My pal Tom Lorentzen used to administer Medicare for the Western Region. Tom is a very sober and responsible political thinker who believes in solving problems from a conservative bent.
Today, he has a piece in the San Francisco Chronicle pushing a plan that would help Obama pivot away from his current disastrous health reform course, while also bringing help to people in need. From his column:
As a community organizer, it is odd that the president has overlooked an opportunity to establish practical and measurable objectives while leveraging a political consensus that already exists among conservatives and liberals. It is a doable approach and can be framed as a “national community-based health care system” modeled after our public libraries and public schools. These would be neighborhood facilities, but integrated with funding and other assistance from local, state and federal governments and the private sector. They are community clinics and health centers.
It isn’t new. The dreaded and heartless Bush increased spending on these clinics back in 2002:
This format already exists and can be expanded. In California, about 800 such sites provide primary medical care, including dental where possible. They serve both underinsured and uninsured. They do not turn away people. Just as public libraries were designed to increase access to information and public schools were designed to increase access to education, so have community health centers been designed to increase access to primary medical care. They strengthen communities and enhance community health objectives.
Nationally, there are about 7,000 sites that serve about 20 million people. The “Health Centers Initiative” of 2002 greatly expanded their numbers and capabilities. A 50 percent increase in utilization occurred between 2001 and 2006. They collaborate with schools, hospitals and other public and private entities to promote health literacy. The community-based model has proven its value, provides clarity of purpose, is consistent with traditional methods of improving access in the United States, is cost effective, and possesses an existing consensus of support in Congress in both parties.
Imagine being a poor single mother and your kid has a fever. You go to a local clinic at the mall and have him checked out for $15. Matched with ,say, vouchers to help the less well off pay for affordabe private insurance high deductible policies, community clinics could strengthen the safety net significantly without breaking the bank. In any event, they certainly beat Obamacre:
Comprehensive health care reform tries to do too much at too great a cost – just as in 1993 – and again seems likely to be rejected as uncertain, unclear and fiscally risky – but that should not be the end of it. We simply need to pivot and frame the subject more precisely within a clear and consensus-driven framework that already works. It is not perfect and will not solve all problems. But, it would be a beneficial step forward that could return a desperately needed sense of comity and common purpose to our country so badly hurting from the wounds of faction and rancor over this important subject.
Well said, Tom. Well said.
January 27th, 2010 | 12:52 pm
This assumes, of course, that the actual goal is the improvement of health care.
I don’t think that is the actual goal. The goal is the governmental control of health care. By unelected governmental officials.
January 27th, 2010 | 2:44 pm
So, an HMO-type cooperative health provider?
My first thought was that if Obama had proposed anything like this, the neo-cons would be screaming “Socialized medicine! Fast track to single-payer!” Then I thought nah, maybe they won’t.
But before I could even type it, suek had already done it.
Sorry to be skeptical, this sounds fairly workable to me if you can persuade people to accept the inevitable rough transition period. Also, you don’t have a whole lot of info in here about who owns the clinics and who pays the bills, if uninsureds and underinsureds are welcome.
And it’s hard for me to reconcile your contention that these clinics are accessible and popular in California with your previous rants about California going to single payer. Why would Schwarzenegger do that if these clinics are viable? (Don’t say, “because he’s crazy,” that only works in the mad scientist movies.)
Wesley J. Smith Reply:
January 27th, 2010 at 2:59 pm
But Bush pushed it and Lorentzen is a long time Rep. political operative sincerely looking for a consensus approach. I think it would be supported, not unanimously, but it would be a terrific way forward.
Single payer is a system of government control. What is covered depends on the budget and the government becomes involved in what is and is not covered. Clinics would be private, if subsidized, allowing access other than at emergency rooms. It would provide tremendous benefit at a far lower cost than the current proposals, much less bureaucracy, and could plug part of the hole that exists in the current system. They are already working. Let’s do more.
January 27th, 2010 | 3:47 pm
Padraig:
Schwarzenegger said he’d veto the single-payer bill, he’s hardly a supporter.
Community clinics are a good idea. They could charge per-use to reduce overconsumption, and I would make them tax-exempt if they accepted the indigent without payment like ERs are currently required to do. Keeping them local would also open up community charitable funding, volunteer unskilled labor, etc.
If we had a low-cost and subsidised as-needed source of primary care for the poor and unemployed, we could have health insurance revert to its role of providing coverage for catastrophes and the unforseen, which would reduce its cost significantly.
January 27th, 2010 | 4:42 pm
Sparky, I was using “Schwarzenegger” to represent “California Government,” so if I misrepresented his position, sorry Ahnold. The question still stands (and it’s a real question, not an argument), why is anyone pushing single-payer if these are so successful? I would absolutely prefer this arrangement to single-payer.
As for me, I’m in a local HMO myself, and vastly prefer it to pay-as-you-go insurance. I rarely see a bill outside of prescription co-pays, and have gotten prompt and effective service whenever I need it.
The biggest drawback to a local clinic is, what happens when you need health care away from home? For me that puts me back in the “pay and hope for reimbursement” pool.
So I’m pretty much with you Sparky, except I’d like membership in such clinics to be paid by Medicare for pretty much any citizen not otherwise provided for. I don’t think they can be viable operating more or less as charities. Also, that would give them the financial base to treat more catastrophic conditions.
January 27th, 2010 | 9:02 pm
I think this is a very good idea, just like the Medicare expansion for seniors that Bush did, which “liberals” tend to hate, are a good idea.
January 28th, 2010 | 7:10 am
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January 28th, 2010 | 9:12 am
safepres, where are these “liberals” that opposed Medicare expansion? Bush’s prescription drug plan drew criticism for being obscenely complicated, and for reducing prescription drug price competition, but I don’t remember anybody hating it.
This is just another example of someone buying into Fox News’ and Limbaugh’s divisive “liberal” straw man propaganda. I live in one of the most liberal communities in America and I’ve only heard one person, a city alder, that talked the way they describe “liberals” talking. She was run out of office for being a looney. Please get out and talk to real people instead of accepting Fox’s unfair and unbalanced descriptions.
January 28th, 2010 | 11:01 am
Padraig:
A community clinic would be a primary care provider, pretty much the equivalent of the clinic I visit for checkups. They’d handle primary care, leaving the more serious stuff to hospitals equipped to handle it.
If these clinics charge directly instead of taking insurance, it would cut “underinsured/uninsured” out of the picture. Insurance would cover hospitalization and more serious things, but cutting primary care out of the coverage would make it cheaper, and divorce your personal doctor from your insurer.
Poor folks could have their charges waived by the clinic, or paid for out of a community charitable fund – keeping the clinics local would promote this. If they need subsidies, I’d prefer local or state to Medicare with its gigantic record-keeping requirements and bloated decision-making process. The government could also help by making HSAs easier to use and making clinic expenses tax-deductible.
January 28th, 2010 | 12:41 pm
That all sounds great, Sparky, and my only quibble is that it still sounds terribly underfunded to me. Funding via state funds and/or charity is highly unstable (see California, state of). Plus the type of coverage you’re talking about cuts off the un/under-insureds just when they need it most, at hospitalization.
I think it would be easier and more stable to provide care via existing HMO’s, many of which are set up as not-for-profits already. Plus I don’t think it’s a good idea to completely divorce health care providers from the payers — that’s how we got our current big health insurers. I’d rather have the providers own the insurers, HMO-style. The providers set the priorities.
January 28th, 2010 | 2:06 pm
Good luck finding enough Drs to work such clinics.
Wesley J. Smith Reply:
January 28th, 2010 at 5:05 pm
David: Physician shortage is a problem for all health care reform. But a lot of the work could be done by certified nurse practitioners under the direction of physicians.
January 28th, 2010 | 5:40 pm
there are a bunch of empty GM dealership sites that would function for county access and parking and modification for exam rooms. All at a lower cost than building the sites from scratch. I just drove through a number of areas that have empty real estate as described.
January 28th, 2010 | 9:09 pm
Padraig:
Primary care by itself is fairly inexpensive, and that’s what makes the community clinic model attractive. It’s cheap enough for communities to fund themselves. Heck, most hospitals are sustained by charitable giving to some extent. The truly poor would still have Medicare/Medicaid, or charity care at hospitals if they needed it, but could now get more reasonably priced health insurance just to cover hospitalization.
I’m open to HMOs as well, but I had thought that people disliked them back in the 90s because they used physicians as gatekeepers.
David:
Clinics could be very popular by cutting insurance and the assorted paperwork out of the picture, giving doctors the chance to focus on practicing medicine. Pilot programs like Hello Health in NYC have attracted quite a few physicians.
January 31st, 2010 | 4:07 am
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February 1st, 2010 | 11:26 am
[...] are many other ways to make health care more affordable, for example, community based clinics. But no matter what system we adopt, we will need to triage government. If we believe health [...]
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