Swerving to avoid being smashed by a big rig, a small car careens through the Interstate 5 median into oncoming rush-hour traffic.

Wildly spinning into the fast lane, the foreign compact crumples when it collides with an oncoming SUV and is sent screeching back onto the median.

Inside the twisted mass of metal is a young woman on her way to her job as a teacher and tutor. She’s bruised, battered and has a broken neck.

Paramedics soon rush to the northern reaches of the county, extract the young woman who’s unable to move, and sprint her away to San Joaquin General Hospital. There, she’s stabilized and observed for signs of lingering brain trauma before her release.

She is sore, stiff and wearing a neck brace, but alive and walking. She is also the reason the county hospital was $15.8 million in the red for 2008-09.

OK, so this one woman — a friend of mine whose name I won’t reveal at her request, but whose story is true — isn’t solely to blame. But stories like hers add up to a significant financial burden for the hospital.

This woman did not have medical insurance. Like so many Americans, she had a job that kind of paid the bills but did not provide health care coverage, and it didn’t pay enough so that she could buy insurance on the open market.

So when the medics asked her where the ambulance should take her, suggesting nearby Lodi Memorial Hospital, she said, “No. Take me to county. I don’t have insurance — it’s cheaper.”

Having just escaped death or paralysis by the sheerest of margins but by no means out of danger, she made a choice that could affect her life because of insurance and expense.

Incredible, but not uncommon. The statistics bear it out.

According to a report submitted in September to the county board of supervisors, San Joaquin General provides care to 62 percent of the county’s indigent and self-pay patients — read: the uninsured.

The hospital has a mandate to give emergency care even to those who can’t afford it. But that creates a problem in how to cover those services.

According to the county report, funding to cover care for that “indigent” population declined by $2.8 million in 2008-09, and another $2.6 million hit is expected this year. No wonder it’s been seven years since San Joaquin General “had sufficient revenue to cover expenses.”

Providing care to the uninsured isn’t the county hospital’s only financial problem — maintaining a residency program for doctors and a low volume of privately insured and Medicare patients, among others, also qualify — but it’s a big one. Caring for the uninsured digs a deeper hole than the outfit’s profitable operations can fill.

Though the money situation has improved significantly since the 2006-07 fiscal year, it’s still dire enough that shuttering the hospital is actually an option.

Expect every possibility to be exhausted before that, however, because the hospital is a crucial resource to the people who live here. If San Joaquin General closed tomorrow, the other hospitals in the region couldn’t handle the volume of patients.

On the other hand, leaving things the way they are isn’t an option, either.

Unfortunately, there aren’t any simple solutions within the current system. As with all things health care-related, the underlying problems and possible solutions are complex beyond the average armchair pundit’s wildest imagination. The more I learn about health care, the more I realize I don’t know.

But it’s at least clear that caring for the uninsured is an untenable unfunded mandate for the county hospital. And something serious must be done to change that if our hospital — or any hospital in the country, for that matter — is going to keep its doors open.

Short of that sweeping change, officials in San Joaquin County are on a desperate search for ways to keep the county hospital affordable and available to the people who live here.

Let’s hope — by hook or by crook — that they do.

Because my friend is walking today at least in part because of San Joaquin General. And that type of care should always be available to those who need it — whether they can pay for it or not.

• Share your thoughts with columnist and associate editor Jon Mendelson at jmendelson@tracypress.com. Or for more Second Thoughts, visit his blog.