Friday, August 31, 2012

Health care for Americans who can't afford health insurance

Of course all 50 U.S. states and possessions each have their own health services for the indigent, both alone and in concert with the federal government, depending on the program, but often we forget the biggest and oldest provider of all, the U.S. Public Health Service, under the Surgeon General, Department of HHS.

The U.S. Public Health Service Commissioned Corps is a team of more than 6,500 full-time, well-trained, highly qualified public health professionals dedicated to delivering the Nation’s public health promotion and disease prevention programs and advancing public health science. As one of America’s seven uniformed services, the Commissioned Corps fills essential public health leadership and service roles within the Nation’s Federal Government agencies and programs. Officers serve their country in communities that are most in need by providing essential health care services to underserved and disadvantaged populations.

If you have unmet medical needs because you have no insurance and low income, seek help at the nearest USPHS hospital, clinic, or field facility. 

Learn more about the USPHS services, and also how you can find a career as a civilian medical professional or uniformed PHS officer with them here.

Native Americans receive medical care without cost to them, regardless of income, through the Indian Health Service (IHS) and, if low income, also are eligible to participate in all low-income programs offered by the states and federal government. Native Americans do not pay for doctor visits, surgeries, hospital stays, wellness care, emergency care, maternity and pediatric, prescriptions, or medical equipment. Medical, dental, vision, hearing, addiction, and counseling services are available free of charge to Native Americans through IHS facilities and clinics.


  1. How interesting, but how limited are the services the Indians receive I wonder? If I lived there I would be called Chief Owe a Lot, and seek medical aid.

    1. How could you even suspect limitations after reading that?

      If you can prove your lineage and Indian blood, and persuade your tribe to agree in writing and issue a tribal ID, you are in like flint, Chief.

    2. And of course you wouldn't owe a lot, so people would wonder why you are named that. :)

  2. The requirements for consideration as a probationary member of the Surgeon General’s Honor Cadre are as follows:

    Must meet the PHS induction height and weight standards.
    Must have supervisor's permission and support to participate in Honor Cadre activities.
    Must possess, at a minimum, a Ceremonial Service Dress Blue uniform.
    Must be willing and able to attend regularly scheduled practices in drill and ceremony.
    Must be willing and available for formal presentations and ceremonies.
    Must be willing to wear the PHS uniform on a daily basis with pride and distinction.
    Must be willing to place the needs of the Corps above personal convenience.

    Mmmm. Core values and all that. Whyever would you want a medical service to be good at drill? Other than a dentist, of course.

    1. Ah, a foreign skeptic.

      No, there is no fat to be trimmed from federal government.

  3. I'm fascinated by these guys. I can see the "Marching Stethoscopes" wheeling to a rousing march by the massed band of the Corps of Dental Hygienists.

    1. They ARE fascinating. Living, as I do, only a mile or so from the largest IHS hospital in America-dom, which is largely stocked with hundreds of civilian (mostly white from faraway states) physicians, and civilian nurses, nurses aides, lab techs and what have you (white, Hispanic, and Indian - Indian preference, of course) AND perhaps 10% PHS captives, in pretend military uniforms. Now, having prior REAL military service myself, I will admit I inwardly snicker when I see them in their "uniforms", some black like the Navy, some brown like boy scouts- carrying backpacks and what have you. Trained doctors and nurses and administrative personnel all. Few native americans but those who are are promoted rapidly and put in charge of something. A cynic (such as I used to be in my annoying days of yesteryear) would probably think they were more concerned with trading work for payments on student loans rather than alleviating the plight of their less fortunate brothers and sisters, Native American-type (and muslim and genuinely homeless - they don't really turn anyone away, even if they are not Native American, and the muslim immigrants (not known to be big spenders even in the best of times) learn quickly where to go for medical care without buying insurance. But that would be a cynic's view, much less compassionate than my own. I have doubts that any of the local boy scout crop have a snowball's chance in hell of getting on the Surgeon General's list of top toilet cleaners, much less some honor cadre or whatever. Put in your time then go back to civilization to be real golfing doctors seems to be the mindset. Again, cynical. The civilian doctors imported on a contractual basis are very compassionate and fancy themselves as relievers of the pain of the noble red man, but also leave on a regular basis, having been disabused of all that and thoroughly burnt out without thanks or appreciation from their demanding patients (many of whom will wait hours to be seen and given a free aspirin since they aren't at all sick (there is a color tv in the air conditioned waiting room, and they are brought popcorn regularly by their extended families, who also sit and watch tv whilst the youngsters break up the government furniture. The tv being placed too high for them to pull down. In the main, there are few complaints at long waits since they are proudly of the 80% unemployed ranks in Indian Country. Why go to work for less money?

      But, somehow, the Indians DO get seen, regardless of what (if anything) is wrong with them, and they, like you, leave without paying.

      I think the uniforms started many years ago when their function was to investigate epidemics and attend natural disasters. They were health "officers", you see, of the Clara Barton and civil war battlefield ilk. Now... who knows.

      The Surgeon General, ensconced securely somewhere in the bowls of some Washington back office, dresses like a Fleet Admiral with gold bands of braid on his black sleeves, and shoulder-boards as well, I think, appears regularly on TV public service announcements warning gravely that if you smoke cigarettes your guts will fall out and women will become barren. Or the like. He is paid handsomely and his picture is probably placed next to a long line of predecessors in some Washington lobby. Or smoking lounge.

    2. I'd heard the term 'Surgeon General', but it never occurred to me for a moment that it was as a member of a quasi-military health-care corps.
      It is all so delightfully quaint. And there was I thinking that europe was the place of bizarre oddities and strange customs. Now I find a whole new set of stories coming to life.
      Tarooo!" Taraaaa! Here comes the 15th bedpan division, galloping over the sagebrush!

      You've still failed to convince me though, of any sort of universally fair healthcare system. I have, however changed my name to 'Cloud-Elk Thunderfarter', in a pre-emptive move to get sugar-pills and aspirin, and watch a colour TV for the first time. Having no offspring of my own to do it, I'll have to break the governments' furniture myself.

    3. I don't want to convince you that our patchwork "system" is better than a well thought out health care system that is fair, because I believe in universal health care. Just not run by a central government, or monies collected directly by said wasteful bloated central government. Regulated by (state) governments, yes.

      I was only countering your own post which seemed to indicate our poor had no access to adequate health care if they chose to come in and get it or consult with a traveling health care group. Your post seemed to indicate that this outside mobile health group was some sort of lifeline to the tragic dying poor in the backwoods areas of the U.S. In fact. one of the most comprehensive IHS facilities is located on the Rosebud rez. All they need to do is put down their beer bottles and come in for treatment. Stop drinking altogether would make a car payment for them if they could get their license back. Or fund a fine retirement plan. The free services are there, Soub. All over. Duplicated. Specialized. For children. For the unemployed. For drunks. For the crazy. For minorities. On reservations. Free clinics in inner cities. Any contribution by by your traveling medics is certainly appreciated too, but most "help" websites have a "please donate so we can help the poor neglected homeless and Indians" link prominently on their home page, usually accompanied by a photo of an abused and hungry Indian child. The one you blogged about does not have such a link button.

      What I would want to do first would be get the people who are neither rich nor poor nor of some special group, covered. That is where a tax-funded forced-contribution or savings program would come in for me.

      As for a universal health plan for America, I generally favor the Republican plan and it's five major goals. Don't really care what final form it takes.

      1. Make quality health care coverage affordable and accessible for every American, regardless of pre-existing health conditions.

      2. Protect Americans from being forced into a new government-run health care plan that would:

      a) eliminate the health care coverage that more than 100 million
      Americans currently receive through their job;

      b) limit your choice of doctors and medical treatment options; and

      c) result in the federal government taking control
      of your health care.

      3. Let Americans who like their health care coverage keep it, and give all Americans the freedom to choose the health plan that best meets their needs.

      4. Ensure that medical decisions are made by patients and their doctors, not government bureaucrats.

      5. Improve Americans’ lives through effective prevention, wellness, and disease management programs, while developing new treatments and cures for life-threatening diseases.

      Now, I wouldn't have worded my plan in such a harsh politically partisan way, but I do want those things. I want choice, I want competition (I don't think yours has competition does it?), I want government regulation, effective and close regulation, against collusion and price-fixing which thwart competition. Some other things I want, such as regulated by the STATE central governments instead of the feds, I probably wouldn't get.

  4. Oh? Sounds like you want the NHS then.
    Because the HNS ticks pretty much all those boxes.

    Back in the old days, I had private medical insurance, I kept paying in, until my circumstances changed and I had to cut down on things which I did not actually need.

    The private insurance gave me, for instance, a shorter wait for an appointment, the option to have my treatment in a nicer hospital. i.e., one more like a hotel. Private rather than shared room, a better choice of menu for my meals, a television, etc.

    But the NHS used the same doctors, and clinically there was little difference to the outcome.
    Yes, we have competition. My mother elected to have her treatment at a hospital twenty miles away, rather than the big one a couple of miles away, because the smaller hospital had shorter wait times, and, she thought, nicer staff.
    The big place has more state-of-the-art equipment, but is more bustling, busy, and impersonal.

    What, I think, I'm most in disagreement with you, is the concept that, in an emergency, you get treatment, regardless of who you are, nobody has to call up your insurer, nobody checks your insurance card, nobody needs to know if you can afford it, because, automatically, you can.
    If I'm not feeling too god, got a pain in my chest, say, I can turn up at my general practitioners reception, at 8-30 in the morning, and I'll be seen in turn, or, if it's a little less urgent, I can phone in, and get a specific time appointment. If I need medications, then I'll get a prescription, and the pharmacy will fill it on my way out. At the pharmacy, I'd have to pay, I think, £7:50 per item, unless, as I do, I'd paid a set fee up-front, entitling me to an unlimited number of prescription items during the year, and definitely a cheaper option for me.
    If I was unemployed, above retirement age, pregnant, diabetic, under the age of 18, etc, there would be no charge.

    All I can say is, it works. It's not perfect. But it's pretty damn good. Nobody needs to fly medical missions into rural areas.

    Your example of native americans reservations is spurious, my example was of how an organisation set up to provide medical aid in third world countries finds itself needed by communities across america.
    Maybe they are the feckless poor, but surely the words of your founding fathers were spoken by people who believed in a better world than that.
    Your nation, my nation, between them seem to have no problems funding hearts and minds medical missions in Afghanistan. A fraction of the cost of a missile, drone, warplane, navy vessel, helicopter, would go a long way in provision of healthcare to ordinary people, who don't currently have the choice of being healthy.

    Here today, gone tomorrow, once or twice a year services aren't the answer. The NHS was set up to provide universal access to healthcare 'from the cradle to the grave' (with the maximum possible period in between). That's what I strongly feel the U.S. is missing.

    1. "Oh? Sounds like you want the NHS then.
      Because the HNS ticks pretty much all those boxes."

      Missing the one tick that is the deal-breaker.

      But even though I like that your systems works well for you, and hate that some of our people have to good through indignity to get cared for, I am perplexed with how we would move from the mishmash we have now over to your system. For example, let's say you were to decide to nationalize all the grocery stores in Britain. How would you go about it? (All the zillions of people who now are employed with private insurance companies here, companies who would no longer exist, would be out of a job. Would you start by firing all the shelf-stockers at Tesco? Would you just throw away the stock that the government decided was not going to be carried anymore? Would you expand the hours of operation, even if some stores didn't warrant it? Would you build more Tescos out in the boondocks so that all had equal service? Tear down existing sotres? I don't see how we could make ourselves fit into your mold, except by gradual change. I would like to see a master plan for that change though, even if it took 25 years to fully implement. Obamacare is not that master plan, and his party refused to take input from the 49% of the people who didn't vote for him. So here we are, still fighting.

    2. "Back in the old days, I had private medical insurance, I kept paying in, until my circumstances changed and I had to cut down on things which I did not actually need.

      The private insurance gave me, for instance, a shorter wait for an appointment, the option to have my treatment in a nicer hospital. i.e., one more like a hotel. Private rather than shared room, a better choice of menu for my meals, a television, etc."

      What you are saying is you reached a point where you could no longer afford first-class private service. Now, you would never think of putting a gun to your neighbor's head and stealing his hard earned money from him to help continue paying for your first-class service. Yet you had no qualms about letting your government rob him for you and give you his money. Socialism is simply not fair to those who earn more money and are not allowed to keep it.

    3. No, my government did not stick a gun to my neighbour's head either. We all pay in, and we all get the service.

      Now what I do object to is that my government takes my money and uses it to drop bombs in far off places like Libya, for purposes I cannot fathom, like deposing Gahdhafi, and letting people who probably hate me as much as he did take over.

      So no, I don't agree with your analysis. My neighbour is welcome to his riches, but I expect him to pay taxes just as I do.

    4. Everyone pays into the system? What a whopper. I do understand why someone who earns more should pay more into the system. What I don't understand is why the ones who can't contribute money aren't made to contribute labor for the good of the, ummmm, masses. Isn't that how it works, this socialism thing? The trouble is not in not having good social programs which are needed, it is in allowing too many freeloaders. They are the reason you (and your neighbor) pay in too much. You both support too many people. That's not fair. Stephen Hawking is able to earn a living. So can the bum on the corner be compelled to contribute something useful. In BOTH of our countries. Especially mine.

    5. Anyway, the problem is not that insurance premiums (or contributions in your country) are too high or unfair, the problem (in my country at least) is that we need to get a leader who knows something about economics and creating high-paying good jobs so that people who don't now have health insurance can afford to buy it. Then this argument would go away.

    6. I object to the bombs, too. And a lot of other things, like maintaining a military presence in Germany (and probably the rest of Europe-I don't know if we still do or not) and Japan, long after any need has disappeared. I want our troops to come home. I want out of NATO. I want out of the UN. I want to stop giving away money to other countries which we have to borrow in the first place. I want a lot of things. I just don't know how to get them to happen. Oh, and I want to drill baby drill and build nuclear power plants and pipelines and I want to use a lot more of our military budget on discovering newer and more fearsome weapons. I saw on tv the other night that we are spending as much on "defense" as the next 17 countries combined. That could go toward research and let the other countries spend THEIR money for their defense. Are we stupid, or what??

  5. Medicine is something your state governments could well provide, but as you're the 'united' states, it's quite reasonable for a federal overview, and a reasonable level of equal provision in all of those states, surely? Or should the states close their borders?

    I am, definitely, quite sympathetic to your distrust of increasing rule by washington, here in yorkshire, just a couple of hundred miles. We distrust our government as people who live and work in a city which neither knows nor cares about what its citizens call 'the regions'.
    When in the Orkneys, off the north coast of Scotland, I was bemused by the amount of London-centric news, and people watching a popular 'soap', East-Enders set in east london. What, I wondered, just what do people here make of that?, here we are, islands with ancient stone circles, people living off farming and fishing, where the tides are more important than who is mayor, or what the traffic's doing around London Bridge.

    And besides, we're nearer to Oslo, than London. Yet people on London daily make laws which affect the Orkneys, and the even more distant Shetlands.

    So yes, I see that the concept of a federal government, far away in a part of America that in no way resembles where you live, might seem to be irrelevant and unwelcome when it tampers with your local affairs.
    I don't have an answer, it's not up to me to rewrite the constitution.

  6. I meant, here in yorkshire, just a couple of hundred miles north of London

    1. My theory is, the farther away from the people that a government is, the more wasteful and less responsive to the people that government is. I believe that for each level of "removal" from the people, that government should have fewer and fewer things to be responsible for.

      Our levels of government are "local or municipal", "County", "State", and "Federal". I believe the local government should take care of sidewalks and water mains, not the states, and CERTAINLY not the feds. Not even if the feds want all our sidewalks to be a certain width or have wheelchair access on all 4 corners. That level of micromanagment simply is not given to the feds by the constitution under the interstate commerce clause. When one is hired on in Washington, it seems the first thing they do is try to expand their realm of power. And they will pass tortuous laws to "comply" with the constitution.

  7. A general note, prompted by a sadly lost comment:

    Although the PHS exists, and is a boon to poor people and those far from other facilities, and they do spring into action when there is a catastrophe or epidemic...

    They WILL put you through the wringer to insure you aren't hiding an ability to pay. They won't refuse you treatment, but they do have a billing department of sorts. It's pretty inept and a false ID will throw them off the track. They have little talent for collecting medical bills, even from insurance companies whose rich automobile drivers have injured one of their non-paying clients, and you may be sure they will soon go away after a couple of amateurish-looking bills. The aforementioned Muslims are well aware of this. Not to jump on Muslims, it's just that in my community they seem to flock to the PHS for medical services second only to Native Americans. Not all are indigent.



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