Imagine having daily debilitating dizziness, near-blinding blurred vision and horrendous headaches - and no remedy.
Kim Fannon, 43, a single mother in the economically depressed town of Coeburn in Southwestern Virginia, doesn’t have to imagine. That was her reality for four long years.
“I was in bad shape, but I didn’t know how bad,” said Ms. Fannon, who subsisted with the help of the federal program Medicaid.
Ms. Fannon got relief - and a scary diagnosis - when she visited a free mobile medical clinic called RAM (Remote Area Medical) a few months ago at the nearby Wise County Fairgrounds.
And she wasn’t alone.
Nearly 2,700 other patients (many who camped out for days) came to the three-day clinic in a scene reminiscent of Walker Evans’ famous photos taken during the Great Depression: Haggard faces that projected desperation - and resignation.
“I came in to check my eyes and get glasses and was sent for a CAT scan immediately,” Ms. Fannon said.
“It turned out I had one large brain tumor as big as a lemon and four small ones,” she said in a drawl that anchored her vowels in the back of her mouth and turned “lemon” into “limon.” Fortunately, they were all benign.
Ms. Fannon’s story is not unique. Roughly 45 million people in the United States are uninsured and 20 million more are underinsured, according to the Kaiser Commission on Medicaid and the Uninsured at the Henry J. Kaiser Family Foundation.
“Lack of access to [affordable] medical care is not a problem confined to poor, inner-city neighborhoods. It’s an American problem,” said Diane Rowland, the commission’s executive director. “It’s a problem that makes people drive three hours and wait for days for free dental care. It’s a problem that makes America look like a Third World country.”
Yet health care - in these financially troubled times - is not a top election issue in 2008, said Paul Herrnson, a political science professor at the University of Maryland.
“Americans care a lot about health care,” Mr. Herrnson said. “But will health care be at the top of people’s minds when they go to the polls on November 4? No, not likely.”
In the most recent presidential debate a week ago, the term “health care” was uttered 28 times. Democratic Sen. Barack Obama and Republican Sen. John McCain agreed that the cost of health care needed to be lowered.
Mr. McCain proposes a $5,000 tax credit for families to choose plans from private insurance companies, while Mr. Obama promises to expand health coverage with a mixture of public and private efforts and to cut costs for families by an average of $2,500 annually.
Each candidate says his plan would help provide insurance to high-risk patients, such as those with existing health problems, and would lower drug costs by increasing competition.
Mr. McCain has said his plan is budget-neutral, meaning it would neither raise nor lower the federal budget deficit. Although he has not offered specifics, his campaign said cutbacks in Medicaid and Medicare will help offset the extra costs. Mr. Obama said he will pay for his proposal by rolling back tax cuts for Americans earning more than $250,000 a year and by retaining the estate tax at its 2009 level rather than allowing it to end, as it’s now scheduled to do.
Ms. Rowland said the candidates’ plans are expensive and therefore would be hard to enact. “It’s not going to be budget-neutral and the budget right now is stressed,” she said.
In addition, voters seem to be focused on the general state of the economy rather than improving health coverage.
In Wise County, however, health care is a pressing matter.
“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.