Vermont has always been on the cutting edge of health care reform, so one has to wonder if the closure of a free clinic in Putney, after nearly 23 of operation, is a sign of things to come.

It was recently announced that the number of people using the clinic's free health services has been declining since the passage of the Affordable Care Act. According to a recent Reformer story, "For almost 23 years (Richard) Fletcher and a small group of volunteer doctors, nurses and assistants served anyone who walked in to the Putney office on a Thursday afternoon.

But now, as Vermont and the nation move ahead with the Affordable Care Act and more people are signing up to health care plans, organizers who run the Putney Walk-in clinic say there is less of a call for their services."

"Last Thursday the clinic closed its doors for the final time. Changes in Vermont's health care system have led to a significant drop in the number of patients who are using the clinic, former clinic Director Leon Cooper said."

"And at the same time, Cooper said, by remaining open the clinic was, in a way, preventing people who should be signing on to the state's new health insurance from doing so.

"Our intention from the beginning was to see ourselves out the door and hope that eventually the country or Vermont would get its act together on health care," Cooper said. "We didn't want to become a permanent finger in the dike."

While there does not seem to be a national trend of free clinic closures, the fact remains that more Americans are now becoming insured and using health care services that were once unaffordable for them.

The free clinic movement in the U.S. grew out of the failure of a market-based system to meet the health care needs of those without the means to buy insurance or to qualify for existing programs. Keep in mind that although Vermont has provided insurance subsidies to people whose incomes have been as high as 200 percent to 300 percent of the Federal Poverty Level, or roughly $20,000 to $30,000 a year, many states would only offer similar subsidies for people earning 30 percent of the FPL or about $3,000 a year.

Free clinics popped up everywhere and doctors and nurses felt compelled to offer their time and expertise at no cost because they felt that too many people were being cast aside because of no fault of their own. The need for these kinds of free services grew over the years and many clinics found it difficult to keep up with the demand.

One of the more striking examples of the demand was the response when the organization Remote Area Medical held clinics in underserved U.S. areas. People lined up days in advance and thousands of people were often turned away for lack of capacity.

The need for free clinics is one of the great American stories of disgrace. One has to believe that access to and affordability of health care is not a matter of money but of priorities. This country has never made a commitment to provide universal access to health care to all of its citizens. The Affordable Care Act was a baby step in the right direction.

We hold a higher priority for being the policemen of the world and for making sure that those who have the most money hold on to it and make it grow. This country has rarely made a move to create a more egalitarian society since the late twentieth century. Prospects for the future look dim.

When one looks at countries that do not need free health clinics common themes emerge. Their citizens have decided that equal access to a basic level of health care is a right, not a privilege, of citizenship and they have decided that it is worth paying more in taxes to provide that level of access.

More free clinics may not be closing any time soon but, hopefully, Vermont will show the rest of the country how to head in that direction.

Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at rbdav@comcast.net.