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At Appalachian Fairgrounds, Charity Tries to Fill Gaps in Health Care
Even Most Sweeping Reforms Would Leave Some Without Coverage
WISE, Va. - On a sunny Saturday at the county fairgrounds in this Appalachian community, the gaps in the American health care system were on vivid display.
Lured by the promise of a weekend of free checkups, surgeries and dental care, thousands of people turned up two weeks ago in the far southwest corner of Virginia, as shown in the video documentary that accompanies this article.
Many of those families would have much better access to medical help under the reform plans being debated in Congress. But a close look at the most recent data indicates even the most sweeping proposals are likely to leave some of them outside the safety net.
About 50 million people in the United States are now uninsured, according to new figures from the Congressional Budget Office. If an overhaul of the system is launched this year, as many as 17 million people would still be without health insurance by the end of the decade, according to preliminary analyses by the CBO.
Up to half of those falling through the cracks would be that portion of the working poor who make too much to qualify for free care or federal subsidies, but feel too cash-strapped to buy their own policies. Most of the rest would be undocumented immigrants.
The three-day free clinic that began July 24 at the Wise County Fairgrounds was run by a charity called the Remote Area Medical Corps, which gathers doctors and nurses who volunteer their services.
Whole families waited for hours in animal stalls set up as temporary offices for mammograms, diabetes tests and checks on various aches and pains.
Hundreds were shut out of eye and dental exams when doctors and medical staff were overwhelmed by the numbers. No one, among those interviewed, could afford to go elsewhere.
"The need has always been great. What we are seeing now, of course, are more people who have lost their jobs or lost their insurance," said Stan Brock, founder of Remote Area Medical Corps, which has been sponsoring clinics around the world and in the United States for two decades.
People at the Wise fairgrounds voiced conflicting thoughts about their status. Some openly feared a government takeover of health care. Others said they doubted that politicians could challenge the special interests that influence the cost and availability of treatments. All admitted they had no inkling if they would be better off after the historic overhaul.
All health care proposals now moving through the House and Senate are aimed at requiring people to carry insurance. People who fall below an expanded poverty line - $14,403 for an individual or $29,326 for a family of four. Families and individuals who earn too much for Medicaid would qualify for direct government subsidies to buy health insurance, either privately or possibly through a government-run option - up to an income cutoff level that is still being debated in Congress.
The Congressional Budget Office has calculated that subsidies could cost as much as $773 billion from 2013 to 2019.
But there are significant differences between the House and Senate over how much to spend on broadening the medical safety net.
The current House proposal would support subsidies for people with incomes up to 400 percent of the poverty level. That means a family of four earning up to $88,200 a year could qualify for some federal help to offset their premiums. An individual could earn up to $43,320 and qualify for some aid.
Talk in the powerful Senate Finance Committee has suggested a more restrained scale of help for those currently uninsured. People could qualify if they earn no more than 300 percent of the poverty level. That means $66,150 for a family of four and $32,490 a year for an individual.
People earning above those levels would begin to pay full premiums and deductibles - although under the current proposals they would be eligible for government aid if they had to pay more than 12 percent of their incomes toward health care.
Doctors familiar with the expectations and needs of the working poor said they are concerned about where the lines of assistance will be drawn. "There will probably still be some people who fall through the cracks," said Wende Kozlow, a staff physician at University of Virginia who has volunteered at the Wise clinic in previous years.
Those who just miss qualifying for the subsidy might figure it would be cheaper to go without insurance, pay the federal penalty - proposed to be up to 2.5 percent of their income - and hope they don't get sick.
"The House bill would help a lot...But the one emerging from the Senate Finance Committee troubles me," said Wendell Potter, a former health care executive who was motivated by Remote Area Medical's work to change his own career and advocate for reform.
Jennifer Tolbert, an analyst for the Kaiser Family Foundation who has monitored the shifting sands of the health care proposals, said the Obama administration has undertaken ambitious reforms. But, she said, universal coverage will be elusive no matter what legislation emerges in the coming weeks.
Some people will inevitably be left behind, Tolbert said, because "we're building on a flawed system."
Lagan Sebert is a staff reporter and Christine Spolar is senior editor at the Huffington Post Investigative Fund, an independent, nonprofit journalism venture based in Washington, D.C.
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9 Comments so far
Show AllLou Dobbs claims that in a CNN Poll 83 percent of Americans were happy with their health care and suggested that all the anger a sympton of people being angry that the best health care system in the world was being tampered with.
83% of what? People who have health insurance. 17% might of used it and got screwed into bankruptcy.
The poll is largely meaningless in the context of US culture where there is a deep-seated, unquestioned belief that everything here is the best. They could be literally living in a pool of shit and they would still think they are living the best life in the world.
Then, throw in the traditional callous USAn attitudes toward the less fortunate - like the thousands who die due to lack of insurance.
Then, there is a media that refuses to investigate and expose the existence of these thousands of deaths. Or events like this one in Wise County.
Finally, most of those 83% have not actually "tested" their insurance yet on a major illness or injury.
And finally again, those who have tested their insurance and find themselves bankrupt, since everything here is the best, will logically enough, blame themselves, resulting in deep feelings of shame, eventually leading spousal abuse and other domestic difficulties.
At this point, I'm happy with my insurance so far and if I was honest, I'd be among those 83% too. But I guess I am one of those rare USAns with a conscience and find the situation of others to be intolerable. And, I would be pretty angry to see my response to this poll used in this way.
As usual, Dobbs is fairly meaningless.
A large majority of Americans want single payer health insurance. They may be happy with the doctor - rightly or wrongly.
So, ask one question, apply it to a different matter - is this a ruse on Dobb's part? Could be.
It's no wonder we feel free to murder and torture people in foreign countries when we treat our citizens the way we do. I'm self-employed and pay for my own health insurance...with great difficulty. I am debt free, but it would only take one financial "surprise" to put me in the shoes of the people in the video.
Watching that video made me cry. Do you think the politicians have any feelings of empathy? I doubt it. They make me sick. The other day there was an article about a Pew poll and it revealed 54% (I think it was 54% or close) of mainstream christians thought torturing is justified. A similar poll would show that at least 54% of same people believes the people at the health fair and others like them should "pull themselves up by their bootstraps." Stop your whining! It's a good thing there is already medicare or else the elderly would surely be heading for the abyss soon. The animals who usually fill those stalls at the fair grounds probably get better health care than the people.
Usually survey questions that show a lot of pathology in the general population are poorly written. And having the survey come from a "good" organisation like Pew or NORC doesn't really matter - even they screw up, sometimes so obviously so that you can only wince in sympathy because you know that when the questionnaire authors sober up they'll go hide under the stairs.
I'd like to see the video, but it appears that over the past year or so, the corporate youtube has decided that those of us with older PC's (slower than 1Ghz) will no longer have usable access.
I wonder if any teabaggers show up at these free clinics to shame these people for not relying on themselves. I wouldn't be surprised if some of those on line for treatment were teabaggers not too long ago, but swallowed their principles when things got bad.
Going back to at least 1980, right wing economists such as those at Cato, have pushed volunteerism. As the recent economic problems have become ever more serious, politicians, Obama included, have publicly praised the "heroes" who volunteer to help others. This naturally takes pressure off of governmental agencies that were created for the "public good", so that money can be funneled to the military, and Wall St. bailouts.