Healthcare Reform and Its Implications for Cooperative Extension

Blogger Matt Yglesias offers a series of compelling thoughts on the future of liberalism — one, I believe, that has direct relevance to the mission of Cooperative Extension.  Big government liberalism is in its death throes not because it has failed but because it achieved what it set out to do decades ago.

For the last few decades, Yglesias says, political debate has centered on questions about the size and scope of the welfare state.

With the passage of health reform, that debate is largely over “with liberals having largely won,” Iglesias says.

Yes, debate will continue to ensue over the scope of health reform.  Nevertheless, with passage of this measure, the basic contours of the federal safety net have been established.  Some significant items remain to be resolved on the progressive political agenda, but none of these will involve impressively large price tables, Yglesias maintains.

From now on, the focus will not be on expanding the welfare state but on rendering the one in place as cost-effective and efficient as possible — a daunting challenge in the midst of ever-tightening federal and state budgetary restraints.

“Most broadly, questions about how to boost growth, how to deliver public services effectively, and about the appropriate balance of social investment between children and the elderly will take center stage,” he says.

Moreover, in the considerably more redistributive policy environment following healthcare reform, he believes liberal proponents of issues such as reduced trade barriers and increased immigration flows will likely feel more emboldened about advancing their agendas.

All of this brings me back to how these changes will affect the Extension agenda.  

In a future in which policymakers will be searching for ways to deliver public services more effectively, Extension may be better positioned than ever fill an enhanced role. Compared to other federal and state programs, our involvement in these services has historically been peripheral.  However, the types of expertise we have provided in the past may acquire greater value in coming years.

I’m reminded of the grassroots model developed by Uva Hester and other Tuskegee Institute Extension educators early in the last century to assist tuberculosis sufferers and others in geographically remote locations not reached by more conventional types of medical assistance.

The Alabama Department of Health’s Division of Chronic Disease Prevention already enlists Alabama Extension agents in a statewide grassroots effort to help people, especially low-income people, develop “self-care strategies” — proactive steps to reduce chronic disease risks, such as type-2 diabetes and hypertension.

These kinds of grassroots efforts deemed marginal in the past may be more highly prized in the future as federal and state policymakers search for more proactive measures to control healthcare costs.

Likewise, the transformed public policy landscape that will likely result from healthcare reform may present other opportunities for Cooperative Extension.  For example, a renewed push for trade expansion and immigration reform will present opportunities for Extension educators representing a wide array of programming areas.

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