Next Sunday’s first round of the Tunisian presidential election is unlikely to produce an outright winner but the country can already lay claim to the most democratic success story in the uncertain post-Arab Spring period.

Earlier this year, the Islamist-led National Constituent Assembly in Tunis produced a pluralist constitution that set the stage for a parliamentary contest on October 26 in which the incumbents lost. That simple fact of political alternation is a historic milestone: Ennahda is not the only Islamist party to lose the confidence of its initial protest-vote electorate, but it is the first to live to tell the tale.

Islamist participation in the democratic process

The birthplace of the Arab Spring offers a tantalizing third way toward Islamist participation in the democratic process: a Goldilocks outcome between Turkish majoritarianism and Egyptian militarism. Tunisia is different: it is smaller, lacks a hegemonic army, and Ennahda doesn’t have anywhere near a majority of votes.

The alluring tableau, however, conceals a fragmented elite and a scattered electorate. Twenty-seven parties declared candidates for president, although a handful have dropped out. Last month, more than 15,000 candidates running on over 1,300 party lists vied for 217 parliamentary seats. Only two-fifths of eligible adults registered to vote and less than two-thirds of them actually voted.

The main pattern to emerge from parliamentary elections is the same that has defined the country for decades: an existential battle between Islamists and anti-Islamists with a majority for neither. The Islamists lost six percentage points (32 percent) but the secularists were not exactly embraced. Taking into account non-registration and abstention, the victorious party Nidaa Tounes’s share of the legislative vote (38 percent) corresponds to roughly one out of five eligible voters.

These results accurately reflect a highly polarized society. Nidaa Tounes is led by presidential frontrunner Beji Caïd Essebsi, an 87-year-old who served under every regime since 1956 independence and who stoked voters’ fear of Ennahda’s “seventh century project” during the campaign. Ennahda’s leadership framed the election as a contest “between supporters of the revolution and supporters of the counter-revolution.” It is the only Muslim-majority country where nearly half of the population claims to never step foot in a mosque.

Do Tunisians favor “authoritarian government”?

For the first time since the 2011 revolution, polling this summer showed a majority of Tunisians favoring “authoritarian government” over an “unstable” democratic government. Also for the first time, Ennahda declined to field a presidential candidate to contain apprehensions about them. While Essebsi mostly enjoys an untainted reputation his party, Nidaa Tounes is a loose coalition including many holdovers from the previous regime.

The last time electoral democracies experienced a comparable juncture was not in 2013 Cairo or Gezi Park, but rather Rome during the tense 1970s. In 1976, the Italian Communist Party received one-third of the votes, making it the largest Communist electoral bloc west of the Iron Curtain. Frequent small-scale terrorist attacks took place against the backdrop of global tensions between NATO and Warsaw Pact members.

It is hard to remember a time when the term “socialism” provoked as much angst as “Sharia” does today, but Tunisia stands at a crossroads analogous to the old Cold War alternatives of Washington and Moscow, with Qatar and other Gulf states filling the shoes of the old “evil empire.”

Recognizing that Italy was too divided to govern alone, party leader Enrico Berlinguer proposed a historic compromise (compromesso storico) with the archenemy Christian Democrats to bridge a seemingly impassible cultural-political gap.

Ennahda party faces doubts

Today’s Ennahda party faces the same doubts as Communist leaders in postwar Europe: are they truly pluralist democrats? Do they accept power sharing? The executive director of Nidaa Tounes, Mondher Belhadj Ali, said in an interview in Tunis earlier this year that Ennahda must undergo the equivalent process of the various leftist parties in Europe during the Cold War. The party needs to renounce its “jihadist logic,” Belhadj said, in the same way that the German left distanced itself from international Marxist-Leninist creed at Bad Godesberg in 1959.^[1]

To be considered trustworthy despite its association with a revolutionary ideology, the Italian Communist Party (Partito Comunista Italiano, or PCI) underwent key shifts. Its leadership broke with the international Comintern by supporting Italy’s NATO membership. They also refused Moscow’s order of “intransigence” through silent partnership with a Christian Democrat-led government, giving way to the “via Italiana” – an Italian path – to socialism.

Why did the PCI pursue this path at a moment of rising strength, when their share of the vote was peaking at 32 percent? Italian Communists had no doubt noticed that NATO countries were willing to forego democratic outcomes in Chile three years earlier in the name of political stability and anti-communism.

“Alternative to the Islamic State”

It is also apparent that Ennahda’s leadership has correctly interpreted the West’s silence after the arrest of Egypt’s first democratically elected president last year. The party’s agreement to omit the word “Sharia” from the constitution, its decision to ban the extremist group Ansar Echaria and its voluntary departure from political posts in 2013 have been taken as early signs of a willingness to compromise. There is no exact Islamist equivalent to Moscow and the Comintern, but Ennahda has offered itself up as “the alternative to the Islamic State.” Ennahda has also adopted an official party line not to govern alone but only in alliance with other parties. Party leader Rached Ghannouchi said he hopes to avoid “the repetition of the Egyptian bilateral polarizing model.”

Political pressure already forced Ennahda and its partners to wage not merely ideological but also actual military war on violent Islamist extremism. The martyrs of the Tunisian Revolution now include not only the two secular politicians who were assassinated in the first half of 2013 but also the 39 Tunisian soldiers who have been killed since then – including five in an attack earlier this month.

The interim government has not hesitated to combat religious enemies of the state. President Moncef Marzouki, a human rights activist, looked ashen in an interview in his office this summer: “I deeply regret it: it means killing and arresting people but I have to defend this state” – at times leading to the deaths of a dozen combatants per month, including six on election weekend.^[2]

In the years since the revolution, through a mixture of coercion and conviction, the religious affairs ministry whittled down the number of prayer spaces under the control of Salafi extremists from over 1000 in 2011 to under 100 today. This summer, the government fired an imam who refused to say prayers for a soldier who died in a raid on an Islamist cell.”^[3]

Like Berlinguer before him, Ghannouchi has made timely visits to meet with American officials and offer democratic reassurances – but to far greater effect than the Italian Communists ever managed. Washington’s reception of the PCI is captured by the chiaroscuro headshot of Berlinguer on a June 1976 cover of Time declaiming “The Red Threat.” In 2012, the magazine named Ghannouchi one of the “World’s Most Influential People,” someone who offers “a vision of a moderate, modern and inclusive political movement.”

Critics will point out that shortly after the compromesso storico, the Communist Party’s electoral base bottomed out. Left-wing terrorism did taper off but not before the Red Brigades kidnapped and executed the Communists’ main Christian Democratic interlocutor, former Prime Minister Aldo Moro, in 1978.

Compromise may lead to national unity

With counterterrorism support to resist such extremist violence on the fringes and more enthusiastic backing from Western capitals, however, a Tunisian historic compromise may yet deliver the national unity that the country needs to advance to self-confident partisan rule – and mutual faith in political alternation. The recent announcement of joint U.S.-Tunisian counter-terrorism exercises and a gift of $14 million worth of equipment and supplies are small in scale but their timing conveys a broader reassurance.

The lack of a clear political mandate may turn out to be the hidden advantage of this inaugural election season in Tunisia. The country’s political parties can now use the first full presidency and parliamentary session of a democratic Tunisia to blaze a third way between military rule and majoritarian Islamist democracy.

Just as Italian communism was a different animal than the Soviet Communist Party, Tunisian exceptionalism is a real thing. The accelerated modernization period under Independence leader Habib Bourguiba after decolonization left behind the lowest illiteracy rate and lowest birthrate in the neighborhood. Its relatively peaceful democratic revolution has now passed several institutional milestones. As President Moncef Marzouki put it, “if the experiment in Islamic democracy doesn’t work here then it’s unlikely to work anywhere.”^[4]

The Italian Communist Party voted to dissolve itself almost 24 years ago, not long after the Berlin Wall fell and sealed its obsolescence. An equivalent geopolitical shift in Sunni Islam – away from the hegemony of ideologically rigid Gulf States – is as unimaginable now as was the thaw of November 1989. But a great compromise between the region’s modern nemeses – secularist and Islamist – could well dislodge the first brick.

An American drone strike that killed leader of the Afghan Taliban Mullah Akhtar Mohammed Mansour may seem like a fillip for the United States’ ally, the embattled government of Afghanistan’s President Ashraf Ghani. But as Vanda Felbab-Brown writes in a new op-ed for The New York Times, it is unlikely to improve Kabul’s immediate national security problems—and may create more difficulties than it solves.

The White House has argued that because Mansour became opposed to peace talks with the Afghan government, removing him became necessary to facilitate new talks. Yet, as Vanda writes in the op-ed, “the notion that the United States can drone-strike its way through the leadership of the Afghan Taliban until it finds an acceptable interlocutor seems optimistic, at best.”

[T]he notion that the United States can drone-strike its way through the leadership of the Afghan Taliban until it finds an acceptable interlocutor seems optimistic, at best.

Mullah Mansour's death does not inevitably translate into substantial weakening of the Taliban's operational capacity or a reprieve from what is shaping up to be a bloody summer in Afghanistan. Any fragmentation of the Taliban to come does not ipso facto imply stronger Afghan security forces or a reduction of violent conflict. Even if Mansour's demise eventually turns out to be an inflection point in the conflict and the Taliban does seriously fragment, such an outcome may only add complexity to the conflict. A lot of other factors, including crucially Afghan politics, influence the capacity of the Afghan security forces and their battlefield performance.

Nor will Mansour’s death motivate the Taliban to start negotiating. That did not happen when it was revealed last July’s the group’s previous leader and founder, Mullah Mohammad Omar, had died in 2013. To the contrary, the Taliban’s subsequent military push has been its strongest in a decade—with its most violent faction, the Haqqani network, striking the heart of Kabul. Mansour had empowered the violent Haqqanis following Omar’s death as a means to reconsolidate the Taliban, and their continued presence portends future violence. Mansour's successor, Mawlawi Haibatullah Akhundzada, the Taliban’s former minister of justice who loved to issue execution orders, is unlikely to be in a position to negotiate (if he even wants to) for a considerable time as he seeks to gain control and create legitimacy within the movement.

The United States has sent a strong signal to Pakistan, which continues to deny the presence of the Afghan Taliban and the Haqqani network within its borders. Motivated by a fear of provoking the groups against itself, Pakistan continues to show no willingness to take them on, despite the conditions on U.S. aid.

Disrupting the group’s leadership by drone-strike decapitation is tempting militarily. But it can be too blunt an instrument, since negotiations and reconciliation ultimately depend on political processes. In decapitation targeting, the U.S. leadership must think critically about whether the likely successor will be better or worse for the counterinsurgency endgame.

From the Arab-Israeli conflict, to the paradigm shift of the Arab Spring, to attacks on U.S. government personnel in Egypt and Libya, to the potentially explosive situation in Syria--events in the greater Middle East region continue to resonate here at home. In a recent study, “Americans on the Middle East,” Nonresident Senior Fellow Shibley Telhami finds that Americans have a great understanding and concern about Middle East events. Learn more about these findings in this episode of @ Brookings.

Video

• Shibley Telhami: What Americans Think about the Middle East

Media coverage of the Islamic State has focused on the group’s grotesque use of violence and archaic governance style. Less attention has been paid, however, to the institutions that make those practices possible—institutions that lend the group legitimacy, at least in the eyes of supporters, as a sovereign state. In her new Brookings Analysis Paper, “The legal foundations of the Islamic State,” Mara Revkin argues that legal institutions play a critical role in the Islamic State’s state-building project. Those structures help the group take and keep territory, as well as provide a measure of accountability to the people living under its rule.

Lesser evil?

Revkin writes that “the Islamic State has attempted to ingratiate itself with civilians by claiming that its legal system is comparatively more legitimate and effective than the available alternatives.” The Syrian and Iraqi governments, Revkin explains, are often perceived as being highly corrupt and ineffective. The Islamic State is able to gain civilians’ favor by arguing that its political and legal institutions are more legitimate than those of the Syrian and Iraqi governments or rival armed groups. She adds: “some Syrians and Iraqis seem to prefer the legal system of the Islamic State to the available alternatives not because they agree with its ideology, but simply because they regard it as the lesser evil.” 

The Syrian and Iraqi governments...are often perceived as being highly corrupt and ineffective.

Revkin writes that for the Islamic State, shariah law is “the only legitimate basis for governance.” In cases where shariah fails to address modern-day problems, she explains, religiously legitimate authorities appointed by the Islamic State—such as military commanders, police officers, and the caliph himself—can issue legal decisions as long as they do not conflict with the divine rules of shariah or harm the welfare of the greater Muslim community. Alongside this is a system of rules and regulations to “govern civilians, discipline its own officials and combatants, and control territory” in areas of rights and duties, behavior, property, trade, and warfare. 

Making the state possible

Legal institutions help the Islamic State advance three main state-building objectives, in Revkin’s view: 

1. First, they support the Islamic State’s territorial expansion by “legitimizing [its] claims to sovereignty, justifying the expropriation of the property and land of enemies, and building goodwill with civilians.” 
2. Legal institutions also allow the Islamic State to enforce compliance and accountability of its own members and maintain internal control and discipline. Revkin describes various types of punishments the Islamic State uses to discipline its own members—these punishments are important, she writes, because “no government can establish itself as legitimate and sovereign without policing the behavior of the people who are responsible for implementing its policies.”
3. Finally, Revkin explores the legal institutions surrounding the Islamic State’s tax policies, which are “critical to financing the Islamic State’s governance and military operations.” Courts and judges, she explains, are crucial to “administering and legitimizing” taxation and justifying “economic activities that might otherwise resemble theft.” 

Weaknesses in the system

Although the Islamic State claims to have legitimate governing authority, based on a defined legal system, that system faces vulnerabilities. Revkin writes, for instance, that reports of corruption and extra-legal violence are “threatening the organization’s long-term sustainability and undermining its ability to win the trust and cooperation of civilians.”

Amid recent signs that the group is losing strength, Revkin argues that it’s struggling to maintain its own moral standards. To further weaken the Islamic State, she recommends working to undermine those institutions. The trouble is, as Revkin points out: “the Islamic State came to power largely by exploiting the weakness and illegitimacy of existing institutions” in Iraq and Syria. Thus, a sustainable plan for ultimately destroying the organization must also involve strengthening political and legal institutions in those countries. 

ACOs have to assess both the opportunities and the challenges in pursuing risk based payment arrangements. However, there are key strategies ACOs can adopt to help with the transition to greater financial accountability, and higher levels of performance. On July 16^th, our ACO Learning Network hosted a webinar that explored critical success factors and barriers, as well as potential lessons for ACOs to increase their risk-bearing capacity.

Different Payment Models Pose Unique Challenges

Drawing upon an issue brief authored with colleagues from the American Academy of Actuaries, Greger Vigen highlighted some of the actuarial concerns inherent in various risk-based payment models. For example, when organizations undertake one-sided or “bonus only” shared savings arrangements, the arrangement should create incentives that are adequately aligned across the system to reward physicians that are providing not just cost-efficient, but also high-value, care. They must also find ways to create additional non-financial support when the size of provider shared savings is minimal. Both one-sided and two-sided shared savings models can lead to complex calculations in determining the true amount of savings resulting from the arrangement. Organizations undertaking bundled or episode-based payments must clearly determine what is included in specific bundles in order to justify assuming risk for those services.  Although partial capitation lends itself to an increased level of risk by creating strong incentives to reduce inefficiencies in certain parts of the system, such arrangements create effects on areas not covered by the partial capitation arrangement. Finally, by virtue of the increased risk level, global payment arrangements raise solvency considerations for organizations and require significant investment in infrastructure (or use resources from aligned partners) to manage utilization and facilitate appropriate organizational culture change. As programs move forward, there may be a combination of approaches used, including broad risk sharing or partial capitation arrangements between buyer and provider organizations. At the same time, more focused initiative may be used between the provider organization and the provider partners, such as bundled payments or partial capitation to certain providers. 

Critical Elements of High Performing Systems

Regardless of which risk-type arrangements ACOs choose to pursue, there are some critical elements that most high-performing systems share. According to Vigen, high-performing systems typically use a highly analytic process to understand their performance over time, rely on financial committees that are clear and “blunt” about the organization’s financial state, have in place multiple targeted financial initiatives, use payment reform to show how expenses could reduce revenue across multiple specific cases, have advanced clinical reporting systems, develop strong partnerships within and outside the organization to transform care, and use “next generation” analytic tools from outside organizations. Vigen contends that, in order to succeed at true transformation, organizations must develop initiatives aimed specifically at financial results, to supplement other initiatives designed to simply improve quality.  Building around these initiatives provides targeted results that can effectively engage and utilize actuaries. Actuaries and other external partners can help ACOs to more fully address financial issues and develop a framework for the prioritization and allocation of resources that identifies which existing processes to discontinue and which new processes to initiate.

Jim Whisler, a Principal at Deloitte Consulting, added that there are a number of opportunities to realize savings, many of which can be achieved through reducing variation. He emphasized that ACOs should take advantage of “low hanging fruit” that decrease utilization and optimize costs, such as ensuring appropriate use of generic and specialty pharmaceuticals, reducing inpatient stays, increasing use of ambulatory surgery center (ASC), and understanding appropriate use of lab, radiation, MRI, and CT scans. Savings and gain sharing can also vary between the different providers—primary care, specialists, and hospitals.  Ultimately, actuaries and clinical staff alike must be able to analyze data and pinpoint the true drivers of variation.

Effective Strategies Can Yield Significant Cost and Quality Improvements

In order to shed more light on how these strategies can be deployed in health systems, Bart Wald, Chief Executive for Physicians Services at Providence Health and Services, discussed the approaches that he undertook as President and CEO of Physician Associates of the Greater San Gabriel Valley, an IPA in California. Unlike compensation in most IPAs, which often relies either on fee-for-service (FFS) or capitation, Physician Associates, developed a system that uses a combination of both payment models. While capitation has traditionally been used more for primary care physicians (PCPs) than specialists, Dr. Wald emphasized that developing financial incentives for specialists was critical to effectively engaging them.  In his mind, specialists must be integrated and engaged in order to create a truly effective model. The IPA also created a “peer satisfaction” bonus program, in which PCPs and specialists rate each other and those attaining the highest ratings are given an additional bonus payment. The ratings are also posted on the web to increase transparency, and impact physician behaviors. In addition to engaging specialists, Physician Associates made sure to integrate hospitalists into the care team and incorporate social services and mental health staff.

The IPA was able to further transform care by building a population health infrastructure that directed funds towards ambulatory care management, patient-centered medical home (PCMH) development, complex care centers and disease management programs for vulnerable patients. They have also focused on improving the collection and sharing of patient data to better manage generic drug utilization, prescribing and adherence; track and attempt to minimize care received by patients outside of the physician network; and ensure effective continuity of care across the system. In summary, Dr. Wald stressed a number of factors for succeeding at risk-sharing—engaged practice members, adequate physician incentives to improve care performed in the outpatient setting, hospitalists and outpatient coordination on referrals, more advanced pharmacy management, extended disease registries, and integration between physicians and hospitals that includes joint expense management and other synergies. These interventions have resulted in a noticeable improvement in quality of care and led Physician Associates to run at a price and expense advantage below IPAs using a purely FFS payment model.

Dr. Wald also discussed an example of how hospitals are attempting to improve performance through creative partnerships with medical staff using a joint venture limited liability corporation between Providence Health Systems California and local physicians to reduce the occurrences of specific clinical conditions, such as hospital acquired complications, readmissions, and sepsis mortality. These physicians participate in a shared savings model.

Successful Risk-Sharing Arrangements Take Time

While the interventions described above may work and possibly work very well, truly effective risk-sharing design is an iterative process. Organizations must be nimble and able to adapt and modify tactics as necessary. As Greger Vigen emphasized, payment reform can be used as a tactic at the provider level in additional to a broad strategy or vision between provider and buyer.

Downloads

• Issue Brief: Improving the Medicare ACO Program

It is well recognized across the health care industry that the major goals of the Affordable Care Act (ACA) include not only expanding health insurance coverage, but also improving the quality of care and the patient health care experience. A key strategy in achieving these goals is improving the efficiency and delivery of care through innovative financing mechanisms and new delivery models, such as Accountable Care Organizations (ACOs), patient-centered medical homes (PCMHs), bundled payments for acute and post-acute care, and population-based models that aim to improve the health of entire communities. These alternative models emphasize quality and outcomes, while moving care away from the traditional and predominant method of fee-for-service (FFS).¹

The Frontline Work Force
Many conversations focused on the implementation of these models typically emphasize the role of physicians. However, the success of these models relies heavily on the support and manpower of a multidisciplinary team; particularly "frontline health care workers." Frontline workers may include medical assistants (MAs), medical office assistants, pharmacy aides, and health care support workers. Oftentimes, they provide routine, critical care that does not require post-baccalaureate training.²

For example, MAs can play an important role in a medical home model. Upon discharge from the hospital, frontline workers can provide direct outreach to patients that are at high risk for readmission, and discuss any lingering symptoms, worsening of conditions, or medication issues. If necessary, MAs can assign a high-risk patient to a social worker, care coordinator or nurse.³

In a team care environment, frontline health care workers are essential for taking over routine tasks and allowing physicians to employ their specialized skills on their most complex patient cases, which allows all team members to work at “the top of their license”.⁴ Frontline workers can also bridge the gap between patients and a multitude of providers and specialists; help deliver care that is culturally and linguistically appropriate; and provide critical patient education and outreach outside of regular office visits. 

A Workforce in Need of Reform
While team-based care is widely accepted as an industry norm, its current infrastructure is not well-supported. While the frontline workforce represents nearly half of all health care professionals, they are markedly underpaid, underappreciated, and lack formal training to transition into higher-skilled and/or higher paid positions.

A recent study by the Brookings Metropolitan Policy Program “Part of the Solution: Pre-Baccalaureate Healthcare Workers in a Time of Health System Change” demonstrates this glaring disparity between current frontline workforce investment and its value to health reform efforts. The study analyzes the characteristics of the top ten ‘pre-baccalaureate health care workers’ (staff that holds less than an associate’s degree) within the US’s one-hundred largest metropolitan areas (see Table 1).

Table 1: Top ten pre-baccalaureate health care workers in the US’s top one-hundred metropolitan areas

Personal care aides represent a striking example of the underinvestment in frontline workers. The study shows that personal care aides have the lowest levels of educational attainment compared to their peers (32% have no more than a high school diploma), and have the lowest median earnings ($20,000 annually). Meanwhile, The Center for Health Workforce Studies’ (CHWS) estimates that this profession is among the top three national occupations with the highest projected job growth between 2010 and 2020. They are also in highest demand: between 2010 and 2020 there will be an estimated 600,000 personal aide vacancies.⁵ According to this study, MAs are also among the least educated and lowest paid frontline professions. Ninety percent lack a bachelor’s degree and a significant share (29%) are classified as ‘working poor.’

Policy Solutions

A number of policy solutions can be applied to enhance the frontline worker infrastructure. Our recommendations include:

Invest in front line health care workforce training and education. Case studies from a recent Engelberg Center toolkit, outlines how providers are training their frontline workforce to master fundamental skills including care management, patient engagement, teamwork, and technological savviness.

For example, a New Jersey ACO carried out clinical transformation by investing in new frontline staff, and by redefining the role of medical assistants to include health coaching. The return on investment for employers is potentially large. After injecting a substantial initial investment into this project, this ACO saw a 12.3% decrease in net health care costs within the first year of the program’s implementation; as well as significantly improved efficiency, quality of care and patient experience. As the educational curricula for frontline professions are largely variable, more attention should also be spent on the quality of educational content to train these occupations, as well as on developing an understanding of how delivery systems are augmenting traditional educational curricula.

2. Active inclusion of frontline health care workers in payment reform. Although the services of frontline health care workers are beginning to play a role in new payment models, typically frontline staff does not benefit directly from any bonus payments or shared savings incentives. However, their increasingly valuable role in the care team may warrant allowing frontline health care staff to be included in the receipt of shared savings and/or bonus payments based on the achievement of specifically tailored performance and outcomes targets.

The increasing demand for frontline health care workers, driven in part by the ACA’s payment and delivery reforms, will likely spell out a brighter future for these occupations, whose services had routinely been undervalued and underpaid. Future policy efforts should be focused on extending educational grants that have been aimed at primary care and nursing to frontline workers, as well as considering dedicating portions of shared savings to enhancing the earning potential for frontline workers. Some efforts, such as the U.S. Department of Labor’s recent rule to grant wage and overtime protections to home health and personal care aides, are early suggestions of a shift toward greater respect and empowerment for these occupations. It is yet to be seen what effects the continuation of such efforts will have on their high projected attrition trends.

Event Information

The Brookings Institution and the American Enterprise Institute (AEI) collaborated to ask: if you were to redesign Medicare without spending more money, what would you keep and what would you change? A new report on a Center for Healthcare Decisions program provided insight into the public’s willingness to restructure Medicare in the face of tightening budget constraints. Using an interactive, computer-based system, program participants faced the challenge of making Medicare more responsive to the needs of current and future beneficiaries.

Were participants willing to accept limits on their choice of provider or reduced coverage of low-value medical care? Would they accept the need for greater personal responsibility in their use of health services? Would they agree that Medicare should adopt other policies to promote fiscal responsibility?

Watch event video.

Event Information

The Millennium Development Goals were adopted in 2000 to encourage and monitor global social and economic developments through 2015. This frame has guided international development activities for the past decade and there is now a growing discussion on what the post-2015 international development framework should look like, and how economic, social and environmental pillars of development can be integrated.

On May 2, Global Economy and Development at Brookings hosted a discussion on the purpose of new development goals, the trade-offs in selecting specific indicators and the difficulties in integrating alternative development concepts into a single framework. The discussion also examined how events like the Rio+20 conference in Brazil can be used to advance the U.S. global development agenda. Panelists included Andrew Steer, incoming president, World Resources Institute; David Steven, nonresident fellow, Center for International Cooperation, New York University; Richard Morgan, director of Policy, United Nations Children’s Fund; and Brookings Nonresident Senior Fellow Colin Bradford. Brookings Senior Fellow Homi Kharas, deputy director of Global Economy and Development, moderated the discussion.

Audio

• What Should Sustainable Development Goals Look Like?

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20120502_sustainable_development

In our latest 21st Century Capitalism initiative paper, "What must corporate directors do? Maximizing shareholder value versus creating value through team production," author Margaret M. Blair explores how the share value maximization norm (or the “short-termism” malady) came to dominate, why it is wrong, and why the “team production” approach provides a better basis for governing corporations over the long term.

Blair reviews the legal and economic theories behind the share-value maximization norm, and then lays out a theory of corporate law building on the economics of team production. Blair demonstrates how the team production theory recognizes that creating wealth for society as a whole requires recognizing the importance of all of the participants in a corporate enterprise, and making sure that all share in the expanding pie so that they continue to collaborate to create wealth.

Arguing that the corporate form itself helps solve the team production problem, Blair details five features which distinguish corporations from other organizational forms:

1. Legal personality
2. Limited liability
3. Transferable shares
4. Management under a Board of Directors
5. Indefinite existence

Blair concludes that these five characteristics are all problematic from a principal-agent point of view where shareholders are principals. However, the team production theory makes sense out of these arrangements. This theory provides a rationale for the role of corporate directors consistent with the role that boards of directors historically understood themselves to play: balancing competing interests so the whole organization stays productive.

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• Download the paper

Event Information

Australia's mandatory Superannuation Guarantee requires its citizens to save at least 9 percent of their income towards retirement. In many Asian nations, economic growth has spurred reexamination of pension systems to meet the needs of rapidly evolving societies. Would a mandatory savings plan be more effective than the current U.S. voluntary system? How have Asian nations have restructured their pension systems to deal with legacy costs? And what can Americans learn from the way Australia uses both employer and employee representatives to shape investment choices?

On September 17, the Retirement Security Project at Brookings and the AARP Public Policy Institute hosted a discussion of what the United States might learn from retirement savings systems in Australia and Asia. Opening speakers included Nick Sherry, who helped shape the Australian system as a cabinet minister and ran a Superannuation fund in the private sector, and Josef Pilger, an advisor on pension reform to both the Malaysian and Hong Kong governments and many industry providers. Steve Utkus, David Harris and Benjamin Harris, retirement experts from both the United States and the United Kingdom, considered how reforms in Australia and Asia can shape the American debate and whether this country should adopt key features from those foreign systems.

Audio

• Retirement Savings in Australia, Asia and Beyond: What are the Lessons for the United States?

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20130917_retirement_savings_transcript

“There is room for everybody in America,” wrote French-American author Hector St. John de Crèvecœur in 1782’s Letters from an American Farmer.

Like most of the founding generation, Crèvecœur believed the sheer size of the new nation meant for a prosperous future. But he was also celebrating an attitude of openness, a willingness to embrace new citizens from around the world into what he called the “melting pot” of American society.

The embrace of openness has survived, in spite of occasional outbreaks of anti-immigrant sentiment, for the intervening two and a half centuries. The United States remains an immigrant nation, in spirit as well as in fact. (A fact for which, as an immigrant from the Old Country, I am grateful). My wife is American, and my high schoolers have had U.S. passports since being born in London. Right now I'm applying for U.S. citizenship. I want America to be my home not just my residence. My story is of course very different to most immigrants - but the point is, all of our stories are different. What unites us is our desire to be American.

But this spirit may be waning. Thanks only in part to Donald Trump, immigration is near the top of the political agenda – and not in a good way.

Trump has brilliantly exploited the imagery of The Wall to tap into the frustrations of white middle America. But America needs immigration. At the most banal level, this is a question of math. We need more young workers to fund the old age of the Baby Boomers. Overall, immigrants are good for the economy, as a recent summary of research from Brookings’ Hamilton Project shows.

Of course, while immigration might be good for the economy as a whole, that does not mean it is good for everyone. Competition for wages and jobs will impact negatively on some existing residents, who may be more economically vulnerable in the first place. Policymakers keen to promote the benefits of immigration should also be attentive to its costs.

But the value of immigration cannot be reduced to an actuarial table or spreadsheet. Immigrants do not simply make America better off. They make America better. Immigrants provide a shot in the nation’s arm.

Immigrants are now twice as likely to start a new business as native-born Americans. While rates of entrepreneurialism are declining among natives, they are rising among immigrants. Immigrant children typically show extraordinary upward mobility, in terms of income, occupation and education. Among children born in Los Angeles to poorly-educated Chinese immigrants, for example, an astonishing 70% complete a four-year-college degree.

As the work of my Brookings colleague William Frey shows, immigrants are migrants within the U. S., too, moving on from traditional immigrant cities — New York and Los Angeles — to other towns and cities in search of a better future.

New Americans are true Americans. We need more of them. But Trump is tapping directly and dangerously into white fears of an America growing steadily browner. According to a 2011 Pew Research Center survey, more than four in ten white seniors say that a growing population of immigrants is a "change for the worse;" half of white boomers believe immigration is "a threat to traditional American customs and values."

Immigration gets at a deep question of American identity in the 21st century. Just like people, societies age. They might also settle down, lose some dynamism. They might trade a little less openness for a little more security. In other words, they get a bit stuck in their ways. Immigrants generate dynamism and aspiration, but they are also unsettling and challenging.

Where this debate ends will therefore tell us a great deal about the trajectory of the nation. An America that closes its doors will be an America that has chosen to settle down rather than grow, allowing security to eclipse dynamism.

Disruption is not costless. But America has always weighed the benefits of dynamism and diversity more heavily. Immigration is an important way in which America hits the refresh button and renews herself. Without immigration, the nation would not only be worse off, but would cease, in some elemental sense, to be America at all.

Editor's note: This piece originally appeared in Fortune.

Impact bonds, and other RBF mechanisms, require the measurement of outcomes and create an incentive for the service provider to deliver results. Both aspects encourage the service provider to improve performance management and, ultimately, the quality of the service. Because governments or donors only pay if results are achieved, funding is not wasted on unsuccessful programs. Furthermore, the guarantee of value can encourage governments or donors to explore new, potentially high-impact interventions, instead of continuing to fund low-impact programs.

Impact bonds may also have other positive spillover effects on development. For example, the involvement of private intermediaries and investors may also help grease the wheels of new government contracting systems or provide a way for the business sector to engage in a social issue.

However, despite the enormous potential of impact bonds, there are also some considerable limitations and challenges associated with their implementation. Three criteria are necessary to even consider the use of an impact bond:

1. The ability of the funder to pay for outcomes rather than inputs
2. Sufficient evidence that a given intervention and service provider will be able to deliver a stated outcome for an investor to take the risk of engaging
3. Meaningful outcomes (i.e., related to the SDG indicators) that can be measured within a time frame suitable to both investors and outcome funders

In addition to these three critical criteria, the ability for the key stakeholders to collaborate with one another has enormous implications for getting an impact bond off the ground. These factors contribute to the complexity and high transaction costs associated with impact bonds (relative to traditional input-based financing). Given these constraints, impact bonds are suited to areas where service providers need flexibility and where risk factors discourage direct funding but are minor enough to attract impact investors.

Thus far, these criteria have limited impact bonds to particular subsectors, regions, and investor types and have restricted their scale (both monetarily and in terms of beneficiary numbers). Impact bonds have been developed in fields with complex service inputs and simple outcomes, and for services that cater to particularly underserved or marginalized populations. The scale of impact bonds has been limited—the majority serve fewer than 2,000 individuals, and the largest reaches less than 16,000. Investors have been limited to philanthropic or impact investors rather than commercial investors. However, all impact bonds thus far have supported interventions that have at least some evidence of effectiveness.

Given trends in the global impact bond market, what role do impact bonds have in fulfilling the financing needs to achieving the SDGs, in particular in developing countries?

Impact bonds are likely to be improve effectiveness of financing rather than increasing volume. They also serve an important role in financing mid-scale interventions with some evidence of effectiveness. While they may not be best suited to large-scale financing of social services, they have the potential to affect large-scale systemic shifts in how governments and service providers think about service provision because they build cultures of monitoring and evaluation, encourage investments in prevention, and incentivize collaboration, all of which are essential to achieving the SDGs.

Event Information

Despite the notable success in enrolling children in primary school over the past decade, the education agenda is unfinished as millions of children are still excluded from learning opportunities and millions more leave school without having acquired the essential knowledge and skills needed to participate in society.

On January 27, the Center for Universal Education at Brookings hosted a half-day conference that focused on the research examining “what works in education” to achieve improved learning opportunities and outcomes. In addition to hearing from researchers studying the effectiveness of various education strategies, participants discussed how to facilitate a future research agenda that could have the most meaningful impact on learning. Senior Fellow Jacques van der Gaag moderated the discussion.

View the full event summary »

Transcript

• Improving Education in the Developing World: Evidence from Randomized Evaluations Presentation (.pdf)
• Sociocultural Gradients for Language Scores by Country Slide (.pdf)
• School Resources and Educational Outcomes in Developing Countries Presentation (.pdf)
• Making Learning for All a Reality Presentation (.pdf)
• Addressing the Global Learning Crisis Presentation (.pdf)

Event Materials

• 0127_improving_education_in_developing_world
• 0127_slide_vandergaag
• 0127_edinptoh
• 0127_king
• 0127_wagner

In the developing world, more than 200 million children under the age of five years are at risk of not reaching their full human potential because they suffer from the negative consequences of poverty, nutritional deficiencies and inadequate learning opportunities. Given these risks, there is a strong case for early childhood development (ECD) interventions in nutrition, health, education and social protection, which can produce long-lasting benefits throughout the life cycle. The results from the 2012 round of the Program for International Student Assessment (PISA)—an international, large-scale assessment that measures 15-year-olds’ performance in mathematics, reading and science literacy—demonstrate the benefits of ECD: Students in the countries that belong to the Organization for Economic Cooperation and Development (OECD) who had the benefit of being enrolled for more than one year in preprimary school scored 53 points higher in mathematics (the equivalent of more than one year of schooling), compared with students who had not attended preprimary school. Although there is much evidence that ECD programs have a great impact and are less costly than educational interventions later in life, very few ECD initiatives are being scaled up in developing countries. For example, in 2010, only 15 percent of children in low-income countries—compared with 48 percent worldwide—were enrolled in preprimary education programs. Furthermore, even though the literature points to larger beneficial effects of ECD for poorer children, within developing countries, disadvantaged families are even less likely to be among those enrolled in ECD programs. For instance, in Ghana, children from wealthy families are four times more likely than children from poor households to be enrolled in preschool programs.

One of the major barriers to scaling up ECD interventions is financing. In order to address financing issues, both policymakers and practitioners need a better understanding of what is currently being spent on ECD interventions, what high-quality interventions cost, and what outcomes these interventions can produce. If stakeholder groups are made more aware of the costs of ECD interventions, they may be able to support decisionmaking on investments in ECD, to better estimate gaps in financing, and to work toward securing stable funding for scaling up service provision and for quality enhancement. One of the weakest areas of ECD policy planning is in the realm of financial planning.6 Good data are scarce on ECD spending and the costs of ECD interventions that are useful for program budgeting and planning; but these data are valuable for a number of reasons, including the fact that they support analyses of what different inputs cost and thus can facilitate considering various alternative modalities for service delivery. In this paper, we focus on what data are available to gain a clearer picture of what is being spent on ECD and what it costs to deliver basic ECD interventions in developing countries.

ECD interventions come in many varieties, and therefore we first define the package of ECD interventions that have been deemed essential. Then we outline a framework for better understanding ECD financing, which combines a top-down approach analyzing expenditures and a bottom-up approach analyzing the costs of delivering individual interventions. We comment on the general methodological issues stemming from these approaches and the limitations of the data that have been produced. Next, we delve into the available data and discuss the different funding sources and financing mechanisms that countries utilize to deliver ECD services and what patterns exist in spending. We provide a brief overview of how many public and private resources in both developed and developing countries are invested in young children, and in which specific subsectors. Although these data on spending illustrate the flows and help us understand how much is being allocated and by whom, the data are limited, and this top-down approach still leaves us with many unanswered questions. Therefore, we turn our attention to the actual costs of individual ECD interventions, which help us further understand what ECD spending can “buy” in different countries. We identify some trends in the actual costs of delivering these services, although there are a number of methodological issues vis-à-vis costing and the services delivered, which lead to wide variations between and within countries and make it difficult to compare programs over time.

Finally, we look at a number of initiatives that are currently under way to collect better data on ECD costs and expenditures, which will be useful for countries in planning programs and identifying funding sources. These initiatives are sponsored by organizations such as UNICEF, Save the Children, the World Bank and the Inter-American Development Bank. Given the gaps in the available data that we identify and the interventions currently under way, we conclude with recommendations for increasing the knowledge base in this area for use in policymaking and planning.

How has the Joint Comprehensive Plan of Action (JCPOA)—signed between the P5+1 and Iran one year ago—played out in practice? Several Brookings scholars, many of whom participated prominently in debates last year surrounding official congressional review, offered their views.

This week, Israeli Prime Minister Benjamin Netanyahu spoke at a joint meeting of Congress. His address sparked an intense debate among U.S. and Israeli lawmakers over the protocol issues raised by the invitation to speak, which came from the Republican speaker of the U.S. House of Representatives without consultation with the Obama White House, as well as the substance of the address — a broadside against Obama’s Iran policy — and its timing during the final days of a closely contested Israeli election.

Brookings scholars weighed in on the debate, through blog posts, op-eds and the media. These include:

Fellow Natan Sachs explained why Netanyahu’s speech was so controversial.  "Israelis, by and large, don't like it when their prime minister quarrels with the United States," Sachs told Vox. "For most voters, especially in the core base on the right and I think center right, here's Bibi doing something that opposition leaders cannot do: speak the way he does with his English and this reception from Americans.” Also read Sachs' blog post on the electoral implications of the speech as well as his Haaretz op-ed with recommendations for Israeli and American strategy toward the Iran nuclear talks.

Tamara Cofman Wittes, director of the Center for Middle East Policy (CMEP) at Brookings, appeared on Charlie Rose following the speech, and said, “I think the speech was very effective, as a speech, particularly at the end when Netanyahu was really playing to his domestic audience and political base more than anyone…I think that’s probably the video clip the Likud will be playing in  ads as the campaign winds down.”

Nonresident Senior Fellow Shibley Telhami looked at poll results examined U.S. public opinion related to Netanyahu’s speech. "Among Democrats, those holding favorable views of the Israeli prime minister declined from 25 percent in November to 16 percent in February, and among Independents from 21 percent to 14 percent. Correspondingly, unfavorable views increased from 22 to 26 percent among Democrats, and from 14 to 21 percent among Independents," he wrote in Foreign Policy.

A New York Times editorial examining Netanyahu's speech discussed American public opinion on the Iran nuclear deal, and cited Telhami’s poll results “show[ing] that a clear majority of Americans — including 61 percent of Republicans and 66 percent of Democrats — favor an agreement.” Telhami also organized and moderated the annual Sadat Forum earlier this week, featuring a discussion on the Iranian nuclear issue and the Netanyahu speech with Brookings Distinguished Fellow Ambassador Thomas Pickering, former president of the Carnegie Endowment for International Peace Jessica Matthews, and CMEP Senior Fellow Suzanne Maloney.

According to Ambassador Martin Indyk, who has served as director of the Foreign Policy program and was just named Brookings Executive Vice President, Netanyahu remained against any agreement. “He was pretty clear about his opposition to the deal,” Indyk told Foreign Policy. “I believe he wants to sink it, not modify it.”

Prior to the speech, Robert Einhorn, senior fellow in the Center for 21st Century Intelligence and Security and the Arms Control and Nonproliferation Initiative, wrote an op-ed published in the International New York Times discussing Netanyahu’s angle on the Iran talks. After Netanyahu’s speech, Einhorn appeared on Christiane Amanpour and argued that the deal was “not an ideal deal, but it’s a good deal, and one that’s better than any realistic alternative.” Einhorn, who formerly participated in the negotiations with Iran as a senior State Department official, was quoted in coverage of the speech published in the Washington Post and Politico, among others.

In an op-ed on U.S. News and World Report, Maloney argued that when it comes to a deal with Iran, “The ever-present illusion of a more perfect deal is not worth risking an imperfect, but minimally sufficient, bargain.”

With the prospect of a nuclear deal between Iran and the P5+1 looking increasingly likely and with the caveat that, “as always, Iran’s future behavior is hard to predict because its motives going into the nuclear negotiations are unclear and its decision-making is always opaque,” Senior Fellow Kenneth M. Pollack examined the possible scenarios and offered his thoughts on whether a nuclear deal would likely make Iran more or less aggressive — or neither. 

Bruce Riedel, senior fellow and director of the Brookings Intelligence Project, wrote about Netanyahu’s address in contrast to Saudi Arabia’s diplomacy. “As Israeli Prime Minister Benjamin Netanyahu plays center stage at the Congress this week to slam the Iran deal-in-the-making, the Saudis are playing a more subtle game,” Riedel wrote. “Iran is priority number one. It's more than just the nuclear issue.” The pot was also quoted in a Bloomberg News analysis of Gulf reaction to the state of play on Iran.

Last week, William Galston, who holds Brookings' Ezra K. Zilkha Chair in Governance Studies, wrote about the implications of Netanyahu’s speech, warning that “[t]he last thing he should want is a negative reception in the United States that fuels Israeli swing voters’ doubts about his capacity to manage Israel’s most important relationship.” And in his Washington Post column last week, Senior Fellow Robert Kagan argued that “there is no doubt that the precedent being set is a bad one” and regretted that “bringing a foreign leader before Congress to challenge a U.S. president’s policies…will be just another weapon in our bitter partisan struggle.”

And finally, for anyone wanting to see what our scholars were tweeting during Netanyahu’s speech, and reaction afterward, here’s a round-up.

Once upon a time, innovation was an isolationist sport. In America’s innovative economy 20 years ago, a worker drove to a nondescript office campus along a suburban corridor, worked in isolation, and kept ideas secret.

Today, by contrast and partly a result of the Great Recession, proximity is everything. Talented people want to work and live in urban places that are walkable, bike-able, connected by transit, and hyper-caffeinated. Major companies across multiple sectors are practicing “open innovation” and want to be close to other firms, research labs, and universities. Entrepreneurs want to start their companies in collaborative spaces, where they can share ideas and have efficient access to everything from legal advice to sophisticated lab equipment.

These disruptive forces are coming to ground in small, primarily urban enclaves—what we and others are calling “innovation districts.” By our definition, innovation districts cluster and connect leading-edge institutions with startups and spin-off companies, business incubators, and accelerators in the relentless pursuit of cutting-edge discoveries for the market. Compact, transit-accessible, and highly networked, they grow talent, foster open collaboration, and offer mixed-used housing, office, retail, and 21st century urban amenities. In many respects, the rise of innovation districts embodies the very essence of cities: an aggregation of talented, driven people assembled in close quarters, who exchange ideas and knowledge. It’s in the vein of what urban historian Sir Peter Hall calls “a dynamic process of innovation, imitation and improvement.”

Globally, Montreal, Seoul, Singapore, Medellin, Barcelona, Cambridge, and Berlin offer just a few examples of evolving innovation districts. In the US, the most iconic innovation districts can be found in the downtowns and midtowns of cities like Atlanta, Cambridge, Philadelphia, Pittsburgh, San Diego, and St. Louis, where advanced research universities, medical complexes, research institutions, and clusters of tech and creative firms are sparking business expansion, as well as residential and commercial growth. Even a cursory visit to Kendall Square in Cambridge, University City in Philadelphia, or midtown Atlanta shows the explosion of growth and mixed development occurring around institutions like MIT, the University of Pennsylvania, and Georgia Tech.

Other innovation districts can be found in Boston, Brooklyn, San Francisco, and Seattle, where former industrial and warehouse areas are charting a new innovative path, powered by their enviable location along transit lines, their proximity to downtowns and waterfronts, and their recent addition of advanced research institutions (reflected by Carnegie Mellon University’s decision to place its Integrative Media Program at the Brooklyn Navy Yard).

Perhaps the greatest validation of this shift is found in the efforts of traditional exurban science parks (like Research Triangle Park in Raleigh-Durham) to urbanize, in order to keep pace with the preferences of their workers for walkable communities and the preference of their firms to be near other firms and collaborative opportunities.

Innovation districts are already attracting an eclectic mix of firms in a diverse group of sectors, including life sciences, clean energy, design, and tech. We even see a return of small-scale and customized manufacturing, made possible by 3D printing, robotics, and other advanced techniques.

Unlike efforts to grow the “consumer city” via sports stadia, luxury housing, and high-end retail, innovation districts are intent on growing the firms, networks, and sectors that drive real, broad-based prosperity.

At a time of increasing concerns over inequality and resilience, innovation districts can spur productive, inclusive, and sustainable growth. If properly structured and scaled, they can provide a strong foundation for the commercialization of ideas, the expansion of firms, and the creation of jobs. They also offer the tantalizing prospect of expanding employment and educational opportunities for disadvantaged populations—many innovation districts are close to low- and moderate-income neighborhoods—as well as sparking more sustainable development patterns, given their embrace of transit, historic buildings, traditional street grids, and existing infrastructure.

Innovation districts represent one of the most positive trends that have emerged in the aftermath of the Great Recession. Smart cities, innovative companies, advanced universities, and financial institutions would be wise to embrace them.

This piece originally appeared on Quartz.

Ahead of Tuesday’s primary elections in Ohio, Florida and other states, the 2016 presidential candidates have been talking about the future of Social Security and its funding shortfalls.

Over the next two decades, the money flowing into Social Security will be too little to pay for all promised benefits. The reserve fund will be exhausted soon after 2030, and the only money available to pay for benefits will be from taxes earmarked for the program. Unless Congress and the President change the law before the reserve is depleted, monthly benefits will have to be cut about 21%.

Needless to say, office holders, who must face voters, are unlikely to allow such a cut. Before the Trust Fund is depleted, lawmakers will agree to some combination of revenue increase and future benefit reduction, eliminating the need for a sudden 21% pension cut. The question is: what combination of revenue increases and benefit cuts does each candidate favor?

The candidate offering the most straightforward but least credible answer is Donald Trump. During the GOP presidential debate last week, he pledged to do everything within his power to leave Social Security “the way it is.” He says he can do this by making the nation rich again, by eliminating budget deficits, and by ridding government programs of waste, fraud, and abuse. In other words, he proposed to do nothing specifically to improve Social Security’s finances. Should Trump’s deal-making fail to make us rich again, he offered no back-up plan for funding benefits after 2034.

The other three GOP candidates proposed to repair Social Security by cutting future pensions. No one in the debate, except U.S. Sen. Marco Rubio from Florida, mentioned a specific way to accomplish this. Rubio’s plan is to raise the age for full retirement benefits. For many years, the full retirement age was 65. In a reform passed in 1983, the retirement age was gradually raised to 66 for people nearing retirement today and to 67 for people born after 1960. Rubio proposes to raise the retirement age to 68 for people who are now in their mid-40s and to 70 for workers who are his children’s age (all currently under 18 years old).

In his campaign literature, Rubio also proposes slowing the future rate of increase in monthly pensions for high-income seniors. However, by increasing the full retirement age, Rubio’s plan will cut monthly pensions for any worker who claims benefits at 62 years old. This is the earliest age at which workers can claim a reduced pension. Also, it is by far the most common age at which low-income seniors claim benefits. Recent research suggests that low-income workers have not shared the gains in life expectancy enjoyed by middle- and especially high-income workers, so Rubio’s proposed cut could seriously harm many low-income workers.

Though he didn’t advertise it in the debate, Sen. Ted Cruz favors raising the normal retirement age and trimming the annual cost-of-living adjustment in Social Security. In the long run, the latter reform will disproportionately cut the monthly pensions of the longest-living seniors. Many people, including me, think this is a questionable plan, because the oldest retirees are also the most likely to have used up their non-Social-Security savings. Finally, Cruz favors allowing workers to fund personal-account pensions with part of their Social Security contributions. Although the details of his plan are murky, if it is designed like earlier GOP privatization plans, it will have the effect of depriving Social Security of needed future revenues, making the funding gap even bigger than it is today.

The most revolutionary part of Cruz’s plan is his proposal to eliminate the payroll tax. For many decades, this has been the main source of Social Security revenue. Presumably, Cruz plans to fund pensions out of revenue from his proposed 10% flat tax and 16% value-added tax (VAT). This would represent a revolutionary change because up to now, Social Security has been largely financed out of its own dedicated revenue stream. By eliminating the independent funding stream, Cruz will sever the perceived link between workers’ contributions and the benefits they ultimately receive. Most observers agree with Franklin Roosevelt that the strong link between contributions and benefits is a vital source of the enduring popularity of the program. Social Security is an earned benefit for retirees rather than a welfare check.

Gov. John Kasich does not propose to boost the retirement age, but he does suggest slowing the growth in future pensions by linking workers’ initial pensions to price changes instead of wage changes. He hints he will impose a means test in calculating pensions, reducing the monthly pensions payable to retirees who have high current incomes. Many students of Social Security think this a bad idea, because it can discourage workers from saving for retirement.

All of the Republican candidates, except Trump, think Social Security’s salvation lies in lower benefit payouts. Nobody mentions higher contributions as part of the solution. In contrast, both Democratic candidates propose raising payroll or other taxes on workers who have incomes above the maximum earnings now subject to Social Security contributions. This reform enjoys broad support among voters, most of whom do not expect to pay higher taxes if the income limit on contributions is lifted. Sen. Bernie Sanders would immediately spend some of the extra revenue on benefit increases for current beneficiaries, but his proposed tax hike on high-income contributors would raise enough money to postpone the year of Trust Fund depletion by about 40 years. Hillary Clinton is less specific about the tax increases and benefit improvements she favors. Like Sanders, however, she would vigorously oppose benefit cuts.

None of the candidates has given us a detailed plan to eliminate Social Security’s funding imbalance. At this stage, it’s not obvious such a plan would be helpful, since the legislative debate to overhaul Social Security won’t begin anytime soon. Sanders has provided the most details about his policy intentions, but his actual plan is unlikely to receive much Congressional support without a massive political realignment. Cruz’s proposal, which calls for eliminating the Social Security payroll tax, also seems far outside the range of the politically feasible.

What we have learned from the GOP presidential debates so far is that Republican candidates, with the exception of Trump, favor balancing Social Security through future benefit cuts, possibly targeted on higher income workers, while Democratic candidates want to protect current benefit promises and will do so with tax hikes on high-income workers. There is no overlap in the two parties’ proposals, and this accounts for Washington’s failure to close Social Security’s funding gap.

Editor’s note: This piece originally appeared in Fortune.