I've been watching this discussion with interest.  I've done my share of
  barter, almost free, and pay me half now and half when you get it
(figuring I'm never going to see the other half) consults.  Most of the
time, the people who balk at paying are not poor.  The truly needy often
try to scrape together the fee without comment.  I've been to apartments
furnished with only a bed and a kitchen table where the parents did not
question the fee (of course I reduced it), and I've been to mansions
where they tried to bargain me down.  What we definately need is for
Medicaid to cover outpatient lactation services for poor mothers, or to
have more hospitals offer these services.  Then our sliding scales and
barter arrangements can handle the folks squeezed in the middle - too
affluent for medicaid, too poor to afford anything beyond the basics of
food and shelter.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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