Las Vegas Sun

November 28, 2014

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Daily Memo: Health Care:

Debate over free clinic in park obscures bigger issue

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Tiffany Brown

Loyce Smith, left, of United Methodist Social Ministries, congratulates Dr. Florence Jameson, center, after the County Commission voted June 2 to approve a clinic for the uninsured that Jameson will run. The clinic will have a one-year lease and be limited to 6,000 patient visits in the first year in deference to the concerns of people who live nearby.

The recent debate about whether a public park is a fitting location for a free medical clinic only teases to the much larger challenge facing the nation: delivering medical care to people without health insurance.

The immediate problem facing Clark County Commission Chairman Rory Reid was to find a middle ground between Volunteers in Medicine of Southern Nevada, which wanted to run a free clinic in a vacant county building in Paradise Park, and park neighbors who complained that a clinic for the uninsured could draw to the park patients who might be homeless or criminals.

Reid ticked off several conditions before the commissioners unanimously approved the agreement: The clinic will have a one-year lease, which will be reviewed before renewal to ensure the park was not harmed by its presence. It would be limited to 6,000 patient visits in the first year. Clinic officials would provide on-site security and monthly reports to Reid to ensure no derelict patients ruined the park, near Tropicana and Eastern avenues.

Reid said he wanted the clinic to serve the people who were most hurt by the health care crisis: those who have jobs that don’t provide insurance, but make too much money to qualify for government-funded health insurance plans. Wealthy people can afford insurance, he said. And people with no money qualify for government-funded plans.

“If you’re in the middle, though, that’s where the hole is in our safety net,” Reid said. “If you’re working and have inadequate insurance or no insurance, you’re worse off than anybody in the community.”

And that’s the rub. The United States is the most affluent nation in the world, but does not provide even basic health care to a large percentage of residents.

The advocacy group Families USA highlighted this problem in a recent report. About 841,000 Nevadans younger than 65 — a third of the non-elderly population — went without insurance in 2007-08, the report said.

According to Families USA:

• More than four in five of Nevada’s uninsured residents were in families with full- or part-time workers.

• Nearly two-thirds of Nevadans from families with annual incomes less than twice the poverty level — $42,400 for a family of four in 2008 — went without health insurance at some point in 2007-2008.

• One in four Nevadans with family incomes at or above twice the poverty level went without health insurance at some point in 2007-08.

For the PBS documentary program “Frontline,” correspondent T.R. Reid visited five other capitalist democracies — England, Germany, Japan, Switzerland and Taiwan — to show how they address the challenge of providing insurance to everyone. The nations used various combinations of employer- or government-provided health insurance to pay for health care. Each nation’s plan had its drawbacks — taxes, doctors who did not get rich, hospitals facing financial difficulties. But one group always came out ahead: patients.

A 2005 study in the policy journal Health Affairs found that illness or injury and subsequent medical bills were a factor in about half of all bankruptcies in the United States. On T.R. Reid’s journey around the world, he asked the same question of medical experts in each country: Have you ever heard of a patient in your country filing for bankruptcy because of medical bills?

The respondents were aghast that such a thing could happen. In some countries patients don’t even see medical bills, much less face an inability to pay them.

Patients at the Volunteers in Medicine clinic, which could open in November, will be charged no fees and will pay no bills.

In America, that’s an exceptional concept. In other developed capitalistic nations, it’s standard.

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