In health bill, billions for parks, paths

Supporters cite prevention, but add-ons’ critics see pork

By Michael Kranish
Globe Staff / July 9, 2009
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WASHINGTON - Sweeping healthcare legislation working its way through Congress is more than an effort to provide insurance to millions of Americans without coverage. Tucked within is a provision that could provide billions of dollars for walking paths, streetlights, jungle gyms, and even farmers’ markets.

The add-ons - characterized as part of a broad effort to improve the nation’s health “infrastructure’’ - appear in House and Senate versions of the bill.

Critics argue the provision is a thinly disguised effort to insert pork-barrel spending into a bill that has been widely portrayed to the public as dealing with expanding health coverage and cutting medical costs. A leading critic, Senator Mike Enzi, a Wyoming Republican, ridicules the local projects, asking: “How can Democrats justify the wasteful spending in this bill?’’

But advocates, including Senator Edward M. Kennedy of Massachusetts, defend the proposed spending as a necessary way to promote healthier lives and, in the long run, cut medical costs. “These are not public works grants; they are community transformation grants,’’ said Anthony Coley, a spokesman for Kennedy, chairman of the Senate health committee whose healthcare bill includes the projects.

“If improving the lighting in a playground or clearing a walking path or a bike path or restoring a park are determined as needed by a community to create more opportunities for physical activity, we should not prohibit this from happening,’’ Coley said in a statement.

The Senate health panel’s bill does not specify how much would go to the community projects. A Senate staff member said the amount of spending will be left up to the Obama administration. A House version of the bill caps the projects at $1.6 billion per year and includes them in a section designed to save money in the long run by reducing obesity and other health problems.

It is not clear yet how the money would be allocated. The legislation says that grants will be awarded to local and state government agencies that will have to submit detailed proposals. The final decisions will be made by the secretary of Health and Human Services.

The proposal was inserted at the urging of a nonprofit, nonpartisan group called Trust for America’s Health, which produces reports about obesity and other health matters. Part of the group’s proposed language for the community grants was inserted into the Senate bill. It called for “creating the infrastructure to support active living and access to nutritious foods in a safe environment.’’ The group provided examples of grants for bike paths, jungle gyms, and lighting, though the Senate bill doesn’t list those specifics.

Jeffrey Levi, the group’s executive director, said that “it is easy to satirize’’ the projects, but they are needed to improve America’s health.

“We will see a return on this investment if you use this money strategically for proven, evidence-based programs,’’ Levi said in an interview, citing efforts to stop smoking and to promote physical activity. “We will prevent or reverse chronic diseases such as heart disease. . . . It will pay for itself.’’

While many may think the healthcare bill strictly aims to increase coverage, Levi said that is a mistaken impression. “This isn’t just about health insurance,’’ he said. “This bill is about creating a healthier country.’’

The group says that a modest community project can lead directly to improvements in public health. In a recent report, the group cited two examples from Massachusetts that it said were effective: Shape Up Somerville, which helped elementary school children lose weight by promoting physical activity, and the Physical Activity Club in Attleboro, which also helped children lose weight.

The idea of using the healthcare bill as a vehicle for preventing diseases has bipartisan appeal. President Obama has called for “the largest investment ever in preventive care, because that’s one of the best ways to keep our people healthy and our costs under control.’’ Enzi, too, has said that “reducing healthcare costs has to begin with promoting healthier behaviors.’’

But there is disagreement about the best way to do that. Senator Tom Harkin, an Iowa Democrat who is working closely with Kennedy on the healthcare bill, has criticized the current healthcare system for focusing on “sick care’’ and has called for more investment in a variety of measures that would help prevent diseases, including the community grants, restricting junk food in schools, and encouraging children to be more active.

“We spend 75 cents of every healthcare dollar treating people with chronic diseases like diabetes, heart disease, and asthma, and only 4 cents on prevention,’’ Harkin said in a statement. “But the majority of these diseases can be prevented through lifestyle and environmental changes.’’

However, it can be difficult to quantify the benefits of a park or pathway, leading some critics to say such funding is an example how the healthcare legislation has spiraled out of control.

Enzi has said that instead of paying for pathways, it would be more effective to encourage lower insurance premiums for individuals who can prove they have taken steps to improve their health. He said that construction grants belong in other bills.

Enzi, the top Republican on the Senate health committee, has unsuccessfully pushed an amendment that would specifically prohibit the use of funds for sidewalks, streetlights, and other infrastructure projects.

Kennedy spokesman Coley said such proposed amendments are counterproductive, stressing that the projects would be modest and are not intended to replace larger ones that can be funded in other bills. Nonetheless, he said, the projects “may be a very cost-effective and long-lasting intervention.’’

Michael Kranish can be reached by email at