Freedom of Choice Gap
One of our most cherished rights as Americans is our freedom of choice.
In choosing our mode of transportation, we Americans can either purchase a luxuriously expensive BMW; purchase a base-model economy Hyundai Accent; not buy a car and ride a bike or take a cab; take the subway or bus – a.k.a. government-funded public transportation; or, if truly destitute, we may get free bus fare from the government.
In choosing a place to live, we, as Americans, may purchase a luxuriously expensive mansion; purchase an older small affordable home; not buy a home at all and rent; qualify for a government-subsidized apartment; or, if truly destitute, receive free section 8 housing from the government.
Such is the case with most of our basic services in America, from buying clothing, to food, to education and childcare for our children.
However, there is an obvious gap when it comes to healthcare in America. If you are a high- to middle-high wage-earning individual, your healthcare is usually free or of minimal cost to you in relation to your income because your employer has generously provided you and your family with an excellent healthcare plan. The lower you are on the company totem pole, the less likely you are to receive a quality healthcare plan from your employer (unless you belong to a union that advocates for a quality health plan on your behalf) and the more you will pay out-of-pocket for healthcare when you need it. On the opposite end of the income spectrum, if you are truly destitute, you can receive free healthcare through the government.
What’s missing is an affordable healthcare option for those in the middle.
How do you obtain healthcare if you don’t have quality health insurance? You can pay out-of-pocket, but this can sometimes be completely unaffordable, especially when a diagnosis involves expensive treatments and medications. Just imagine the out-of-pocket costs for surgery!
Clinics Can Offer Quality Basic Healthcare
Clinics, also called community healthcare centers, are an excellent source of affordable healthcare for those who may have a job, but don’t have health insurance, or perhaps don’t make enough money to pay for out-of-pocket co-pays or other expenses.
Currently, the social stigma of a clinic is a filthy run-down building, located in a dangerous neighborhood, and packed full of sick and unkempt ne’er-do-wells. The only place I’ve ever seen such a clinic is on television.
While in college, every time I felt under the weather, I wandered over to the 24/7 free campus clinic and saw a doctor. I didn’t have to get an appointment, yet I was usually able to see someone within half an hour and I didn’t mind that I saw a different nurse and doctor every time. If I had an allergic reaction at four o’clock in the morning, someone was at the clinic to take me in. If I was seriously ill, the clinic transported me to the local hospital emergency room.
Some private insurance companies operate walk-in clinics as part of their managed health care plans (HMOs). These plans are typically much more affordable than traditional health care plans where patients see private doctors in that doctor’s office.
In addition, retail store pharmacies have begun to offer walk-in clinics as part of their services. Customers know in advance what they will pay because prices are clearly listed. Depending on their size, these clinics can offer everything from basic immunizations, strep cultures, blood tests, bone density screenings, eye exams, mammograms, and thorough physical exams.
However, not all cities are large enough to justify having a community health center. Many small towns do not have a clinic at all.
Clinics Can Operate Cost-Effectively
The National Association of Community Health Centers (NACHC) is a privately run, non-profit organization composed of representatives from both for-profit and non-profit clinics, doctors, universities, corporations, and other individuals throughout the United States. They regularly study and examine the costs, benefits, and impacts of community health centers on the general population.
Direct from the NACHC website:
“Community Health Centers have actually improved health outcomes and lowered the costs of treating patients with chronic illnesses, and have compiled a remarkable record of achievement in providing care of superior quality, with exceptional cost-effectiveness and efficiency. Their costs of care rank among the lowest, and they reduce the need for more expensive emergency room, hospital in-patient and specialty care. Both the Institute of Medicine and the General Accountability Office have recognized Community Health Centers as effective models for reducing health disparities and for managing the care of people with chronic conditions such as diabetes, cardiovascular disease, and HIV; and the White House Office of Management and Budget has ranked them as one of the 10 most effective government programs. The American Academy of Family Physicians’ Robert Graham Center recently found that the total cost of care for health center patients is 41% lower annually than the total cost of care for individuals served by other providers. Community Health Centers serve as living proof that providing high-quality, continuous care to people and communities without adequate sources of health care improves health outcomes, narrows health disparities, and generates significant savings to the health care system – up to $18 billion last year alone – while bringing much-needed economic benefits to the low income communities they serve. Once health centers reach the ACCESS goal of serving 30 million patients by 2015, the cost savings they generate for the health care system will double to $40 billion annually.”
Teaching Hospitals Offer Quality Catastrophic Healthcare
Some hospitals also operate as a “teaching hospital” by opening their doors to the public at extremely affordable sliding scale rates. While you are there, you will get the very best health care in the world: multiple doctors, a room full of eager and curious students; and the most recent technology and treatments available. Of course, you must be willing to be filmed or photographed – a small price to pay for excellent health care.
Sadly, few people live near a teaching hospital.
Step 5C - Government Run or Subsidized Clinics and Teaching Hospitals
Local, state, and federal governments currently fund and operate clinics throughout the United States. By expanding the network of existing clinics, both public and private, the federal government can help to ensure that every community, no matter how small, has access to a quality health clinic, community health center, and hospital that is open to everyone.
Contracts with existing clinics and hospitals
Private and county-run clinics, community health centers, and hospitals are usually found in large, metropolitan areas where they can serve the largest populations most efficiently. Where there is already an existing private clinic or teaching hospital, the federal government can contract with them to expand service to the general public.
Build new clinics in small and rural communities
To improve access to affordable healthcare in smaller communities, the federal government can explore the possibility of building a clinic and operating it themselves, or contracting with a private healthcare provider to do this.
No-to-Low Interest Loans and Infrastructure
To encourage private healthcare providers to build more clinics where there is currently a lack of them, the federal government can offer no- to low-interest loans for renovating, building, furnishing, staffing, and other start-up costs. The government can also step in to provide the necessary road and sidewalk improvements and other infrastructure. Public transportation to and from the clinic may also have to be created.
Access must be expanded to include everyone of all income levels
Many clinics currently are only accessible to individuals who are either considered low income, or to those with specific conditions, such as pregnant women or those carrying contagious diseases, where healthcare is provided for the welfare of the general public.
The past assumption of if you are earning a middle-class income, you do not need to go to a clinic because you can afford to go to a private doctor no longer holds true. Due to a lack of employer provided insurance, insurance policies which do not cover all treatments or costs, and the high cost of living, medical care has become unaffordable, even to those in the middle class.
Funding and Staffing
Funding for these clinics will come from a variety of sources:
Taxpayers
A portion of funding must come from the federal government, essentially from taxpayers. There is no way around this. Currently, clinics which are open to lower income and impoverished Americans are already funded by taxpayers. With proper budgeting and planning, the cost to American taxpayers should be minimal. The cost of building a clinic to serve the general public now will be cheaper than paying for the public’s expensive medical treatments down the road, after they file for bankruptcy.
Work Exchange Staffing
If you serve in the armed forces, you qualify for a college scholarship. The same work exchange system could be used to staff clinics.
Rather than take out a loan or rely on dear old mum and dad, students can go to medical school on the government’s dime. Within a few years of graduating, the student can then serve the same number of years in a community heath center or hospital as a nurse, doctor, surgeon, anesthesiologist, radiologist, or other medical expert.
Sliding scale payments
Patients can pay for costs on a sliding scale. For instance, a visit to a doctor could be the same as a co-pay which a middle-income patient would normally pay if they had quality health insurance coverage.
Public private partnerships
Private corporations may make donations of equipment and pharmaceuticals in exchange for generous tax breaks. Universities may offer their students to staff the facilities in exchange for the ability to do research using new diagnostic treatments, pharmaceuticals and equipment.
The National Association of Community Health Centers (NACHC) lists in its 2008 annual report a number of private and public partnerships in funding and operating community health centers throughout the United States. Covidien, a supplier of medical instruments, has offered $2 million over three years in matching grants to help renovate centers, and an additional $50,000 per year for training. Roche, a medical diagnostic and pharmaceutical company, has donated $1.75 million in Hepatitis C treatments. Pfizer pharmaceutical company has provided low-cost medications since 1993 through its “Sharing the Care” program.
Additional sources for this blog article:
Primary Care Access: An Essential Building Block of Health Reform
Income, Poverty, and Health Insurance Coverage in the United States: 2007
A few facts – food for thought:
While researching this article, I was able to find the following facts reported within the 2007 US Census.
Average salaries by earning level:
The total number of American households are divided equally into 1/5’s, called quintiles. The average salary per household in 2007 was $50,233. A household can be one person living alone, a family of four, roommates, or any group of people who live together and pool their money to pay the rent and utility bills.
The lowest quintile of households earn an average of $8,500 per year.
The second lowest quintile of households earn an average of $22,000 per year.
The middle level quintile of households earn an average of $36,000 per year.
The fourth highest quintile of households earn an average of $57,000 per year.
The highest quintile of households earn an average of $127,000 per year.
Total household earnings in relation to health insurance coverage in 2007:
24.8% of American households earn less than $25,000 per year.
Of these, 25% do not have health insurance of any kind.
24.8% of American households earn $25,000 to $49,999 per year.
Of these, 21% do not have health insurance of any kind.
18.2% of American households earn $50,000 to $74,999 per year.
Of these, 14.5% do not have health insurance of any kind.
32.1% of American households earn more than $75,000 per year.
Of these, 7.8% do not have health insurance of any kind.
How I Would Fix Healthcare
Step 1 – Employers must provide a minimum $300 health insurance policy allowance for each and every worker.
Step 2 – Insurance agencies may not take more than $40 per policy for profit and administrative costs.
Step 3 – Protect Health Insurance Surplus Coffers
Step 4 – Preventative Healthcare Maintenance Schedule
Step 5 – Improve Healthcare Access
Step 1 – Employers must provide a minimum $300 health insurance policy allowance for each and every worker.
Step 2 – Insurance agencies may not take more than $40 per policy for profit and administrative costs.
Step 3 – Protect Health Insurance Surplus Coffers
Step 4 – Preventative Healthcare Maintenance Schedule
Step 5 – Improve Healthcare Access
A. Institute a “public option”;
B. Regulate rates with blind menu pricing; and/or
C. Provide free clinics and access to community health centers
Stay tuned for steps 6 and 7
