Montana's State-Run Free Clinic Sees Early Success

[frigidmagi]

NPR

A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.

A year later, the state says the clinic is already saving money.

Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.

"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.

That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.

"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.

He wonders what that free price tag is actually costing the state government as well as the wider Helena community.

"If they're taking money out of the hospital's pocket, the hospital's raising the price on other things to offset that," Lewis says.

He and others faulted then-Gov. Brian Schweitzer for moving ahead with the clinic last year without approval of the state legislature, although it was not needed.

Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.

"They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.

Lower Costs For Employees And Montana

The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.

"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.

Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.

“ Because there's no markup, our cost per visit is lower than in a private fee-for-service environment.
- Russ Hill of the Montana Health Center
Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years.

Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money.

Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him.

"Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says.

That personal attention has proved valuable for library technician Pamela Weitz. A mammogram late last year found a lump.

"That doctor called me like three or four times, and I had like three letters from the clinic reminding me, 'You can't let this go, you've got to follow up on it,' " she says.

Two more mammograms and an ultrasound later, doctors think it's just a calcium deposit, but they want her to keep watching it and come in for another mammogram in October.

Weitz says they've had that same persistence with her other health issues like her high blood pressure. She feels the clinic really cares about her.

"Yeah, they've been very good, very good," she says.

Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works.

Huh, how about that.

[Lys]

Montana has long been a state with its own strange mix of socialist leaning tendency and frontier rugged individualism. Perhaps the best way to put it is that they're the last hold outs of good old fashioned pre-Wilson progressivism. Take note that 2/3 of their Congressional delegation is Democratic, as is their Governor. This isn't unusual, they're consistently willing to vote for moderate Democrats that won't take their gun away (to put it in simplistic terms). They are also willing to do things like put in a state run free clinic, and i'm not the least bit surprised it happened in Montana.

[frigidmagi]

I'll admit, I would have fewer qualms on Democrats if they were less gun-grabby. I don't expect them to change however, considering I vote for them fairly regularly as it is. But really, look at my options here.

[Lys]

Yeah, same here in pretty much. Frankly the anti-gun stance in the Democratic party seems almost pathological. The voters who are anti-gun will, by and large, still vote for them regardless of whether the Democrats are willing to fight for it or not. Whereas there are a fair number of voters who would be more willing to consider Democratic candidates if they weren't anti-gun. Thus the logical political position to take on gun control for the DNC is one of blasé indifference, as that's the one that's most secure politically.

Though, on second thought calling it "pathological" is more than a little unfair. There are voters who very much appreciate their representatives holding on to ideological positions regardless of whether it's politically safe or not. Plenty of pro-gun-control people are clearly very passionate about it, and surely they want their position defended as much as we want ours to be defended.

[Josh]

My personal opinion is that a lot of the anti-gun attitude of the Dems is more for show than any sort of actual intent. The last time they actually managed to pass gun control, they took a historic beating for which gun control was a large portion of the motivation. What they did get through was watered down and lapsed out by a decade later, leaving only the original NRA-backed instant check.

(This was before the NRA had fully climbed into bed with the Republicans the way it has now, which has essentially made it into an obnoxious mouthpiece outfit that I want no part of.)

So basically the issue has languished and rightfully so. There hasn't been a single major piece of proposed antigun legislation that wasn't either based on fallacious premises at the root (assault weapons are sweeping the country/cops are dying from AP ammo/plastic guns from the eighties could swoop through metal detectors/etc.) or was useless and expensive (national licensing schemes, registration, etc.) Instant check was the sole exception, that came through and provides a certain level of obstacle to the criminal while being no obstacle at all for the law-abiding citizen*.

3D printers are going to make it even more ridiculous of a concept than it already is, while also likely demonstrating that areas where violence was already low manage to stay low on violence.

So while I find the gun-grabby rhetoric that the Dem leadership gets into annoying, I regard it as primarily a money-making activity that appeals to a certain segment of their base. It is annoying because they could make a great deal of hay in certain regions if they were smart enough to drop it from the national ticket, but I think that in time they will drop it as the generation of pols trained in the eighties and nineties-style of politics fade from the scene.

If I thought they were actually in a position to pull it off, I'd be a lot more leery of voting for them. As it is, I do use it as a litmus test for the more dishonest among them- if they're big on antigun rhetoric, they're either dumb as shit or dirty filthy liars on the subject. If they're willing to back fallacious positions driven by emotional propaganda, then they're not going to be taken at their word on much else either.

So it really does boil down to the lesser of two evils. But I'll never be a fucking shit-brained Dem anyway, or say I'm lined up with any fucking political party. I'll just keep strategically voting for who I think will fuck me less, fuck the country and its citizens less, or fuck up less in general. Right now, that almost universally pushes me toward the blue end of the ticket.

*The exception being if you're a CDL driver and your mailing address is different from your home address. I bumped up against that once, fortunately it was relatively easily resolved. In certain states it could be a royal pain in the ass, though.