By Sen. Bernie Sanders

Our health care system is disintegrating.

Forty-six million people lack any health insurance, more are underinsured, we spend far more per capita than any other country, and our health care outcomes lag behind other industrialized nations. We remain the only major county without a national health care program guaranteeing health care for all.

And yet, as bad as the overall health care situation in the United States is, what is even more absurd is how we deal with primary care. Today, some 60 million Americans do not have a doctor of their own and far more lack access to a dentist.

As a nation, while we have an overabundance of high-paid specialists we have a major shortage of primary health care physicians, dentists, nurses and other medical personnel.

The result is not only that about 20,000 Americans a year die because of a lack of health care access, but costs soar as people who lack primary health care flock to expensive emergency rooms for their medical needs. Further, because people who lack access to a doctor often delay getting the medical treatment they need, they get even sicker and end up in a hospital.

That's the bad news. The good news is that with a new administration and a new Congress understanding the need to substantially improve primary health care, we are beginning to make some real progress. In the recently-passed stimulus package, Congress doubled the amount of money going to community health centers and tripled the amount of money for the National Health Service Corps, which will substantially increase primary health care doctors, dentists and nurses.

Community health centers, created by the Federally Qualified Health Centers program, have been around for a long time. More than 40 years ago, Senator Edward Kennedy had the foresight to author legislation creating the community health centers. Today, support for this extremely cost-effective program cuts across party lines. The program was expanded under President George W. Bush, is strongly supported by President Barack Obama, and has widespread tri-partisan support in Congress.

Today, community health centers provide primary medical care to 18 million Americans in underserved rural areas and inner cities. Their doors are open to all, including patients with Medicare, Medicaid, private insurance, and those who have no insurance at all. Furthermore, the centers provide their services on a sliding-scale basis, meaning that those with low incomes receive discounts. No patient who walks into a community health center is turned away because he or she lacks payment.

While we have made significant progress in the last year in expanding community health centers and providing increased support for existing centers, much more has to be done. Our goal should be to make sure that every underserved area in America has a federally-funded community health center so that anyone in the area can receive high-quality health care, dental care, mental health counseling and low-cost prescription drugs.

There is widespread support for this concept which would quadruple the number of community health centers from 1,100 to 4,800, and would increase, over a five-year period, funding for this program from $2.1 billion to $8.3 billion. As a result of the work of Representative Jim Clyburn in the House and a number of us in the Senate we have garnered strong support for legislation which would address this goal.

What creates a win-win situation is that as we increase primary health care access to all Americans, we actually reduce health care spending in our country by between $10 billion and $18 billion a year.

It is not often that we are presented program that meets critical needs while reducing expenditures by more than it costs. No wonder that federal auditors consistently rate community health centers as one of the most efficient uses of federal funds.

In the richest country in the world, no American should have to go without basic health care. Community health centers are a critical lifeline for millions of Americans and we must build upon their success by expanding them to all those in need.

This piece ran in The Hill newspaper.