Uninsured Americans turn to mobile clinics

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By Gabriella Boston

"Health care in this country has become a privilege of the well-to-do and the well-insured," said RAM founder Stan Brock. His nonprofit organization, based in Knoxville, Tenn., has treated 10,563 uninsured and underinsured people free of charge in the past 12 months. The medical services RAM provided were valued at $3.6 million.

"I started RAM as a medical relief force for the Third World, but the need is so great in the United States that we do most of our work here now," Mr. Brock said. "It's hard to believe this is happening in America; it's depressing."

During the three-day free clinic in Wise County - about 400 miles southwest of the nation's capital - RAM treated 2,670 patients, the group's single-largest effort of the year. Still, the clinic had to turn away hundreds of people.

"This is a huge problem particularly in rural America," said Dr. Arthur Kellerman, chairman of emergency medicine at Emory University School of Medicine in Atlanta.

Dr. Kellerman, who grew up in rural Tennessee at a time when doctors would treat patients for a "little cash and the occasional chicken," studies emergency room usage by uninsured patients.

The lack of access to affordable preventive care drives some uninsured and underinsured patients to hospital emergency rooms, where the law entitles them to treatment but expects them to pay the bill.

"Contrary to what you might think, only about 9 percent of ER visits are made by the uninsured," Dr. Kellerman said.

"Most of the uninsured are scared to death of going to the ER because of the high costs," he added. "They just hope that abdominal pain will go away on its own."

According to Kaiser, nearly half of the uninsured did not see a health care professional in 2007.

For many of the patients at the RAM clinic in July, the visit was their first to a doctor in more than a year.

Most came for dental and vision care, which are not covered by Medicaid and other low-income insurance programs. But many discovered during the course of their examinations that they also had medical conditions such as diabetes and high blood pressure.

"The perception is that we do mostly vision and dental care, but we do more general medical than anything else," Mr. Brock said. "Many of their conditions are due to lifestyle choices. ... Cigarette smoke is always thick in the air and many of their main meals come from Wal-Mart and McDonald's."

RAM staffs its clinics with hundreds of volunteer doctors, optometrists and dentists who give up their weekends to help the poor. But even with so many hands, the doctors are not able to see everyone who comes and routinely have to turn away several hundred prospective patients.

Karen O'Quinn, a registered nurse who works at the Health Wagon, a free, mobile medical clinic based in nearby Dickinson County, said the problem of affordable and accessible health care for the uninsured is growing worse, especially as the economy falters.

"People here are hard workers, but many are losing their jobs and they just can't afford to pay for medical care along with everything else," she said. Often, she added, people have to choose between medicine and food.

"It surprises me that health care is not at the forefront of the campaign."

Yet it isn't.

Mr. Obama and Mr. McCain were invited to the Wise County Fairground by Mr. Brock this summer. Both declined the invitation.