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I first wrote about community health centers in the health care law in December, and have subsequently written at least 20 other articles referring to them. I maintain that it was the best money in the entire bill, adding the capacity for millions of people to access what amounts to a universal care program of free or near-free primary care medicine. They can also be centers for innovation in how we provide and even finance medical care, with the use of bundled payments and “medical homes” concepts.
Months and months later, the New York Times gets around to profiling one of these centers, in Portland, Maine.
First through the door of the Portland Community Health Center on Thursday morning was a stick figure of a man, oblivious to the homemade signs and the White House advance team across the street. He had a bald eagle drawn on his sweatshirt, a street-hard weariness in his eyes, and a throbbing pain in his right hand.
Sarah Andel, a nurse practitioner, knew this man, James Hierl: how he lived in a shelter; how his depression made eating seem futile. As she held his numbed hand, working to remove a painful wart with a blade, she coaxed and coddled him: You have to eat; you have to see your psychiatrist; and please, James, eat.
“You’re going to come back in a week,” Ms. Andel said, as her patient headed for the door, finger bandaged, cheeks concave, looking older than his 53 years. “O.K., James?”
Portland’s community health center is very new, having been established thanks to a stimulus grant last year. They provide care regardless of insurance or income, and patients pay a small fee on a sliding scale based on income ($3 per visit for someone making $10,000/year, for example). The center serves immigrants and low-income Mainers who would otherwise cost the state much more in uncompensated care. And the center appears to be a friendly spot for people to get both mental and physical health needs met.
With $11.5 billion in additional funding over the next five years, community health centers can play a major role in improving people’s daily lives, allowing them to be productive, even saving them from death. It’s an incredibly good, compassionate program and its importance should not be overlooked.
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will there be community health centers in just the big cities?
It is a uniquely U.S. tragedy that people are poor enough to require such medical services.
I wish the media would discover Food Banks too.
The FoodBanker Sister-in-Law is telling me some bad stories. This summer is going to be awful.
I’m lucky enough to live in a county where there is a public health clinic that is staffed enough to see patients. Extremely lucky. If it’s an emergency you won’t be seen that day unless they have a no show. But there are doctors, and adult and pre-natal care.
I hope you mean “If it’s NOT an emergency …”
I don’t think how this reads is what you meant?
What a salute to “American Exceptionalism”! This demonstrates how we’re innately superior to the rest of the Developed World and their Universal Health Care! People like James take great pride in their suffering, they know that by enduring needless pain and suffering, they ensure that no one important is over-taxed, which in this Country must be the primary consideration.
Like all patriotic Americans, the ever swelling ranks of the homeless, dispossessed, Veterans, mentally ill, and the evictees would much prefer to suffer their petty ailments and cheer on our mighty Army to victory than impinge upon the funding for a single sorely needed C-17 Transport and the employment prospects of
Senatorsworkers in over 40 States.Interesting Brit study reported in JAMA in the past week or so. Poor people aren’t as healthy and don’t live as long as well off people. They tried to attibute it to bad behavior on the part of poor people as the cause. (any surprise in this mean blame the victim world?) But science had its way with this study. The conclusion is that being poor is hard on you. Wonder how much that little piece of startling information cost the Brits.
The central limitation
These clinics are a great idea. I volunteer in one. Primary Care is, or should be, the hub of medicine, the resource available to the patinet to help him or her manage the full range of his or her care.
And that’s the problem wiht just providing free Primary Care, it’s only a part of the full panoply of medical services. A large part of what I do as a Primary Care physician is to be alert for serious illness underlying any new complaint of finding the patient may present with. But if I do find such, the patient will almost always need care from specialists. At that point, your community health center is dependent on the kindness of strangers. If the specialist service needed is limited, only involving one provider, we can often find someone to do the work pro bono. But the big stuff, even minor surgery, needs admission to a hospital, and the services of all sorts of technicians and specialists, and no one individual can donate the services of all these people gratis.
Primary Care isn’t an alternative to the full range of medical services, it’s just the most cost-effective and high-quality mode of letting the patinet manage that whole range of services, none of which are made unnecessary by Primary Care. Community Medicine Centers aren’t an alternative to full medical coverage, and won’t be until their patients can be freely referred to the whole range of medical services.