Utne Reader January 30, 2004

Ithaca Times, November 14, 2001

by Carey Solomon

Primary Care

Ithaca Health Alliance takes non-traditional approach to doctors' bills Young children worry in a health care setting because they're not sure what's coming next. By the time they're adults, if they've been lucky enough to have health care, most have outgrown those fears. But the uncertainty of how they'll pay for medical care adds another layer of worry to a health care visit for many Americans. They're not alone. It's said that one in six Americans (43.2 million) were without health insurance in 1997 and another 40 million had only limited coverage. Where these numbers are likely to go in a time of economic slowdown is easy to guess. Local community activist Paul Glover knows things could be different. For instance, members of nearby Amish communities don't use health insurance. Instead, community members gather periodically to pool their medical bills and help each other pay them. More recently, in 1947 a group of 15,000 farmers in Swift Current Saskatchewan, Canada, banded together to form a medical cooperative. By 1962, their plan had grown to cover the entire Province of Saskatchewan; and in 1971, it had expanded to include all of Canada. In February 1997, Glover says he saw "a big hole to fill. The Cayuga Medical Center was arguing with Blue Cross. There was a study indicating that 40% of Americans relied on alternative healing. There was a long list of alternative healers affiliated with Ithaca Hours." (Ithaca Hours is a local paper money system dedicated to reinforcing trading among local businesses, begun by Glover in 1991.) At the same ti me, Karen Hanson, a certified social worker in private practice, was feeling increasingly concerned about the shortcomings of the health insurance system, particularly in the field of mental health, where dealing with the bureaucracy of the insurance system may actually risk undermining the mental health of those who need services. Hanson envisioned a membership-based community health center "where health care providers would donate time each month as part of creating an alternative for people. Health care providers banded together could provide discounts and services for people with inadequate or no insurance coverage so they could get needed health care. The whole community could be involved in making a system like this work, like the barter system of Ithaca Hours," Hanson says. Hanson has been a member from the beginning, and served on the original Board of Directors. After many conversations with Hanson and other local people on the difficulty of obtaining the health coverage that met their needs, Glover drafted a set of ground rules for a program that would begin more modestly. He began approaching people to ask them to join.

The first member was local herbalist 7song. "Joe Wetmore, owner of Autumn Leaves Books, joined 15 seconds later, and Dan Cogan became the third member," Glover says. "It happened so fast I was fourth in line myself!" Wetmore jokes that he regretted not being the first to join - he lost time having to cross the room to get his money. He joined, he says, "because Paul has a good track record showing that he can put things together. Look at Ithaca Hours. We've got a health crisis in this country where some people can afford any elective surgery they're interested in and some can't afford basic health care. This is the beginning of the US taking health care back from the major corporations and making it affordable to everybody."

"People need to support it at the beginning so it can come to its fruition," continues Wetmore. "We're seeing it move from the stage of people who are in it because they're enlightened to a more mainstream thing... to where it be- comes a community health care system for everybody."

In talking about health care, Glover conducted a random, informal poll of 125 Ithacans and learned 37% of those he spoke with did not have health insurance - and 98% lacked dental insurance. Among those who did have health insurance coverage, a large percentage "considered it a financial burden that did not cover the care they preferred," he says.

"Health insurance isn't an option for me financially, nor does it cover the kind of care I'd look for," says Shawn Tubridy, an early enrollee in the Health Fund. Tubridy is a provider of alternative health care and currently serves as a board member for the fund. "The current health system doesn't work," she says. "It's essential we explore more ways."

Recent data tells us about $50 million is spent in Tompkins County annually for prescription drugs, medical services and medical insurance policies - about $500 for each Tompkins County resident, much of this leaving the county. Glover has idea found a small but growing and receptive audience.

"When we began, we had nothing to offer anyone but an idea," Glover says. "But thanks to the pioneering participation by people willing to help that idea become real, we've created a pretty strong cushion for everyday emergencies, all for the same $100 bill." As membership in the group has grown - there are now more than 350 members - and assets of more than $90,000.

"Anyone in the world can join and we make payments anywhere in the world," says Glover. "We've got one member in Australia, three in New York City, one in California." The local components are the board meetings, which take place in Tompkins County, and the discount part of the plan, which so far is limited to area health care providers.

Among these is Cayuga Medical Center, which has been a member of the Ithaca Health Fund and offered a discount to its members from the beginning. Marsha Eger, Vice President for Community Relations for the Cayuga Medical Center says, "We think it's a wonderful way for the community to meet a very special need. The lack of insurance for a lot of people is a national problem. This is a local way to meet a local need and to empower people to pay for some of their own health care costs. And also, we are part of the health care continuum for the community, so it makes sense. We're very proud that we're in a community that's innovative." Cayuga Medical Center also accepts Ithaca Hours for certain types of payments.

Recently incorporated as a not-for-profit corporation known as the Ithaca Health Alliance, the group's mission includes promoting wellness, providing information and facilitating lower-cost access to health services. Members pay $100 annually - slightly lower rates apply for couples and/or families enrolling together as well as businesses enrolling multiple employees.

It's not traditional health insurance - in fact, board members emphasize, it's not to be confused with insurance at all. "Call it health assurance," says board member Mark Sammo, a clinical nurse specialist and mind/body therapist.

The Ithaca Health Alliance currently offers its paid members grants of up to $2,000 for broken bones, up to $1,500 for an emergency appendectomy, as much as $600 for post-exposure rabies inoculations, $500 for second or third degree burns, and $400 for ambulance rides or emergency stitches.

Unlike traditional insurance plans, which don't begin reimbursing patients until they've had significant expenditures in any calendar year, the Ithaca Health Fund begins helping from the first dollar paid out by the patient. Payments are made anywhere in the world with any credentialed provider.

Further, they offer $20 rebates per member per year for a choice among dental checkup or cleaning, eye exam, genito-urinary exam, hearing test, medical exam or periodontal exam as well as interest-free loans for dental crown work (after 2 years' membership); discounts to member health providers, including health services at Cayuga Medical Center; and a one time rebate of $50 for those who quit smoking and remain smoke-free after 6 months.

"We're babies," Sammo says. "Where we are now is not where we want to be. As more and more people join and the pool of money and resources goes up, we can do more. We do have major medical as a long-term goal. But we're not there now and we probably won't be there next year. Interview us again in five years!"

Later, he expands on this idea. "Obviously there's a huge range of what people need in health care needs across their life span from prenatal care all the way to hospice. The Health Fund is very interested in creating a fund that will meet the needs of members across the life span. As our membership base increases we can do more and more of that.

"I would like to see us, as we have more resources and more money able to be invested, to make the fund reasonably available to the membership to meet their health care costs. It would follow that as we have more and more money, our categories where we can offer grants to members for health care expenses will increase and come closer to providing what people need in terms of their health care needs."

Sammo, with other Board members, emphasizes a major divergence between the non-profit membership-controlled Ithaca Health Fund and traditional or for-profit health insurance companies and health maintenance organizations (HMOs). "The corporate needs of insurers and providers have created a top-heavy, monstrous situation, where 'there was money available so we could charge this,'" he says. "That big business mentality which spends so much money on administration to the extent where HMOs are denying care to people. See a doctor for a routine office visit and it's not uncommon to come out with a bill of $100-200. And this may not be paid by your insurance carrier." Instead, "We've put in the bylaws that no employee will ever earn more than twice the living wage [as computed by Alternatives Federal Credit Union]."

Some might say the group's approach to health care is naive. Much runs on trust. And, as Sammo points out, "None of us have a great deal of education in actuary tables, risk/benefit ratios of covering certain things or not - but we're doing the best we can in terms of what the membership wants."

Some Health Fund members, like Eamonn and Marilee Murphy carry traditional health insurance and use this as a supplement. "We're self-employed and the health insurance we have is catastrophic," says Eamonn, who works as a massage therapist; wife Marilee is an acupuncturist.

This past summer, their 12-year-old son Derek had an accident while playing with friends at Taughannock Park. The children were climbing the side of the gorge when a dislodged rock struck Derek and opened a gash in his forehead. Emergency room treatment cost about $700, of which the Health Fund promptly reimbursed $400. "In fact, I think Paul may have hand-delivered the check," Eamonn says. "You didn't have to fill out a whole lot of paperwork and plead your case on the phone. You just felt you were being taken care of."

Derek made a great recovery and his parents post information about the Health Fund on the wall at their office. "Many of our patients ask us about it and we talk about it all the time," he says.

"Conventional health insurance isn't a rational economic decision, especially if you're young," says Olivia Direnzo. "It's not so much it's unaffordable but simply not attractive." After joining the Health fund, Direnzo began taking advantage of the discounts available for health care and points out these are not insignificant. Despite these advantages, this is not her major reason for belonging. "More importantly, it's also a way to support an idea," she says.

Dentist Joe Piskorowski, a Health Fund member as well as a care provider, enthusiastically endorses the discount plan for the idea behind it. "I like to put the emphasis on prevention," he says. "Too much of what we do is response because it's too late. Every day I see a patient with a $1,000 treatment on a tooth - had they only seen me earlier, it might have been only $150." Piskorowski says he's not in medicine purely to make money. "As someone lucky enough to be born a white male in the richest country in the world, why shouldn't I give something back to help the community?" he says. His participation in the Health Fund has impacted his practice, giving him, among other things, more contact with young adults and young children. This gives him an opportunity to educate people, particularly new parents, on dental health for themselves and their children. He likes to think of this as building health for the future. Piskorowski's attitude and that of many others who participate in the fund was foreshadowed by a poem Hanson wrote, now posted on the Health Fund's website at One of the verses reads,

Let the healers heal,
and those in need receive.
Let everyone be welcome,
and every offering respected.
Let the homegrown wealth,
goodness, groceries and skills,
flow gracefully
between us. We can do it.

It's important to note that Glover's outlook, like that of many Health Fund members, is political as well as social in its approach to health. In this context, health care is part of a much larger picture. "Entire cities can become intentional communities by reclaiming direct grassroots control over food and fuel supply, housing, transportation, finance and health care," he writes in an article called "Community Health Security," for Communities magazine. And, he notes, the federal government's choice of weapons over health care is a political one as well.

But at least one local politician has recently gone on record with an enthusiastic endorsement of the Ithaca Health Fund. Assemblyman Marty Luster recently wrote a letter to the group. After noting the unlikelihood of enacting a state health-care initiative he favors, he adds, "It is that reality that makes grassroots movements such as yours so important. Our community is grateful for the existence of the Fund and I continue to have great hope and expectation that it will become a prototype for communities around the state."

It might. "Every big thing starts small and proceeds to grow by meeting needs and developing trust.," says Glover. "Cornell started with one building. General Motors started small. So did the Federal government..."

Community Health Fund Passes 1st Test: Inaugural Payment Made

Ithaca Journal, July 7, 1998

by Franklin Crawford

Health care Goliaths pay heed: the upstart Ithaca Health Fund made its landmark first payment in June.

"We started out just a year ago and have already implemented the second stage of a much broader plan of low cost, nonprofit, community-controlled health care," said Paul Glover, founder of the grassroots system.

The pioneer fund member is Groton resident Ruth Lance. The fund paid $556.57 to cover the cost of treating Lance's broken wrist, sustained from a fall. The Ithaca Orthopedic Group received $530.32, and Cayuga medical Center accepted another 2.625 worth of Ithaca Hours totaling $26.25 as payment. Ithaca Hours is an alternative cash system established by Glover in 1991. The payment was made just four days after the fund received the bill. "They paid faster than any insurance company I've ever dealt with," said Priscilla Bingham, billing agent with Ithaca Orthopedic. "They put all the insurance companies to shame."

For Lance, the payment was a high point in a withering two-year streak of bad luck. "I never knew it was going to pay me back like this," said Lance. "I always liked the idea of it--but the reality of it is even better." Lance tumbled down a darkened staircase at home in June. Unemployed and lacking health insurance, the slip in the dark was metaphorical as well as literal. Recently divorced, she'd been struggling with a bout of tendonitis in both arms. She was unable to work. Then, Lance got whiplash in a car accident.

She spent the rest of the night of her fall with ice packs on her arms, weeping. "I was in such pain, but wouldn't dare go to the hospital because I couldn't afford to," she said "I cried and prayed--and then I remembered I had joined the health fund.

She had no idea it would cover her expenses. But the next day a friend insisted on taking her to the Convenient Care center on Warren Road. "I showed them my Ithaca Health Fund card, and they kind of laughed because they never heard of it before," she said. "But I found out I was covered. I was so happy. It really was one of the nicest things that's happened to me in a long, long time."

The health fund announced in May that it would begin making payments for broken bones and ambulance rides "to a maximum of 5 percent of the fund's balance at the time of need," Glover said. The fund now boasts 220 participants, 110 health care providers and 114 general members. Membership costs $100 a year for individuals and $175 a year for couples. Glover is hoping to swell the ranks to 2,000 members. At that point, the fund would operate a nonprofit dental clinic, with free checkups and cleanings, Glover said.

As Glover envisioned it, the fund is supported mutually by general members, providers and support businesses. Card-carrying members qualify for discounts from health providers. Cayuga Medical Center offers a 3% discount for Ithaca Health Fund members and also accepts partial payment from Ithaca Hours. Glover is pleased with the growth of the fund, remembering how the Ithaca Hours system was started with a similar core group of participants. Ithaca Money is now used by more than 2,000 people and accepted at more than 350 local businesses. "Given present trends with both government and private insurers, we would be prudent to create a system by which we can take care of each other," Glover said. "In 20 years no one will care about us--but us."

Ithaca Times, May 22, 1997

by Gene Ira Katz

Feeling Better: Community Health Fund Picks Up Momentum

With all the national, even international, notice Ithaca has garnered with the development and growth of a local currency system, Ithaca Hours,anot her pioneering alternative to standard financing is taking shape. The Ithaca Health Fund is a radically new approach to health treatment that emphasizes prevention and is designed to cover non-standard medical practices such as acupuncture and herbal remedies.

"This fund is not only for people who have no health insurance, it's for everybody," explains the health fund's inventor, Paul Glover, the man who designed Ithaca Hours. "The Boomers, during the next 20 and 30 years, are going to become seriously old, and if present trends are an indication we should not depend on the generosity of either government or private corporations to provide health coverage for us," he says. "We need a locally-controlled safety net, and of course the children and grandchildren coming along are going to face an even more harsh situation, for which there will be no substitute for locally-networked health underwriting."

The Ithaca Health Fund establishes locally-controlled, non-profit, mutual health financing, notes Glover. "I interviewed over 120 people at random and found that 37 percent have no health coverage at all. So, the story of the fund is not only what we are doing but why we are doing it," he says. "We are responding to the failure of government and private corporations to give us the security that our health needs will be met without exhausting us to pay for it, without making us sick, working overtime to afford it in the first place. And even for the people who do have health coverage, the cost is higher than people can comfortably afford."

Based on his random survey, chiropractic, massage, and herbal treatment, as well as mental health services, were cited as priority complementary care that is not generally covered by most traditional insurance plans. "We have a broader idea of health coverage than merely pills and surgery," says Glover. "For instance, there are organic farmers who have agreed to give discounts to members of the fund."

The basic premise is simple: for a modest fee of about $100 a year, fund members receive a package of direct payments for certain specified treatments, in addition to discounts from participating health-care providers and support businesses. "Initially, when the fund is small there will be a limited variety of most urgent needs - emergencies such as heart attacks, broken bones and ambulance rides. We'll pay a maximum of 3 percent of whatever's in the fund," Glover says. "So if there's $50,000 in the fund the maximum payment would be $1,500. Our niche initially, as a local health plan, will be to cover the deductible for those who are insured. But long-range, as we accumulate funds, we will have the capabilities to cover catastrophic illness."

An organizational meeting for the Ithaca Health Fund was held on May 12, with about three dozen in attendance, including Leslie Strebel, president of the Tompkins-Cortland Life Underwriters Association. Strebel decided to become actively involved in fleshing out the bare bones of the program. "I didn't want people feeling that insurance agents, especially in a small community like this, are the enemy," she says. "I came in support of the health fund. I think that surprised a lot of people. It's our responsibility to work together and provide people with the safety nets they need and the healthy lifestyle we can all benefit from." Strebel has joined with six others to form an acting board of directors for the fund.

One of those is Dooley Kiefer, a member of the Tompkins County Board of Representatives(10th District) who sits on the Board's Health Benefits Reform Committee. "The general discontent with our health-care system is very widespread," she says. "It's not getting any better with the move toward managed care, which is really just managed cost. In Ithaca there are many devotees of the old-time traditional medicine practices which are not covered by conventional insurance.

"[The fund] is an attempt to fill a huge need," Kiefer says. "It seems to have two different thrusts. One is to stress prevention and allow traditional treatments besides our current medical system. And the other thrust is to make sure uninsured people have some kind of insurance. I think everybody would agree that prevention is a better approach to wellness than treating diseases."

"Currently the way most insurance works, you have to be sick, sick, sick in order to reap the benefits, because of the high deductibles," says Jacqueline Melton-Scott, Director of the Southside Community Center and a vocal proponent of alternative approaches to standard medical practice.

"Many of the illnesses that we are being hospitalized for can be prevented. But our medical system does not deal with prevention. The health services that exist now are reluctant to, or they refuse to, refer you to other possibilities to deal with your good health. I think that's ridiculous. If standard approaches are not working, or if you can partner with other approaches that are not standard to achieve better health, then that's what you should do. And if it's the choice of the person who's putting their money into the insurance to try something alternative, why is it that the doctors can't partner with you to find what that healing could be? I think all health funds should be about that - working with the patient for healing and good health and not just one way to do it."

In addition to serving on the interim board, Melton-Scott's agency will provide a conduit for the health fund to receive tax-deductible donations, as the Southside Community Center is already a not-for-profit 501(c)3 enterprise. Members' fees will be held in an escrow account until the Ithaca Health Fund is a full organizational entity.

"I'm interested in an alternative health plan that addresses holistic medicine and prevention and humanity," says Melton-Scott. "Coming at it through a bank of bureaucracy is not appropriate for humans. We know that if we listen to our bodies and are able to go to a health adviser and say, 'I think this is going on,' we can prevent having to be heavily medicated and major surgery. We should be looking at, nationally, health plans that stress prevention."

Jon and Sara Widercrantz, newcomers to Ithaca, also decided to serve on the interim board of directors. "I came here to get involved in a community," says Jon. "We think the health fund is going to help a lot a people, on all levels, individuals and businesses alike. This seems like a good alternative to getting health benefits through an employer, because there's a wider base of choices of practitioners." Also, he says, there's a large burden placed on businesses that have to provide health-care benefits. "They're shelling out so much money that I have a feeling this is a good way to save money," Jon says. "Employers will get a better deal in terms of what's available for health care."

His wife Sarah adds, "Affordable insurance is certainly part of it, because the cost of insurance is prohibitive for people who don't have it subsidized by their company. But also the fact that it covers other than conventional health practices, like chiropractic or acupuncture - or will eventually. That's appealing to us. The other thing about the health fund that's very attractive to us is that it helps promote community, and that it encourages good health to begin with. For example, you can get a discount at a local health club or discounts on organic produce. So it's partly about learning to keep yourself healthy as opposed to acting once you've become sick."

The fund already has some 50 health-care practitioners ready to participate, providing care at discounted cost and benefiting by acquiring discounts themselves. Todd Stein, a chiropractor since 1994, recently set up shop in Ithaca. "I'm excited by the whole prospect. It's one of the only things I've seen like it in the world. I'm excited to be involved in the forefront."

Stein says he's been frustrated in trying to deal with those who wanted to receive care but weren't covered under their insurance, or didn't have the funds for treatment. "And as much as I've tried to help them out, they still had a victim consciousness, that the whole insurance industry was too much for them to handle. So I like the fact that we're taking a local stand against this monstrosity."

Optometrist Larry Wallace, practicing on Aurora Street for the past 20 years, agrees. "If you look at what's happening in health care today, it's all being driven by corporations. Health insurance companies are dictating the whole health-care system. They're deciding who pays, how much you should get paid, what services you have access to. Freedom of choice is being taken away by managed care. The Ithaca Health Fund is offering an alternative to that and I think health providers should take a look at this because they're all being squeezed by the system." Wallace is one health-care provider who emphasizes preventative measures, and he has a long history of bartering for his services with clients.

Another provider who supports the concept of the health fund is Bill Wittlin, a psychiatrist practicing in Ithaca for the past six years. "This offers a chance to re-moralize medicine. There's been a tremendous demoralization that has taken place during the last five to 10 years," he says. "The pressures on physicians in terms of managed care, in terms of corporate entities, have worn away at their ability to do good by their patients This gives a chance for both providers and patients to be involved in a process, at the community level, of defining what good health care is.

This isn't like some done deal that's coming in and putting its formula on us. It's what we make it as a community."

Wittlin joins the chorus of criticism directed at the current health-care system. "The providers know how much they are being controlled in ways that are not in the patients' interests," he says. "They're painfully aware of that on a day-to-day basis. And they also know that perhaps half the patients have no, or grossly inadequate, health insurance, or grossly inadequate managed-care limits on what may be provided. [The health plan] gives a chance for medicine to return to its traditional roots and for alternative ways of healing to be part of the dialogue in the health-care network."

Glover sees the situation from another perspective. "Basically what we're doing is self-insuring each other. Big companies have figured out how to reduce the cost of health insurance for employees by putting money into a special fund, usually an investment fund, rather than giving the money to an insurance company. They keep control of the money, and they assess the risks, and they are able to reduce the costs. So we as a community can do as some of the large corporations have done, which is to self-insure each other, by recapturing some of the tens of millions of dollars which ordinarily leave Tompkins County every year, benefiting primarily the major insurers.

With most health insurance coverage, people get nothing unless they are sick, Glover says. With the Ithaca Health Fund, if you're a member you have not only the prospect of payment in case of an illness; members have the certainty of discounts at support businesses and providers.

He describes a new trend in economic development, networks of local people whose talents are pooled with lower costs resulting. Flexible payment options are an important aspect of this fund, Glover points out.

"People don't have to have a tight grip on scarce dollars to afford access to preventive health care. Through this program they can use Ithaca Hours, and they can use barter." For example, he says, if someone calls the health fund and says they sew and repair clothing, "We look in the data base and see if there's a chiropractor who may need sewing and would accept it for payment."

Wallace underscores the process: "The idea is that you're circulating your money in the local economy and you're creating a sense of wealth in your community because people who may not have other ways of raising capital can do work, and trade for their health care. It's one way of creating wealth in your community that may not have been there otherwise. It helps the whole concept of sustainability in the local community, supporting community members. People who can't afford traditional insurance can get services through this fund."

"It's absolutely a win-win situation for both the members and the providers," says Stein. "As a provider you'll be attracting more potential patients, I believe. I don't see any problems for providers."

Strebel, as an insurance professional, has long considered the problems in the current system. "I'm not a big believer in sending hundreds of dollars each month to an insurer and hoping that you get sick so that you can recoup some of your premium. And that mentality exists out there," she says.

There are many reasons why we have a health-care crisis in this country, Strebel says, "And I'm sure the insurance companies are responsible in part for some of that, but there are an awful lot of other factors." She explains that her clients, primarily individuals and small businesses, have been adversely affected by changes in New York State's health-care legislation. "I'm a big believer in preventative health care and alternative health care, and since most insurers are not, that's also a very attractive part of the health fund.

"I'm not personally or professionally threatened by the health fund at all," Strebel says. "I would recommend the fund highly to my clients in conjunction with a high-deductible plan, which is much more cost effective and much more wellness-based than paying big dollars for HMO premiums or low-deductible, traditional insurance premiums."

That's the strategy she's used for herself and her family, and Strebel says it has worked out quite well. "We bank on wellness, we have a wellness-centered lifestyle and we use alternative forms of medicine which would not be covered by traditional insurance anyway," she says. At this point the health fund can't take the place of traditional insurance, Strebel points out, especially for those with chronic conditions, or those who have some kind of catastrophic experience requiring hundreds of thousands of dollars. "But I think it can complement (policies with large deductibles)."

Cayuga Medical Center is examining several options for becoming involved with the fund as a major provider. "We look forward to working with the steering committee," states CMC President and CEO Bonnie Howell.

"The plan to establish a health safety net through a membership organization may very well be a viable approach to address the needs of the underinsured and uninsured in our community, and to provide a way to cover costs for alternative protocols not yet recognized by major insurers. Most important, it is a local response to a locally-recognized need."

Ithaca Mayor Alan Cohen was among the first to join the health fund. "I believe the idea has merit. There are a lot of people in the community who don't have health-care coverage, or don't have enough coverage, and this is a way to get it to them." The mayor adds, "I also feel that Paul Glover has a good track record. People were skeptical of the Hours system, which has proven itself."

Glover downplays his own role in the process. "All I've done is to kick this into play. It is now up to the board of directors and the community in general to suggest and enact policies which refine the fund in order to maximize direct benefits to members while expanding the long-range infrastructure aims of the fund that the membership will define, such as establishing a clinic or hiring our own doctors to provide us services without charge," he says. "Again, all such long-range goals are the option of the members, whose priorities will determine how we make payments. For the long-range health and sustainability of these things, like Ithaca Hours and the Ithaca Health Fund, it has to be understood as owned and operated and led by community members."

Sarah Widercrantz is excited by the future potential of the fund. "This is a very new idea and there's a lot of questions and what-ifs about it. I have a lot of faith that this could become an important part of the health-care scene in Ithaca. The first year is not going to be major in terms of actual monetary benefits for people who are sick or injured, but they can get these discounts through Greenstar and various health practitioners."

"It's a very skeletal proposal," says Kiefer. "We're breaking new ground, so a lot of thought and discussion are going to be required."

"We need to better define what the parameters of this plan will be," adds Strebel. "I don't see people dropping their traditional insurance, especially at this stage."

"My interest in one of service," says Stein. "If it's going to make it easier for the average person to get significant health care then that's what we've got to do. The more people who have input in this thing, the stronger it will be."

Melton-Scott points to some of the immediate practical needs in developing the fund, citing low-cost legal assistance as a priority. "We're hoping to get a lot of people to contribute their expertise so we can refine this process. The more you put bureaucratic layers on, the less service goes to the people using the fund."

The next step is getting the word out, communicating with people in the community and letting them know what it's about, and also to do some brainstorming," notes Jon Widercrantz. "This has a lot of potential.

There's a lot of positive energy. Whether it was 20 people involved or 20,000 people involved, it's going to help everybody, even if you're not directly involved," he says. "We're already an enlightened community, now we have to be a healthy community."

Buzzsaw Haircut, January 2003

by Matt Hourihan

A Healthy Ithaca

Paul Glover could have easily grown frustrated when he took a look at the state of health care in America. Scores of millions of people can't afford adequate, meaningful insurance, if they can afford any at all. Nationwide, hospitals feel the strain of budget cutbacks and lack of Alliances, and are forced to argue with private insurers over payments. If power shifts more firmly into the hands of for-profit insurance companies and HMOs, the problems straining the system may only get worse in the years to come.

But rather than getting disillusioned, Glover got motivated. He started the Ithaca Health Alliance. The Health Alliance is essentially an affordable money pool, an idealized form of medical coverage. With low overhead and a list of eligible emergency services, it is basically what Glover sees as "assurance" in place of "insurance." It offers payments covering trauma care, especially where bloated deductibles demanded by prehistoric commercial health companies come into play.

In order to join, adult members pay $100 per year, with varying rates for spousal membership and children. In return, paying members receive coverage for a list of trauma-related services, from broken bones to massage therapy. As the list of members and contributors grows, the Alliance will cover a wider range of services, for greater expenses. The Health Alliance breaks from standard insurance practices in a number of innovative ways. For starters, it is a heavily community-oriented association that relies on trust, rather than its impersonal, oversized brethren. In this sense, it is not driven by the needs of a private corporation that can haggle over payments and could require an inordinate amount of red tape.

One of the Health Alliance's supporters is the Cayuga Medical Center. Opinion within the halls of the clinic has been extremely positive regarding the Health Alliance and the benefits it provides. Says Marcia Eger, Vice President of Community Relations, "From the beginning, the Health Alliance has been a unique way of dealing with the underinsured. It provides coverage for people who in the past wouldn't have had coverage otherwise."

Glover is an interesting man, easy to spot in a crowd and bristling with passion. He is the creator of the Ithaca HOURS program, a barter economy system dedicated to supporting Ithaca's small businesses. He is known around town as a tireless activist with real plans - not just an idealist, but a man who works with his hands and his words to affect real change. He places emphasis on both ideas and results.

Brad Edmondson, a self-employed writer based in Ithaca, is one who will vouch for the Health Alliance's results. Two years ago Brad's only source of insurance was Blue Cross. His policy held him to a deductible of approximately $3,000. In the case of accidents, he would not have been able to cover out-of-pocket costs in the thousands. "There are a lot of me people like me who are self-employed," he says. "We don't have access to meaningful coverage."

Brad says that when Glover told him about the Alliance last year, he signed up. The Alliance later paid when he broke his collarbone in a bicycling accident-$1800, which would have entirely come out of Brad's pocket otherwise. "I would never have joined if it was just an idea. I saw a practical good."

Despite the work ethics of those involved, it is the idealism behind the project itself that has generated interest. Interest leads to involvement, and involvement makes it stand out as a viable alternative, and has fueled its preliminary success. "The first people to join did so because it's a noble idea-the idea of having a non-profit member-owned volunteer managed low-overhead health finance system."

The creation of the Ithaca Health Alliance is a direct reaction to the current state of affairs in the American health care system. Health care is one of the largest industries in America with, over $1 trillion pumped into the system annually. According to a comprehensive study by Public Citizen, a non-governmental organization (NGO) that acts as a watchdog on a number of issues, the dominance and flaws private Health Maintenance Organi-zations (HMOs) are at the root of the problem. The HMO was intended as a cheaper alternative to full insurance plans, and an intermediary between Medicare and the average beneficiary.

According to the study, which was released in September, HMOs actually add to health care costs in a number of areas. HMOs currently spend 15 percent of their revenues on administrative costs, as opposed to 2 percent expenditures by Medicare. According to federal investigators, HMOs are overpaid-and have been for years-but still demand and receive more Allianceing from federal sources. When an HMO is overpaid, it refers to required costs outside of health bills alone. In 1998, the fiscal high point for this overpayment, HMOs received excessive Allianceing to the tune of $5.2 billion. Also driving up costs are the countless instances of litigation in which patients are denied reimbursement. Champions of privatization in Washington reinforce this system.

Given these figures, if the Medicare program dealt directly with the provided care, and HMOs were cut out of the loop completely, the potential savings would be estimated by millions of dollars. This is one of the ideas behind the Health Alliance.

The real state of affairs isn't just measured by numbers, either. All over the country, particularly in high-density, low-income areas such as inner cities, Emergency Room waiting areas are packed with people waiting to receive care. This is thanks to the inefficient system the HMO has created. With large portions of federal Allianceing ending up in corporate hands, the pool from which both urban hospitals and their smaller rural counterparts may draw grows smaller each year.

The potential for growth can be seen in effect on a huge scale nearby-Canada. Canada's insurance system-which covers every Canadian, nationally-began much like the Health Alliance, as a municipal system created by a small community, specifically the farming town of Swift Current, Saskatchewan. The community created their pool in 1947. By 1962, the entire province of Saskatchewan adopted the plan; nine years later, Canada adopted the plan nationally.

While he is aware of the large-scale structural problems of health care, Glover maintains his local emphasis with the Health Alliance-but this doesn't mean that his vision is limited locally. "I'd like to see this become a model for communities nationwide, and have the communities linked to one another to multiply their collective power and, moreover, to create a system of health clinics for medical and dental care."

The most ominous signs come from the state of California. California pioneered many of the programs that are now standard state health care systems. It is the most privatized, heavily managed health care market in the country. Both its urban and rural hospitals are in dire straits.

Los Angeles County's public health care system is inching nearer to the brink. Mass hospital closings-"rolling medical blackouts" as they're called-could become a reality within the next two years. What this really means is unavailable trauma care for everyone, from the poorest migrant worker to the wealthiest businessman.

Out in the country, California's rural hospitals are facing similar problems. In general, rural communities have older populations, are more economically depressed, and take in lower incomes. Like in Los Angeles and other urban areas, rural hospitals also experience high costs of operation that are not covered by revenues from various sources. The result is the same: the high cost of privatized care puts a strain on local hospitals. In the end, the real victims could be those who cannot receive treatment for serious injury.

The Health Alliance is steadily living up to Glover's expectations as an archetypal community health insurance model. There are currently over 500 people enrolled in the Alliance-"co-owners" as Glover calls them. These include people from all over the country and the world. Says David Elliott, a librarian in Cornell's library system, "I'm going to Russia soon. If I break a bone, it covers it over there." David recently broke a finger, for which the Health Alliance helped with several hundred dollars.

In a few years, the money encompassed by the Alliance has grown to nearly $150,000, and the categories of coverage have expanded. Further, specific payment ceilings for certain treatments have increased as well. "We were really careful initially. We said the maximum we will pay for a broken bone is 5 percent of whatever is in the Alliance," said Glover.

"So far, each and every month for really the last six years, we've brought in more money than we've paid out. We started out where the maximum payment for a broken bone was like $550. Now we're up to $2,500."

Eger points out the nature of Ithaca as a place where innovations like the Ithaca Health Alliance can happen. "We have such a wonderful, unique place here, where these types of things can happen. We've received attention from all over the world for things like this. People are getting quick and direct benefits from the Health Alliance. It really is impressive." Says Elliot, "The Ithaca Health Alliance is rockin'."

Health Care Facts:
Percent of Persons Under Age 65 Without Health Insurance: 16.8% (2000)
Number of Persons Under Age 65 Without Health Insurance: 40.5 million (2000)
Percent of Children Under Age 18 Without Health Insurance: 12.4% (2000)
Number of Persons Age 65 and Over With Medicare and Private Insurance: 20.6 million (2000)
Percent of Persons Age 65 and Over With Medicare Only: 26.7% (2000)
Percent of Persons under age 65 Enrolled in Health Maintenance Organizations: 34.1 million (2000)
National Health Expenditures as a Percent of Gross Domestic Product: 13.0% (1999)
source: National Center for Health Statistics

Matt Hourihan is a senior journalism major. Buzzsaw Haircut is Ithaca College's alternative monthly.

Ithaca Health Alliance
helps launch Ithaca Free Clinic in '06
By: Jill Raygor
Ithaca Times 11/16/2005

Today, the terms health care and health insurance are synonymous with money. How much will it cost? Can I afford it? Can I afford to go without it?
      The Ithaca Health Alliance (IHA) has worked for nearly a decade to make health care available and affordable to area residents. Now, through the formation of a new organization and with the help of its current board member Dr. Justine Waldman, it is taking health care one step farther.
      The IHA has formed the Ithaca Free Clinic, one of the first organization's long-term goals, with the help of health care providers and other volunteers within the community that is set to open in January 2006.
      Scott Marsland, a registered nurse at Cayuga Medical Center (CMC), is a member of the board of directors for the clinic, who credits Waldman, an emergency room doctor at CMC, with making the project happen.
      "In my mind, a lot of why this project got feet so to speak is because of Justine's relationships with people at the medical center like myself, Frank Austin, Beth Harrington, Bill Tyler and others," Marsland said.
      Waldman could not be reached for comment prior to press time.
      Marsland began working with the clinic in May 2005, and has helped in every aspect from ensuring that a rented location at 225 S. Fulton St. (above the former Gallagher's Electronics) is painted and filled with the necessary equipment to finding a way to stretch the $45,000 pledged by the IHA for the year 2006.
      That money will cover rent, equipment, supplies and two part-time employees - an office manager and Clinical Coordinator Marie Constant. Beyond $45,000, every person and item will be on a volunteer basis only.
      Constant is a medical doctor from Haiti, who has opened clinics with little raw materials, Marsland said. He said her experience in working on a "shoe string budget" would help the IHA and the clinic to get the most out of the funds available.
      The location was chosen based on several items, including proximity to public transportation, accessibility to people with disabilities and layout in terms of individual medical rooms.
      To date, the clinic has received positive responses from approximately 60 volunteers in the medical field, 25 of whom are physicians, offering assistance of some sort at the clinic. Additional volunteers and funding will come over time, the board hopes.
      "We're venturing into relatively new territory here," Marsland said, adding that over time new legislation will also be necessary in New York State.
Jill Raygor

Free health care

Ithaca clinic offers basic servicesK/h3>


March 23, 2006

Until recently, the estimated 10,000 Tompkins County residents without health insurance either went without treatment or had to absorb the costs themselves. But since the opening of the Ithaca Free Clinic on Jan. 23, residents can receive primary medical care from doctors, nurses, acupuncturists and massage therapists for free.

The clinic is open from 2 to 6 p.m. Mondays and from 4 to 8 p.m. Thursdays and is located at 225 S. Fulton Street, next to Radio Shack. Within the first month of its opening, the clinic has treated more than 138 patients and enlisted the work of more than 60 volunteers.

The Ithaca Health Alliance, an alliance formed in 1997 whose mission is to facilitate free health care for all, dreamed up the idea for a free clinic in Ithaca eight years ago. The need to help the uninsured in Tompkins County was evident, said Scott Marsland, co-chair of the clinic steering committee and a volunteer nurse. Walking up the stairs to the clinic, which is five minutes from the college, visitors find volunteers scurrying from one room to another while patients sit in the lemon-colored waiting room. Health and wellness materials are available on the bookshelf on the right side of the room.

A nurse calls a patient’s name, welcomes him to the clinic and takes him down the hall, which is decorated with abstract artwork, into one of the examining rooms. More than $6,000 worth of new medical tools, donated by Welch Allyn, a company based out of Skaneateles, N.Y., await them. The clinic’s alternative care services are offered in the clinic’s other austere room, which contains only a cabinet of herbal remedies and a massage table. Last Thursday, the clinic saw 33 patients in four hours, the busiest day yet. “People are finding us,” Marsland said.

Marsland said the opening of the clinic is evidence of the success he and the other volunteers have achieved. In addition to the many services offered, the clinic works to educate the public.

Amanda Smith, co-chair of the education subcommittee and lecturer for the department of modern languages and literature at the college, has been working on organizing a series of “Wellness Workshops” at the clinic for the Ithaca community to be held the last Tuesday of every month. One workshop was led by Dr. Deanna Hope Berman, who spoke about holistic medicine. This month’s guest speaker is 7Song, director of the Northeast School of Botanical Medicine. 7Song will speak about herbal medicine at 7 p.m. Tuesday. Smith said she hopes the public will continue to support the clinic’s activities. “This is something the community needs to back up in every way possible,” said Smith.

Brooke Olson, assistant professor of anthropology at the college, is co-chair of the education subcommittee with Smith and is also working on bringing speakers and potentially helping refugees get health care at the clinic. Olson said she also encourages her students to visit the clinic and take a tour. She had the clinical coordinator, Marie Constant, speak to her medical anthropology class in the fall. Olson said she wants to increase conversation about health-care issues and the need for community support. “I’m trying to bridge the campus and community,” said Olson. Smith said there is always a need for more volunteers. Any health- care provider or college student interested in the medical field can volunteer at the clinic, Smith said. Volunteers are needed to help with reception work, help with research, work as support staff and educate the public about what the clinic offers.

Jay Patel, a junior human development student at Cornell University and a new volunteer at the clinic, said he hopes to help out at least once or twice a month. He said volunteering at the clinic has given him an insider’s view of the health-care system, watching an organization grow from its beginnings. “I’ve liked to see it from the ground up, see how it works,” Patel said.

The Ithaca Free Clinic depends on the work of volunteers in order to operate, but also on the financial support of the community. All services at the clinic are completely free and open to anyone, but the clinic welcomes and appreciates donations of any form.

Patients can also opt to become members of the Ithaca Health Alliance for $100 a year. Members of the Health Alliance receive benefits — such as guaranteed grants, interest-free loans and discounts for services that are not offered at the clinic, such as dental work and emergency care.

The clinic is having its first fundraiser at 6 p.m. Saturday at Olivia Restaurant. Tickets are $100 per person and those attending will celebrate the opening of the clinic with food, drinks, an auction and musical entertainment by Mary Bentley, chair of health promotion and physical education at the college, and her band. Calls and donations arrive every day, said Sarah Bankert, an organizer of the event. “People have been so generous,” Bankert said.

Developing the clinic has posed some challenges, but progressive social change is made by people who are used to struggles, Marsland said.

“Their swords are drawn, hammers out, ready to do battle,” Marsland said. “We’ve had to put down our swords and hammers to become allies.”

Both Smith and Marsland agreed outreach still needs to be done, and they hope to continue to work to find ways to improve the clinic. But after a long process, their hopes of offering more health-care options to the community are becoming a reality.

“It was months and months of work, years of dreaming,” Smith said.

Philadelphia Weekly story about PhilaHealthia: 1/4/06