De kliniek die wint van de dokter die van Clinton won

[Cees Binkhorst]

REPLY TO: D66 at nic.surfnet.nl

Zie ook mijn mail 'Mijn dokter won ook van Clinton' van 22maart10.

Het onderstaande bericht is waarschijnlijk het antwoord op de dokter die
ook van Clinton won, die graag zijn inkomen op het oude peil houdt ten
koste van zijn landgenoten.

Groet / Cees

The Unsung Victor of Health Care Reform
http://www.thebigmoney.com/print/5999
By chadwick.matlin
Created 03/24/2010 - 1:07am

Nine months ago I was in Nashville [2], standing inside of an empty
hardware store that was supposed to become a community health center by
October 2009. The same day, President Obama was in the White House Rose
Garden, telling us health care was going to be passed soon. After months
of delays, the health center is finally set to open next week. After
months of delays, Obama finally signed a completed health care bill on
Tuesday [3].

It’s only fitting that the progress of each was indirectly related to
the other. Nationally, community health centers were hoping for health
care reform like a criminal prays for a pardon. Without reform, health
centers could suffer through the status quo, but there’s no way they
would have had the freedom to expand. And that expansion was necessary
to keep up with the increased demand for medical services for the newly
unemployed and uninsured. But now that health reform is law, health
centers—and their quirky, nonprofit, federally subisidized business
model—are the lynchpin of making sure we can actually treat all these
newly insured Americans.

Outside of veterans’ hospitals, community health centers are the closest
we presently come to government-supplied health care. Every one of them
is nonprofit, with the government (federal and state) bankrolling them
in part through grants. Their task is noble: to provide medical care to
even the uninsured, regardless of their ability to pay for it. Of
course, that assumes the health centers have the resources to do so.
Those resources—staff, supplies, equipment—cost money, especially when
you’re trying to woo a medical student with hundreds of thousands of
dollars in debt to work amidst urban blight or in a rural backwater. To
pay for those doctors, then, you need some revenue. And to generate
revenue you need people to pay for services. That’s where the insured
ones come in.

As of now, 60 percent of health care patients have some kind of
insurance. They pay for the 40 percent who do not. On the surface, the
system appears to work. Mainly because there’s no way for it not to.
Nationally, health centers have been breaking relatively even,
overall—in 2008, they had $10.065 billion in costs, $10.059 billion in
revenue. But that’s because the centers have calibrated their costs down
to how much money they can bring in. And that calibration has left many
patients without adequate care. In order to expand, health centers need
even more people who can pay for not only their own care, but also for
that of the uninsureds. This need has grown increasingly acute; last
year health centers saw a 21 percent increase in uninsured patients as
employees got laid off and lost their insurance.

That influx put a greater strain on the system, one that the stimulus
stepped in to alleviate. The stimulus funneled $2 billion to community
health centers, partly as a stopgap measure to fortify the existing
infrastructure when all those newly unemployeds came coughing through
the door, and partly as an investment in a future Obama was convinced
would soon come to pass—a future with new centers to help
freshly-insured Americans. Nancy Pelosi broadly articulated the point
right before the vote Sunday night: “This began over a year ago under
[Obama’s] leadership in the American Recovery and Reinvestment Act.”

When I was touring that empty health center in Nashville last summer,
the woman in charge of it, Mary Bufwack, told me she was appreciative
for the stimulus money that helped build it [2]. But a lack of health
care reform would just as soon tear it down. “[It's] wonderful because
now we have a doorway in. I hate to think it's a doorway to nowhere,”
she told me then.

Now we at least know who’s waiting on the other side of that doorway: 32
million people eager to flash their new insurance cards. A large swath
of them are going to end up in community health centers like Bufwack’s.
Of those 32 million, 16 million are going to be insured through
Medicaid, which means they’re low-income people likely living in
low-income areas. Those are precisely the places where nonprofits put
community health centers. Bufwack estimates that two-thirds of her
patients who are currently uninsured will be covered by the new Medicaid
provision. For that 32 million, health centers aren’t just safety nets,
they’re often the only line of defense.

Which makes the stimulus investment, premeditated though it was, seem
prescient. But that $2 billion wasn’t enough to prepare the system for a
crush of newly insured patients. Luckily for the health centers—but not
as lucky for those currently ill—the Medicaid expansion and the new
insurance mandate don’t kick in until 2014. That gives them some time to
build a few new wings, hire a few new doctors, and go to Costco for a
few new filing cabinets. To do all that, the new health law gives the
centers $11 billion. When the insured masses start knocking on the door,
the health centers better be ready.

Because if they aren’t, we’re going to have a problem. A Massachusetts
kind of problem. After Massachusetts forced its residents to have
health-insurance, it realized it didn’t have enough doctors to actually
care for all these people [4]. The same thing will happen nationally if
health centers don’t get their act together in time.

Luckily, the health centers’ business models are well-suited to scale
up. The biggest drag on health centers’ growth thus far has been the
lack of insured patients. With more people insured, they’ll have more
revenue to toss around, which will help them build more centers for the
people who still aren’t insured—illegal immigrants, mainly. And because
they’re nonprofit, they don’t have to siphon money from this huge new
revenue stream. It just goes back into the system. Or as Bufwack might
put it, it just goes back around the revolving doorway.

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