A Particularly Bad Cut

October 6th, 2011 at 11:31 pm

There are a lot of budget cuts to get upset about these days, but this one really struck a (dissonant) chord (from today’s WaPo): Community health centers hit hard by Washington deficit cuts.

I recently gave a talk to the administrators, doctors, and nurses who run these centers, and in preparing, I was reminded of how their model was “bending the health-care cost curve” long before anyone even knew there was such a curve (they save the health system about $25 billion a year).  And their model is that much more effective in that they achieve these cost savings while serving a much poorer and sicker population than that seen by the typical health clinic or hospital (72% of the folks they serve are poor, about 40% are uninsured, about that same share are on Medicaid; see here).

In fact, when the health care law was coming together, the administration recognized the importance of the CHCs (community health centers) in efficiently serving a tough population, and built a significant boost for them into the Affordable Care Act.

Most recently, according to the WaPo:

Rather than handing out $250 million to establish new patient-care sites to serve more than 2 million additional people, as originally expected, the Obama administration gave $29 million to 67 nonprofit organizations that will serve an additional 286,000 patients.

The funding cut was a result of a federal budget compromise in March to keep the government running. That agreement reduced federal spending by nearly $80 billion, including a $600 million trim in funding for ongoing operations at existing health centers.

Some of that trim got put back but the centers have not been able to expand to meet the increase in need generated by job and income losses in the recession, much less get ready to ramp up for the influx of newly covered patients under the health care bill.

One of my main interests in the CHCs was how they provide quality care less expensively than pretty much any other players in the game.  It looks like it they do it with:

–Health care homes—consistent point of service

–Management of chronic disease (hypertension, diabetes, asthma)

–Preventive services

–Avoiding hospitalization and emergency room use

–Low operating margins

The WaPo piece provided a few examples of what we’re losing here:

A dental exam room at FoundCare Health Center in West Palm Beach, Fla., will remain unused four days a week because there’s no money to hire a dentist.

Triad Adult and Pediatric Medicine in Greensboro, N.C., might face a repeat of last winter when more than 700 adult patients were put on a months-long waiting list for care, and the center had to stop taking new pediatric patients because of a lack of doctors.

Heartland Community Health Center in Lawrence, Kan., will have to continue to tell patients they must wait at least two months for an appointment.

It’s another in a truly troubling and destructive set of examples of how we have solutions to our biggest problems staring us in the face, yet we turn away from them.  When future historians look back on our era and try to figure out what went wrong, they’ll be forced to conclude we were either highly dysfunctional or highly masochistic.  Or both.

 

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2 comments in reply to "A Particularly Bad Cut"

  1. D. C. Sessions says:

    Two-month wait for care pretty much nixes several of the advantages such as “health-care home” and preventive services for chronic conditions.

    But the thing that really caught my eye was that this is the “rationing” that the Right finds so objectionable. Once again, the party of “government doesn’t work” is working to prove themselves right.


  2. general c. san desist says:

    …no, they’ll look at the WMD…weapons of media distortion. It has been quite clear since the Goldwater defeat that trouble was-a-brewing. Organizations set up to recruit the neo-conservative bullies, pitching the Think Tank synopsis of the Left as the ungrateful spawn of a liberal middle class upbringing. If they couldn’t win an election, then they would surely hate-weight the primary decision.

    The radical right in the form of Lush bin Limbaugh & Henpeck are claiming the high road with Steve Jobs…shame on them. He was a pot smoking, acid eating, free thinking dropout that had a great measure of success…& did not suffer fools quietly. He would no sooner cross the street to put out the self combustion of either than agree with the seditious distortion of all that leaves their pie holes.

    Consider their logic…knowing full well of the two year sabbatical clause allowed Professors joining the President’s cabinet or advisor position, the conservative brotherhood will allude to the twist-a-facts that…”his advisors are abandoning him after only two years.” Like the rules of economics, they also chose to ignore reality & pitch distortion. I guess they can’t help it, their adherents beg to be spoon fed.

    With the 99% crowd awakening, perhaps a Stop The Military sentiment join in or a resurrection of the Fairness Doctrine crowd or Rebuild America or Rewire the Grid or Help the Poor stuff will spontaneously arise…maybe all! Where are the committee investigations on the Bush administration & their crony style of economic mayhem? How blatant are the attacks on ‘green’ alternatives & Solyndra? Shit happens, business, at times, must fail. Governments, at times, must turn on the pump.

    They are Faux News…”We distort, you decide.” Enough of this Hoover junk, where is the FDR sentiment…one election away? This is ’31.


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