Contents page 1 — “Without these people I would probably be dead,” page 2 — Ambivalent relationship to Barack Obama’s health care reform To a page

From the rear of the converted motorhome rumbles. The door to the treatment room beating loud against the wooden frame, if the Health Wagon shall, on the winding mountain road in the curve. The front of the Cab, two women are sitting in coats in white Doctor. Routinely, you can control the twelve-Meter-long mobile clinic through the woody landscape of the Appalachian mountains.

In one of the poorest regions in Virginia, the Physician Paula Hill that day with a colleague on the way to treat free people that can’t afford a doctor’s visit. The problems in the US health care system, are likely to dominate the coming U.S. election campaign, is particularly evident here. “Many have no insurance and no money for gas,” says Hill. Medical specialists are often located several hours by car. “That’s why we bring health care to the people.”

For almost 40 years, touring the Health Wagon by Wise County and adjacent regions in the extreme West of Virginia, on the border with Kentucky. In 1980, sister Bernie Kenny began to treat patients from the trunk of their VW beetle. Since then, the mobile hospitals have become increasingly larger. The demand is increasing. One out of every five in Wise County lives below the poverty line. The median income is just over $ 36,000, which is about two-thirds of the national average. Especially in the remote Coeburn, many residents are dependent on the free treatment. There, the Health Wagon makes to this day.

13.7 percent of the adult U.S. Americans, according to a Gallup study, no health insurance.

On a spacious car Park close to the main street, the residential mobile. The Shop next door sells guitars and guns. The first patients have arrived, as the Health Wagon opens its doors.

Including David Gent. The 63-Year-old since a stroke in January, on the floor, and the three stages can cope to the RV slowly. “In the right half of the body I still have hardly any feeling,” says the former miner. Slowly his health improved. But the Gent don’t go around wearing only the visible traces of his disease, but also high debt. “After my stroke, I was admitted in the emergency Department,” says Gent. Cost of treatment: $ 2,300. For a day stay in a nearby hospital provided the early retired a further $ 6,000 in the account. “How am I supposed to pay that?” ask Gent, and shakes his head. “My treatments in a month, cost more money than I get in a year in pension. And I have an eleven-year-old son and a mortgage that I need to pay off.”

Actually, Gents health insurance, the treatment costs to cover – but, like 98 per cent of Paula Hills patients, he can’t afford it. A policy would cost hundreds of dollars a month. The money has not Gent. And, therefore, only going to the Health Wagon. “Without these people I would probably be dead,” says Gent.

$ 30,000 for three days in the hospital, So much a hospital stay costs, according to the Ministry of health on average in the United States.

Because Paula Hill has not treated, only Gents stroke, but also his diabetes. The hundreds of dollars on expensive medicines would exceed the budget by Far, the Health Wagon, there are the medicines for free. In the narrow waiting room in the front of the RV Gent helps when you Switch a fluorescent tube and in the repair of the air conditioning. It is his way to say thank you for the help.

Why has someone like David Gent, no health insurance? The reason for the gaps in the U.S. health care system. Because, actually, there is a free public health insurance (Medicaid) for needy people like him. However, the Federal States decide who comes to this question. In Virginia, it is especially difficult to be in the public health program. As a basis for not only the own income but also the income of the partner. Gents wife earns to much. For the second state health system Medicare, he is too young. Only the severely disabled, pensioners aged 65 and over and children will be covered.

David Gent will help the Health Wagon to replace a fluorescent tube. © Jörg Wimalasena for TIME, ONLINE

The Appalachian mountains are one of the most important coal districts in the United States. For 35 years, Gent has worked in the Mines. His body, he has ruined the hard work, but the money was right. “I gained in a year times $ 110,000,” he says. Since he lost four years ago his Job, he lives from a small pension. Gents biography is like many that come on this day to the Health Wagon. Former mine workers without a University degree, drawn from the decades-long Drudgery. Do you suffer from lung diseases, joint problems and back problems. “The work has made to these people at a young age old men,” says Paula Hill. “And now you don’t even have health insurance.”

Many patients look resigned or angry. Especially Barack Obama, make the people in Coeburn for the plight in the Region. Its environmental policy was the decline of the coal industry, it is believed here. His health policy, many are disappointed. Because under the name of Obamacare known health care reform of 2010 helped with the expansion of Medicaid to the Poorest, but the people in the mountains of the Appalachian mountains remained. Many patients of the Health Wagon will feel at a disadvantage.