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Bowen Rodkey for WORLD

Patients & partners

Healthcare | Invisible to the healthcare debate in Washington, clinics that serve the poor could provide a model for helping the uninsured

Issue: "All-American adoption story," Nov. 21, 2009

Zaarephath, N.J.-The line of patients usually forms long before the clinic doors are opened. This night is no different: Nearly 40 people are waiting for their turn with two volunteer doctors at a cottage turned clinic on the campus of a local church.

Once inside one of two examining rooms at the Zarephath Health Center, the patients, many of them repeat customers, frequently utter the same two words: I'm miserable.

There are Sabine, 51, who lost her job as manager of a craft store her first workday back from surgery, and Jessica, 22, who no longer can afford the $88 a month it costs to see her regular doctor, plus Brenda, 48, who winces and shakes as the staff pricks her finger to test her blood sugar.

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"It's Halloween, so next time we can take it off your neck," jokes John Eck, a founding doctor of the clinic.

Eck's patients are black, white, Asian, and Hispanic. Some are homeless, others jobless, and many are luckless. But they all share one thing in common, and it's what brings them here tonight: no insurance.

As the declining economy erodes America's middle class, the nation's healthcare system continues to spiral out of control, sending even more patients to this free clinic: From 1,700 patient visits in 2007, the clinic is on track to see 3,000 this year.

"It's like Grand Central Station in there," says John Fasoli, 55, shaking his head as he waits outside for his turn. An uninsured electrician, Fasoli is making his fourth visit to the clinic to treat an infected foot. "But to run into people willing to help like this is a breath of fresh air."

Following the words of Matthew 11:28-30, which are painted on the waiting room wall, the volunteers at the center are trying to provide healing for those who are weary from disease, illness, and injuries but burdened by the inability to pay for treatment.

With the federal government closing in on a year-long push to spend nearly a trillion dollars to provide a safety net for people like John Fasoli, Zarephath stands as a modest reminder that places already exist for those who must walk life's high wire without insurance.

It is indeed a comforting place where hugs are doled out almost as much as free medicines. It is a place where one remembers why the word care is attached to the word health.

And that care comes cheap. While it currently costs the government between $110 to $120 per patient visit when the uninsured seek medical help, Alieta Eck, the clinic's other founding doctor and John's wife, says they have gotten costs down to between $10 to $20 a patient. The cost to the government: zero.

This clinic is tucked away in rural New Jersey, 214 miles from Washington, D.C. But the marathon healthcare debate that has enveloped the nation's capital this year seems thousands of miles away.

Still, John Eck has one message to the lawmakers he sees on television preaching about the best ways to cure the nation's healthcare ills: Come visit.

Zarephath is one of many clinics that serve those with low-paying jobs but no insurance. There are more than 1,200 free medical clinics around the country, serving more than 3 million patients each year. They are doing their part to keep patients from going to the nation's expensive emergency rooms-a practice that is a key driver behind the nation's escalating healthcare costs.

Sadly, the role of such clinics in a federally remade healthcare landscape has been ignored during the ongoing legislative debate: Several doctors associated with these clinics told me that they have not been given a seat at the negotiating table. Lawmakers are excluding insights from the very people who already are serving the uninsured population that any new law will try to reach.

So when I asked John Eck, while following him to the center's well-stocked pharmacy of entirely donated drugs, if he had any ideas for Obamacare, he quickly pulled from his pocket a green note card with the words "Goals of Healthcare Reform" printed at the top.

With $70,000, the Ecks started their clinic six years ago and now operate it on a shoestring $60,000 annual budget. Its formula for success depends on a platoon of volunteers, who know how to stretch a dollar and who desire to build relationships with their patients: all things John Eck is skeptical will occur if the government gets more involved in healthcare.

The Ecks have a vision of a nationwide network of similar clinics that would provide care to the needy while costing taxpayers very little. How to get enough doctors to staff the clinics? John Eck's plan is to have the government extend free medical malpractice coverage to the practice of professionals who donate 20 hours a month to free care for the poor.

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