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Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




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Should the US follow the UK to a Universal Credit?


British debates about welfare reform have often been influenced by American ideas. The Clinton-era welfare reforms were echoed in some of Tony Blair’s alterations to British benefits. Gordon Brown, as Chancellor, introduced a new Working Tax Credit as a direct result of studying the Earned Income Tax Credit. Brown particularly liked the political advantages of a ‘tax cut for hard-working families’, as opposed to a ‘benefit handout to welfare families’.

But now the transatlantic traffic in ideas on welfare is going the other way. The U.K.’s introduction of a single, unified system of transfer payments – the Universal Credit – is getting quite a bit of attention in the wonkier regions of D.C. politics. Paul Ryan, at a Brookings summit on social mobility, mentioned the Universal Credit (UC) as a possible inspiration for a new round of welfare reform. (Ryan is giving a speech at AEI in a couple of weeks: we’re likely to hear more about his thinking then.) When the architect of the UC, Iain Duncan Smith, visited D.C. recently, he held a series of meetings with leading Republicans to discuss his reforms.

The main attractions of the Universal Credit are fourfold:

  1. Simplicity. By unifying five cash benefits and an ‘in kind’ benefit (Housing Benefit) into a single, monthly payment, the complexity of the system from the point of view of the recipient will be greatly reduced.

  2. Cost control. Housing Benefit is paid directly to the landlord, which reduces the tenant’s incentive to control costs.  Add that to the crazily overheated U.K. housing market, and should come as no surprise that Housing Benefit has become a major strain on the system, quintupling in cost in real terms over the last two decades to hit £24 billion a year (c. $41bn), to become the second-biggest element of the U.K.’s system, after pensions.  By including an allowance for housing in the single cash payment in UC, the recipient will be incentivized to control their own housing costs.
     
  3. Stronger work incentives. The UC has a flatter ‘taper’ than existing benefits, meaning that cash payments are reduced more slowly as earnings rise. In particular, the UC will allow benefit recipients to work part-time (less than 16 hours a week), and still keep claiming. On the downside, incentives for second earners in two-adult families will be reduced. 

  4. Tighter and more targeted work requirements. The UC will contain stronger requirements to seek work than existing benefits, and importantly, has a ‘sliding scale’ of requirements, depending on the position of the recipient. For example, parents with children under the age of 1 will be exempt from work requirements; those with children aged between  1 and 5 will be obliged to attend for interviews with a case worker to prepare for a return to work; those with children at school will be required to ‘actively seek work’.

Sounds pretty good, doesn't it? And in fact it is, on paper at least. In practice the introduction of UC has been marked with huge overspend and delay on the required new IT system. The whole exercise has also been made much harder by cuts in many of the relevant cash benefits, as well as the introduction of a ‘household cap’ on total welfare receipts. The Universal Credit as an idea has a lot of support. As so often, it has been putting the idea a reality that has been difficult.

What—if anything—can the U.S. take from the UC? Short answer: not much. 

Many of the problems the UC addresses do not really apply in the U.S. Work incentives are already pretty strong in the U.S., thanks to the relative generosity of the EITC, and the relative meanness of out-of-work welfare supports. Also, there are already much stronger work requirements in the U.S. system. Some want to go further, and add work requirements to the receipt of food stamps, for example. But this would not require a major overhaul.  As Melissa Boteach and her colleagues at the Center for American Progress write,“the primary problem that the Universal Credit is supposed to address in the United Kingdom—the lack of incentive for jobless workers to enter the labor force—is far less of an issue in the United States”.

The UC also further centralizes an already highly centralized system, by getting rid of Housing Benefit, which is currently administered by Local Authorities. The U.S. system is much less centralized, with states and cities having a high degree of control over the way TANF and SNAP are administered. It is hard to see how anything like a UC could work in the U.S. at anything higher than State level. A Wisconsin Universal Credit makes sense in a way that a U.S. Universal Credit does not.  But if shifting towards block grants to states is really what this is about (see Marco Rubio’s ‘flex fund’ idea),that’s a whole different debate.

A final point. Simplicity and ease of use for the recipient is a key goal of the UC, and a worthy one. The stress and difficulties faced by low-income families just in applying for assistance is unacceptable in the 21st century. But it is not clear that the whole system has to be upended to achieve this goal. Technology ought to allow a single access point to the system, with the complexity out of sight of the user. 

In the U.K. the Universal Credit has a strong rationale, despite the implementation challenges. In the U.S., it is a solution in search of a problem. 

Publication: Real Clear Markets
Image Source: © Jessica Rinaldi / Reuters
     
 
 




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Money for nothing: Why a universal basic income is a step too far


The idea of a universal basic income (UBI) is certainly an intriguing one, and has been gaining traction. Swiss voters just turned it down. But it is still alive in Finland, in the Netherlands, in Alaska, in Oakland, CA, and in parts of Canada. 

Advocates of a UBI include Charles Murray on the right and Anthony Atkinson on the left. This surprising alliance alone makes it interesting, and it is a reasonable response to a growing pool of Americans made jobless by the march of technology and a safety net that is overly complex and bureaucratic. A comprehensive and excellent analysis in The Economist points out that while fears about technological unemployment have previously proved misleading, “the past is not always a good guide to the future.”

Hurting the poor

Robert Greenstein argues, however, that a UBI would actually hurt the poor by reallocating support up the income scale. His logic is inescapable: either we have to spend additional trillions providing income grants to all Americans or we have to limit assistance to those who need it most. 

One option is to provide unconditional payments along the lines of a UBI, but to phase it out as income rises. Libertarians like this approach since it gets rid of bureaucracies and leaves the poor free to spend the money on whatever they choose, rather than providing specific funds for particular needs. Liberals fear that such unconditional assistance would be unpopular and would be an easy target for elimination in the face of budget pressures. Right now most of our social programs are conditional. With the exception of the aged and the disabled, assistance is tied to work or to the consumption of necessities such as food, housing, or medical care, and our two largest means-tested programs are Food Stamps and the Earned Income Tax Credit.

The case for paternalism

Liberals have been less willing to openly acknowledge that a little paternalism in social policy may not be such a bad thing. In fact, progressives and libertarians alike are loath to admit that many of the poor and jobless are lacking more than just cash. They may be addicted to drugs or alcohol, suffer from mental health issues, have criminal records, or have difficulty functioning in a complex society. Money may be needed but money by itself does not cure such ills. 

A humane and wealthy society should provide the disadvantaged with adequate services and support. But there is nothing wrong with making assistance conditional on individuals fulfilling some obligation whether it is work, training, getting treatment, or living in a supportive but supervised environment.

In the end, the biggest problem with a universal basic income may not be its costs or its distributive implications, but the flawed assumption that money cures all ills.  

Image Source: © Tom Polansek / Reuters
      
 
 




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Webinar: A conversation with Secretary of Defense Mark T. Esper

The COVID-19 pandemic is among the most serious challenges confronting the globe since World War II. Its projected human and economic costs are devastating. While the armed forces of the United States will rise to this challenge as they have others, the Department of Defense will not stop planning for long-term threats to America's security,…

       




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




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The Politics of Climate Change: A Conversation with Joseph Aldy

Robert Stavins, director of the Harvard Environmental Economics Program, speaks with Joseph Aldy, professor of the practice of public policy at Harvard Kennedy School. The discussion covers Aldy's experience in government service, and the prospects for meaningful and effective climate change policy in the United States.




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Confronting COVID-19: A Conversation with Columbia University Professor Scott Barrett

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

The Politics of Climate Change: A Conversation with Joseph Aldy

Robert Stavins, director of the Harvard Environmental Economics Program, speaks with Joseph Aldy, professor of the practice of public policy at Harvard Kennedy School. The discussion covers Aldy's experience in government service, and the prospects for meaningful and effective climate change policy in the United States.




rsa

Confronting COVID-19: A Conversation with Columbia University Professor Scott Barrett

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

The Politics of Climate Change: A Conversation with Joseph Aldy

Robert Stavins, director of the Harvard Environmental Economics Program, speaks with Joseph Aldy, professor of the practice of public policy at Harvard Kennedy School. The discussion covers Aldy's experience in government service, and the prospects for meaningful and effective climate change policy in the United States.




rsa

Confronting COVID-19: A Conversation with Columbia University Professor Scott Barrett

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.




rsa

Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

The Politics of Climate Change: A Conversation with Joseph Aldy

Robert Stavins, director of the Harvard Environmental Economics Program, speaks with Joseph Aldy, professor of the practice of public policy at Harvard Kennedy School. The discussion covers Aldy's experience in government service, and the prospects for meaningful and effective climate change policy in the United States.




rsa

Confronting COVID-19: A Conversation with Columbia University Professor Scott Barrett

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.




rsa

Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




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Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




rsa

Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




rsa

Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

The Politics of Climate Change: A Conversation with Joseph Aldy

Robert Stavins, director of the Harvard Environmental Economics Program, speaks with Joseph Aldy, professor of the practice of public policy at Harvard Kennedy School. The discussion covers Aldy's experience in government service, and the prospects for meaningful and effective climate change policy in the United States.




rsa

Confronting COVID-19: A Conversation with Columbia University Professor Scott Barrett

Columbia University Professor Scott Barrett assessed the massive global efforts underway to address COVID-19 and the potential impacts of the pandemic on our lives in the future in a special episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.




rsa

Organizational Responses to COVID-19 and Climate Change: A Conversation with Rebecca Henderson

Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, shared her perspectives on how large organizations are changing in response to the coronavirus pandemic and climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.”




rsa

Next Moves on Climate Policy: A Conversation with Sue Biniaz

Sue Biniaz, former lead climate negotiator for the United States, shared her thoughts on the postponement of COP-26, and on the possible re-engagement of the U.S. in the international effort to address climate change in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program,” a podcast produced by the Harvard Environmental Economics Program.




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Webinar: A conversation with Secretary of Defense Mark T. Esper

The COVID-19 pandemic is among the most serious challenges confronting the globe since World War II. Its projected human and economic costs are devastating. While the armed forces of the United States will rise to this challenge as they have others, the Department of Defense will not stop planning for long-term threats to America's security,…

       




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A conversation with Somali Finance Minister Abdirahman Duale Beileh on economic adjustment in fragile African states

Fragile and conflict-affected states in Africa currently account for about one-third of those living in extreme poverty worldwide. These states struggle with tradeoffs between development and stabilization, the need for economic stimulus and debt sustainability, and global financial stewardship and transparency. Addressing fragility requires innovative approaches, the strengthening of public and private sector capacity, and…

       




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How a VAT could tax the rich and pay for universal basic income

The Congressional Budget Office just projected a series of $1 trillion budget deficits—as far as the eye can see. Narrowing that deficit will require not only spending reductions and economic growth but also new taxes. One solution that I’ve laid out in a new Hamilton Project paper, "Raising Revenue with a Progressive Value-Added Tax,” is…

       




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3 ways to move the conversation on public health forward


Editor's note: This piece was written in response to John McDonough's article in the American Journal of Public Health titled "Shorter lives and poorer health on the campaign trail." Read McDonough's article here


McDonough is right about two very important things. First, that in America we have quite dismal outcomes for the enormous amount we spend on health care. And second, that there is a real opportunity for a new political dialog between left and right to take root—though perhaps one that is more of a quiet agreement than a high-profile grand bargain. 

McDonough wisely draws attention in Figure 3 of his editorial to the sharp distinction between the United States and other Organisation for Economic Cooperation and Development countries in the relative proportions of gross domestic product spent on health services and social services. The United States is a lonely outlier because we overmedicalize our approach to health conditions and community health. Generally a blend of social, housing, public health, and other preventive strategies would yield better health results than calling an ambulance—and at a fraction of the cost. Even our higher survival rates after age 75 years is a mixed blessing, as Gawande points out, because expensive and frequent medical interventions may extend age but often not the quality of life.1 

The good news, both substantively and politically in this election year, is the growing recognition that addressing the social determinants of health is a key—perhaps the key—to improving health outcomes while slowing the growth in health spending as a proportion of gross domestic product and public spending. McDonough and I agree on that, despite his affection for Bernie Sanders’ utopian Medicare-for-all, which likely would do little to address the underlying cost and outcomes problem. 

So how could a new conversation develop, of the kind both we both would like to see? I think on several fronts. 

First, building on existing collaboration, serious analysts and policymakers on both sides of the political spectrum should explain more extensively how resources currently restricted to either health care or social services and housing should and could be more routinely braided together. Despite some interesting experiments and demonstrations that allow certain health and housing money to be mixed and used creatively, budget restrictions and payment systems generally make this dif- ficult. We could seek to agree on a mixture of legislative action on payments and budgets, and using Medicaid (Section 1115) waivers, to permit money currently available only for medical services to be used instead for housing and social services where that could be shown to improve the health of individuals in a community. 

Second, we could agree on bipartisan steps to allow states to experiment with more creative approaches to alter the blend of strategies they have available to achieve improved health outcomes. Section 1332 of the Affordable Care Act (Pub L No. 111–148) is a start, since it will allow states to propose alternatives to some Affordable Care Act provisions to improve coverage and outcomes without increasing federal costs. McDonough and I agree on using 1332 waivers in this way. But a further step would be legislation to allow states to seek even broader waivers to shift money between health and social service programs. For that to happen, conservatives would have to accept increases in total spending on some social service programs. Progressives would have to accept reductions in health programs and reduce their reluctance to granting states more flexibility. Both would have to accept rigorous evaluation to determine what works and what does not. 

And third, there is an opportunity for agreement on empowering intermediary institutions2 in neighborhoods, including charter and community schools, as well as health systems,3 to serve as hubs for integrated approaches to achieving health communities. That approach combines the conservative emphasis on the importance of nongovernmental institutions with the progressive emphasis on community action. Again, systematic evaluation is needed. 

Hopefully there can be cross-party congressional support agreement on these themes, as McDonough notes has occurred in alternative sentencing. But it is unlikely in the election season that such themes will be seized upon by presidential candidates. In my view, that is probably good, because presidential elections are about differences, not path-breaking agreements. Better, during this election cycle, to foster positive conversations that cause such themes to be taken out of the election debates, so that they will have broad support for enactment after the Election Day dust has settled. 


1. Gawande A. Being Mortal. New York, NY: Metropolitan Books; 2015. 

2. Singh P, Butler SM. Intermediaries in Integrated Approaches to Health and Economic Mobility. Washington, DC: The Brookings Institution; 2015. 

3. Butler SM, Grabinsky J, Masi D. Hospitals as Hubs to Create Healthy Communities: Lessons From Washington Adventist Hospital. Washington, DC: The Brookings Institution; 2015.


Editor's note: This piece originally appeared in the American Journal of Public Health

Publication: American Journal of Public Health
Image Source: © Mike Segar / Reuters
      




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@ Brookings Podcast: International Volunteers and the 50th Anniversary of the Peace Corps

David Caprara, a Brookings nonresident fellow and expert on volunteering, says that John F. Kennedy’s call to service a half-century ago led to the founding of dozens of international aid organizations, and leaves a legacy of programs aimed at improving health, nutrition, education, living standards and peaceful cooperation around the globe.

Subscribe to audio and video podcasts of Brookings events and policy research »

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Audio

     
 
 




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CANCELED – A conversation on national security with General David Petraeus

Out of an abundance of caution regarding the spread of COVID-19, this afternoon’s event has been canceled. We apologize for any inconvenience. More than 18 years after the 9/11 attacks, the United States has shifted its focus to competition with near-peer great competitors while still deterring rogue states like Iran and North Korea. During the…