White Coat Wisdom: Discussion with Dr. George Schneider

Excerpted from White Coat Wisdom by Stephen J. Busalacchi

The rancor over how to reform America’s healthcare system rages on, as millions of uninsured and underinsured people struggle to find affordable medical care. Meanwhile, volunteer health professionals from across the country, like those at the Greater Milwaukee Free Clinic, do their best to put a bandage on a serious national wound.

Author Stephen J. Busalacchi highlights the work of internist George Schneider, MD, of Milwaukee, in his oral history, White Coat Wisdom: Extraordinary doctors talk about what they do, how they got there and why medicine is so much more than a job.

In this excerpt from the chapter titled, Sick, Huddled Masses, Dr. Schneider reveals that the vast majority of patients he sees at his free clinic twice per week are working people who can’t afford health insurance.

Visiting the Greater Milwaukee Free Clinic is like walking back in time. It’s as if it was preserved from the 1970s, even though this space had been a private practice doctor’s office until the early 1990s. The carpet is drab, the chairs are worn and the other furnishings are a mish-mash of donated stuff that fills the gap. Even the clock on the wall has a pharmaceutical company name emblazoned on it, as do other free supplies.

The office has “crappy file cabinets,” according to Dr. George Schneider, the medical director, but he’s grateful for them and all of the other donations, because they allow him to help people who are not getting medical care.

When you’re sick and have nowhere to go, you probably don’t give a damn about these frivolous details. Patients come here in droves twice a week to receive care from the dozens of physicians, nurses and others who volunteer their services.

Although the doors don’t open until five, Dr. Schneider says it’s not unusual to have somebody waiting at three. By the time the clinic opens, a crowd is huddled in front of the building.

Schneider, who founded the free clinic with his wife, Kathleen, in 1995, sees its popularity as a bellwether for the failings in our current health care system.

Dr. George Schneider, Medical Director, Milwaukee Free Clinic

Dr. Schneider:  Growing up, the idea of doing something charitable was something that went on in our family. My mother was from Northern Wisconsin, from a small farm in a small town, and it seemed to me there were always people coming to the house and staying for a while, who were moving from northern Wisconsin to the city. They heard about her. They stopped in, maybe had a meal. Maybe spent a few nights. I remember my mother giving things away.

“Here are some clothes. Here are some pots and pans and plates and pencils, to help get you started.”

My father was a garbage man who worked for the city of Milwaukee, but he also had an interest in real estate and had multiple duplexes in town. Some of his tenants were not always very timely in paying their rent, but he let them stay, as much as he could. He did not evict anybody. There was always that background in our house about doing things for people who were kind of down on their luck. The free clinic maybe was a natural evolution of that.

Last year, we saw about 1,930 patients. The volume has probably increased by about 25% a year over the last several years. Volume has increased over the past several years, compared to the first seven years of the clinic.

Does that worry you?

Yeah, it’s a concern because the very existence of free clinics is a reflection on the whole health care system. The system is breaking, and it’s broken in some areas. So yeah, it’s nice to say your numbers are going up, but not at the free clinic.

One of our original goals when we started back ten years ago was for the clinic to go out of business, but it doesn’t look like that’s going to happen anytime soon. We see more immigrants who come to the clinic. We see more working people whose employers are making them pay more of the premium and the cost is prohibitive. It’s basically, a question of fairness and justness.

The current model based on employment isn’t working. In my practice, I see people whose deductibles are going up. The employers are paying less and less their share of the premium, and so more of my patients are raising issues of cost and testing and primary care services, especially drugs.

Covering the uninsured is an issue society has to deal with. That number keeps rising every year, and society and politicians sort of dance around the issue and nobody really does anything. The uninsured, that’s not really a group of people anybody is looking to take care of and get their support and vote.

Single payer is really the way to go. Whether that’s national health or some other model, I don’t know. I don’t have enough knowledge to answer that question. I feel the current system with private insurance companies—that’s a very expensive system. The overhead is high. Their overhead runs anywhere from 15 to 20 percent. Medicare runs with three or four percent overhead. You could cover all the uninsured on savings from administrative costs.

Will it happen?

I think, slowly. The system is crashing, slowly, but inevitably. More and more people are complaining about it, everything from the uninsured poor to those who are working, who have insurance. The deductibles are higher, and the co-pays are higher.

The clinic’s open two nights per week. When we first started, we had one physician working. But because of the volume increase over the past two years, I’ve gone there pretty much two nights per week to work along with the regular physician of the night, and probably working three to three and a half hours a night.

The doors don’t open until five, but lots of times there’s somebody sitting out there at three. We have twenty chairs in the waiting room and they’re usually all filled. We start seeing patients around six and we leave when we’re done. An early night, we might get out by eight-thirty. Some nights we’re there until ten or eleven.

Who are these people who come to the free clinic?

The typical patient we see reflects my practice—an adult with hypertension, diabetes, smoking, bronchitis, or arthritis. It’s really the working poor. Our mission statement says that we see low-income, working, uninsured people—people who fall through the cracks, those that don’t have health insurance, but they make a little more money and they don’t quality for other programs.

We see a lot of people who work part-time jobs, who maybe earn $15,000 a year and live on that. Some of them work multiple part-time jobs. Some have full-time jobs, but they can’t afford the insurance that’s offered, or maybe insurance just isn’t offered.

Benefits aren’t provided for those who work for a temp agency. We see people who—and this is a situation we’ve become more aware of recently—who qualify for disability, and get on social security and disability, so that raises their income, which in turn, disqualifies them from participation in government programs because their income went up. We do see more and more people chronically unemployed, chronically not working.

I saw this patient who had lost his job and noticed some swelling in his abdomen. He went to another physician, and was told, based on the examination, that, “You have cancer. You’re going to be dead in two months.”  So this guy was just going downhill from already being down and depressed. We asked a few questions. Where were you? Who said this? He was a little vague, so we ordered the $800 x-ray.

He didn’t seem that ill, just very depressed. He was kind of getting ready to die. We did a CT scan of his abdomen, and there was nothing wrong with him. There was nothing wrong with him, so we told him that, gave him the good news. It kind of turned his life around. He was ready to cash in his chips and die. He never came back to the clinic, so I assume he went out and got a job.

How much satisfaction do you derive from this?

It’s a great feeling to see somebody who comes in who’s not feeling well, who’s not doing well, who is sick—and you’re able, with just an examination and some testing and interpretation of the results, to cheer them up, and get them feeling better. Yeah, it’s very satisfying. You get a real high from that.

They’re grateful, but we’ve noticed an attitude develop over the past few years, kind of an entitlement mentality. You give somebody something and they want more. That’s very discouraging for volunteers, and being at the free clinic it gives us a little freedom to say, “No, we don’t have it. That’s all you get.” Some people we’ve kind of told, “We don’t want you to come back here anymore. Go someplace else.” We might be free, but we’re not stupid. That’s just a small minority, but it only takes one a night to ruin the whole night for everybody.

We’ve fired patients from the clinic just because we don’t want one bad apple to ruin it for everybody else. The volunteers see that, and it typically happens with a new volunteer, and it’s easy to say, “I don’t need this. I’m not coming back here. These people are abusive. I could be doing other things.”

Is the demand going to keep increasing?

I think so, until something is done. In the United States, we have a wonderful health care system, but we don’t have a fair health care system. The resources aren’t going to the people that need them. You see the people who need it the most, but can’t get it because they don’t have insurance. It’s a fairness issue more than anything.

Stephen J. Busalacchi is author of White Coat Wisdom: Extraordinary doctors talk about what they do, how they got there and why medicine is so much more than a job www.whitecoatwisdom.com ©2009 Apollo’s Voice, LLC