Spending just moments with Dr. Joseph Smiddy is a cascade of chilling water for those claiming faith in the American health care system. What a lot of people proclaim as the best medical system in the world isn’t delivering for many with the greatest need right here in Virginia.
“It’s not just that they can’t afford any sort of insurance that might be available to them under the Affordable Care Act. It’s that this is a horribly underserved region in terms of medical resources.” – Henry Schuster, 60 Minutes producer (at 3:17)
Organizers of an expeditionary Remote Area Medical (RAM) clinic just outside of Jonesville, Virginia expect something on the order of 600 patients today and tomorrow. This is the first of this kind of event in Lee County, set up in and around the airport that sits further west than Columbus, Ohio and Detroit, Michigan, far removed from Richmond. Sadly, this constitutes primary care for many residents. When I arrived yesterday as a volunteer, 22 hours before the first patient would be seen, there were already three carloads of people lined up to ensure they could get one of the specialty services. They know the routine.
Somehow Delegate Terry Kilgore (R-Gate City) avoids discerning scrutiny from his constituency. Even with all that tobacco money he is bringing home, many of those living in Virginia’s poorest county rely upon the generosity of others for any health care at all. The county’s only hospital closed about a year ago.
On September 30, 2013, the Lee Regional Medical Center closed its doors after serving the community for 70 years. With the loss of jobs and decreased access to medical care, the residents of Lee County have been deeply impacted by the hospital’s closure. – Lee County Hospital Authority
The Health Wagon is the only regular option for health care for many in six Virginia counties; even counties with hospitals. There has been some good news about the Health Wagon even since the last RAM event in Wise County: they have a brand spanking new truck! The old RV, featured on 60 Minutes (note that the ads in the video straighten out after a couple of minutes) last spring will not go into full retirement; they will eke out every last drop of utility by rolling it to RAM and similar events.
There were a good number of RAM volunteers including the local high school football team members in their “Generals” game jerseys. They didn’t have a game this week so they were prime for this mission. Medical students from VCU-MCV pitched in. Most of the RAM setup volunteers, one from as far away as Bethesda, Maryland, cited having some of their “families’ people” living nearby or in similar circumstances.
The Washington Post had a reporter and photographer there and a cameraman from NBC News spent time with those who had lined up at the gate a day early. One of the RAM regulars told me she recognized the Post reporter as a regular at the Wise County event. There were some local officials who walked through looking like they felt out of place.
Back to Dr. Smiddy. He seemed irritated that the demand for services like RAM or the Health Wagon might be reduced to hot button phrases like “Medicaid gap.” The issue looms so much larger for him. Smiddy has practiced in the region for 41 years. What he sees is that we are sicker than we have ever been with lung and chronic obstructive pulmonary diseases, diabetes, hypertension, obesity, asthma, and dental problems. Our health has improved in the area of heart disease because of all the stints. So there is some improvement in health from modern medical care and imaging technology. “And we have wonderful practitioners.”
But, Smiddy continues, people who have Medicare or Medicaid face other obstacles. They simply don’t have the co-pays; they don’t have a ride; they don’t have a provider; nobody will take their insurance, Medicare, Medicaid, whatever. There’s geographic isolation; they are separated from health care from causes like the hospital in Jonesville being closed. So, yes, there’s a crisis in health care: people are in the gap; they are in the donut hole. People have insurance but there’s a $5,000 deductible before the insurance ever kicks in.
“We have more people staying away from the doctor. They are just dying at home.” People with serious illnesses are not going to the doctor because they are out of the payment system.
“America…I work in several countries…America is the only country in the world where you get sick and lose your home. There’s not another country like that.
And everybody says, “Oh, you’re sick in Lee County, just drive over to Holston Valley’s (Kingston, Tennessee) emergency room.” They’re either going to throw you out or they’re going to get money; a lot of money. It’s not going to be what it ought to be. It’s not the real answer. So it’s complicated, it’s expensive, it’s going to get worse. If Virginia expands Medicaid, if Tennessee expands Medicaid…which is doubtful…they’re going to do a little version of it, but it’s not going to reach many people.
The main thing that RAM does, is you look out and they’re real people. They have real names and real faces and you don’t see them if you don’t come to this type of event.” – Dr. Joseph F Smiddy, Treasurer, Central Appalachia Health Wagon.
Wonder if the Earl of Kilgorvia will attend this event.