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HOME > ABOUT > PRESS > IF I HAD A HAMMER
Article published - October 31, 2007
Credit: THE CALIFORNIA ENDOWMENT
If I Had a Hammer: The Question of National Health Reform
Robert K. Ross, M.D.
The question for the week: if you were czar (or at least the President) who would you pick to draft a plan to fix the U.S. health system?
While you take a moment to ponder this utterly hypothetical question, I can save you the energy of exercising your brain cells, because I have the best answer. Forget about the prestigious think tanks, liberal or conservative. Forget about the high-priced consulting firms. Pass on the university hotshots with hundreds of academic publications and well-researched books on their resumes. And pass on us high-falutin’ private foundations who seemingly have policy briefs to address any civic challenge.
For my money, I would entrust the overhaul of our ridiculously expensive and dysfunctional health system to directors of community health centers. I would put a dozen of them in a room for a weekend, shove a pizza under the door every few hours, and within a couple days I would have a sensible, affordable plan for health reform.
For too long, America has viewed community health centers quite uni-dimensionally: as the place where poor people and the uninsured can access health services. While this is true, it is a limited view. Community health centers (CHCs in shorthand) represent this nation’s best investment of this nation’s health care dollar; no other dollar spent comes close.
The CHC movement (and it is a movement) is now, unofficially, close to four decades old. They started as “free health clinics” in the '60s and '70s, and they have matured, evolved and grown since then. Have they grown enough to entrust their leaders with intellectual custody of designing a new U.S. health system with $1.7 trillion in spending? You bet. And here are five reasons why:
- CHC leaders would begin a conversation about health reform with two words that are important to American health consumers but rarely uttered in current discourse: “mission” and “values.” Terms like dignity, respect and patient-centered would drive the planning, rather than being relegated to an afterthought (which is what we have in national and state reform discussions now).
- While developing a mission-driven, values-based plan, CHC leaders are best equipped to craft an approach that is also hard-nosed with respect to costs. During the past decade, CHCs have been perfecting the art and science of delivering quality health care services at a reasonable cost to virtually anyone who shows up at their doorstep.
- CHCs would advance a paradigm shift with our health care system that is badly needed. They would develop a system that is more heavily focused on community-based prevention and primary care, and they are experienced in understanding how to reduce unnecessary emergency room visits and hospitalizations. We can no longer afford to view hospitals at the center of gravity for the U.S. health system.
- No segment of the U.S. health system is better experienced at providing health services to a racially and ethnically diverse America. CHC’s are governed by boards of directors and professional staff that closely resemble the communities that they serve. They also represent an economic engine for working-class neighborhoods, generating decent jobs along the way.
- CHCs and their leaders represent the most credible and admired segment of our health system. As nonprofit entities, they avoid the wrath of Americans’ distrust of the profit motive in providing health services. As private sector providers, they do not carry the “big, inefficient government” label. CHCs are admired and supported by Democrats and Republicans alike for providing quality, cost-effective care. They are health care’s good guys – and this label is well-deserved.
Millions and millions of dollars will be spent over the next two years hiring lobbyists, consultants, and political strategists to wrangle over needed changes to our health system. For the cost of a hotel conference room and a couple of pizzas, a group of community health center leaders are fully capable of telling our President and Congress what we need to do to fix it.
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