Free clinic is vital till single-payer health care system arrives

By Andrew D. Coates
The Daily Gazette (Schenectady, N.Y.), Nov. 7, 2010

The Schenectady Free Health Clinic provides high-quality care to some 2,600 patients, about 18 percent of Schenectady County’s uninsured, free of charge. The need for the clinic is increasing.

The Census Bureau recently reported a one-year 10 percent increase in the uninsured – to 50.7 million people, or 16.7 percent of our population.  A jump of 4 million people is alarming. Harvard researchers recently showed that for every 1 million with diminished access due to no health insurance, roughly 1,000 people die.

Daunting out-of-pocket expenses, co-insurance payments, co-pays and high deductibles, together with unaffordable premiums, weigh upon everyone.  Our nation spends, per person, more than twice what any other nation spends for health care.

Yet for all the money, our health outcomes remain mediocre.  Among many health indicators the United States continues to rank dead last among developed nations.  In life expectancy our rank in the world is now number 49.

Awareness of the ongoing health care crisis led the Capital District chapter of Physicians for a National Health Program to sponsor a fundraiser for the Schenectady Free Health Clinic on Oct. 29.  As physicians we know intimately that preventable tragedy can result when money causes a person to postpone or forgo necessary care.

Because perverse financial incentives so often undermine the practice of medicine, we also recognize the Schenectady Free Health Clinic as an oasis of compassionate care. The event brought over one hundred people together to celebrate the best of our community, including its physicians, people who refuse to forget those most in need.  We are pleased to report over $8,500 in new donations for the clinic.

But is something wrong with this picture?  Health care crisis?  Free clinic?  Aren’t we supposed to be “status post health reform”?

The omnibus bill signed by President Obama earlier this year promises to decrease the number of uninsured starting in 2014.  Even so, the Congressional Budget Office estimates that if the new health law works just as planned, 10 years from now there will still be about 23 million people with no health insurance.

The cornerstone of the reform is compulsory private health insurance.  Curiously, although passed by Democrats, the individual mandate was first proposed by GOP leaders (including George H.W. Bush) and first enacted in 2006 in Massachusetts under Republican Gov. Mitt Romney. The legislation President Obama signed will make it federal policy in 2014.

From the Massachusetts experience we know that the individual mandate can neither control costs nor cover everybody.  Because health insurance is simply not affordable for millions who will be required to purchase it, under the new law federal taxpayers will give an estimated $447 billion by 2019 to private insurance companies to subsidize premium payments for those with low incomes.

The reform also aims to add some 16 million people to Medicaid by increasing income eligibility to 133 percent of the federal poverty level (excluding all undocumented immigrants and also legal immigrants who have lived here for six years or less).

Overall, regrettably, reducing by half the number of uninsured while expanding the influence of private insurance companies, means we still need free health clinics.  Health reform worthy of the name should eliminate that need.

At the fundraiser for the Schenectady Free Health Clinic, Dr. Paul Sorum, founder of the local chapter of Physicians for a National Health Program, made a spirited appeal.  He pointed out that the Schenectady free clinic reminds us all of the way medicine ought to be practiced.  Everyone should have access to comprehensive, quality care, with no payments for individual services, he explained, for user fees undermine the doctor-patient relationship.

A system of single-payer national health insurance remains the best way to provide access to care for everybody, with each person paying a fair share. Out of pocket expenses including co-pays, for necessary care, would be eliminated.

Fiscally responsible, single-payer would save about $400 billion annually, eliminating the wasteful paperwork and bureaucracy associated with multiple private insurers while creating strong cost-control tools, like bulk purchasing, needs-based planning and the elimination of profiteering from the sick.

Sooner or later a Medicare-for-all finance system will begin to heal our broken health system.  Until then, Schenectady Free Health Clinic will remain vital to our community.

Dr. Coates practices internal medicine in Albany.  He is assistant professor of medicine and psychiatry at Albany Medical College and newly elected chair of the Capital District Chapter of Physicians for a National Health Program.