The cost of ‘free:’ Americans are surviving not because of the system, but in spite of it
Food, clothes and hygiene products are provided free of charge to some of the region’s most vulnerable residents. Cory Vaillancourt photo
Squeezed into a corner room on the ground floor of what was once a grade school in a quiet Waynesville neighborhood, a small free pantry and market provides food, clothing and household goods to some of Haywood County’s most vulnerable citizens at no cost. The pantry is one of many, rooted in compassion and community, but also in contradiction.
Pop-up lifelines — the rise of free goods and services — were not unheard-of pre-Helene, but their proliferation in Western North Carolina points to a deeper crisis.
They signal not abundance, but absence, serving as a quiet indictment of the systems meant to ensure no one would need them in the first place — systems that are currently under attack.
Last week, the cavernous Harrah’s Cherokee Center in downtown Asheville transformed into something most residents have never seen before — a hospital without billing codes, a doctor’s office without insurance cards, a clinic without co-pays. For three days beginning June 4, the arena hosted a free “mega clinic,” offering thousands of dollars’ worth of medical, dental and vision care at absolutely no cost to anyone who walks through the door.
“The main reason is because I realized that there were a lot of people, despite the wonderful health care systems that we have, there’s still a big gap and there’s a lot of people that still are missing opportunities,” said Dr. Lela Lewis, founder of the Liberty Health Alliance.
Lewis is an OB/GYN who practices in Arizona but periodically sets up the volunteer-staffed mega clinics around the country. Everything about the event seems designed to reverse the usual flow of American healthcare. There are no eligibility requirements. No referrals. No means testing. No gatekeeping. Services are offered on a first-come, first-serve basis, no questions asked.
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More than 500 volunteers provided X-rays, pap smears, dental cleanings, eye exams, extractions, minor surgical procedures, massages, mental health counseling and even free glasses. Childcare was always available onsite. Plant-based meals were served. For three days, a system notorious for complexity and exclusion ran on simplicity and inclusion.
But the clinic’s existence also asks an uncomfortable question: Why is this necessary at all?
Organized by Lewis and the LHA, a Seventh-day Adventist-affiliated nonprofit based in Arizona, the Asheville event was part of a growing network of large-scale, volunteer-powered clinics that have quietly swept the country in recent years. Similar operations led by the same group and its president have appeared in cities like Phoenix, Tampa and Washington, D.C.
In every case, they draw thousands, and in every case, they are praised not only for the care they provide, but for exposing just how many people still go without it.
“When I started, I actually thought that we would end up treating mostly homeless people,” Lewis said. “I was very surprised, even in that very first event in Oakland and San Francisco — and it’s been the same case all over the country, any city I’ve ever gone to — that the vast majority of the people are the working-class poor. They may or may not have health insurance, and if they do have health insurance, the co-pays and deductibles are too high. It’s a question of, do they put food on the table or for their family or do they get the services that they need, particularly dental and vision?”
On its face, this is a story about generosity. Hundreds of licensed medical professionals and support staff from across the country donate their time and labor to treat the community —particularly those still reeling from the effects of Hurricane Helene. But scratch beneath the surface, and another story emerges, one of structural failure, policy neglect and the normalization of stopgap survival in place of systemic care.
“This is not a fix-all,” Lewis said.
In a country with the world’s highest per capita health spending, the rise of volunteer-run mega clinics means the market isn’t working, and in Western North Carolina, like so many other places, the cracks have become gorges.
While the clinic is nominally a response to Helene, it’s clear that the need for it predates any storm. Hurricanes may damage homes, but they don’t explain the thousands of people across the state who rely on mutual aid, mobile pantries, pop-up clinics and free stores to meet the most basic human needs. This is not about disaster relief. It’s about the disaster of ordinary life in a country where insulin costs thousands each year, a dental extraction can take a month’s rent and dental care is considered a luxury.
The LHA’s last financial report shows revenues of nearly $500,000 and nary a nickel from any local, state or federal government agency. Lewis is the LHA’s only paid employee and earned $46,000 in 2023 — a fraction of what she could make if she devoted more of her time to private practice.
Events like this one are, by nature, episodic. For three days, care floods into a city like a wave, then recedes. Those lucky enough to be seen will walk away in better shape, or at the very least, with some sense of being acknowledged. The problems they face — poverty, chronic illness, a lack of stable housing or childcare — won’t vanish on the ride home.
If anything, the scale of the event serves as a referendum on what local, state and federal governments are not doing. Asheville, like much of Western North Carolina, has seen the quiet disappearance of primary care physicians, the consolidation of health systems and the continued struggle for affordable dental and vision services. Mental health beds are scarce. Preventive care is inconsistent. And while the Affordable Care Act reduced the number of uninsured residents, it did little to ensure those with coverage can actually use it without financial ruin.
Lewis said it would take a literal miracle for the clinic’s services to not be needed.
“For Jesus to come back in the clouds and take us home,” she said. “And I don’t say that facetiously. I’m a Christian, and Jesus said ‘The poor you will always have with you.’ We live in a bad situation. Will services for those who are in need ever be no longer needed? No, not until this difficult, sinful situation is eradicated, whenever it is God decides to end this thing.”
According to a metric used by the National Institutes of Health called “vast majority income,” most Americans subsisted on an average annual income of less than $24,633 between 2019 and 2023.
Vast majority income is defined as that which is earned by the lowest-earning 80% of the population.
Only 17 of North Carolina’s 100 counties have a VMI above the average for the country as a whole. Only 21 have a VMI above the state average of $22,835.
In Western North Carolina, only Buncombe, Henderson and Transylvania has a higher VMI than the state’s average.
Rutherford County has the lowest VMI in the west, at $17,178. Graham, Jackson, McDowell and Swain counties round out the bottom five. At $22,363, Haywood County scores just below the state average.
At the same time, so-called fair market rents published each year by the U.S. Department of Housing and Urban Development eat up most, if not all, of that income. In Haywood County, for example, a fair-market one-bedroom goes for $1,105 a month, or $13,260 a year — leaving a person who earns the VMI just $9,103 per year, or about $759 per month, for everything else. Utilities. Transportation. Clothes. Health care coverage. Food.
Given that HUD also defines people who spend more than 30% of their income on housing as “housing cost burdened,” there’s not a single county in Western North Carolina where a significant portion of the population isn’t housing cost burdened. In fact, those who spend more than 50% of their income on housing are defined as “severely burdened.”
Last fall, the U.S. Census Bureau said that nearly half of all renters are cost-burdened, with many others severely burdened.
To relieve the burden for the vast majority, at least in Haywood County, a one-bedroom would have to go for less than $450 a month.
President Donald Trump’s so-called “big beautiful bill” — a sweeping package of tax cuts and spending reforms — promises relief but delivers it with a tilted scale even as his tariffs disproportionately erode purchasing power.
At its heart are permanent extensions of the 2017 Trump tax cuts, preserving the seven-tier bracket system while ensuring millionaires continue to benefit the most.
According to the Congressional Budget Office, the top 1% would receive an average tax cut of more than $48,000 annually, while middle-income households would see less than $900.
The bill also eliminates federal taxes on tips and overtime pay for workers earning under $160,000 but does nothing to shift the broader imbalance that favors the ultra-wealthy. Meanwhile, the cost of those tax breaks is recouped not from corporate subsidies or defense spending, but from the wallets of the poor.
The bill would impose new Medicaid work requirements, restrict eligibility and freeze provider payments, saving $793 billion, but as a result, 8.6 million people — disproportionately low-income, rural and disabled — would lose coverage over the next decade, according to the Congressional Budget Office. Estimates show that decision will affect between 300,000 and 400,000 people in North Carolina.
Despite the cuts and reforms, the bill would also add $2.4 trillion to the national debt over 10 years. On the day Trump took office in 2017, the national debt stood at $19.9 trillion. On the day that President Joe Biden took office in 2021, it stood at $27.9 trillion. On the day Trump took office again in 2025, it was $36.2 trillion.
In the name of tax relief and with no regard for debt, the bill cuts a direct line through the safety net, reinforcing what events like the mega clinic already make clear — survival is a policy choice.
Over at Church Street Studios, the former school and daycare that now serves as a community hub for wellness-centered businesses in Waynesville, that small corner room on the ground flood is packed with donated clothes, canned goods and all manner of personal hygiene items.
There are no forms to fill out. No proof of income required. No gatekeepers doling out rationed goods from behind a desk. Just open doors, open shelves, and an open invitation: take what you need.
The Little Free Queer Store, a project of the nonprofit HayCo Pride, did not begin as a disaster relief program. It was supposed to debut at a community event on Oct. 5, 2024, with free food, free haircuts, free notaries and free health care services.
But Hurricane Helene had arrived just days earlier, displacing thousands across the region and rewriting the store’s mission before it even began.
“This was always a part of the work and our mission as an organization,” said founder Chelsea White-Hoglen.
Despite the disruption, the store now serves anyone — hurricane survivor or not — who walks through the door.
“We don’t have any eligibility requirements or screening process for, like, shoppers of the free store,” White-Hoglen said. “We also don’t limit what people can take by quantity or item or anything like that.”
What’s inside? The overlooked, the unglamorous, the essential. Diapers. Postpartum supplies. Over-the-counter pain relievers. Tampons. Toothpaste. Things that SNAP and WIC won’t touch.
White-Hoglen, a Jackson County native with a master’s degree in social work, sees a clear trend in the 20 to 25 people who show up each week. More than half are parents. Most are in their late 20s or early 30s. A lot of them are moms, including one who’d come in earlier that day, toting a toddler.
“It’s people who look like they probably have a roof over their head, but it’s on a month-to-month basis of whether that’s going to continue to be over their head,” she said.
It is not, in other words, the stereotype of the destitute. These are the people who are supposed to be okay. The nearly-middle class. The system’s strivers, who find themselves broke at the register when their kid spikes a fever and the acetaminophen costs $11.47.
White-Hoglen has learned plenty just by watching what people reach for and how they respond. She recalled one woman who “literally started crying. She was like, ‘You guys are so nice. I go to soup kitchens and pantries in the area and I feel so shamed and judged, and I come here and like it feels like I’m here in community.’”
That sense of dignity, of refusing to separate the needy from the worthy, is foundational. The “queer” part of the store’s name is meant to signify a judgement-free zone in terms of gender identity or sexuality, but it also extends across the board.
“Any good ol’ boy with a MAGA hat could walk in here and I’d be like, ‘Take what you need,’” she said. The space itself reinforces that feeling. “We had this shelf that was essentially an all-access shelf anytime that the building was open, so even outside of our open hours, folks could access those things,”
That practice was discontinued due to a fire code violation. Traffic dipped, but word-of-mouth remains powerful. A single social media post still draws a crowd.
“It’s people who the public perception would probably call, ‘the working poor,’” White-Hoglen said.
One of the most surprising dynamics, however, has been how quickly users of the store become contributors, recycling crutches, or maternity clothes, when they’re no longer needed.
“I think whether or not they feel this way before they came in, it’s folks who now find themselves feeling like they can both give and receive, like they are a part of a like ecology or like internal economy,” she said, resisting the idea that this work is only temporary. She sees the entire model as a counterweight to American hyperindividualism.
More than that, she says, the project is a rejection of “the lies that we’ve been sold that we can work ourselves into a better life, when really, first of all, that’s something very few people can do. Sure, if all of us worked 90 to 100 hours [a week], maybe we could work our way into a better life. But at what cost?”
The store exists in a broader mutual aid network, reaching from the Piedmont to Central Appalachia and indeed all across a country that spends billions on defense and doles out billions in corporate subsidies. HayCo Pride operates yearly on a budget of just $8,000. Not all of that goes to the pantry.
But it’s the free clinics and the sidewalk pantries that are quietly revealing the truth — millions of Americans are surviving not because of the system, but in spite of it. The real “cost of free” is what it says about who we’ve chosen to leave behind.
“I think the forward-facing work as it appears, as direct aid, is a short-term solution,” White-Hoglen said. “Changing the dynamic — I think that is the long-term work.”
