BAR and restaurant employees, easily one of the most underinsured groups in the American workforce, have been dealt a holistic hand by a small group of physicians who have made industry health care their priority.
Founded in New York City in 2007, by Dr. David Ores - and in Philly since last fall, thanks to South Philly M.D. Bruce Hopper - the Restaurant Worker Referral Program is aggressively focused on the needs of workers "in the biz." You can gather as much from the nonprofit's logo - serpents intertwined around a fistful of cutlery instead of a staff. But the cooperative's true intrigue lies in its doctors, all of whom seek to reinvent the manner in which primary care is delivered to their food-handling patients.
"Health care was once a profession. Now it's just an industry," said Ores, who has been practicing medicine since 1987. A self-described "conscientious objector to health insurance," the New York native runs a direct-pay, cash-only operation on the Lower East Side, which naturally led to him treating a large number of restaurant workers.
Ores emphasizes that what RWRP offers isn't health insurance; it's simply access to affordable primary medical care.
Whether it was offered by employers or not, Ores observed that even bare-bones insurance coverage has been out of reach for most in the food-service industry, which inspired him to develop a straightforward plan for treating these patients.
"Over the years, I kept seeing patients who'd cut their finger or had a cough, and I started getting really annoyed because I was seeing them too late," he said. "I found that their approach to health care was, 'I'll wait for it to go away or see if it gets worse,' " a deleterious mentality developed by a number of factors, most notably price, an inability to skip shifts due to sickness and the legal fears common among undocumented employees.
To reverse the trend, Ores offered restaurant owners a simple deal. Into a "coffee pot," proprietors pay a monthly figure ($50 to $400) determined by how many uninsured employees they have in-house. Any time an employee needs an office visit, the participating physician pulls what he or she needs from the pot for treatment, at zero cost to the worker.
A vast majority of patients have common problems that are easy to treat so long as they're caught early - cuts requiring stitches, muscular- and skeletal-overuse injuries, respiratory illnesses and the like. For more serious issues, Ores is able to refer to like-minded specialists and help navigate public-health options.
Paging Dr. Welby
The RWRP came to Philadelphia this past September via Ores' relationship with Hopper, who runs a cash-only practice at 16th and South. A former sports-medicine specialist who worked with the Phillies during their 2008 World Series run, Hopper has diversified his focus, embracing a "Marcus Welby" approach that allows him to "take care of pretty much everything."
Hopper says primary care is among the most troubled areas of modern medicine. "Morale among primary-care doctors is horrible," he said. "All we want to do is directly care for our patients, but with all this admin and overhead, the nondoctor stuff gets between patients and ourselves."
Outside the examination room, Hopper handles much of his day-to-day operations from his smartphone. Patients can contact him 24/7, and he's even diagnosed common maladies like strep throat via text message.
Participation in the RWRP, Hopper feels, is another way to circumvent bureaucratic gaps. Restaurant and food-service jobs account for nearly 10 percent of overall employment in the commonwealth, according to the Pennsylvania Restaurant & Lodging Association.
He and Ores have ingratiated themselves into this population in the most old-school manner possible - face-to-face meetings with restaurant staffs, which tend to come with a solid helping of wide-eyed stares.
"They thought we were quacks," Hopper said of his recent chat with the staffs of South Philadelphia Tap Room and American Sardine Bar, two early local adopters of the RWRP. (Ores works with roughly 30 restaurants in New York; Hopper's got about 10 signed up in Philly.) "It took a month for anybody to come see me, but once they did, more and more have been coming in."
Then came Obamacare
That meeting was facilitated by SPTR/ASB owner John Longacre, an active member of the Pennsylvania Licensed Beverage Association. "The second I found out about it, I took it to our membership," he said. "I couldn't believe it even existed."
Longacre has explored the option of insurance coverage but found it too cost-prohibitive for his businesses and employees. The RWRP volleys that concern back, as well as the confusion surrounding the Affordable Care Act.
"With Obamacare coming on, there are so many question marks," Longacre said. "With this, they don't have to worry about anything - copays, a network. And it's top-of-the-line treatment."
Hopper agrees that there are plenty of unanswered questions as Obamacare moves forward. But he believes that RWRP-type programs would still have a place in a mandatory-insurance world by offering a more affordable option for primary medical care.
"Quite honestly, I can't wait for Obamacare to roll out," Hopper said. "It's only going to make us look better."
"It's really a revolutionary process," said Heather Keating, an American Sardine Bar server with 15 years in the industry. She's been offered insurance at previous jobs, but it was simply too expensive to be realistic. "Too often, we don't think about our futures - we just think about our shift and doing a good job."
Restaurants like Honey's Sit 'n Eat, the Happy Rooster and Bistrot La Minette joined Longacre's bars by signing up for RWRP, with several more businesses exploring the option. Hopper hopes that it reaches the point where new, Philly-based doctors will have to come on to address demand.
"This is a great, grass-roots way to start," he said. "I don't think we're going to change the world overnight, but this is the beginning."
Drew Lazor has been writing about the local food scene since 2005. His twice-monthly column focuses on unexpected people doing unexpected things in Philadelphia food. If you come across a chef, restaurant, dish or food-related topic that bears investigation, contact him at firstname.lastname@example.org or on Twitter @drewlazor.