NHSC: A quiet triumph of the Obama stimulus plan

Thousands of National Health Service Corps members help provide basic services to an estimated 10.5 million Americans, a dramatic expansion facilitated by the 2009 stimulus package.

Conventional wisdom is that American Recovery and Reinvestment Act (ARRA) didn’t do much. That’s wrong. ARRA did much good, especially in some very practical, low-tech activities in public health and other areas.

One of its less-noticed contributions was made within the domain of safety-net care. Secretary of Health and Human Services Kathleen Sebelius just announced that the number of participants in the National Health Service Corps (NHSC) has nearly tripled. More than 10,000 NHSC members – doctors, nurses, dentists, and others – provide basic health services to an estimated 10.5 million Americans, almost triple the number served in 2008. (h/t Alice Chen)

The stimulus package expanded NHSC, a sound, cost-effective program that assists needy Americans while strengthening the primary care workforce. For example, NHSC’s loan repayment program provides an initial, tax-free award of up to $60‚000 in return for two years of service in an underserved community. People can pay off more of their health professional student loans if they continue in these services. Many young providers who participate in NHSC programs go on to spend their careers caring for needy patients after they complete their service obligations.

Did the deployment of several thousand health providers to needy areas end the recession? No. Did these efforts help many, many people? Yes.

Was this $300 million (I believe about 0.04 percent of ARRA’s overall expenditures) well-spent? Absolutely.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

14 thoughts on “NHSC: A quiet triumph of the Obama stimulus plan”

  1. Amen, this a tremendous investment. Worth remembering also that these people will become well-paid professionals, paying significant taxes for decades into the public purse.

  2. Truly a sad moment in our nation’s history when a sitting president has pushed policies, and actually helped pass a few, that are focused on solving many an economic problem. Stymied by in-your-face Republican resistance at every turn, this President trudges on while mis-perceptions, misnomers and myths are spread by his political opponents who can’t bring themselves to engage in honest political debate.

    Woe to the American people if they are hoodwinked into voting Republican in the next election cycle!

  3. My own story: after being laid off, I was able to support my family through unemployment extensions and – biggest of all – having 2/3 of my COBRA plan paid for, meaning health care and multiple prescriptions covered. I honestly don’t know what we would have done.

  4. Not only will the people who entered the healthcare profession be able to contribute more to the federal purse, so will the people they treat. Being sick and staying that way because you don’t have access to care is a serious drag on both earning and spending, not just for the patient but also for the people around them.

    When a national party’s understanding of public health in the 21st century has not even progressed as far as Otto von Bismarck, one kinda gets worried.

  5. Eli–I’m glad you could use that COBRA subsidy. I can’t believe they just let that expire.

  6. Of course trumpeting programs like this just highlights the ESSENTIAL flaws in the US system — pathologies that Obama appears to have zero interest in fixing.

    Two obvious such flaws include
    – why is the number of doctors educated by America capped at such a ridiculously low level. The SAME number of med school slots is available today as was the case 30 years ago, when America had 25% lower population — and many more of those slots are going to women who, for better or worse, have a shorter working life as doctors?
    – why does the system of paying for medical education continue to be the same insane gambling on the future that’s been for the past 30+ years? There are plenty of other ways to pay for medical education than forcing kids to take on massive debt — which then encourages them to believe that they damn well “deserve” massive salaries to make up for the deprivation and fear of their early career years.

    What Harold sees as triumph I see as America’s version of the Europe’s refusal to face economic reality — band-aids and attempts to kick the can down the road eight more years. “He kicked the can down the road eight more years” is, I’m sorry, not an achievement that qualifies you as anything more than a mediocre president.

  7. Gee, Keith, THAT was a constructive comment.
    Have we now reached the point where criticizing the Dear Leader automatically means my fondest desire is to provide aid and succor to his enemies?

    (a) Am I WRONG in anything I said? Wrong in my factual points? Wrong in the implications I draw from those factual points?
    (b) Has Rick Perry said ANYTHING constructive about the two points I raised, or about healthcare in general? If not, then why would what I have said here suggest I intend to vote for him?

    1. All of your factual points are correct. What NONE of them do is support this claim: “pathologies that Obama appears to have zero interest in fixing.” We actually don’t know what Obama is interested in fixing because of two things:

      1) He’s is fundamentally a pragmatist and very clearly believes in accomplishing what he can rather than deploying rhetoric to make an issue of what he can’t;
      2) He is also very clearly not the veto point that is limiting what can be achieved on health care. That veto point is a combination of Republicans and conservative Democrats in the Senate.

      We all understand that you think Obama is wrong in adopting the approach outlined in my first point. Fine. I disagree with you to a great extent, but that isn’t even relevant here. What is relevant is that that is the approach he adopts. Given that, we would only know what Obama is interested in fixing if HE were the veto point limiting further action.

      I agree that this is a frustrating thing for those of us on the outside watching Obama operate. It would add a lot of clarity as to his own policy vision if he didn’t play his cards so close to the vest. For all I know, you are right and he doesn’t have any interest in fixing the obvious problems in the American health care system. But by the same token, you don’t have any idea whether he does or doesn’t, either. We elected a poker player to be president, so we shouldn’t be very surprised when he acts like a poker player and refuses to show you his hand even after it’s been played.

      That you fervently believe that deploying rhetoric more firmly than Obama does would be valuable appears to have clouded your mind as to what we can tell by his comparative lack of such an approach. You are projecting your disagreement as to process onto questions of policy.

      1. J Michael Neal, are you familiar with _Mother Night_ by Kurt Vonnegut? Is Howard W Campbell Jr a villain or not?

        Given that I believe a MASSIVE part of the POLICY of the administration should be constant rhetoric educating the public as to the realities of our situation — medical and otherwise — my disagreement here is more than simply a disagreement over process.

        1. Be that is it may, it does not support the actual claim that you made. No matter how much you want Obama to be more strident in his rhetoric, and no matter whether you consider that to be a policy question or not, the lack of rhetoric does not mean that Obama has no interest in solving the problems. It may well just mean that he has a completely different idea about how to solve those problems.

          Unless you think that a lack of rhetoric is one of those problems in and of itself. If you do, I’ll likely have to conclude that you are completely nuts, because no one has ever been cured of a disease thanks to political rhetoric. Never. They are only cured by changes in health care delivery that that rhetoric might bring about. No matter how much you insist otherwise, that means that rhetoric is an element of process, not public policy. It is possible to have a policy about the usage of rhetoric, which is what you seem to be claiming, but that is not itself health care policy.

      2. I like this particular post and come back to it occasionally. My comment is so long in coming I doubt J. Michael Neal will ever read it, but I just wanted to say that I recently read AMERICAN UPRISING: THE UNTOLD STORY OF AMERICA’S LARGEST SLAVE REVOLT and, as I did so, I thought often of President Obama’s instinctive strategy of playing his cards very close to the vest. He comes by that instinct quite honestly as an African American, I would say. NOT to do so would have been costly in dreadful ways for any slave. It’s in his DNA. I like Obama’s pragmatism. Despite all the hand-wringing on the left, the Poker-Player-in-Chief (thanks, Mark Kleiman) gets quite a bit of what he sets out to get — even without showing his cards to others around the table.

  8. The trouble with “quiet” triumphs is that they are, well, quiet. The electorate can’t be expected to reward triumphs it doesn’t hear about. Every bit of publicity helps, of course, so many thanks to Harold for the post. But one could wish that Obama himself would tout his own triumphs more loudly.


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