Noisy health-care debate overlooks free clinics' struggles

http://www.mcclatchydc.com/economy/story/74698.html

Posted on Sunday, September 6, 2009
Noisy health-care debate overlooks free clinics' struggles

By Leila Fadel | McClatchy Newspapers

FREDERICK, Md. — One recent Monday, the line in the Church of the Brethren parking lot began to form at around 2:30 a.m. when a husband and wife arrived. They came almost 8 hours early in the hope of seeing a dentist — for free.

They soon watched the headlights of other cars as they pulled into the lot. Some would-be patients laid out blankets and sat on the pavement to wait for hours so they'd make the top of the walk-in list to see a doctor or dentist at the Mission of Mercy traveling clinic.

By the time the clinic, a converted recreational vehicle, opened its doors and the church's multi-purpose room became a waiting room, a nursing station and a dental office with blue dividers and folding chairs, more than 100 people had assembled.

At the check-in table, new patients were asked one question: "Are you insured?"

The Mission of Mercy, a group of traveling clinics that circulate through towns in Maryland, Pennsylvania, Texas and Arizona, is one of more than 1,200 free clinics across the nation that are feeling the effects of the economic downturn.

Their patient lists are growing as Americans lose their jobs and their health insurance, but as demand grows with rising unemployment, their donations are dwindling. This year, Mission of Mercy has $350,000 less than it did last year; it takes no government funds for its services.

"People are so afraid to give now, because they're thinking they could lose their job next," said Linda Ryan, the executive director of Mission of Mercy. "We're squished because we have more people in need; we need to grow now more than ever — who knows what will happen with health care?"

Over the past year, free clinics across the country have seen a 20 percent decrease in donations and a 40 percent to 50 percent increase in patients, said Nicole D. Lamoureux, the executive director of the National Association of Free Clinics. Last year, the clinics the association represents — which largely have been excluded from the health care debate — treated 4 million people. This year, Lamoureux expects, they'll serve some 8 million, 83 percent of whom come from homes in which at least one person works full time.

"Quite frankly, the need is so great at some point in time we'll hit a place where we have to say we need to start cutting," Lamoureux said. "We'd like to be a part of those discussions (on health care.) We really need to make sure that this legislation gives the people we serve access to quality health care."

On the outskirts of the nation's capital in Silver Spring, Md., on a recent Sunday, the waiting room of the Muslim Community Center Medical Clinic was packed with uninsured patients. It, too, has grown almost 50 percent in the last year, and about 15 percent of the new patients are uninsured after losing their jobs.

Although the U.S. spends more on health care each year than any other nation does, about 46 million people in America have no health insurance, according to the Census Bureau. While the number of uninsured Americans dropped from 2006 to 2007, indications are that the number has increased drastically in recent years and will continue to rise as unemployment swells.

Of uninsured families, about 27 percent make less than $25,000 a year, according to the census survey. About 19 percent of families make $50,000 or more a year. The federal poverty line is $22,050 a year for a family of four.

Even those with insurance, however, aren't safe from financial disaster when dealing with medical problems. More than 60 percent of bankruptcies are partly attributable to medical problems, according to a recent article in the American Journal of Medicine. Three quarters of those bankruptcies were among the insured.

Many who come to Mission of Mercy and the Muslim Community Center clinic work 40 hours a week or more, but still can't afford health care.

In the waiting areas of these clinics, most of the patients had no strong opinions on proposed health care changes; they don't have the time or desire to rage at protests. They want to see a doctor without bill collectors showing up at their doors demanding thousands of dollars or having loan officers denying them car and home loans because of their bad credit, they said.

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"I thought I'd seen it all, from violent alcoholics, bank presidents, to the poorest of the poor who couldn't buy Tylenol for their child, but I was wrong," said Romane, a 35-year veteran of emergency medicine. "It was never possible for me to have any way of knowing whether that person leaving with a prescription I gave them could get it filled . . . . I never looked at a wound and said, 'I wonder if this person can afford this treatment?' I just treated the wound."

Now Romane tries to find the cheapest options for patients by running the smallest number of tests and providing the best care he can for free.

"To my mind, a lot could be learned if some of the people trying to reform health care spent a night in the ER or a day at the Mission of Mercy," he said.

In Silver Spring, Dr. Asif Qadri starts his day at the MCC Clinic. The clinic provides free health care to the uninsured and the poor.

At his private practice, Qadri often saw elderly immigrants with no insurance. So in 2003 he opened this clinic, and it's grown from one day a week to six. After failing to find a doctor willing to leave his private practice, Qadri retired and now works full time at the clinic.

"It's mind boggling how people manage," he said after seeing a father of four who supports his family on the roughly $7 an hour he makes as a gas station attendant.

"There needs to be an option for these people. The people who get crazy in these protests on health care, they're getting wrong information. It's scare tactics about killing granny and death panels. Maybe reform won't cover everyone, but it won't be 46 million uninsured."

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