Today on TNR.com, Harold Pollack speaks with a series of health care experts, activists, and practitioners in search of the answer to one question: How could Obama most effectively improve our public health with a few billion of the $775 billion set aside for stimulus? Here are just two of the suggestions he receives:
Tom Fisher, an up-and-coming leader in this field, notes that emergency departments EDs are required to spend large sums providing uncompensated care to uninsured or under-insured patients. A federal law called EMTALA rightly forbids hospitals from turning away emergent patients and pregnant women in active labor. Unfortunately, the feds don't provide the funds to finance this (and other) care. One predictable result: increasing numbers of EDs are closing, despite--or rather because of--rising demand for their services. These facilities play a vital role in protecting us against mass casualty events, in addressing youth violence, child abuse, flu, and pretty much every other public health problem. Especially given painful layoffs now underway at many places, channeling some stimulus here would be powerful.
Nutrition and obesity
Between 1974 and 2004, the prevalence of child obesity has more than doubled, with accompanying marked increases among adults. The Omnivore's Dilemma author Michael Pollan's writings on food policy have proved extremely influential: Barack Obama himself has name-checked Pollan's work. When I asked Pollan for stimulus ideas, he delivered quite a list. Perhaps his most interesting ideas concern "food deserts"--low-income communities that lack access to reasonably-priced groceries with nutritious foods. Many of these communities struggle to support farmers' markets. Pollan argues that such facilities are often itinerant and physically constrained, in part because they are outdoors. He suggests investing in rather basic structures on the model of Seattle's Pike Place or Philadelphia's Reading Terminal to build four-season farmers' markets. "These could give a tremendous boost to the local economy, creating beautiful structures while improving nutrition."