There are things that families and neighbors used to do for each other, mostly without being paid for them. Many of those things have been moved into the marketplace, where they have not gotten cheaper, or kinder, or closer to home.
But the older form has not entirely stopped. Here are three pairs of short stories — one from each side.
Keeping warm
The shutoff
The gas company sent the first letter in October. The bill was three hundred and forty dollars. The letter said the family had thirty days. The family was already three months behind. The mother had been laid off in August. The father drove for a grocery delivery company that paid by the trip, and there had been fewer trips.
The shutoff happened on a Tuesday. A technician came. He was polite. He left a note on the door that said it was for safety. He had locked the meter.
The family kept the children in coats inside the house. They ran a space heater in one bedroom. The space heater drew so much electricity that the lights dimmed when it kicked on. They opened the oven door after dinner and stood near it. They could see their breath in the kitchen by November.
The mother called the gas company every week. Each time, she was offered a payment plan she could not afford.
What had been a thing that ran through pipes in the wall — invisible, taken for granted, the temperature of the house — was now something the family was being kept outside of, inside their own house.
The basement
A church in the same town opens its basement at five in the afternoon all winter, from November through March. The basement has folding tables, plastic chairs, an old upright piano, a coffee pot, and three space heaters that warm the room slowly to about seventy degrees.
People come for the warmth. They also come for the coffee, and the cookies the older women bring, and the company. A retired bus driver fixes everyone's small things — a phone screen, a watch, a lamp. The pastor doesn't try to convert anyone. He sometimes reads aloud from books that aren't about religion.
In one corner of the basement is a clipboard. The clipboard is a fund. People put in a few dollars when they have it. The fund pays the gas bill for whichever neighbor is closest to a shutoff. Last winter the fund paid five bills. This winter it has already paid three.
Nobody on the clipboard signs up to receive. The deacon, who is also a school crossing guard, knows whose meter has been locked. He pays the bill quietly. Nobody knows whose bill it was unless the person says.
What had been the cost of staying alive in a cold place — a private matter, a private failure — was, on Tuesday and Thursday evenings, a thing that several people were inside together.
Getting well
The hospital bill
Her appendix burst on a Saturday. She drove herself to the hospital. The surgery took two hours. She spent one night in a hospital bed and went home Sunday afternoon, sore but recovering.
The bill arrived six weeks later. It came in an envelope marked URGENT in red. The bill was for forty-eight thousand seven hundred and thirty-two dollars.
She read it three times. There was a line for the surgeon. There was a line for the anesthesiologist. There was a line for the operating room. There was a line for the recovery room. There was a line for the nine-hour stay overnight. There were lines she did not understand.
She had insurance. The insurance paid eleven thousand two hundred dollars. She owed thirty-seven thousand five hundred and thirty-two.
She called the hospital. The hospital had a financial assistance program. She filled out forms. The forms asked about her income, her assets, her dependents. After three months of letters back and forth, the hospital reduced the bill to nine thousand four hundred.
She paid it off over eighteen months at five hundred and twenty-two dollars a month. She did not see a doctor again until something else went wrong, four years later.
What had been the price of not dying — a thing the hospital had calculated to its own satisfaction, in its own currency — left her afraid to get sick.
The free clinic
The clinic on the second floor of the strip mall, next to the dollar store, has a sliding fee. The sliding fee starts at zero. They will not turn anyone away.
The clinic is staffed by two doctors who work three days a week and want to. They are paid through a grant and a few private donors. There are also two nurses, a receptionist, and four volunteer translators who cover Spanish, Mandarin, Haitian Creole, and Arabic.
People come for blood pressure checks, for diabetes care, for the kids' vaccines, for the things that go wrong slowly and quietly when there is nowhere to take them. The clinic does not do surgery. It cannot save everyone. But it can keep a lot of people from arriving at the emergency room with something that should have been caught months ago.
Last year the clinic saw four thousand people. Most of them were people who would have waited too long.
The doctors say the clinic does not solve the problem. The doctors are right. But on a Tuesday morning, in a strip mall next to a dollar store, the cost of seeing a doctor was not the cost of not dying. The cost was sometimes nothing.
Growing old
The facility
The facility on the edge of town is owned by a company headquartered in Tennessee. The company owns more than two hundred facilities. A private room costs about eighty-four hundred dollars a month.
The mother had been moved there after her stroke. She was eighty-one. Her room had a window that looked out at the parking lot. The food was warm enough. The aides were kind, mostly — they were paid fourteen dollars an hour and rarely stayed more than a year.
Her daughter visited on Sundays. The daughter noticed, over the months, that her mother's hands shook more, that her mother said less, that her mother was harder to wake. The daughter asked the staff. The staff said her mother was settling in.
What had been a woman who could pick out a song on the piano without sheet music — who had taught fifth grade for thirty years, who had held a granddaughter the day she was born — was, on Sundays, a smaller woman in a chair by a window facing a parking lot.
The facility was not the worst of its kind. The facility was not the best of its kind. The facility was, on average, a place where people got worse a little faster than they would have at home.
The household
In another house in the same town, three generations live under one roof. The grandmother is seventy-eight. She has her own bedroom on the first floor, near the bathroom, because her knees no longer like stairs. She watches the youngest grandchild after school until the parents come home. She does not cook anymore but she chops things at the kitchen counter.
The grandmother teaches the granddaughter how to crochet. The granddaughter teaches the grandmother how to use the phone for video calls. Each laughs at the other.
The house is too small for everyone. The arrangement was not the family's first choice. The family could not afford anything else.
But the grandmother knows the names of the grandchildren and remembers the songs from the radio of her youth. The grandmother sees her family every day. The grandmother is not in a chair by a window facing a parking lot.
The other direction
These were once the things people did for each other without sending a bill. They have been mostly moved into the marketplace. The gas bill. The hospital bill. The eldercare invoice. The looking-after became a thing you bought.
But on Tuesday and Thursday evenings in the church basement, in the strip mall next to the dollar store, in a too-small house with three generations and one bathroom — the older thing is happening anyway. Quietly. Mostly without paperwork. Sometimes at no cost, sometimes at a few dollars on a clipboard, sometimes at the cost of being more crowded than anyone would have chosen.
The looking-after has not stopped. It has only been hidden, behind the louder business of being charged for it.