How Much Care Goes Into Health Care?

Every July since 1999 the fairgrounds in Wise, Virginia have been turned into a field hospital by the "Remote Area Medical Expedition". Free care is provided to those in need. Sanitized horse stalls become examining rooms. A poultry barn is fitted with optometry equipment. An open-air pavilion is filled with dental chairs and lamps. A converted 18-wheeler is an x-ray facility. During the 3-day event 2,700 people from 16 states were treated. Over 50% had no health insurance and 47% were underinsured. In 2009 expeditions are scheduled from Virginia to California - filing in gaps in the health care system.

The first retail clinics opened in 2000, providing more convenient and less expensive health care. A 2009 study published in the "Annals of Internal Medicine" compared the treatment of 3 routine illnesses - ear infection, sore throat and urinary track infection - at retail clinics, doctors' offices, urgent care centers and hospital emergency rooms and found no significant difference in patient outcome. In 2009 there are 1200 retail clinics. Unfortunately, more than half are in Florida, California, Texas, Minnesota and Illinois, with 18 states having none. The biggest concern about retail clinics is there aren't enough of them.

In 2008 the Maple City Health Care Center, a low-cost clinic in Goshen, Indiana, provided a way for money-strapped patients to pay for medical services. In the "More Than Money" program patients can pay by doing community service. The clinic offers $10 an hour toward payment of medical bills if patients volunteer at other non-profit organizations, such as a health care agency or a co-op market. As of November 2009 - about a year into the program - 34 patients have logged approximately 350 hours of community service. Not only do the patients benefit from this program, but the non-profits profit.

Finally, research published in "Health Affairs" shows that medical spending averages $1,400 more a year for obese people. Obesity-related health spending reached $147 billion in 2009 - double what it was about a decade ago. Obesity-related conditions, such as heart disease and diabetes, account for 9.1% of all medical spending compared to 6.5% in 1998. Excess weight is the biggest factor in developing diabetes, which costs $190 billion a year to treat; and about one-third of adult Americans are obese. It seems we won't get the fat out of any health care plan until we get the fat out of Americans.