Point Austin: Ounces of Prevention, Or

This might have been the year of health-care reform.

For the last several weeks, health-care issues had begun to permeate the public buzz, with the presidential campaigns arguing over the best strategy, local public forums advancing the discussion, and even a nationally broadcast public television documentary helping to focus attention on nonprofits and other groups working on the issue (see www.klru.org/criticalcondition). In election season, health care is inevitably among the handful of priority issues (for discussion and demagogy, if not action). Closer to home, advocacy groups have begun to raise their profiles in anticipation of the 2009 legislative session, which starts Jan. 13. It's at least possible that some momentum might be generated for real progress by early next year, if a new administration in Washington and a new legislative mix at the Capitol can change the political priorities.

Hope, as somebody's been saying, is in the air.

It was easy to feel the optimism last Saturday, watching the grand opening of a new Community Health Center on South I-35 at William Cannon, near Dove Springs. Amidst a family atmosphere of barbecue and gospel music, neighborhood activists and area dignitaries celebrated the latest project of the Travis County Health­care District, which now has more than a dozen of these clinics across the city, with another scheduled to open near Brackenridge Hospital in a few weeks. Among the celebrants were county Commissioner Mar­gar­et Gomez, state Rep. Eddie Rodriguez, and clinic board member David Campos, who emceed the informal proceedings. The officials said all the right things about community services and public access, but the hit of the morning was Ofelia Zapata, an Austin Interfaith activist who, along with folks from the Wesley Center for Family and Neighborhood Development, had done much of the legwork of surveying nearby neighborhoods about their health-care needs in the planning stages of the project.

Zapata bubbled over with enthusiasm for the clinic and the community and announced proudly that this storefront clinic is only the beginning and that she hopes for a clinic the size of a nearby H-E-B. Brandishing the blind cane that helps her navigate, she declared, "I may not see, but I have big visions."

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A Clinic at a Time

The person in charge of official local health-care visions is Trish Young Brown, president and CEO of the Healthcare District. At the clinic opening, while walking through its brightly painted rooms, Brown said that formal planning had begun a little more than a year ago; that the clinic would largely deliver nonemergency care to children, mothers, and the elderly without other access to health care (patients use Medicare, Medicaid, or a sliding payment scale); and that it would reach full patient capacity in about six months. Every such local clinic not only contributes to the general community welfare but removes a resource and financial burden from local emergency rooms; Brown pointed out that the Brackenridge clinic, set to open on Red River in a few weeks, will directly relieve pressure on Brack's strained emergency services. Despite limited resources of its own, since its 2004 creation, the Healthcare District has steadily moved to anchor and expand the delivery of services across the county.

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Curing the System

On Saturday morning, it was easy to catch the optimism of the day and to imagine that another low-cost clinic in every strip mall is the best way to address the lack of community health care across the county and the country. Those folks consistently working on the health-care issue know differently. The state and the nation have simply not committed the resources necessary to bring everybody into the system, which in the short term means providing some sort of health insurance to the 40 or 50 million people going without. Tuesday night, it was refreshing to hear Barack Obama, in response to a question from moderator Tom Brokaw, define health care as a "right." Certainly the explicit Declaration of Independence guarantee of "life, liberty, and the pursuit of happiness" carries with it the promise of equal access to quality of life for every citizen. Our scandalous record on health care is not just a humanitarian crisis; it's a stain on the promise of democracy.

A few days after the clinic opening, I asked Anne Dunkelberg of the Center for Public Policy Priorities if she is optimistic that the new legislative session will bring some progress on these matters. Judicious advocate that she is, she declined to make predictions and pointed to two major unanticipated obstacles likely to affect all state budget planning. "There's the untallied but certain to be large cost of [Hurricane] Ike," she said, "and it's still very unclear what effect the national economic crisis is going to have on state budgets."

Most of the difficulty in Texas health care is of course man-made – not just budget slashes but "rationing by regulation." Dunkelberg pointed out that by simply extending the enrollment period for Medicaid from six months to one year (as it did for the Chidren's Health Insurance Program, which serves families better off), the state could make a major dent in the enormous number (1.9 million) of children without insurance. Moreover, the state is at the latter days of an extremely foolish and wasteful experiment in privatizing eligibility access, a "conservative" project that has left the Health and Human Services Commission with an unworkable computer program manned by only 60% of the staff HHSC had 10 years ago, worn down and shrunken by attrition – all of which had been predicted when the budget-slashing project began.

As I began, this might have been the year of health-care reform. The last few weeks, filled with gloomy headlines about economic disaster and government flailing in search of a remedy, have made it seem less and less likely that we will have much of a near-term opportunity to address the glaring public needs, such as health care, that have been neglected in D.C. and at the Capitol for far too long. But when public officials inevitably insist, "There isn't any money," tell them if they can find the money to cure Goldman Sachs and Merrill Lynch, they can find the money to care for mothers and children.