Sen. Bernie Sanders: Health-care bill could spark "a revolution in primary health care"

Tell me a bit about the provisions to expand community health centers that you added into the Senate bill.

In most areas of Vermont right now, you can drive to a community health center near you where you’ll get excellent quality primary health care. If you have no health insurance, you’re charged on a sliding scale basis. If you have Medicare or Medicaid, they’re delighted to have you. And private health insurance, that’s great, too. We’ve gone from two community health centers in Vermont to eight. And those eight centers have 41 separate locations and are used by about 100,000 people – and that’s in a population a bit over 600,000. So we know they work.

As of this point, we have added $10 billion for the program in the Senate bill. Congressman Jim Clyburn has added $14 billion in the House bill. And my hope is the conference committee will go with the $14 billion. What we would do with $14 billion is expand access from the current 20 million people served by community health centers to 45 million people. It will mean establishing CHCs and their satellites in 10,000 new communities. What it also means is that we will dramatically increase funding for the National Health Service Corps so we have an additional 20,000 doctors, dentists and nurses. It’s a revolution in primary health care if we get what I hope we get.

Let’s focus on that for a second. One of the issues in the health-care system that hasn’t gotten enough attention is the focus on specialty medicine. Those doctors make more money, so more and more medical students are going in that direction, but they also cost a lot more money, as they create demand for expensive procedures. I’ve heard people say we can afford a universal primary-health-care system, but not a universal specialty-health-care system.



We need to expand the National Health Service Corps. If you go to the University of Vermont, you’re going to graduate with $150,000 in debt. So you become a specialist and make a lot of money and repay the debt. But we’re going to give the NHSC enough money to forgive the debt of 20,000 students to practice in underserved communities. The other thing we need to do is raise the reimbursement for primary-care doctors.

And these community health centers are sort of seen as a front line for access to primary care?

When we talk about health care, people tend to talk about insurance. But equally important is access. You need to be able to find a primary-care physician and a dentist and a mental-health counselor. The $14 billion will have a profound impact on addressing the crisis in primary care in this country. We’re not graduating enough primary-care doctors, and even people with insurance often can’t find one. But the insanity is that we’re not just depriving people of primary care they need, but we’re sending them to the emergency room. And the emergency room will treat you for the common cold and charge $600 to $1,000, and the community health center will cost $100. If we spend on community health centers, you actually save money.

We also have a major problem with dental care in this country. But community health centers provide that, and so, too, with mental-health counseling. They also provide some of the lowest-cost prescription drugs in America. This program, ironically enough, has widespread bipartisan support. Even George W. Bush put money into this program. John McCain campaigned on it. In the stimulus package, we doubled funding to about $2 billion a year and brought it up to $4 billion.

How much of a funding increase would the $14 billion represent?

It’s over five years. The $2 billion would have been $10 billion for that period. The $14 billion of new money is on top of $10 billion. So we’ll have more than doubled the size of the program. And that includes going from 100 million to 300 million for the National Health Service Corps.

Alongside the community health centers, where else does the bill have room to be improved in conference?

I won't be on the conference committee so I won’t speculate. My main focus right now is to get the $14 billion for this program.

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