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Budget at Odds with Bush Health-Clinic Plan

President Bush says he wants to dramatically increase the number of community health centers -- government-funded clinics that provide basic health care. But a new study suggests that goal could be threatened if the administration carries out plans to cut funding for the training programs that provide the doctors who actually deliver the care.

The president, who isn't a big fan of government-provided health care, has long made an exception when it comes to community health centers. He talks about them in nearly every speech on health care, including one at the headquarters of the fast-food chain Wendy's in Ohio in February. "Since I took office we've opened or expanded about 800 health centers. There are now 3,700 of these centers around the United States serving 13 million Americans," he said. "It is a cost-effective way to provide primary care for those who need help. And I'm going to call upon Congress and work with Congress to put 400 more of those health centers in."

Community Health Centers operate in mostly rural and inner-city areas where there are few medical services available, and where they serve mostly low-income and uninsured patients.

But while the need for more care in medically underserved areas is clear, the feasibility of the president's plan is not. "The question was, whether or not it would be possible to expand these community health centers if there wasn't anybody there to staff them," said Roger Rosenblatt, a professor of family medicine at the University of Washington. Rosenblatt and colleagues polled all of the nation's health centers to find out.

He says the news they got back -- published in this week's Journal of the American Medical Association -- was ominous: "There were large numbers of vacancies, particularly for family physicians, at a time when the number of students going into family medicine had decreased 52 percent in seven years."

Adding to the problem, says Rosenblatt, is the fact that the administration is proposing to cut or freeze the few federal programs that help pay for the training of family doctors. The president's budget for Fiscal 2007 would eliminate the primary care training programs under Title VII of the Public Health Service Act, and it would provide no increase for the National Health Service Corps. The NHSC provides scholarships and loan-repayment programs for medical students who agree to practice in areas with doctor shortages.

Rosenblatt says that expanding one program while cutting others makes little sense. "I think the administration hasn't got a clear comprehensive picture about how all these parts are tied together," he said. "You have to have a workforce to provide the care. Just having an edifice or the organization isn't enough."

But Elizabeth Duke, head of the Health Resources and Services Administration at the Department of Health and Human Services, defended the administration's budget priorities. Her division oversees both the community health centers and training programs. She says Title VII training programs, in particular, haven't been that effective in getting services to those who need them. "Studies have shown that the folks who get trained in those programs, only about 20 percent of them actually work in service to the underserved" after graduation, she said.

Others say they're confident that health centers will ultimately find the staff they need. Dan Hawkins of the National Association of Community Health Centers, says the shortage of primary care practitioners the study found is more ominous for the REST of the population. "This is a story for all Americans, not just for those living in rural and inner city communities," he said. "And not just for health centers. We are the canary in the coal mine. We are the ones who can point to what's happening."

Hawkins says the staffing difficulties of community health centers highlight the need for the federal government to step in to address the fact that so few of today's medical students are choosing careers in primary care. "The looming shortage in primary care is going to take a public policy solution," he said. "There are no market forces that are lending themselves toward a trend in resolving this through economic mechanisms only. It's gonna take a public policy solution."

Duke says that's not where her priorities are. "We've tried to focus on real shortages that exist now. The nursing shortage is now. the subject that's being referred to in the article talks about the study which projected a physician shortage in 2020."

And while President Bush likes to talk about market solutions to solving the nation's health care problem, study author Rosenblatt says the fact that some 46 million Americans have no health insurance, and the very need for the government-funded health centers, shows that the "the market doesn't work in medical care."

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