Dr. Linda Farley died Tuesday, June 9, at the age of 80. Along with her husband and fellow physician Gene, she was a longtime leading proponent of health care reform and a courageous activist on behalf of the idea that quality medicine is a universal human right.
The following cover story by Esty Dinur was published in the November 19, 2004, edition of Isthmus.
Linda and Gene Farley are well into their 70s, retired from lifetimes of work as family physicians. But the longtime Madison-area residents remain as active as ever in the fight for universal health care.
"We think that health care is a basic human right," says Gene Farley. "Those who don't must answer the question, What would you do if you found a dying person on your doorstep? Would you leave them to die?"
The Farleys have practiced what they preach. Married for 49 years, they've cared for the uninsured in inner cities and rural areas, worked on a Navajo reservation, trained nurses in Jamaica and agitated from both within and outside the system. If it were up to them, Americans would have a government-funded program that would cover everyone, save vast sums of money, and help businesses thrive.
Unique among developed countries, the U.S. regards health care not as a right but as a moneymaking venture. In extreme cases, people may lose all they have or go into insurmountable debt because of health-care costs. More typically, people make decisions about where to work based on whether health insurance is included; and loss of work, no matter the reason, can mean the loss of health insurance.
None of this is likely to change in the foreseeable future, especially given the Nov. 2 victory of President George Bush and the solidification of Republican control over the Wisconsin Legislature.
According to the U.S. Census Bureau, 10.4% of Wisconsin residents had no health insurance in 2002-03, up from 8.7% in 2000-01. Nationwide, 45 million people now lack health insurance, up from about 40 million since Bush took office and made former Wisconsin Gov. Tommy Thompson his secretary of Health and Human Services.
"Bush's approach is, 'Let's do it with tax subsidies that will enrich the already existing big businesses, and with charity,'" says Linda Farley, Wisconsin coordinator for Physicians for a National Health Program. "Tommy Thompson said recently, 'Everybody gets health care in the U.S.; they can go to the emergency room.'
"Well, a lot of emergency rooms are so full that if an ambulance calls and says, 'I'm bringing someone in,' it's told to go someplace else. Or people are sent to charity hospitals when they are in serious conditions, and charity hospitals are being very deliberately underfunded." Some have closed, and many others are struggling.
In the 1950s, the Farleys worked in Denver's inner city, where neonatal mortality approached Third World levels. They returned to Denver many years later, after the Neighborhood Health Center Network had been established and health outcomes of the poor matched those in the suburbs.
But under President Reagan, elected in 1980, millions of dollars were cut from the program, which "successfully increased the death rates again," says Gene. "I use strong terms because the public thinks it's just cutting money to be more efficient and cut waste, but you have to realize that more people die after defunding."
Living and learning
The Farleys live on 40-some acres in the town of Verona, in a beautiful house built by Gene and the couple's four sons. Some of the art on the walls is by Linda ("Lindy" to Gene); some was given to the Farleys by Navajo and other patients.
Gene is from Pennsylvania, Linda from New York. She wanted to be a doctor since she was 12. She worked for Eastman Kodak and at a state hospital as a nurse's aide to pay for her schooling. Gene also worked as an attendant in state hospitals in Pennsylvania and New York after serving in the Navy's Hospital Corps.
"Linda was a year behind me in med school at the University of Rochester, New York," recounts Gene. "I knew about her before I met her. She was always going out with someone, and it took a couple years before I got the nerve to say 'Hey!'"
They married, had their first son, Jonathan, and worked in Denver. Then, in 1956, the Farleys were offered a job as field officers on the Navajo reservation in northeastern Arizona. They moved to the reservation, living in an 8-by-28-foot trailer. They spent two years there, studying tuberculosis and providing general medical care for a mostly Navajo community spread over 800 square miles.
The Farleys' philosophy and attitudes toward medicine were transformed during that time. The Navajo believe health depends on living in harmony with the environment, and they don't separate mental and physical health. "Their medicine men explained some of their ways to us and we helped them understand what we tried to do, and we worked very close together," says Linda. "We learned a lot about community and cross-cultural medicine." The Farleys' second son, Tillman, was born on the reservation.
In 1959, the Farleys had a third son, Shedden, and began a practice in Trumansburg, a mostly Republican town of about 1,500 people north of Ithaca, N.Y. They were active in the civil rights movement and taught sex education through the American Legion and Episcopal Church. (The high school wouldn't allow it, even though 11% of the babies Gene delivered were to young, unmarried girls.)
"In my practice," says Gene, "I had the Republican Party chairman, the Democratic Party chairman, the ex-Communist Party chairman, two or three Lincoln Brigade members and John Birchers. Everybody knew our politics, and I knew the politics of my patients. They couldn't dismiss us as 'pinkies.' When you are part of a small community and they know you, it can be very opening."
In Trumansburg, the Farleys had a fourth son, Joshua, and served as host family for a Ugandan couple who married and had a baby boy, Patrick. Later, when they returned to Africa, the couple asked the Farleys to take Patrick in. Uganda was then under the control of despot Idi Amin, and the couple belonged to a dissident tribe. "We hesitated, for many reasons," says Gene, "but we only had eight hours to decide." They agreed, and their family grew yet again. (Patrick is now back in Uganda.)
After seven years of being on call every night and every other weekend, the Farleys decided, says Linda, that "either we were going to die or we had to go." Gene got a Master's of Public Health and Linda worked at Johns Hopkins pediatric clinic. In 1967, they moved to Rochester, where Gene pioneered one of the earliest programs in family medicine and Linda took a part-time residency in psychiatry and worked in a neighborhood health center that served mostly people of color. They stayed there for 11 years.
Then came a year in Jamaica, where Linda trained nurse practitioners. The only microscope was the one the Farleys brought with them, and the pharmacies were so strapped that aspirin was dispensed just 10 at a time. Here, as before, they toiled to save patients' health and lives.
In 1982, the UW-Madison Medical School invited Gene to chair its department of family medicine, and the Farleys moved again. Linda worked for 10 years at a clinic in Belleville, again seeing many patients who didn't have insurance. During this time, the Farleys went to Las Vegas to protest the nuclear test site and got arrested. "Somebody did an article on us for the newspaper," says Gene, "and right after that appeared, someone from Belleville called to say, 'I want you as my doctor because I like where you stand.'"
Gene, now 77, stepped down as chair of the department of family medicine in 1992 and took a sabbatical at Meharry, a historically black medical school in Nashville, Tenn. He worked there for two years, developing a faculty training program under David Satcher, later named U.S. surgeon general by President Bill Clinton.
In 1995, Gene was on the verge of making a bid for Congress against Republican Scott Klug. But he bowed out when then-Madison Mayor Paul Soglin entered the race. Farley supported Soglin, who lost, but "was very frustrated because Soglin didn't go out and speak about the issues." He was delighted two years later when Tammy Baldwin decided to run: "She's very strong on health-care issues." He considers Baldwin a true champion of area families, as opposed to right-wingers "who think anti-choice and anti-gay and death penalty are family values."
Linda, 75, still volunteers at the Madison Community Health Center and at the Salvation Army clinic, supervising medical students. "I'd volunteer more," she says, "but I'm so busy working on the universal health-care stuff."
The bottom line
Each year, the Farleys give more than 40 talks about the need for universal care. One of their goals is to recruit other doctors to the cause.
That's not easy. Physicians for a National Health Program ( The Farleys respond that this happens all the time. Even people who have insurance are usually limited to certain providers and treatment options. Insurers seek to limit hospital stays, regardless of how patients feel.
"If you're the CEO of the insurance company," says Gene, "you have to make sure your investors get the best profit, not that patients get the best care. If you don't deliver the best profit, they'll fire you. You succeed if you deny health care to those who need it most."
Health care "has gone from being a service to a business," adds Linda. "In 1991-92, I could still write on a form of a patient who I knew had no money, 'No charge.' Now a doctor can't do that anymore. The business office won't allow it."
Prentiss and other critics of universal care insist a government-run program would be inefficient. Sighs Linda, "The physicians' mantra in this country is that we can't do it because the government doesn't do anything else right." She says the American Medical Association "from the beginning of time has been against anything having to do with government, even though a national health program would not be government-run, just financed by the government. They've been fighting it since 1906, when Teddy Roosevelt first tried to introduce something."
Despite AMA opposition, President Lyndon Johnson in 1965 got Congress to approve, says Linda, "the one sort of universal health plan that we have -- Medicare, an entitlement for people over 65. It was enacted only because no insurance company wanted to insure the elderly because they cost a lot of money." Subsequent attempts to expand the federal government's health-care role, under Presidents Nixon and Clinton, came to naught.
Dr. Susan Turney, executive vice president and CEO of the Wisconsin Medical Society, agrees the current system needs fixing but disagrees with what the Farleys prescribe. "Single-payer plans are extremely controversial and have virtually no chance of passing at either the state or national level," she says. "Such divisiveness will only delay our ability to get something in place relatively soon that is more effective than what we have now."
According to Turney, "There's tremendous concern on the part of the public, lawmakers and the Wisconsin Medical Society that creating a government bureaucracy to control our health-care system may create more problems than it solves. Besides, most people are served quite well by the current system and are unlikely to support such a massive change for fear their health-care access or cost of care will worsen. We don't need to blow up the system and start all over again to make health insurance more accessible and affordable."
Linda Farley notes that government is already paying the health care of 45% of Americans, including recipients of Medicare and Medicaid, veterans, Native Americans and public employees. "We already have a huge publicly funded health-care system," she says, "but the government seems to care more about corporate profits than about the well-being of its citizens."
Ailing system
Take the cost of prescription drugs, for example. With so many people covered through various public programs, the Farleys say government should negotiate with pharmaceutical companies for volume discounts, as do HMOs. Instead, Bush's Medicare reform bill prohibits this. It also bars the importation of cheaper drugs from Canada.
Not surprisingly, Medicare premiums and co-pays have gone up this year and are likely to continue going up. "This is the sad thing," says Gene. "Some things should not be in the stock market. To invest in health care and pharmaceuticals is nonsense. There should be no excess profits from health care."
Earlier, Bush floated a plan to make Medicare compete with private insurance companies, so the elderly would have to shop for their health insurance. There was so much outcry, even among Republicans, that the president backed down. The current plan is to start testing privatization through several pilot projects.
One feature of the government's plan is to give the elderly a subsidy to purchase health insurance, ending the current system of entitlement. Those who don't have much money, predicts Gene Farley, will buy a very cheap program that won't cover much "and very soon go bankrupt."
The Wisconsin Medical Society, concerned about rising costs and people without insurance, has proposed building on the current employer-based system. It would create a "pay or play" system, wherein every employer would be required to offer a standard plan or pay a tax to finance the standard plan for their employees. Incentives could be built into the system to encourage preventive care and discourage unnecessary urgent or emergency room care. The result, says Turney, would be lower premiums for all.
State Republicans, notes Prentiss, back market-based solutions. A bill introduced by GOP state Sen. Sheila Harsdorf and passed into law last session allowed for the creation of a pilot program for health-care purchase cooperatives -- groups of small businesses and local governments that band together to get cheaper premiums.
But the Farleys say it's easier -- and better for business -- to get individual employers out of the picture.
"The really puzzling question is why don't business people and the corporations understand that universal health care is good for business," says Gene. If everyone had their health-care needs covered independent of their job, companies "wouldn't have that terrible expense and worry of, 'Can I afford to hire people?'"
Prentiss says such a system would cost Wisconsin $37 billion a year, about twice as much as the state's current total health-care costs. The Farleys dispute this, citing a paper authored by Physicians for a National Health Program and published in the New England Journal of Medicine. It reckons that if the U.S. financed a Canada-style health-care system, Wisconsin would have saved some $5 billion in 2003, mostly due to reduced overhead costs.
"Chrysler has to add over $1,000 to the price of a car to be able to pay for their employees' health insurance," says Gene. "In Canada, with universal health-care coverage, it's less than $200. The bureaucratic and administrative inefficiencies of our system, with 1,500 insurance companies, each with different policies, are staggering."
In the years they have left, the Farleys hope to spend time making art, visiting their children and 11 grandchildren, and, as they put it in a joint e-mail, "enjoying this beautiful piece of Wisconsin where we live and this magnificent planet that we must preserve and share."
The Farleys also jointly answer a question on whether they expect to see universal health in their lifetime.
"Yes," they say, especially if health-care costs continue to escalate, sucking life from the economy. Then, "legislators will recognize that the only solution is a national health program." Already, public opinion polls "show wide approval of publicly funded universal health care. People are realizing that they are not getting what they pay for because so much of the money goes towards the huge overhead and investor profits....
"We see our major work in the years left to us involves educating the public and their elected representatives towards understanding that a rational health-care reform is a moral issue and is politically feasible."
Single payer vs. the status quo
Here are some facts and figures cited by Gene and Linda Farley in their advocacy of universal health care:
- In Canada, businesses pay 0.6% of payroll for health insurance. In the U.S., it's 8%.
- Not-for-profit health-care systems, like Kaiser Permanente or Group Health Cooperative, have a much lower overhead than the dominant for-investor-profit health care sector.
- A 900-bed hospital in Toronto, Canada, has three to four billing staff, and patients never get the bill. A hospital of similar size in Massachusetts has 352 people taking care of the billing and administrative overhead.
- Blue Cross/Blue Shield of Wisconsin, a formerly not-for-profit private insurer, became privatized as "Cobalt" in 2001. Cobalt has been bought by Wellpoint, which is merging with Anthem to become one of the nation's biggest insurers. When the deal gets approved, Wellpoint CEO Leonard Schaeffer, who makes $2.2 million in salary and had $45 million in stock holdings, will receive 3.3 million shares of the combined new company, WellPoint Inc., valued at about $257 million, plus an additional $78 million in cash.
- Pharmaceutical companies' average margin of profit is about 18%; some make as much as 30%. The average Fortune 500 company profit margin is 5%.
- Infant mortality is higher in the U.S. than in any other developed nation. In Milwaukee, the death rate for African American infants up to age 1 is about 18.3 per 1,000 live births, compared to five per 1,000 in Wisconsin as a whole.
- Forty-five percent of bankruptcies in this country are due to health-related crises.
- Fifty percent of the nation's uninsured are employed. Another 25% are children, about 9 million nationwide. No elected legislator is uninsured.
