Editorial: A Step Forward

Help for Community Health

If you're wondering what to make of 2,074 pages of mandates, regulations, tax credits, surcharges and government pilot projects that is the Senate health-care bill, we suggest you take a cue from Vermont Sen. Bernie Sanders, a reluctant supporter: “The bill is not as strong as I wanted, and I will work to improve it, but it begins to move this country toward the long-time goal of providing comprehensive, affordable health care for all Americans.”

In other words, it's a start.

Sanders would have preferred a bill to impose a Canadian-style single-payer health-care system. But he agreed to support the unwieldy legislation in exchange for an extra $10 billion for more federally supported health centers. That wasn't such a bad bargain, considering other party favors the Democrats doled out during Senate negotiations in order to win the 60 votes they needed.

Federally supported community health centers are nonprofit medical facilities open to all, regardless of an individual's ability to pay or insurance status. Most of the nation's 1,200 community health centers and 7,500 satellite clinics are located in places where primary care and other medical services are hard to find -- rural areas and inner cities.

“This is not gonna solve all the problems of the world,” Sanders told The Nation. “But expanding access to high-quality primary health care and low-cost prescription drugs and mental health counseling and dental care -- which is a big issue -- this is a very significant step forward. If you walk into a health clinic and you have no insurance at all, they will treat you on a sliding scale basis. So, that's affordable health care.”

Some 20 million people -- most of them low-income, uninsured patients -- use community health centers nationwide. That includes more than 160,000 people in the Twin States; Vermont's eight community health centers and 46 satellite offices, in fact, serve one out of every six Vermonters, the highest rate of use per capita in the country.

Additional funding on the order of $10 billion would help community health centers such as Little Rivers Health Care in Bradford, East Corinth and Wells River hire more doctors and possibly expand to other sites (the House version of the health-care legislation calls for spending $14 billion). It would also allow for the construction of new centers in 10,000 additional communities across the country, according to Sanders, as well as finance the training of 20,000 more primary-care workers through the National Health Service Corps. Sanders' office estimates that such an expansion would help 25 million more Americans, bringing the total served at community health centers to 45 million.

No, this will not solve all the problems in U.S. health care, but an increase in community health centers complements what is perhaps the most important piece of the legislation being worked out in the House and Senate: the expansion of health insurance to some 31 million more Americans. As Sanders' health policy adviser points out, a federal requirement to carry insurance won't improve health care unless there are sufficient health-care workers, especially in medically underserved areas. More federally funded community health clinics should improve access to care.

And medical costs should go down. A George Washington University study found that $14 billion spent on community health centers would save $23 billion in Medicaid expenses. That's because primary care is cheaper and more cost-efficient than emergency-room care.

Incremental changes -- such as expanding community health centers -- may be the best anyone can hope for when it comes to reforming American health care. As Sanders said, “We can do better, but this is an important step forward.”