David A. Kindig, MD, PhD
For me, reading David Brooks’ twice weekly New York Times column is a must. Dubbed “the liberals favorite conservative,” Brooks writes from a moderate and evidence based perspective that is almost always illuminating and refreshing.
In his June 13 column titled Pundit Under Protest, he complained about having to cover the upcoming Presidential campaign because “the two parties contesting this election are unusually pathetic. Their programs are unusually unimaginative. Their policies are unusually incommensurate to the problem at hand.”
Brooks said that what the country needs is a political party that “would be offering a multifaceted reinvigoration agenda. It would grab growth ideas from all spots on the political spectrum and blend them together. Its program would be based on the essential political logic: If you want to get anything passed, you have to offer an intertwined package that smashes the Big Government vs. Small Government orthodoxies and gives everybody something they want.”
He described this reinvigoration package as four baskets (quoted below). While he sees this as an agenda for total national revitalization, think of them as you read them from a population health policy perspective.
There would be an entitlement reform package designed to redistribute money from health care and the elderly toward innovation and the young. Unless we get health care inflation under control by replacing the perverse fee-for-service incentive structure, there will be no money for anything else.
There would be a targeted working-class basket: early childhood education, technical education, community colleges, an infrastructure bank, asset distribution to help people start businesses, a new wave industrial policy if need be — anything that might give the working class a leg up.
There would be a political corruption basket. The Tea Parties are right about the unholy alliance between business and government that is polluting the country. It’s time to drain the swamp by simplifying the tax code and streamlining the regulations businesses use to squash their smaller competitors.
There would also be a pro-business basket: lower corporate rates, a sane visa policy for skilled immigrants, a sane patent and permitting system, more money for research.
I am certain that Brooks was not thinking of this from a population health improvement lens, but many aspects of what he suggests support the multiple determinants of health perspective we advocate every week. Some things are missing of course like health care access, specific public health and prevention programs, and the physical environment. But the challenges are equally broad, and fresh bipartisan approaches commensurate to the scope of the problem are essential.
The contents of Brooks’ baskets are certainly not new – that’s not his point. No idea is immune from the capricious political processes which ultimately determine the fate of even the best proposals. Brook’s major frustration is that current politics do not allow necessary action to proceed. I don’t know if a new national political entity is required, or if first we need a generation of local mutisectoral partnerships with appropriate incentives to show the way. I do know that making significant improvements to population health is a huge challenge requiring action on a scale that he suggests.
So we welcome a growing list of covert population health advocates – first Sam Brownback and now David Brooks. Who’s next?
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.
Let us know when your governor there in Wisconsin becomes a pop health advocate....
Posted by: Pamela Russo | 06/22/2011 at 12:22 PM