TCS Daily

The Free Clinic Movement

By Connie Marshner - November 6, 2007 12:00 AM

Warren County, Virginia, at the confluence of the North and South Forks of the Shenandoah River has neither the rolling hills of horse country nor the fertile plains of the Shenandoah Valley.

Of its 36,000 citizens, an estimated 6,000 are uninsured. Typically, when they get sick, the uninsured go to the emergency room, which is about the most inefficient and costly way of delivering primary medical care.

But, thanks to the initiative of some local Christians, the uninsured of Warren County can instead go to the St. Luke Community Clinic for free medical care. In FY 2006, 2,633 uninsured people did just that.

St. Luke Clinic is one of an estimated two thousand Free Clinics around the country, fifty of them in Virginia. In 2006, the total budget of all the Free Clinics in Virginia was about $18 million, which they leveraged to a value in excess of $80 million.

The Free Clinic movement is living embodiment of many conservative principles: the principles of subsidiarity and voluntarism, the spirit of enterprise and of community self-reliance. As health care becomes more and more of a national concern, if people are truly concerned about the less fortunate, there should be a population explosion in the number of free clinics around the country.

What's a Free Clinic?

Free Clinics are private, non-profit organizations that provide medical, dental, pharmaceutical and/or mental health services at little or no cost to low-income, uninsured and underinsured people. These clinics are truly free - both to their clients and to the taxpayers.

Unlike federally-qualified so-called "free clinics", they do not submit receipts to Medicare or Medicaid for reimbursement. St. Luke and the other authentic Free Clinics in Virginia do not submit bills to anybody for reimbursement.

Each Free Clinic is unique, rooted in the volunteer resources of the local community. Some are mobile, some are in church basements, some occupy their own buildings. Frequently, as is the case with St. Luke, there is a religious impetus behind the founding of the Clinic. In the words of Nicole Lamoureux, Executive Director of the National Association of Free Clinics, "When you've seen one Free Clinic, you've seen one Free Clinic."

At a Free Clinic, everything is accomplished through the donation of time, talent, and treasure: the entire budget, doctors, nurses, medications, supplies, support volunteers, and even physical plant. Funding is raised on the local level and if there is government funding or support, it is from the town or county.

The impetus in Front Royal, Virginia, came from an immigrant, Dr. Furadoon Irani, whose ancestral faith was Zoroastrianism. After converting to Christianity he told his pastor, Rev. C. Thomas Rhyne, of the Front Royal Presbyterian Church, "God has been kind to me," and suggested the church provide medical assistance for people who could not afford it.

Pastor Rhyne agreed, but his church committee soon found the task daunting, so all the churches in town were invited to join the effort. Fifteen month later, the doors opened, in November, 1996. It is still going strong.

Fifteen months from idea to operation is a time frame many industrialists would envy. No federal funds are involved. Today, the Clinic holds a mortgage on its own building and serves the working poor four days a week.

Secret of Success

The secret of success is careful planning, and meticulous management. The job description for the position of Executive Director does not require medical experience: just management and fundraising skills. The small staff includes one part-time doctor, but most of the medical skills come from the volunteer nurses, doctors, labs, and hospitals.

Any patient will be seen once, but to become a regular patient at St. Luke one must be uninsured and have income below 150% of the federal poverty level -- $30,975 for a family of four - and not be eligible for any other ongoing federal health program, such as Medicare. Patients are re-certified every six months.

Primary medical care needs are met in the walk-in hours at the Clinic, which begin on Thursdays at 5 p.m. On that day, some of the volunteer physicians, who are mainly internists or family practice specialists, serve on a rotating schedule. Everybody works until all patients have been seen. The Clinic will soon begin a trial walk-in clinic a second evening a week.

Chronic illness is treated by appointment Monday through Wednesday from 9:00 a.m. until 5:00 p.m. and Thursday from 9:00 until 3:30 p.m. Mental health needs are met on Tuesdays, by appointment with a mental health nurse practitioner. Women patients between the ages of 40 and 64 can participate in the free breast and cervical cancer screening program.

At the right time of year, St. Luke holds a Flu Clinic with shots for its 300 highest risk patients with chronic diseases. The date is set after the Clinic has negotiated the best deal on the vaccines.

Drug and alcohol problems get referred elsewhere. No obstetrical service is available. Children under 19 are eligible for FAMIS, the Virginia version of S-CHIP, so no pediatric services are provided either. No social worker is employed by or volunteers at St. Luke. This is a place for true medical care.

The local hospital, part of the Valley Health System that serves Virginia, West Virginia, and Maryland, donates labwork and diagnostic services. For surgery, patients are referred to the University of Virginia Medical School, a two hour drive to the southeast.

Pastor Rhyne, still the Chairman of the Board, takes pride in saying that "With our budget of $265,000, we provided over five million dollars worth of health care. We leveraged $19 for every $1 we received through donations."

The biggest chunk of the leverage is pharmaceuticals. Every major pharmaceutical company has a free donation plan, or Patient Assistance Program. By maximizing those programs, St. Luke was able to dispense 31,134 prescriptions in 2006. However, every company has different medications, rules, forms, and schedules. The process is so complicated that the clinic employs two staff members work on it only slightly less than full-time. In 2006, the Free Clinics in Virginia provided about $42 million worth of donated medications to all their patients.

The National Association of Free Clinics came into existence because of a threat that Washington would make illegal the free distribution of pharmaceuticals to Free Clinics. Evidently, Washington did not know of the existence of legitimate medical providers who served the needy for free, without reimbursement from somewhere. The National Association of Free Clinics hired Nicole Lamoureux, who soon set them straight, and preserved the freedom of pharmaceutical companies to cooperate with private citizens to help those in need.

Devil in the Details

All the good intentions in the world would not make a free clinic possible in our litigious society. But that problem has been solved in Virginia, whose example could easily be followed.

With the help of the Virginia Association of Free Clinics, the state recently established the "VaRISK2" liability risk management program. Operating under the Division of Risk Management of the Department of the Treasury, of the Commonwealth of Virginia, the program indemnifies Directors, Officers, employees, and volunteers in a Free Clinic.

Volunteers in private medical clinics received federal tort claim coverage when Senator Dan Coats' 1996 Medical Volunteer Act became law as part of the Kennedy-Kassebaum Health Care Reform Act. Prior to Coats' action, only volunteers in government-funded clinics typically received coverage for liability at the federal level.

In 2006 calendar year, 57,000 individuals were served by Free Clinics across the Commonwealth of Virginia. State officials estimate that there are over a million uninsured people in Virginia, so the Free Clinics meet about five percent of the medical need in the state.

For private individuals, working voluntarily with no government assistance, to meet five percent of a state's medical need is an inspiring example of the power of personal compassion in action in the bureaucratized world of today.

Marshner is a Visiting Fellow in Domestic Policy at the Heritage Foundation.



the way it should be
Rather than having government programs like Medicaid, free clinics, which are usually still supported in some part by government funds, are a cheaper and better alternative.

Finally somebody is following our advice
A big congrats for them doing what we've been suggesting around here for years. We told you it wasn't necesary for a nanny state, but that liberals could get together and do this, just like they did before the welfare state came about. Now they should dismantle the whole medicare crappy program. Separation of church and state; separation of medicine and state is the way to go.

this is impossible, according to eric
he's been quite vociferous in his claims that charity is impossible unless it's from the govt.

You guys will go to any lengths to avoid paying ten cents to help people needing medical attention.

If you were likely to ever pay into a charity fund like this church, you'd be okay with paying in to the USG, who can do the same thing only on a national scale. But you like having the churches pay, because it won't be coming out of your own wad of cash.

Cheap cheap. Look at the money you're saving.

How long will it be before the Feds shut them down?
The government hates competition.

Yes, I'm a cheapskate
I have a limited amount of money. If I find a charity that can dispense services at only 6% of the cost of of the USG's services, then I have 94% of my "giving budget" left over to give to feed the hungry, clothe the indigent, etc.

Think economically, and have more to give; give locally, and address the highest percentage of need. Alternately, give to the government, and let someone else do the thinking. I choose the former.

How about effiency?

Why does the government insist upon forcing people to the most expensive care, emergency rooms?

You think the government can spend the money more efficiently than the church?

How many volunteers will the government get?

Don't forget about Roy.
He can't imagine charity doing the job better than the government.

as usual, roy believes he can read minds
he declares that none of us donate to charities, based solely on the fact that we don't believe govt is a good source of "charity".

As for myself, I usually give at least 15% of my income to charity. That's before tax income.

How much do you give roy? Or is the limit of your charity work demanding that other people's taxes be raised?

Why do you want insurance companies to make money?
Health insurance is not health care.

What is most important, insurance or care, or ensuring care?

Why is no one addressing the COSTS of health care?

Why shouldn't health care costs be subject to market forces like any other product or service?

Efficiencies of scale
"Why does the government insist upon forcing people to the most expensive care, emergency rooms?"

They don't. Because people like you have blocked any viable national health plan for decades, sick people without adequate funds have to go to the emergency room. It's hospitals who decide to take anyone in, regardless of their ability to pay.

So who ends up paying for them?

Not everyone. Studies show very clearly that the cost of indigent care is tacked onto the bills of self-insured people... who pay as much as triple what a health plan might allow for equivalent care. It's your rich people who are currently getting socked by our lack of any national plan.

Is that fair? Better if we spread the costs among all taxpayers.

"You think the government can spend the money more efficiently than the church?"

Quite possibly. The government has access to vast stores of data regarding reasonable and customary health costs for every procedure. Bill's Country Church doesn't. They have to just pay what they're charged, and don't have the clout of a major medical plan.

But there's another thing. We need affordable health plans in every zip code in the country where poor people might live. Do you think we can count on every last one of those zip codes having a church that's as caring as the one in the article?

You're kidding
This is the dumbest of all objections to a national plan.

Under the current system, with any rational national system blocked in Congress, health plans are left to private industry. That means:

1. Duplication of effort. Every medical office has to hire a full time person just to handle all the billings. And health care providers have to staff huge offices with clerical workers, to process those same claims. This is a mountain of cost added onto the simple cost of net health care.

2. Private insurors make a profit. And they make a LOT of profit. The government can do the same thing more efficiently, and do it at cost.

Think not? How come the Social Security Administration can handle the sums it handles at a processing cost of less than one percent? Which among our for-profit financial advisers adevertises that they can manage your retirement account at less than one percent in fees?

The reason health care costs should not be "subject to market forces" is that that way has been shown to be the most expensive. During the years market forces have held sway in this area, health costs have risen faster than nearly any other sector in our economy-- showing us that something is very wrong with our current model.

Time to change it.

health care
there is no such thing as a viable national health plan

Why do you believe that the only options are national, govt run plans, or everyone dying from lack of health care.

It's been people like you, insisting on plans that have failed everywhere else that they've been tried, that has blocked progress to a solution.

Why do you believe that private charities will be unable to access the same information that the govt has?

Are you still trying to convince us that people who don't work for the govt are stupid?

spreading the cost
roy whines:

"Better if we spread the costs among all taxpayers."

translation, roy wants someone else to pay for his medical care.

'We need affordable health plans": Why not affordable health CARE?

Why do you insist upon a health PLAN and not health CARE?
Market forces have driven down the costs of all medical procedures NOT covered by insurance.

"health costs have risen faster than nearly any other sector in our economy--"

Because third parties pick up the tab, not YOU.

It's the same with post secondary education.

Please go on
Obviously these virtually synonymous terms, "health plan" and "health care", mean different things to you. Please amplify-- I have no idea what you're referring to.

Not a great example
What you appear to be saying is that we should not have a national plan-- or any single payer plan. Nor should we have our existing health insurance system, with multiple payers and profits tacked on.

So what, then, should we have? Just everyone who can afford health care that occasionally runs into the hundreds of thousands to pay up when billed? And everyone who can't afford it dies?

Please explain in more detail.

If you take post secondary education as an example, costs are rising nearly as fast as health care costs-- thus neatly refuting your point.

It's individuals who pay for college. Maybe you are confusing "student loans" with "student awards".

So what, then, is your solution?
"Why do you believe that the only options are national, govt run plans, or everyone dying from lack of health care."

A single payer system would reduce costs. Obviously one can not be run by a for-profit corporation. There you have many-- it would be just like what we have now.

Do you have a better way to arrange for health care for everyone? Or does everyone deserve to live?

"It's been people like you, insisting on plans that have failed everywhere else that they've been tried, that has blocked progress to a solution."

A national plan has never been tried in this country. And the kinds of plans under consideration differ substantially from those in effect in other nations. So that would be incorrect.

Further, you are in a real minority. Nearly every candidate in either party has a national plan. And most are almost identical. So I think we will be getting one.

You seem to be unhappy with the present system. So what method would you use to allow all Americans top receive reasonable care when needed, including catastrophic coverage?

Not so sure one statement you made is accurate
"We told you it wasn't necesary for a nanny state, but that liberals could get together and do this, just like they did before the welfare state came about."

I doubt that it is liberals doing this. Typically they don't care enough about the poor to actually help them. They only care enough about the poor to force other people to "help" them. Of course what they consider "help" isn't actually help at all.

What is a health plan?

I go to a medical facility to obtain health care, not a health plan.

If you want insurance, buy it.
Costs are rising becuase the person receiving the service is NOT paying for it.

Do you get oil changes with your comprehensive auto insurance?

Roy, you really DON'T understand conservatives and libertarians, do you? We are AGAINST the government taking over institutions that can be provided by the private sphere (including religious organizations). There is a BIG difference between voluntarily giving money to charity (which is what the Bible commands us), and being coerced into giving money to big government. Maybe Roy missed the studies that say conservatives give far more to charities than liberals?

Roy really doesn't understand the difference, and it is not surprising, given his positions. He doesn't understand that doing such things on a NATIONAL scale may not be the best solution. Maybe some variety and different solutions would better server the public? Not to Roy, who wants the faceless bureaucrats to do it.

And the thought that government can do it cheaper is insane.


Socialists must trust people
How else do they assume those in government jobs will always do everything the best, most efficient way and not be corrupted?

But they usually laugh at honor and are suprised when there is corruption. (paraphrasing CS Lewis.)

Like my wife buying something on sale and telling me how much money she saved?
Yeah except it isn't just ten cents now is it? Also, charity is VOLUNTARY now isn't it?

Stumbling over the bodies
I am really tired of people telling me how miserable things are.

Is there some point at which people assume some level of personal responsibility? In fact, were already paying it so why the clamor for nationalized care?

Top Reasonable Care
Except under a government plan that is impossible. The solution is to get the government out of health care not more into it. Hell, why not nationalize oil and food production? After all, doesn't everyone need food?

Ever wonder why doctors don't take medicare patients? Just because it has failed everywhere else doesn't mean it won't fail here right?

Sort of like socialism hasn't worked because the right people haven't run it?

This is emotional hogwash.

Lets let the government do everything then.
Why stop at health care, obviously the lack of profit motive makes goods and services cheaper.

another solution
Here's another idea nobody has mentioned. What about private insurance 100%, but for those losers who can't afford the premiums, then liberals set up a fund to simply pay for the premiums of such people. In this matter it's stilll voluntary, not coerced the way liberals want it to be. They could also go to the radical measure of actually letting people buy insurance from out of state companies. Then if they wanted to be really radical they would let some braches of foreign clinics come in to help out americans and show them how to provide such care; like the excellent private hospitals and clinics you get all over asian these past few years.


Why is it wiser for the citizens of a locality to incur the expense to send money to the usg and then have the usg return a necessarily reduced amount? Ben Franklin would heartily approve of the approach presented in the essay, I think.

Emotional hogwash
Now that I'm on Medicare, I notice that nearly all doctors, clinics, labs and hospitals accept it.

There goes that theory.

"Top Reasonable Care Except under a government plan that is impossible. The solution is to get the government out of health care not more into it."

Not sure what you mean here, with your impossible top reasonable care.

"Get the government out" is not a plan. What replaces government? Do you mean just continue with the privately run mess we have now?

You really don't know, do you?
I can't believe you're not familiar with the term. A "health plan" is what you use to pay the bill when you go to a medical facility.

Without a health plan, you have to take out your check book and write the whole check yourself. I have two... Medicare is one, my State Health Plan is the other.

How much is your health CARE? Or don't you CARE?
Why should you, I am paying for it.

Basic concepts
"Costs are rising becuase the person receiving the service is NOT paying for it."

You don't even think before you write, do you?

I have two health plans. And I pay for both of them.

Here's how it works. If I stay healthy I lose money. But if I get sick, I get the costs covered.

It's called insurance. And if we go to a national health plan, which seems very likely, it will work in exactly the same way.

That doesn't follow
You mistake me for an advocate of government. As it happens I've spent an entire career battling obstinate, rule-bound bureaucrats. They are, for me, a last resort.

But in managing a health plan I think they would do as good a job as private insurors... and do it for less money. So I'm for a single payer plan, administered by the government. As are several of the Republican candidates. already tried that approach
"Roy, you really DON'T understand conservatives and libertarians, do you? We are AGAINST the government taking over institutions that can be provided by the private sphere (including religious organizations)."

Yes, I understand you fellows very well. Your positions on any given issue are entirely predictable.

But that's beside the point. What I was commenting on was the approach to our health care problems that I personally favor. And I've been giving the reasons why.

"There is a BIG difference between voluntarily giving money to charity (which is what the Bible commands us), and being coerced into giving money to big government. Maybe Roy missed the studies that say conservatives give far more to charities than liberals?"

People give to charity right now. And we still have a terrivble shortfall in affordable health care. Forty-odd million Americans live without that fundamental safety net.

So what I'm saying is that charity alone has been shown to be IN-SUF-FICIENT. Merely depending on the alleged charity of your fellow conservatives ISN'T GETTING THE JOB DONE.

It's time to try some other approach. We tried the kindness of strangers-- and they weren't all that kind.

Complaining about an insurance plan
See my reply above, "We've already tried that". Charity isn't getting the job done.

We still pay full retail for poor treatment, when it comes to the uninsured. The author has managed to find a single church, bringing health care to what, dozens of people? How does that solve the problem of 40-odd million uninsured Americans?

The alleged expense of sending money to Uncle Sam amounts to a princely 41 cents. Uncle even provides a free envelope, to send your money in.

Do you complain when your other insurance premiums come due?

What's private about the mess we have now?
Government controls nearly all aspects of health care. Even for employers.

All sorts of rules and regulations for tax exemptions.

How much does an office visits cost?
How much does each procedure cost?

What do you care, your insurance pays.

Ever wonder why lasik surgery has gotten better and cheaper? Most insurance won't cover it and people want it.

Charity used to work before government messed it up in WWII.

Charity IS working in VA.

Political Catastrophe
Free clinics are a return to the days when concerned citizens and community effort was more important than national political control of our lives.The socialization of the US started when Edwin Witte PhD wrote Mr. Roosevelts Social Security Billand included a national healthcare program. Political wisdom confined the bill to old age insurance. In 1953 Prof. Witte addressed our MD class at the U.Wis stating "before you finish your resident physician training we (the government) will own you". Commonly referred to as slavery. It was accomplished by making the medical schools research institutions dependent upon government grants, rather that local funding and patient care. In Milwaukee it caused the bankruptcy of the Marquette Medical School because the scientists told the voluntary faculty to "get the f--- out- we don't need your" This has been the cause of the change from medical education from patient oriented care to research and dollar generating care. The story is complicated and I lived it all, including being a professor at Stanford. The goal of political medicine is not patients, but votes and political power. Waxman was quoted in a published interview saying," It is our (Congress) intent to make medical care cost so much that people will demand government care " Well folks you've got government controlled care and it is costly and degenerate. At an executive meeting at Stanford I was asked by a Nobel prize winning researcher " Why do we need patients, this is a medical school? " Think about these things when you vote for more government degeneration of the " Healthcare Industry " You used to have physicians who cared - now you have a government that doesn't give a damn. The cheapest form of therapy is a dead patient and that is what the government has to offer.

Some of us don't want 'healthcare insurance'
We don't want to be required to pay for insurance premiums every month. Such things as healthcare insurance should be either voluntary or abolished. It would be cheaper saving whatever money would go for premiums & just pay the doctor as needed for services rendered. Free clinics are a better idea than mandatory healthcare insurance for the uninsured.

From the horse's mouth. Roy (personally) favors the gun.

to true believers like roy and eric, there's pure communism, and everything else is a variant of capitalism.

Do you mean Blue Cross Blue Shield?
I shouldn't be surprised that you haven't noticed. Most health care in this country is paid for via privately run health plans. Should an employer wish to provide a health package for his employees, he goes to one of those plans and pays a portion of the premiums they charge.

Runaway costs have occurred, as these plans merely pass on the added costs charged to them by providers. A single payer who was committed to the common good would be in a position to crack down on such cost inflation.

Uninformed but noisy
What an utter moron you are. You don't pay for my health care, I do.

I pay the taxes that fund the Medicare system. Additionally I pay my regular premium for Plans A and B. But you wouldn't know anything about that-- because you're just too stupid to actually look into how Medicare works.

My secondary insurance is the State Plan. And I pay regular premiums on that policy as well.

These conversations would be very different if you ever decided to inform yourself before running off at the mouth.

The reason for all the fuss
The issue is whether or not the current health care system is in need of reform. And I would maintain that it is.

Down with insurance!
"How much does each procedure cost? What do you care, your insurance pays."

It's hard to imagine you're that stupid. Nearly everyone else understands that we end up paying anyway. When costs go up, premiums go up. And we pay the premiums. Not to mention the deductibles and the copays. But you very likely are unfamiliar with those terms.

By your logic, if lasik surgery has gotten better and cheaper because insurance isn't involved, the country would be better off if health insurance didn't exist.

Then everyone but the very rich would die off when faced with an expensive illness. Why don't you think this one through a little better?

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