School-Based Health Clinics
I can understand people's concerns about school clinics being a way to sneak
condoms to teenagers behind their parents' backs, or refer them for abortions
to avoid all the problems of teenage pregnancy. Those are political hot
potatoes. But let's face it: sex is going on among our youth, and STD's,
pregnancy and abortion are rampant in our high schools. Besides, there are tons
of OTHER health issues of low-income teenagers that aren't being addressed the
way the health system works now. So what's wrong with school-based health care?
A lot of people, including a lot of
physicians, would say nothing is wrong with school-based health clinics. They
support them when they are positioned in areas where the current medical needs
of low-income, uninsured adolescents aren't being met by their own parents.
At last count there were more than 1,100 school-based health
clinics in place in American schools. Each one tends to employ a school nurse
or public-health nurse, a nurse practitioner, a mental health counselor, and a
receptionist, offering students confidentiality, convenience of appointments,
and, through Medicaid and other managed care programs, often little or no
expense. Though the clinics are geared toward low-income teens who have no
health-care alternatives, all students are eligible for clinic services. Often
the clinics lead school-wide participation in wellness activities such as
screenings and health fairs.
But you're right. The controversies swirling around
school-based health clinics go far beyond reproductive health care issues to:
- The undermining of parental
authority, replacing it with governmental employees in charge of a child's
health status in a "captive audience" type setting.
- Parents sign blanket consent forms
for their child to visit the clinic for routine purposes. They probably do
not realize that they are giving away their parental rights and power of
attorney status to clinic and school personnel, and will be neither
informed nor their consent sought for much more serious procedures or
prescriptions that may happen later.
- Promises of reductions in the
teenage pregnancy and STD rates if taxpayers allow a clinic in their
school have almost always fallen far short. School clinics advocates
themselves admit that kids do not decrease their risk-taking activities,
including sex, despite having the clinic supposedly promoting better
health practices to them. Though it is hard to get reliable statistics, it
appears that the presence of a clinic greatly increases the abortion rate
at any given school.
- There is a real possibility of
massive data collection and mental-health profiling on students and their
families, with a high risk of incorrect "profiling" with all the problems
that causes, and invasions of privacy.
- There will be high pressure on
the school system to identify children as being "at risk" medically or
psychologically so that the school system can get more Medicaid funding
for medication or disability services, leaving the child with a lifelong
"label" that may not even be correct.
- Medicaid dollars aren't limited
to medical care; they can also pay for psychological services like bogus
self-esteem "group work," social work, nursing, hearing and vision
screening, transportation and educational hardware and software, all at
taxpayer expense but with little taxpayer oversight, since Medicaid
oversight is so lax and this funding skirts the school board
- There will be scant local
school-board or legislative oversight, because the funding is through
Medicaid. That virtually guarantees spikes in health-care costs, even
though the local school district won't show those extra costs on its
- There are often non-government
organizations such as foundations involved as "partners" that donate money
for start-ups. Taxpayers will typically have to pick up the costs in later
years when the grants run out. While nothing nefarious is suspected, it is
important to note that many of the start-up donors are hospitals or
foundations affiliated with companies that employ the type of personnel
the clinics will be staffed with, and sell the very same health-care
products as the school-based health clinics will be dispensing.
Bottom line: health care is the job of moms and dads, not
schools. Clinics end-run parents. They block our chance to nurture our own
children's bodies. They enable the weak parents among us to neglect our
children even more. They push us out of the loop. They go behind our backs.
It is excellent public policy to find ways to serve the
medical needs of disadvantaged teenagers. But is that the job of the schools,
when the "solution" appears to be creating so many more problems? It could be
argued that school-based health clinics are just one more example of "mission
bloat," in which we're forcing our schools to take on yet another distraction
to keep them from fulfilling their academic mission. And that's enough to make
taxpayers . . . sick!
the chapter, "The Health Education Connection" in the book, Government Nannies by Cathy Duffy. For a well-documented article by a
physician on Medicaid and its spiraling influence on school operations,
including school-based health clinics, see: