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Facts on the ground

By Dylan Matthews

Dan Barry at the New York Times has a great feature on the community health center in Portland, Maine, on the occasion of President Obama's visit:

A year ago, there was no Portland Community Health Center, though for years the city had been seeking federal money for a center that would provide care regardless of income or insurance. One that would reach the many new immigrants and refugees -- from Rwanda, Iraq, Congo -- who are finding their way to this southern Maine hub; save money; offer help.

Then, last year, the city received $1.3 million in stimulus money to open a community health center. It created a board, hired a staff, and found some vacant but tired space in a building on Park Avenue. On Nov. 2, the doors opened. ...

Patients without insurance pay on a sliding fee scale that is made possible by Medicaid reimbursement. For example, if they earn $10,830 or less a year, which is the usual case here, they pay $3 a visit.

So far, this community health center has seen 750 patients who, employees say, would otherwise have gone to the emergency room or gone without treatment. Half have no insurance. Many are Mainers, but just as many are recently arrived immigrants who often bear the mental scars of war. Interpreters are part of the everyday life here.

It's cases like this that make health-care reform and the stimulus moral issues. There are arguments to be had about the proper level of government involvement in health care or whether the Medicare cuts and excise tax will stick, but it's pretty hard to say that things like the $11 billion the health-care reform package will provide to community health centers won't reduce human suffering. And it's things like this, and Medicaid expansion, and subsidies to low-income workers that make up the bulk of the law's cost. Providing that care is not "indulgent," it's an act of basic human decency, and deficit worrywarts ought to think seriously about whether the interests of bond traders ought to be worthy of more government attention than those of refugees making under $10,830 a year.

-- Dylan Matthews is a student at Harvard and a researcher at The Washington Post

By Washington Post editor  |  April 2, 2010; 8:19 AM ET
Categories:  Health Reform  
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Posted by: monolisa02 | April 2, 2010 8:42 AM | Report abuse

Refugees? Will Obama's critics be moved by the plight of refugees? We shall see.

Posted by: MikeCervantes | April 2, 2010 8:50 AM | Report abuse

" Providing that care is not "indulgent," it's an act of basic human decency,"


thank you for saying that.

those who are concerned with the united states being a nation born in christian principles and faith, and bring their guns along, as a reminder of how strongly they defend their principles, .can try to argue against this, on ..... good friday?

but then, it seems, their views on government have a completely different value system from the most guiding principles of the christian religion.

"helping the last, the least and the lost is an act of human decency."

Posted by: jkaren | April 2, 2010 9:40 AM | Report abuse

I fully agree that these are worthwhile efforts, and that it is entirely appropriate for government to take on that kind of responsibility.

The concern I share with many others is reconciling the ledger. The stimulus was borrowed money. I would feel much more comfortable with these programs if a real decision to commit to them was made; meaning if we spend money to do this, we must cut spending somewhere else.

We only spend money in this manner because it does not require any real decision or any real courage. It would really demonstrate moral fortitude, not to mention responsible government, if we spent money for these programs and reduced deficit spending or eliminated farm subsidies, just as two examples. sacrifice anywhere else. As it is, it only places a burden on future generations who will somehow be expected to make decisions we couldn't or wouldn't.

And that is an immoral act.

Posted by: kjfitzgib | April 2, 2010 9:41 AM | Report abuse

750 patients in 5 months? That's 7 patients per weekday - not quite a patient an hour. Something is not right.

Posted by: Bloix | April 2, 2010 9:54 AM | Report abuse

At the typical billed cost of an ER visit, the savings on 750 patients have already paid back the $1.3M in stimulus money that it cost to open the center.

Posted by: paul314 | April 2, 2010 10:42 AM | Report abuse

Every time I hear a conservative or libertarian calling for market-oriented health care finance and health insurance , the moral question raises its important head. "Market based" practices inherently include the purchaser's right NOT to purchase a product (this point is behind much of the anger directed at the 'mandate' from the Right).

But most conservatives and libertarians simply won't respond to the following scenario: "A young healthy adult chooses not to purchase health insurance, making a rational calculation that the risk does not warrant the cost. The adult has a bicycle accident, and arrives at the emergency room with head trauma, no insurance, and not enough assets to pay for the necessary care. Should the emergency room refuse to treat the uninsured patient (except, perhaps, by providing a quiet room for her to live, or die)?"

The reason proponents of the market refuse to respond is that there is no 'market-based' answer to this question. It is, ultimately, a moral question which trumps the 'free market.'

Few, indeed, are willing to follow their putative libertarian or free market principles to the conclusion that the willfully uninsured must be refused emergency treatment (even though that is the only 'market-based' answer).

Among those who do respond, some maintain that emergency rooms do not turn anyone away. But that's not a 'market-based' answer, either: it's simply imposing a mandate to cover the cost of treating the uninsured on others, either via the state or via the costs charged, on some market, to other customers, as has been demonstrated extensively.

A few honest conservatives argue that some kind of catastrophic insurance plan should indeed be mandatory. But then, of course, they have accepted mandatory purchase of insurance, but simply disagree on the purely prudential point about how it should be structured. This is a reasonable and honorable position, but it accepts the authority of the government to mandate some kind of health insurance purchases on individuals, either through a state-operated (public option, single payer) catastrophic insurance plan (possibly funded through taxes rather than premiums), or through mandatory purchase from private insurance companies. Fine: let's debate the best way to structure the mandate...but 'free market' as a _general_ solution is now off the table.

Most conservatives, however, simply try to avoid this scenario...and that's dishononest, in my book.

Posted by: PQuincy | April 2, 2010 11:36 AM | Report abuse

A moral issue? How old are you, ten? Every single one of these "moral" expenditures involves taking money from someone in order to provide it to someone else. The money will not be taken from Obama or Axelrod, either. Of that you can be certain.

Posted by: truck1 | April 3, 2010 5:26 PM | Report abuse

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