Health care is largely a for-profit business in the United States. Most Americans pay for medical care, either directly to the provider, or indirectly through commercial health insurance. Millions more American retirees and military personnel receive medical care directly from government facilities, or indirectly through entitlements such as Medicare or Medicaid. But there's a third type of health care in the United States: non-profit medicine.
Non-profit health care in one small American town
The Moorehouse children are back at the doctor's again, being examined at Mercy Children's Clinic in Franklin, Tennessee. Two of the family's three children have chronic health problems, so mom Candy Moorehouse said she spends a lot of time in doctor's offices.
"Last month, I think there was a period when I was here every single week, and for a couple of those weeks I was here three times for each of those!"
The family pays for every visit. Additional tests, medical procedures and medications all mean additional charges. It's a significant drain on their modest income, but it could be much worse. Dan Moorehouse currently has medical insurance for his family, but that hasn't always been the case.
"There was a time when I changed jobs and had my own business and didn't have insurance," Moorehouse said. Mercy Children's Clinic helped him fill the gap. "They were here for us during that time and helped us out."
Two charity clinic models in the U.S.
The Moorehouse family received that support because Mercy is a non-profit facility. There are two types of these charity clinics. One is generally referred to as a free clinic. Free clinics charge little or nothing for medical care and are usually staffed by volunteers. Almost all the patients they see have no health insurance.
Mercy Children's Clinic is what's called a community clinic. It treats insured and uninsured patients alike. Those without health coverage are asked to pay, but only what they can afford. Both types of clinics solicit donations from the community to cover the remaining costs of care. About half of all non-profit clinics are affiliated with faith-based organizations.
A need for non-profit clinics everywhere
Ironically, Mercy Children's Clinic is located in a wealthy community. The average per-capita income in the city of Franklin, just south of Nashville, is one of the highest in the nation. In spite of that, David Winningham, the clinic's Executive Director, says the eight-year-old facility's case load continues to grow.
"The first year the clinic existed, they saw 135 patients; thought it was pretty busy. This past year we had 16,000 visits to the clinic," he reported.
Those patients are being seen by medical practitioners who are either volunteering their time, or receiving salaries well below average. But Winningham said their skills are well above average. "I've got a former chief resident from Vanderbilt Children's Hospital. I've got Ivy League-trained doctors," he pointed out. "The last doctor that showed up here to work came all the way from Oregon. He found us on the Internet. He took a 60 percent cut in pay."
A 40 year old movement for free clinics
Gregory Weiss is impressed by the quality of care at America's non-profit clinics. The sociologist researched more than 40 clinics nationwide, and published his findings under the title Grass Roots Medicine: The Story of America's Free Health Clinics. Weiss said he routinely witnessed the facilities providing services well beyond standard care.
"A very good example would be a clinic in North Carolina, where staff members go grocery shopping with the patients and help them select foods that would be nutritious and economical," Weiss said.
Weiss traces the origin of the free clinic movement in America to 1967's so-called "Summer of Love" when tens of thousands of young people descended on San Francisco. They pushed the social boundaries of the day, experimenting with illicit drugs and casual sex. When the inevitable health consequences followed, so did free clinics. San Francisco's Haight-Ashbury clinic remains in operation to this day.
But more recently, non-profit clinics are treating the working poor; people who can't afford insurance, or can't afford enough of it. Among developed nations, Weiss pointed out, it's a uniquely American problem. "All other modern countries in the world provide universal access to care. People in other countries have ready access to care, in a way that millions of people in the United States don't."
Need for 'benevolent medicine' continues
Although impressed by the work of America's free clinics, Weiss doesn't believe they will ever close the nation's health care gap. He estimated that less than 10 percent of the country's roughly 45 million uninsured citizens are treated at non-profit clinics. He noted that even the rosiest health care reform scenarios currently being debated in Washington leave plenty of room for benevolent medicine.
"Ninety-five or 97 percent of all Americans would be covered in the early stages of a universal access. That would still leave out millions of people and presumably that would become a target population for free clinics," Weiss said.
No one at Mercy Children's Clinic is concerned about being put out of business any time soon. In fact, the clinic will be moving to a larger facility before the end of the year, a facility paid for by wealthy local donors.