I am a Maine-trained family physician and a volunteer in a school-based health center, which is a partnership of the Portland Public Health Division, public schools and Maine Medical Center. Every week, I operate in the dual spheres of primary care and public health, so I was dismayed by the false choice between the two that the LePage administration recently advanced.
Gov. Paul LePage’s biennial budget initiative annually would take $5 million of tobacco settlement money (not taxpayer dollars) out of public health programs, such as the school-based health centers, and use it to pay the state’s MaineCare and Medicaid debt to physicians and other primary care providers.
Primary care is indeed the bedrock of a high-quality, low-cost health care system. Health and Human Services Commissioner Mary Mayhew reasons that we should use the money flowing into our state from the 1998 tobacco industry settlement to pay MaineCare debts to primary care providers rather than support public health efforts. This false choice is where her logic veers from reality.
Myth 1: People can simply go to their primary care providers for care.
Reality: Data released in early 2015 show that 125,000 Mainers still lack health insurance, even after the state’s uninsured rate fell from 16.1 percent in 2013 to 11.6 percent in 2014, the first year of the Affordable Care Act. The LePage administration has actually worked hard against efforts to expand coverage and reduced funding for rescue programs that offer primary care to those without insurance.
Myth 2: People visit the doctor regularly to discuss smoking cessation and other important health matters.
Reality: During the formative adolescent years when crucial health habits crystallize, large numbers of teens do not visit their primary care providers. A random sampling of high school health center records shows that many teens simply do not have primary care providers, and half of those who do have one on paper have not seen their provider in more than two years.
Two years is a very long time in adolescence. School-based health centers — which Mayhew’s proposal would essentially eradicate — are high-yield, embedded primary care augmentation sites. School-based health centers work alongside school faculty and staff, they communicate with primary care provider offices and they provide excellent, inexpensive, convenient and timely care, similar to that of a primary care provider, inside schools.
Myth 3: Public health efforts do not provide returns on investment.
Reality: The U.S. Centers for Disease Control and Prevention noted that in the 20th century, average life expectancy in our country grew by 30 years, and 25 of those years were due to public health efforts. Those public health campaigns focused on things such as tobacco, infectious disease and vaccinations, family planning and motor vehicle safety — all of which are routinely addressed in school-based health centers across Maine (with parental consent in the case of minors).
School-based health centers are also an incredible value. They address acute infections and vaccinations, sports injury prevention and treatment, family planning, substance abuse, depression, exacerbations of chronic conditions such as asthma, and many other issues. Such timely, convenient, patient-oriented care helps keep teens in school and parents at work, and reduces unnecessary ER visits and overall costs.
Studies published in medical journals including Pediatrics and The Archives of Pediatric Adolescent Medicine show that school-based health centers actually reduce overall health care costs. This is especially true in the Medicaid population, which Mayhew purports to be helping by taking money from school-based health centers.
Mayhew’s proposal is detached from on-the-ground reality. I urge the Legislature to let it wither and instead continue to fund public health programs, such as school-based health centers. Funding primary care and public health is the best way to get the high-quality, low-cost and equitable health outcomes Mainers deserve.
Dr. Sam Zager of Portland researches Maine-focused and national-level components of healthy communities.