Harold Pollack

Harold Pollack is the Helen Ross Professor of Social Service Administration and Public Health Sciences at the University of Chicago and a nonresident Fellow of the Century Foundation.

Recent Articles

The Real Problem with the Independent Payment Advisory Board

When I was a graduate student, abandoned houses were a real problem in my community. These eyesores blighted the neighborhood. In many cases, the city needed to quickly condemn these properties to address public safety concerns. Aldermen loudly complained about the cumbersome administrative process which produced a long waiting list of abandoned properties. I asked an expert why we couldn't fix this, and let the Mayor follow a fairer and more efficient process. "The aldermen would never allow that," he responded. They needed a decentralized, opaque, and inefficient process, which allowed them to perform visible constituency services, moving particular properties up the waiting list. It didn't hurt that the most powerful aldermen could provide the most valued services, too. To allow someone else--the Mayor, yet--to address these problems through an explicit, centralized process was a nonstarter. I remembered that story when I read Paul Krugman's nice op-ed yesterday. In defending the...

Barbour on Medicaid

"Some politicians act like they love our constituents more than we do." So says Mississippi Gov. Haley Barbour. But it's hard to imagine "love for his constituents" being the first phrase that comes to mind when people think of Barbour, whose arguments in support of charging Medicaid recipients pharmaceutical co-payments included the nugget: "We have people pulling up at the pharmacy window in a BMW and say that they can't afford their co-payment." For anyone old enough to remember Ronald Reagan, Barbour's folksy account of Medicaid queens speaks for itself. Barbour made both comments at a governors' conference at which he argued states should have greater flexibility to trim Medicaid benefits and eligibility. To put it mildly, Mississippi is not the ideal state for Republicans to argue the supposed merits of local control in public assistance and health policy. This is a state that sets its maximum monthly welfare benefit for a family of three at $170. This is also a state that has...

Put to the Test

Genetic screening is more accessible than ever, and health-care providers are scrambling to catch up.

Scientist John Sulston announcing the completion of the mapping of the human genome in 2001. (AP Photo/Adam Butler)
When my children were born in the mid-1990s, new parents could already see that prenatal genetic testing was altering the terrain of pregnancy and childbirth. Growing numbers of educated women were having children at older ages, with resulting difficulties and risks. More and more parents faced challenging, deeply personal decisions about whether to engage in genetic testing and what to do if they received unfavorable results. I remember my own anxieties when my wife, Veronica, took a blood test that searched for elevated alpha-fetoproteins, which are associated with diverse ailments ranging from spina bifida to anencephaly. The mere prospect of these rare conditions -- and even the choice to undergo the tests -- was surprisingly painful. At least genetic counselors and other professionals were available to help guide us. By that point, amniocentesis had been in wide use for more than two decades. As researchers identified the genetic markers associated with a growing list of...

The Cost of Delayed Reform

The temporary federal high-risk pools won't reach most of the medically uninsured.

Several million Americans without insurance face the challenges of cancer, heart failure, or other serious illnesses. As of 2014, they'll receive coverage through a new and inclusive system of health-insurance exchanges, affordability credits, and other measures, but what happens to them in the interim? The Affordable Care Act includes a number of measures that go into effect in the short term -- some of them this year, such as a regulation prohibiting insurers from denying coverage of children's pre-existing conditions. That provision, along with the expansion of the Children's Health Insurance Program, should help many families with sick or disabled children who would otherwise be uninsured. The picture continues to be grim, though, for uninsured adults with serious medical problems. The legislation does provide funds for temporary high-risk pools, but this program, the Pre-Existing Condition Insurance Plan, suffers from major drawbacks. The most serious of those drawbacks is that...

Neglecting the Swine Flu Frontlines

Stimulus spending couldn't have hit the ground fast enough to avert the current swine flu crisis. But moderate senators -- including new Democrat Arlen Specter -- still have a lot to answer for in terms of their lack of support for local public-health funding.

Tuesday morning, I walked into our university hospital for a meeting. I was stopped at the door by a police officer. He didn't check my ID, he pointed to a bottle of hand sanitizer. As I scrubbed, he gave me a card telling me what to do if I had a fever or other symptoms. That's good. Chicago has had some likely cases of H1N1 flu. We aren't panicking, but we are paying attention. Such experiences remind us that local institutions are at the real front lines in addressing public-health emergencies. The capacity of state and local governments to coordinate and mobilize these efforts is a crucial, and readily overlooked, variable in the current flu challenge. Unfortunately, these components of our nation's public-health infrastructure are less prepared and less capable than they would otherwise be, thanks to that small but critical group of Senate moderates who controlled Senate votes on this year's stimulus bill. Perhaps these votes would have gone differently had H1N1 arrived three...