The Progressive Economic Narrative in Obama's State of the Union

Feb 13, 2013Richard Kirsch

President Obama has begun telling the right story about the economy. Now we need to make sure that story spreads.

President Obama has begun telling the right story about the economy. Now we need to make sure that story spreads.

Two years ago, frustrated by a conservative resurgence in the 2010 election, a group of progressive activists, economists, communicators, and pollsters came together to write a compelling story about our view of the economy (as Mike Lux relates). Our goal was to write a story that people could easily understand, based on our beliefs about how to create an economy that delivered broadly shared prosperity -- a story that could stand up against the right’s familiar recipe of free markets, limited government, and rugged individualism. The core of the story we developed in our progressive economic narrative (PEN) was: “The middle class is the engine of our economy. We build a large, prosperous middle class by decisions we make together.”

So it was a milestone in our work to hear President Obama tell our story and use our language in his State of the Union address. The key line, delivered at the top of the speech and quoted in almost every news story, was “It is our generation’s task, then, to reignite the true engine of America’s economic growth: a rising, thriving middle class.”

Taking another lesson from PEN, the president prefaced that quote with an explanation of what the economic problem is, focusing on how working families and the middle class have been crushed. In PEN we say, “American families are working harder and getting paid less, falling behind our parents' generation. Too many Americans can’t find good jobs and too many jobs don’t pay enough to support a family. Big corporations have cut our wages and benefits and shipped our jobs overseas.” Here’s the president’s version:

But – we gather here knowing that there are millions of Americans whose hard work and dedication have not been rewarded. Our economy is adding jobs, but too many people still can’t find full-time employment. Corporate profits have skyrocketed to all-time highs, but for more than a decade, wages and incomes have barely budged. It is our generation’s task, then, to reignite the true engine of Americas economic growth: a rising, thriving middle class.

When it came to describing how we build this middle-class engine, the president again used the same ideas frame laid out in PEN: “We build a large and prosperous middle class through the decisions we make together; investing in our people, expanding opportunity and security, paving the way for business to innovate, and to do business in ways that create prosperity and economic security for Americans.” The president’s agenda was based on these same concepts:

  • Invest in people through education (starting at Pre-K), skills we need for today’s jobs, affordable health care, and a secure retirement.
  • Pave the way for businesses through research, infrastructure, and green energy.
  • Do business in ways that create prosperity, with a higher minimum wage and pay equity for women.

The president’s story contrasted sharply with Marco Rubio’s. Rubio also paid homage to the middle class, but he told the conservative tale:

This opportunity – to make it to the middle class or beyond no matter where you start out in life – it isn’t bestowed on us from Washington. It comes from a vibrant free economy where people can risk their own money to open a business. And when they succeed, they hire more people, who in turn invest or spend the money they make, helping others start a business and create jobs. Presidents in both parties – from John F. Kennedy to Ronald Reagan – have known that our free enterprise economy is the source of our middle class prosperity.

So the fight is joined. For too long, progressives have not taken on the conservative story with our own narrative. As a result, even when people agree with us on specific issues, they still hold fast to the right’s definition of how to move the economy forward. We have, with the simple tale told by the president and in the progressive economic narrative, a very different story, an economy driven by working families and the middle class, which we create by decisions we make together, with our government as the catalyst.

Our next task is to tell this same story over and over again in all of our communications. Repetition is key. People need to hear the story whenever we communicate on an economic issue. We give examples of how do to that on job quality, job creation, the federal fiscal mess, and health care at progressivenarrative.org.

President Obama left out one part of the progressive economic narrative in his speech. As we say in PEN, “Our political system has been captured by the rich and powerful and corrupted by big money in politics. The issue is not the size of the government, it’s who the government works for – powerful corporations and the richest few, or all of us. We have to take our democracy back to ensure that our economy will work for all of us. ”

That’s a story that politicians are reluctant to tell. As always, we need to lead and the leaders will follow. It is up to us to build an America and economy that works for all us. Clearly describing our vision of how to do that is a crucial element of building power that progressives overlooked for too long. We’re much closer when the president tells that story to the nation. It’s up to us to keep telling it every day.

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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Memo to Lawmakers: Young Americans Demand More Health Care, Not Less

Feb 13, 2013Rahul Rekhi

President Obama's SOTU mentioned Medicare, but he still fails to realize that young people are ready for even greater investment in health care.

President Obama's SOTU mentioned Medicare, but he still fails to realize that young people are ready for even greater investment in health care.

Last night, President Obama delivered a State of the Union address that outlined an ambitious second term agenda while touting a steadily recovering economy and asserting the need to strike a budget deal that preserves the generational promise of Medicare. What he did not mention, however, is an underlying but oft-neglected truth: that our national health care debate still neglects the needs, perspectives, and interests of young adults. The State of the Union may be stronger, but for young Americans around the country, its health requires a new prescription. This is perhaps most critical in two key but distinct areas: innovation and mental illness.

Consider, firstly, that the health reform debate—subsumed into the longstanding clashes on the federal debt and deficit—has lately centered on cost cutting. Thus far, such discourse has largely been framed as benefiting young Americans, those who, the argument goes, will bear the brunt of the nation's debt burden in the absence of immediate cuts to the federal healthcare budget. However, from a young person’s perspective, there exists compelling evidence for a converse narrative: public health care as an incubator for innovation. The safety net that health care provides actually emboldens young people to take risks, to try creating the next Facebook or Google, rather than play it safe for fear of being denied care in later years. 

Evidence of the critical role that public health care can play in entrepreneurship and innovation is plentiful in the research literature. For instance, a recent RAND Corporation study observed the prevalence of so-called "entrepreneurship lock": a phenomenon in which prohibitively high costs of obtaining health insurance as individuals preclude workers from leaving large firms that can offer subsidized premiums to strike out on their own. But we can also look across the Atlantic to see the catalytic properties of such social insurance—and the costs of not providing it—in action. For example, Sweden, a nation that possesses a social safety net among the world’s most robust, ranked 2nd globally on the INSEAD’s Global Innovation Index. The US, with comparatively meager public insurance, came in at a distant 10th. Such nations as Norway, Finland, Denmark, and Switzerland–hardly bastions of Randian self-sufficiency—also handily outstripped our own ranking on this measure.

This is not to say that public health care is the only factor that will determine the fates of Googles to come. But this data should prompt us to reformulate our rhetoric around programs like Medicare and Medicaid: not as hammocks, but springboards. We should not be focused on heavy-handed cost-shifting measures that merely limit the scope of coverage, but instead how to thoughtfully modernize the fundamental societal value that these programs provide. It is precisely this values-based approach to national health care financing that young Americans value most greatly, as attested to by thousands of students in the Roosevelt Institute | Campus Network’s recently published Government By and For Millennial America.

Arguably the most significant example of this false dichotomy between cost and value is mental health care. Much has been made of our healthcare system’s dismal performance on health indicators, but in no field does this ring truer than in psychiatric care. Yet what’s often overlooked is that mental healthcare is, above all, a youth problem, afflicting no demographic more than my fellow young Americans—my classmates, colleagues, and friends. Millennials, as a demographic, report rates of depression well above the baseline: almost 9 percent of 20-somethings in America are thought to have developed major depression, panic disorder, or anxiety. The shocking nature of this statistic is only amplified by considering that a full 75 percent of diagnosable, life-long mental health illnesses develop by age 24. Yet an estimated 75-80 percent percent of youth in need of mental health services do not receive any care.

But potential solutions abound, even for such a complex problem. If states are the laboratories of our democracy, mental health has proven no exception. Even while the U.S. lags nationally on mental health—rated a ‘D’ by the National Alliance on Mental Illness—states like Connecticut, Massachusetts, and Maryland lead the pack in developing thoughtful, innovative proposals to improve the quality and coverage of care. Moreover, a recent study out of UCLA in California demonstrates that sound mental healthcare can actually be a cost-saving measure.

Ultimately, progress on both of these fronts depends on whether our political leaders choose to prioritize young Americans across the nation. The health of an entire generation hangs in the balance.

Rahul Rekhi is a student at Rice University and the Senior Fellow in Health Care Policy for the Roosevelt Institute | Campus Network.

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The Battle Over Women's Health is a Fight for Human Rights

Dec 5, 2012Andrea Flynn

The election is over, but the work of expanding and improving women's access to quality health care is just beginning.

The election is over, but the work of expanding and improving women's access to quality health care is just beginning.

Last month, the United Nations declared access to family planning to be a universal human right that all member countries should respect, protect, and fulfill—a decidedly non-controversial concept for most of the developed world, and indeed not a novel concept for the UN or its members. That is, of course, with the exception of the United States, where human rights are mostly regarded as instruments for other countries to adopt and implement while considered quite unnecessary for our own advancement and wellbeing. So far are we from adopting a human rights framework at home that it’s hard to imagine what would happen if U.S. policymakers approached access to health care – and women’s health in particular – as a right akin to free speech, bearing arms, or practicing our religion. However, given our domestic women’s health crises, we could certainly benefit from adopting some outside perspectives on the right to health care.

Women’s health issues were front and center in the 2012 presidential campaign, garnering far more mainstream attention than in previous elections. From serious discussion in the primary and general election debates to thoroughly considered policy positions to uncensored public remarks, hot-button women’s health issues—rape, abortion, contraception—created a gender gap in the electorate to which many attribute President Obama’s victory. As we look toward the commencement of Obama’s second term, it's clear that the president has numerous monumental challenges before him. But we must not let the protection of women’s health and rights be compromised by other priorities such as the fiscal cliff, the federal budget, or foreign policy crises.

Obama’s victory was a win for women in the short term because it averted the immediate decimation of women’s health funding and infrastructure promised by Romney and his Republican counterparts across the country. But the country needs a long-term win: one that will improve the lives of American women and girls for generations to come. Such a win will require the president’s unwavering determination to improve women’s access to health services and their health outcomes throughout the course of his second term. And it is the job of women and the people who love them to provide a constant reminder that he must deliver on his promises.

Our government should ensure that all women have access to affordable, quality health care not only because it is morally the right thing to do, but because it is the smart and necessary thing to do to strengthen the entire country. Critical indicators such as maternal mortality, teen pregnancy, and unintended pregnancy illustrate the high cost of treating women’s health care as a privilege instead of a right. The United States trails 49 other nations in a ranking of maternal deaths worldwide and has a teen pregnancy rate higher than almost all other industrialized countries. Moreover, nearly half of all pregnancies in the United States are unintended. The data below illustrate how the health circumstances of women of color and low-income women have truly reached crisis proportions and demand immediate action.

(Sources: 1. National Campaign to Prevent Teen and Unplanned Pregnancy, 2. Centers for Disease Control and Prevention, 3. Guttmacher Institute, 4. Ibid, 5. Amnesty International, 6. Ibid, 7. New York City Maternal Mortality Review Project Team)

These inequities in women’s health in the United States are shameful, are a violation of human rights, and are, of course, directly related to the quality and availability of family planning and reproductive health care. Obamacare is certainly a historic step in the right direction. It has already extended contraceptive coverage (including highly effective methods such as the IUD, hormonal implants, and injections) to more than 1 million young women, and by 2016 it will cover nearly 13 million more. It also mandates the inclusion of other critical services: one annual “well woman” visit to a primary care physician, access to emergency contraception (also known as the morning-after pill), HPV testing, screenings for STDs, screenings for gestational diabetes, and coverage for maternal health care, including breast-feeding support.

Despite the immediate improvements to women’s health and the long-term cost savings associated with expanded coverage, Obamacare faces a steep uphill battle. Twenty-seven states have filed suit against the president’s plan, challenging its constitutionality. Additionally, over the last year a number of states have attempted to defund Planned Parenthood and other facilities that provide information about, referrals for, or counseling on abortion (even though none of these providers actually perform abortions), threatening to dismantle an irreplaceable infrastructure that has provided millions of women across the country with critical health services.

So far none of these states have succeeded in their lawsuits, but new challenges pop up every day. In Texas alone, more than 50 women’s health providers have closed over the past year as a result of Governor Rick Perry’s decision to slash the state family planning budget by two-thirds and his promise to eliminate Planned Parenthood and other clinics from the state’s Women’s Health Program. Numerous court battles are underway, but regardless of their outcome, the governor has successfully chipped away at a system of care upon which thousands of women – particularly young women, poor women, immigrant women, and women of color – have relied for decades. This system cannot be easily rebuilt.  As anti-choice and anti-family planning lawmakers across the country continue to face resistance from the courts, they will likely look to Texas for strategies of how to successfully defund our nation’s most effective, far-reaching women’s health care providers. Even if Obamacare succeeds in continuing the expansion of Medicaid and private insurance coverage, its impact will be diluted if women have fewer places to receive comprehensive, quality care.

The United States cannot afford these inequities. The National Campaign to Prevent Teen and Unplanned Pregnancy reports that nearly three in ten girls become pregnant in their teenage years and that teen childbearing now costs U.S. taxpayers more than $10 billion annually. Thirty-eight percent of African American girls and 36 percent of Latino girls who dropped out of high school in 2006 reported doing so because of pregnancy or parenthood. And only 40 percent of teens with children complete high school, with less than 2 percent finishing college by the time they are 30. Teen pregnancies levy an additional toll on young women and the U.S. public by contributing to these higher drop-out rates and reducing the potential lifetime income for teen moms.

Unintended pregnancy among women of all ages is a major drain on U.S. coffers. According to the Guttmacher Institute, public insurance programs paid for more than 60 percent of all births resulting from unintended pregnancies, with total public expenditures for these births totaling more than $11 billion in 2006. A number of studies have shown that by expanding contraceptive coverage to underserved communities, Obamacare would drastically reduce these expenditures.

Providing all women better care before and during their pregnancies is clearly the smart thing to do financially. It is also, plain and simple, the right thing to do. The UN says that access to family planning is a right that should be enjoyed by all women because it “permits the enjoyment of other rights, including the rights to health, education, and the achievement of a life with dignity.” Women fully understand that having the ability to control their bodies, preserve their reproductive and sexual health, and make fully informed decisions about when they will have children impacts their ability to thrive socially and economically.

The election may be behind us, but the battle for women’s health is far from over. States will continue to push back against the mandates of Obamacare and conservative legislators will continue to peel away at women’s health rights and their ability to access the care they need. Women in the United States must remain diligent as Obama begins his second term, reminding him, along with local, state, and national leaders that they demand and expect better health care and better health outcomes in the four years to come. They should do so because having affordable and accessible health care and the ability to make fully informed decisions about their bodies is a universal human right. And that is an idea that anyone invested in America’s long-term stability, strength, and security should embrace.

Andrea Flynn is a Fellow at the Roosevelt Institute.

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Mike Konczal: Is Occupy a Small Government Movement?

Nov 29, 2012

In the latest episode of the Roosevelt Institute's Bloggingheads series, Fireside Chats, Fellow Mike Konczal talks to Yale JD/PhD candidate Jeremy Kessler about the intersection of the law and the left and about

In the latest episode of the Roosevelt Institute's Bloggingheads series, Fireside Chats, Fellow Mike Konczal talks to Yale JD/PhD candidate Jeremy Kessler about the intersection of the law and the left and about leftists who dissent from mainstream progressivism. In the clip below, they discuss whether the Occupy movement, which Mike says has "made a comeback recently" with Strike Debt and Occupy Sandy, represents a libertarian rejection of the state rather than a progressive revolution.

Mike notes that despite Occupy's renewed vigor, some progressives continue to write "quasi-obituaries" that paint it as an aimless anarchist movement. Critics argue that "when you think of them creating a whole new world in Zuccotti Park" it sounds like "the gulches of Ayn Rand novels," and that "a lot of this focus on mutual aid essentially fills in for a rapidly receding government presence under neoliberalism." Mike says this can be seen with Occupy Sandy, which essentially serves as a replacement for FEMA, or the push for homeschooling, which is "just amplifying the way the state is privatizing and dismantling public education." But while Jeremy admits "there is a lot of allergy to the idea of centralized power" in the movement, he and Mike agree that it advances the left's cause by highlighting the failure of the neoliberal state and the "zones of privation" that the shrinking of government has created.

For more, including their discussion of the changing politics of the Supreme Court and the conservative police state, check out the full video below:

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Mike Konczal: Is Occupy a Small Government Movement?

Nov 29, 2012

In the latest episode of the Roosevelt Institute's Bloggingheads series, Fireside Chats, Fellow Mike Konczal talks to Yale JD/PhD candidate Jeremy Kessler about the intersection of the law and the left and about leftists who dissent from mainstream progressivism. In the clip below, they discuss whether the Occupy movement, which Mike says has "made a comeback recently" with Strike Debt and Occupy Sandy, represents a libertarian rejection of the state rather than a progressive revolution.

In the latest episode of the Roosevelt Institute's Bloggingheads series, Fireside Chats, Fellow Mike Konczal talks to Yale JD/PhD candidate Jeremy Kessler about the intersection of the law and the left and about leftists who dissent from mainstream progressivism. In the clip below, they discuss whether the Occupy movement, which Mike says has "made a comeback recently" with Strike Debt and Occupy Sandy, represents a libertarian rejection of the state rather than a progressive revolution.

Mike notes that despite Occupy's renewed vigor, some progressives continue to write "quasi-obituaries" that paint it as an aimless anarchist movement. Critics argue that "when you think of them creating a whole new world in Zuccotti Park" it sounds like "the gulches of Ayn Rand novels," and that "a lot of this focus on mutual aid essentially fills in for a rapidly receding government presence under neoliberalism." Mike says this can be seen with Occupy Sandy, which essentially serves as a replacement for FEMA, or the push for homeschooling, which is "just amplifying the way the state is privatizing and dismantling public education." But while Jeremy admits "there is a lot of allergy to the idea of centralized power" in the movement, he and Mike agree that it advances the left's cause by highlighting the failure of the neoliberal state and the "zones of privation" that the shrinking of government has created.

For more, including their discussion of the changing politics of the Supreme Court and the conservative police state, check out the full video below:

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The Fiscal Cliff Showdown Will Set the Agenda for the Next Four Years

Nov 16, 2012Richard Kirsch

As part of our series "A Rooseveltian Second Term Agenda," a look at the four biggest budget issues that will be debated in the next four months.

As part of our series "A Rooseveltian Second Term Agenda," a look at the four biggest budget issues that will be debated in the next four months.

The very next day after the election, congressional leaders held dueling press conferences in Washington to start the stampede to the fiscal cliff. But December 31st is not a cliff; it’s a slope. Actually, the better metaphor is a showdown between two different visions for the country – a showdown that will not only take place over the next four months, but will dominate debate about the economy for the next four years.

It is true that if Congress allows the tax hikes and spending cuts to be fully implemented, the economy will go into a tailspin, with four million people forced out of their jobs. But that won’t happen on January 1st. The impact of both tax hikes and spending cuts take time to accumulate. If Congress acts on taxes early in the year, it can make lower tax rates retroactive to the beginning of the year. Between federal contracts already in place and the time it takes to implement program cuts, budget cuts too will take a while before they slow down the economy. Better for Congress to walk down and back up the slope early in the year than be stampeded into bad decisions.

In this showdown we have a choice between two paths: prosperity for working families and the middle class or more for millionaires and CEOs. While the showdown will play out in the next few months, the issues will continue to set the economic agenda for the president’s second term. Both the immediate and continued battles will be over four issues: taxes, social insurance, federal discretionary spending, and investments to create jobs.

1. Taxes: The immediate battle will be whether or not to end the Bush tax rates on income over $250,000. The president has rightly made this his line in the sand. If Republican don’t budge, Democrats should wait until next year when all the Bush tax cuts expire, forcing House Republicans to continue to protect tax preferences for the wealthy while taxes go up on working and middle-class families.

The four-year agenda is to restore progressivity to the tax system. Progressives should define tax reform as taxing wealth at the same rate as income from work and enacting higher rates on the highest incomes. With corporate taxes the lowest they have ever been as a share of federal revenue, our agenda should be to end the loopholes and tax preferences for corporations that ship profits and jobs overseas and the breaks from exploiting our natural resources. We should raise more money from a loophole-free corporate tax system.

2. Social insurance: The big three social insurance programs – Social Security, Medicare, and Medicaid – are all protected from the automatic spending cuts, but that hasn’t stopped deficit hawks from trying to bring them into the upcoming debate. Changes to Social Security, like the Simpson-Bowles plan’s “adjustments” to the COLA that will result in 15 percent or more cuts in benefits to middle-class recipients, may well be put on the table as part of “grand bargain.” Democrats should follow Senate Majority Leader Harry Reid, who declared that Social Security is not on the agenda. Over the next four years, progressives should push for the obvious fix to the projected shortfall in the Social Security trust fund: raising or eliminating the cap on how much of earnings are subject to Social Security payroll taxes. That solution would extend the life of the trust fund to 2075 and beyond. It is politically popular, easy to explain, and fits within the broader progressive theme of a tax system that bolsters working families and the middle class by requiring a little more from those with more.

While Social Security does not add a dime to federal deficits, the same can’t be said of the rising pressures of health care spending on Medicare and Medicaid. Both programs should remain off the immediate fiscal showdown agenda, with Democrats pointing out that health care inflation over the past two years is at the lowest level in decades. Some of that is because of changes being put in place by the Affordable Care Act, which has a number of measures to control health care spending in Medicare by eliminating wasteful care and overpayments to health insurance companies. The big agenda for the next four years on health care is to continue to accelerate the changes put in place by the ACA, including that new panel – which the right likes to demonize – that will push Medicare to force providers to provide better care or see their revenues drop. Another top priority is for the federal government as well as states to follow what Massachusetts is doing: use the new health care marketplaces to review health insurance company rate increases and pressure health care providers to provide better quality care at lower cost.

3: Federal discretionary spending: The choice here is straightforward: the amount of revenue raised from ending the Bush tax cuts on income over $250,000 is almost the same as the total cuts to federal discretionary spending. Republicans are eager to stop the Pentagon’s half of the automatic cuts. While many Democrats want to protect the Pentagon, they also want to block the slashing of vital services for families and all the other things – from environmental protections to diplomatic functions – that the federal government does. Progressives should focus on those services that most support low-income and working families, like Pell grants, Head Start, WIC, and food stamps. These are very popular with the public and make the choice crystal clear.

In response to the Pentagon lobbying for more, progressives should argue that Pentagon spending can easily be trimmed, since even if the automatic cuts go through the Pentagon will still be spending more than at the height of the Cold War. Over the next four years, progressives will need to drive home the point that Pentagon spending creates far fewer jobs than spending on health care, education, and other domestic programs, so that reshaping the Pentagon for the 21st century makes both military and economic sense.

It is crucial that progressives link spending choices to jobs. For example, if unemployment insurance for the long-term unemployed is allowed to expire at the end of the year, the loss of benefits to 5 million people will result in another 448,000 being pushed onto the unemployment rolls in 2013. In fact, the biggest job losses among the many choices facing Congress would come from ending long-term unemployment insurance and cutting domestic spending.

4. Good jobs: One thing not on the immediate fiscal agenda is a program to create good jobs. It should be, as the sluggish economy and long-term decline in wages and benefits promises to keep millions of Americans out of work and a growing share of the workforce struggling to make ends meet. Progressive should use the fiscal showdown to go beyond highlighting the job impact of spending cuts. Instead, we should put forth a two-pronged jobs agenda and make this the central push for the next four years.

One prong is investment to create jobs: infrastructure, green jobs, “caring jobs” like day care, elder care, and putting more teachers in our classrooms. We should be pushing for a big youth jobs program. The second prong is job quality: restoring the rights of people to effectively organize unions, modernizing basic work standards by doing thing like raising the minimum wage and indexing it to inflation, and requiring all employers to provide a set number of paid sick days.

The Affordable Care Act will address the growing problem of jobs not coming with health care; here implementation is key. We should also be pushing for the establishment of a new retirement program, such as proposed by Senator Tom Harkin, under which workers would put aside a share of earnings in a pooled, professionally managed plan, with guaranteed, lifetime benefits at retirement or upon permanent disability.

The push for the comprehensive progressive economic agenda above – fair taxes, stronger social insurance programs, protecting vital public services for working families, and investment in good jobs – should start with the upcoming fiscal showdown. The battle between a vision of prosperity for working families and the middle class versus more for millionaires and CEOs is one we should wage for the next four years.

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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The Fight for Health Care Reform Isn't Over Yet

Nov 13, 2012Rahul Rekhi

As part of the "Millennial Priorities for the First 100 Days" series, a call for President Obama to finish the health care overhaul he began with the Affordable Care Act.

As part of the "Millennial Priorities for the First 100 Days" series, a call for President Obama to finish the health care overhaul he began with the Affordable Care Act.

While the principle focus of this year’s presidential campaign was clearly the economy, the election carried more profound implications for the future of American health care then any other area of policy. The choice was clear: would we see the reaffirmation of the Affordable Care Act and with that, an opportunity for its provisions to be phased in at last? Or would we see a rapid repeal and systemic overhaul under the ascendant Romney administration? With the reelection of President Obama, the signature health care legislation of his first term is secure. But to truly reform our health care system, he still has much more work to do in his second term.

Because of President Obama’s historic win, he will be able to fully implement provisions that extend health coverage to over 30 million Americans, end denial of care on the basis of pre-existing conditions, and allow young Americans nationwide to remain covered while continuing their education. But despite this leap forward, significant challenges to our health care system remain. Though the Affordable Care Act tackled the coverage problem, concerns about ever-rising health care costs--and the concomitant budgetary pressures--remain at the forefront. Moreover, debates about end-of-life care, prevention, and the proper role of medical technology in our health care system remain unresolved.

Some of these health policy concerns will take years to tackle. Others must necessarily extend beyond even President Obama’s term limit. But there should be a particular focus on issues regarding health science and technology that we must tackle in the first 100 days, while the electoral mandate remains clear.

The consensus among health economists of all stripes is clear: medical technology is the single most significant driver of rising health care costs in America. These advancements, while making significant gains in extending our lifespans and improving the quality of life for the U.S., simultaneously impose significant cost burdens and threaten the fiscal sustainability of our health care system. The Affordable Care Act takes steps to address this concern, most notably by funding so-called “comparative effectiveness research,” a systematic means of assessing the therapeutic efficacy of clinical treatments and weeding out those that exhibit no health benefits despite their substantial costs. This isn’t rationing—it’s rational.

However, due to political pressures, “Obamacare” contained no provision or mechanism for the results of such comparative effectiveness research to be implemented in a meaningful way. Even the one model that it did call for—the Independent Payment Advisory Board, a “Federal Reserve” of medicine—has been effectively neutered by congressional officials and only served an advisory role. If we are to truly and systematically address the cost burdens of health technology in a meaningful way, what we need is a form of health technology assessment, such as the one pioneered by the National Institute for Health and Clinical Excellence in the United Kingdom. Until then, we will have a patchwork policy at best, and a downright nonexistent one at worst.

Realizing the benefits of these technologies will also necessitate a regulatory overhaul. Despite (occasional?) failures and controversies, the Food and Drug Administration deserves great acclaim for helping to ensure the safety of the American patient for the last century. But the critical nature of this mandate does not obviate the benefits that could be derived from a deep overhaul of the FDA approval process. For instance, there is ample opportunity to bring the FDA into the 21st century, with opportunities to authorize statistical modeling techniques that allow for smaller, leaner, and quicker clinical trials guidelines, and by mandating that the results of all drug trails be published online. These are measures with potentially broad bipartisan support.

Policy has also fallen short in the development of these technologies. Case in point: funding for the National Institutes of Health has largely remained flat in recent years, even under the Obama administration. Yet the importance of biomedical research in maintaining America’s edge in innovation cannot be overstated. It’s no coincidence that over half of the Nobel Laureates in medicine have come from within our borders; it is this edge on health science and technology that has allowed life-saving treatments such as statins, angioplasty, and MRIs into the clinic. As other nations begin to ramp up their investments in biomedical research, it is critical that the U.S. not lose its position of global leadership.

These health policy areas represent means for the president to reaffirm his vision for our health care system. Admittedly, with a looming fiscal cliff, persistently high unemployment, and issues of energy and immigration beginning to enter the national spotlight, turning back to health care may carry with it great political risk. However, while the Affordable Care Act was initially highly polarizing and contentious across the electorate, there is emerging evidence that as its provisions are phased in, support among Americans is growing—and fast. Reaching across the aisle early with these bipartisan policies to further advance our nation’s health care can cement the president’s principle legacy, setting the tone for another transformative term. Ultimately, their impacts will extend well beyond the next 100 days or even the next two years, for the path to a truly 21st century health care system lies ahead.

Rahul Rekhi is a student at Rice University and the Senior Fellow in Health Care Policy for the Roosevelt Institute | Campus Network.

 

Barack Obama image via Shutterstock.com.

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Voters Demand a Progressive Second Term Agenda

Nov 13, 2012Felicia Wong

As part of our series "A Rooseveltian Second Term Agenda," a call for progressives to seize the moment after Election Day.

As part of our series "A Rooseveltian Second Term Agenda," a call for progressives to seize the moment after Election Day.

Last week’s election results weren’t just a win for the president. Across the board, voters went to the polls and registered their support for progressive values, supporting needed tax increases, passing marriage equality for gay and lesbian Americans, and giving a candidate who ran on a platform of proactive government and a strong safety net a second term. The message was clear: despite an economy that continues to recover too slowly, the direction that progressives are taking the country in is the right one.

The polling we have done with Democracy Corps makes it plain – voters don’t want austerity or cuts in Medicare and Social Security. They want to fix the economy with long-term investments in infrastructure and a focus on jobs. And they want solutions – like raising taxes on the well-off and reforming the financial industry – that can raise the revenue to pay for it. As Hurricane Sandy made apparent, we need to update the country’s infrastructure, and we can put people back to work doing it.

So our job has just begun. Now is when we really have to roll up our sleeves and work to achieve an ambitious agenda. The politics won’t necessarily be much easier than they were over the last four years. But with a Democratic president, a Democratic majority in the Senate, and an electorate strongly behind us, progressives have an opportunity to seize over the next four years.

Over the next few weeks, Roosevelt Institute Fellows and staff will weigh in with their thoughts on what our national agenda should look like. While we might differ on some of the specifics, we all agree on basic values and goals: reducing inequality, creating jobs, kick-starting economic growth, building a community among the American people, and regaining trust in both the private sector through functioning markets and in the government and our political system.

On the eve of a second Obama term, and with some fundamental economic and political choices before us, we are proud to be in this historic moment together, Our goals are ambitious. We believe that our ideas can have real impact. As President Franklin Roosevelt put it 80 years ago, “The country needs and, unless I mistake its temper, the country demands bold, persistent experimentation.” Nothing could be truer of our times. Progressives must lead the way.

Felicia Wong is President and CEO of the Roosevelt Institute.

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A New Era in Health Care Begins

Nov 7, 2012Richard Kirsch

Despite the bill's flaws, its passage -- and Obama's reelection -- ensure a whole new ball game.

Despite the bill's flaws, its passage -- and Obama's reelection -- ensure a whole new ball game.

Four years ago, my wife and I planted an oak tree on Election Day – our Obama Oak – at the front of our house. The remarkable thing about the tree is how long it holds on to its leaves. I see it from my window, now doubled in height, still holding its crimson leaves, even after Sandy’s winds blew the leaves off of every other tree in the surrounding Taconic Hills. For me, the Obama Oak’s hardiness is a testament to perseverance of a health reform movement and a president, who together completed the 100-year quest to make health care a government-guaranteed right in the United States. With the president’s reelection, that quest is now secure and a new era in American health care begins.

I am sure that skeptics on the left will scoff at the assertion that the ACA launches a new era in health care. After all, a key to securing congressional passage of the Affordable Care Act was that the law did not upend the current system of health care financing in the United States. The ACA maintains and expands the current three pillars of health coverage: coverage at work, coverage from the government, and coverage purchased by individuals. But unlike those skeptics, the opponents of ObamaCare understand that once the government is responsible for arranging affordable health coverage for its citizens, it is a whole new ball game.

There are two ways to get a glimpse of the new world, one by looking at Medicare and Social Security, the other by seeing what’s happening under RomneyCare in Massachusetts.

Congress has debated changes in Social Security and Medicare almost every year since each program was enacted. Throughout that time, conservatives have tried to stop the programs from expanding and pushed to privatize these public gems. They continue to do so today at their continued political peril. But the history of the programs is that each slowly expands to cover more people with more benefits, as Americans increasingly rely on them for their financial security.

Since its passage in 1935, Social Security’s initial meager payments, available to only a limited set of workers, were expanded over time to provide decent (though far from generous) benefits to almost all workers and extended to surviving spouses and dependent children. Medicare also continued to expand the services i covered, including adding prescription drug coverage a decade ago and just last month improving coverage for some chronically ill beneficiaries. Medicaid has also become a very popular part of the social insurance structure, relied upon by low-income families, the disabled, and an increasing number of the aged.

In writing this, I don’t mean to gloss over the flaws and even setbacks in Social Security, Medicare, and Medicaid. Each of the programs could be improved. But the vital point is that debates over the programs happen largely in public. Health and retirement security for seniors is not a matter just of market forces or private arrangements; it makes up a substantial amount of federal spending and policy. And politicians have found that Social Security and Medicare are the third rails of American politics.

The same will be true for the Affordable Care Act once its key provisions to expand coverage to tens of millions of people start in 2014. At that point, the mystery that is ObamaCare will begin to be cleared up, as millions of people – touching many more millions of family members – find that they have access to affordable health coverage, either from the government or purchased with government subsidies. People will learn first-hand that if they lose their job, start a small business, or retire early, they will still be able to be insured. All the fear-mongering will lose its bite when instead of the sky falling, people have a new floor of health security.

Congressional fights over the ACA will become an annual staple of American politics. The right will continue to try to gut many of its main provisions. Progressives will work to make the law more affordable, building on the popular support that will be established and pushing for improvements. The health care industry will fight over how it impacts their bottom line. There will be big public debates on how the ACA controls health care spending and how much the government can afford to spend. Through all this, as more people are covered by the ACA, ObamaCare will join Social Security, Medicare, and Medicaid as integral parts of how Americans attain a basic level of financial security and personal well-being.

We can already see some of this in Massachusetts. RomneyCare is very popular, a settled part of the political landscape. It is working well: Romney even bragged that 98 percent of Massachusetts residents were covered in the third presidential debate. Health costs have gone up less quickly than neighboring states, and more employers are providing coverage.

But because the state is now responsible for more of the cost of health coverage, the Massachusetts legislature, often at the urging of Governor Deval Patrick, has vigorous debates every year on how to better rein in the growth of health spending. This year it passed a law intended to set limits on the rise in health spending. Under pressure from the new law, health insurance companies and hospital systems are agreeing to new cost control measures. The people who run the subsidized marketplace for private insurance have used their market clout to get insurers to improve quality while controlling costs. And in liberal Massachusetts – I won’t predict this for Congress – there has been no serious consideration of cutting benefits or subsidies to people.

With President Obama’s reelection and the Democratic majority under Harry Reid in the Senate, there is no doubt that the Affordable Care Act will be fully implemented in 2014. States in which Republican governors and legislatures have delayed taking action will need to decide by November 16th whether to run the new individual and small business marketplaces (the “exchanges”) or hand that authority to the federal government. States and the federal government will start moving aggressively to meet the deadline to begin enrollment next October. A huge new expansion of Medicaid will be agreed to in all but a handful of states. There will be new regulations, furious maneuvering in the health care industry, continued political posturing. And a new era in health care, an era in which the right to health care is a public matter, a matter of regular, government policy, will finally have begun in the United States.

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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What We’re Not Talking About When We Talk About Inequality

Oct 31, 2012Joelle Gamble

It's not enough to maintain a safety net that catches people when they fall. We have to keep them from falling in the first place.

It's not enough to maintain a safety net that catches people when they fall. We have to keep them from falling in the first place.

As a millennial, my generation has been told that if we simply work hard and go to college we will be able to achieve even greater economic gains than our parents. That promise now rings false. The gap between the economic have and have-nots is widening dramatically. Those of us who grow up in middle or low-income families may not have the opportunity to move up the socioeconomic ladder. With the widening gulf between rich and poor hampering economic opportunity so markedly that economist Alan Kreuger has named the phenomenon the Great Gatsby Curve, we need to ask ourselves if our political leadership is taking the right steps to address inequality in America.

The current election debate has focused on progressive tax policy and debt reduction as the central components of how government will both spur growth and reduce inequality in America. We only hear about how education, infrastructure, and health care play into the debate on specific occasions, such as when a question is directed toward one of those topics.

Meanwhile, the conversation around government priorities, outside of direct fiscal policy, has been limited to what programs people will lose if a particular candidate is elected. The two major presidential candidates, as well as many down ticket national candidates, regularly accuse each other of wanting to destroy social security “as it is” or restrict access to Medicare for seniors.

How we change tax rates on the middle class and how we continue to fund our social safety net are both important questions. Our government must ensure that the tax code is working fairly. It must make sure that social programs protect individuals when they fall. But the larger drivers of our economic growth and equality in the United States are being largely ignored in favor of these narrow topics. It is not enough to catch people when they fall. Government must, more importantly, ensure that its citizens have the equal access to resources that will make them less likely to fall in the first place. By providing equality and opportunity, we can spur long-term economic growth and prevent higher costs.

There are some investments that government can make that will do more for long-term economic growth and equality in America than others. Investing in education and job training, building a strong infrastructure of Internet access, and providing quality health care has been shown to not only reduce inequality but also promote economic growth.

Education and training are paramount in providing job opportunities. One of the largest factors affecting earnings inequality in the United States is technological change. Innovation has caused many modern companies and industries to become increasingly dependent on the availability of human capital found in the communities in which they are located. Areas with higher percentages of college-educated works are doing better at attracting and retaining business (and the jobs they bring) than areas with less educated populations. American workers need affordable access to education and skills training to be able to compete in the changing labor market.

Future worker competitiveness will also depend on building strong information infrastructure, especially increasing access to high-speed Internet, as Roosevelt Institute Fellow Susan Crawford rightly argues. Technology has created jobs that require workers to be able to work with large quantities of information and work collaboratively with partners who may not live in the same country, yet alone the same city. Even simple processes such as job applications or unemployment benefit applications now require access to a stable Internet connection. Currently, around one-third of Americans lack access to high-speed Internet.

As has been widely shown, access to quality, affordable health care reduces costs for individuals and their families, as well as American taxpayers as a whole. In the absence of access to affordable preventative care, only individuals with significant financial resources can pay for regular doctor visits, examinations and, potentially, long hospital stays. For those without large incomes, these basic health care needs can severely affect their ability to pay bills and sometimes send them into bankruptcy. Beyond basic care and insurance, affordable care for reproductive health services can serve as a step toward gender parity.

Not only do education, Internet access, and health care move us toward a more equal society, they also give taxpayers more for their tax-dollar. Individuals without access to quality schools and health care grow up to have fewer choices and opportunities to get high-skill, high-pay jobs that offer benefits. This makes them more likely to need social programs during the course of their lives. Making a stronger initial investment in programs such as education and heath care that give people opportunities is wiser than allowing the negative effects of failing to do so cripple the federal budget and the economy over the long run.

Making a stronger initial investment in opportunity via programs such as education and heath care is wiser than allowing the negative effects of not making those investments cripple the federal budget and the economy over the long run. None of this is to say that spending on defense, physical infrastructure, and our basic social safety net are not needed. But the United States needs to change its priorities and push for long-term planning with investments in long-term results. Education, information, and quality care are key to producing a more equitable society.

Joelle Gamble is Deputy Field Director of the Roosevelt Institute | Campus Network.

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