By Daniel Barlow, Vermont Press Bureau

MONTPELIER - Dr. John Matthew of Plainfield traveled to Washington, D.C., Thursday and told lawmakers that building a new network of primary care doctors needs to be the first step toward major health care reform in the country.

Dr. Matthew, the longtime head of The Health Center in Plainfield, told the United States Senate Committee on Health, Education, Labor and Pensions that there are 60 million Americans who cannot find a doctor because of a shortage in the field.

"The days of physicians setting up shop in small communities and suburbs, even if we did train a sufficient number to care for the population, are going fast, if not gone," Matthew testified. "No primary care physician has set up a private practice in central Vermont in many years."

Matthew was in D.C. to testify in favor of U.S. Sen. Bernard Sanders' proposal to quadruple funding for Federally Qualified Health Centers, community organizations that offer primary care, including for those without insurance or from low-income households.

Sanders' proposal would allocate $8.3 billion over five years for expansion of the community health centers program, increasing the total amount of these organizations from 1,100 to 4,800. It would also allocate $1.2 billion for the National Health Service Corps, a program that forgives medical debt for students who agree to work in underserved areas.

The bill by Vermont's independent senator is supported by the rest of the state's congressional delegation and U.S. Sen. Edward Kennedy, D-Mass., who wrote the legislation 40 years ago creating community health centers.

"The reality is that there are 46 million Americans with no health insurance," said Sanders, who presided over the Senate committee hearing Thursday. "But even if tomorrow, magically, we could provide an insurance card for every American, you would have 60 million Americans with insurance, but still unable to find a doctor or a dentist."

Matthew told lawmakers that The Health Center first operated as a designated Rural Health Center, but that often the reimbursement rates for services were too low and the office actually lost money for each Medicare or Medicaid office visit.

The organization later become a designated Federally Qualified Health Center, greatly increasing its reimbursement rates for many services, he explained. Because of that new designation, the office has grown in the last two years from 34 full-time and 19 part-time positions to 47 full-time and 30 part-time staffers, he added.

At the same time, the list of its patients increased from 7,800 to 9,400.

"We are expanding our medical and our dental staff to meet the unmet medical and dental needs in the area," Matthew said. "All of the local medical practices, other than The Health Center, have been closed to new patients for most of the past few years."

Dan Hawkins, the senior vice president of the National Association of Community Health Centers in Bethesda, Maryland, told the committee that such organizations are often the "entry point" for affordable care for patients.

"If every American had access to a community health center, we would see $500 billion in health care cost savings," Hawkins asserted.

But if the federal government was to clear the way for more community health centers, there would need to be a new influx of doctors to staff them, Matthew said. Expanding the National Health Service Corps would be a great step in that direction, he said, and reverse the decline of primary care.

"This is the essence of health care reform," he said.

Sanders said the trend among new medical students is toward entering highly-specialized and highly-paid fields that don't involve primary care for their local community. He said that trend - which he heard first-hand recently from Dartmouth-Hitchcock Medical Center students - needs to be reversed.

He said a medical student told him that his classmates thought he was either crazy or a poor student for considering entering primary practice.

"This is where we are today," Sanders said. "The most important work is disparaged."