Who’s going to pay for the poor and the sick?

You may be aware of the challenges taking place over the funding of the Moss Free Clinic.

The clinic is running out of the money collected by a capital campaign managed by Mary Washington Hospital Foundation in 2004. It is also being hit with extra charges that formerly Mary Washington Health Care (MWHC) was paying for the facility built specifically for the Clinic. This all threatens the future viability of the clinic and its mission to provide healthcare services to vulnerable people.

This was first reported by Adele Uphaus in the online news site Fredericksburg Advance and further in last Sunday’s Free Lance-Star by Cathy Dyson. The clinic has been in existence for just over 30 years and was started when Fredericksburg Medical Society responded to a state Senate resolution noting the plight of the medically underserved. 

I have been medical director there since I tried to retire in 2010 and am concerned for both the patients and the staff. How we will get funds to continue the medical, dental, mental health and pharmacy services that we provide to the medically indigent, and how this whole rather acrimonious business will turn out. 

Though on the Moss board, being medical rather than a banker, a businessman, or a lawyer I’m not sure I’m the person to discuss the rights and wrongs of what MWHC is doing and why, and risk further stirring the hornets’ nest.

What this whole business brings into focus is, how do people who can’t afford it get the healthcare they need?

Who Should Pay?

Some seem to believe it is just too bad if you are poor and get sick. Perhaps these people have brought it on themselves – have smoked, drunk and eaten themselves into ill-health -  and they will just have  to muddle by as best they can with their own devices.

If you don’t believe this, then whose responsibility is it to provide care? Is it that of the organizations providing healthcare to our community? That would mean MWHC and HCA Healthcare that owns Spotsylvania Regional Medical Center as the main players – or perhaps the community as a whole, though some doctors and other providers in the community volunteer (which the patients are very grateful for).

Or does it go beyond that just local? Is it the responsibility of society as a whole? Or, as in so many other countries, should healthcare be an entitlement paid for out of taxes? 

Maybe I have a prejudice, being British and growing up with, and a proponent of, the National Health Service – which is of course a government run system that provides universal care, that is paid for out of taxes. 

This is the norm for industrialized countries. The US is an outlier, being about the only one which doesn’t provide universal coverage. 

I have often wondered what it is about Americans philosophy that there is no universal or nationalized healthcare. 

Any question like this I have about the American culture, I bring to my learned buddies in the coffee Klatsch – this group of old farts I have mentioned before, who get together regularly and discuss the meaning of life – or equivalently heady topics. 

“It’s all to do with stubborn individualism and a philosophy of self-reliance” they told me. “Programs of public good are often seen as welfare, as handouts. . . . . . handouts to people who are just too lazy to do for themselves.” 

 Also, when I was over in London one time, and was talking to Dr Janet Rebstein – a friend of my sister, a native New Yorker, but now a Professor of Psychology at the University of Exeter. 

Her take was “Americans are strong believers in individual effort and consequent individual reward.”  And “Each individual is ultimately responsible for his or her own fate” so “the concept of treating people medically as a collective right got identified as a socialist gesture, rather than a part of what each individual pays for, as in social security.” 

An Expensive Privilege

Healthcare seems to be seen as a privilege rather than a right in the US – though grade-school education, defense, law-enforcement, rescue services, social security, Medicare, Medicaid, parks, any number of government agencies and a whole civic infrastructure of roads, buildings, bridges etc. do seem to be considered a legitimate, righteous use of taxes. 

We need a reincarnation of Aneurin Bevin, a Welshman and a bit of a firebrand, who was minister of Health at the time of the formation of the NHS and who said “illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalized.” Rather, it is “a misfortune the cost of which should be shared by the community.”

It doesn’t help of course that healthcare is so expensive in the US –  costing $12,531 a head in the US in 2020, compared with $2.638 per capita expenditure as an average for the 55 other countries, according to the Bloomberg Index – which of course also pushes up the cost of health insurance, so premiums have gone from $13,770 to $22,463 for family coverage from 2010 to 2022 according to the Kaiser Family Foundation Employer Health Benefits Survey.

Moss Clinic has served 16,000 patients, dispensed more than 880,000 prescriptions and provided $325 million worth of healthcare. What will happen to all the needy recipients of this care if we don’t find the funds to keep going?

It’s a troubling question. As is, who is going to provide those funds?

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