If community clinics are gonna become our public option...

[juno jones]

I don't OP much, but I'm putting on my pragmatic hat now. I think that unfortunately we're gonna get what we're going to get from these bastards in our congress and they will act the whole time like their pubic hairs were plucked painfully one by one whilst drinking hot lead just to get WHERE WE ARE NOW.

If community clinics are to become our public option they need some serious re-tooling.

I know there are many benefits to these clinics and many do a wonderful job despite their limitations. I go to one now and the fact that my doc there helped me diagnose a minor chronic problem that other docs I trusted had brushed aside makes me eternally grateful that such a system exists and there are a few good docs in it.

However...

Community Clinics are great in inception, but in this country are sorely lacking in resources, goals, and sadly in some, heart. As they exist now, it is medicine of last resort and in no way resembles the private clinic or office of your local GP.

These are some of the disparities that I would wish be rectified before we plunge headlong into funding this:

1) Make sure that equal resources are allocated at every level. Community clinics should do everything in house that a normal clinic does, and any referrals should be subject to the same sliding fee scale. Clinics in poor neighborhoods and towns should be as comfortable and well-stocked as the clinic in the 'nicer' neighborhoods. Pain medicine for acute afflictions should be offered when appropriate and out-of-house chronic pain management should be willingly offered and on the same sliding scale as other treatment. That same sliding scale should be available for out-of-house tests like x-rays, sonography, thermography, blood tests, etc and all tests should be covered, not just basic ones. There should be a system to at least triage some minor acute emergencies to reduce the number of people sent to ER's when treatment at one's clinic would have been more appropriate.

2) Make those clinics are at least part UncleSamgovt owned and not extensions of the 'faith-based' octopus that is attempting to eat out public education. I know this is a little optimistic, but I think we should set standards that are requirements for participating in the national clinic funding via this bill. Much of our community system already depends on systems like the catholic hospital in which you can not utter the name of the Pill. The health of women, transgendered, gay, etc depend on being able to find healthcare in a non-judgemental and secular setting. Now even more so, it seems.

3) Make sure the eligibility requirements as measured in this country is brought up to a standard that guarantees a basic income in this country including protections for the worker and make all state medicare requirements nationally reflect that standard. The working class does the heavy lifting of our society, but earns little praise or recompense for it, generally getting kicked to the side when they eventually wear out. The poverty levels need to reflect a true living standard for citizens and eligibility for medicare and subsidies must reflect that level in all states, even Alabama. There has to be recognition of occupational repetitive illness as a factor in debilitating illness and better long-term care of people injured on-the-job via medicare, etc.

4) The adjacent dental offices need to be accessible not just to children and dire emergency, but to adults who wish to have preventative and maintenance care of their teeth as well. This should also covered to some extent and the remainder be billed according the a sliding scale as well. Bad teeth can fuck you up. So can no teeth. Teeth are not cosmetic and should never have been considered such except for procedures like caps and whitening.

5) Last but not least, modify the unrealistic means testing standards for medicare eligibility. You should be able to own your home, a decent car and have a retirement savings. And there should be no coming after your estate for 'repayment' when you die. This is punative of the middle-class and poor, many of whose illnesses took root in the jobs they performed as contributing members of their society, swallowing the last of their assets to pay for the profit of others.

We need to start shaping the community clinics NOW, sending a message to our congresspeople that blatant discrepancies in care based on income are not going to fly, especially as more and more middle class are forced to use these clinics due to the sliding scale and medicare assistance. We need to jump now before the spin, before the hands go out for the funding. We need to keep this from becoming a faith-based morass like education is becoming. We need to do this for us.

I think we should get ahold of our progressive reps and cite these points and others not addressed in this OP. I intend to send some version of these thoughts on to my rep and senators. We need to demand that there be no ghettoization of treatment! No double-standard two-tier system! I sm posting this OP as a cautionary tale, because I, and many of my friends have been dealing with this sort of thing for years. If you have not, nor anybody you know ever encountered this, then you are either extremely fortunate...or unfortunate as there are many 'poor' people who are wonderful friends with so much life experience to share. I don't wish the experiences I've had with bottom-tier health care on any of you, so lets make it better for all building a strong support for a future universal system of care. I think all reasonable people no matter their take on the bill can agree that we can work together to insure fair treatment for all.

The next life you save may be your own.

If we feed the Pony properly the 'sausage' on the other end will be firmer and stink less. To mix a metaphor.

Just some thoughts. If you have thoughts to add, I would love to hear them.

[leftstreet]

1. People won't have any interest in community clinics until they're forced to use them

Excellent OP - this is where the focus should be for quality care.

[juno jones]

2. Sad but true.

But I'll play Cassandra for now. You never know. :hi:

[cali]

15. If they're good, people- with and without insurance- will use them. nearly 20%

of Vermont's population uses a CHC for their primary care.

[juno jones]

25. I would love to see income dissappear as a motivator for using these clinics.

The care would improve if it was serving a larger and more diverse portion of our population. Frankly many middle class people wouldn't stand for things the poor accept simply because they lack the choice to leave. It would be nice to have parity of care for all and an influx of people used to decent care could do nothing but improve the situation. the poor can't do it alone, we need the middle class to stand by us, since we really are all in the same boat, just on different scales. :hi:

[jwirr]

26. Most of our people in Minnesota use community clinics and are

referred for special testing. Some post here seem to be saying community clinics are different than what I am talking about - are we talking free clinics or women's health clinics or what. I have been thinking about our First Plan HMO clinic that was originally started by the Railroad and is non-profit.

[juno jones]

27. They are in WA state too.

But often referals do not always guarantee the same sliding scale availible at the clinic itself, thus pricing them out of the reach of some. They will try to find someone to work with you, but they can't always.

[Hello_Kitty]

3. A most enthusiastic K and R for this post! eom

[juno jones]

4. Thanks!

:hi:

[MineralMan]

5. Good ideas.

I like the idea of government run primary-care clinics. Either that or heavily regulated clinics run by a consortium of the local hospitals. They'd be interested because of the ER overload so many of them face these days. ERs are handling so much primary care that goes unpaid for that I think a well-proposed clinic system would get some interest, even from the commercial hospitals.

But I'd prefer government-owned and operated ones. It could be local governments, supported with federal grants, which would be more palatable than federally-run clinics.

[juno jones]

10. Good idea.

Thanks!:hi:

I really would prefer the government to have the hand in it. That's one of the reasons I posted this. I got to wondering if we would be opening up the same kind of chasm in healthcare that is tearing apart our school system now. I gave birth in a catholic hospital because it was cheaper for medicare, however, many of their subtle religious policies (like saving the baby over the mother) were never explained to me beforehand. I didn't even think about it until after I had delivered and my doc shhh-ed me when I asked when I should start using BC again.

If we are going to have to pay for it, I want it all, or at least a mandatory referral to someone who will.

[WhiteTara]

6. I loved my last community clinic

and if there was one here, I would go in a heartbeat. I agree that 'faith based' clinics aren't the answer.

[juno jones]

11. My current one is actually 'faith-based'.

I like them so far. They're called Interfaith and I suspect they're more Methodist-Lutheran than crazy baptist in leanings, although since I'm a straight white female who took herself out of the breeding pool 15 years ago I don't have much opportunity to discover their shortcomings.

I just want to make sure certain standards are enforced and referrals mandated when questions are raised about something the clinic can't provide on premise. :hi:

[polmaven]

33. If your current clinic

is faith based, then it is not part of the CHC network for which Senator Sanders arranged additional funding. Those are federally and state funded and do, of course also accept all insurance plans. They are non profit, and actually must follow certain federal guidelines in order to continue receiving the grants/endowments, etc.

The Boards of Directors are all volunteer, and must also meet some federal requirements. They are not in ANY WAY faith based.

I am employed, with insurance, and I have been a patient of a CHC since 1990, and a member of its Board of Directors since 1992.

How many of the private clinics you know of actually make house calls to its more elderly and/or infirm patients?

edit to add......The Community Health Centers referred to by Senator Sanders were actually first brought in to existence by Senator Ted Kennedy.

[jwirr]

7. It is medicaid that is means tested not medicare.

[juno jones]

13. Yes.

I'm sorry, That was a hard sentence and I obviously didn't get it right. :) It's a very confusing thing, not helped by the similarity of terms. :hi:


From what I've seen, many permanently injured are denied medicare despite their debilitation. Some of these people are on medicaid (which is not the same thing) because of their income. Some aren't, but are still just as crippled. They should be allowed medicare, which is a far better and more secure system, mostly because it ISN'T an income-based benefit. However, in a mandatory system, there shouldn't be any disparity between the medicine the rich and poor recieve, so maybe the difference between the two would become moot.


I would hope that either coverage would be acceptable at the proposed clinics.

[jwirr]

24. Just wanted the post to be correct and you are right before they finally

let you on Medicare for disability almost everyone spends some time using Medicaid. Both programs are important to community clinics so your basic statement is correct. I think what you are saying is very important because they are local and there are things we can do to help improve them. Our clinic and hospital work together on ownership of the big diagnostic machinery. I also think both are non-profit which helps. Thank you for your post.

[KittyWampus]

8. maybe if Americans have to start using these clinics they'll be more inclined to get off their asses

to make sure they are in better condition.

[juno jones]

14. I would hope so

But hope springs eternal and all that. :hi:

[defendandprotect]

9. Insurance companies are probably passing legislation now to STOP losing their

customers in this way!!

[juno jones]

16. If a line cook from Wa state is thinking it, I'm

sure that some creep somewhere is already on it. :hi:

I just want to throw out a new line of questioning. We have only days to start shaping the clinics before the companies digest the rotting carcass they've been thrown and start moving against us again. I would think Saunders and the progressive causus might be interested in a few arguements for improvements that might make the unsweetened kool-aid go down a little better.

[prairierose]

12. These are very good and...

important ideas. I am bookmarking this so that I can come back to it and write letters to my congresscritters based on this.

[juno jones]

19. Thank you.

I hope we will get more ideas from folk on this thread. I don't mind community clinics, but I don't want any of this 'separate but equal stuff', we know where that leads.

:hi:

[global1]

17. Get Your Thoughts Over To Sen. Bernie Sanders.......

he was the one who got the $'s in to the HCR for community clinics. He should now be enlisted to shape those clinics into something that will be good for us.

[juno jones]

21. Thank you.

I hadn't thought of him, but I will do that. :hi:

[laughingliberal]

18. K & R nt

[juno jones]

22. ...

:fistbump:

[Gregorian]

20. We have a post office in every town. Why not a good clinic.

I've lived in a few places. From Stanford to Coquille. And Coquille is no Stanford in terms of medical help.

Look, I know we can have clinics in every town. But that doesn't mean we can have good ones in every town. This is my big gripe. Unless one lives in an extraordinarily good metro area, the clinics generally suck.

I'd like to see a...oh the hell with it we just went through this. Americans are too stupid to know what's good for them. I just hope I don't get sick enough to really need help. We aren't going to become a smart nation over night, I guess. I was going to say that what we should have is a good VA style health care facility in every town. One that is staffed by quality medical staff.

I guess that just makes too much sense.


So yes, I agree with your post. And why is it that we cannot seem to get what the people need and want. I shouldn't be so hard on Americans. It's their misrepresentatives who are causing the trouble. Lieberman.

[juno jones]

23. I know.

What you have decribed is very much what we need. I hope we can keep real government involvement in these clinics rather than handing them off to management orgs and faith-based groups.

Thank you. :hi:

[jwirr]

31. I don't think most of our communities could afford a VA type facility.

I live in an area where most small towns are around 5000 to 15000 population and we surround Duluth which is bigger. Most of our little communities have clinic with 2 or more doctors and visiting specialists who come from the Duluth clinics every so many days/weeks. We start our care in the small satellite clinic and if needed we are referred to Duluth. Many of these small communities also have a hospital for simple surgeries etc. In recent years the clinic and hospital have teamed up to get our own MRI and Cat scan machines and digital mammogram machine. We have a traveling ultra-sound service. Also I suspect that the poor and those without insurance are taken care of one way or the other. It helps that we have Minnesota Care.

[truedelphi]

28. Thank you for your OP and also

Especially thank you for point five.

5) Last but not least, modify the unrealistic means testing standards for medicare eligibility. You should be able to own your home, a decent car and have a retirement savings. And there should be no coming after your estate for 'repayment' when you die. This is punative of the middle-class and poor, many of whose illnesses took root in the jobs they performed as contributing members of their society, swallowing the last of their assets to pay for the profit of others.


It has been so disheartening to watch as neighbors face tremendous loss of income due to health issues, but they cannot get on MedicAide (or County provided medical) because they want to hold on to their house!

That is such an unbelievably cruel policy!

[juno jones]

29. Hi TD!

:hi:

Thank you.

I'm sorry your neighbors are going thru that. If the rich can keep their millions due to low taxes and lax inheiritance laws, we should be able to keep our meager personal assets which probably are much more critical for our well-being than their excess wealth is for theirs.

[truedelphi]

30. Malcolm Gladwell was discussing on Charlie Rose

The "One Million Dollar" man of Reno, Nevada.

This is a homeless individual whose social services tab, including police arrest (probably for vagrancy!) and his six week hospital treatment for pneumonia went past the one million dolalr mark in just over eleven and a half months of living out on the streets.

It makes no sense whatsoever to deprive people of their homes. The government has some very real and very terrible costs associated with homelessness.

And the psychic costs to people who are forced to choose between heating their home/eating or buying meds is a horrible one also.

[juno jones]

32. Kicking one more time.

I'm heading our for an employee x-mas party. I am told we are lucky not to have to wait til Febraury to have it this year. :) We'll be going bowling. I might need some health care after this. :)

I won't be able to this thread for a bit, but I'll check it later. I look forward to more ideas and discussions! :D

[ChicagoSuz219]

34. I couldn't get health insurance for 5 years...

...due to a pre-existing condition. Other than a few ER visits, I had no healthcare. Finally, someone turned me onto these clinics. They're great. The one I went to was based on a sliding scale... think it cost $20. I was able to get all the 'women' tests - pap smears, mammograms (free!), etc., as well as treatment for any other ailments I had, including affordable Rx.

The last Specialist visit I had cost $425 for a 15-minute visit! BIG difference!

[juno jones]

35. They are wonderful and I love them.

My latest clinic doc helped me diagnose a problem that other docs had ignored for years. For that I am most grateful.

But I've, and people I've known, had some, shall we say, less than optimal experiences with them over the years.

I simply want to see them expanded and brought up to par with the state of the art you would find in any community of your size. :hi: