Resident Fellow  Scott Gottlieb, M.D.

When Michelle Obama was an executive at the University of Chicago Medical Center, she worked to expand a program that encouraged uninsured patients on Chicago's South Side to visit local health clinics in lieu of her hospital's emergency room. That "Urban Health Initiative" saved her hospital money, and it also surely improved the health of the people it served.

Mrs. Obama's role in the program was the subject of a snarky news story in the Washington Post focusing on the university's concerns that it would be accused of trying to profit with these clinics at the expense of the poor. In 2006 the University of Chicago hired David Axelrod--who would soon become Sen. Barack Obama's top political strategist--for political advice on correctly positioning the program. Mr. Axelrod counseled the hospital to acknowledge that the program was in its economic self-interest, as well as the personal interests of its patients.

Too bad Mr. Axelrod's new client hasn't absorbed the same guidance, because our health-care system would be in better shape today if more of our political class didn't fall prey to old suspicions that economic reasoning only worsens clinical outcomes. The success of Chicago's local health clinics tells a different story. But those clinics have been hampered by state and federal regulations that try to promote "fairness" in our health-care system, only to undermine simple, local efforts aimed at genuine reform.

First among these regulations are mandates that require clinics to offer certain health-care services. In many cases a particular mandate can be defended. But the accumulated total makes it harder for some bare-bones clinics to offer any services at all.

Illinois law--including a bill co-sponsored by Mr. Obama while he was in the State Senate--requires local clinics to provide specialized services such as obstetrics and dental care, and even suggest "special occupation-related health services for migratory and seasonal agricultural workers."

Similar requirements are an important feature in Mr. Obama's presidential health-care proposals. The Obama proposals create a federally run health-care plan that would take patients out of private insurance and into a centrally planned health-care program. It would rely on the kinds of prescriptive mandates on covered services that have been a hindrance to community health clinics like those championed by his wife and the University of Chicago.

Yes, Mr. Obama has pointed to public and private clinics as a way to extend coverage, and he recently co-sponsored the Senate's "Access for All America Act" that aims to expand support for the clinics. But the bill contains the usual fare of requirements thrust from Washington onto local health-care providers.

The success of these community health clinics is supported by plenty of clinical data proving that patients are helped by the continuity care that they offer. The fact is, many poor patients visit ERs simply because they don't have a family doctor. Medical expenses for community health centers run about 40% lower compared to patients seen in ERs. Overall, the clinics have been estimated by the National Association for Community Health Centers to save up to $17.6 billion a year.

President Bush launched a program in 2002 to double the number of patients served by federally chartered health clinics as well as nonfederal "look alikes," giving the clinics a big boost. But these clinics still face an uncertain future.

One big challenge is attracting and retaining skilled medical professionals. Pay is low, and the risks to providers high. Here, Sen. Obama's plan is no help. The Economic Policy Institute estimates that the Obama plan will cost about $1.6 trillion over 10 years. Give or take a handful of billions, funding his plan will eventually mean the same cuts to providers working under programs like Medicare and Medicaid that were used to subsidize other big health-care expansions.

Liability is also a concern. Federal legislation protects doctors working in federally "qualified" clinics from many lawsuits but doesn't extend to "look alike" clinics that don't meet all of the same federal requirements on the scope of services they provide. The clinics have complained recently that the government is even starting to repudiate some clinical settings where the liability shield was previously ironclad. This kind of malpractice reform remains deeply unfashionable among Democrats like Mr. Obama favor litigation as a backstop to regulation. But the legal jeopardy discourages doctors from practicing in clinics.

The community health clinics that Michelle Obama collaborated with have continued to thrive since she took leave of her job to hit the campaign trail. But the more you push her husband's logic on health-care reform, the less you get the kind of success she experienced--and helped engineer--on Chicago's South Side.

Scott Gottlieb, M.D., is a resident fellow at AEI.