In an era when the cost of medical care is downright frightening, a quiet revolution is going on inside Shepherd's Clinic, a trim suite just a few steps down from the sidewalks of St. Paul Street.
Just listen to Kathy Moss, the administrator responsible for myriad chores, including making appointments and charging patients for their care.
"I'm not going to bill them; I'm not going to bill the patients," she said emphatically yesterday, a few minutes after the first patients walked into Baltimore's newest medical clinic. Before patients walk out the door, she said, she will politely tell them what they owe and request payment as soon as possible.
Then, she'll wait. "If it's been a few months, I might pick up the phone to remind them. It just depends on the situation."
Everything you see inside Shepherd's Clinic was donated: the scale, examining tables, file cabinets, autoclave and toys. The doctor, nurse and receptionist are working for free. A patient's bill? It's what he or she makes during one hour of work.
Three years in the making, Shepherd's Clinic is how a consortium of midtown churches has decided to tackle the growing problem of working people who can't afford basic medical care.
An estimated 38 million Americans -- as many as 600,000 in Maryland alone -- have fallen into this terrifying situation. They don't get company health insurance and can't afford their own but aren't poor enough to qualify for Medicaid or other public health benefits.
"Our culture and our government have done a terrible disservice to this particular population," said Hunt Gressett, a physician's assistant at Union Memorial Hospital, who conceived the idea of a low-cost clinic for the working poor.
"These are people working at multiple part-time jobs or in the lowest echelons of a company. Or they are doing menial jobs that don't carry any benefits -- the most important of which is health insurance."
In Maryland, they often rely on hospital emergency rooms because hospitals cannot legally turn anyone away. Ms. Gressett said they account for 27 percent of the people who file into Union Memorial's emergency room, where she works.
"The economics of it are terrifying, but that is the least of the problem," Ms. Gressett said. "The bulk of the problem is the human suffering. These people don't come to the emergency room until they are so ill they cannot function."
Shepherd's Clinic is at 1927 St. Paul, in the basement of a three-story town house across the street from Seventh Baptist Church and St. Mark's Evangelical Lutheran Church. The town house is owned by Seventh Baptist, which rents the space to Shepherd's for the rock-bottom price of $50 a month.
Contributions have flooded in, particularly from the congregations that make up the Midtown Churches consortium. But there have been surprises, too. Like the physician in North Carolina who somehow heard about the project, packed up all his office equipment and shipped it to Baltimore. He was retiring, Ms. Moss said, and rightly figured that Shepherd's could use the stuff.