Nurse Home Visits in Health Reform

Raising kids is hard. It’s also incredibly important. And there’s tons of evidence that the environment children grow up in from the youngest age makes a big difference in long-term development and life trajectory. And one thing parents with a lot of financial resources and social capital do is draw on those resources to get a lot of help, both practical help and just advice, about what they should do. And as Mark Kleiman notes, it turns out that when you take parents who lack those resources and go out of your way to help them out the results are very positive:

Thirty years ago, a professor of pediatrics named David Olds (then at Cornell, now at the University of Colorado, Denver) came up with a straightforward idea: send nurses into the homes of poor and undereducated first-time teenage mothers to coach them through their children’s difficult first two years. There are now 18,000 families receiving that service in 29 states, from a variety of local government agencies and nonprofit groups, supported by some $80 million per year of federal, state, and foundation funds, under the watchful eye of the Nurse-Family Partnership National Service Office, a spinoff of the University of Colorado.

The program was designed to improve health, not to control crime, and the health-care savings from lower rates of sickness, substance abuse and welfare dependency among the mothers and children more than cover its costs. But it turned out that by the time the kids were 15 years old, those served by the program had been arrested less than half as often, and convicted only one fifth as often, as similar children who weren’t given the assistance.

Seems like the kind of program I would fund in expand in a national health reform effort. Or, if I were a conservative, the kind of thing I might demagogue and misdescribe in an effort to kill reform:


When a provision for nurse home visit grants was added to the House version of the health-care bill, the House Republican Conference promptly issued a statement mocking the program as a “nanny-state boondoggle.” They called it “billions for babysitters” and suggested buying copies of Dr. Spock’s child-care book instead. Lindsey Burke of the conservative Heritage Foundation warned of a “stealth agenda” to “impose a federally directed, top-down approach to parenting” and an increase in the federal role in preschool education. […]

to Heritage legal expert David Muhlhausen, small-government principles outweigh crime control. “Open up your Constitution and read Article I, Section 8,” he says, referring to the section that enumerates the powers of the Congress. “Juvenile delinquency prevention is not in there.”

You see here the cost of a really irresponsible elite in the United States of America. Surely even Koch Industries and Ruper Murdoch don’t really have a problem with a cost-effective program to improve children’s health outcomes that turns out to also have substantial crime reduction benefits. But they can’t be bothered to think this kind of through.