Like so many nonprofits, operating on thin margins is nothing new to our community health centers, and they have consistently proven just how resourceful they can be – but demanding that they expand their capacity while withholding the means to do so is nothing short of a “set-up.”

One of the more exciting opportunities of health care reform was to have been the development and testing of new collaborative models, such as Community-based Collaborative Care Networks and Accountable Care Organizations. And while we would prefer to see this strength-based approach to collaboration win the day, the diversion of community health center expansion funds reminds us that collaboration is also a strategy for dealing with adversity.

The California HeathCare Foundation views collaboration as an essential strategy for community health centers to be able to draw upon – in both good times and bad. We have partnered with them over the past three years to develop resources to help clinic leaders assess their collaborative options. We are also in the midst of working with four clinic groups in California, providing technical assistance as they explore and develop partnerships.  We look forward to sharing what we learn from this continuing work in future posts and publications.

Yet in recent weeks we have seen two more major affiliates of well-known national nonprofits leave the fold. Planned Parenthood Golden Gate, in Northern California, is now Golden Gate Community Health, and KCET, the PBS affiliate in Los Angeles, recently announced its intention to leave the PBS family in January 2011.

Each of these situations is unique and involves a combination of differing perspectives, financial tensions and interpersonal conflicts, but I wonder if economic pressures are increasingly going to drive large affiliates of national organizations to leave behind their household brand name in favor of independence.

KCET will lose access to crucial PBS programs such as Sesame Street, while the two health organizations named above will continue to offer the same service but without the benefit of instant name recognition.

Given the demands of participation in a national organization (financial, programmatic, quality review, brand usage and the like) we may see additional large affiliates deciding they can do better on their own.

In the short run that may be true, but it remains to be seen whether they can replace the instant name recognition and credibility of their former national partners with local support. And of course there is always the possibility – indeed the likelihood – that the national organization will establish a new franchise in the same area, providing a high profile competitor who will build on the previous organization’s name recognition, now abandoned.

Stay tuned.

But the really interesting piece was a serious discussion of whether, if elected in the fall polls, David will take paid paternity pay, which is his right. Apparently, even Tony Blair took a paltry (by British standards) two weeks paid leave when he was prime minister, appointing someone else to hold the fort while he bonded with his family.

Can you imagine an American politician taking paternity leave – paid no less – right after winning the White House? “Sorry folks, I have to take the 4AM feeding, the world will have to wait.” The UK seems just a little bit more civilized than my own nation every day I am here, as things which would be anathema at home are a matter of course in Britain.

In another article, lauding Obama’s health reform success and trying to explain to a British reader just how strong opposition to it is, the paper writes “Europeans may struggle to grasp how health insurance subsidies could be seen as an assault on freedom. . .but they are part of a battle for the soul of America.”

I couldn’t help him, there is no defense. In the UK, health care is a right, and is not generally the political football we use it for in the US. Brits across the political spectrum support their national health insurance arrangement as the only sane manner to address a nation’s health needs. Everyone here is covered, and everyone pays in, along with their contributions to the UK equivalent of Social Security, charmingly referred to as Old Age Pensions. Premium amounts vary with income and circumstances, not age, gender and health condition.

As a part-time semi-retired cabbie, my new friend pays the equivalent of $20 a month for his coverage. As an American, it was both refreshing and embarrassing to compare health care systems. If health reform dies, it won’t get easier.