Giving Back

By Nelson Bradshaw

Ben Friedell is a physician, a family practitioner, in a group practice at Fox Hospital in Oneonta. He has lived and practiced in the region for more than 20 years. Not coincidentally, Dr. Friedell is also an advocate for those who need medical care but lack resources to pay for it. Ideally, in his view, the government would manage and pay for a national health care system. But, deferring to reality, he recognizes that there is no such program on the near horizon.

For now, Friedell and several like-minded associates are taking steps to intercede on a small scale. They’re opening a free clinic, with Dr. Friedell as Chairman of the Board as well as a volunteer practitioner. The Oneonta Free Clinic is expected to begin seeing patients in early 2008, at 22 Academy Street in Oneonta. The clinic will be open, initially, only two evenings a week, a few hours each night. Organizers expect to be able to serve eight to twelve patients an evening under these circumstances.

The use of the building on Academy Street is being donated. In fact, the clinic is depending entirely on donations for its support at this point. The group has a few thousand dollars in the bank as well as the donated services of medical professionals like Dr. Friedell. Non-medical people are contributing their time, too. The clinic is in the process of applying for incorporation under 501(c)3 status, which would designate it a charitable organization, so that donations could be written off.

Dr. Friedell acknowledges that the free clinic may attract more patients than it can serve, unless it grows to meet demand. But that growth would depend on an increased supply of volunteers and donations as well as the needs of patients. “How many volunteers, especially medical providers, can I get to come in and join us?” Friedell wonders. “We don’t have a large reservoir of retired physicians and nurse practitioners to call on in Oneonta, like some communities do. We will depend heavily on people like myself, who work part-time or full-time at local hospitals or in private practice and are willing to give a few hours of their time a month.”

Another source of support for the clinic is Fox Hospital, which is offering to pay for lab and X-ray testing services. Fox is already involved in giving medical care to patients who are short of resources. Like other hospitals, it is required by the government to provide some care for the indigent every year. Fox does not choose to meet that obligation by opening a free clinic, however. Such a clinic could be overwhelmed by patients or simply prove too costly. Instead, the hospital works out individual payment agreements for those who can’t cover their bills the standard way.

“After you have received care in the hospital you are presented a bill,” explains Doctor Friedell. “You may then go into the business office and show them just how much you can’t afford to pay. They will try to work out a payment plan with you. They might even write it off for you. Still, going into the hospital without insurance, you don’t really know whether you will get the help you need or not.” Fox Hospital wants the free clinic to succeed for humanitarian reasons. But, it also wants the clinic to absorb as many of the uninsured as possible, in order to reduce the hospital’s role in providing for them.

Over his years of practice with Fox, Friedell has seen the effects of not having insurance or money to pay for treatment on numerous patients. “They’re reluctant to come in,” he notes. “By the time they do come in, their medical problems are more advanced than they would have been if they had come in early. Then, when they get here, they’re wary about having any testing done. That makes it difficult to treat them.”

Friedell defined the population that he and his colleagues in the clinic intend to serve. “They are people who have neither insurance nor the funds to pay for care,” says Friedell. “They do not include a 25-year-old, healthy and successful entrepreneur, who chooses not to purchase medical insurance because he is young and healthy. We are targeting the vast majority of the uninsured in this state, who are the working poor, often supporting families. They cannot pay for insurance and the small businesses and farms they work for cannot afford to purchase it for them. They are within 200% to 250% of the Federal poverty guidelines. They also make too much to qualify for Medicaid, the State and Federal program for the poor.” That targeted group makes up 12% to 15% of the population in Otsego, Delaware and Schoharie counties.

The Oneonta Free Clinic will make a valiant effort meet the medical needs of these people. But small, private clinics are not the real answer to the nation’s mounting health care crisis, according to Doctor Friedell. “A free clinic is just a band-aid,” says the physician. “It’s a way of getting care to people in a hurry. My personal belief is that we need a single-payer health insurance system in this country. A simple name for the program might be Medicare for Everybody. Medicare is the Federally funded system that pays for everybody who is over 65-years-old or who is disabled. It is a single-payer system. All the bills go to the Federal government. It works very well. The customers are quite satisfied. Nevertheless, there has been a tremendous amount of resistance to establishing a similar program for the whole country.”

Friedell notes that the existence of a one-payer, national system would mean that just by virtue of being a citizen of this country, you would be insured from the time of your birth to the time of your death. Friedell expands, “You would never have to worry about that, no matter how many times you changed your job or college or your status in the military.”

Most opponents of a proposed national system say that the country can’t afford it. Dr. Friedell argues that, first, a patient wouldn’t be able to get just any treatment or an infinite amount of care under a national plan. “There would be a cut-off point,” Friedell asserts. “Medicare, Medicaid and the Veteran’s Administration are all examples of government-run, single-payer systems. They have cut-offs.”

Second, a single-payer system would save a lot on administrative costs, the doctor points out. “The advantage of using a single-payer program is that it eliminates bureaucracy and expense,” he says. “If you come to my office now for treatment, for example, you have to show your insurance card. My staff has to get on the phone or a Web site and verify that you still have coverage. There is a plethora of insurance companies in our area alone, and they all have different rules and different measures of membership and services covered.It is really very frustrating.”

Friedell concedes that one point frequently raised by national health care plan critics is valid—some procedures would have to be rationed. “If we go to a single-payer system, certainly if you want an elective procedure like having a cataract removed or a hip replaced, you’re going to have wait a few months,” says the doctor. “These things are not emergencies. However, if you come into a hospital with a true emergency, if will get taken care of that day or the next day.

Doctor Friedell also points out that health care is rationed under the current system. “If you live in New York City, you can get in to see a gastroenterologist quickly,” he states. “But, if you live up here and you want to see one, you’ve got a long wait ahead of you. If you have the money or insurance and you live in an urban area or can travel, you can get whatever medical care you want. But, you can’t if you lack insurance or if you reside upstate or in a poor part of town. We’re doing de facto rationing right now. We’re limiting medical care on an economic basis.”

Another fear raised by the critics of a proposed national care system is idea that the government would make a mess of it. “They talk about the idea that you can’t trust government to run health care,” Doctor Friedell notes. “But, the government’s been doing it very effectively for over 40 years. Medicare and Medicaid have been in existence since the mid '60s. Medicare spends a very small percentage of its funding on administration. That allows more money to be spent on doctors, nurses and medicine.”

After the next presidential election, there could be a public debate on a national scale about the single-payer idea. But a small, determined group in Oneonta is ready to do what it can right now.

Dr. Friedell does a lot for his community. He served on the Otsego County Board for two years. He is presently on several boards of local organizations. He is involved in local theatre. But, the most salient of his contributions is his advocacy for a progressive medical care system in the United States. He has been behind the idea for years. Now he is putting his time, skill, and heart where his mouth is.

For more information on the clinic, log onto www.oneontafreeclinic.org.