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Revolutionizing Primary Healthcare | The Nation

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Katrina vanden Heuvel

Katrina vanden Heuvel

Politics, current affairs and riffs and reflections on the news.

Revolutionizing Primary Healthcare

"If you are willing to volunteer in your neighborhood or give back to your community or serve your country, we will make sure that you can afford a higher education."
-- President Obama, Address to Joint Session of Congress

I've always believed it's important that we redefine national service so that it isn't the exclusive province of the military. That is why this line in President Obama's powerful speech on Tuesday night was good to hear. One critical achievement in the Recovery bill was that it tripled funding for the National Health Service Corps (NHSC) to $300 million to provide incentives -- including debt forgiveness and grants -- for physicians and dentists, medical and dental students, to practice in underserved areas.

Thursday, Senator Bernie Sanders and House Majority Whip James Clyburn announced legislation that is very much in sync with the President's stated priorities. The Access for All Americans Act -- with 21 Senate cosponsors and 72 cosponsors in the House -- would greatly expand the Federally Qualified Health Centers (FQHC) program that currently provides primary care to 18 million Americans in 1,100 community health centers so that every American in a medically underserved area would have access to care. (Even George Bush supported this program.) It would also increase funding for the NHSC over the next five years to $1.1 billion, providing loan repayment and scholarships to those who pursue primary medical and dental care careers in underserved communities, recruiting 24,000 new healthcare professionals to serve those areas.

"Insurance coverage is not the only healthcare crisis that we face," Sen. Sanders said Thursday at a press conference at the Capitol. "Today, over 56 million Americans -- insured and uninsured -- are finding it extremely difficult to gain access to a doctor. They're looking all over their community, they cannot get into a doctor's office. This means that when [many] Americans get sick… they delay going to a doctor, then they end up getting sicker… and then go into an emergency room or end up in a hospital at great cost to our society and to themselves." He noted that 18,000 Americans die annually due to their inability to afford insurance or care.

The legislation is timely since President Obama -- who Sen. Sanders noted was the first co-sponsor of a similar bill he introduced last session -- signaled Tuesday night that he intends to focus on "preventive care, because that is one of the best ways to keep our people healthy and our costs under control." Also, President Obama announced that his 10-year budget will include a $634 billion reserve fund for healthcare reform, half of which "would come from proposed cost savings in Medicare, Medicaid and other health programs," according to the New York Times.

Both Sen. Sanders and Rep. Clyburn pointed out that federal community health centers in mostly impoverished areas -- providing doctors, dentists, mental health counselors and low-cost prescription drugs on a sliding-scale fee so that no one is turned away -- are one of the best ways to achieve those cost savings.

"The American Academy of Family Physicians found that total medical expenses for health center patients were 41 percent lower compared to patients seen elsewhere, okay?" Sen. Sanders later told me. "On average, Medicaid patients seen at health centers have total medical expenses per year that are almost $1,000 less than Medicaid patients who use other providers -- due to inappropriate emergency room use and unnecessary hospital admissions."

Sen. Sanders said that fully funding the bill would raise fifth-year spending from the current $2 billion for 1100 health centers, to $8.3 billion for 4800 health centers that would provide care to 56 million Americans. It's estimated that about 17 million Medicaid patients would be among those receiving care. Just through reducing expenses by $1,000 per Medicaid patient, this would save the health care system $17 billion, more than twice the amount Sen. Sanders and Rep. Clyburn propose spending on the health centers.

Rep. Clyburn reflected on the history of the program that was created in 1966 by one of the cosponsors of the current legislation, Senator Edward Kennedy. Sen. Kennedy was inspired by a clinic opened in Boston by two graduates of Tufts Medical School. The Majority Whip said that the centers have become "pillars in their communities" throughout South Carolina, often serving people who are "50 or 60 miles away from an emergency room."

In a statement, Sen. Kennedy -- who chairs the Health, Education, Labor and Pensions Committee -- said: "At a time when the cost of health care and the number of uninsured are rising, community health centers and the National Health Service Corps are more important than ever. From inner city clinics to low-income communities across the country, they make a large difference in the health of millions of our people… I look forward to working with my colleagues to strengthen these two vital programs as part of our commitment to achieve quality, affordable health care for all Americans."

Rep. Clyburn said he would be speaking with President Obama about the legislation later in the day at a Congressional Black Caucus meeting at the White House.

"Through these proven cost-effective programs, we have an opportunity, over the next five years, to provide comprehensive primary medical care, dental care, mental health counseling, and low cost prescription drugs in every medically-underserved region in the country, and remarkably, to actually save money in the process," Sen. Sanders later told me. "In this hour of deepening economic crisis, President Obama has called on us to invest in programs that work and that meet our people's needs. Community health centers and the National Health Service Corps do both."

With reporting from Capitol Hill by Nation Reporter/Researcher Greg Kaufmann.

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