A Presidents' Day Reflection On Something The Last Guy Did Right

You may have already seen C-SPAN's Survey of Presidential Leadership, released today in honor of Presidents' Day. If you have, you know that the last White House occupant, George W. Bush, did not fare very well amongst the 65 historians surveyed, coming in at number 36, making him the 7th worst president in the participants' estimation.

But despite the harsh glare of history's lens, there are a few things that former Pres. Bush did to expand opportunity in America. Foremost among them is his pivotal work in expanding community health centers. As profiled in the New York Times on Christmas Day,

"Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas."

Community health centers are not only part of the health care safety net for underserved communities in poor urban neighborhoods or rural areas, but have also been cited as models for what "medical homes"--community-centered hubs of primary and preventative care--might look like. In California, the Community Clinics Initiative works with community health centers throughout the state to support their infrastructure and capacity so that they can fulfill a mission of not just treating illness, but helping communities to achieve and maintain better health status. Undoubtedly, the doubling of community health centers by former Pres. Bush should be viewed by historians as one of the highlights of his tenure. But of course, as the New York Times article points out, where there has been progress, there is always still yet more work to be done, and with it, and opportunity for the current president to shine:

"With federal encouragement, the centers have made a major push this decade to expand dental and mental health services, open on-site pharmacies, extend hours to nights and weekends and accommodate recent immigrants — legal and otherwise — by employing bilingual staff. More than a third of patients are now Hispanic, according to the National Association of Community Health Centers.

"The centers now serve one of every three people who live in poverty and one of every eight without insurance. But a study released in August by the Government Accountability Office found that 43 percent of the country’s medically underserved areas lack a health center site. The National Association of Community Health Centers and the American Academy of Family Physicians estimated last year that 56 million people were “medically disenfranchised” because they lived in areas with inadequate primary care.

"President-elect Barack Obama has said little about how the centers may fit into his plans to remake American health care. But he was a sponsor of a Senate bill in August that would quadruple federal spending on the program — to $8 billion from $2.1 billion — and increase incentives for medical students to choose primary care. His wife, Michelle, worked closely with health centers in Chicago as vice president for community and external relations at the University of Chicago Medical Center."

In moving toward health care reform, which President Obama has continued to insist will be a priority of his Administration, policymakers and advocates alike must remember that health care cannot just be about insurance coverage. True movement toward quality universal health care must also be about making sure that the medical provider infrastructure is in place to serve those who currently lack care, whether due to lack of insurance or--as the article makes clear is often the case--due to lack of providers in medically underserved communities. "Health care" reform that is focused on the "care" element would go a long way toward where a president might end up on the next C-SPAN list, after all.