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.
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