ABSTRACT

The way in which medical services affect local communities and the social capital of small places in the United States is the dirty little secret of the medical economy. In fact, there was a period in which it appeared the United States might develop a local healthcare system that supported communities as it provided medical services to individuals. In 1966 and 1967, Congress created a system of community-based primary-care centers to serve poor rural communities and poor inner-city neighborhoods. The centers encouraged community self-reliance, because community members governed them, a bold experiment in local democracy and community control. In recent years, most knowledgeable observers note with a mixture of sadness and shame that the best primary care in the United States is practiced at the health centers, although most Americans still wrongly suppose that the Community Health Centers deliver the healthcare of last resort to people who have no other option.