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Oregon Doctor Lives Faith, Notion of Health Reform at Clinic
By Ed Langlois
Source: Catholic News Service
Published: Wednesday, November 04, 2009
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Dr. Michael Grady talks with a patient at his clinic for low-income people in Silverton, Ore., Oct. 7.
PORTLAND, Ore. (CNS)—In a converted Mexican restaurant, a small-town Catholic doctor lives out his notion of health care reform—and his faith.

Dr. Michael Grady, 59, runs the McClaine Street Clinic, next to a grocery store in a shopping center in Silverton, a city of 10,000.

The clinic serves patients so poor they qualify for the state health plan or Medicaid. Many doctors in private practice don't accept patients with such insurance, because reimbursement rates are so low.

Grady, a member of St. Paul Parish, wants his clinic to be a "medical home" for patients, a place where they and their health conditions are well-known and where they can see a steady team of health providers for preventive care.

Thirty years of research show that health outcomes improve and costs drop when patients have a defined primary care provider, as opposed to having to visit emergency rooms and multiple clinics only after their situation has become dire.

Proponents of health care reform say if nothing changes in the way health care is paid for, more Americans will be in such situations. A recent White House report showed that while health insurance premiums have grown 139 percent, wages have increased only 39 percent.

A physician for 33 years, Grady is assembling a full array of providers at McClaine Street: a nurse practitioner, nurses who do immunizations and mental health workers. Someday he would like to have a dietician and a social worker to help manage patients' health in a coordinated way.

Many of those who come to the clinic have chronic conditions such as diabetes, hypertension, heart disease, obesity, addictions, asthma and mental illness.

"The old model of the doctor seeing a patient for 10 or 15 minutes and being done is over," says Grady, who favors slacks and a button-down shirt to a white coat.

Patients who come to his clinic—15 to 20 per day—tend to be low-income seniors, disabled adults and members of single-parent families.

What needs to change in health care, Grady said, is where the money goes. Now, doctors in the U.S. get highly paid for heroic measures when people are acutely ill. Instead, he argued, the incentives should go to providers who keep people healthy in the first place.

Grady said the U.S. has fallen into a "health care industrial complex," in which insurers, drug makers and medical-device companies create needs as a way of making big money.

"The system is set up to produce health care, not health," he said.

For seven years, Grady worked for Group Health on Washington's Puget Sound. A cooperative, its physicians get salaries instead of fees for services. He said it worked well, because the focus was figuring out the best way to keep a patient healthy.

It's the model he's brought to McClaine Street, in conjunction with the public health plans.
Critics of managed care fear longer wait times for elective procedures. Using the example of waiting six months instead of one month for a hip replacement, Grady calls such inconveniences "a premium I'd pay for justice."

He attended Catholic schools in the Portland area and graduated from Jesuit-run Santa Clara University before earning a medical degree from Oregon Health and Science University. He said the Jesuits taught him that religion and faith matter not only for personal piety, but for "how you operate in the world."

When he was 15, his 12-year-old sister died of leukemia. That led to his determined fascination with medicine. He never considered much else as a career beside becoming a family doctor.

Less than a mile away from the McClaine Street office is a free clinic for the uninsured. Grady and a dozen other physicians or nurse practitioners volunteer there and community fundraisers help pay for supplies and operating costs.

"Forty thousand Americans dying every year simply because they have no access to affordable health insurance is a travesty that none of us should tolerate," said Grady, citing numbers from a September Harvard study. "If we had a disease that killed that many, we'd have a telethon."

Grady brings up the issue of the uninsured regularly when he speaks at churches. He wants Catholics to bring their values to the health care debate—respect for human dignity, the common good and preferential option for the poor among them.

Past president of the Oregon Academy of Physicians, Grady argued that the nation should give everyone basic health coverage, with additional private insurance available for those who can pay.

He lauded such a single-payer plan as the "most efficient and fairest" reform, but would accept as a second choice a "robust public option that serves as a check on private insurance companies."

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