First Ladies of health: Obama, Clinton

by Mark Silva

Former First lady Hillary Clinton wasn't the only spouse in the White House with a hand in health-care reform:

First Lady Michelle Obama organized and ran a health-care initiative in Chicago credited for cutting emergency room costs, a model that the House has built upon in a $1-trillion health-care bill which Democratic leaders plan to take to a House vote on Saturday.

The Obamas' home on the South Side of Chicago is blocks away from Washington Park, a neighborhood home to rampant disease. When impoverished residents of Washington Park needed health care, they have turned to the University of Chicago's hospital emergency room - where 80 percent of the patients arrive with no insurance and three in 10 lack a family physician.

In 2002, Bloomberg News' John Lippert reports in a long piece for Bloomberg's magazine, the hospital hired a Harvard University-trained lawyer as executive director of community affairs to reach out to South Side residents: Michelle Obama. Three years later, he writes of the first lady and a close friend still at the hospital in the November issue and in an article online today, "as the university organized a network of neighborhood clinics offering preventive and primary care, it handed the future First Lady control of what later became known as the Urban Health Initiative.

"In that role, Michelle Obama worked to improve the clinics the university once fought as rivals and turn them into "medical homes" for routine care. The UHI's so-called patient advocates -- administrative gatekeepers hired by the university -- help ER patients find family doctors. Some clinics are staffed by university physicians or by doctors whose student loans are forgiven for community service. The program now includes 28 clinics and hospitals on the South Side.''

Yet it is not without criticism. Some university doctors say it diverts personnel and funding from emergency rooms, while a number of local people complain they're being cut off from the best medical care.

It costs an average of $100 to treat a patient with routine ailments at a local clinic. That's one-tenth the price of similar care at the ER, according to Eric Whitaker, a longtime friend of the Obamas who took over the program after the Obamas left for Washington in January.

Whitaker is a frequent visitor at the White House today, a weekend partner in the president's golf games. Michelle Obama is, well, the first lady. And Valerie Jarrett, a former chairman of the University of Chicago hospital's board (from 2006-2009) who once hired Michelle Obama to work in Chicago Mayor Richard Daley's office (1991), is a senior adviser to the president of the United States (since January 2009.)

The concept of clinics has "gained support'' in Congress, Lippert notes. On Oct. 13, the Senate Finance Committee approved an $829 billion health-care bill that includes $10 billion over 10 years for a Medicaid "innovation center" to ease pressure on ERs. Last week, House Speaker Nancy Pelosi introduced a health-care bill with an estimated price tag of $1.055 trillion. It includes provisions for clinic care.

"The UHI is an important model for the country in building health delivery systems that are cost-effective and yet accessible for vulnerable populations," Patricia Terrell, an analyst in Chicago for Health Management Associates, a medical consulting company based in Lansing, Michigan, tells Bloomberg. The University of Chicago has cut the share of Medicaid funding in its budget.

Ties between the Obamas and the University of Chicago run deep. The future president taught constitutional law at the school while serving as a state legislator and turned down an offer of a permanent position there after losing a race for Congress in 2000. Valerie Jarrett, 52, a lawyer who was chairwoman of the hospital board from 2006 to 2009, hired Michelle Obama in 1991 to be an assistant to Chicago Mayor Richard M. Daley. Jarrett is now a White House senior adviser.

Hillary Clinton, who pushed for health-care reform during the first year of her husband's presidency, is now secretary of state for President Obama. Her plan never passed. The president is pressing Congress to pass its plan by the end of the year. The first floor vote comes Saturday.