Cartoon by Jamie Smith

Bartering for HealthCare
A Falmouth clinic takes a creative approach to time swapping.

While the politicians have been endlessly debating ObamaCare, RomneyCare, and Maine’s own Dirigo Health, a Falmouth medical clinic has been making some of its services more affordable to uninsured patients for years.
 
In a twist on the age-old practice of bartering, patients at True North Health Center earn office visits with their doctors by performing services like housecleaning, tutoring, or shoveling snow. It is not a direct swap. Rather, patient and practitioner are both members of Hour Exchange Portland through which they acquire “time dollars” by doing work for other members. They then use that currency to acquire services for themselves.

“We started this collaboration with the Hour Exchange pretty much when we opened our doors about ten years ago,” says Sorcha Cribben-Merrill, marketing manager for True North. “It has evolved with the needs of our patients and practitioners.”

Members of Hour Exchange Portland, which was founded in 1995, offer a wide variety of services, from dog walking to cooking. Jobs are valued equally, regardless of their market value — that is, a member who gives an hour of his time can receive an hour of any other member’s time. True North was the first healthcare practice to participate in the program, and it remains the only one whose practitioners include doctors trained in conventional medicine.

True North is anything but a conventional practice, however. In addition to several MDs, DOs, and registered nurses, its staff includes a healing touch practitioner, a naturopathic doctor, an acupuncturist, and a massage therapist. Moreover, the non-profit practice is not contracted with any insurance companies, which means doctors can spend as much time with their patients as they deem necessary. “A typical initial visit is one to one and a half hours, and there are no external limits on how many sessions are needed for a particular diagnosis,” Cribben-Merrill explains.

True North’s approach to billing is an extension of that philosophy, Cribben-Merrill says. Insured patients submit their own forms for reimbursement. Those who are uninsured or under-insured work out a payment plan with their practitioner; for some, that may mean paying with time dollars.

“It’s a fantastic opportunity to receive good quality healthcare,” says Lindsay Bushnell, of Brownfield, who uses time dollars to pay for her own doctor’s visits, as well as her husband’s and son’s. And what service does Bushnell offer through Time Exchange Portland? Health care. Bushnell is a midwife. “It feels really balanced to me,” she says.

A Maine Public Radio piece about True North’s unusual payment arrangements this past fall produced a ripple of reports by other news media, including the CBS Early Show, as well as a satirical riff on healthcare politics by Stephen Colbert, who suggested absurd ways that terminally ill patients might earn time dollars.

Colbert is right, of course — bartering has limitations — but that doesn’t make us any less impressed with the flexibility of True North’s practitioners and patients when it comes to noncritical care. Too bad their creative practicality isn’t infectious.

Our Future Editor
An eleven year old from Massachusetts has an eye on our jobs.

We at Down East know we’re lucky to be making our living by sharing our love for Maine with you through words and images. Every once and a while, though, a reader comes along and makes us aware of just how special this gig really is. Recently, that reader was eleven-year-old Lindsey Lambert of Paxton, Massachusetts.

“I am writing to inform you that once I graduate from college I am REALLY hoping to work for Down East,” Lindsey told us in a letter neatly handwritten on white lined paper, which, she noted, “could very well be part of my resume when I apply to work for Down East.”

We called Lindsey and learned that she and her family visit Maine every year, staying at an inn just one mile from our office in Rockport. “I like waking up and seeing the same sight and knowing that nothing changes,” the sixth grader says. “It stays as beautiful as it was the year before.” The inn has a grassy path to the beach, where she kayaks with her mom and dad, Daphne and Jim Lambert, her fraternal twin, Kristen, and thirteen-year-old sister, Katie. “They like Maine as much as I do,” she says.

But it is Lindsey’s view of Down East that we find especially rewarding. “Even if I’m not in Maine, I can read Down East and feel like I’m still there,” she says. “The magazine has a Maine feel.”

An all-A student whose favorite subjects are writing and reading, Lindsey hopes to attend Anna Maria College in her hometown or the University of Maine, which, she notes, has the advantage of getting her to the state she plans to call home all that much sooner. As for her letter, Lindsey suggests we keep it handy. “So go right now to your filing cabinet and put me in a file labeled ‘Lambert, Lindsey,’ ” she writes, “because even if you throw this away, I swear that won’t be the last of me.”

We’ll keep a desk waiting, Lindsey.

Million Mile Joe
One Norway man and his Honda Accord reach an automotive milestone.

Were you lucky enough to witness the moment your Subaru’s odometer clicked over to two hundred thousand miles? Did you take a picture to mark the occasion, like one of our editors has? It’s a momentous feat, but one that brings with it the knowledge that the vehicle has likely entered its twilight years. Sure, you may dream the car will just roll along forever, but that’s impossible. Right?

Meet True Blue, a 1990 Honda Accord, and its owner, Joe LoCicero — a.k.a Million Mile Joe.

On October 20, LoCicero’s faded blue Accord crossed the unthinkable threshold from 999,999 to 000,000 miles. It’s an achievement so unlikely, Honda didn’t bother adding an extra digit to its odometer when it designed the car.

LoCicero works as an independent mechanical inspector, which means traveling around the state and evaluating car lease turn-ins for various dealerships. “I sometimes feel like a human Ping-Pong ball,” he says. And our state is large, larger than most realize. There is greater distance between Kittery and Fort Kent than there is between Kittery and Philadelphia, and 90 percent of LoCicero’s travel occurred within Maine’s borders.

“My job is such that the best way for me to do it well was to make sure I didn’t have to buy another car,” he says. “I did everything by the book. I never let it get low on oil or gas. I always warmed up the car before using it, and I checked the fluids weekly.” The car still runs off its original transmission. The relationship between LoCicero and his Honda not only lasted longer than most marriages, but it displayed a similar dedication of love and care. “There can sometimes be a jealousy or rivalry between my car and my wife,” he says, laughing.

When LoCicero finally hit his milestone, he rolled up to the Saco City Hall expecting a small press conference hosted by Honda. Instead, he received a celebration as surreal as the very notion of driving a 1990 Accord the equivalent of forty times around the globe. A band marched down Main Street, accompanied by men on stilts, waving flags plastered with Joe’s face. A plane flew overhead with the message “Way to Go, Joe!” as a human-sized odometer float powered by six people in hamster cages rolled down the street. Miss Maine capped off the celebration by handing LoCicero the keys to a brand new blue 2011 Accord.

With his new car, LoCicero will slowly faze out True Blue. After twenty-one years the stalwart sedan averaged the equivalent of driving across country every two weeks, taking two trips around the world a year, or flying to the moon and back every decade. LoCicero expects to treat his new vehicle with the same care.

So if you happen to see a well-maintained navy blue 2011 Accord Ping-Ponging its way down your road, give a wave and say, “Way to Go, Joe!”

All Fired Up
In Maine, heating with wood is as much about lifestyle as it is about savings.

No doubt you’re familiar with the expression, “Wood heats you thrice — once when you cut it down, once when you split it, and once when you burn it.” Turns out, a surprising number of Mainers take this old adage to heart: For them, the firewood ritual, not cost, is the chief reason they heat their homes with wood.

That’s one of the intriguing findings of a study on wood heat being conducted by the College of the Atlantic (COA) in Bar Harbor. Here’s another: It appears that far more Mainers are heating with wood than census data, which put the number at 11 percent, suggest. A survey of 120 Hancock County households found that 58 percent use at least some wood heat, reports Gray Cox, a COA political economics professor and the director of the Hancock County Firewood Initiative.

“If you ask people if they heat with wood exclusively, then it is 10 or 11 percent,” Cox says, explaining the discrepancy, “but if you ask if they heat with wood ‘almost exclusively,’ or ‘primarily,’ or ‘half-and-half,’ or ‘supplementally,’ then you find a pretty even distribution.” Cox says it’s unlikely that the popularity of wood heating is strictly a Hancock County phenomenon.

The COA study focuses on a variety of issues related to firewood, including forest health and the impact of wood burning on air and water. Cox directs the component that is identifying cultural influences on heating choices. “We have found two patterns that we refer to as the modern consumer family and the self-reliant Yankee family,” he says.

The two groups not only have very different perspectives on the cost of wood heat, but also contrasting expectations of how a home should function. Explains Cox, “The modern consumer type might say, ‘I don’t heat with wood. My time is worth more than that.’ If you ask him what he does for exercise, he may say he has a six hundred dollar membership at the YMCA. By contrast, the self-reliant Yankee’s point of view is that if you split wood, you get your exercise for free.”

Modern consumers want home systems to run efficiently and as invisibly as possible, demanding little of their attention, whereas independent Yankees view heating and other forms of homemaking as activities that are integral to their lifestyle. “They expect indoor temperature differences from room to room and season to season,” Cox says. “And they love to talk about it — how they stack their wood, how they cut their wood, and how they like the smell of burning wood.”

The good news for Yankee types that has emerged from another branch of the study is that wood heat, especially when generated by a modern, clean-burning stove, is much kinder to the environment than oil heat, Cox reveals.

Far from being a disappearing tradition, wood heat clearly has a place in the future of the country’s most forested state.