Just One Face of Community Health Clinics

[Drags out her public health soapbox]

Last week I had the misfortune of breaking a tooth on a delicious hamburger. While there was no pain, no blood, no gaping hole in my smile, there were nearly immediately tears. I felt very anxious, maybe even panicked for a few minutes.

I don’t have dental insurance.

While I kept telling my dinner companion “I’m fine, I’m fine,” in my head, the wheels were turning at a furious pace as I added up the potential costs of having this tooth treated. There would be an exam fee, an x-ray fee, maybe a fee for cleaning, and while I didn’t know what the procedure would be to fix it, I knew it would be expensive. An extraction? A crown? An implant?! The sum I kept coming up with was thousands of dollars.

I am in this period of my life I like to call the Great (and Extended) Transition. I got my masters degree when it was ‘a great time to be a student’ but an awful time to be a recent graduate. Further, I am passionate about working in a field that is heavily dependent on government funding. When the government suffers, the public health workforce does too. Currently, I am working at exactly the thing I am most passionate about and I actually love going in to work, but for only 20-32 hours per week. Not eligible for benefits. (Don’t worry, the irony that I work every day to protect the public’s health and access to treatment and yet I do not qualify for health benefits is not lost on me.) I make a livable wage and have no problem paying rent for a modest apartment, healthy groceries, and gas to fuel the car. I can afford my gym membership and my phone bill. I budget well and save for the fun things in life like vacations and marathons and the new IKEA chairs I so desperately needed wanted a week ago, but it’s hard to budget for a surprise dental procedure. I have money in savings, but there is a constant and pervasive fear in the Great (and Extended) Transition, that I could lose my job again and be reliant on that cash.

Luckily my career in public health has taught me at least one very important thing about access to care: somewhere, someone treats everyone regardless of the patient’s ability to pay. Those people are found in community clinics. While I do have health insurance, I have often gone to community health clinics for preventative care such as vaccinations. I do it because I am able to pay my co-pay in full and my health insurance provider reimburses the clinic in full. I am hopeful that these full payments allow the clinic to offer a reduced fee to someone who needs it.

Yesterday, I arrived at a community dental clinic for the first time as that someone who needs it. Maybe that’s not a completely fair representation– I could probably pay full price for the work, but with serious consequences to my savings account that I am relying on in case of another employment emergency. I arrived shaking like a leaf– nervous about the cost, nervous about the procedure, and nervous about that needle-like tool the hygeniest always jabs into your gums.

They were more than gracious. They cared about more than my busted tooth or my financial situation. They cared about me. I met with the financial coordinator first and we talked about sliding fee and what, if anything, I would qualify for and I was shocked that I did qualify for a modest discount. My doctor was notified that I was a self-pay patient and when he ordered a test but wasn’t sure it would change the diagnosis or treatment plan, he didn’t charge me for it. As we discussed treatment options, I sat down with the financial coordinator and the doctor to discuss all possible outcomes and the detailed cost of each. It was the most aware I have been of my medical or dental treatment in my life. I left with a still-busted tooth and an appointment to fix it. I left with a complete understanding of cost and was already calmly deciding how I would budget my own finances to cover the cost. I left knowing that this clinic had heard me, took time to understand my concerns and answer my questions, and reassured me that this would be affordable and I was going to be okay. I cannot say enough about my experience.

I have always advocated for community clinics– we know they do good work and provide access to care for people who don’t have access through other avenues. I won’t spell out all of the benefits of them here, but if you want more information check out this article from The Center for American Progress. But maybe more important than just my blanket advocacy for community clinics, I want to remind everyone what the face of someone who needs a little extra help from time-to-time looks like:

We need to let go of the stereotypes we have of the people using a community clinic. I am a healthy 20-something, American-born, well-educated, and a working professional. And I needed a little help. But I am not down and out; I am up and coming. I’m probably not who you think of when you say harsh remarks like “I shouldn’t have to work and pay for my health care so other people can get theirs for free.” You probably don’t think twice before you tell me in a discussion over cocktails that health should be a commodity, bought and sold under the rules of the market, like an iPad or socks.  The more money you have, the more health you can have? That’s absurd.

Be mindful. Be respectful. Be understanding. The health care system isn’t perfect for anyone, and health care reform isn’t going to make it perfect either. But it will help community clinics continue to provide care and even expand.  Because everyone deserves access. And if you took a moment to really realize how some of us up and comers are fighting hard to make it but we just need a tiny boost, you might not be so critical.

“The greatest wealth is health.”


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