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Scenes From the Ragged Edge of American Health Care

At a Remote Area Medical clinic outside the nation's capital, doctors treat those who have fallen through the cracks in the system.

Mindy Cooper/Remote Area Medical

It’s 5:30 a.m., and Michael and Lancelot have been sitting on a metal bench in the dark for two and a half hours. At the Beltway Church of Christ in Suitland, Maryland, the two brothers are wrapped in blankets in the December cold; when the sun rises, a faded marble sign will tell us that this patch of grass is called the Fallen Saints Garden. They aren’t homeless, lost, or just very eager to attend church: They’re here to attend a free clinic put on by Remote Area Medical.

RAM is an organization founded in 1985 by Stan Brock, a former actor and ascetic servant of the poor; according to a profile in The Independent in 2014, Brock slept on a “cowboy’s mat inside the offices” of RAM. As the name implies, the organization was founded with the intent to serve inaccessible parts of the world, but it quickly became clear that the need was also severe closer to home. The organization even serves places right outside our nation’s capital—the home of some of the most extravagant and undeserved wealth in America, where Jeff Bezos can buy a $23 million house with 25 bathrooms.

On that bench in the dark, Michael told me he’s employed as a shopper for Amazon—one of thousands of workers who made Jeff Bezos’s Bathroom Versailles possible—but has no health insurance, he said, because he couldn’t afford the premiums. He said he could have opted for health insurance through his job, but a silver plan would have cost him $162 a paycheck, and a gold plan would have been over $200. He lives with Lancelot, his brother, in Springfield, Virginia, about 20 miles away. They took an Uber to get to the clinic. (Approximate cost: $30 each way, roughly what a co-pay might be if they were privately insured.) The two brothers came to the United States from Jamaica 20 years ago and are American citizens. I thought Lancelot, who is currently unemployed, probably ought to qualify for Medicaid. I asked him if he’d ever tried to get on Medicaid, but he said he hasn’t because they “do not know the process.” Would he sign up if he had someone to help him? “Yes,” he said. For now, they are here: on a cold, hard bench 20 miles from home at 5:30 in the morning.

The clinic, which was held over two days last week, made use of several rooms in the church. The triage, medical, and dental checkup teams worked in the cavernous nave, with patients waiting quietly on the pews. A long table on one side of the room held dozens of pairs of glasses, but the clinic also had a lens lab in a truck outside, which could grind lenses to patients’ prescriptions once they had their eyes examined. On the other side of the entrance foyer, several smaller rooms were devoted to eye care or providing dental fillings. This particular clinic was held in partnership with the U.S. Public Health Service, which has a commissioned corps of more than 6,000 public health professionals; approximately 90 of its members staffed this clinic. A total of 222 volunteers checked in to support the clinic over both days, according to RAM.

The clinic coordinator, Vicki Gregg, has worked at RAM for about five years, after a lengthy tenure as a volunteer. She spoke with admiration and at length about Brock, as we discussed the irony of RAM having to serve areas as wealthy as Washington, D.C. Unlike the remote places that inspired RAM’s creation, she said, in America, it’s “a financial border,” not a geographic one, that stops people getting health care. She said RAM has even been asked to go to Martha’s Vineyard—to serve the service workers who prop up that plutocratic aerie. I asked her if the Affordable Care Act had made any difference to the number or needs of patients who showed up; she shook her head.

Almost everyone I spoke to at this clinic was either employed at least part-time or retired. In the short line at the door, before the clinic opened, I spoke to Kevin from Capitol Heights. He’s a part-time postal worker, turned out in his U.S. Postal Service uniform, and a veteran. He said he heard about the clinic from the VA—he doesn’t get health care from them, because he’s not on disability, and he’s never tried to get on Medicaid, either. The RAM volunteers at the doors started cheerfully shouting instructions to the line of patients, so I stepped away to let them do their job, but I caught up with Kevin while he was waiting for dental care.

The RAM clinic provides a range of dental services, from cleanings to fillings—RAM said there were 26 dentists, two oral surgeons, and three hygienists present throughout the weekend—and Kevin said he was just getting a routine dental checkup. I asked how long it had been since he last saw a dentist, and he somewhat shyly said it had “been a while, about a year.” I let him know that I have definitely gone longer than a year between dental visits, and he admitted, “it may have been longer than that.” I said I hate the dentist; Kevin doesn’t “have any ill feelings toward them,” but “sometimes time doesn’t allow you to do it.” He has dental insurance, but he said, “You don’t know how much you have” when you go—and you don’t know how much it’s going to cost. At RAM, that’s not a problem. Everything is free.

A young man, Kameron, was there to get his painful teeth extracted—they’d been bothering him for years, he said. He spoke as if his mouth was full of painful teeth. (Another person I asked to interview said he couldn’t talk because his teeth hurt so much.) He works with a CBD company that doesn’t provide insurance and said he gets “state” health insurance but doesn’t have dental coverage. He had actually seen a dentist a month before, at a free Howard University dental clinic, but they suggested going to RAM for additional care. He arrived at 11 p.m. the previous night to get his ticket, went home, and returned to the clinic just before 6 a.m.—inconvenient, but “it’s worth it.” He said he doesn’t have much trouble getting to the doctor, and he’s generally in “really good” health, though his teeth “mess with my self-esteem.”

Mary, 70, had come to the clinic with her husband, Anthony, 71. She has Medicare but no dental or vision insurance; last time she saw a dentist was about a year ago, to have a tooth pulled, for which she paid the full cost. She had only heard about the clinic at 6 p.m. the night before, when she read the local paper, and showed up at 11 p.m. to get her ticket. Since she lives nearby, she’d been able to get home “and get about four hours of sleep” before arriving back at 5:30 a.m.

Mary said she has “at least $3,000 in outstanding medical debt” from getting a cataract removed last year. This stops her seeing the doctor again, she said, since “I would not schedule an appointment if I had an outstanding bill, because when you go to the doctors, up front, you have to pay what you owe.” I asked her how she would feel if a presidential candidate promised to eliminate medical debt: “I would vote for them, if I agree with their other policies.” She added: “I probably would campaign for them, too.”

This clinic was less busy than many other RAM clinics, which often fill up by the time tickets are given out. Their spokesperson told me that about 120 people ended up showing up on Friday, but almost 300 came on Saturday. As I was preparing to leave, one of the RAM workers suggested that another worker should get their eyes examined, since it was so quiet, and I joked that I needed mine checked, since it had been about 10 years. The worker immediately insisted that I do so and whisked me to the registration desk to get signed up. A volunteer put my information in the system, asking me for the usual personal details, but also whether I have a regular doctor and when I’d last seen a dentist. I went to an intake nurse with the U.S. Public Health Service, who took my blood pressure. It was 99/56; a RAM volunteer nurse had told me earlier that she had just seen a woman whose systolic blood pressure was 199.

Afterward, she escorted me to the vision test area, where four USPHS corps members checked my eyes. Each was incredibly nice, professional, cheery, and funny. One had the unpleasant job of checking the pressure inside my eye with some horrifying tool and made sure to warn me how weird it would feel; another shone a light into my eyes while asking me about where I’m from and why I came to America.

That question takes on a whole different life at a place like this. This kind of clinic—serving employed and unemployed, “insured” and uninsured, young and old—is quintessentially American, both in the remarkable selflessness and commitment of its volunteers, as well as in the utter insanity that it has to exist at all. Serving these people’s health care needs could be done much more efficiently in actual hospitals instead of between the pews of a church. It’s not impossible to provide everyone in the United States with medical, dental, vision, and hearing care. We could certainly eradicate the roadblocks to care that crop up as a result of bureaucratic hurdles, complicated application forms, and the lack of ready assistance in navigating the system. Instead, we have Amazon workers sitting on a bench in the dark of a December night because the richest corporation in creation won’t provide them with affordable health insurance. But thank God we have “choice”—and what a choice we have made.