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"  It might sound morbid, or exploitative, but every hospital fundraiser knows that when affluent people or those they love become seriously ill and are successfully treated, they&amp;#039;re ripe for charitable giving. Grateful to have their health back, they may help bankroll a new wing, pay for a cutting-edge diagnostic machine, or put their money toward research to develop the next generation of therapies or cures. What they&amp;#039;re usually not rushing to support\u2014what has to be one of the least sexy philanthropic causes around\u2014is health care for the poor and uninsured. That&amp;#039;s one element that makes the story of Dee Dee Ricks\u2014a multimillionaire Manhattan hedge fund consultant who within weeks of being diagnosed with stage II breast cancer at age 39 was searching for a way to put her wealth and rainmaking skills to use\u2014so compelling, worthy of a documentary debuting this month on HBO. Just as compelling, especially at a time when Republicans are vowing to repeal &amp;quot;Obamacare&amp;quot; should they win the White House in 2012, is the focus The Education of Dee Dee Ricks puts on the everyday horror of suffering a potentially fatal illness without a way to pay for treatment.  At the center of the story is the odd-couple partnership of Ricks\u2014who&amp;#039;s brash, blonde, and deliriously fond of the F-word\u2014and Harold Freeman, a 78-year-old breast cancer surgeon and one of the nation&amp;#039;s scientific and rhetorical leaders on the impact of poverty and race on cancer. He&amp;#039;s also a man who, for all his steely determination to fight a system in which &amp;quot;poverty is an offense punishable by death,&amp;quot; couldn&amp;#039;t be more cerebral, soft-spoken, or gracious.  The first time the pair encounter each other\u2014in real life and in the documen\u00ADtary, which grew out of Ricks&amp;#039; wish to give her young sons something to remember her by should she die\u2014is when her driver deposits her at Freeman&amp;#039;s Harlem office. Freeman heads the Ralph Lauren Center for Cancer Care and Prevention, founded in 2002 with a $5 million grant from the designer to care for the medically disenfranchised. Ricks is there because, despite being just about to start chemotherapy (having had a double mastectomy) and despite being a divorced mother who has to work for a living, she&amp;#039;s decided she wants to help someone who &amp;quot;doesn&amp;#039;t have the penthouse apartment, doesn&amp;#039;t have a home in the Hamptons...doesn&amp;#039;t have nannies, [doesn&amp;#039;t have] everything at her disposal.&amp;quot;  What happens between the courtly physician and the voluble Ricks reads like the penultimate scene from a Frank Capra movie. First Freeman tells Ricks about his work\u2014how, when he first started practicing in the community 40 years ago, women came in with their breasts literally &amp;quot;replaced&amp;quot; by cancer, how the &amp;quot;patient navigation system&amp;quot; he developed (which, though he doesn&amp;#039;t say it, has been copied nationwide) helped raise the five-year survival rate of the center&amp;#039;s breast cancer patients from an appalling 39 percent to 72 percent, though the average for white women is still higher, at 90 percent. Then: &amp;quot;I guess I&amp;#039;m here to ask you,&amp;quot; Ricks says to Freeman, &amp;quot;where&amp;#039;s the biggest need for you?&amp;quot;  &amp;quot;Recently we were given a challenge by Mr. Ralph Lauren,&amp;quot; the doctor replies. &amp;quot;He said, `I will give you 2.5 million dollars if you can raise 2.5 million to match it.&amp;#039;&amp;quot; &amp;quot;Where are you in this?&amp;quot; Ricks asks. &amp;quot;At the very beginning,&amp;quot; Freeman says, a bit abashed. &amp;quot;That&amp;#039;s a huge challenge.&amp;quot; &amp;quot;And you need 2.5 million dollars? Consider it done. I will get you your 2.5 million.&amp;quot; &amp;quot;You...you...you...&amp;quot; Freeman stammers. &amp;quot;I will get you your money.&amp;quot; &amp;quot;Oh my God,&amp;quot; Freeman says, removing his glasses and wiping his eyes.  &amp;quot;And I&amp;#039;m gonna get it for you in the next couple months, Dr. Freeman,&amp;quot; Ricks says, her voice breaking. &amp;quot;Oh, my God. Oh, God.&amp;quot; &amp;quot;What you&amp;#039;ve done for this nation and the fact that you have to go out there and work to raise 2.5 million is a disgrace,&amp;quot; Ricks says. &amp;quot;You&amp;#039;ll get your 2.5 million dollars, and you&amp;#039;re gonna get a whole lot more. This is gonna be my job.&amp;quot;  Ricks&amp;#039; choice to help poor women can be traced back to her childhood. As she cheerfully says in the film, &amp;quot;I grew up in the South, one step away from being poor white trash&amp;quot;\u2014a description of herself that Freeman says, when I interview the two together at the exclusive Core Club in Manhattan, &amp;quot;bothers me a great deal.&amp;quot; &amp;quot;I&amp;#039;ve told her many times, `Don&amp;#039;t ever say that,&amp;#039;\u2009&amp;quot; says the doctor, who was raised &amp;quot;in a cultured, educated family&amp;quot;\u2014his grandfather was a physician, his mother a schoolteacher, and his father became a lawyer at 43 (though he tragically died not long after, when Harold was 13)\u2014but they had little money and lived in segregated Washington, DC. &amp;quot;Nobody is trash,&amp;quot; Freeman goes on. &amp;quot;I&amp;#039;ve struggled for 40 years to disentangle the meaning of being black and being poor. I knew Dee Dee understood what I was trying to do because of where she came from.&amp;quot;  Ricks was on her own by age 13, having left home after her &amp;quot;severely depressed&amp;quot; secretary mother made &amp;quot;multiple suicide attempts,&amp;quot; she tells me. A friend&amp;#039;s family took her in, and she &amp;quot;started workin&amp;#039;.&amp;quot; And this girl knew how to work (first job: punching the cash register at Chick-fil-A) as well as earn. In fact, she seems preternaturally gifted at the latter. She put herself through college at the University of Florida (&amp;quot;BS in beer drinking&amp;quot;), landed a job at a Manhattan executive recruitment firm, started her own recruitment practice a few years later because she was sick of making money for the partners and not herself, signed a hedge fund guy as her first client (in the early &amp;#039;90s, when no one knew what hedge funds were), and, from there, developed her business into the success it is today.  Ricks calls herself someone &amp;quot;who jumps off a bridge, then learns how to fly,&amp;quot; and her quest to fundraise for Freeman turns out to be much harder than she expected. &amp;quot;No one&amp;#039;s coming. I have Lance fuckin&amp;#039; Armstrong, and I have no one,&amp;quot; she cries in the film as she plans a dinner party from which she&amp;#039;d hoped to reap $1.5 million. Meanwhile, she endures chemotherapy and its side effects, struggles to keep the cash rolling in from her job as the econ\u00ADomy falters, and befriends a breast cancer patient from the Lauren Center whom she asked Freeman to introduce to her.  It&amp;#039;s this woman, Cynthia Dodson, who gives the documentary larger resonance. A 41-year-old African-American receptionist with a whopping 7-centimeter breast tumor, Dodson doesn&amp;#039;t have insurance for the same reason so many other full-time workers don&amp;#039;t: She was hired on contract precisely so her employer wouldn&amp;#039;t have to give her benefits. This trend started before the recession and only accelerated during it, and last fall the number of uninsured hit a record high of 50.7 million, according to census figures. Like Ricks, Dodson is a talker, but she lacks Ricks&amp;#039; pugnacious bluster and is more affecting for it. &amp;quot;To hear you have cancer and to know you have no means to undergo treatment is&amp;quot;\u2014Dodson pauses, dabbing her large brown eyes with a tissue and speaking directly into the camera\u2014&amp;quot;very scary.&amp;quot; The first thing that occurs to most people who want to improve breast cancer survival among the poor is mammograms. And while the percentage of poor, uninsured, and minority women who get them is indeed substantially lower than that of their white, wealthier counterparts, access to screening is only a start. Equally important is what happens after a woman without means gets a suspicious finding on a mammogram.  Imagine it: She&amp;#039;s unlikely to have a regular doctor to consult for a referral, so she calls around trying to find someone who&amp;#039;ll accept a patient without insurance for a biopsy, or whatever diagnostic test she needs\u2014how&amp;#039;s she supposed to know? A public hospital agrees to take her, though she has to wait a month for an appointment. The biopsy shows she does have a tumor; now to find a surgeon to remove it. Then she has to get enrolled in radiation or chemotherapy. She manages all that but can&amp;#039;t find anyone to watch her kids during her chemo, or she becomes so exhausted midway through the cycle that getting to appointments on a bus seems impossible\u2014how to scrounge up enough money for a cab? She&amp;#039;s had to take unpaid leave from her job during her treatment (or was fired outright for missing too much work). Then there&amp;#039;s her medicine: It costs $130 per pill. Oh, and did I mention that she keeps hearing that to beat cancer, you need to stay positive and focus on getting well?  Anyone who&amp;#039;s lucky enough to get to the Lauren Center, as Dodson was, is assigned a &amp;quot;patient navigator&amp;quot; to help surmount such barriers, financial and otherwise, but clinics that are as well funded and comprehensive as this one are an anomaly. Which again raises the issue of insurance.  Obama&amp;#039;s plan, assuming it survives to 2014 when it&amp;#039;s slated to go into effect, will add an estimated 32 million Americans to the ranks of the insured. And interestingly, just this July, new, rather conclusive evidence was published showing that medical coverage does increase access to health care for the poor, presumably making them healthier. Dodson didn&amp;#039;t need a study to prove it, but the question has lingered because some policy makers have argued that the uninsured can already use the safety net of ERs and clinics like the Lauren Center, or\u2014as risible as this seems to anyone who&amp;#039;s tried to get past a medical receptionist without an insurance card\u2014can just go to the doctor and not pay the bill.  Yes, the skeptics knew that there are reams of data to show that the uninsured are sicker and get less care than the insured, but they questioned whether medical coverage was the decisive factor, because people with insurance and those without are different in many ways that can affect health (quality of diet and housing, levels of stress and education, etc.). Enter Oregon&amp;#039;s 2008 decision to extend Medicaid to more of the uninsured. Ninety thousand people signed up for 10,000 initial slots, and beneficiaries were selected by random lottery, creating the ideal experimental design. Among the findings: Those who got Medicaid were more likely to go to a clinic or a doctor (35 percent), get a mammogram (60 percent) or cholesterol test (20 percent), report being in good or excellent health (25 percent), and have a &amp;quot;medical home,&amp;quot; a certain place they visit for care (70 percent). (Next up for the researchers: comparing the two groups&amp;#039; blood pressure, cholesterol, weight, and actual health.) Academics had to wait for this &amp;quot;natural&amp;quot; study, by the way, because it&amp;#039;s considered unethical to take a group of poor people and give only half insurance, which, if you think about it, means our whole country might be deemed unethical, since medical care is treated as a commodity available to those who can afford it rather than as a public good like education. That is definitely Freeman&amp;#039;s point of view\u2014&amp;quot;This is a moral question, not a medical question&amp;quot; is a mantra of his\u2014and one Ricks holds as well.  Paradoxically, as Ricks comes to realize in the documentary that money can buy health, she concludes that it doesn&amp;#039;t get her something just as important\u2014namely, meaning. This conversion isn&amp;#039;t a foregone conclusion: Ricks had good reason to see money as a kind of magical cape, and judging from how lustily she regales viewers with the perks of her life\u2014how she flies on private jets, lives in a &amp;quot;$14 million apartment,&amp;quot; eats at the &amp;quot;best restaurants&amp;quot;\u2014this woman loves living large. But after she finishes her chemo\u2014and Dodson, sadly, dies\u2014Ricks decides that while she&amp;#039;s not about to stop working, she also wants to spend more time with her sons and continue full-bore fundraising for Freeman. (To facilitate that, she downsizes, moving to a much less expensive apartment.) When I interview her and Freeman, in fact, she&amp;#039;s all amped up about their next venture (and, yes, she met the original $2.5 million goal and has since roughly doubled it): In alliance with the Harvard Global Equity Initiative, she&amp;#039;s hoping to help fund &amp;quot;cross-border patient navigation&amp;quot; for Mexican-born people diagnosed with cancer. The project would target both uninsured people living in the United States legally and those who are undocumented. And how would a chunk of the money be spent? Getting people back to Mexico, where, Ricks says, the access to breast cancer care is better than it is here.   Read more about reducing your risk for breast cancer "^^<http://www.w3.org/2001/XMLSchema#string>
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