02/02/2009 12:17 pm ET Updated May 25, 2011

Our Frankenstein Stimulus Plan

Our Frankenstein stimulus plan, hodge podged and patched---and near passage--- leaves much to ponder. It is not all wrong. Extending unemployment benefits, increasing food stamps and so forth are almost certainly necessary at this time. Some of the infrastructure investments make sense.

The core and glaring problem is that almost nothing is included that is designed to make things right. Like poor hacked and assembled Frankenstein, the stimulus is big, it breathes, but its central failing will haunt its own creators.

Some $800 billion is being spent without any focused effort to use well known strategies which employ the poor, the dependent and the ill to start to overcome their own most serious problems. To the contrary, this great outpouring of public money---throwing billions to existing bureaucracies to gobble in the same old-same old ways---only takes us closer to a national precipice of unsustainable entitlements and strangling dependency.

Let me give one example. As I have described in detail, a national program to train local diabetes prevention educators could be launched in a few months. The National Institutes of Health has already spent millions---I suspect at least $100 million--- testing out a diabetes prevention mini-course which proved twice as effective as standard medication in stopping "prediabetics" ---- of which the United States has 54 million--- from developing outright diabetes. (The course and all the needed instruction materials now sit moldering on the N.I.H. website, hardly used.).

Here is the basis for a great national undertaking. Minorities in urban areas could join poor whites in the Diabetes Belt of the South in a real and feasible fight to slash the toll of chronic disease; educating and coaching people to lose weight and increase exercise---the essence of diabetes prevention------also helps prevent heart disease, high blood pressure and a range of other chronic illness. More, exercise---and possibly weight loss---are significant natural preventers of Alzheimer's. People without college---or high school--degrees can be readily trained as the educators. In sum, it's a win-win-win-win; thousands of unemployed put to work as local health educators in a way that demonstrably slashes chronic disease and and future medical costs--- and the ongoing poverty so attendant to endemic illness.

But, nothing in the stimulus bill moves people in this way---spending now to set them along the road to the self-responsibility that the President has eloquently evoked. Instead for "health" we have Medicaid increases---including eligibility for all unemployed, no matter how high their income---and some vague wellness funds with their uses to be largely decided by the CDC, an organization not intended or designed to lead a community health revival. There is an enormous difference for the future between providing health "services" and educating and empowering "high risk" populations to promote their own health. Basically, we can expect a lot of "health" money will go to the salaries of MPH's at state health departments who will just do more of the "health studies" which are the specialty of MPHs.

One can go down the list: A vast yearning for volunteerism and community service has gripped the nation; but, as Kenneth Goldsmith, the Board Chair of the Corporation for National Service and Community has written, the stimulus gives no real support for properly organizing--and usefully sustaining that energy and promise. The "stimulus" contains $3.5 billion for crime control and police, but nothing for the prisoner " re-entry" programs which are so well proven to halve the re-imprisonment rate of paroled prisoners. One would think in a country where prison budgets, on average, already consume 10% of state budgets, that proven programs which reduce both crime---and the future obligations of bankrupt states---would capture some interest. But, they don't. Even the funds for rebuilding the transportation infrastructure pour billions more into highways than into mass transport, just the opposite of what the future needs.

Ironically, a few of the best ideas to save in the future---electronic medical records and a "comparative effectiveness" panel to try and curtail some of the ludicrous misspending in American medicine---don't really create jobs.

What we get, in the outraged summary of David Brooks, is "a sloppy profusion of 152 appropriations...that mostly create costlier versions of the status quo."

Yet, the country is already broke and going broker and one of the few hopes to ameliorate that is to use every possible public penny in ways that transform our social infrastructure, enabling people to be independent and take constructive control over their own health, lives and communities. Such strategies that look to the future are not just "nice", they are the obligation of older Americans, who have so relentlessly mortgaged and bankrupted the country, toward arranging even a minimally viable future for the young.

The idea that the Congressional Democrats, who largely formed this bill don't understand how truly broke the country is even beyond its financial collapse-- that its hugely wasteful "healthcare" and "social service" industries, especially as promoted by state governments to whom the stimulus sends billions to keep going without reform--- already constitute the next internal Ponzi scheme waiting to fall---or that the Obama Administration won't make them understand that---is frightening.

The day after the inauguration, I stopped for a few hours at the House Appropriations Committee hearings on the the stimulus bill. The hearings, described with sardonic accuracy by Mr. Brooks as "showing the old era is very much alive", were quite jolting after the many perfections of the Inaugural.

Like so many, I will always be grateful to all, beginning with our new President, who made possible that wondrous day, which in itself profoundly changed America. That Tuesday there were the masses of young people, who stood out, so promising and happy, among the millions gathered in enthusiasm and rededication to their nation. But, the next day, came this cobbled and cobbling give away which does so little to protect the future of those young people. With all the jobs saved and guaranteed for bureaucrats and their linked unions, where even was any money toward our pathetically under-funded "summer youth" jobs program which now only provides six weeks of summer minimum wage employment to a fraction of the teens who apply?. Out of all those billions claimed to be for "jobs", couldn't these hopeful, yearning young citizens even get minimum wage for six weeks?

I had to leave the hearings to take a late bus back to New York. Walking around the base of Capitol Hill, now dark, I recalled that when I had arrived by train at about 8:30 Monday evening, Amtrak staff were "clearing out" Union Station. Dozens of young people who came for the Inaugural had evidently thought they could doze in the semi-warmth of our national train station for the night, but they were thrown out into the frozen and freezing cold.