OPINION: Moss Is the Symptom
The closing of the Moss Free Clinic is more than a local tragedy, it's a canary in the coal mine pointing to an even greater health-care disaster staring down Americans.
By Jay Brock
COMMENTATOR
The Moss Free Clinic, a local nonprofit institution that has given medical care to uninsured and underinsured people living in the Fredericksburg region since 1993, has closed. This month it ran out of money after a long-term association with Mary Washington Healthcare ended.
In 2023, the Free Clinic saw 7,500 patient visits and dispensed 73,000 prescriptions. Total expenses were $6.8 million.
The closing will be a blow to the community, the hundreds of dedicated volunteers and physicians who helped run the clinic or provided care, and the patients who must now seek their care elsewhere.
It’s a sad day for the region.
Other communities and populations across the country are likely to have similar days of disappointment and worry in the coming years: the Republicans in control in Washington are actively pursuing ways to cut Medicaid and other healthcare funding that could drop 11 million people off their government-funded health insurance.
One unfortunate but foreseeable result of these cuts: With less funding for Medicaid, less money goes to hospitals around the country. Less money to hospitals means many potential hospital closures. Especially affected: rural hospitals in Red states. When hospitals close down, the negative impacts are not only on people’s health, but the region’s finances as well: many hospitals are major employers upon which local economies, not just employees, depend.
The local problem in Fredericksburg is a stark mirror of a much larger health insurance problem we have on a national scale: the United States is the only advanced nation where what passes for a national health insurance system fails to do the two things any such system should do: cover everyone; and do it affordably.
Instead, we have a dysfunctional hodgepodge of public and private insurers with thousands of moving parts that is not only nearly incomprehensibly complex, it is also exorbitantly expensive to run: each year the system wastes about $1 trillion of the $5 trillion we spend on “healthcare”. (A trillion here, a trillion there, and pretty soon we’re talking about some real money.) Dollars are wasted on building a bigger bureaucracy (billing is a huge component of the waste—for example, there is on average one hospital billing employee for each hospital bed in the country); dollars are wasted on overcharges by the for-profit health insurance and pharmaceutical industries; dollars are wasted on profit, overhead, and marketing; and dollars are wasted on industry lobbying. Not the best use of our hard-earned healthcare dollars.
Those wasted dollars are a huge reason why we spend so much more per person on healthcare than any other advanced nation—yet we still leave 85 million (and soon to rise) Americans either uninsured or underinsured. Underinsured means out-of-pocket costs are so high, many people cannot afford to use the insurance they have. In fact, the majority of the half-million yearly medical bankruptcies in the country involve folks who have some kind of health insurance. The most telling statistic: with our current health insurance system, three-fourths of Americans worry they won’t be able to afford to pay their medical bills if they get sick. Those numbers may be boring statistics, but they’re the hallmark of a failed health insurance system.
Bottom line: we are the only advanced nation where “free clinics” such as the Moss are an integral part of a national health insurance system.
Many healthcare experts join the majority of physicians (and most Americans) in supporting single payer Medicare for All as the best path to universal affordable healthcare. Briefly, in a single payer health insurance system, a government-related entity collects our healthcare contributions (mostly based on our income, so it’s truly affordable) and pays 100% of the cost of all medically necessary care we need. No copays. No deductibles. No for-profit health insurance companies who act as completely unnecessary but hugely expensive middlemen who think that once they get your healthcare dollars, that money belongs to them and that THEY should then be in charge of how (or whether) those dollars get spent on your healthcare.
Not only would healthcare under such a single payer system be universal and affordable, it would ensure that no more hospitals would close because of lack of funds. How would that work? Turns out that the problem for most hospitals that close isn’t a lack of patients. It’s a lack of patients who can afford to pay their bills. Under such a single payer system, each hospital would receive a global budget that would cover all expected care for the following year. Hospitals would get enough dollars to remain economically viable.
Such a system would keep almost everyone happy: patients, hospital administrators, their employees and patients; and communities and their chambers of commerce that would benefit economically from financially healthy hospitals. Not happy: for-profit health insurance and pharmaceutical industry CEO’s and their stockholders.
Also not happy: a whole bunch of Washington politicians of both parties who seem to be highly allergic to any real change in our health insurance system.
Expect some teeth gnashing, and expressions of thoughts and prayers from our Washington politicians, when beloved institutions such as the Moss Free Clinic close, but don’t expect them to vote any time soon to change our failed system to one that will finally do what any decent health insurance system should do: cover everyone, and do it affordably.
Jay Brock, MD, is a retired physician and lives in Fredericksburg.
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Yep, what he said.