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Universal Health Care - Using Primary Care as the Building Block for Reform
Tuesday, July 1, 2008
(Ron Carlson) --
The current political debates have resurfaced
the issue of "health care for all". It's
clear in listening to the exchange of views
that the subject of universal health care is as
contentious today as it was twenty years.
Questions are still being asked about how the
more than 47 million uninsured will be assured
access to medical and health care
services. And the perennial "stopper" is
not whether there is a need, but where the
money will come from to pay the bill. Of
course, the estimates are more staggering than
ever especially given the country's rather
dismal financial outlook. A clearer and very
different direction is needed if we are ever to
realize our goal. My recommended
approach: rebuild and expand the system
of primary and preventive care services and
capacity.
The job of health care reform
is overwhelming no matter how focused the topic
might be. What's important however, is to
create the environment that best assures the
opportunity for "new and critical
thinking". This means taking two
important steps. First, take the
so-called "big ticket" items of hospital and
specialty care off the table so that undivided
attention can be given to the lesser expensive
parts of the system, namely, primary care and
preventive care services. Second,
identify the areas where the health care needs
are the greatest and the enhancement of
services are most apt to yield a positive
return in terms of improved health status and
reduced costs. The bottom line: set aside
the parts of the system that are politically
and financially "impossible" to resolve in the
short term and work on the "possible" by
mapping a course of action that will bring
primary and preventive care to the more 56
million people who don't now have
them.
Just a few years ago when
comprehensive reform of the U.S. health system
was on everyone's radar screen, it seemed as
though the "universal health care" door would
finally open. Several proposals were
given a lot of attention and it looked as
though one of them might make it, especially
the program (however complex) developed by the
Clinton Administration back in 1993. The
reform ideas were ambitious and all had one
theme in common, i.e., assure that everyone had
access to primary and preventive care service.
Unfortunately, and to the disappointment of
many, the reform initiatives failed for one
reason or another. The impact of these
set-backs were enormous. This had
long-term consequences that resulted in the
country being worse off, because of economic
issues, than it was more than two decades
earlier. While there were changes such as the
State Children's Health Insurance Program and
the controversial Pharmaceutical coverage under
Medicare, they only marginally advanced the
goal of universal health care. There were
no significant changes in entitlement programs
that benefited access to primary care and
preventive care
services.
Investing in Primary Care Makes
Sense
The National Association of
Community Health Centers (NACHC) is the
organization that represents the more than 900
community-based health care providers of
medical and health care services to the
medically underserved throughout the
country. For the most part, these are
Community Health Centers (CHC), some of which
have been in operation since the 1960s.
The program for more than forty years has
continued to grow so that it now serves more
than 17 million people in some 6,000
communities. The Chase
Brexton Health Center in Howard County is an
example of one such provider. Other CHCs
and Federally Qualified Health Centers are
distributed throughout underserved areas in
Maryland. NACHC recently outlined its very
ambitious vision for America's future health
care system. The goal, while
far-reaching, may be much more realistic than
it first appears. It invites policy
makers to step back and …"imagine a health
care system in which every person in America
has access to comprehensive primary health
care, regardless of their ability to pay, while
at the same time the cost of care actually goes
down". The vision is certain to capture
everyone's attention because it so clearly
paints picture of what universal health care
should be and what it should accomplish.
As if often the case, there are skeptics including those in the insurance industry and even many consumer advocates who question the wisdom of taking this course, especially one proposed by the NACHC. Why is that? Because Community Health Centers are generally seen as the providers of "last resort"; as clinics that serve only the poor, or since government is involved, the quality of care will be marginal and waiting times will be excessive. Of course, the greater "overarching" worry is that to go down the NACHC path is to lay the seeds for an unwanted "National Health Service" along the lines of the program found in Canada and throughout the European community. But once surviving the initial trauma, again step back and ask the question, "why not a plan to develop a "national health service in the U.S.A."?
Based on the data available from the federal Department of Health and Human Service there are good and positive reasons to look further as to the feasibility of pursuing the NACHC vision. Community Health Centers have demonstrated over the years that they improve health outcomes and lower the costs of treating patients with chronic disease. In tracking the performance of CHCs across the country the data demonstrate that "their costs of care rank among the lowest in the nation, and in addition reduce the need for more expensive emergency room, hospital in-patient and specialty care". NACHC estimates savings to the health care system to be in the ballpark of $18 billion last year alone. Both the Institute of Medicine and the General Accountability Office recognize Community Health Centers as effective for reducing health disparities and very importantly, for managing the care of people with chronic conditions. Even the White House Office of Management and Budget ranks CHCs as one of the ten most effective government programs.