With Jackson's governing body scheduled to meet Monday to decide how to cut up to $229 million out of the struggling public-health system, the situation is personal for Gaston Procopio, whose 51-year-old mother is getting radiation treatment at Jackson Memorial.

``She depends on that treatment for her life,'' Procopio said. The radiation oncology program is one of those that Jackson Chief Executive Eneida Roldan has proposed to shut down in a recovery plan that includes laying off 4,500 workers and closing two suburban hospitals.

``We're worried. We don't know what's happening,'' said Procopio, whose mother also goes to Jackson's Jefferson Reaves clinic in Overtown, another possible cut. ``We may have to go to Europe, where they have socialized medicine.''

The Procopios' family problem is one example of the reverberations that a smaller Jackson Health System will have throughout Miami-Dade. Mayor Carlos Alvarez wants the Public Health Trust to finish its agonizing decisions on Monday so the County Commission can consider them on Tuesday.

Regardless of the exact form the cuts take, experts say everyone in the county is likely to feel the impact:

• The poor and uninsured will struggle to find care. Some will go to emergency rooms, the one place in America where the law requires everyone to be treated. Others will stay at home, getting sicker and sicker.

• Those who have health insurance will have the immediate problem of longer waits in ERs, where delays can already be mind-numbing and painful. The longer-term problem: higher insurance premiums to cover the cost of private hospitals dealing with more uninsured.

• Taxpayers face a different danger. They already put $350 million a year into Jackson -- through a half-penny sales tax and property tax. If the Jackson cuts are too small, then the county will have to finance Jackson's payroll -- $80 million a month. In that case, the mayor has said he'll have to cut basic services such as police.

PROPOSED CLOSINGS

``This is de facto rationing, no question about it,'' said Michael Kosnitzky, a former chairman of the Public Health Trust, which oversees the Jackson Health System. ``Poor people often need public transportation. The farther away help is, the less likely they are to get it.''

That was one reason the system purchased Jackson North and South -- to facilitate easier access to care. If facilities are closed down, Kosnitzky said, patients are ``going to sit home, get sicker. Morbidity and mortality rates are going to go up.''

``The repercussions to the health of the community are going to go on and on,'' said Robert Schwartz, who oversees family medicine at the University of Miami. ``This is going to create long-term problems for Miami-Dade.''

Roldan is getting major opposition about the proposed hospital closings from the County Commission and members of the Public Health Trust, but regardless of the specifics, it's clear that fewer people are going be treated.

For example, one alternative to closing the Jackson North and Jackson South hospitals is to close Jackson's inner-city primary-care clinics. One of those, Jefferson Reaves Sr. Health Center in Overtown, gets 30,000 patient visits a year from the inner-city poor -- and serves as the training center for the University of Miami's family medicine program.

Half of the clinic's patients have chronic diseases -- high blood pressure, diabetes and others -- and if their conditions are kept under control in primary care, they stay out of hospitals, says Schwartz.