Fear and Waiting: What the Wise County Clinic Means This Year

My neighbor Lisa has seen the Wise County Clinic personally. Her family owns a farm just over the mountain from the fairgrounds where the annual health care road show gathers. She described the experience of watching it in a recent email: "Just the line of cars -- literally for several miles -- and the sea of people, standing quietly in line for hours and hours to get care, was enough to bring you to tears. You feel as if you're in another country."

Every summer in the poor southwestern part of Virginia there's a free medical clinic at the Wise County Fairgrounds, conducted by the Remote Area Medical (RAM) volunteer corps. Last year, the 20-bed clinic treated over 1,500 patients, some driving up to five hours and sleeping in their cars to secure a place in line.

RAM founder Stan Brock started his organization with the intention of serving remote areas in underdeveloped parts of the world like the upper Amazon basin, where he once lived. But now sixty percent of RAM's work is in the United States. Though the Washington Post and 60 Minutes gave extensive coverage to the 2008 Wise County RAM clinic the tour of Appalachia lasts all year long with 13 stops in Tennessee, Kentucky, and Virginia and two out west in California and Utah. RAM uses the same wording for their trips to the Amazon as they do for Appalachia -- volunteers go on "expeditions" and are warned of "social unrest."

In Virginia, the Roanoke Times' Rob Johnson touched on the surrounding tensions in his interview with Barbara Hale, Chief Financial Officer of Norton Community Hospital, a non-profit acute-care facility that serves the Wise area:

We see an increase every year in the need. We've had a 381 percent increase in charity write-offs since 2001... It's all about insurance. Our unemployment here is high and many of our patients who do have insurance either have insufficient coverage or such large deductibles that they're still afraid to seek care.

The "consumer-driven" policies to which Hale is referring have been interpreted by consumer watchdog organizations as the health insurance industry's latest way to cheat their customers. Though some think tanks tout the affordability of consumer driven insurance, the Consumers Union investigated these policies in 2004 and sounded the alarm, testifying before Congress against them and warning on their website in bold letters:

Consumers Union believes that this coverage is misnamed, misguided from a policy perspective, and a dangerous distraction from the need to solve the health insurance crisis that faces 43.6 million uninsured consumers and tens of millions of underinsured consumers.

Bill Moyers of PBS recently interviewed Wendell Potter, the CIGNA health insurance executive who was inspired by the 2007 Wise County RAM clinic to abandon his senior position (and corporate jet) to work as a whistle blower for health care reform.

Potter described how Wall Street hijacked our health insurance industry and turned it into what Bill Moyers called "a giant ATM for Wall Street."

Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves... I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

So let's put these pieces together. Organizations like RAM can rally volunteers and provide over $33 million in free health care to Americans so needy they're willing to wait for days in the Southern summer heat for it. The industry response is a "consumer driven" system that's also called a "dangerous distraction from the need to solve the health care crisis." Of course, Wall Street hates it when the health insurance industry spends premium dollars doing what it's supposed to be doing: saving our lives.

But for some reason Wall Street is not offended when health insurance companies pay out millions of dollars a day for K street lobbyists and campaign donations to Congress.

In a report released in June, Common Cause summarized health insurance payouts to lawmakers. The accompanying summary release presented the facts in a bulleted list:

Health industries - including health insurance, pharmaceuticals and health products, hospitals and HMOs, and health professionals - have contributed over $372 million in campaign contributions to members of Congress since 2000...

Political spending by the health industries has increased 73 percent since 2000...

The major health interests have spent an average of $1.4 million per day to lobby Congress so far this year and are on track to spend more than half a billion dollars by the end 2009.

Reading over that report, I couldn't help but think, "That's our money."

That's our money. That's our premium payments, the steep and rapidly climbing health insurance payments that many of us can no longer afford. That's our money, that's the health insurance premiums we pay so our kids will be covered, the premiums that make us worry about funding our retirements and our kids' educations. And we live in fear.

Some pundits, like Dr. Frank Luntz, have even become propagandeers. As Luntz's 28-page memo instructed Republican politicians to talk about health care reform in a particularly Orwellian way. According to Luntz himself, terms like "government takeover" and warnings of "WASTE, FRAUD, and ABUSE" in the memo are appropriate because health care reform is so popular.

We are literally being scared out of our wits.

We still have excellent doctors, nurses and hospitals and other dedicated medical professionals. Nevertheless, the best we can do is send them into the mountains where -- like some surreal jam band festival turned humanitarian feat -- those afraid of losing their livelihood can attempt to save their own lives.

There is something dangerous about this system. I've seen it. My friends have seen it. And I know you've seen it, too.


If you, or someone you know, will be at the Wise County health clinic this weekend or has attended any of the RAM clinics, either as a volunteer or as a patient, we want to hear from you. Tell us about your experience, about the treatment you receive and about the other people who attend. What do the volunteer doctors think about the heath care system and how to the patients want their elected officials to address? Send your stories from Wise County to us at [e-mail].

Annual Schedule for RAM Clinics Nationwide:
Jan. 31-Feb 1: Jacobs Building at Chilhowee Park, Knoxville, TN (D, Vis, M)
March 14-15: Pigeon Forge H.S. Sevier County, TN (D, Vis, M)
April 18-19: Van Buren County, TN (D, Vis, M)
May 2-3: Cleveland, Ohio POSTPONED (D, Vis, M)
May 30-31: Tex Turner Arena at Lincoln Memorial University, Harrogate, TN (D, Vis, M, Vet)
June 27-28: Pike County Central H.S. Pike Co. KY (D, Vis, M)
July 18-19: Cocke County (D, Vis, M, Vet)
July 24-25-26: Wise County Fairgrounds, Wise, VA (D, Vis, M)
August 11-18: RAM-LA, at The Forum in Inglewood, CA (D, Vis, M)
August 22-26: RAM Utah in Fort Duchesne, UT, Northern Ute Tribes Reservation (D, Vis, W)
Sept. 19-20: Roane County, TN (D, Vis, M)
Sept 26-27: Letcher County Central H.S. KY (D, Vis, M)
Oct 3-4: Grundy, Virginia at Riverview Elementary School (D, Vis, M)
Oct. 17-18: Franklin County H.S. (D, Vis, M)
Oct 17-18: RAM Veterinary Clinic, Newport High School, Newport TN:
The Big Fix: spay and neuter small animals (Vet)
Nov. 14-15: Union Co. H.S. Maynardsville, Tn (D, Vis, M)


A=Airborne, D=Dental, M=Medical, Vet=Veterinary, Vis=Vision, W=Women's Health

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Comments

[blooddoc]

This story is just sad on so many levels, and should serve as clear warning to those who believe the current system can, or should, survive. Something as important as the health of a nation should never have been turned over to Wall Street, an entity that cares only about feeding itself. The slide of medicine into big business has been insidious, and like a cancer, the cure will require strong treatment that will likely make the patient sick in the short term (debt, deficits, de facto rationing, etc.). To do nothing, however, is not an option because we know where that road goes.

[zanzig]

Are these the same people that Joe Bageant writes of in Deer Hunting With Jesus? Those who continue to vote Republican against all their better interests.

[LiberalDem]

It's quite possible that these are people who don't vote, period. They may belong to that portion of the population who do not think their vote counts.
Or, they might vote Republican-does that mean that they should be denied health care?

[Mixpixlix]

Great Article. The health insurance industry is on track to devour itself. They know the current scheme of raising premius, and cutting care while giving themselves bonsus can't continue. They're literaly killing the golden gooose. But in the meantime they're raking in all the gold they can and that should be a criminal offense.

I've seent he work of RAM and it's a wonder. And, one wonders why the rest of the medical services in this country can't do the same. There are a multiptude of resouces and if applied in a fair and logical manner, no one would wait 5 hours to see a medical practtioner. The irony is go to your local E.R. (if you're uninsured or its after hours) and you'll wait 5 hours, too. The main difference is the bill that will follow you home from the hospital.

Support RAM. Support real healthcare reform.

[quidam56]

Mitch McConnell says he's worried the best health care system in the world will begin to ration health care. That's what we already have. They're worried about people having to get in long lines just to get health care. We already have that too. http://www.wisecountyissues.com

[tompoe]

How much respect do you have for any elected official that accepts lobbyist money from the healthcare industry? How much respect do you have for any elected official that demands any offers of money from a healthcare lobbyist be directed to RAM?

[SeriousBlack]

Great article - only one small quibble, when you said

"We are literally being scared out of our wits."

it should have been:

"We are literally being scared to death."

[hoosier96]

Actually, both sides are using scare tactics.

[ReedYoung]

No, only insurance companies and their tools in Congress are substituting fear for facts. Single payer advocates and supporters of at least a robust public option are telling the truth about real problems. That is a truth tactic. Telling scary _lies_ is what "scare tactic" means.

[r3768]

Great, great article. Thanks so much. From the perspective of a 24-year nursing/medical vet, your piece has pinned the problem -- and the way we fund our own demise -- better than anything I've read in months. I also plan on volunteering for this great cause in California if they need more hands on deck.

[sockman]

Seems like most of the RAM clinics will be held in perdominately red states who continue to vote against their own interest. Bet most seeking help at these clinics are opposed to the "public option" of the Obama plan....or as Luntz would put it to them "gubbermunt tekover" of "their" health care.

[mowoods]

How could you possibly know what these people are thinking? Have you gone to one of these clinics? Have you spoken to people in the lines? You don't know how they feel about the public option. You are simply judging people without any knowledge of them. In other words, you are prejudiced. It seem ironic to me as well that you would make fun of others since you can't even spell correctly in a simple post. The word "perdominately" which you put in your post isn't an actual word. Perhaps you meant to say predominantly which is a real word. You might want to take a look in the mirror before you start judging others so harshly.

[arnray]

I have been to one of these clinics and I have spoken to those in line around me. Sockman is correct in his assumption that the overwhelming majority of those present vote Republican, if they vote at all. I was in Wise county last year while the election was still ongoing and I heard the N-word used several times in reference to then candidate Obama and the word "communists" used to describe anyone else in line who had the audacity to bring up the concept of universal health care. If the Republicans were not able to get low information voters to vote against their own interests they would cease to exist as a national party.

[ReedYoung]

Unlikely. 50% of Republicans support a strong public option, even if taxes have to be increased.

[Samalabear]

Thank you for writing about Wise County. I wish that someone would stand up in Obama's conference tonight and read something like this to him and then ask him directly why he is so insistent on keeping the insurance companies front and center, building on the should-be-defunct employer-based model with private insurers rather than Medicare for All with boutique insurance on the side. I don't think it would do any good to read this in front of Baucus and others like him because they already know and they don't care.

Then someone can ask Obama -- as was done once before -- if he thinks it is a conflict of interest that Max Baucus and others like him be the key reformers of health care.

Then another point someone can ask Obama -- why is he trying to negotiate with these corporate health interests and trying to negotiate with them in an effort to keep them honest, when they have never been honest?

There are so many questions that Mr. Obama has not been asked. I realize that without the questions being pre-screened and answers written out on the teleprompter it would be difficult to answer, but who cares? We need the answers -- and I don't care if he hems and haws and ah-ah, kind of like George Bush.