Volunteer Doctors Can't Keep Up with Needs of Uninsured and Underinsured

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A few months before I left my job in the insurance industry in 2008, I was working on a "white paper" to try to persuade people -- especially lawmakers and candidates running for office that year -- that the problem of the uninsured in this country was not a big deal.

At that time, according to the U.S. Census Bureau, there were an estimated 47 million Americans who were uninsured, a number that has increased since then by about 4 million. My job was to slice and dice the Census data in such a way to convince people that most of those without coverage were just shirking their personal responsibility to buy it.

One of the statistics I used in the paper was that more than 40 percent of the uninsured are young adults who probably consider themselves sufficiently healthy and bullet proof to make insurance a needless expense. Another was that more than 35 percent of the uninsured earn at least $50,000, and consequently should be able to afford coverage.

What I didn't note in the paper, of course, was that many of the young adults are unemployed or earn so little money that sending monthly premiums to a health insurance company is not a possibility. I also didn't note that many of the people who earn $50,000 or more are considered by insurance companies to be "uninsurable" because of prior illnesses. Insurers, including the nonprofit Blue Cross plans, maintain a long list of "pre-existing conditions" they use to deny coverage.

As Congress debated reform, it became clear to me that many lawmakers were buying what I and others in the insurance industry were selling. They also seemed to believe another fabrication opponents of reform were peddling: that for those who were uninsured for reasons other than irresponsibility, there was an adequate safety net in place. That's when I decided to quit my job and begin explaining how the insurance industry and other special interests have made it impossible for millions of Americans to have access to affordable and quality care.

The myth that the U.S. has a reliable safety net continues to be accepted as truth by many people, as I learned when I was in Chicago a few days ago for Remote Area Medical's first free medical clinic in that city. Since it was founded in 1985 to provide health care services to people in remote areas of Africa and South America, Remote Area Medical (RAM) has provided care to more than half a million people, although since the 1990s most of those people are U.S. citizens. While RAM still flies doctors and other caregivers to nearly inaccessible villages abroad, the majority of its clinics are now held in this country.

A Band-Aid Instead of a Solution

At RAM clinics, which have become annual or semiannual events in a growing number of small towns and big cities in the U.S., thousands of people line up before dawn to get care that is provided free by doctors who volunteer their time, often for several days.

One of the volunteers in Chicago was Tres Savage, executive director of RAM's affiliate organization in Oklahoma, which hosted a three-day clinic at the state fairgrounds in Oklahoma City in July 2010. Savage was one of several doctors from outside Illinois -- others came from as far away as Maine and Washington state -- who traveled to Chicago to help treat thousands of area residents who came to Malcolm X College for free medical, dental and vision care.

(Illinois recently passed legislation allowing doctors from other states to volunteer for RAM clinics and others like them. Most states have not yet done so, which limits the number of patients who can be treated. As a consequence, people are frequently turned away because there are not enough doctors, dentists, ophthalmologists and optometrists to meet the growing demand.)

Savage told me that as he and others were planning the Oklahoma clinic, many political and business leaders would make it clear that they had no clue just how shredded the safety net really is in the U.S.

"Inevitably, people would say, 'See this is what we need, organizations like Remote Area Medical,'" Savage said. "They would say, 'What you're doing is great. This is the solution (to our health care problems.).'"

"And I would tell them, well let's say we're going to get 2,000 patients treated this weekend, and let's say that we could do that every weekend of the year in Oklahoma. So we're going to do this 52 weeks a year, which is impossible, but let's just say that if we could do it, that would be 104,000 people that we could see. Well, there are 604,000 uninsured Oklahomans. So if we did one of these (clinics) every weekend of the year, we could help one-sixth of just the uninsured. That doesn't count the underinsured and the people who have some medical insurance but no coverage for dental care or vision care."

As it turns out, Oklahomans are luckier than folks in most states. RAM and similar organizations that rely exclusively on volunteers and donated money and supplies can operate in only a limited number of states every year. As much good as they do, they simply don't have the resources to make much more than a dent.

The health care reform law, when fully implemented, will go a long way toward solving the access problem in this country. When fully implemented, the number of uninsured Americans will drop by an estimated 30 million. But more than 20 million others will still be uninsured.

The reform law is already providing money to enable community organizations to provide needed care to the underserved, and those and other grants will help mend the safety net. As helpful as that is, Savage and others who volunteer at RAM's clinics don't expect the need for their services to disappear any time soon.