For a story on health care, a reporter from the Guardian visited a poor area in Kansas. Soon, the area will have only one doctor serving it, as most medical services have moved to affluent areas. However, reporter Ed Pilkington does find a Health care clinic that operates via donations instead of insurance reimbursements. For many in this poor area of Kansas, it's the only place they can turn to for health care.
Lee's clinic, Family Health Care, is a refuge of last resort. It picks up the pieces of lives left shattered by a health system that has failed them, and tries to glue them back together. It exists largely outside the parameters of formal health provision, raising funds through donations and paying all its 50 staff – Lee included – a flat rate of just $12 an hour.
Lee has just opened an outpost of her clinic in the outlying neighbourhood of Quindaro, an area of boarded-up houses and deserted factories where work is hard to find and crack plentiful and a per capita income is $11,025. A third of the population is below the federally defined poverty line.
And yet the local health department has decided the only health centre in the area will be closed by the end of this year and moved 30 blocks west to a much more prosperous part of the city where income levels are five times higher. Before long, one of the poorest areas of Kansas – of America – will be left without a single doctor, with only Lee's voluntary services to fall back on.
Even that is academic. Many of the residents of Quindaro were unable to see a doctor in any case – because they were uninsured. In Kansas, anyone who is able-bodied but unemployed is not eligible for government-backed health insurance as is anyone earning more than 39% of federal poverty levels. That leaves a huge army of jobless and low-income working families who are left in limbo. "It's the working poor who are most at disadvantage," Lee says.
As a result, she sees the same pattern repeating itself over and over. People with no insurance avoid seeking medical help for fear of the bills that follow, until it is too late. "When people come in they are already very, very sick. They have avoided seeing the doctor thinking that something may clear up, hoping they may be getting better."
Beth Gabaree, who came in to see Lee for the first time this morning, has experiences that sound extreme but are in fact quite typical. She has diabetes and a heart condition. Until two years ago they were controlled through ongoing treatment paid for by her husband's work-based health insurance. But he was in a motorbike crash that pulverised his right leg and put him out of work.
That Catch 22 again: no work, no insurance, no treatment. Except in this case it was Beth who went without treatment, in order to put her husband's dire needs first. He receives ongoing specialist care that costs them $500 a go, leaving nothing for her. So she stopped seeing a doctor, and effectively began self-medicating. She cut down from two different insulin drugs to regulate her diabetes to one, and restricted her heart drugs. "I do what I think I need to do to keep four steps out of hospital. I know that's not the right thing, but I can't justify seeing the doctor when my family's already in money trouble."
The problem is that she hasn't kept herself four steps out of hospital. Her health deteriorated and earlier this year she became bedridden. Even then, it took her family several days to persuade her to go to the emergency room because she didn't want to incur the hospital costs. "It was hard enough without that," she says.
After an initial consultation, Lee has now booked Gabaree for a new round of tests for her diabetes and is arranging for free medication. "It's wonderful," Gabaree says. "I'm so blessed. I didn't know you could get this sort of help."
That she sees basic healthcare as a blessing, not as a right, speaks volumes about attitudes among the mass of the working poor. Also revealing is the fact that Gabaree has absolutely no idea about the debate raging across America. She hasn't even heard of Obama's push for health reform, nor the Republican efforts to prevent it. "I don't watch much television," she says.