guest post by Peter Beilenson, MD, MPH
As the former Baltimore City Health Commissioner, I spent thirteen years working with Mayors Kurt Schmoke and Martin O’Malley trying to address the myriad issues affecting a large city. Thus, I am particularly distressed that virtually none of the 360 minutes allotted to the four debates between the Democratic and Republican tickets have concerned urban problems (the President’s mention of violence in Chicago being the only brief exception).
America’s major cities are home to well over half of the country’s population and serve as the economic engines of the regions in which they are located. If a city is prospering and vibrant, the entire region is likely to be in good shape as well. If a city is dysfunctional and beset by crime and poverty, the whole region is affected negatively. It is imperative that the nation’s voters—whether they live in city or suburb—have some knowledge of how President Obama and Governor Romney wish to address a wide variety of urban issues.
Through my experience in Baltimore and my observations of other major cities, it seems clear to me that for a city (or a community within a given city) to be successful requires a “four-legged stool” of attributes: 1) access to health care and healthy foods; 2) effective public schools; 3) decent housing in a safe environment; and, probably most important, 4) availability of liveable wage jobs (not minimum wage jobs).
While it is true that the level of influence a President has on these different legs of the stool varies, there is much that a President can do that would enable more cities and communities around the country to strengthen these four legs.
1) Access to health care—here the President can have a very strong role, as exemplified by President Obama’s championing of the Affordable Care Act. While far from perfect, tens of millions of America’s uninsured will gain health coverage because of Obamacare. Conversely, Governor Romney’s promise to repeal and replace Obamacare will likely result in more Americans going without insurance. Where are the questions in the debates about how exactly he intends to replace Obamacare?
2) Effective public schools—aside from a few platitudes from both candidates about the importance of a strong system of public education, no questions have been asked about their stands on teacher standards, the importance of testing and the like. Although most of the authority for public education rests with local and state governments, the President does have the bully pulpit to push for reform—and, at least under Obama’s Secretary of Education Arne Duncan, has used federal funding as leverage for pushing states to implement reforms.
3) Decent housing—not one question from the moderators nor one word from the candidates has been spoken about the importance of decent, safe housing, particularly in impoverished areas of cities where lead, mold, or rodent infestation is a major public health concern. Strategic use of federal housing dollars could go a long way toward addressing this problem affecting millions of Americans—why no attention paid to this during the debates?
4) Liveable wage jobs—everyone agrees that the best antidote to poverty is a job; however, many low wage workers remain impoverished. The President can influence the availability of liveable wage jobs in many different ways, from creatively using the tax system (for example, by giving tax credits to businesses which set up shop in certain impoverished areas and provide liveable wage jobs) to changing federal purchasing policies to greatly favor bidders who pay liveable wages. A creative thinker could come up with many more examples. Although a fair amount of debate time has focused on unemployment rates and lofty talk of the need to create more good-paying jobs to overcome the recession, little in the way of specifics have been proposed by either candidate. Governor Romney insistently mentions vague promises that reducing the deficit by “magic math” will somehow lead to millions of great jobs, and President Obama talks about the five million new jobs created on his watch without prescribing how liveable wage jobs will be generated in a new term.
The lack of focus on these and other issues of import to the hundreds of millions of city dwellers in this year’s debates is a serious failing of the system. One can only hope that whoever wins the Presidency in two weeks will focus the effort that is needed to address these issues, despite the lack of attention paid to them in either the debates or the campaigns.
Peter Beilenson is the former health commissioner of Baltimore City and Howard County, Maryland. He is now the CEO of Evergreen Health Cooperative, a non-profit health insurance cooperative enabled by the Affordable Care Act. He is also the author of a new book about urban issues, Tapping Into The Wire: The Real Urban Crisis, published by the JHU Press.