What makes a town are its people, but without a core of services, its commercial activity, the accelerating value of land and the very health of the community are slowed and diminished. Today, in the early 21st century, many of the critical services – education, police, fire, health – face budgetary constraints which threaten the lives of our citizens and limit the hopes for our children.

Our nation has always balanced the virtues and pressures of individual fulfillment with the public good. At best, they inform and strengthen each other. At worst, the American dream of opportunity for all is overwhelmed by a Tsunami, a perfect storm of low wages, outsourcing of jobs, gated enclaves of wealth, begrudging every dollar to the public good.

This is a rich nation, and its wealth has thus far provided a safety-net. In healthcare, the area of my focus, and the focus of our Center, we work a little harder, well, maybe a lot harder. We stretch the net, worry that it is frayed at the edges, even that it will collapse. Ordinary care is often dispensed in Emergency Rooms. Expensive testing and procedures are easily, perhaps too easily available to those on top of the line insurance plans. Chronic disease is treated later than it should be, and the expense catches up with our society through uncompensated care delivered by hospitals, and personal tragedy for patients.

In our state houses and city halls, politicians and administrators bow their heads in deference to the strident cries of pressure groups: “Cut spending. Raise spending. Tort reform.” The cost of liability insurance and the frustration of completing endless paperwork drives some physicians into an early retirement. In our towns and cities, on the streets behind Main Street, people skimp on their medications, delay care, deny conditions, die quietly.

The stories we have to tell are both worse and better. They are worse because the people who are hurt by the deterioration of services will step out from the shadows and offer an indictment of business as usual. The stories are better, not only because the people we care for are stubbornly human and so worth helping, but because in the primary care we deliver are the seeds, the essence of a healthcare system that is affordable for the individual and affordable for the society.

The wringing of hands, the comparative statistics that rank us poorly as a nation in critical indicators of national health, the projected collapse of Medicaid and Medicare in 2020 or 2040 – none of it is inevitable or necessary. We have the potential to provide everyone with care that would be the envy of the world. How to do that without bankrupting our treasuries is based on the experience and practical innovations taking place every day in the communities surrounding our Main Streets. Those of us who are finally responsible for the care of our communities do not have the option of failing. We have had no alternative but to rewrite the book – the story you will be reading in the pages of this website.

The story I am most familiar with takes place on the Main Streets. We serve, from the coastal cities of Stamford, Norwalk, Clinton, New London and Groton, up the Connecticut River to Middletown, Meriden and New Britain 70,000 patients a year with 350 staff in a dozen sites, providing primary medical, dental and mental health, linked to hospitals, specialist practices and social services.
In our cities, towns and rural areas, we have created a system of healthcare that is available to everyone: quality care, efficiently delivered. It isn’t perfect, but day-by-day, it gets the job done. A medical home focused on primary care, prevention, education and necessary interventions.

Accommodations to our complex payer mix of insurance, fee for service and grants that through careful management has helped The Community Health Center, Inc. grow to $25 million a year in non-profit revenues. Collaborations with our partners in the medical establishment and city hall in every one of our cities that accomplishes a virtually seamless delivery of care for even the least able of our patients.

This we know how to do, and through a seemingly endless stream of exchanged site visits, phone calls, e-mails, conferences and meetings attended, our participation in the national collaboratives on chronic disease sponsored by HRSA (the national Health Resources and Services Administration of the Bureau of Primary Care) the wonderful experience and contacts I’ve developed with my colleagues in the Healthy Communities Access Program and my Robert Wood Johnson Fellowship, I know we are not alone.

From the gentle coast of Connecticut, through the heartland of America, to the Colorado Rockies, to the shores of California, north and south, east and west, our story is also the story of hundreds of communities, thousands of committed providers, millions of patients. Someday, it could be the story of all healthcare in America.
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Margaret Flinter is Vice President and Clinical Director of the Community Health Center, Inc.; a Robert Wood Johnson Executive Nurse Fellow, President of the Connecticut Nurses Association, holds an Advanced Practice Family Practice Masters Degree from Yale University, and is completing her Ph.D. studies at the University of Connecticut, where she did her undergraduate work. Margaret also serves on the Board of Directors o Trillium Asset Management.