Now that the wingnuts and their Republican allies in Congress have managed to make something as anodyne as paying for voluntary counseling in the preparation of Advance Directives into a plot to kill off old people, they’ve decided to start at the other end of the age distribution. They’re trying to portray health insurance coverage of nurse home visitation as a plot against the family.
The idea is simple, appealing, and backed by a ton of research: since a baby doesn’t come with a user’s manual, many women, especially first-time mothers who are also poor, poorly-educated, and young, could greatly benefit from a little bit of advice, and that device is best delivered at home (where the adviser can see, and comment, on, the home environment) by a public-health nurse.
Like the advance-directives proposal, originally the project of Johnny Isaakson, nurse home visitation legislation has conservative Republican sponsorship: in this case, from Kit Bond. Doesn’t matter. The interests threatened by reform, plus the cynical pols who are simply devoted to destroying the Obama Presidency, have decided to pull out all the stops: no tactic is beneath them, no lie to outrageous to tell.
In the nurse-home-visitation case, though, they may have gone a bridge too far. It turns out that among the many benefits of visitation – smaller families, better child and maternal health, reduced child abuse, improved school performance, less need for special education – is reduced crime. In the Elmira experiment,
Adolescents whose mothers received nurse home visitation services over a decade earlier were 60 percent less likely than adolescents whose mothers had not received a nurse home visitor to have run away, 55 percent less likely to have been arrested, and 80 percent less likely to have been convicted of a crime, including a violation of probation (Olds, Henderson et al., 1998). They also had smoked fewer cigarettes per day, had consumed less alcohol in the past 6 months, and had exhibited fewer behavioral problems related to alcohol and drug use.
Among the mothers, arrests and convictions were reduced by more than 80%, compared to matched controls.
Several months ago I had the privilege of sharing a platform with James Q. Wilson, who is, among other distinctions, the dean of conservative crime-control thinkers. (Wilson, who taught in the Harvard Government Department and then at UCLA, is now the Ronald Reagan Professor of Public Policy at Pepperdine.) Our topic was crime control, and each speaker was asked to list a few promising programs. Naturally, I concentrated on probation enforcement and dynamic concentration of enforcement resources. The first thing Jim mentioned? Nurse home visitation.
If I were the President, or the Attorney General, I’d be completely relentless about this. The attacks on nurse visitation as “anti-family” don’t even pass the very limited giggle test that wingnut audiences apply. I’d hammer at the fact that the Republican fury against health insurance reform goes so far that they’re willing to increase the crime rate to satisfy their partisan blood-lust. By pushing this issue, which is an undoubted winner politically as well as substantively, we might be able to discredit the rest of the lies being told about the proposals on the table to fix health care finance.
Footnote Nurse home visitation has one difficult design choice: doing it universally would cost lots of money, and it’s not clear that most mothers gain much from coaching, but doing it selectively risks labeling some mothers and children as “at-risk.” My compromise proposal: make a first visit part of routine prenatal care (optional for the expectant mother but mandatory for the insurance company to cover), and then let the visitor make a clinical judgment, based on stated criteria, whether to say at the end of the visit “Here’s my card if you need any help or advice; good luck to your and your baby!” or, instead, “Would Tuesdays at 6pm be a convenient time for me to come back?”