The day after the Affordable Care Act was signed, I was at a forum with many of the nation’s leading children’s health experts, discussing funding advocacy for children's health. The vast majority applauded the measure but bemoaned the missed opportunity: If kids had been the top priority in the drafting of that bill, every child, including those with severe health issues, would have been guaranteed access to the top-flight medical care of their choosing. It was an especially aggravating oversight, given how inexpensive kids are relative to the federal government’s nearly $2 trillion (yes, trillion) health care budget. Comprehensive care for kids would have essentially been “budget dust”: a sprinkling on top of the cake, relatively speaking, but a game changer in absolute terms.

Other interests with better-funded government lobbyists got much of what they wanted from the bill: i.e., hospitals, providers, and insurance companies. Children’s advocacy groups were certainly paraded around to help win final passage (“It’s for the kids!”), but a dearth of advocacy dollars kept them from being at the negotiating table to truly prioritize kids.

Why did this happen? Why have there been so many missed opportunities to fund advocacy, making public investments and reforms that would help children? It’s not because kids don’t vote. After all, "private equity" doesn’t have that many voters, per se. And billions are donated annually on behalf of kids. Why hasn’t it been enough?

The problem is that, for far too long, charitable support for kids has been disconnected from systemic change, being primarily geared, instead, toward direct service programs. That’s perfectly understandable. Donors like to quickly see, firsthand, the impact of their giving. But when that giving doesn’t scale, it only impacts hundreds or thousands of kids, not millions of kids, and doesn’t lead to shifts of billions of dollars, underscoring the importance of funding advocacy for systems change.

This kind of massive missed opportunity simply doesn’t exist in the same way in other sectors, where it is more generally understood that government policy, regardless of which politicians are in power, is where the money is. Only when it comes to kids do we see this over-reliance on private donations for (what should be) a public good. I have never seen a city planning department, county DA’s office, state transportation agency, or the Pentagon have a fundraising drive to secure basic supplies and services like public schools regularly do.

Read the full article about funding advocacy to improve children's health by Ted Lempert at Stanford Social Innovation Review.