Insights from the Free Clinic

Five years ago I retired from cardiology practice and began to work two half-days a week in our local free clinic for the uninsured. I suppose I learned more about how America’s health care system works (or doesn’t work) in the past five years than the preceding 30 years in private practice.

Mary Smith (not her real name) provides a good example of how our present healthcare system causes unnecessary hardship. Mary is in her early 50’s and works for $8.50/hr. at Walmart. At the age of 20, Mary had her thyroid gland removed and had been on thyroid replacement medication ever since. When Mary came to our clinic 2 years ago she was extremely hypothyroid so I asked why she was no longer taking her medication.

She told me the problem wasn’t the cost of the medication as it was relatively inexpensive. Her problem was that she could not obtain a prescription for the medication as she no longer had insurance and could not afford to pay for a doctor visit or lab tests to monitor her condition. Her doctor did not feel comfortable writing a prescription for a patient he was no longer seeing and testing. Fortunately, Mary eventually learned about our clinic where we were happy to see her for free and resume her usual dose of thyroid medication.

Unfortunately, free clinics don’t exist everywhere and often have significant limits on the range of healthcare they can provide. Had Mary been covered by the Pennsylvania Health Care Plan, HB 1688, she would not have had her care interrupted and visiting a free clinic would not have been necessary.

Under the health care plan Mary would not have been denied doctor visits because of her low income because by paying a 3% tax on her earnings she would have been eligible to receive all necessary medical treatment no matter how expensive. Her employer, in this case Walmart, would be required to pay a payroll tax of 10% as would their competition making a level playing field among all businesses without yearly hassles with insurance companies. Mary’s doctor would not need to compromise his income, as all patient visits would be reimbursed, guaranteed by the Pennsylvania Health Care Plan, just like with Medicare. By eliminating time and income consuming hassles with insurance and pharmaceutical companies there is more time and resources for patients, like Mary.


William R. Davidson, Jr., M. D.
Founding Member of Health Care 4 All PA
Member of Physicians for a National Health Program