Socialized Medicine by the Back Door: School-based Clinics in Arizona

Joseph M. Scherzer, MD
Article Type: 
Report from the States
Summer 1996
Volume Number: 
Issue Number: 

The winter of 1996 generated “interesting times” for the Arizona Chapter of the AAPS. After our legislative success in establishing an HMO Disclosure bill last year, we attempted to expand on past accomplishments by seeking passage of a Patient Protection Act. Our bid was summarily killed by a legislator who the Arizona Medical Association (ArMA) had supported. (This individual is an avowed advocate of managed care.) We then discovered Arizona was facing a state version of the Clinton health care plan — House Bill 2047,  The Children First Fund — which was also supported by our state medical association.

The Children First Fund was spearheaded by The Children’s Action Alliance, a compatriot of the Children’s Defense Fund. The immediate, purported goal simply was to provide health care for “children” under 21 and “uncovered family members” in the entire state of Arizona. This undertaking was to be seeded by some of the tobacco tax money raised by a measure that passed the Arizona legislature last year. However, a thorough reading of the bill revealed the framework of an expansive agenda that involved much more than initially met the eye.

A vague, empowering mandate would have awarded enormous power to a health care “czar” and to a new bureaucracy the bill sought to establish, “…the Executive Director has such powers as are necessary to carry out the functions of the Children First Fund,” and “Board members and Board employees or agents are immune from civil liability for any action they take…in the performance of their powers and duties.” As we well know, such power has always been abused by bureaucrats whenever so delegated.

The original version of HB 2047 delegated the orchestration of health care of children as well as adults to an already overburdened public school system or to “community-based clinics.” (HB 2047 was based on a Florida bill — The Florida Healthy Kids Corporation Act — which also provides health care under a school-based system.) As you may remember, school- and community-based clinics would have played a major role in the Clinton Health Care Security Act, with an expanded role for paramedical personnel.

In such a system, the structure of parental consent becomes a problematic issue. Acceptance could have been automatic unless a rejection was received. (Interestingly, the House sponsor of HB 2047 also sponsored a vaccination-reporting bill, which forces physicians to violate patient confidentiality or face charges of unprofessional conduct. Reporting must be automatic unless parents specifically refuse to have such information released. This latter bill was also supported by ArMA. It is now law.) In the setting of school-based clinics (SBC) and school medical practices, consent is often “blanket” (all-encompassing) in form. Complete control of medical care is obtained from parents. Operated by outside agencies, such clinics are not bound by school law, under which nurses may not even dispense aspirin without parental permission. Parents need not be told about anything that occurs within the jurisdiction of such a clinic. (A recent Washington Times article detailed the remarkable tale of sixth-graders forced to undergo unscheduled pelvic examinations in their school.)

I can imagine the concerns such a SBC system raises with a major portion of the electorate. This is only one small area where critical details of this potentially far-reaching bill had not been fleshed out. A glaring lack of detail was evident throughout HB 2047. Without specificity in legislative language, the potential for abuse is limitless. Furthermore, coverage would have been coordinated among all children in defined counties, even with those who were already insured, apparently forcing all concerned into compliance with state rules. Since Arizona statutes permitted the Children First Fund to equate eligibility with disability, Medicaid funds could have been solicited down the road. This is exactly what transpired in Minnesota, a state in which a much smaller scale “Children First” initiative promulgated by the Children’s Defense Fund (also by means of tobacco tax money) has led to a budget-breaking system of rationed, nearly universal, managed care.(1) Minnesota’s plan bean with only 7,000 children. Arizona would have enrolled 160,000 or more, right out of the chute.

Notable figures in health care (e.g., David Eddy) have been remarkably candid in conceding that while their goal of universal coverage may not be obtainable at a federal level, it can still be implemented by legislating universal coverage at the state level. While supposedly the Clinton plan has come and gone on the federal level, health care “reform” has been quietly proceeding state by state. Medicaid eligibility has been expanding dramatically on a nationwide basis. [“In Idaho, 42% of births are now covered by Medicaid.”(2)] With demographic changes automatically enlarging the rolls of Medicare, and Medicaid growing sufficiently, both programs could easily “meet in the middle.” We would then find ourselves confronted with government-run and corporate-managed health care on a universal scale.

Is this the way socialized medicine will arrive — by the back door? According to American Medical News (12/18/95), Medicaid legislation may give states “unprecedented freedom to determine who will be covered and what benefits will be provided.” With such trends in mind, we in the states must become ever more vigilant. For what the state gives, it can also take away. It is doing so in Minnesota.

The sponsors of the Children First Fund had garnered a great deal of supportive testimony for their measure. It had already passed the Arizona House by the time we learned of it. (HB 2047 was originally a minor “vehicle” bill, which was then transformed into a wholly different striker, apparently passing through the House with many legislators left in the dark about its true nature.) Fortunately, opportunity, preparedness, and the very existence of the Arizona Chapter of the AAPS interceded and we were able to expose the inner workings of this bill in our Senate, which eventually killed the measure. Only AAPS representatives and a representative from Eagle Forum testified against the Children First Fund — but those testimonies sufficed.

While many political figures would have us believe they regard medical care as a “right,” it is obvious to the AAPS the movers and shakers in our government do not believe that at all. If that were the case, the AAPS would not have found it necessary to sure HHS (Stewart v. Sullivan) to prove patients “entitled” to Medicare insurance should have the right to contract freely with physicians of their choice, for the health care of their choice using their own funds. If there is one lesson the AAPS has learned, it is that those who would socialize American health care will not give up. I wonder if these “elites” have decided their current strategy is to make this the Year of the Child?

You may know that Marian Wright Edelman, a major architect of our failed welfare state, recently orchestrated a “Stand for Children” march on Washington. (Ms. Edelman has the support of the American Academy of Pediatrics.) Remarkably, one week after Arizona’s Children First Fund died, people dressed in clown suits were parading outside YMCAs and community colleges, holding placards announcing a “Healthy Arizona” initiative spearheaded by none other than the Children’s Action Alliance. At the same time, Tucson’s major newspaper ran an editorial lamenting the failure of our legislature to do something for those children who are too wealthy for AHCCCS (our state’s version of Medicaid). The fact of the matter is this year our legislature did pass a measure to consider offering the working poor not qualifying for AHCCCS to buy into the system on a sliding scale. We must wait and see what transpires — and remain ever vigilant.


1. McMenamin B. In bed with the devil. Forbes, September 12, 1994.

2. Scherzer JM. Socialized medicine. Letter to the editor; Tribune Newspapers, November 9, 1994.

Joseph M. Scherzer, MD, President, Arizona Chapter of the AAPS. Dr. Scherzer is a dermatologist in Scottsdale, Arizona and a member of the Board of Directors of AAPS. His address is 10900 N. Scottsdale Road,  #502, Scottsdale, AZ 85254.   

Originally published in the Medical Sentinel 1996;1(2):27-28. Copyright©1996 Association of American Physicians and Surgeons (AAPS)



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