More Federal Doctors?

Harold Pollack, with whom I've had the pleasure of guest-blogging before, has a piece up at The New Republic with a number of suggestions for how President-elect Obama could direct stimulus funding towards improvements in public health. On his list:

Public health workforce

Across the street from my office at the University of Chicago is a gleaming billion-dollar hospital. If I walk the other way, I pass crowded and understaffed primary health care facilities with out-of-date computer systems, old facilities, and other great resource needs. Merrill Goozner of the Center for Science in the Public Interest has written extensively about these issues. So has Mickey Eder, director of research programs at ACCESS Community Health Network, one of America's largest safety-net providers. Both suggest variants of a new Health Corps.

Goozner notes that the current National Health Service Corps of primary care doctors could be expanded to include nurses, dietitians, and a variety of vital lay health workers and paraprofessionals. One can create many more jobs by hiring these men and women than by hiring more doctors. The public health benefit would be greater, too. Health Corps workers could provide home visits to help patients manage blood pressure, cholesterol, and glucose. They could help pregnant women manage the logistics of prenatal care. They could organize community walking circles, visits to local groceries to buy healthy foods. Rather than using costly space at hospitals and medical facilities, Health Corps groups could rent local storefronts and partner with local churches and civic groups. They could serve as useful ambassadors within communities mutually estranged from medical and public health systems.

In the midst of a lot of fairly abstracted conversations about service that have largely ignored federal employment, it's nice to see someone make a firm connection between what federal employees do and the public good. In this next administration, I think it's likely that the federal government's role in American health, be it health care reform, expansion of public health programs, or a more visible Surgeon General will expand dramatically. I'd be curious to see how you think that expansion will affect current programs, and the federal health bureaucracy as a whole.