Community clinics not an optimal solution

It will take the suffering of many more before anyone will start to take this seriously.

It was interesting to listen to President George W. Bush’s stump speech last week and hear the name of Cedar Riverside People’s Center used as a symbol of a working health-care policy. The center is a community clinic in downtown Minneapolis. It applies to me because I work there as a physician. The clinic serves the uninsured and the underinsured of the Minneapolis area. As many community clinics, we are the last safety net of medical care. It is interesting to me that any community clinic could be used as a symbol of a functioning health-care system.

The clinic benefited from a grant received during the present administration, and we are grateful for the support. This grant is helpful, but it does not begin to meet the needs of our clinic and our patients. The idea that we are a symbol of a compassionate health-care policy is difficult to understand. The health-care debate in this country has gone the way of all politics, the politics of sound bites and dehumanizing opponents.

The fact that the wealthiest country in the world even has “community clinics” should be the debate, not that community clinics are part of the solution. If you take a look at the global picture of health care, you will see our clinic is a microcosm of what is going on with the entire system. Cost-shifting, also called tax reductions and the balancing of government budget deficits, has placed a burden on communities to find solutions to the problems they have created. With the growing number of uninsured and unemployed, community clinics have had to become an even bigger safety net.

Our clinic is responsible for caring for our nation’s uninsured. This means that the poorest of the poor clinics are responsible for the lack of accountability of an entire nation.

What is not clear to many is that the cost of not addressing our health-care disaster is only a delay of the inevitable. There was an attempt to discuss this national crisis approximately 12 years ago, but it became a political hot potato and was dropped. Everybody was scared by the sound bite of rationing.

For those of us working to serve the uninsured, it is clear that health care is already rationed. It is rationed between the haves and the have-nots. For many of our patients, preventative medicine is not part of their health care. At the clinic we are limited both by our resources to treat and our resources to prevent. We make decisions daily, balancing ways to help our patients, without putting our clinic at financial risk of having to close its doors (even with our present grant).

Many come to us after their medical concerns are advanced. Cancer, diabetes, heart disease, depression and high-risk pregnancies all bring great costs, not only in individual suffering, but also to the rapidly rising health-care burden. This cost is going to be shared by us all. The cost of health-care problems that are left unattended should be obvious to everyone.

It should also be embarrassing to a civilized society that this is even an issue. Unfortunately, it appears that it will take the suffering of many more before anyone will start to take this seriously. For those at the end of the trickle, in trickle-down economics, the debate on a serious health-care policy cannot begin too soon.

The health-care providers at our clinic are the most committed and highest-quality health-care providers I know. The difficulty of practicing medicine in an environment that makes you the only chance for quality health care is both rewarding and frustrating. The present system that makes our clinic responsible for the needs of so many, and also financially responsible if they are unable to pay, does not make sense in a civilized society. For a country’s health-care policy to place the burden of the care for the poor on the backs of the poorest clinic is neither compassionate nor conservative.

So maybe community clinics are “poster children” for our health-care system, but not for one that works.

Jeff Hanson is a medical doctor. This opinion is his and does not reflect or represent the staff or management of Cedar Riverside People’s Center. Please send comments to [email protected]