Reforming Health Care with Doctors Instead of Insurance

Imagine a health reform plan that has nothing to do with insurance. It adds no new regulations on insurance companies, no subsidies to help people purchase policies, and no individual mandate to force people to maintain coverage. And it does nothing to expand public programs, like Medicare and Medicaid.

Is such a plan possible? Could it do anything for the 50 million or so Americans who can't get the care they need because they are uninsured?

The answer is that such a plan is not only possible but has already been implemented by the Obama administration. It takes the form of a major expansion of the National Health Service Corps, a program that sends doctors, nurses and other health care providers to underserved areas, where one-fifth of the population lives.

The Corps, which was established in 1972, provides scholarships and loan repayment awards for students who commit to spending their first years of clinical practice in rural and inner city communities. The 2009 stimulus bill included $300 million to expand the program, and the health reform law added another $300 million a year for five years starting in 2010.

With this financial infusion, the Corps has almost tripled in size since 2008.  It had 3,600 members then, and it has 10,000 today, the largest number in its history.

More importantly, the number of people served by the Corps has also almost tripled from 3.7 million to 10.5 million. These people live in places where it is difficult to find a doctor or a nurse when you need one. No amount of insurance can help with that.

And health care has been extended in these regions at a cost that is microscopic compared with most other programs that expand health care access, both public and private.

The Association of American Medical Colleges estimates that America has about  13,700 fewer doctors than it needs. Under health reform, the gap will expand as more people are able to afford care. By 2020, it could reach 91,500.

The Association projects the shortfall to be greatest in primary care. Rural and inner city areas feel it most acutely. This is the kind of care and the kind of geographic region that the Corps is intended to help.

This is not to say that expanding the Corps constitutes a comprehensive solution to the nation's health care access problems. It provides only a front line for people who would lack basic primary care. They still need access to hospitals, specialists, drugs, and a range of other services.

However, the Corps meets a vital need. Without a front line of primary care, many patients have no means of access to any care at all.

Comprehensive health reform remains crucially important. We can't continue to deny care to tens of millions of citizens because they are unable to get insurance. But comprehensive reform in any form is expensive and controversial.

While debates over broader health reform continue, quieter efforts, like expanding the Corps, are being pursued in the background to improve things on a smaller scale. For millions of people, those reforms can be a lifesaver.

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