Montana’s State-Run Free Clinic Sees Early Success

By Dan Boyce
NPR, July 30,2013

A year ago, Montana opened the nation’s first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health.

A year later, the state says the clinic is already saving money.

(Government employees still have their) normal health insurance provided by the state. But at the clinic, (there are) no co-pays, no deductibles. It’s free.

That’s the case for the Helena area’s 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor.

“For goodness sakes, of course the employees and the retirees like it, it’s free,” says Republican State Sen. Dave Lewis.

He and others faulted then-Gov. Brian Schweitzer for moving ahead with the clinic last year without approval of the state legislature, although it was not needed.

Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.

The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it’s actually costing the state $1,500,000 less for healthcare than before the clinic opened.

“Because there’s no markup, our cost per visit is lower than in a private fee-for-service environment,” Hill says.

Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.

Bottom line: a patient’s visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it’s free to patients, hundreds of people have come in who had not seen a doctor for at least two years.

Montana recently opened a second state employee health clinic in Billings, the state’s largest city. Others are in the works.…

Let’s see. This Montana state-run free clinic is government owned, the physicians are salaried, there are no deductibles or co-pays, employees and retirees including Republicans like it, and it costs the state “about half what it would cost if that patient went to a private doctor.” Wow!

The single payer model of social insurance usually calls for a government-run insurance program that pays for our largely private health care delivery system, with all of its inefficiencies and inequities. But what if it paid for a government owned and financed health care delivery system similar to this Montana clinic, but with government ownership expanded throughout the entire delivery system.

Instead of just aiming for the goal of a single payer social insurance program, we could have a program of socialized medicine – government ownership of the delivery system. Considering that it is a much lower cost system with which everyone is happy, is that such a bad idea?