Thursday, December 10, 2009

Free clinics should open our eyes to the real problems

On December 9 and 10, 2009, a massive “C.A.R.E.” clinic, sponsored by the National Association of Free Health Clinics occurred in Bartle Hall, the huge Convention Center in Kansas City. On the first day alone, with temperatures well below 20 degrees and the roads covered with ice from the snow that fell the night before, as many as 1,000 people showed up to receive health care from 1,600 volunteers, including 100 doctors, dentists, and nurse practitioners. It may end up seeing more people than similar events previous held in Houston, New Orleans and Little Rock. There is excellent coverage of the event in an article by Alan Bavley in the Kansas City Star, accompanied online by photos and videos by the Star’s Todd Feeback.

The purpose of these clinics is, of course, to provide some care to the people who attend – often the only care they have gotten in years. People were diagnosed and sometimes treated for acute conditions, such as pneumonia, or diagnosed with chronic diseases such as high blood pressure, high cholesterol, and diabetes. Indeed, most often they were really re-diagnosed; they knew they had these conditions but had been unable to afford medications or medical care. But another, even more important purpose, as Sherri Wood, Director of the Kansas City Free Clinic, says in the video, is to “put a face on the uninsured”. They are not only, or mostly, homeless, alcoholic, completely down-and-out, or even mostly unemployed. Rather, they are employed in low-wage jobs (not infrequently 2 or 3 jobs!) that do not offer health insurance, or they are employed part-time so that their employer does not have to buy their insurance. They are people, American people, our friends and families and neighbors. And they could be us; most Americans are a layoff away from uninsurance, and not too many paychecks away from dire financial straits and even homelessness.

The excellent accompanying editorial in the Star is titled “Massive free clinic at Bartle Hall a great event, but reform is still needed”. The editorial, along with the story, includes interviews with and comments from people who came for services (“Making three dollars an hour plus tips I can’t afford to see a doctor. When you have a house payment and your bills, it’s hard.”), but it also clearly states that “Although impressive, the free clinic clearly is no substitute for reliable medical care”. Yes, indeed. Or rather, No, indeed, it is certainly not. “Charity isn’t a good substitute for justice”, as I have quoted Jonathan Kozol before.

The Star editorial goes further, making the point that I have often made that a solution to the health care problem includes producing more primary care physicians. “Too many medical school graduates gravitate to high-paying specialties partly to pay off burdensome student loans.” We must, it says, “…encourage physicians to take up primary care.” It is appropriately critical of the fact that “The reform bills in Congress contain few incentives to set things right…Expanding access won’t work unless we start now to increase the supply of primary care physicians.”

So the problem is clear. And the solution is clear. Universal health coverage. Based on the principle that we need to ensure that people receive care, not that for profit companies make money. It has been figured out by every first-world (and some not quite first world) countries. It is not tricky, difficult, or even expensive (certainly not compared to what we are spending now). Not that it will happen, or happen easily, as the “debate” in Congress is currently demonstrating.

Maybe some of the opponents of real, meaningful, comprehensive health reform are just mean, evil, selfish people. I don’t rule that out. But more likely they are “blinkered”, like a horse, looking at only one aspect of the problem, such as the Kansas legislator who is proposing that our state refuse to participate in any health reform plan passed by Congress. (I am trying really hard to believe that this is his/her issue, being like the blind men of India with the elephant, not that s/he is mean, evil and selfish.) Plus the campaign contributions from the insurance companies and drug companies and health providers who are doing just fine, thank you, under the current system of literally leaving people out in the cold, help sway their beliefs.

It is time for the leaders of our country to stop compromising on a core need of our people, and ensure that everyone has access to quality health care. And they can do it in a responsible and cost effective manner through a single payer system, although there are other alternatives. The Star editorial says “A compassionate and cost-effective system would provide every American with a medical ‘home’ from which to receive preventive and needed care.”

I hope that most of our congressmen and other leaders are compassionate, and am certain that they wish to be cost-effective. But they need to abandon pandering to big contributors and keep this core value front and center: Quality health care for all.

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