Health-Care Reform Can Reduce Crime

Twenty years ago, crime was a major political issue. Crime in the United States was four times higher in 1990 than it had been in 1960. Americans murdered each other at four times the rate of Canadians. Willie Horton, a Massachusetts prisoner who committed a horrible crime while on furlough, helped sink Michael Dukakis's 1988 presidential campaign.

Today, the once potent issue for Republicans has been neutralized in national politics. We have half as much crime now as we did 15 years ago, and President Clinton's crime bill can claim partial credit for that drop. Crime is what one Democratic strategist calls a "jump ball issue" between the parties, with neither having decisive advantage.

But crime still exacts a terrible toll and the fear of crime continues to shape cities and suburbs. Businesses, and families who can afford it, flee the high-crime zones, leaving behind a lot of hapless prey, a few predators, and almost no jobs. The U.S. still has two-and-a-half times as much crime per person as it did in 1960, and our homicide rate still stands out from the rest of the developed world. We spend $200 billion on the criminal-justice system, have 2.3 million prisoners. Budgets are at the breaking point, with fiscally strapped cities laying off police.

Ironically, an issue that has replaced crime as a political hot button—health care reform—has the potential for reducing crime at very little cost.

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.

Of course there are unknowns and questions. Studies about the effects on adult crime are still awaiting publication. Will the program work as well when it grows past the control of its founder? What is the best way to target the service to those who need it most? Should it operate as a stand-alone program or should it be folded in to the health-care system?

But there is no question that nurse home visits prevent crime while saving money. So you would think adopting the program, nationally, as many congressional Democrats want to, might be uncontroversial. And it has some Republican support, notably from Sen. Kit Bond of Missouri and from former Homeland Security chief Tom Ridge, who implemented the program as governor of Pennsylvania. James Q. Wilson, the Ronald Reagan professor of public policy at Pepperdine University, cites nurse home visitation as the single best opportunity to reduce the crime rate.

But in the heated atmosphere of the health-care debate almost anything can become politicized. 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.

Fox News anchor Glenn Beck says the program reminds him of 1984, suggesting it will be forced on families with overweight children by the fat police. Chuck Norris, TV's Walker, Texas Ranger and an early supporter of Mike Huckabee's presidential campaign, calls the program "Obamacare's home intrusion and indoctrination family services."

No doubt it would shock the House Republican Conference, the Heritage Foundation, Glenn Beck, and Chuck Norris to be called pro-crime. But 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."

It's a cliché that the only things the two parties in Washington can agree on supporting are motherhood and apple pie—but maybe they cannot even agree on motherhood anymore.