the Independent in Vermont and health care

Dr. Weeks Comment:   Laura worked for Bernie back when he was mayor of Burlington and he is a prince.

August 15, 2009

Op-Ed Columnist

Hard to Believe!

Plainfield, Vt.

It was strange to find in this economically stressed, rural region of Vermont, not far from the state capital of Montpelier, a good news story about health care.

Those who live in the area, no matter what their income, can get high-quality primary care, dental care, prescription drug services and mental health assistance at a price they can afford. All they have to do is call or stop by the Health Center at Plainfield, which is part of a national network of centers that are officially (and clumsily) known as Federally Qualified Health Centers.

I was somewhat skeptical when Senator Bernie Sanders, an independent from Vermont, told me that these centers (there are 39 sites of various size in the state) had “essentially solved the problem of primary care” for local residents. Politicians are in the business of making big claims. Most of the time you don’t hold it against them. But you don’t take the claims as gospel, either.

In this case, the senator’s claim seems to be very much on the money. The center at Plainfield is modern and well equipped, spotlessly clean, quiet and efficient. Patients that I spoke with marveled at the friendliness of doctors and staffers and said they never felt intimidated. Appointments are easily made, and if it is necessary to see a physician on the same day, or within 24 hours, that is usually not a problem.

All types of patients are served at the center, from the well off to the impoverished. There is a sliding scale of fees for patients without insurance. They are charged what they can afford. No one is turned away.

“This place is so important,” said Kathleen Hoyne, who was at the center with her 14-year-old son, Daniel. “Neither my husband nor I have health insurance through work.” Daniel, she said, is covered by Vermont’s expanded children’s health insurance program.

There are similar health centers across the country serving primarily low-income patients in areas where medical services are scarce. They are a crucial resource, even in those cases where staffing is difficult or other challenges arise. But there are not enough of them.

What is impressive is how much sense the centers make. They are nonprofit and receive federal support, but they don’t require a ton of taxpayer dollars. By focusing intently on primary care and preventive services, they save tremendous amounts of money.

Given the toxic tone of the current health care debate, it’s interesting to note that the centers actually have significant bipartisan support. (President George W. Bush was a strong advocate.) And the Office of Management and Budget has rated them as among the most efficient and effective users of taxpayer money.

Nearly 10,000 patients are served by the Plainfield center, which is a godsend because there are no other primary care physicians in the vicinity, and very few dentists in private practice will treat poor patients, who usually are covered by Medicaid.

When you look at the number of people who are served by these health centers nationally and then look at the number still in need of the services, you begin to get a sense of the scope of the crisis in health care in the U.S. The centers currently serve about 20 million people and receive approximately $2 billion a year from the federal government. It is estimated that another 40 million people in medically underserved areas, primarily rural areas and inner cities, need the services a health center would provide.

Senator Sanders and Representative James Clyburn, a South Carolina Democrat, are sponsoring legislation (as part of the current push for health care reform) that would quadruple the number of centers across the country over the next five years.

In the areas served by the centers in Vermont, the problem of access to primary care does, in fact, seem to have been solved. The centers not only provide patient care, they offer transportation (often crucial in rural areas), counseling, health education classes and a range of other community services. And still the costs are substantially lower than average for comparable health-related services.

Twenty miles from Plainfield, at the Northern Counties Dental Center at Hardwick, I ran into a stark example of the difference that proper health care (in this case, dental care) can make. Armando Gelineau, a grizzled, toothless old-timer who has spent much of his life coaching boxing, was leaving the center with his granddaughter, a young woman named Morgan Worden.

When Ms. Worden smiled, you couldn’t help but notice that her teeth seemed perfect. “I come here every six months for a checkup and cleaning,” she said. “They’re very friendly.”

Mr. Gelineau laughed, flashing his gums. “They didn’t have that in my day,” he said.


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