House Republicans recently approved the “Death Tax Repeal Act of 2015.”  If we care about our debt obligations, social mobility, or equality of opportunity, we should consider doing just the opposite: raising the tax and applying it to more of the super-wealthy.

Currently, the estate tax doesn't touch the first $5.43 million of an individual’s assets and the first $10.86 million of couples’ assets. The tax kicks in after that amount, eventually rising to a top rate of 40 percent.  

Proponents of repeal make a number of claims to make their case. Let’s examine the most common.

1. The estate tax affects a significant portion of Americans. Only about 5,400 estates will pay any estate tax this year. That’s about 0.2% of all estates – that’s right, just two tenths of one percent.  That’s a fortieth of the 1970’s share. Americans worried about the Estate Tax have nothing to fear but fear itself. 
2. The estate tax hurts small farms and businesses. In fact, the estate tax touches virtually no small farms or businesses. The Urban-Brookings Tax Policy estimated how many farm and business estates worth under $5 million paid any tax in 2013. Twenty did. Twenty small farms and businesses paid any estate tax in 2013. And those 20 estates faced an average tax rate of 4.9%. Only 660 farm estates—of any size—paid the tax in 2013, and 100 of those farms had assets worth over $20 million. The USDA estimates that 0.6% of all farm estates owed federal estate tax in 2013. This is because families who farm for a living have access to generous deductions: up to $1 million for continuing to farm the land for the next 10 years and up to $500,000 for adopting conservation easements. They can also delay payment and lighten their tax liability by gifting their land to heirs. Small businesses have similarly generous carve-out.
3. Repealing the estate tax doesn't affect the budget, because it’s a small share of federal revenue. In 2014, the estate tax represented 0.6% of federal collections, or roughly $20 billion annually, according to the Joint Committee on Taxation. But part of the reason that’s so low is because Congress has increased the exemption and lowered the rate in recent years; in 2001, the top rate was 55% and the exemption was only $675,000. Still, even today, repealing the tax is costly. The JCT estimates that repeal would cost the government $269 billion over the next decade.
4. The estate tax represents double taxation. Well, maybe. It is true that people  pay taxes on their income when earned and then may have to pay again when they pass it on to their heirs.  However, because the super-wealthy keep much of their assets as unrealized capital gains (55% for those estates worth over $100 million), the estate tax is the only way, right now, to tax these capital gains. In that sense it can be viewed as a partial corrective within our funhouse of a tax system. Some capital gains, to be sure, are the fruits of hard work and entrepreneurial creativity but a lot are simply the result of gains among those wealthy enough to participate in speculative ventures. 

One thing is true: repeal would mean a large tax break for the wealthiest 0.2% of the population. The 1,336 families with estates worth more than $20 million would get almost three-fourths of the benefit from the repeal and enjoy an average windfall of $10 million each, according to the Center on Budget and Policy Priorities. The 318 families with estates worth more than $50 million would see an average windfall of $20 million each.

These facts are often obscured by our penchant for individual stories. One Washington Post story for example, acknowledges many of the statistics above, but then goes on to give two examples of farmers who had to sell land to meet their tax burden, one of which is several decades old, when the exemption was much lower. Elected officials love these kinds of stories and tell them often. Are they unaware of the generous special provisions for this group?  Do they truly believe that very wealthy families are the ones we should be helping? Or are they thinking about who is going to finance their next campaign?

The estate tax is one of the most progressive aspects of our tax system. In a time of increasing inequality, it provides a way to counteract the formation of a “permanent ownership class.” If anything, we should consider raising the rate and lowering the exemption to pay down debt and invest in opportunities for the unlucky children at the bottom of the wealth ladder. We could start by closing the stepped-up basis loophole and raising the estate tax to Clinton-era levels. We could do so in a way that protects real farmers and small business owners. Wealthy heirs, meanwhile, will still do very well, much better than the rest of America. A serious estate tax would allow us to come closer to our national ideal, in which no child is born a prince, and every child can become as rich as a king.

Note: An earlier version of this post said that the estate tax only applies to assets in excess of the exemption, which is incorrect. The estate tax is levied on the entire estate but is offset by a credit equal to the tax on the first $5.43 million. This version is corrected.

The United States exported and imported $4.0 trillion worth of international goods in 2014, making it the world’s second-largest trader, after China. The responsibility for moving all those products falls to the country’s 400-plus seaports, airports, and border-crossing facilities, though a smaller group does most of the country’s heavy lifting. In fact, ports in just 10 metropolitan areas move 60 percent of all international goods by value.

This level of concentrated port activity creates a spatial mismatch in the country’s trade flows. While a few ports handle a majority of international trade, few of the goods leaving or entering those ports start or end their journey in that port’s local market: 96 percent actually move to or from other parts of the United States. As a result, problems within and outside certain port facilities—whether a labor dispute like the recent West Coast port strike or congestion near Philadelphia’s seaport or airport—quickly become logistical costs borne by the entire country.

The 10 largest metropolitan port complexes represent a wide range of U.S. geographies, modal specialties, and international connections. Total volumes for these port complexes, listed below, are based on an aggregation of imports and exports across all sea, air, truck, rail, and pipeline facilities in each region. All data are from 2010, and you can find more detailed metrics within the Metro Freight interactive.

10. Chicago-Joliet-Naperville, IL-IN-WI

Total Value: $92.8 billion
Local Share: 4.6 percent
Top Trade Region: Asia Pacific ($41.5 billion)

A traditional Midwest powerhouse of production, metropolitan Chicago is home to a variety of industries and infrastructure assets that connect it to the Midwest and global marketplace. The proximity of factories, warehouses, and rail lines to its major port facilities, particularly O'Hare International Airport, places Chicago at a strategic crossroads for goods distribution.

9. San Francisco-Oakland-Fremont, CA

Total Value: $103.9 billion
Local Share: 4.4 percent
Top Trade Region: Asia Pacific ($77.6 billion)

The San Francisco metro area—and the Bay Area as a whole—may be more well-known as a center for tech innovation, but it also contains some of the largest port facilities in the country. The Port of Oakland and the Port of San Francisco  account for the bulk of water traffic ($55.3 billion overall) moving through the area, while Oakland International Airport and San Francisco International Airport help transport nearly $48.6 billion in electronics, precision instruments, and other high-value goods.

8. Seattle-Tacoma-Bellevue, WA

Total Value: $116.9 billion
Local Share: 8.2 percent
Top Trade Region: Asia Pacific ($89.4 billion)

The Seattle metro area plays a critical role cycling goods throughout the Pacific Northwest and the rest of the country, largely owing to the key connections its port facilities have forged with China ($47.9 billion) and Japan ($22.0 billion). Valuable transportation equipment and electronics represent a large chunk of these port volumes ($52.7 billion), although sizable amounts of machinery, textiles, and agricultural products are also processed through area facilities. The Port of Seattle and the Port of Tacoma are especially important in this respect, as they look to partner more closely in years to come.

7. Miami-Fort Lauderdale-Pompano Beach, FL

Total Value: $123.7 billion
Local Share: 2.0 percent
Top Trade Region: Latin America ($97.2 billion)

Miami is the country’s primary gateway to Latin America, especially when excluding petroleum-related trade moving through Gulf Coast ports. And while the region and state have made impressive investments at the Port Miami seaport, it is actually Miami International Airport that generates the most regional trade ($74.8 billion). Miami’s facilities are a key component of Florida’s statewide strategy to use trade and logistics to grow local industries.

6. Laredo, TX

Total Value: $124.4 billion
Local Share: 0.0 percent
Top Trade Region: NAFTA ($121.0 billion)

Laredo may only house 250,000 people, but it might be the most important Texas metro area you’ve never heard of, considering that virtually every international good passing through it heads somewhere else in the U.S. The border town is the southernmost point of Interstate 35—the so-called NAFTA superhighway—and handles almost half of U.S./Mexican surface trade. With automotive and other supply chains continuing to stretch across the binational border, Laredo is poised to grow in importance over the coming years.

5. Anchorage, AK

Total Value: $137.4 billion
Local Share: 0.2 percent
Top Trade Region: Asia Pacific ($136.0 billion)

Anchorage may be thousands of miles from the closest U.S. market, but it has a long legacy as a major connector to the Pacific marketplace, resting less than 9.5 hours by air from 90 percent of the industrialized world. In particular, Ted Stevens International Airport was the cargo hub for Northwest Airlines Cargo, once the country’s largest carrier, and still has a vibrant freight business led by FedEx Express and UPS hubs. Continued growth in high-value, low-weight goods trade with Asia can only benefit Anchorage’s cargo business.

4. Houston-Sugar Land-Baytown, TX

Total Value: $168.1 billion
Local Share: 10.6 percent
Top Trade Region: Latin America ($48.3 billion)

As one of the world’s leading centers for energy and chemical production, the Houston metro area—along with other parts of the Gulf Coast region—depends on an enormous set of seaport facilities to transport these goods. Collectively, $100.6 billion of energy products and chemicals/plastics pass through these ports annually, accounting for about 60 percent of all their international goods. Stretching more than 25 miles in length and situated close to the Gulf of Mexico, the Port of Houston houses many of the area’s marine terminals.

3. Detroit-Warren-Livonia, MI

Total Value: $206.7 billion
Local Share: 4.9 percent
Top Trade Region: NAFTA ($186.6 billion)

Although the Detroit metro area contains a number of freight facilities, such as the Port of Detroit, that unite the Great Lakes region, its land border crossings to Canada make it one of the busiest sites of commerce in North America and beyond. Each year, nearly $175.8 billion in international goods travel by truck and rail between Detroit and Canada—relying almost exclusively on the aging Ambassador Bridge and the Michigan Central Railway Tunnel. The planned New International Trade Crossing (NITC), however, holds promise for expanding capacity at this crucial junction.

2. New York-Northern New Jersey-Long Island, NY-NJ-PA

Total Value: $349.2 billion
Local Share: 9.7 percent
Top Trade Region: Europe ($153.9 billion)

The Port of New York and New Jersey, which spans several marine facilities including the Port Newark-Elizabeth Marine Terminal, is one of the biggest freight assets in the country, cementing the New York metro area’s role as the chief East Coast seaport complex ($185.0 billion). Remarkably, almost the same value of goods ($162.7 billion) flows through the area’s expansive air cargo facilities, including John F. Kennedy International Airport and Newark Liberty International Airport. Combined with New York’s enormous amount of global corporate headquarters, New York is the country’s most globally fluent metro area.

1. Los Angeles-Long Beach-Santa Ana, CA

Total Value: $417.5 billion
Local Share: 6.0 percent
Top Trade Region: Asia Pacific ($362.2 billion)

The Los Angeles metropolitan area not only boasts two of the largest seaports in the Western Hemisphere—the Port of Los Angeles and the Port of Long Beach—but also has one of the busiest cargo airports nationally, Los Angeles International Airport (LAX). Together, these port facilities channel a wide range of international goods like electronics, machinery, and textiles across the country, many of which come from Asian trade partners like China ($211.3 billion) and Japan ($58.5 billion). Still, only a fraction of these goods actually start or end locally (6 percent), speaking to the port complex’s extensive geographic reach in the U.S.

The United States exported and imported $4.0 trillion worth of international goods in 2014, making it the world’s second-largest trader, after China. The responsibility for moving all those products falls to the country’s 400-plus seaports, airports, and border-crossing facilities, though a smaller group does most of the country’s heavy lifting. In fact, ports in just 10 metropolitan areas move 60 percent of all international goods by value.

This level of concentrated port activity creates a spatial mismatch in the country’s trade flows. While a few ports handle a majority of international trade, few of the goods leaving or entering those ports start or end their journey in that port’s local market: 96 percent actually move to or from other parts of the United States. As a result, problems within and outside certain port facilities—whether a labor dispute like the recent West Coast port strike or congestion near Philadelphia’s seaport or airport—quickly become logistical costs borne by the entire country.

The 10 largest metropolitan port complexes represent a wide range of U.S. geographies, modal specialties, and international connections. Total volumes for these port complexes, listed below, are based on an aggregation of imports and exports across all sea, air, truck, rail, and pipeline facilities in each region. All data are from 2010, and you can find more detailed metrics within the Metro Freight interactive.

10. Chicago-Joliet-Naperville, IL-IN-WI

Total Value: $92.8 billion
Local Share: 4.6 percent
Top Trade Region: Asia Pacific ($41.5 billion)

A traditional Midwest powerhouse of production, metropolitan Chicago is home to a variety of industries and infrastructure assets that connect it to the Midwest and global marketplace. The proximity of factories, warehouses, and rail lines to its major port facilities, particularly O'Hare International Airport, places Chicago at a strategic crossroads for goods distribution.

9. San Francisco-Oakland-Fremont, CA

Total Value: $103.9 billion
Local Share: 4.4 percent
Top Trade Region: Asia Pacific ($77.6 billion)

The San Francisco metro area—and the Bay Area as a whole—may be more well-known as a center for tech innovation, but it also contains some of the largest port facilities in the country. The Port of Oakland and the Port of San Francisco  account for the bulk of water traffic ($55.3 billion overall) moving through the area, while Oakland International Airport and San Francisco International Airport help transport nearly $48.6 billion in electronics, precision instruments, and other high-value goods.

8. Seattle-Tacoma-Bellevue, WA

Total Value: $116.9 billion
Local Share: 8.2 percent
Top Trade Region: Asia Pacific ($89.4 billion)

The Seattle metro area plays a critical role cycling goods throughout the Pacific Northwest and the rest of the country, largely owing to the key connections its port facilities have forged with China ($47.9 billion) and Japan ($22.0 billion). Valuable transportation equipment and electronics represent a large chunk of these port volumes ($52.7 billion), although sizable amounts of machinery, textiles, and agricultural products are also processed through area facilities. The Port of Seattle and the Port of Tacoma are especially important in this respect, as they look to partner more closely in years to come.

7. Miami-Fort Lauderdale-Pompano Beach, FL

Total Value: $123.7 billion
Local Share: 2.0 percent
Top Trade Region: Latin America ($97.2 billion)

Miami is the country’s primary gateway to Latin America, especially when excluding petroleum-related trade moving through Gulf Coast ports. And while the region and state have made impressive investments at the Port Miami seaport, it is actually Miami International Airport that generates the most regional trade ($74.8 billion). Miami’s facilities are a key component of Florida’s statewide strategy to use trade and logistics to grow local industries.

6. Laredo, TX

Total Value: $124.4 billion
Local Share: 0.0 percent
Top Trade Region: NAFTA ($121.0 billion)

Laredo may only house 250,000 people, but it might be the most important Texas metro area you’ve never heard of, considering that virtually every international good passing through it heads somewhere else in the U.S. The border town is the southernmost point of Interstate 35—the so-called NAFTA superhighway—and handles almost half of U.S./Mexican surface trade. With automotive and other supply chains continuing to stretch across the binational border, Laredo is poised to grow in importance over the coming years.

5. Anchorage, AK

Total Value: $137.4 billion
Local Share: 0.2 percent
Top Trade Region: Asia Pacific ($136.0 billion)

Anchorage may be thousands of miles from the closest U.S. market, but it has a long legacy as a major connector to the Pacific marketplace, resting less than 9.5 hours by air from 90 percent of the industrialized world. In particular, Ted Stevens International Airport was the cargo hub for Northwest Airlines Cargo, once the country’s largest carrier, and still has a vibrant freight business led by FedEx Express and UPS hubs. Continued growth in high-value, low-weight goods trade with Asia can only benefit Anchorage’s cargo business.

4. Houston-Sugar Land-Baytown, TX

Total Value: $168.1 billion
Local Share: 10.6 percent
Top Trade Region: Latin America ($48.3 billion)

As one of the world’s leading centers for energy and chemical production, the Houston metro area—along with other parts of the Gulf Coast region—depends on an enormous set of seaport facilities to transport these goods. Collectively, $100.6 billion of energy products and chemicals/plastics pass through these ports annually, accounting for about 60 percent of all their international goods. Stretching more than 25 miles in length and situated close to the Gulf of Mexico, the Port of Houston houses many of the area’s marine terminals.

3. Detroit-Warren-Livonia, MI

Total Value: $206.7 billion
Local Share: 4.9 percent
Top Trade Region: NAFTA ($186.6 billion)

Although the Detroit metro area contains a number of freight facilities, such as the Port of Detroit, that unite the Great Lakes region, its land border crossings to Canada make it one of the busiest sites of commerce in North America and beyond. Each year, nearly $175.8 billion in international goods travel by truck and rail between Detroit and Canada—relying almost exclusively on the aging Ambassador Bridge and the Michigan Central Railway Tunnel. The planned New International Trade Crossing (NITC), however, holds promise for expanding capacity at this crucial junction.

2. New York-Northern New Jersey-Long Island, NY-NJ-PA

Total Value: $349.2 billion
Local Share: 9.7 percent
Top Trade Region: Europe ($153.9 billion)

The Port of New York and New Jersey, which spans several marine facilities including the Port Newark-Elizabeth Marine Terminal, is one of the biggest freight assets in the country, cementing the New York metro area’s role as the chief East Coast seaport complex ($185.0 billion). Remarkably, almost the same value of goods ($162.7 billion) flows through the area’s expansive air cargo facilities, including John F. Kennedy International Airport and Newark Liberty International Airport. Combined with New York’s enormous amount of global corporate headquarters, New York is the country’s most globally fluent metro area.

1. Los Angeles-Long Beach-Santa Ana, CA

Total Value: $417.5 billion
Local Share: 6.0 percent
Top Trade Region: Asia Pacific ($362.2 billion)

The Los Angeles metropolitan area not only boasts two of the largest seaports in the Western Hemisphere—the Port of Los Angeles and the Port of Long Beach—but also has one of the busiest cargo airports nationally, Los Angeles International Airport (LAX). Together, these port facilities channel a wide range of international goods like electronics, machinery, and textiles across the country, many of which come from Asian trade partners like China ($211.3 billion) and Japan ($58.5 billion). Still, only a fraction of these goods actually start or end locally (6 percent), speaking to the port complex’s extensive geographic reach in the U.S.

During the height of the Ebola crisis in September 2014 there were 21 confirmed cases of the virus and 8 deaths in Nigeria. The African nation has the continent’s largest population, a high poverty rate, and the government spends relatively little on health care. At the time many were worried about a scenario where the virus spread throughout Nigeria. But, the Nigerian Minister of Health Onyebuchi Chukwu disagreed with that assessment. He commented to Forbes, “Nigeria will be as clean as any other country as far as Ebola virus disease is concerned.” His comments were proven to be accurate in the coming months. There were a variety of factors that contributed to Nigeria’s success at combating the disease. One important factor was the use of mobile electronic health records programs.

How mobile fights disease

1. Training Healthcare Workers

Training health care providers was a priority at the beginning of the Ebola outbreak. A survey found that 85 percent of health care workers in the country believed you could avoid Ebola by abstaining from handshakes or touching. Correcting these myths about the disease was a critical part of the response effort, especially for health care workers.

2. Rapid Deployment

One of the virtues of mHealth is its speed and flexibility. Mobile allows officials to quickly disseminate the latest information to front line health care workers. Increasing the speed of communication is a general boon to any large public health response.

3. Virtual Records

Ebola Treatment Units (ETU) greatly benefitted from using digital rather than paper records. Paper records cannot be removed from an ETU. Deborah Theobald co-founder of Vecna Technologies that created the mHealth platform in Nigeria has pointed out that, “If the patient is isolated, so is their paperwork”. Electronic records are easy to share and also lower the risk of infection for health care workers.

Mobile health policy challenges

Despite the potential benefits of mHealth, barriers in some countries prevent the full positive impact of these technologies from coming into effect. Many developing nations lack the electrical infrastructure that is necessary to power mobile devices. Health care regulations are often too overly bureaucratic and burdensome. This makes it difficult for innovators to develop and equip workers with mobile tools and applications. It often takes an emergency situation like the Ebola crisis to make substantive changes. Success in the long term is only possible if leaders create an environment that is more hospitable to mHealth.

Mobile interventions have also demonstrated potential to address important public health issues. Recently experts gathered at the Brookings Institution to discuss how mHealth can improve health outcomes. Apps like Mobile Midwife and Text4Baby can encourage healthy pregnancies by providing valuable tips to expecting mothers. Mobile health platforms are successful because they directly inform caregivers. The proliferation of mobile phones through the developing world presents a health opportunity to communicate with the people who need help.

One of the foundational notions of digital financial services has been the distinction between payment rails and services running on the rails. This is a logical distinction to make, one easily understood by engineers who tend to think in terms of hierarchies (or stacks) of functionalities, capabilities, and protocols that need to be brought together. But this distinction makes less sense when it is taken to represent a logical temporal sequencing of those layers.

It is not too much of a caricature to portray the argument —and, alas, much common practice— like this: I’ll first build a state-of-the art digital payments platform, and then I’ll secure a great agent network to acquire customers and offer them cash services. Once I have mastered all that, then I’ll focus on bringing new services to delight more of my customers. The result is that research on customer preferences gets postponed, and product design projects are outsourced to external consultants who run innovation projects in a way that is disconnected from the rest of the business.

This mindset is understandable given limited organizational, financial and human resource capabilities. But the problem with such narrow sequencing is that all these elements reinforce each other. Without adequate services (a.k.a. customer proposition), the rails will not bed down (a.k.a. no business case for the provider or the agents). In businesses such as digital payments that exhibit strong network effects, it’s a race to reach a critical mass of users. You need to drive the entire stack to get there, as quickly as possible. Unless, you develop a killer app early on, as M-PESA seems to have done with the send money home use case in the Kenyan environment.

It is tough for any organization to advance on all these fronts simultaneously. Only superhero organizations can get this complex job done. I have argued in a previous post that the piece that needs to be parceled off is not the service creation but rather cash management: that can be handled by independently licensed organizations working at arms length from the digital rails-and-products providers.

What are payment rails?

Payment rails are a collection of capabilities that allow value to be passed around digitally. This could include sending money home, paying for a good or a bill, pushing money into my or someone else’s savings account, funding a withdrawal at an agent, or repaying a loan. The first set of capabilities relates to identity: being able to establish you are the rightful owner of the funds in your account, and to designate the intended recipient in a money transfer. The second set of capabilities relates to the accounting or ledger system: keeping track of balances held and owed, and authorizing transactions when there are sufficient funds per the account rules. The third set of capabilities relates to messaging: collecting the necessary transaction details from the payment initiator, conveying that information securely to the authorizing entity, and providing confirmations.

Only the third piece has been transformed by the rise of mobile phones: we now have an increasingly inclusive and ubiquitous real-time messaging fabric. Impressive as that is, this messaging capability is still linked to legacy approaches on identity and accounting. Which is why mobile money is still more an evolution than a revolution in the quest for financial inclusion.

The keepers of the accounts —traditionally, the banks— are, of course, the guardians of the system’s choke points. There is now recognition in financial inclusion circles that to expand access to finance it is not enough to proliferate the world with mobile phones and agents: you need to increase the number and type of account keepers, under the guise of mobile money operators, e-money issuers or payment banks. But that doesn’t change the fundamental dynamics, which is that there still are choke point guardians who need to be convinced that there is a business case in order to invest in marketing to poor people, that there are opportunities to innovate to meet their needs, and that perhaps all players can be better off if only they interoperated. A true transformation would be to open up these ledgers, so anyone can check the validity of any transaction and write them into the ledger.

That’s what crypto-currencies are after: decentralizing the accounting and transaction authorization piece, much in the same way as mobile phones have decentralized the transaction origination piece. Banks seek to protect the integrity of their accounting and authorizations systems —and hence their role as arbiters of financial transactions— by hiding them behind huge IT walls; crypto-currencies such as Bitcoin and Ripple do the opposite: they use sophisticated protocols to create a shared consensus for all to see and use.

The other set of capabilities in the digital rails, identity, is also still in the dark ages. Let me convince you of that through a personal experience. My wallet was stolen recently, and it contained my credit card. I can understand the bank wanting to know my name, but why is the bank announcing my name to the thief by printing it on the credit card, thereby making it easier for him to impersonate me? The reason is, of course, that the bank wants merchants to be able to cross check the name on the card with a piece of customer ID. But as you can imagine, my national ID got stolen along with my credit card, and because of that the thief knows not only my name but also my address. That was an issue because I also kept a key to my house in the wallet. None of this makes sense: why are these “trusted” institutions subverting my sense of personal security, not to mention privacy?

The problem is that the current financial regulatory framework is premised on a direct binding of every transaction to my full legal identity. As David Porteous and I argue in a recent paper, what we need is a more nuanced digital identity system that allows me to present different personas to different identity-requesting entities and choose precisely which attributes of myself get revealed in each case, while still allowing the authorities to trace the identity unequivocally back to me in case I break the law.

The much-celebrated success of mobile money has so far really only transformed one third (messaging) of one half (payment rails) of the financial inclusion agenda. We ain’t seen nothin’ yet.

In new Urban-Brookings Tax Policy Center analysis of Earned Income Tax Credit (EITC) take-up at the county level, Benjamin Harris, a fellow in Economic Studies, and Research Assistant Lucie Parker use zip-code level data on taxes and demographics to take a "fresh look" at the EITC. "Since its creation in 1975," they write, "the Earned Income Tax Credit has played a major role in the U.S. safety net." Earlier this year, Harris presented EITC take-up using IRS data from 2007. Compare that to the new list of ten counties with the highest share of EITC recipients below:

"The regional variation EITC claiming is stark," Harris and Parker conclude. "The counties with the highest share of taxpayers claiming the EITC are overwhelming located in the Southeast. ... [O]ver half the taxpayers in a large share of counties in Alabama, Georgia, and Mississippi claim the EITC. With few exceptions, almost all counties with high EITC claiming are located in the South. Relative to the South, the Northeast and the Midwest have much lower claiming rates. Moreover, average EITC benefit closely follows the pattern for share of taxpayers taking up the credit: in counties where more taxpayers claim the credit, the credit is larger on the whole."

Visit this U.S. map interactive to get county level data on share of taxpayers claiming EITC as well as average EITC amount, in dollars, per county.

Introduction

The post-World War II era has witnessed the nearly exclusive building of low density suburbia, here termed “drivable sub-urban” development, as the American metropolitan built environment. However, over the past 15 years, there has been a gradual shift in how Americans have created their built environment (defined as the real estate, which is generally privately owned, and the infrastructure that supports real estate, majority publicly owned), as demonstrated by the success of the many downtown revitalizations, new urbanism, and transit-oriented development. This has been the result of the re-introduction and expansion of higher density “walkable urban” places. This new trend is the focus of the recently published book, The Option of Urbanism: Investing in a New American Dream (Island Press, November 2007).

This field survey attempts to identify the number and location of “regional-serving” walkable urban places in the 30 largest metropolitan areas in the U.S., where 138 million, or 46 percent, of the U.S. population lives. This field survey determines where these walkable urban places are most prevalent on a per capita basis, where they are generally located within the metro area, and the extent to which rail transit service is associated with walkable urban development.

The first section defines the key concepts used in the survey, providing relevant background information for those who have not read The Option of Urbanism. The second section outlines the methodology. The third section, which is the heart of the report, outlines the findings and conclusions of the survey.

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One of the foundational notions of digital financial services has been the distinction between payment rails and services running on the rails. This is a logical distinction to make, one easily understood by engineers who tend to think in terms of hierarchies (or stacks) of functionalities, capabilities, and protocols that need to be brought together. But this distinction makes less sense when it is taken to represent a logical temporal sequencing of those layers.

It is not too much of a caricature to portray the argument —and, alas, much common practice— like this: I’ll first build a state-of-the art digital payments platform, and then I’ll secure a great agent network to acquire customers and offer them cash services. Once I have mastered all that, then I’ll focus on bringing new services to delight more of my customers. The result is that research on customer preferences gets postponed, and product design projects are outsourced to external consultants who run innovation projects in a way that is disconnected from the rest of the business.

This mindset is understandable given limited organizational, financial and human resource capabilities. But the problem with such narrow sequencing is that all these elements reinforce each other. Without adequate services (a.k.a. customer proposition), the rails will not bed down (a.k.a. no business case for the provider or the agents). In businesses such as digital payments that exhibit strong network effects, it’s a race to reach a critical mass of users. You need to drive the entire stack to get there, as quickly as possible. Unless, you develop a killer app early on, as M-PESA seems to have done with the send money home use case in the Kenyan environment.

It is tough for any organization to advance on all these fronts simultaneously. Only superhero organizations can get this complex job done. I have argued in a previous post that the piece that needs to be parceled off is not the service creation but rather cash management: that can be handled by independently licensed organizations working at arms length from the digital rails-and-products providers.

What are payment rails?

Payment rails are a collection of capabilities that allow value to be passed around digitally. This could include sending money home, paying for a good or a bill, pushing money into my or someone else’s savings account, funding a withdrawal at an agent, or repaying a loan. The first set of capabilities relates to identity: being able to establish you are the rightful owner of the funds in your account, and to designate the intended recipient in a money transfer. The second set of capabilities relates to the accounting or ledger system: keeping track of balances held and owed, and authorizing transactions when there are sufficient funds per the account rules. The third set of capabilities relates to messaging: collecting the necessary transaction details from the payment initiator, conveying that information securely to the authorizing entity, and providing confirmations.

Only the third piece has been transformed by the rise of mobile phones: we now have an increasingly inclusive and ubiquitous real-time messaging fabric. Impressive as that is, this messaging capability is still linked to legacy approaches on identity and accounting. Which is why mobile money is still more an evolution than a revolution in the quest for financial inclusion.

The keepers of the accounts —traditionally, the banks— are, of course, the guardians of the system’s choke points. There is now recognition in financial inclusion circles that to expand access to finance it is not enough to proliferate the world with mobile phones and agents: you need to increase the number and type of account keepers, under the guise of mobile money operators, e-money issuers or payment banks. But that doesn’t change the fundamental dynamics, which is that there still are choke point guardians who need to be convinced that there is a business case in order to invest in marketing to poor people, that there are opportunities to innovate to meet their needs, and that perhaps all players can be better off if only they interoperated. A true transformation would be to open up these ledgers, so anyone can check the validity of any transaction and write them into the ledger.

That’s what crypto-currencies are after: decentralizing the accounting and transaction authorization piece, much in the same way as mobile phones have decentralized the transaction origination piece. Banks seek to protect the integrity of their accounting and authorizations systems —and hence their role as arbiters of financial transactions— by hiding them behind huge IT walls; crypto-currencies such as Bitcoin and Ripple do the opposite: they use sophisticated protocols to create a shared consensus for all to see and use.

The other set of capabilities in the digital rails, identity, is also still in the dark ages. Let me convince you of that through a personal experience. My wallet was stolen recently, and it contained my credit card. I can understand the bank wanting to know my name, but why is the bank announcing my name to the thief by printing it on the credit card, thereby making it easier for him to impersonate me? The reason is, of course, that the bank wants merchants to be able to cross check the name on the card with a piece of customer ID. But as you can imagine, my national ID got stolen along with my credit card, and because of that the thief knows not only my name but also my address. That was an issue because I also kept a key to my house in the wallet. None of this makes sense: why are these “trusted” institutions subverting my sense of personal security, not to mention privacy?

The problem is that the current financial regulatory framework is premised on a direct binding of every transaction to my full legal identity. As David Porteous and I argue in a recent paper, what we need is a more nuanced digital identity system that allows me to present different personas to different identity-requesting entities and choose precisely which attributes of myself get revealed in each case, while still allowing the authorities to trace the identity unequivocally back to me in case I break the law.

The much-celebrated success of mobile money has so far really only transformed one third (messaging) of one half (payment rails) of the financial inclusion agenda. We ain’t seen nothin’ yet.

Rooftop solar is booming in U.S. cities.

One of the most exciting infrastructure developments within metropolitan America, the installation of over a million solar photovoltaic (PV) systems in recent years, represents nothing less than a breakthrough for urban sustainability — and the climate.

Prices for solar panels have fallen dramatically. Residential solar installations surged by 66 percent between 2014 and 2015 helping to ensure that solar accounted for 30 percent of all new U.S. electric generating capacity. And for that matter, recent analyses conclude that the cost of residential solar is often comparable to the average price of power on the utility grid, a threshold known as grid parity.

So, what’s not to like? Rooftop solar is a total winner, right?

Well, not quite: The spread of rooftop solar has raised tricky issues for utilities and the public utilities commissions (PUCs) that regulate them. 

Specifically, the proliferation of rooftop solar installations is challenging the traditional utility business model by altering the relationship of household and utility—and not just by reducing electricity sales. In this respect, the solar boom has prompted significant debates in states like New York and California about the best rates and policies to ensure that state utility rules and rates provide a way for distributed solar to flourish even as utilities are rewarded for meeting customer demands. Increasingly, this ferment is leading to thoughtful dialogues aimed at devising new forms of policy and rate design that can—as in New York—encourage distributed energy resources (DERs) while allowing for distribution utilities to adapt to the new era.

However, in some states, the ferment has prompted a cruder set of backlashes. Most pointedly, some utilities contend that the “net-metering” fees paid to homeowners with rooftop installations for excess solar power they send back to the grid unfairly transfer costs to the utilities and their non-solar customers.

And so in a number of states, utility interests have sought to persuade state regulators to roll back net-metering provisions, arguing they are a net cost to the overall electricity system.  Most glaringly, the local utility in Nevada successfully wielded the cost-shift theory last winter to get the Nevada Public Utilities Commission to drastically curtail the state’s net-metering payments, prompting Solar City, Sunrun, and Vivint Solar—the state’s three largest providers of rooftop panels—to leave the Nevada market entirely. The result: New residential solar installation permits plunged 92 percent in Nevada in the first quarter of 2016.

All of which highlights a burning question for the present and future of rooftop solar: Does net metering really represent a net cost shift from solar-owning households to others? Or does it in fact contribute net benefits to the grid, utilities, and other ratepayer groups when all costs and benefits are factored in? As to the answer, it’s getting clearer (even if it’s not unanimous). Net metering — contra the Nevada decision — frequently benefits all ratepayers when all costs and benefits are accounted for, which is a finding state public utility commissions, or PUCs, need to take seriously as the fight over net metering rages in states like Arizona, California, and Nevada.  Regulators everywhere need to put in place processes that fairly consider the full range of benefits (as well as costs) of net metering as well as other policies as they set and update the policies, regulations, and tariffs that will play a critical role in determining the extent to which the distributed solar industry continues to grow.

Fortunately, such cost-benefit analyses have become an important feature of state rate-setting processes and offer important guidance to states like Nevada.  So what does the accumulating national literature on costs and benefits of net metering say?  Increasingly it concludes— whether conducted by PUCs, national labs, or academics — that the economic benefits of net metering actually outweigh the costs and impose no significant cost increase for non-solar customers.  Far from a net cost, net metering is in most cases a net benefit—for the utility and for non-solar rate-payers.

Of course, there are legitimate cost-recovery issues associated with net metering, and they vary from market to market. Moreover, getting to a good rate design, which is essential for both utility revenues and the growth of distributed generation, is undeniably complicated.  If rates go too far in the direction of “volumetric energy charges”—charging customers based on energy use—utilities could have trouble recovering costs when distributed energy sources reach higher levels of penetration. On the other hand, if rates lean more towards fixed charges—not dependent on usage—it may reduce incentives for customers to consider solar and other distributed generation technologies.  

Moreover, cost-benefit assessments can vary due to differences in valuation approach and methodology, leading to inconsistent outcomes. For instance, a Louisiana Public Utility Commission study last year found that that state’s net-metering customers do not pay the full cost of service and are subsidized by other ratepayers. How that squares with other states’ analyses is hard to parse.

Nevertheless, by the end of 2015, regulators in at least 10 states had conducted studies to develop methodologies to value distributed generation and net metering, while other states conducted less formal inquiries, ranging from direct rate design or net-metering policy changes to general education of decisionmakers and the public. And there is a degree of consensus.  What do the commission-sponsored analyses show? A growing number show that net metering benefits all utility customers:

• In 2013 Vermont’s Public Service Department conducted a study that concluded that “net-metered systems do not impose a significant net cost to ratepayers who are not net-metering participants.” The legislatively mandated analysis deemed the policy a successful component of the state’s overall energy strategy that is cost effectively advancing Vermont’s renewable energy goals.

• In 2014 a study commissioned by the Nevada Public Utility Commission itself concluded that net metering provided $36 million in benefits to all NV Energy customers, confirming that solar energy can provide cost savings for both solar and non-solar customers alike. What’s more, solar installations will make fewer costly grid upgrades necessary, leading to additional savings. The study estimated a net benefit of $166 million over the lifetime of solar systems installed through 2016. Furthermore, due to changes to utility incentives and net-metering policies in Nevada starting in 2014, solar customers would not be significantly shifting costs to other ratepayers.

• A 2014 study commissioned by the Mississippi Public Services Commission concluded that the benefits of implementing net metering for solar PV in Mississippi outweigh the costs in all but one scenario. The study found that distributed solar can help avoid significant infrastructure investments, take pressure off the state's oil and gas generation at peak demand times, and lower rates. (However, the study also warned that increased penetrations of distributed solar could lead to lower revenues for utilities and suggested that the state investigate Value of Solar Tariffs, or VOST, and other alternative valuations to calculate the true cost of solar.)

• In 2014 Minnesota’s Public Utility Commission approved a first-ever statewide “value of solar” methodology which affirmed that distributed solar generation is worth more than its retail price and concluded that net metering undervalues rooftop solar. The “value of solar” methodology is designed to capture the societal value of PV-generated electricity. The PUC found that the value of solar was at 14.5 cents per kilowatt hour (kWh)—which was 3 to 3.5 cents more per kilowatt than Xcel's retail rates—when other metrics such as the social cost of carbon, the avoided construction of new power stations, and the displacement of more expensive power sources were factored in.

• Another study commissioned by the Maine Public Utility Commission in 2015 put a value of $0.33 per kWh on energy generated by distributed solar, compared to the average retail price of $0.13 per kWh — the rate at which electricity is sold to residential customers as well as the rate at which distributed solar is compensated. The study concludes that solar power provides a substantial public benefit because it reduces electricity prices due to the displacement of more expensive power sources, reduces air and climate pollution, reduces costs for the electric grid system, reduces the need to build more power plants to meet peak demand, stabilizes prices, and promotes energy security. These avoided costs represent a net benefit for non-solar ratepayers.

These generally positive PUC conclusions about the benefits of net metering have been supported by research done by a national lab and several think tanks. Important lab research has examined how substantially higher adoption of distributed resources might look.

In a forward-looking analysis of the financial impacts of net-metered energy on utilities and ratepayers, Lawrence Berkeley National Lab found that while high use of net-metered solar generation may decrease utility shareholders' earnings, it will have a "relatively modest" impact on ratepayers. The report examined solar penetration levels that are "substantially higher than [those that] exist today" — 10 percent compared to today's 0.2 percent — and concluded that “even at penetration levels significantly higher than today, the impacts of customer-sited PV on average retail rates may be relatively modest." The report further said that utilities and regulators "may have sufficient time to address concerns about the rate impacts of PV in a measured and deliberate manner"

Similarly, a growing number of academic and think tank studies have found that solar energy is being undervalued and that it delivers benefits far beyond what solar customers are receiving in net-metering credits:

• For instance, a review of 11 net metering studies by Environment America Research and Policy Center has found that distributed solar offers net benefits to the entire electric grid through reduced capital investment costs, avoided energy costs, and reduced environmental compliance costs. Eight of the 11 studies found the value of solar energy to be higher than the average local residential retail electricity rate: The median value of solar power across all 11 studies was nearly 17 cents per unit, compared to the nation’s average retail electricity rate of about 12 cents per unit.

• A 2015 cost-benefit study of net metering in Missouri by the Missouri Energy Initiative found that even accounting for increased utility administrative costs and the shifting of some fixed expenses, net metering is a net benefit for all customers regardless of whether they have rooftop solar. The study used values for two kinds of costs and two benefits and concluded that net metering’s “net effect” is positive. The typical solar owner pays only 20 percent less in fixed grid costs and costs the utility an estimated $187 per interconnection. Meanwhile, solar owners benefit the system through reduced emissions and energy costs.

• Likewise, a study by Acadia Center found the value of solar to exceed 22 cents per kWh of value for Massachusetts ratepayers through reduced energy and infrastructure costs, lower fuel prices, and lowering the cost of compliance with the Commonwealth's greenhouse gas requirements. This value was estimated to exceed the retail rate provided through net metering.

• In yet another study, researchers at the University at Albany, George Washington University, and Clean Power Research have found that solar installations in New York deliver between 15 and 40 cents per kWh to ratepayers. The study noted that these numbers provide economic justification for the existence of incentives that transfer value from those who benefit from solar electric generation to those who invest in solar electric generation.

In short, while the conclusions vary, a significant body of cost-benefit research conducted by PUCs, consultants, and research organizations provides substantial evidence that net metering is more often than not a net benefit to the grid and all ratepayers.

As to the takeaways, they are quite clear: Regulators and utilities need to engage in a broader and more honest conversation about how to integrate distributed-generation technologies into the grid nationwide, with an eye toward instituting a fair utility-cost recovery strategy that does not pose significant challenges to solar adoption.

From the state PUCs’ perspective, until broad changes are made to the increasingly outdated and ineffective standard utility business model, which is built largely around selling increasing amounts of electricity, net-metering policies should be viewed as an important tool for encouraging the integration of renewable energy into states’ energy portfolios as part of the transition beyond fossil fuels. To that end, progressive regulators should explore and implement reforms that arrive at more beneficial and equitable rate designs that do not prevent solar expansion in their states. The following reforms range from the simplest to the hardest:

• Adopt a rigorous and transparent methodology for identifying, assessing, and quantifying the full range of benefits and costs of distributed generation technologies. While it is not always possible to quantify or assess sources of benefits and costs comprehensively, PUCs must ensure that all cost-benefit studies explicitly decide how to account for each source of value and state which ones are included and which are not. Currently methodological differences in evaluating the full value of distributed generation technologies make comparisons challenging. States start from different sets of questions and assumptions and use different data. For instance, while there is consensus on the basic approach to energy value estimation (avoided energy and energy losses via the transmission and distribution system), differences arise in calculating other costs and benefits, especially unmonetized values such as financial risks, environmental benefits, and social values. In this regard, the Interstate Renewable Energy Council’s “A Regulator’s Guidebook: Calculating the Benefits and Costs of Distributed Solar Generation” and the National Renewable Energy Laboratory’s “Methods for Analyzing the Benefits and Costs of Distributed Photovoltaic Generation to the U.S. Electric Utility System” represent helpful resources for identifying norms in the selection of categories, definitions, and  methodologies to measure various benefits and costs.

• Undertake and implement a rigorous, transparent, and precise “value of solar” analytic and rate-setting approach that would compensate rooftop solar customers based on the benefit that they provide to the grid. Seen as an alternative to ‘traditional’ net-metering rate design, a “value of solar” approach would credit solar owners for (1) avoiding the purchase of energy from other, polluting sources; (2) avoiding the need to build additional power plant capacity to meet peak energy needs; (3) providing energy for decades at a fixed prices; and (4) reducing wear and tear on the electric grid. While calculating the “value of solar” is very complex and highly location-dependent, ultimately PUCs may want to head toward an approach that accurately reflects all benefits and costs from all energy sources. Value of solar tariffs are being used in Austin, Texas (active use) and Minnesota (under development).

• Implement a well-designed decoupling mechanism that will encourage utilities to promote energy efficiency and distributed generation technologies like solar PV, without seeing them as an automatic threat to their revenues. As of January 2016, 15 states have implemented electric decoupling and eight more are considering it. Not surprisingly, it is states that have not decoupled electricity (such as Nevada) that are fighting net metering the hardest. Typically, decoupling has been used as a mechanism to encourage regulated utilities to promote energy efficiency for their customers. However, it can also be used as a tool to incentivize net metering by breaking the link between utility profits and utility sales and encouraging maximum solar penetration. Advocates of decoupling note that it is even more effective when paired with time-of-use pricing and minimum monthly billing.

• Move towards a rate design structure that can meet the needs of a distributed resource future. A sizable disconnect is opening between the rapidly evolving new world of distributed energy technologies and an old world of electricity pricing. In this new world, bundled, block, “volumetric” pricing—the most common rate structure for both residential and small commercial customers—can no longer meet the needs of all stakeholders. The changing grid calls, instead, for new rate structures that respond better to the deployment of new grid technologies and the proliferation of myriad distributed energy resources, whether solar, geothermal, or other.  A more sophisticated rate design structure, in this regard, would take into consideration three things: (1) the unbundling of rates to specifically price energy, capacity, ancillary services,  and so on; (2) moving from volumetric bloc rates to pricing structures that recognize the  variable time-based value of electricity generation and consumption (moving beyond just peak versus off-peak pricing to  fully real-time pricing); and (3) moving from pricing that treats all customers equally to a pricing structure that more accurately compensates for unique, location-specific and technology specific values.

• Move towards a performance-based utility rate-making model for the modern era. Performance based regulation (PBR) is a different way of structuring utility regulation designed to align a utility’s financial success with its ability to deliver what customers and society want. Moving to a model that pays the utility based on whether it achieves quantitatively defined outcomes (like system resilience, affordability, or distributed generation integration) can make it profitable for them to pursue optimal grid solutions to meet those outcomes. The new business model would require the PUC and utilities to make a number of changes, including overhauling the regulatory framework, removing utility incentives for increasing capital assets and kilowatt hours sold, and replacing those incentives with a new set of performance standard metrics such as reliability, safety, and demand-side management. New York’s Reforming the Energy Vision  proceeding is the most high-profile attempt in the country to implement a PBR model.

Options also exist for utilities to address the challenges posed by net metering:

• Utilities, most notably, have the opportunity to adjust their existing business models by themselves owning and operating distributed PV assets (though not to the exclusion of other providers).  On this front, utilities could move to assemble distributed generation systems, such as for rooftop solar, and sell or lease them to homeowners. In this regard, utilities have an advantage over third-party installers currently dominating the residential rooftop solar industry due to their proprietary system knowledge, brand recognition, and an existing relationship with their customers. Utilities in several states such as Arizona, California, and New York are investigating or have already invested in the opportunity.

• Furthermore, utilities can also push the envelope on grid modernization by investing in a more digital and distributed power grid that enables interaction with thousands of distributed energy resources and devices.

Ultimately, distributed solar is here to stay at increasing scale, and so state policies to support it have entered an important new transitional phase. More and more states will now likely move to update their net-metering policies as the cost of solar continues to drop and more homeowners opt to install solar panels on their homes.

As they do that, states need to rigorously and fairly evaluate the costs and benefits posed by net metering, grid fees, and other policies to shape a smart, progressive regulatory system that works for all of the stakeholders touched by distributed solar.

Utilities should have a shot at fair revenues and adequate ratepayers. Solar customers and providers have a right to cost-effective, reliable access to the grid. And the broader public should be able to expect a continued solar power boom in U.S. regions as well as accelerated decarbonization of state economies. All of which matters intensely. As observes the North Carolina Clean Energy Technology Center and Meister Consultants Group: “How key state policies and rates are adapted will play a significant role in determining the extent to which the [solar PV] industry will continue to grow and in what markets.”

There are now more than 335 Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) in 47 states, DC, and Puerto Rico. Early results show that most Medicare ACOs are succeeding at meeting their quality benchmarks, but only about a quarter of MSSP participants have been able to reduce their spending enough below projected financial targets to qualify for shared savings. While these results are encouraging, especially given the financial and practice transformation necessary to succeed as an ACO, they also suggest that more work is needed from both CMS and the providers to ensure continued sustainability of the MSSP ACOs.

Given that the first three year cycle of MSSP ends in 2015 and more providers will likely be entering the MSSP in the coming years , the Centers for Medicare and Medicaid Services (CMS) has indicated that they intend to release a Notice of Proposed Rulemaking (NPRM) that will establish the rule for participation in the Medicare ACO program. In anticipation of these coming changes, the Engelberg Center for Health Care Reform released an issue brief that identifies the "Top Eight ACO Challenges" to encourage further discussion and considerations for ensuring the continued success of ACOs. These potential policy alternatives build on discussions with ACO Learning Network members and other related stakeholders implementing accountable care across the country and include the following issues.

These issues, and many others, will be a focus of the discussions at the upcoming Fifth National ACO Summit later this week.

Top Eight Medicare ACO Challenges

1. Make Technical Adjustments to Benchmarks and Payments
In order for ACOs to qualify for shared savings, they must be able to hold spending below a financial benchmark set using historical spending patterns and meet a certain threshold of person and population-level quality metrics. A number of issues should be considered that affect the ACO’s chances of being able to attain shared savings and have more predictability about their performance: benchmark calculation methodology, how to adjust for regional variation in performance, and risk adjustment.

2. Transition to More Person-Based Payments
The ultimate goal of an ACO is to improve quality at the patient and population level and control the growth of health care costs. In order to successfully achieve this mission, ACOs must over time make a transition to payments that involve the assumption of more risk by the provider organization with a reward for better health outcomes for groups of patients. ACOs must have a clear transition path for increasing accountability and assumption of more risk for patient health outcomes.

3. Increase Beneficiary Engagement
Patients can play a critical role in helping to achieve the goals of an ACO. Health outcomes are determined by whether patients follow prescribed therapies. Increasing beneficiary engagement holds the potential to make patients more activated members of the ACO who can contribute to its success. A number of issues should be considered to improve beneficiary engagement, including adjusting attribution methods, creating more incentives for patients to seek care within the ACO, and finding opportunities to activate patients as part of the care team.

4. Enhance and Improve Alignment of Performance Measures
A central tenet of Medicare ACOs is delivering high quality health care as determined by performance on 33 measures established by CMS. ACOs must meet performance benchmarks in order to be eligible for shared savings, ensuring that these organizations are delivering high value, rather than simply cheaper, care. A number of barriers exist to achieving better performance measurement, including administrative burdens, lack of measure alignment among payers, lack of rewards for quality improvement, and concerns about measure selection.

5. Enable Better and More Consistent Supporting Data
In order to succeed as an ACO, organizations must be able to effectively collect, interpret, and use clinical and claims data to transform care of their patients. ACOs need to adopt new health IT systems and other technologies in order to collect and use the growing amount of data. ACOs currently struggle with reconciling data between different sources, dealing with patients who opt out of data sharing, lack of timeliness for receiving data, difficulty of tracking patients through the health system, and delays in performance feedback.

6. Link to Additional Value-Based Payment Reforms
ACOs are just one of many payment reforms that health care organizations across the country are implementing to improve quality and reduce costs. Aligning the vision and components of these other initiatives with ACO reforms has the potential to reinforce the shared goals and fundamentally change the health system. However, there are barriers to achieving this alignment such as lacks of linkages to bundled payments and other new payment models, multi-payer ACOs with different payment systems, and inability for organizations to participate in multiple CMS payment innovations.

7. Develop Bonus Payments and Other Incentives to Participate
In order to effectively transform clinical practice, ACOs must create or procure significant financial and human capital, as well as transform their information technology and delivery infrastructure. A recent survey estimates the average start-up cost for creating an ACO to be $2 million, with some ACOs investing significantly more in their first few years. Many ACOs, especially smaller ones, struggle to find sufficient start-up capital, are uncertain if they can assume the level of risk required for an ACO, and need significant staff and clinical change to effectively transform care.

8. Support Clinical Transformation
Becoming and succeeding as an ACO is a vast undertaking that requires immediately beginning to transform practice, finance, and operations. However, many providers, particularly those that are less experienced at systemic practice transformation, need more support in undertaking clinical transformation.

Downloads

• Issue Brief: Improving the Medicare ACO Program

British politics is starting to resemble a bowling alley. One after another, political figures are tumbling–including the leading lights of the Brexit campaign. They sowed the wind and now are reaping the whirlwind.

First to topple was the prime minister. After the referendum, David Cameron announced that he would step down. Last week fellow Conservative Boris Johnson, the leading light of the Brexit campaign, said he would not run to succeed Mr. Cameron after his ally Michael Gove, the justice secretary, concluded, in quintessentially British style, that Mr. Johnson lacked “the team captaincy” required. Then Nigel Farage stepped down as leader of the UK Independence Party, saying “I want my life back.” Labour Party leader Jeremy Corbyn has lost the support of his parliamentary colleagues and may be next to fall.

The exit of the leading Brexiteers is a relief. The skills required to run a populist, fact-averse campaign are not the same skills needed to lead a nation. For all his mercurial talents, on full display during his colorful stint as mayor of London, Boris Johnson would have been a disastrous prime minister. The alternatives–especially Mr. Gove and Home Secretary Theresa May–are steadier souls. Both are also better positioned to unite Conservative members of Parliament and hold on until the next scheduled general election, in 2020.

Mr. Corbyn is likely to go; the question really is when. It he doesn’t, the Labour Party will break apart. In his case the departure will be only slightly about the vote to remain in or leave the European Union. Broadly, his fellow Labour MPs didn’t want him as their leader in the first place; it was the votes of more left-wing party members that propelled him to the leadership, and many see him as an electoral liability. (He is.)

There is no direct connection between Brexit and Donald Trump. But a few things can still be deduced on this side of the pond. First, Mr. Trump may succeed in making the connection tighter. His immediate announcement that the vote was about “declaring independence” reflected his sharpening political instincts. The day after the vote, Mr. Trump said: “The people of the United Kingdom have exercised the sacred right of all free peoples. They have declared their independence from the European Union. … Come November, the American people will have the chance to re-declare their independence. Americans will have a chance to vote for trade, immigration and foreign policies that put our citizens first.”

Independence is a powerful populist theme, one Mr. Trump is likely to exploit it to its fullest.

Brexit and the economic and political chaos it has already sparked are proof that no matter how crazy or far-fetched an electoral outcome appears, it can happen. Right up to the last minute, many believed that even if the vote were close, it would be to remain in the EU. At some level we just couldn’t imagine the alternative. Maybe Mr. Cameron and Mr. Corybn felt the same, which is why they were so complacent. Not so, the other side.

All this suggests the wisdom of treating every poll with a fistful of salt. Electorates are becoming more volatile and more visceral. Pollsters are getting it wrong as often as they get it right. The last general election in the U.K. is another case in point. Populist sentiment wrecks standard political models. When people are angry, they don’t weigh the costs and benefits of their actions in the usual way; that’s true in life and it’s true in voting.

It’s also why it’s risky to allow populist campaigners near the levers of power. I’ve written in this space before about the dangers of injecting direct democracy in a parliamentary political system. Think of referendums as akin to Ming vases: something rare, to be handled with great care. The British Parliament is now acting as a firebreak. The leading populists will not get the keys to 10 Downing Street.

But the United States holds direct elections for president. If Donald Trump wins in November, he will assume the most powerful office in the world. There is no firebreak, no buffer, no second chance.

Editor's note: This piece originally appeared on the Wall Street Journal's Washington Wire blog.

A major oil spill will result in cleanup spending that boosts GDP, but no one thinks oil spills are good. Oil spills and other forms of pollution are examples of negative externalities — harm caused to others by the economic activity of a firm or industry. These externalities represent a failure of the market, and unless there is corrective action, their presence means that there is too much production of something that causes negative spillovers.

That criticism can be applied to the financial services industry. Many say that it grew too large, triggered a financial crisis and damaged the rest of the economy. Is that still the case, and is financialization spoiling the economy? Despite the alarmist rhetoric around today’s finance sector, the answer is generally “no” because of changes made to financial regulation.

First, a check on the facts: How large is the industry and how much has it grown? The broad definition of the financial sector includes finance, insurance and real estate, known by the acronym “FIRE.” It was 17.5 percent of gross domestic product in 1990 and rose to 20.0 percent in 2014, but that figure is misleading as it includes office and apartment rents and leases — stuff that has little to do with Wall Street.

Finance and insurance separately peaked well before the financial crisis at 7.7 percent of GDP, which was up from 5.8 percent in 1990. In 2014, it was 7.0 percent of GDP. Employment in finance and insurance has been on a downtrend since 2003 and is currently 4.25 percent of total nonfarm payrolls. Most of those jobs are in offices and bank branches around the country. (The output data given here are drawn from the Bureau of Economic Analysis, GDP by Industry data. The employment data are from the Bureau of Labor Statistics, Payroll Employment data. Author’s calculations.)

Still, salaries and bonuses at the top are extremely attractive, so perhaps the externality plays out by drawing the best and brightest away from other more productive activities. The Harvard Crimson reported that in 2007, 23 percent of graduating Harvard seniors said they planned to enter finance. That is an impressive number, but things turned around sharply, with the 23 percent figure falling to 11.5 percent in 2009 after the financial crisis. At this point, the financial industry really isn’t large enough to crowd out other parts of the economy.

Meanwhile, the insurance industry serves an important social purpose providing life, property, and casualty insurance. AIG got into trouble in the crisis because it strayed into providing very risky financial services, not because of its main insurance business. Likewise, the core value of banks is financial intermediation between savers and investors, giving savers relatively secure and liquid assets while also funding investment.

There are critics of how well our banking industry serves this core purpose, a quality that is hard to determine. My judgment is that it does the job pretty well compared to most other countries. As the IMF reported in September 2015, the non-performing loan problem among European banks remains severe, whereas most U.S. banks now have strong balance sheets. Good financial intermediation means that most of the savings dollars are transferred to investors and are not lost through inefficient bank operations. A 2002 study that I participated in found bank productivity higher in the United States than in France or Germany.

The parts of the financial sector that give rise to the most concern are market-making, deal-making and the creation and trading of derivatives on Wall Street. The volume of market trading has increased exponentially because of the increased speed of computers and communications. Up to a certain point, the increased volume is helpful because it adds to the liquidity of markets, but the advent of high-frequency trading has taken us over the top. As Michael Lewis describes in his book Flash Boys, the high speed traders are finding ways to shave milliseconds off the time needed to make trades. That is thoroughly wasteful. As for deal-making, it has been going on for a long time — indeed the go-go years for deals were in the 1980s — so it is hard to blame the recent slowing of economic growth on this activity.

Still, the explosion of derivatives and other overly-complex instruments was problematic, and it is crystal clear that the mortgage market became too opaque and removed accountability from the system. The layering of complex derivatives on top of lousy mortgages (and other shaky assets) distorted the economy, resulted in the overbuilding of houses, and caused the financial crisis. There are plenty of people at fault besides the bankers, but the smart people on Wall Street were driving the process, and they should have known better. The excessive financialization obscured the reality of loans that depended upon ever-rising home prices and thus were never going to be paid back. There was an externality because the private calculations of potential profit ignored the risks being imposed on society.

Is that still the situation today? No. Things have changed. Banks and other financial institutions that create risks for the whole economy are now required to hold sufficient capital to cover losses even in periods of economic and financial stress, plus a liquidity buffer (they must pass “stress tests” administered by the Federal Reserve). The screws have been turned pretty tight, and the owners of large financial institutions will bear the costs of future failures — not taxpayers. This brings private incentives in line with the public interest, getting rid of the externality that gave us too much financialization in the first place. But to keep the future safe, we’ll have to make sure no one forgets what happened in the last crisis, and ensure that new risks are not created in other, less-regulated parts of the industry.

Editor's note: This piece originally appeared in the Washington Post.

Even before the eruption of anti-Muslim rhetoric in the past several weeks, I had a privileged position from which to observe the deep current of Islamophobia that ran beneath the crust of mainstream politics over the fourteen years since 9/11. Because I work on Islamist extremism, my dad often forwards emails about Americans Muslims he receives from friends to ask if they are true. I don’t blame him for asking: they’re truly scary. Muslims imposing Sharia law over the objections of their fellow Americans. Muslims infiltrating the U.S. government to subvert it. And so on.

But as with most Internet rumors circulated over email, the vast majority of the scary reports aren’t true. Take a peek at the “25 Hottest Urban Legends” on the rumor-busting website Snopes and you’ll see what I mean. The 11th on the list is about Muslim passengers on an AirTran flight that attempted a dry run to bring down a plane (they didn’t). The 15th is about an American Muslim who oversees all U.S. immigration (she just coordinates special naturalization ceremonies). The underlying message is that American Muslims are not to be trusted because of their religion.

One reason these rumors have currency is that most Americans don’t know many of their Muslim neighbors. For all the worry of a Muslim takeover, there are only around 4 million in this country, a little over 1 percent of the total population. Most of them do not live in Republican strongholds, where they are most feared.

[A]s with most Internet rumors circulated over email, the vast majority of the scary reports aren’t true.

Of course, familiarity does not always lessen fears or tensions. But it does complicate easy stories about an unfamiliar culture and those who identify with it. For example, because I’ve worked on counterterrorism in the U.S. government, I’ve never bought the story that American Muslims are infiltrating the U.S. government to subvert it. I’ve simply met too many Muslims in the government working impossible hours to keep this country and its Constitution safe.

American Muslims have their own easy stories to tell about non-Muslims that could use some complicating. Several of my Muslim friends have been surprised at the number of non-Muslim strangers who’ve come up to them and voiced their support. They’re surprised, presumably, because they assume that most non-Muslims in this country agree with Trump's rhetoric, which they don’t.

Some American Muslims view Islamophobia a natural outgrowth of white American racism, religious bigotry, and xenophobia. That easy story may account for some Islamophobia but it ignores something major: actions by Muslims to deliberately set non-Muslims against them. Jihadist groups like al-Qaida and ISIS carry out attacks in this country to create popular backlash against Muslims in hopes of recruiting those who are angered by the backlash. 

Even though most Muslims reject the siren call of the jihadists, the backlash still leads some Muslims to expect the worst of nonbelievers and of the American government. Like the anti-Muslim rumor mill, they spread half-truths about Christian vigilante violence and government plots. For example, at least one prominent religious leader in the American Muslim community has insinuated that the San Bernardino attackers were patsies in a government conspiracy against Muslims. 

My hope is that we’ll all try to be a little less suspicious of one another’s motives and a little more suspicious of the easy stories we tell.

Since it’s the holiday season, I shall indulge in a wish for the New Year. My hope is that we’ll all try to be a little less suspicious of one another’s motives and a little more suspicious of the easy stories we tell. I know the wish is fanciful given the current political climate but I’ve been struck by the number of Americans—Muslim and non-Muslim—who have been willing to confront their biases over the past few weeks and see things from the other side. If our enemies succeed by eroding our empathy for one another, we will succeed by reinforcing and expanding it.