Motivation
The United States’ health care system is plagued by persistent disparities by race and socioeconomic status. This stark reality is most apparent in one of the simplest and most shameful public health measures: infant mortality. Infant deaths per thousand have risen over the past three years to just over 15 for non-whites, nearly three times the value for whites, as well as the OECD average. [1]  Throughout many communities, especially in the South, child deaths have climbed as high as 33 infant deaths per thousand live births—values comparable with developing countries. [2]  Nearly all of this increase is amongst preventable deaths. [1]  These inequities are largely the result of systematic, vicious cycles, whereby socioeconomic, insurance, and health care infrastructure factors interact to produce poor health outcomes. Simultaneously, our health system suffers from a lack of quality primary care, that is, care that emphasizes preventative practices and public health outreach over expensive and often unnecessary procedures.

Proposal
What our country needs is a ground-level force dedicated to improving individual health and health practices, as well as health care provision, in communities afflicted by the gravest racial and socioeconomic disparities. I propose expanding both the size and the mission of the U.S. Public Health Service Commissioned Corps (PHSC) to become such a force for health care. Approximately 6,000 strong, the U.S. PHSC is comprised of highly skilled health professionals dedicated to providing public health disaster management, research, education, and outreach. It already delivers much of the health care for disadvantaged populations such as American Indians, federal prisoners, and disabled veterans; thus, expanding their mandate to include a broader reach for traditionally minority and poorer communities would be a natural extension for the corps.

Working with the Centers for Disease Control and Prevention and other national health monitoring agencies, members of the PHSC would identify communities, cities, and regions where there was marked underperformance in health outcomes, as measured by a host of indicators, including child health and disease incidence. Groups of PHSC officers would enter and deploy a community-based approach to improving health, making use of organizations and institutions such as schools, churches, and businesses to raise awareness of strategies to improve personal and family health. Employing techniques most often used in developing countries for HIV/AIDS and malaria, the PHSC would then offer mobile clinics within these communities to test for cardiovascular disease, diabetes, asthma, and other conditions common in disadvantaged populations. In addition to testing, these clinics would counsel individuals on strategies to reduce risk factors for disease. Officers would also work on the supply-side to generate proposals for improving health monitoring and care delivery in public facilities within these communities. In this way, the PHSC would ensure that all the distinct elements of a particular community in need would complement each other to support improvements and investments in health.

Financing the Proposal
The proposal could initially be tested by requiring a subset of the current corps to participate in community-based public health interventions, and monitoring the results of this experiment. Depending on the success of the small-scale test, the program could then be scaled up by recruiting several hundred additional officers to perform dedicated community health functions. The cost of these hires could be largely offset by using a fraction of the revenue derived from the termination of the employer tax exclusion for health insurance for those earning over $250,000—savings of approximately $2 billion. [3]  The proposal would ultimately save money in the long run as public health care providers increased their efficiency and efficacy and the targeted communities and populations began to focus on preventative strategies that preempted the need for costly medical treatments.

Politics of Implementation
A community-based strategy to reduce disparities in health through the PHSC is politically viable. The Public Health Service and Commissioned Corps have lobbied in recent years for an increased focus on the outreach component of their mandate, and the PHSC has already demonstrated their extraordinary effectiveness in the face of extreme hardship during hurricanes Katrina and Rita. Many of the communities that would be targeted by this proposal are dramatically underfunded and understaffed and have already called for creative, grassroots-driven interventions. [4]  Politically, the proposal could be heralded as both a triumph for individual responsibility, as PHSC officers educated and aided community members to improve their own health care, and for progressive politics, as the need for national solidarity is reinforced by the government. 
 
Fit with Hillary’s Platform
This policy would be in line with both Hillary’s health care platform and broader vision for political reform. She has championed the reduction of racial and socioeconomic health care disparities as a key component of her health care agenda, especially from a community-driven perspective. [5]  This proposal also represents the sort of pragmatic idealism towards change that Hillary has espoused in recent months.

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[1] TJ Mathews, and MF MacDorman. 2006. "Infant mortality statistics from the 2003 period linked birth/infant death data set." National Vital Statistics Report 54 (16):1-29.
[2] Eckholm, Erick. April 22, 2007. "In Turnabout, Infant Deaths Climb in South." The New York Times.[3] "Tax Policy Projections." 2007. Washington, DC: Tax Policy Center.
[4] Braithwaite, Ronald L., Henrie Treadwell, Marguerite Ro, and Kisha Braithwaite. 2006. "Community Voices: Health Care for the Underserved." Journal of Health Care for the Poor and Underserved 17 (1):v-xi.
[5] "The American Health Choices Plan." 2007. Hillary Clinton for President 2008 Campaign.