For Wasfi Barakat, driving a cab is not the way to get good benefits. Drivers have to rent the car, pay for gas and other expenses and get to keep whatever is left as the end of the day, said Barakat, a cab driver.
"Sometimes you make it, sometimes you don't," he said.
Barakat's is one of many jobs in the region that don't offer health benefits; he and others have to turn to county-funded health centers for their health care.
Health insurance "is too expensive. I can't afford it," said Barakat last week as he waited to see a doctor at the North County Health Center in Reston.
"I've got diabetes," he added. "That's why I keep my regular check-ups."
Pat Mesirow is in a similar situation. Because she works part time in the Fox Mill Elementary School cafeteria, the county's public schools don't give her insurance. Like Barakat, she uses the county clinic. Without it, she said, "I would have to go to the emergency room with any simple problem or medical concern, which is a waste of the emergency room."
THE COUNTY'S community health clinics, located in Reston, Bailey's Crossroads and Alexandria, are funded entirely by the county to provide care to uninsured county residents who meet federal poverty guidelines. Last year, the three clinics served about 14,000 people, less than a third of the estimated 45,000 people who are eligible for the service, said Christina Stevens, program director for the Community Health Care Network. The program is at capacity so there is no way to increase the number of people served, she added.
The sagging economy has also forced struggling employers to lay off workers or to cancel their insurance coverage which is pushing up the demand for the county program, she said. About 80 percent of the people served by the clinics are employed.
Three years ago, the demand in the county was estimated to be at 37,000 but those estimates came from 1990 census numbers so it is not clear how accurate they are, said Steve Horan, executive director of Community Health Resources Center, a Richmond-based group that provided the statistics for the county's health department.
Nevertheless, he said, "Everybody who works in the field agrees that the number of people is rising because they see them walking in the door."
"People used to say, 'Aww, just get a job, but the employer-sponsored health benefits are eroding," said Stevens. "I continue to be amazed that people are not aware of the magnitude of the problem. More and more middle-income working folks are being hit very hard with high cost of premiums, high cost of co-payments."
AT THE RESTON clinic, nurse manager Rita Basanti said that 60 to 65 people come in for appointments every day. There is also a six-months-long waiting list to get into the program. Patients at the county's clinics speak over 100 languages. In Reston, the most popular foreign language is Persian, followed by Spanish, said Basanti.
"They're here in a foreign country, they don't speak the language. They're used to a specific kind of health treatment back in their home."
They come to the clinic for a variety of reasons but Basanti said that nurses and physicians there find that "the majority of their ailments is depression."
The clinic has X-ray machines, a lab and a pharmacy. It offers free immunizations to children.
"We have everything that we need," said Basanti. "We try to recruit specialists from the community to come and see outpatients for a minimal fee."
The clinic also takes part in a program with drug companies to provide free or reduce-rate medications. Bonnie Brandt, who heads the South County Health Center in Alexandria said finding affordable drugs to treat patients is one of her biggest challenges.
Otherwise, she said, "What's the point?"