In the waiting room of the Borinquen Centre, most of the patients are regulars. This Miami clinic is where everyone who can’t afford health insurance goes.
“In a private clinic, they make you pay $250-350 at the first appointment;” explains the clinic’s director, Paul Velez. Here, the most disadvantaged patients will pay one tenth of that price.
“We often have to wait hours but this is the only place where I can get all of my family treated without it costing too much,” says one woman, sitting in the waiting room with her husband and children. Like many patients, she comes from Little Haïti, the Haitian district of Miami, just a few streets from the centre.
Since it opened its doors in 1972, the centre has increased its staff and opened two further centres in the Florida area. It now receives more than 20,000 patients a year.
In the US, primary care health centres are subsidised by the state. The Borinquen Centre receives $10 million per year. This pays 11 doctors, four dentists, social workers, nurses, psychiatrists as well as two psychiatrists. Centres such as this one are increasingly rare – they are not profitable so not many stay open for long.
Nadia Ade is in charge of the ‘Healthy Start’ program for pregnant women and young children. “We teach them how to feed and take care of their child properly,” she says. “I go to their houses as well, since the majority of these women don’t have a car.” Sonia, a 22-year-old single mother, is not eligible for Medicaid, which is reserved for the poorest two per cent of the US population. “So I have to count on other programs and types of benefits. I can’t pay insurance for myself and my child. Luckily there are benefit schemes in Florida, especially for children, and centres like Borinquen.”
Afraid of the cost, patients get treatment too late
A scale of variable payment has been introduced, based on patients’ income: $25 a basic consultation for patients in bracket ‘A’, the poorest, and a little more for an X-ray or dental care ($45-60). Patients in category B pay $35 and the wealthiest up to $140 for the same type of care.
For Paul Velez, this scale of payment could be a solution to the problems in the American healthcare system. “We are the most closely guarded secret in the country,” says Borinquen’s director with a hint of irony: “Local health centres are the most concrete solution to improve our healthcare system. The ideal plan would be to create these payment scales that we have!” Between its prices and state subsidies, the centre is able to balance its budget. But it doesn’t make any profit – hence the small number of this type of centre in the US.
Borinquen is a real refuge for uninsured Americans and indeed for illegal immigrants, says Paul Velez. “The problem,” he explains, “is that these people are afraid of what they have to pay and get treated too late.” “Some 800,000 uninsured people in Miami! Out of a population numbering 2.5 million, that’s almost a third,” insists Deborah Gracia, a doctor at the Borinquen Centre.
Out of a population of 300 million, 50 million Americans don’t have any form of health insurance. Approximately 90 million people rely on state programs for elderly people or those without the means to pay. Finally, 15 per cent of Americans are ‘under-insured’ according to the Commonwealth Fund, an American think tank. Their insurance proves insufficient and they have to fork out huge sums of money to pay for healthcare. Most of the time, they simply stop getting treatment.
Healthcare is higher than ever on the political stakes
Paul Velez is worried about the future of healthcare in his country. He remembers the failure of the last universal social security plan. Presented by former First Lady Hillary Clinton in 1993, the policy was widely rejected.“The project came down from above, from the bureaucrats,” he insists. “Nobody came to see the real work of medical staff or to find out patients’ needs.”
Since then, health insurance has become a major preoccupation for current presidential candidates with both candidates promising – in their own way – universal healthcare. But Paul Velez says “I need to hear a clear vision of a strong health program from both parties.”
“What we want is to continue to provide high quality treatment at a low cost,” says Deborah Gracia. “But we are not a hospital. When a patient needs serious treatment, we have to send them to Miami’s Jackson Memorial hospital. But there, certain people can’t pay.”