With thirty-seven million people now without medical insurance,
private insurers have argued that caring for those unable to pay for
the services they need or without insurance is a public responsibility
and not an overhead cost. However, tax-conscious voters have limited
the ability of governments to spend more for health. An additional and
sometimes overlooked possibility for dealing with uncompensated
care is the responses that local communities can make. A community
services budget framework that includes the inputs of volunteers
makes large-scale and sophisticated responses possible through forms
of collective organization outside the usual public programs. This
framework, applied to one community, illustrates the responses that
are possible and the policy questions that must be addressed to expand
the options for dealing with the challenge of uncompensated medical
care.
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