“We wish there was no such thing as the Weill Cornell Community Clinic.”
That may seem like a surprising statement coming from the current directors of the student-run clinic affiliated with Weill Cornell Medical College in New York City, but let us explain.
Since 2006, the Weill Cornell Community Clinic has been providing free or low-cost care to underserved and uninsured New Yorkers who make less than 400 percent of the federal poverty level. Patients approach us for a multitude of reasons: Some have worked their entire lives only to lose their jobs — and insurance — during the financial crisis; some have never worked a day in their lives. Some are in their late twenties, recent graduates looking for full-time employment and no longer covered by their parents’ insurance; some are just shy of the 65-year-old age requirement to qualify for Medicare. Some speak fluent English; some speak barely a word of it.
What sets organizations such as the WCCC apart is that we provide healthcare to patients regardless of other socioeconomic factors that would limit their access to basic and essential medical needs. The WCCC provides a virtual safety net for our patients in the same way a trapeze performer relies on a real safety net — to catch him or her in case of a fall.
Safety nets must exist because we currently do not have a universal program for equally insuring everyone who lives in the United States. The most well-known and largest safety net programs in the United States are Medicare and Medicaid. But even these programs can leave patients vulnerable. Public hospitals, willing physicians and local clinics must provide access for these patients.
There are also community-based centers, known as Federally Qualified Health Centers, which are funded by the Health Resources and Services Administration of the Department of Health and Human Services. FQHCs provide comprehensive care to those with private, public or no insurance and they offer sliding scale payment options for those who are underinsured or uninsured.
So, if safety net programs exist, why then do people continue to argue for a national, universal healthcare system?
First of all, there are the numbers. Even with recent healthcare reform legislation slated to take full effect in 2014, the most optimistic statistics estimate that at least 20 million, or eight percent of Americans, will remain uninsured. This is assuming that 30 million of the currently 50 million uninsured will qualify under these new laws. Furthermore, given the current political climate, it is in no way guaranteed that healthcare legislation as we see it now will remain intact.
Then, there is the very real toll taken on our country due to so many remaining uninsured. Despite the availability of numerous safety net programs there are Americans that continue to fall through the proverbial cracks. A recent New England Journal of Medicine article estimated that at least 22,000 deaths in the United States in 2006 were directly related to people being uninsured and not having access to medical care. And alarmingly, the number of deaths related to lack of coverage has been increasing by about 1,000 every year.
Finally, there are the people. We have had to look patients in the eye and say, “I’m sorry, there is nothing more we can do,” simply because they were uninsured. It is hard to tell someone who cannot walk, let alone work, because of debilitating hip pain from severe osteoarthritis that a hip replacement is “elective” and therefore not eligible for charity care.
In an ideal healthcare system, safety net facilities like ours would not exist, because everyone would be insured. It should now be apparent why student-run free clinics like ours exist.
But running the WCCC, like most aspects of healthcare, provides its own set of challenges. The clinic requires a skill set not included in the basic science or clinical curriculum of medical school, yet is completely run by students. We may know the Krebs’ cycle backwards and forwards and the nerves of the brachial and sacral plexuses, but ask most medical students about finances, billing, coding and medication and laboratory pricing, and most will look at you with a blank stare. These are all crucial to ensuring not only that our patients receive the best care but also that our clinic remains in the black.
More importantly, the WCCC is anything but “free.” While we are free to our patients, no clinic is free from time or monetary constraints. We are fortunate that so many volunteer their time to ensure our patients get care. And we have also been able to negotiate reduced rates for imaging, pathology and referrals. Through grants, private donations and fundraisers, medical students cover the remaining operating costs of the clinic. In fact, a recent event brought artists, who are often plagued with insurance issues, from around New York City together to raise funds for the clinic. Our event, which we aptly titled “Without a Safety Net,” helped us raise over $25,000 for the WCCC.
Walking through the streets of NYC, watching unemployment rates rise and listening to disconnected politicians discuss the future of healthcare in Washington D.C., it is apparent why safety nets like ours exist. The system is broken, and these work to catch the millions of Americans who pour through the cracks. As the rifts widen and are haphazardly and ineffectively patched up, the need for safety nets will continue to grow. We plan to be there, helping those left behind.
Perhaps, in retrospect, our opening statement was a bit bold and should be rephrased. “We wish there was no need for the Weill Cornell Community Clinic.”
For now, we proudly provide a safety net for those in need of healthcare in New York City. We hope some day a person’s income or current employment status will not determine the quality of their health and that no one will have to wait to go to the doctor because they are afraid of being unable to pay.
Dan Belkin and Megan Riddle also contributed to this article.
Dan Belkin and Ximena Levander are fourth-year medical students at Weill Cornell Medical College and co-directors of the WCCC. Megan Riddle and Joshua Salvi are MD/PhD students at Weill Cornell Medical College and executive co-directors of the WCCC. They may be reached at
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