The cover of the July/August 2002 issue of Utne Reader magazine reads, "The Power of Talk: Create social change by starting a conversation." This intrigued me in part due to the fact that I am someone who, from an early age, has been considered to be a "talker." For example, I remember something that frequently showed up on my elementary school report cards: "Very talkative, often talks out-of-turn in class."
As I began my research for this article, I recognized a connection between the Marquette County Medical Care Access Coalition's (MCAC) story and the concept of creating social change by starting a conversation. For MCAC, it all started over three years ago with a conversation between a few members of the First Presbyterian Church in Marquette that perhaps went something like this..."Did you know so and so has not had a medical check-up for years because they don't have health insurance coverage?" The circle broadened input about their friend who was unable to purchase prescription medication and about how there seemed to be medical care access assistance programs for children but not adults. They then collectively asked, "How can we, as a caring community, continue to not do something?"
Those early conversationalists began to tap the shoulders of others in the community whom they thought could be a part of the discussion.
Before long, the Medical Care Access Coalition was organized and articulated their purpose: Ensure that all residents in Marquette County will have access with dignity to quality, affordable health care.
According to a May 2002 Institute of Medicine Report, more than 18,000 working age Americans died prematurely in 2000 because they lacked health insurance. Uninsured Americans ages eighteen to sixty-four suffering heart attacks, cancer, traumatic injury and HIV infection were twenty-five percent more likely to die than patients with health insurance. Factors contributing to the uninsured's shorter life span included the fact that life threatening conditions tend to be diagnosed later when prospects for recovery are lower. Chronic diseases such as heart disease and diabetes are less likely to be appropriately monitored and treated with medication.
The objective of the MCAC Medical Access Program (MAP) is to establish an organized, easily accessible referral and case management network, linking volunteer physician services, hospital-based care, lab, x-ray and pharmacy services needed to complete treatment.

Where is MCAC today?
The following excerpts from the MCAC newsletter Health Care Connections, and Medical Access Program brochure provide a glimpse of where MCAC is today. MCAC determines eligibility for Medical Access Program services:

••Eligible–those who have a total household income at or below 200 percent of the federal poverty level, are over age eighteen and under sixty-five and are residents of Marquette County.
••Not Eligible–those people with access to health coverage, those with medical insurance coverage or persons suffering from work-related injuries involving Worker's Compensation.
Participating physicians are volunteering to see patients without charge. Physicians and pharmacy representatives are donating medication samples. MCAC-MAP staff help patients enroll in patient assistance programs of pharmaceutical companies. The Pharmacy Committee, along with consultation from other programs, developed a list of medications enrollees obtain with a four dollar co-payment. Bell Memorial and Marquette General Health System cover costs of the ten most frequently ordered lab tests.
The Marquette County Health Department provided initial outreach funding and links patients with dental services, breast and cervical cancer screening and family planning. The Dental Committee recently has recruited a number of local dentists to help serve MCAC patients. Emergency dental care recently became available on a limited basis. Participating dentists have agreed to evaluate and treat patients presented with acute problems.
The Family Independence Agency screens clients for potential Medicaid eligibility. The Superior Walk-In Clinic, located in the U.P. Medical Center, has agreed to see patients for urgent care if the assigned primary care physician is not available. MCAC–MAP office space is provided by the Upper Peninsula Medical Center for rent of a dollar per year. A federal Community Assistance Program grant has provided infrastructure funding. Area-wide religious institutions provide volunteers and have funded medications and start-up needs.

Conference planned for September 9
"Access to Medical Care for the Uninsured; Who Cares?" is the title of a dynamic conference MCAC is hosting at NMU on September 9 and 10. Planning committee members are seeking to broaden the Marquette County vision to encompass the entire fifteen counties of the Upper Peninsula.

According to MCAC Board President Sue LeGalley, "We felt a need to share our lessons learned with other communities. We hope to attract ten people from each of the U.P. counties willing to work toward medical care access solutions in their area." The first day of the conference will examine models that work in the U.P. and around the state and nation. The second day, each county group will envision what can work in their county to improve medical care access.

Create social change with conversation
Anthropologist Margaret Mead is credited with the quote, "Never doubt that a small group of committed citizens can change the world. Indeed, it is the only thing that ever has." I'd like to think that small groups get started with conversations and that people listen (something I've tried to improve upon since grade school), as well as talk.
MCAC is calling together more people to talk and listen at their September conference as they plan to start access to medical care conversations across the Upper Peninsula. Recently, I was with MCAC Board President Sue LeGalley at a community fundraising event. She had just witnessed what I'll call a "random act of volunteerism" in support of the cause. She turned to me and said, "Don't we live in a great community?"
We certainly do. Especially when people like Sue and others get together and start talking.
—Leslie Bek
••102 physician volunteers
••318 currently enrolled clients
••800 clients served to date
••57 percent of clients are working full or part time

Client Illnesses:
••12 percent, hypertension
••12 percent, diabetes
••29 percent, asthma
••35 percent, depression

••20 percent of clients have been referred to existing social service programs (i.e. Michigan Works)
••15 percent of clients were found to be eligible and enrolled in other programs (i.e. Medicaid)

Total value of donated physician services.............................$55,757
Total value of laboratory services donated.............................$10,545
Total value of pharmaceutical samples donated..............$93,500
Total value of pharmaceutical assistance programs........$44,000

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