Bartering For Care

Growing up in suburban New Jersey, my father was a hematologist; most of his patients suffered from leukemia. In the 1960’s and early 70s, there were few effective treatment options for many of them and my father spent a lot of time running to the hospital in the middle of the night to provide blood transfusions for those who were in crisis; offering support and personal attention to each of them.

These patients were mostly working-class or indigent men and women who lived in Newark and the gritty industrial towns that surrounded that tattered city. I don’t know what kind of insurance my father’s patients had or whether they paid mostly out of pocket for their care, but I was vaguely aware that an unofficial barter system had developed over the years in lieu of some payment. That barter system, born not only from need, but also gratitude toward a devoted doctor, served our family well.

At least twice a month my father would come home from the hospital toting several paper bags filled with fresh produce; this was a form of payment from a patient who owned a fruit and vegetable market. The few times my family of five took a vacation by plane, the husband of one of his long-term patients would drive us to and from the airport in his commercial van. And during the oil crisis in the 1970’s, again, we profited from an unofficial exchange of services. While others had to line up for gas on designated weekdays, Danny from the Esso station let my father come down the night before and park our Plymouth Duster right in front of the gas pump so we could be the first in line when the station opened. Danny had been treated successfully with a new regimen of chemotherapy and by then, had been in remission for several years.

This family history came to mind when I read the surprising piece “Bartering for Health Care Rises” by Rochelle Sharpe in today’s Kaiser Health News. In her article, Sharpe writes about the growing practice of bartering services like house painting, personal training, car repair and construction in exchange for medical or dental care--even psychological counseling. One man offered up his Harley-Davidson motorcycle in exchange for orthodontia for his daughter.

According to the article:

“With the economy in recession and many people strapped for cash, bartering of various kinds has increased. But now health care is surpassing auto repair and advertising as the service in most demand, say people who run local barter exchanges. Alan Zimmerman, a spokesman for ITEX Corporation, the largest network of barter exchanges in North America, says in the past two years the demand for health care has jumped by more than 20 percent. The company has 551 physicians and 618 dentists who participate in its 100 local barter groups.

Barter is little more than a stopgap solution for the uninsured. But with doctors, dentists, psychiatrists, chiropractors and even cosmetic surgeons offering their services, bartering is providing a temporary safety net of sorts for some workers who have lost their jobs and health coverage. And in some cases, people who have inadequate insurance are using barter to get critical services, such as dental and vision benefits."

It turns out that doctors and dentists aren’t the only ones using the barter system to treat the un- or under-insured. Sharpe found that a few hospitals, perhaps hoping to recoup on some of their uncompensated care, have devised exchange programs as well:

“At Woodhull Hospital in Brooklyn, N.Y., artists without health insurance earn credits toward free care if they perform or work with patients and staff. More than 400 people, including former Broadway actors, have participated in Artist Access since it began in 2005, painting murals on walls, drawing with sick children, and coaching medical residents on breaking bad news to patients.

At Franklin Memorial Hospital in Farmington, Maine, indigent patients can work off their bills by doing volunteer work. If the patients are too ill, friends or relatives can do the volunteer work for them.”

There are two ways of looking at the rise in bartering for care. On the one hand, it’s a sign of just how dysfunctional our health care system has become that people have to go out and try to trade services to access necessary care. This system may work for healthy adults who have valuable talents and skills to offer. But many of the uninsured or under-insured are not in this category and don’t have the ways and means to barter for needed health services for themselves or their children. Many of these folks are in poor health or working so many hours that they don’t have time to trade for care.

On the other hand, the resourcefulness of this enterprise is encouraging and it’s also what makes this a good story. It reminds us of the importance of community, especially in these trying economic times. The idea of bartering for care is not part of anyone’s health reform plan, and likely will not be taken up by Congress or any other group hammering out the details of financing. It’s hard to imagine that a few bags of fresh vegetables or a ride to the airport would be accepted as valuable currency in our current corporate-driven medical system. But as this article shows, there is still room in the system for barter, and it highlights what was right about smaller, community-based medicine in the first place.

 

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check out www.favorpals.com for bartering.

[David P]

My grandfather was a physician during the early days of WWII. I have a diary written by my grandmother which tracked the services and payment for services he provided. He spent his days doing inlistment physicals for solders going to war. In the evenings and nights he provided home visits. Never was the charge more than $2. Often, even that amount was paid in eggs, chickens or other services.
Bartering has always been important. But, 70 years ago, prices were reasonable and grampa provided the medicine along with the $2 fee. Today, to pay for one of my prescriptions, if what the pharmacy tells me is correct, I would have to sell my car for a one month supply. I can't barter that away.
David

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