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The study, by the National Association of Community Health Centers, the Robert Graham Center and Capital Link, found that medical expenses for health center patients are 41 percent lower than for other patients.

In Alaska, the centers have been used to good effect. In some rural areas, Native tribal groups operate centers. They get funding for both Native and community health care, so anyone can use their facilities.

That's an efficient system, and solves the problem of caring for rural residents who don't qualify for Native health care benefits.

Around the state, half of the community health care centers' patients were below the federal poverty level and 40 percent were uninsured in 2005, the latest published figures.

The clinics charge a sliding scale of fees. People who can't find another doctor or can't afford one always have a place to go.

Poor and uninsured Alaskans can get primary care at 124 sites across the state, at clinics offered by 26 organizations. A map of the sites shows them strung out from Unalaska in the Aleutians to Hydaburg in Southeast, and from Savoonga on the Bering Sea to Fort Yukon in the Interior.

In 2001, the state got a special federal appropriation to boost the number of clinics, thanks to a push by Alaska's congressional delegation, said Marilyn Kasmar, executive director of the Alaska Primary Care Association.

After that, the number of statewide sites increased rapidly. "We were pretty behind the eight-ball," she said. "We had some catching up to do."

Kasmar says the community health centers "are the best health care investment America can make." They reduce the need for people to use emergency rooms, and get medical care into rural areas where there isn't any.

The Alaska clinics serve nearly 80,000 people, according to the Alaska Primary Care Association.

In an era when so many things are wrong with the way Americans get health care, it's great that one piece of the system is turning into a model for success.