Today, during an appearance on CNN’s American Morning, Rep. James Clyburn (D-SC) again suggested that the best way to get to universal health care coverage is through incremental reform and “to use community health centers as a foundation”:
I have always believed that the way to get to universal access to health care is to use community health centers as a foundation. If you go back to 1994 when we were doing this I was working with Congressman Roland from Georgia, I was trying to get this to be the foundation upon which we do this in 1994. So I’m not late to this, you guys are just beginning to listen to a little bit of what I say.
Clyburn agrees with the goal of affordable health care for all, he just doesn’t see how we get there in one big push. But again, it’s all in how you talk about it. Health care costs have contributed to the economic crisis and the ill economy is making patients sick. Politicians can build support for reforming both systems by educating the public and building support for reform.
After all, it’s what good policy making and politics are all about. First you lay out the situation, and then you suggest solutions. In this case, isolating the economic downturn from the health care crisis and pretending that the two are not related not only distorts reality but also undermines the cause.
Americans understand, (far too well these days) that unemployment can lead to the loss of health insurance coverage and that an unexpected medical emergency can send a family into medical bankruptcy. Yes people need jobs, but during a time of economic crisis, they also need health insurance to protect their families from financial disaster.
It’s that kind of urgency that will make reform possible. And, politically, isn’t it the easier case to make? As Atul Gawande argues in the latest New Yorker, European nations achieved universal health insurance during a period of crisis: their reforms came out of necessity, not slow investments in community health centers and expansions of a tiny program here or there.
There is nothing wrong with community health centers, they’re just not the answer to solving our health care crisis. Chris Jennings recently pointed out that “if you’ve looked at the debates in incrementalism, what happens is people don’t care enough about the incremental population you’re trying to deal with“:
The only people who really tend to care are the people you’re hitting to pay for them – it’s the offset population, the paid for population. In a comprehensive reform debate, when you have all levers on the table, people are willing to compromise more in certain areas in order to get something else.”
Instituting comprehensive reform is the kind of flamboyant political theater that ropes in “the incremental population.” Unfortunately, Clyburn is missing the opportunity for adopting such change. He’s sacrificing a compelling case for health care reform for what’s what’s politically comfortable.
CLYBURN: Well Barack Obama as a candidate laid out health care reform at one point as being the big issue in the campaign, that was about a year before last November’s elections. Then about six months later it became energy, everybody was talking about gasoline prices. By the time we got around to election day the big thing was getting people back to work. So I think the primary- in his thoughts, has got to be getting Americans back to work. We just hear what- 55,000 additional layoffs and still more to come. I think that’s the first priority. Now, if you couple that with things that we’re already doing- we’ve passed the State Children’s Health Insurance Program and we are pretty much on point, at least in the House, to do something about the community health centers. I think that we ought to really do this thing incrementally, but first get people back to work.
CLYBURN: Well we’re not tinkering around the edges, if you cover 11 million children that’s a 4 million increase in what we call SCHIP- the Children’s Health Insurance Program- and if you quadruple as proposed by Bernie Saunders and myself that we do with community health centers that’s not tinkering around the edges. Community health centers have been around for forty years, they’re very accepted, they are the kinds of programs that will get people out of emergency rooms and into health care within their communities. That’s a big, big part of this. Now we’re doing F-mat (hard to hear that word), we’re going to expand Medicare, we’re going to—all in this comprehensive program. So what I’m saying is you can reach universal access to health care without having one big mammoth program bitten off this year.
CLYBURN: No, no, no I agree with Senator Kennedy. All we are talking about here is the approach to get there. I think to get there over a 12 to 24 month period is a way to go especially when we’ve got to now pass something between a 125 billion and 900 billion recovery package that’s not a whole lot about health care. So none of this was on the agenda when Senator Kennedy first laid out his approach, but I agree with him, that’s where we need to get but the question is do we get there tomorrow or do we get there a few days later?
CLYBURN: Well you know John nobody was listening to me back in the campaign, I have been talking about this—community health centers, I’ve been there, we celebrate the 40th anniversary of community health centers a year before last, I expressed this at that point. I have always believed that the way to get to universal access to health care is to use community health centers as a foundation. If you go back to 1994 when we were doing this I was working with Congressman Roland from Georgia, I was trying to get this to be the foundation upon which we do this in 1994. So I’m not late to this, you guys are just beginning to listen to a little bit of what I say