A Crash Course in American Healthcare

By Janet Marshall Watkins

It’s a tidy story: Mary Washington Healthcare leaders tried to save the Moss Free Clinic. They knew Moss was running low on funds and warned them. It was like seeing a plane head into a nosedive and realizing the pilot wasn’t changing course, MWHC CEO Mike McDermott told Pie & Chai recently. “And now the plane’s hitting the ground,” he said, “and [they’re saying] that’s our fault.”

It’s a catchy if ghastly metaphor. And it elicits sympathy for the hospital corporation, the would-be heroes. But the metaphor neglects some important things.

First, the people who sounded the alarm also accelerated the crash—by sticking Moss with hundreds of thousands in new financial costs just as the Moss endowment fund was running out of money. Second, the plane was being flown in unprecedented conditions due to COVID. And third, let’s face it: The focus shouldn’t be on what the hospital corporation or the clinic board did or didn’t do. It should be on the people who will suffer most if Moss goes down: The passengers.

The hero of the story, at this sad point, will be whoever steps forward to provide Moss with the support it needs to stay open even a little while longer. The clinic has only about six week’s worth of cash on hand, according to information provided to board members at an emergency meeting on April 22 and shared with Pie & Chai. So even a temporary lifeline would be an investment in indigent care as Moss’s roughly 1,300 active patients face the prospect of a tough search for new care elsewhere—because if the clinic closes its doors, which could happen as early as this summer, there will be few good options remaining. 

A few hundred thousand dollars in donations or grants would buy the Moss Clinic desperately needed time to try to line up new sources of funding. Or, if that can’t happen, give these patients time to have at least one more visit with their Moss caregivers, get refills on needed prescriptions, address urgent dental needs, and get help figuring out where they can possibly go next.  


Moss was supposed to exist “in perpetuity” after a community fundraising campaign led by the hospital in 2004 raised $10 million to build Moss a building and create an endowment to fund operations. But as has been widely reported, the endowment, which was managed by the hospital’s foundation, is now fully depleted. And contrary to what many people thought, the Moss building isn’t owned by Moss. It’s owned by the Mary Washington Healthcare corporation. MWHC had been giving Moss five-year leases for a buck a year. But that changed last year. 

The hospital corporation offered to take over Moss, to pull the free clinic out of its financial crisis, in 2021. After researching the proposal, Moss rejected it in 2023, fearing, among other things, that MWHC would cut its dental and pharmacy services. MWHC then shortened Moss’ lease to a single year and started charging about $10,500 a month for janitorial and other services MWHC used to provide for free. MWHC also stopped providing technology and accounting services, forcing Moss to hire outside vendors. In all, MWHC’s cut-off of in-kind support has added more than $20,000 per month to the clinic’s budget.

Moss has vacated office space it can no longer afford on the second floor of the building, cut its hours to four days a week, and possibly three, and put a temporary freeze on accepting any new patients. It’s not a stretch to think its staff are searching for new jobs. Some have already been let go.

The would-be heroes, the ones who warned that the plane might crash—then accelerated its descent? They’re wishing Moss and its patients well.


Averting the crash didn’t have to be an either-or situation: Either the clinic accepts MWHC’s takeover proposal, or MWHC sticks it with massive new costs and pretends the patients can find comprehensive care elsewhere.

MWHC leaders could have offered Moss grant funds to offset the costs of the in-kind services MWHC decided to no longer provide. They could have, as their predecessors did, offered to spearhead another fundraising campaign to ensure the clinic’s services exist “in perpetuity.” They could have taken a hard look at their own budget—the millions the nonprofit hospital corporation has been pouring into executive compensation, expansion plans, etc.—and carved a path to keep the free clinic in operation. After all, patients who get preventative and ongoing care are less likely to land in the ER.

But MWHC made a business decision, and that decision didn’t include supporting Moss. 


For years, MWHC has prided itself on its commitment to serving this community and it has done so well, in a multitude of ways. The hospital provides millions a year in charity care for patients who need emergency treatment but can’t afford it. During COVID, McDermott and his team held virtual town hall meetings to keep the community informed, required hospital staff to get vaccinated, and proactively built a field hospital in the parking garage in case the hospital became overrun with patients during the pandemic.

My family has received excellent care, for the most part, when we have been in MWHC facilities for emergencies and scheduled procedures, and I have been especially grateful for the top-notch care of compassionate nurses. Those nurses, as well as doctors and other staff, were heroic in their efforts to treat severely ill patients and keep so many alive when COVID made life absolutely miserable.

It was an unprecedented time for the hospital, and for Moss, too. For nonprofits like Moss, the pandemic created especially difficult fundraising conditions. In-person fundraisers got canceled. Donors lost jobs. Workplace fundraising campaigns became nonexistent as offices emptied. These were the conditions Moss faced as the endowment funds dwindled. 

Moss and MWCH both function in a challenging healthcare environment, with COVID compounding the cruelty that the “system” inflicts on patients and medical providers every day. But only one of these institutions is now desperately short on money, and it’s the one that serves the most vulnerable patients. 

The optics are terrible. Mary Washington Healthcare recently put forth plans to double the size of a mansion on its campus to create a luxurious residential dwelling—at the same time the Moss Clinic is poised to shut down, leaving about 1,300 low-income people to scramble for medical, dental, mental health and pharmacy care. 

The childcare center on campus is also facing imminent closure to make room for more lucrative medical facilities—leaving hundreds of parents, many of them hospital employees, scrambling for affordable, and available, alternatives. MWHC plans to demolish the center and build a 2-story medical building and a 3-story office/conference center—at a time when other hospital systems around the country are exploring ways to add child care to help recruit and retain staff, especially nurses. 

I can’t see into the minds of MWHC leaders. Maybe they underestimated the community’s attachment to Moss. Maybe they underestimated our ability to sift through their spin, which included the suggestion that the hospital corporation’s new residency clinic, where it’s hard to get an appointment—coupled with some far-flung free clinics—would somehow absorb all of Moss’ patients (who would then also, somehow, find their own dental care elsewhere and a way to afford their medicine). Maybe they figured the people whose opinions they value most—those with deeper pockets than mine—would understand their business strategy.

Most likely, they decided the short-term cost of any bad PR they got would be worth the longer-term benefit of continuing their quest to own, use, and make money from as many buildings as possible on their campus.


Moss is a community institution, and I have an especially soft heart for it. Its longtime volunteer medical director, Dr. Patrick Neustatter, is a good friend, and I have seen him and Moss staff members out in 90+ degree heat and humidity caring for people at The Table at Market Square, a weekly fresh food market for people in need. Neustatter and the Moss crew set up shop at the Table every other week, rain or shine, frigid temps or sweltering ones. During COVID, they gave people vaccines, and they routinely check people’s blood sugar and blood pressure, identifying those with unhealthy levels who need quick follow-up care. They’ve connected people to the clinic’s services and treated people with compassion.

McDermott has lamented that Moss is not cost-efficient enough, that it costs too much per-patient to run the clinic. I don’t know what the right cost is to provide low-income, uninsured and underinsured people with a one-stop place to get medical, dental, pharmaceutical, and mental health care. I do know that the financial metrics hospitals and clinics get judged by are a sad way to measure health care. They don’t align with my values, and I suspect they don’t align with the values of lots of people in the healing professions. 

Last weekend, I attended a rally to save the clinic. About a hundred people gathered in a parking lot alongside U.S. 1 near the hospital entrance to wave signs, encourage donations to Moss, and share stories about the clinic’s importance. One man talked about getting treated at the clinic for a dental abscess. Then he got diagnosed with ADHD, and then with abdominal tumors. He was overflowing with gratitude for the care he received at Moss. I wonder: What would have happened if he hadn’t had that one-stop shop for comprehensive care? I shudder to think about patients who won’t have it from here on out.


Though McDermott’s plane metaphor is catchy, I don’t think it’s the right one. I think a better one is this: Moss is the worker. MWHC is the big corporation. The corporation talks about the worker like they’re family—right up to the day they lay you off.

Whose fault is it? You can blame Moss for not doing enough fundraising. The endowment meant to keep it afloat was roughly half of the $10 million raised by the community, after the rest was spent on the building. In hindsight, the endowment wasn’t ever going to last “in perpetuity,” which was what the corporation promised. It isn’t cheap providing comprehensive care to Moss patients, most of whom have chronic illnesses, some of whom come straight from the hospital after suffering an acute illness or injury, many of whom have a multitude of challenging needs. So sure, Moss should have fundraised more. But easier said than done, especially during a pandemic.

You can also blame MWHC for kicking Moss to the curb after Moss rejected its takeover proposal. Obviously, MWHC could have chosen, and could still choose, to keep Moss afloat. It’s planning to spend god-knows how many millions expanding Snowden House—the figure we’ve heard is $3.5 million—not to treat patients or improve the quality of healthcare for the community, but to create a single-family residence with space for hosting events. It is a whopper of a stretch to think any of that investment will trickle down to the people who need Moss.

MWHC, as many have noted, pays its CEO $2.4 million (the amount listed on the hospital corporation’s 2021 IRS Form 990)—about as much in a year as it takes to operate the Moss Clinic. A 10 percent pay cut for MWHC’s executive team, which is packed with high-six-figure and even million-dollar earners, would easily keep Moss going, and the executives would all still be loaded and able to afford whatever health care they need. Is it their responsibility to help fund a nonprofit clinic that they don’t actually operate? Their answer, for most of the past 20 years, was yes. Now it’s clearly “no.” 

Step back farther, of course, and you can say the blame rests with the American health care system. The deficient, uncaring, money-driven “system” that created the need for the Moss Free Clinic in the first place. It’s a system that makes the cost of care vary depending on what kind of insurance you have, what facility you get treated in, whether you have insurance at all. A system that measures physicians by how many patients they see in a day, that reimburses physicians differently depending on what kind of medicine they practice, and that financially disincentives longer conversations between doctors and patients that might elicit information that leads to better health care. 

Always in this system—always—the people with the least end up suffering the most. 


Janet Marshall Watkins is the co-founder of Pie & Chai. She is a writer, mom, grandma, dog owner, former nonprofit director, and longtime advocate for people suffering from violence, food insecurity, and other challenges.