into the emergency room at our local hospital about 24 hours after a Sunday morning accident. My family doctor told me to go to the ER first to get an x-ray and then take it over to his office later that Monday afternoon.

It is a familiar place, this rural community hospital. In fact, it seems pretty much unchanged in the forty-years since I helped plant its initial trees for our fourth-grade Arbor Day project. Oh, it has enjoyed new names and titles, in addition to having gone bankrupt a number of times since the 1950s. In various metamorphoses over the decades, the hospital has gone from a municipal to a state to a federal to a quasi-public entity—various government agencies intervening to cover millions of dollars of its annual unpaid bills.

Still, I don't go the 20 miles to Fresno if I can help it and have an attachment for our local community hospital. My aunt and grandfather died there. So did my dad. All three of my kids were born there during the eighties (their doctor and deliveries paid for with carefully saved cash, given the lack of affordable health insurance in those days for self-employed raisin farmers.) From time to time, I've taken a bleeding child in for stitches. So I pretty much knew what to expect—and I was not disappointed on this latest visit.

 A word of caution here: Fresno County is among the poorer counties in a state now reeling from massive annual deficits, stubborn unemployment, and a god-awful agricultural economy of worthless raisins and tree-fruit farm bankruptcies. Indeed, my rural hometown in its southwestern quadrant is among the poorest of California's municipalities, where unemployment hovers around 20-25%, and a large minority of its mostly Hispanic population are "undocumented" residents. On the way into town I noticed dozens of young men loitering on lawns and corners on a Monday mid-morning. All presumably reflect the endemic unemployment of the Central Valley and perhaps also the presence of some 5 million illegal aliens who now reside in the state.

When I listened to Howard Dean, John Edwards, and John Kerry rail about "30 million Americans without health care" I assume they are talking about impoverished places like my hometown, not their own pricey digs around Burlington, Georgetown, or Beacon Hill.

Still, when I arrived there last week I was a little startled by the contrast between my cars and the others in the parking lot. My 1999 Mazda with the door badly dented and a weak battery was put to shame by brand new Chevy and Ford trucks that were lined up in front of the ER entrance. There were a couple of new Ford Rangers and some assorted late model Toyotas and Hondas.

In the cohort of waiting patients, I was the only one who seemed either to speak English or have health insurance. I waited my long turn, as the ER admirably ran simply on the basis of triaged first-come, first serve. Insurance, citizenship, or knowledge of English made absolutely no difference. There was no class, race, or even legal hierarchy that determined who saw the doctor first.

And what followed might have further impressed Ted Kennedy. None of the patients were turned away, although many of their apparent ailments that morning—sniffles, a bad hangover, a sprained wrist, a turned ankle, and back pain—seemed to me less urgent than my then swollen broken arm. One woman was knitting; another was talking on her cell phone about Mel Gibson's The Passion; and in my rudimentary Spanish I gathered the fellow next to me was complaining about migraines.

I looked around and counted some 25 patients in the waiting room. In fact, nine were talking on cell phones, and another eleven had them on their belts or in their hands. All were not badly dressed (plenty of gold jewelry) and looked healthy enough. And while none could speak English, two extremely competent young hospital employees not only translated for them, but also went out to the general waiting room and helped patients fill in the forms. I was envious inasmuch as the lengthy questionnaire sometimes confounded me. I doubt very much, should I immigrate to rural Mexico and do so illegally, that my local clinic there would offer me quality health care, treat me in English, provide an English interpreter to fill out my Spanish-language government forms—and do it all at no cost to me, new car, cell phone, and all. And that truth, it seems, makes all the difference in the world to some 12 million who come north rather than go south.

I accept that most of the patients may have been either unemployed or disabled, or perhaps frightened to seek regular employment given their questionable legal status. But nevertheless their poverty was also, it seemed to me, quite different from what I had grown up with in this same community some 40 years ago, when outdoor privies and dilapidated cars were commonplace.

Cell-phones and new pick-ups—whether they are products of cheap Chinese labor or easy American credit—are nevertheless optional expenditures. One really does make a decision of sorts to buy on credit a 30,000 twin-cab Ford pick-up, or pay $100 a month for a cell-phone family-plan than purchase cheap HMO health insurance. Perhaps there was a general sense then among those waiting for the doctor that while the government does not provide new cars or cell phones it really does, after all, extend free health care.  In any case, if the emergency room in one of the poorest towns in this nation is a litmus test of horrific poverty and neglect, then it is a strange sort of poverty that about 5 billion on the planet outside our borders could only envy.

Once inside the patient waiting rooms, I noticed that my old hospital was still spotless, the nurses competent, and the doctor skilled. The examinations around me were conducted in Spanish, and it was clear that not having health insurance, not being a US citizen, not being in the United States legally, and not speaking English meant nothing at all in the level of care administered. My university’s Chicano Studies Department may be convinced that America is a racist, uncaring place; but people in Oaxaca would beg to differ, and clearly prefer our local hospital to what passes for health care offered by the Mexican government some seven hours to the south of here. In short, there was a sense of dignity everywhere that transcended the particular circumstances of particular patients; they were united in the assurance that they were getting good medical care without much care who they were or what they did or did not earn.

When my turn came, I asked the doctor why so many of the patients seem to have such minor complaints—assessing the Democratic mantra that without health insurance the poor have no private physicians and thus were forced to go to less-qualified but more expensive ER health care workers for what otherwise might be routine visits to family doctors. There was sort of a silence at such a rude question, perhaps sensing that in this age of lawsuits no care provider in his right mind is going to turn away anyone from the emergency room. Or was the hesitation more self-interested? Why question the steady stream of patients who account for the very need of such a large and extensive emergency room in the first place?

Still, the cryptic answers I sort of got from one or two of the guarded staff could perhaps be summed up that a lot of people just liked going to doctors, whether out of loneliness or in need of conversation and attention.   Only one person that morning seemed to be in real pain; there were no emergencies that I could detect. In any case, I got my x-ray, temporary cast, sling, and went home—and now await the bill from a Blue Shield HMO for a $50 deductible fee not covered in my ever more expensive monthly premiums.

Whatever one thinks of illegal immigration, however one laments the absence of HMO cards like mine in the hands of every American resident, and despite the rhetoric that our poorest communities are given inadequate health care, the destitute without attention is not what I saw last week and many such times in the last 20 years with my accident prone children.

In some of America's most impoverished landscapes, our government at great cost and in the hallowed traditions of American humanity and magnanimity is offering hourly excellent medical care to literally anyone who walks through the emergency room door, whether they have a broken arm or a sprained ankle. That is how it should be—but also how it should be acknowledged as well.

So we should perhaps remember that we are not heartless the next time some demagogue slurs the United States as an oppressive society that ignores its less fortunate. By any definition of classical poverty and neglect, the patients I sat with last week were neither terribly impoverished nor without care—nor worried in the least about how all the nurses, doctors, receptionists, and expensive machines and drugs that they took for granted would be at their service were going to be paid for.