A man struggles to get to the dental area of the Remote Area Medical clinic in 2014, where he was hoping to get some work on his damaged teeth. (Michael S. Williamson/The Washington Post)

I had a friend named Daniel. When I moved to the sticks of Southwest Virginia, the part above Tennessee, I hired him to do some work. Daniel was very protective, and he insisted on bringing to my land a 15-foot trailer for me to stay in because he was worried about my camping out while my house was being built.

Daniel had been a coal miner and a moonshiner. Unfortunately, as a moonshiner, he was his own best customer. When his skin turned yellow, he said, he found God. He taught himself how to read so that he could read the Bible.

He fell ill as a result of both his professions. He also “fell between the cracks,” as those in power who like to avoid responsibility say. In Virginia, being impoverished is not enough to get you medical care.

Long after my house was built, I ran into Daniel in the tiny town nearby. He looked terrible, and I resolved to visit him and his wife. But I got busy, and by the time I visited, Daniel was dead. He was 59 years old.

Daniel and his wife always went to an annual free health clinic held in Wise, Va., which will come this month to serve people in the part of Southwest Virginia where I live. This is not the part that the commonwealth of Virginia uses as a paradigm for Southwest Virginia, which is Roanoke. It you were to draw a line from Northern Virginia down the West Virginia border and continue all the way to North Carolina, Roanoke indeed would be Southwest Virginia. But there is quite a lot of land west of there that is part of Virginia.

I’ve never been to Roanoke. More than a few people here have never been outside their own county.

I’m not sure anybody could tell, from the free health clinic, that we’re part of any civilized country. Many people here cannot afford insurance, and in this state, they don’t qualify for Medicaid no matter how impoverished they are unless they also are disabled or have dependent children. So they rely on the services of Remote Area Medical, which tries valiantly each year to mend, heal and comfort masses of people who otherwise would have no access to health care.

The clinic is a first-come, first-served affair held over three days. People start lining up at the site early the day before the doors open. They bring lawn chairs and blankets and rain gear if necessary to hold their place in line. They carry coolers with food. And then they wait. They spend the night in lawn chairs. In return for all this trouble and patience, they receive competent health care.

For many, it’s the only health care they receive all year.

From what I can tell, the state tolerates this because it would prefer to ignore our existence and to persist in thinking of us as hillbillies. The federal government would prefer to ignore the existence of needy people everywhere, because, well, you know the answer to that.

Our country is almost alone among industrialized nations that do not have universal health care. Even Kyrgyzstan and Rwanda have universal health care. We definitely have the money. But we prefer to waffle on universal health care because we know the wealthy are watching.

Virginia’s governor, Terry McAuliffe, is in favor of accepting federal money to expand Medicaid. However, McAuliffe is a Democrat, and our state legislature is controlled by Republicans. In fact, my state representative, Terry G. Kilgore, whose district comprises many of the people who show up at the health clinic in Wise, voted with his fellow Republicans against the expansion of Medicaid. His and his colleagues’ resistance to expanding Medicaid means the billions of dollars that Virginians pay in federal income taxes helps pay for Medicaid expansion in other states but not here.

As long as this is the case, the poor people who show up at the traveling health clinic will continue to rely on the kindness of strangers, much as do their brothers and sisters in undeveloped countries. We joke here about our part of Appalachia being a Third World country, but in this case the joke is all too real. Even the people who represent us in state government don’t seem to care. And given that our state’s idea of Southwest Virginia is Roanoke, we “hillbillies” have little reason to wonder why.