M*A*S*H USA

Is it a problem providing charity care in the U.S.?
The biggest problem we have is licensure; it's easier for a U.S. doctor to go to Guyana and provide care then it is to cross state lines and provide charity care. We ran into problems when we tried to help after Hurricane Katrina. I recently testified in front of the House Ways and Means Committee [in April 2008] and told them the biggest impediment to providing free care is that volunteer health providers holding licenses in one state are not allowed to provide free care in another state. The good news is that the state of Tennessee changed this back in 1995. They have the Volunteer Health Care Services Act, which means that volunteer medical help and veterinarians licensed anywhere in the U.S. can come into Tennessee to provide free care. There was a resolution back in 1997 to try and see if other states could adopt the Tennessee model. As far as I know, it never got out of committee.

Do you think people have misconceptions about the folks that turn out for your program?
Absolutely. I don't think people realize how easy it is to lose health care coverage. And I don't think people realize that dental care isn't usually covered for adults who get [government] aid of some sort. The majority of people we see aren't substance abusers or lazy. They are just hard-working people looking for help. They are in pain from rotten teeth, broken teeth. They can't afford routine care, and things can get out of hand quickly for them. It's a vicious cycle.

People have limited money, and what are they going to spend it on—food or a filling? By the time we see people, sometimes the best thing to do is an extraction. The teeth are so far gone, or if they could be saved, how is someone who has limited funds going to put gas in their truck and drive a good distance and pay money for continual upkeep? These people are hurting, and then they can't eat right because their mouths hurt. It's horrible. A lot of times their eyeglass prescription is so bad they can't see well. And they can't afford to see a doctor and get a new one. We have women who haven't had PAP smears in years, let alone a mammogram.

What happens if a professional discovers something serious, say a potential cancer?
We make arrangements for follow-up. Sometimes it's frustrating. People's phones get disconnected or they have to move to find work. I have a bunch of eyeglasses from previous events that were [never picked up] and I'm still trying to find the people.

Is this just a problem among the Appalachian underserved?
No, absolutely not. Throw a dart on the map of the U.S. and you'll find a need. We get calls from everywhere. I was talking to people in Cleveland, Ohio, last week.

What's your solution?
That's the big question. I'm a British citizen, but I'm not advocating that the U.S. follow Britain's national health service plan. I'm not sure that can ever happen in the U.S. I mean, it took a war for it to happen in Britain. But we need to make it easier for practitioners [to be] allowed to cross state lines to provide free care for those in need. The system of free care that RAM has developed and proven throughout all these years could be replicated throughout America. If practitioners were allowed to cross state lines to provide free care for those in need, and had some type of protection against malpractice, I think we could do this anywhere in the U.S.

Do you ever get frustrated?
I get frustrated that we have to turn people away. Every year, there's a family that just gets to you. This year it was a family of four. The mom and dad had two little girls who were clutching raggedy teddy bears. The mom and dad needed dental care, but they came after we closed. Fortunately, there was still a dentist [around] and we reopened for them. But somewhere, there's someone who came and we couldn't help. People line up early, but you only have so much time. You only have so many resources. Sometimes I just want to cry. Sometimes I do.

© 2008