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.