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The checkup is in the mail? Soliciting letter carriers to help deliver health care | COMMENTARY

A mail carrier delivers mail on Coolidge Avenue In the Violetville neighborhood on the southwest side of Baltimore in April. In March, the United States Postal Service Office of Inspector General suggested the USPS could play a role in bringing health services to underserved areas in the U.S.
A mail carrier delivers mail on Coolidge Avenue In the Violetville neighborhood on the southwest side of Baltimore in April. In March, the United States Postal Service Office of Inspector General suggested the USPS could play a role in bringing health services to underserved areas in the U.S. (Barbara Haddock Taylor)

Two of America’s toughest problems can be tempered with one solution. The baby boom generation is graying, creating an ever-larger population of older people, many isolated, whose needs the nation is ill equipped to meet or even monitor. Meanwhile, the U.S. Postal Service has gone $160 billion into debt, in part as digital communications have replaced snail mail.

So here’s a potential win-win scenario: Have letter carriers spend less time delivering mail and, instead, include in their responsibilities home visits and basic health checks on the growing population of frail and elderly.

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This may sound out-of-the-box, but it’s already done successfully and profitably in other countries, like France and Japan. Indeed, the idea that the USPS could get more involved in home health services — to fill a need and earn money — was suggested by the agency’s own Office of the Inspector General in March.

Tens of millions of older Americans are unable to live safely at home without help preparing medicine or meals. In Maine, the state with the oldest population, an estimated 10,000 hours of needed and approved home care is not provided every week because of a dearth of workers. That leaves patients with early dementia fending for themselves at great risk.

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Postal workers are already on most blocks of America six days a week. Yes, letter carriers are already busy, in part because of the volume of package deliveries, which jumped during the pandemic. But what about scrapping the idea of everyday delivery? That too was suggested by the agency’s inspector general — a decade ago. Mail could be delivered just a few times a week, say, every other day. And on the off days, presto: We get a new on-the-ground home health workforce.

They could do home visits, to redress an epidemic of loneliness among older homebound Americans and check on whether a customer has an adequate supply of food and medicines. With a bit of retraining, they could check and record blood pressure, test blood sugar levels in people with diabetes and even administer pills.

Letter carriers already effectively serve as informal watchdogs, noticing if an older client hasn’t picked up mail, for example. In some parts of the country, that function is formalized under a voluntary program called Carrier Alert, in which the Postal Service notifies a participating service agency.

In France, since 2017, families have been able to pay a small monthly fee to La Poste — about 20 euros, or $24 — to have home check-ins for an older relative. The service, called Watch Over My Parents, offers one to six visits per week, and the postal worker reports the resident’s condition to the client each time.

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Japan launched a similar postal program through a public-private partnership in 2017, to underwrite paid, monthly, half-hour visits (a friendly chat and health check) with members of the aging at-home population.

Of course, this alone will not close the USPS’ $160 billion budget gap, the bulk of which resulted from a government mandate that it prefund the agency’s pension plan and, especially, its retiree health benefits. Without that, the USPS would have been in the black (often just barely) for about half of the years since 2006 — though, overall, it was nearly $10 billion in debt during the period.

Solving that requirement will take congressional intervention; changes will also be needed in a law that currently requires six-day-a-week delivery and generally precludes the USPS from offering “nonpostal” products. Bipartisan legislation introduced in the Senate this year seeks to loosen the latter restriction to help the USPS earn money from services of “enhanced value to the public” (like selling hunting and fishing licenses).

The post office’s essential functions — like delivering the federal government’s $1,200 pandemic relief checks, mail-in ballots and prescription medicines — are too important to lose. But it just makes sense financially and socially for the agency to evolve to meet the nation’s current needs. Why not instead redeploy some of the U.S. Postal Service’s vast supply of human resources to deliver a service our aging population — and our country — desperately needs?

Elisabeth Rosenthal (erosenthal@kff.org) is editor-in-chief of Kaiser Health News, a national newsroom that produces in-depth journalism about health issues. Her book, “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” (Penguin Random House, 2017), was a New York Times bestseller and a Washington Post notable book of the year.

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