Commentary: Health centers should be centerpiece of reform

Little known to the public, a grassroots system for taking care of the uninsured in America has been growing within the health care industry.

Community health centers are non-profits funded through federal grants, patient reimbursements, Medicaid and Medicare and private donations. The Arizona Republic reported that "in 2008, the nation's 7,000 community health centers saw more than

20 million patients." The National Association of Community Health Centers has a goal of serving 30 million people by 2015. The clinics strive to provide both management of chronic illness and routine tests and treatment. Patients pay a sliding fee based on income.

There are a reported 46 million uninsured people in America. In Reno, the Health Access Washoe County Clinic provides care to a predominantly uninsured, low-income population. The HAWC Clinic sees 6,000 patients a

month, or 72,000 patients annually. Carson City's FISH Clinic, run by volunteer physicians, has

treated local uninsured and poor for years.

As a skin cancer specialist, I have often treated referrals from both the FISH and HAWC clinics. Referrals from either clinic, or from primary care doctors with hardship cases, are treated on a sliding scale. Many area doctors have treated the uninsured poor at a discounted rate; often without reimbursement.

The federal government's cost for grants supporting 7,000 centers for the next two years is

$2 billion, as provided by the American Recovery and Reinvestment Act. If $2 billion supports 20 million patients, would $10 billion cover 100 million patients? And would this cover all the primary care for the 46 million uninsured Americans? This is a small investment compared to the trillions of dollars that Congress wants to spend on health care reform.

Bipartisan support would be possible for expansion of the clinics. Our president wins by announcing a pro bono health care initiative. Just like the legal system provides pro bono attorneys for the poor in America, America will provide health centers to serve anyone in America.

Health centers should be initiated at every medical school and adjacent to every emergency room to divert the uninsured, non-emergency patients away from our high-tech ERs. Doctors currently in medical school can be challenged to help treat the uninsured not covered by the health centers. Federal grants for doctors to attend medical school can be tied to five years of service at a health center. Retiring physicians can be a valuable source of recruitment.

This kind of health care reform can be sustained by the American taxpayer, and there may even be big savings in emergency room costs, making health care more affordable.

• Dan E. Rowe, M.D., is a founding partner of Skin Cancer and Dermatology Institute, with offices in Carson City, Reno and Fallon.