When Paul Bowling suffered a stroke three years ago and lost his health insurance he turned not to an emergency hospital for long-term care but to a community health center.
Like many Americans, he found his regular doctor was not an option. Without insurance, even routine visits would have cost $125 a time and the Atlanta business owner needed weekly blood tests and rehabilitation.
"They just brush you aside. All they want is the money," he said of his previous doctor, while sitting in the spacious reception area of the West End Medical Centers community health care center in Atlanta.
Americans spend more per capita on health care than any other country. But studies suggest they get poorer care than in industrialized countries with national health care plans.
President Barack Obama has promised reform of the U.S. healthcare system and on Thursday convenes a meeting of officials and experts to find a way forward.
Opponents of those reforms say individuals are responsible for their own health care and the country should avoid moving toward a more European-style system of "socialized medicine."
Bowling is one of 16 million people who used the centers for primary health care including dental and mental health care in 2008. Nearly 40 percent of those have no health insurance and one-third are children, according to government figures.
The centers focus on preventive medicine and could play a big part in reforms for the health sector, which is groaning under the cost of federally funded health insurance programs and the weight of 37 million uninsured.
But the economic recession presents the 7,000 community health centers with a paradox: it increases demand for their services while reducing the funding available to them.
The West End center, which has 10 doctors, said it sees 65,000 patients a year who pay through government and private insurance as well as personal contributions determined on a sliding scale.
Before the recession about 30 percent of its patients were uninsured but that figure could rise by 10 percent this year, said Michael Brooks, the center's vice president.
"Our biggest problem is seeing people who have chronic illnesses," said Brooks. Many uninsured people avoid expensive doctor visits and contract more serious health problems.
SCARCE HEALTH RESOURCES
The centers play a big role in public health by taking stress off big state-funded hospitals seen as a last resort for the uninsured.
In doing so, they help save money and the quality of care they offer should make them a first choice for the insured as well as a good choice for the uninsured, Brooks said.
Doctors at St Joseph's Hospital and Medical Center, the largest hospital in Arizona, applauded the work of the centers, arguing that they could take the strain of emergency medicine.
The emergency department in central Phoenix treats up to 250 patients a day, around 70 percent of them people who could see a primary care doctor for conditions ranging from a sprained ankle to chronic diabetes.
"Many of the patients who present to my emergency department have a physician, have health insurance, but are unable to get in to see them," said Michael Christopher, the emergency department medical director.
A more robust primary care network makes sense because it would free up scarce resources at hospitals like St. Joseph's and enable doctors there to devote more time to using their skills in emergency medicine, Christopher said.
"My job is to snatch people from the jaws of death. That's what I should be focusing on," he said.
LIFELINE
The community health network spans both rural and urban areas and there are centers that cater for specific ethnic groups.
Some 95 percent of patients at the West End center are African American, reflecting the ethnic makeup of the community that surrounds the center.
On the west coast, an association of community health centers serves the interests of Asian Americans who represent 3.5 percent of the population but have particular health needs.
"Many people in this community don't have strong language skills," said Jeff Caballero, executive director of the Association of Asian Pacific Community Health Organizations.
They "are often excluded from participating in the local and national dialogue," he said.
Many health workers in the sector said the fact that they are often not well known reduces their chances of attract more patients.
But for Bowling, the center served as a lifeline.
"When you are used to paying your way not just medically but in life and raising a family and all of a sudden your funds have disappeared and your savings have gone it is devastating mentally and physically," he said.
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