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We know about most of the details of the public option “compromise” out there – Ryan Grim has yet another rundown – but a new addition to the compromise could be a step forward for caring for the most vulnerable elements of society.

Bernie Sanders has been generally supportive of the new health care compromise, whatever that is, but there’s a report out this morning suggesting that Sanders is seeking a separate element that is fairly interesting (caveat – this is from Fox):

Negotiators, attempting to find a compromise alternative to the public option, have told Fox that since they are not able to figure out a way to afford a major expansion of Medicaid (beyond the 133% in the bill), they have sent a proposal to CBO that would expand community health centers.

Just this week, on the Senate floor, (Sen. Bernie) Sanders extolled the benefits of the centers:

“What a federally qualified community health center is about…is saying that anyone in an underserved area can walk into that facility, get healthcare either through Medicaid, Medicare, private insurance, or a sliding scale. If you don’t have enough money, you pay on a sliding scale basis. Low-cost prescription drugs – this is a very, very successful program that now provides health care to over 20 million americans, and it is a 40-year-old program, again supported widely in the House and the Senate.”

The stimulus package provided two billion dollars for community health centers, which primarily goes to staffing and renovations. Just yesterday, President Obama delivered $600 million of that money to fund construction as well as outfit the centers with health information technology. He also created a demonstration project inside the community health centers called “medical homes”:

That’s the purpose of the final initiative I’m announcing today as well -– a demonstration project to evaluate the benefits of the “medical home” model of care that many of our health centers aspire to. The idea here is very simple: that in order for care to be effective, it needs to be coordinated. It’s a model where the center that serves as your medical home might help you keep track of your prescriptions, or get the referrals you need, or work with you to develop a plan of care that ensures your providers are working together to keep you healthy.

So taken together, these three initiatives –- funding for construction, technology, and a medical home demonstration –- they won’t just save money over the long term and create more jobs, they’re also going to give more people the peace of mind of knowing that health care will be there for them and their families when they need it.

Medical homes are a completely different way of providing care, away from fee-for-service and toward a more coordinated and efficient model. They’ve been working in Vermont to provide better care for chronic conditions and prevention. This Commonwealth Fund report endorses the medical home concept:

In 2007, four primary care specialty societies—representing more than 300,000 internists, family physicians, pediatricians, and osteopaths—agreed on the Joint Principles of the Patient-Centered Medical Home:

personal physician;
whole-person orientation;
safe and high-quality care (e.g., evidence-based medicine, appropriate use of health information technology);
enhanced access to care; and
payment that recognized the added value provided to patients who have a patient-centered medical home.

Creating medical homes throughout the country will clearly require a significant restructuring of our existing health care delivery “system.” Whereas most doctors’ offices and hospitals are currently isolated from each other—electronically and otherwise—providing patients with around-the-clock access to coordinated care will require that providers are linked and working together. For example, small physicians’ offices could pool with other offices to provide regional urgent care centers that would be open from 5 p.m. to 9 a.m. Individual practices also will need support to redesign their practices or clinics as medical homes. A recent study of primary care practices in Massachusetts showed that many practices do not currently have the information systems, personnel, or quality improvement initiatives in place to function as medical homes.

While the medical home is not a “magic bullet” that will provide an immediate return on the investment, studies have demonstrated tangible benefits, including improved quality, lower costs, and fewer disparities in care.

It seems that such a demonstration project is liable to work well with community health centers that service underserved communities where the patients have few other options for treatment. They are getting the information systems to conduct coordinated care, and they would be a one-stop shop for the poor to find the care they need.

The $2 billion in the stimulus is not enough to scale up community health centers. But what Sen. Sanders (pictured in the above photo) may want is a much larger investment, building a network of care for low-income communities. A similar model is being used in San Francisco, with its Healthy SF program. The mayor, Gavin Newsom, likes to describe it as universal health care rather than universal health coverage. Under Healthy SF (actually spearheaded not just by Newsom but also former Board of Supervisors President and current California Assemblyman Tom Ammiano), everyone in San Francisco is eligible for a medical home (there’s that phrase again) and a primary care physician, as well as care beyond prevention or checkups should illness or injury strike. Employers can choose Healthy SF as their provider for their employees, and individuals can enroll for a sliding-scale fee based on income. All of the participating health clinics are public and non-profit. Within San Francisco, they can visit their medical home at any time. It’s funded through an employer tax.

There are still problems with Healthy SF – most important, the fact that enrollees don’t have insurance outside the city of San Francisco – but as a safety-net program, it’s been successful in giving universal care to everyone within the city’s borders. Federal dollars to community health centers can create a similar dynamic. And this is not single-payer insurance, but universal care. Obviously we don’t know the details of what Sanders has in mind, but a huge expansion of community health centers could help millions of vulnerable Americans the care they need.

David Dayen

David Dayen

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