Map of life expectancy at birth from Global Education Project.

Friday, October 03, 2008

A low-cost/no cost public health agenda for President Obama

We know that he will take office with some very big problems. Even though he hasn't been willing to specify what he's going to give up because of the economic and fiscal catastrophe he will inherit, we all know that there will be no choice but to scale back the ambitious policy agenda the Obama campaign has laid out.

So what can we accomplish in a first Obama term?

Health care reform: That absolutely must go forward because it is essential to the long-term solvency of the federal government, the viability of the economy, and the preservation of a political culture that values justice and equity. The Republicans will claim that it costs taxpayer dollars and it's creeping socialism and government intrusion into our lives and all that idiotic lying jive, but the people don't want to hear it any more. It will actually benefit to the government's fiscal condition, if it's done right, but that will mean keeping the drug and insurance companies big fat snouts out of the trough. That's going to be the real challenge.

Renewable energy: Will require an immediate investment, but that kind of investment will be essential to prevent Great Depression II, so borrowing money to do this can be justified on multiple grounds. From a public health point of view, motor vehicle emissions shorten the lives of millions of people. You would be astonished how dangerous it is to live near a major highway or to spend a lot of time communting or driving a truck. Sustained exposure to near highway pollution increases your age adjusted risk of AMI by more than 30%.

Also will mean reduced emissions from coal fired power plants, less mercury in the environment and less particulates in the air.

Raise the federal gasoline tax: Helps achieve the above, also means fewer highway miles traveled. Invest the proceeds, not in new roadways, but in maintaining existing roads and building mass transit. Give a refundable credit to low income people so they don't suffer. You can make it revenue neutral, but we really need to bring in more money.

Tobacco control: Little or no federal money has to be spent, all we need is legislation allowing the federal government to encourage state and local tobacco control measures such as workplace smoking bans, higher tobacco excise taxes, and anti-tobacco marketing campaigns, by making existing federal grants to the states contingent on such laws. If a state doesn't want to go along, the federal government actually saves money. Long-term, we save money on health care and we have a more productive workforce.

Criminal justice reform: We need fewer people in jail, and that starts with a rational drug control policy that decriminalizes addiction. It costs a whole lot less to treat people than it does to incarcerate them, and it also means they don't commit crimes and they do go to work and pay taxes. Smart all around.

That's my short list for starters. What else?

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