Deb Barth is raking leaves for Lesley Jones. But Barth isn’t earning money for her yardwork, at least not in physical currency. She’s earning “time dollars” — for every two hours she spends doing odd jobs, she’ll earn a free visit with her doctor.
As a struggling artist, Barth’s income qualifies her for the program at True North, a nonprofit health care clinic in Falmouth, Maine. She’s one of 33 patients who pay with time dollars there.
“I do things like deep cleaning, organizing,” Barth says. “I also offer caregiver support for people who may be caring for an older parent.”
So how does her doctor cash in these time credits? By getting free services from any of the other hundreds of people who belong to The Portland Hour Exchange Program.
Tom Dahlborg, the executive director of True North who used to work in Medicaid, says the program has many benefits. He noticed when people were receiving free care through Medicaid they would often feel guilty and undeserving of good treatment, so they would settle for less than what they needed. But patients who pay through time dollars work hard for their care, and as a result, are more fully engaged.
Another enormous benefit is the program cuts through the red tape that Medicaid beneficiaries increasingly have to contend with as Republican legislators enact more requirements, tests, and eligibility restrictions. Therapist Jennifer Lunden works with True North as well as the state’s Medicaid program and says, “For me, the biggest burden of taking especially MaineCare is the amount of paperwork and the amount of hoops that need to be jumped through.”
The program is commendable for accepting the types of payments that poor participants can offer, and organizing it into an efficient system. But it also has limitations, which highlight the need for a more inclusive health care system that doesn’t leave millions out in the cold to fend for themselves.
Dahlborg says that while there are no shortage of eager patients, finding doctors who are willing to go outside the system and barter for health care has been a challenge. And if patients without insurance need specialized or emergency care that True North can’t offer, they have to go elsewhere and pay out of pocket. They also have to leave the program if their income goes up too much.