Mercutio: I am hurt. A plague a’ both your houses! I am sped. Is he gone and hath nothing? — Romeo and Juliet, Act 3, scene 1, 90–92

The eurozone crisis, which includes the Greek crisis but is not restricted to it, has undermined the credibility of the EU institutions and left millions of Europeans disillusioned with the European Project. The euro was either introduced too early, or it included countries that should never have been included, or both were true. High rates of inflation left countries in the periphery uncompetitive and the constraint of a single currency removed a key adjustment mechanism. Capital flows allowed this problem to be papered over until the global financial crisis hit.

The leaders of the international institutions, the European Commission, the European Central Bank, and the International Monetary Fund, together with the governments of the stronger economies, were asked to figure out a solution and they emphasized fiscal consolidation, which they made a condition for assistance with heavy debt burdens. The eurozone as a whole has paid the price, with real GDP in the first quarter of 2015 being about 1.5 percent below its peak in the first quarter of 2008, seven years earlier, and with a current unemployment rate of 11 percent. By contrast, the sluggish U.S. recovery looks rocket-powered, with GDP 8.6 percent above its previous peak and an unemployment rate of 5.5 percent.

The burden of the euro crisis has been very unevenly distributed, with Greece facing unemployment of 25 percent and rising, Spain 23 percent, Italy 12 percent, and Ireland 9.7 percent, while German unemployment is 4.7 percent. It is not surprising that so many Europeans are unhappy with their policy leaders who moved too quickly into a currency union and then dealt with the crisis in a way that pushed countries into economic depression. The common currency has been a boon to Germany, with its $287 billion current account surplus, but the bane of the southern periphery. Greece bears considerable culpability for its own problems, having failed to collect taxes or open up an economy full of competitive restrictions, but that does not excuse the policy failures among Europe’s leaders. A plague on both sides in the Greek crisis!

During the Great Moderation, it seemed that the Bretton Woods institutions were losing their usefulness because private markets could provide needed funding. The financial crisis and the global recession that followed it shattered this belief. The IMF did not foresee the crisis, nor was it a central player in dealing with the period of greatest peril from 2007 to 2009. National treasuries, the Federal Reserve, and the European Central Bank were the only institutions that had the resources and the power to deal with the bank failures, the shortage of liquidity, and the freezing up of markets. Still, the IMF became relevant again and played an important role in the euro crisis, although at the cost of sharing the unpopularity of the policy response to that crisis.

China’s new Asian Infrastructure Investment Bank is the result of China’s growing power and influence and the failure of the West, particularly the United States, to come to terms with this seismic shift. The Trans-Pacific Partnership trade negotiations have deliberately excluded China, the largest economy in Asia and largest trading partner in the world. Reform of the governance structure of the World Bank and the IMF has stalled with disproportionate power still held by the United States and Europe. Unsurprisingly, China has decided to exercise its influence in other ways, establishing the new Asian bank and increasing the role of the yuan in international transactions. U.S. policymakers underestimated China’s strength and the willingness of other countries to cooperate with it, and the result has been to reduce the role and influence of the Bretton Woods institutions.

Can the old institutions be reinvented and made more effective? In Europe, the biggest problem is that bad decisions were made by national governments and by the international institutions (although the ECB policies have been generally good). The World Bank and IMF do need to reform their governance, but it may be too late to bring China back into the fold.

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On June 23, voters in the United Kingdom will go to the polls for a referendum on the country’s membership in the European Union. As one of the EU’s largest and wealthiest member states, Britain’s exit, or “Brexit”, would not only alter the U.K.’s institutional, political, and economic relationships, but would also send shock waves across the entire continent and beyond, with a possible Brexit fundamentally reshaping transatlantic relations.

On May 6, the Center on the United States and Europe (CUSE) at Brookings, in cooperation with the Heinrich Böll Stiftung North America, the UK in a Changing Europe Initiative based at King's College London, and Wilton Park USA, will host a discussion to assess the range of implications that could result from the United Kingdom’s referendum. 

After each panel, the participants will take questions from the audience.

Join the conversation on Twitter using #UKReferendum

Audio

• Brexit—in or out? Implications of the United Kingdom’s referendum on EU membership

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20160506_uk_eu_brexit_transcript

There are lots of ways for Syria to go wrong for Russia. Analysts have tended to focus on Moscow’s military shortcomings in that theater, wondering if Syria will become Russia’s Vietnam. They’ve also pointed to Russia’s deep economic troubles—exacerbated, of course, by very low oil prices—which call into question its ability to pay for the military campaign over time.

One of the understudied aspects of Russia’s involvement in the Syrian conflict is the ramifications it could have for the Russian government’s relations with Muslims back at home. Moscow is now home to the largest Muslim community of any city in Europe (with between 1.5 and 2 million Muslims out of a population of around 13 million, although illegal immigration has distorted many of the figures). Russian President Vladimir Putin and other leaders have consciously avoided choosing sides in the Sunni-Shiite divide in the Middle East—recognizing that doing so could provoke a backlash among Russian Muslims.

The rise of an extremist, Salafi- or Wahhabi-inspired, religious state in Syria—an Islamic caliphate established either by the Islamic State or by any religiously-based extremist group in the region—could pose a significant problem for Russia. That’s both because of how it’s likely to behave toward other states in the region (including key Russian partners like Israel, Egypt, and Iran) and because of what it could inspire in Mother Russia, where efforts by militant groups to create their own “caliphate” or “emirate” in the North Caucasus have created headaches for Moscow since the early 2000s. 

Islam and Russia go way back

Russia is a Muslim state. Islam is arguably older than Christianity in traditional Russian territory––with Muslim communities first appearing in southeastern Russia in the 8th century. It is firmly established as the dominant religion among the Tatars of the Volga region and the diverse peoples of the Russian North Caucasus. These indigenous Sunni Muslims have their own unique heritage, history, and religious experience. The Tatars launched a reformist movement in the 19th century that later morphed into ideas of “Euro-Islam,” a progressive credo that could coexist, and even compete, with Russian Orthodoxy and other Christian denominations. Sufi movements, rooted in private forms of belief and practice, similarly prevailed in the Russian North Caucasus after the late 18th century. 

Before the collapse of the Soviet Union in the 1980s, when Central Asia and the South Caucasus were also part of the state, the USSR’s demography was in flux. The “ethnic” Muslim share of the population was rising as a result of high birthrates in Central Asia, while the Slavic, primarily Orthodox, populations of Russia, Belarus, and Ukraine were declining from high mortality and low birthrates. Since the dissolution of the USSR, Russia’s nominal Muslim population has swelled with labor migration from Central Asia and Azerbaijan, which has brought more Shiite Muslims into the mix, in the case of Azeri immigrants. As in other countries, Russia has also had its share of converts to Islam as the population rediscovered religion in the 1990s and 2000s after the enforced atheism of the Soviet period came to an end.

The foreign fighter problem

The Kremlin cannot afford the rise of any group that fuses religion and politics, and has outside allegiances that might encourage opposition to the Russian state among its Muslim populations. The religious wars in the Middle East are not a side show for Russia. Thousands of foreign fighters have flocked to Syria from Russia, as well as from Central Asia and the South Caucasus, all attracted by the extreme messages of ISIS and other groups.

Extremist groups have been active in Russia since the Chechen wars of the 1990s and 2000s. A recent Reuters report reveals how Russia allowed—and even encouraged—militants and radicals from the North Caucasus to go and fight in Syria in 2013, in an effort to divert them away from potential domestic terrorist attacks ahead of the February 2014 Sochi Winter Olympics. The Kremlin now worries that these and other fighters will return from Syria and further radicalize and inflame the situation in the North Caucasus and elsewhere in Russia. Putin intends to eliminate the fighters, in place, before they have an opportunity to come back home.

Putin also knows a thing or two about extremists from his time in the KGB, as well as his reading of Russian history. As a result, he does little to distinguish among them. For Putin, an extremist is an extremist—no matter what name he or she adopts. Indeed, Russian revolutionaries in the 19th and 20th centuries wrote the playbook for fusing ideology with terror and brutality; and Putin has recently become very critical of that revolutionary approach––moving even to criticize Soviet founder and Bolshevik Party leader Vladimir Lenin for destroying the Russian state and empire one hundred years ago in the Russian Revolution of 1917. For Putin, anyone whose views and ideas can become the base for violence in opposition to the legal, legitimate state (and its leader) is an extremist who must be countered. Syria is a crucial front in holding the line.

The long haul

With this in mind, we can be sure that Putin sees Russia in for the long haul in Syria. Recent signs that Russia may be creating a new army base in Palmyra to complement its bases in Latakia and Tarsus, underscore this point. Having watched the United States returning to its old battlegrounds in both Afghanistan and Iraq to head off new extremist threats, Putin will want to prepare contingencies and keep his options open. 

The fight with extremists is only beginning for Russia in Syria, now that Moscow has bolstered the position of Bashar Assad and the secular Alawite regime. For Putin and for Russia, Syria is the focal point of international action, and the current arena for diplomatic as well as military interaction with the United States, but it is also a critical element for Putin in his efforts to maintain control of the homefront.

Terrorist attacks with high casualties usually create a sense of national solidarity and patriotic reaction in societies that fall victim to such heinous acts. Not in Turkey, however. Despite a growing number of terrorist attacks by the so-called Islamic State on Turkish soil in the last 12 months, the country remains as polarized as ever under strongman President Recep Tayyip Erdogan.

In fact, for two reasons, jihadist terrorism is exacerbating the division. First, Turkey's domestic polarization already has an Islamist-versus-secularist dimension. Most secularists hold Erdogan responsible for having created domestic political conditions that turn a blind eye to jihadist activities within Turkey.

It must also be said that polarization between secularists and Islamists in Turkey often fails to capture the complexity of Turkish politics, where not all secularists are democrats and not all Islamists are autocrats. In fact, there was a time when Erdogan was hailed as the great democratic reformer against the old secularist establishment under the guardianship of the military.

Yet, in the last five years, the religiosity and conservatism of the ruling Justice and Development Party, also known by its Turkish acronym AKP, on issues ranging from gender equality to public education has fueled the perception of rapid Islamization. Erdogan's anti-Western foreign policy discourse -- and the fact that Ankara has been strongly supportive of the Muslim Brotherhood in the wake of the Arab Spring -- exacerbates the secular-versus-Islamist divide in Turkish society.

Erdogan doesn't fully support the eradication of jihadist groups in Syria.

The days Erdogan represented the great hope of a Turkish model where Islam, secularism, democracy and pro-Western orientation came together are long gone. Despite all this, it is sociologically more accurate to analyze the polarization in Turkey as one between democracy and autocracy rather than one of Islam versus secularism.

The second reason why ISIS terrorism is exacerbating Turkey's polarization is related to foreign policy. A significant segment of Turkish society believes Erdogan's Syria policy has ended up strengthening ISIS. In an attempt to facilitate Syrian President Bashar Assad's overthrow, the AKP turned a blind eye to the flow of foreign volunteers transiting Turkey to join extremist groups in Syria. Until last year, Ankara often allowed Islamists to openly organize and procure equipment and supplies on the Turkish side of the Syria border.

Making things worse is the widely held belief that Turkey's National Intelligence Organization, or MİT, facilitated the supply of weapons to extremist Islamist elements amongst the Syrian rebels. Most of the links were with organizations such as Jabhat al-Nusra, Ahrar al-Sham and Islamist extremists from Syria's Turkish-speaking Turkmen minority.

He is trying to present the PKK as enemy number one.

Turkey's support for Islamist groups in Syria had another rationale in addition to facilitating the downfall of the Assad regime: the emerging Kurdish threat in the north of the country. Syria's Kurds are closely linked with Turkey's Kurdish nemesis, the Kurdistan Workers' Party, or PKK, which has been conducting an insurgency for greater rights for Turkey's Kurds since 1984.

On the one hand, Ankara has hardened its stance against ISIS by opening the airbase at Incirlik in southern Turkey for use by the U.S-led coalition targeting the organization with air strikes. However, Erdogan doesn't fully support the eradication of jihadist groups in Syria. The reason is simple: the Arab and Turkmen Islamist groups are the main bulwark against the expansion of the de facto autonomous Kurdish enclave in northern Syria. The AKP is concerned that the expansion and consolidation of a Kurdish state in Syria would both strengthen the PKK and further fuel similar aspirations amongst Turkey's own Kurds.

Will the most recent ISIS terrorist attack in Istanbul change anything in Turkey's main threat perception? When will the Turkish government finally realize that the jihadist threat in the country needs to be prioritized? If you listen to Erdogan's remarks, you will quickly realize that the real enemy he wants to fight is still the PKK. He tries hard after each ISIS attack to create a "generic" threat of terrorism in which all groups are bundled up together without any clear references to ISIS. He is trying to present the PKK as enemy number one.

Only after a peace process with Kurds will Turkey be able to understand that ISIS is an existential threat to national security.

Under such circumstances, Turkish society will remain deeply polarized between Islamists, secularists, Turkish nationalists and Kurdish rebels. Terrorist attacks, such as the one in Istanbul this week and the one in Ankara in July that killed more than 100 people, will only exacerbate these divisions.

Finally, it is important to note that the Turkish obsession with the Kurdish threat has also created a major impasse in Turkish-American relations in Syria. Unlike Ankara, Washington's top priority in Syria is to defeat ISIS. The fact that U.S. strategy consists of using proxy forces such as Syrian Kurds against ISIS further complicates the situation.

There will be no real progress in Turkey's fight against ISIS unless there is a much more serious strategy to get Ankara to focus on peace with the PKK. Only after a peace process with Kurds will Turkey be able to understand that ISIS is an existential threat to national security.

This piece was originally posted by The Huffington Post.

Event Information

The 2008 elections showcased the power of the Internet to generate voter enthusiasm, mobilize volunteers and increase small-donor contributions. After the political world has been arguing about campaign finance policy for decades, the digital revolution has altered the calculus of participation.

On January 14, a joint project of the Campaign Finance Institute, American Enterprise Institute and the Brookings Institution unveiled a new report that seeks to change the ongoing national dialogue about money in politics. At this event, the four authors of the report will detail their findings and recommendations. Relying on lessons from the record-shattering 2008 elections and the rise of Internet campaigning, experts will present a new vision of how campaign finance and communications policy can help further democracy through broader participation.

Video

• Thomas Mann
• Michael Malbin
• Anthony Corrado
• Norm Ornstein

Audio

• Campaign Reform in the Networked Age: Fostering Participation through Small Donors and Volunteers

Transcript

• Transcript (.pdf)

Event Materials

• 20090114_campaign_finance

Executive Summary

The political world has been arguing about campaign finance policy for decades. A once rich conversation has become a stale two-sided battleground. One side sees contribution or spending limits as essential to restraining corruption, the appearance of corruption, or the “undue influence” of wealthy donors. The other resists any such limits in the name of free speech. The time has come to leap over this gulf and, as much as possible, move the disputes from the courts. Preventing corruption and protecting free speech should each be among the key goals of any policy regime, but they should not be the only objectives. This report seeks to change the ongoing conversation. Put simply, instead of focusing on attempts to further restrict the wealthy few, it seeks to focus on activating the many.

This is not a brief for deregulation. The members of this working group support limits on contributions to candidates and political parties. But we also recognize the limits of limits. More importantly, we believe that some of the key objectives can be pursued more effectively by expanding the playing field.

Interactive communications technology potentially can transform the political calculus. But technology alone cannot do the trick. Sound governmental policies will be essential: first, to protect the conditions under which a politically beneficial technology may flourish and, second, to encourage more candidates — particularly those below the top of the national ticket — to reach out to small donors and volunteers.

We focus on participation for two reasons. First, if enough people come into the system at the low end there may be less reason to worry about the top. Second, heightened participation would be healthy for its own sake. A more engaged citizenry would mean a greater share of the public following political events and participating in public life. And the evidence seems to suggest that giving and doing are reciprocal activities: volunteering stimulates giving, while giving small amounts seems to heighten non-financial forms of participation by people who feel more invested in the process.

For these reasons, we aim to promote equality and civic engagement by enlarging the participatory pie instead of shrinking it. The Supreme Court has ruled out pursuing equality or civic engagement by constraining speech. But the Court has never ruled out pursuing these goals through policies that do not constrain speech.

This report will show how to further these ends. The first half surveys current conditions; the second contains detailed recommendations for moving forward.

The report begins with new opportunities. The digital revolution is altering the calculus of participation by reducing the costs of both individual and collective action. Millions of American went online in 2008 to access campaign materials, comment on news reports, watch campaign videos and share information. The many can now communicate with the many without the intervention of elite or centralized organizations. This capacity has made new forms of political organizations easier to create, while permitting the traditional organizations — candidates and parties — to achieve unprecedented scales of citizen participation. No example better illustrates this potential than the Obama campaign of 2008, which is discussed at length in the full report.

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• Download Full Report »

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• Expanding Participation
• Improving Transparency

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• Table of Contents
• Sample Chapter

• {9ABF977A-E4A6-41C8-B030-0FD655E07DBF}, 978-0-8157-0332-7, $32.95 Add to Cart

Federal departments and agencies received just above $133 billion in R&D funds in 2013. To put that figure in perspective, World Bank data for 2013 shows that, 130 countries had a GDP below that level; U.S. R&D is larger than the entire economy of 60 percent of all countries in the world.

The chart below shows how those funds are allocated among the most important federal departments and agencies in terms of R&D.

Despite the impressive size of defense R&D, we hear little about it. While much of defense research and development is classified, in time, civilian applications find their way into mainstream commercial uses—the Internet and GPS emerged from research done at DARPA. Far more visible than defense R&D is biomedical research, clean energy research, or news about truly impressive discoveries either in distant galaxies or in the depths of our oceans.

What produces this asymmetry of visibility of federal R&D work?

In a recent Brookings paper, a colleague and I suggest that the answer lies in the prominence of R&D in the agencies’ accounting books. In short: How visible is R&D and how much the agency seeks to discuss it in public fora depends not on the relative importance, but on how large a portion of the agency’s budget is dedicated to R&D.

From a budget perspective, we identified two types of agencies performing R&D: those agencies whose main mission is to perform research and development, and those agencies that perform many functions in addition to R&D. For the former, the share of R&D in the discretionary budget is consistently high, while for the latter group, R&D is only a small part of their total budget (see the chart below). This distinction influences how agencies will argue for their R&D money, because they will make their case on the most important uses of their budget. If agencies have a low R&D share, they will keep it mixed with other functions and programs; for instance, research efforts will be justified only as supporting the main agency mission. In turn, agencies with a high R&D share must argue for their budgets highlighting the social outcomes of their work. These include three agencies whose primary mission is research (NASA, NSF, NIH), and a fourth (DoE) where research is a significant element of its mission.

There is little question that the four agencies with high R&D share produce greatly beneficial research for society. Their strategy of promoting their work publicly is not only smart budget politics but also civic and pedagogical in the sense of helping taxpayers understand that their tax dollars are well-spent. However, it is interesting to observe that other agencies may be producing research of equal social impact that flies under the public radar, mainly because those agencies prefer as a matter of good budget policy to keep a low profile for their R&D work.

One interesting conclusion for institutional design from this analysis is that promoting a research agency to the level of departments of government or its director to a cabinet rank position may bring prominence to its research, not because more and better research will necessarily get done but simply because that agency will seek public recognition for their work in order to justify its budget. Likewise, placing a research agency within a larger department may help conceal and protect their R&D funding; the politics of the department will focus on its main goals and R&D would recede to a concern of secondary interest in political battles.

In the Politics of Federal R&D we discuss in more detail the changing politics of budget and how R&D agencies can respond. The general strategies of concealment and self-promotion are likely to become more important for agencies to protect a steady growth of their research and development budgets.

Data sources: R&D data from the American Association for the Advancement of Sciences historical trends in Federal R&D. Total non-discretionary spending by federal agency from the Office of Management and Budget.

Event Information

On June 13, Brookings launched a new public opinion survey focusing on American attitudes toward refugees from the Middle East and from Syria in particular.

With violence in the Middle East and the associated refugee crisis continuing unabated, these issues remain prominent in Washington policy debates. It is therefore increasingly important for U.S. policymakers, political candidates, and voters to understand the American public’s attitudes toward the conflicts in the Middle East and the refugees fleeing those crises.

On June 13, Brookings launched a new public opinion survey focusing on American attitudes toward refugees from the Middle East and from Syria in particular. Conducted by Nonresident Senior Fellow Shibley Telhami, the poll looks at a range of questions, from whether Americans feel the United States has a moral obligation to take in refugees to whether these refugees pose a threat to national security. The national poll takes into account an expanded set of demographic variables and includes an over-sized sample of millennials.  

Telhami was joined in discussion by POLITICO Magazine and Boston Globe contributor Indira Lakshmanan. William McCants, senior fellow and director of the Project on U.S. Relations with the Islamic World at Brookings, provided introductory remarks and moderated the discussion.

This event launched the Brookings Refugees Forum, which will take place on June 14 and 15.

Join the conversation on Twitter using #RefugeeCrisis.

Video

• American attitudes on refugees from the Middle East - Part 1
• American attitudes on refugees from the Middle East - Part 2

Audio

• American attitudes on refugees from the Middle East

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20160613_telhami_poll_presentation
• 20160613_american_opinion_refugees_transcript

Event Information

A conversation with Senator John McCain

On May 19, the Center for 21st Century Security and Intelligence at Brookings (21CSI) hosted Senator John McCain (R-Ariz.) to address major reforms to the organization of the Department of Defense, the defense acquisition system, and the military health system included in the National Defense Authorization Act for Fiscal Year 2017, which is planned for consideration by the Senate as soon as next week.

Given his role as chairman of the Senate Armed Services Committee, McCain also addressed ongoing budget challenges for the Department of Defense and the military and his views on what needs to be done. Michael O’Hanlon, senior fellow and co-director of 21CSI, moderated the discussion.

Join the conversation on Twitter using #FY17NDAA

Video

• Introduction by Martin Indyk, and remarks by Sen. John McCain
• Discussion between Sen. John McCain and Michael O'Hanlon

Audio

• New demands on the military and the 2017 National Defense Authorization Act

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20160519_mccain_defense_transcript

I was honored today to speak at the kick off meeting of the new ReFormers Caucus. This group of over 100 former members of the U.S. Senate, the House, and governors of both parties, has come together to fight for meaningful campaign finance reform. In the bipartisan spirit of the caucus, I shared speaking duties with Professor Richard Painter, who was the Bush administration ethics czar and my predecessor before I had a similar role in the Obama White House. 

As I told the distinguished audience of ReFormers (get the pun?) gathered over lunch on Capitol Hill, I wish they had existed when in my Obama administration role I was working for the passage of the Disclose Act. That bill would have brought true transparency to the post-Citizens United campaign finance system, yet it failed by just one vote in Congress.  But it is not too late for Americans, working together, to secure enhanced transparency and other campaign finance changes that are desperately needed.  Momentum is building, with increasing levels of public outrage, as reflected in state and local referenda passing in Maine, Seattle and San Francisco just this week, and much more to come at the federal, state and local level.

On June 20, I moderated a conversation on the future of the Department of Veterans Affairs with Secretary Robert McDonald. When he took office almost two years ago, Secretary McDonald inherited an organization in crisis: too many veterans faced shockingly long wait-times before they received care, VA officials had allegedly falsified records, and other allegations of mismanagement abounded.

Photo: Paul Morigi

Since he was sworn into office, Secretary McDonald has led the VA through a period of ambitious reform, anchored by the MyVA program. He and his team have embraced three core strategies that are securing meaningful change. They are important insights for all government leaders, and private sector ones as well.

1. Set bold goals

Secretary McDonald’s vision is for the VA to become the number one customer-service agency in the federal government. But he and his team know that words alone won’t make this happen. They developed twelve breakthrough priorities for 2016 that will directly improve service to veterans. These actionable short-term objectives support the VA’s longer term aim to deliver an exceptional experience for our veterans. By aiming high, and also drafting a concrete roadmap, the VA has put itself on a path to success.

2. Hybridize the best of public and private sectors

To accomplish their ambitious goal, VA leadership is applying the best practices of customer-service businesses around the nation. The Secretary and his colleagues are leveraging the goodwill, resources, and expertise of both the private and public sector. To do that, the VA has brought together diverse groups of business leaders, medical professionals, government executives, and veteran advocates under their umbrella MyVA Advisory Committee. Following the examples set by private sector leaders in service provision and innovation, the VA is developing user-friendly mobile apps for veterans, modernizing its website, and seeking to make hiring practices faster, more competitive, and more efficient. And so that no good idea is left unheard, the VA has created a "shark tank” to capture and enact suggestions and recommendations for improvement from the folks who best understand daily VA operations—VA employees themselves.

3. Data, data, data

The benefits of data-driven decision making in government are well known. As led by Secretary McDonald, the VA has continued to embrace the use of data to inform its policies and improve its performance. Already a leader in the collection and publication of data, the VA has recently taken even greater strides in sharing information between its healthcare delivery agencies. In addition to collecting administrative and health-outcomes information, the VA is gathering data from veterans about what they think . Automated kiosks allow veterans to check in for appointments, and to record their level of satisfaction with the services provided.

The results that the Secretary and his team have achieved speak for themselves:

• 5 million more appointments completed last fiscal year over the previous fiscal year
• 7 million additional hours of care for veterans in the last two years (based on an increase in the clinical workload of 11 percent over the last two years)
• 97 percent of appointments completed within 30 days of the veteran’s preferred date; 86 percent within 7 days; 22 percent the same day
• Average wait times of 5 days for primary care, 6 days for specialty care, and 2 days for mental health are
• 90 percent of veterans say they are satisfied or completely satisfied with when they got their appointment (less than 3 percent said they were dissatisfied or completely dissatisfied).
• The backlog for disability claims—once over 600,000 claims that were more than 125 days old—is down almost 90 percent.

Thanks to Secretary McDonald’s continued commitment to modernization, the VA has made significant progress. Problems, of course, remain at the VA and the Secretary has more work to do to ensure America honors the debt it owes its veterans, but the past two years of reform have moved the Department in the right direction. His strategies are instructive for managers of change everywhere.

Fred Dews and Andrew Kenealy contributed to this post.

Part II of the 2015 Brown Center Report on American Education

Over the next several years, policy analysts will evaluate the impact of the Common Core State Standards (CCSS) on U.S. education.  The task promises to be challenging.  The question most analysts will focus on is whether the CCSS is good or bad policy.  This section of the Brown Center Report (BCR) tackles a set of seemingly innocuous questions compared to the hot-button question of whether Common Core is wise or foolish.  The questions all have to do with when Common Core actually started, or more precisely, when the Common Core started having an effect on student learning.  And if it hasn’t yet had an effect, how will we know that CCSS has started to influence student achievement? 

The analysis below probes this issue empirically, hopefully persuading readers that deciding when a policy begins is elemental to evaluating its effects.  The question of a policy’s starting point is not always easy to answer.  Yet the answer has consequences.  You can’t figure out whether a policy worked or not unless you know when it began.^[i] 

The analysis uses surveys of state implementation to model different CCSS starting points for states and produces a second early report card on how CCSS is doing.  The first report card, focusing on math, was presented in last year’s BCR.  The current study updates state implementation ratings that were presented in that report and extends the analysis to achievement in reading.  The goal is not only to estimate CCSS’s early impact, but also to lay out a fair approach for establishing when the Common Core’s impact began—and to do it now before data are generated that either critics or supporters can use to bolster their arguments.  The experience of No Child Left Behind (NCLB) illustrates this necessity.

After the 2008 National Assessment of Educational Progress (NAEP) scores were released, former Secretary of Education Margaret Spellings claimed that the new scores showed “we are on the right track.”^[ii] She pointed out that NAEP gains in the previous decade, 1999-2009, were much larger than in prior decades.  Mark Schneider of the American Institutes of Research (and a former Commissioner of the National Center for Education Statistics [NCES]) reached a different conclusion. He compared NAEP gains from 1996-2003 to 2003-2009 and declared NCLB’s impact disappointing.  “The pre-NCLB gains were greater than the post-NCLB gains.”^[iii]  It is important to highlight that Schneider used the 2003 NAEP scores as the starting point for assessing NCLB.  A report from FairTest on the tenth anniversary of NCLB used the same demarcation for pre- and post-NCLB time frames.^[iv]  FairTest is an advocacy group critical of high stakes testing—and harshly critical of NCLB—but if the 2003 starting point for NAEP is accepted, its conclusion is indisputable, “NAEP score improvement slowed or stopped in both reading and math after NCLB was implemented.” 

Choosing 2003 as NCLB’s starting date is intuitively appealing.  The law was introduced, debated, and passed by Congress in 2001.  President Bush signed NCLB into law on January 8, 2002.  It takes time to implement any law.  The 2003 NAEP is arguably the first chance that the assessment had to register NCLB’s effects. 

Selecting 2003 is consequential, however.  Some of the largest gains in NAEP’s history were registered between 2000 and 2003.  Once 2003 is established as a starting point (or baseline), pre-2003 gains become “pre-NCLB.”  But what if the 2003 NAEP scores were influenced by NCLB? Experiments evaluating the effects of new drugs collect baseline data from subjects before treatment, not after the treatment has begun.   Similarly, evaluating the effects of public policies require that baseline data are not influenced by the policies under evaluation.   

Avoiding such problems is particularly difficult when state or local policies are adopted nationally.  The federal effort to establish a speed limit of 55 miles per hour in the 1970s is a good example.  Several states already had speed limits of 55 mph or lower prior to the federal law’s enactment.  Moreover, a few states lowered speed limits in anticipation of the federal limit while the bill was debated in Congress.  On the day President Nixon signed the bill into law—January 2, 1974—the Associated Press reported that only 29 states would be required to lower speed limits.  Evaluating the effects of the 1974 law with national data but neglecting to adjust for what states were already doing would obviously yield tainted baseline data.

There are comparable reasons for questioning 2003 as a good baseline for evaluating NCLB’s effects.  The key components of NCLB’s accountability provisions—testing students, publicizing the results, and holding schools accountable for results—were already in place in nearly half the states.  In some states they had been in place for several years.  The 1999 iteration of Quality Counts, Education Week’s annual report on state-level efforts to improve public education, entitled Rewarding Results, Punishing Failure, was devoted to state accountability systems and the assessments underpinning them. Testing and accountability are especially important because they have drawn fire from critics of NCLB, a law that wasn’t passed until years later.

The Congressional debate of NCLB legislation took all of 2001, allowing states to pass anticipatory policies.  Derek Neal and Diane Whitmore Schanzenbach reported that “with the passage of NCLB lurking on the horizon,” Illinois placed hundreds of schools on a watch list and declared that future state testing would be high stakes.^[v] In the summer and fall of 2002, with NCLB now the law of the land, state after state released lists of schools falling short of NCLB’s requirements.  Then the 2002-2003 school year began, during which the 2003 NAEP was administered.  Using 2003 as a NAEP baseline assumes that none of these activities—previous accountability systems, public lists of schools in need of improvement, anticipatory policy shifts—influenced achievement.  That is unlikely.^[vi]

Unlike NCLB, there was no “pre-CCSS” state version of Common Core.  States vary in how quickly and aggressively they have implemented CCSS.  For the BCR analyses, two indexes were constructed to model CCSS implementation.  They are based on surveys of state education agencies and named for the two years that the surveys were conducted.  The 2011 survey reported the number of programs (e.g., professional development, new materials) on which states reported spending federal funds to implement CCSS.  Strong implementers spent money on more activities.  The 2011 index was used to investigate eighth grade math achievement in the 2014 BCR.  A new implementation index was created for this year’s study of reading achievement.  The 2013 index is based on a survey asking states when they planned to complete full implementation of CCSS in classrooms.  Strong states aimed for full implementation by 2012-2013 or earlier.      

Fourth grade NAEP reading scores serve as the achievement measure.  Why fourth grade and not eighth?  Reading instruction is a key activity of elementary classrooms but by eighth grade has all but disappeared.  What remains of “reading” as an independent subject, which has typically morphed into the study of literature, is subsumed under the English-Language Arts curriculum, a catchall term that also includes writing, vocabulary, listening, and public speaking.  Most students in fourth grade are in self-contained classes; they receive instruction in all subjects from one teacher.  The impact of CCSS on reading instruction—the recommendation that non-fiction take a larger role in reading materials is a good example—will be concentrated in the activities of a single teacher in elementary schools. The burden for meeting CCSS’s press for non-fiction, on the other hand, is expected to be shared by all middle and high school teachers.^[vii] 

Table 2-1 displays NAEP gains using the 2011 implementation index.  The four year period between 2009 and 2013 is broken down into two parts: 2009-2011 and 2011-2013.  Nineteen states are categorized as “strong” implementers of CCSS on the 2011 index, and from 2009-2013, they outscored the four states that did not adopt CCSS by a little more than one scale score point (0.87 vs. -0.24 for a 1.11 difference).  The non-adopters are the logical control group for CCSS, but with only four states in that category—Alaska, Nebraska, Texas, and Virginia—it is sensitive to big changes in one or two states.  Alaska and Texas both experienced a decline in fourth grade reading scores from 2009-2013.

The 1.11 point advantage in reading gains for strong CCSS implementers is similar to the 1.27 point advantage reported last year for eighth grade math.  Both are small.  The reading difference in favor of CCSS is equal to approximately 0.03 standard deviations of the 2009 baseline reading score.  Also note that the differences were greater in 2009-2011 than in 2011-2013 and that the “medium” implementers performed as well as or better than the strong implementers over the entire four year period (gain of 0.99).

Table 2-2 displays calculations using the 2013 implementation index.  Twelve states are rated as strong CCSS implementers, seven fewer than on the 2011 index.^[viii]  Data for the non-adopters are the same as in the previous table.  In 2009-2013, the strong implementers gained 1.27 NAEP points compared to -0.24 among the non-adopters, a difference of 1.51 points.  The thirty-four states rated as medium implementers gained 0.82.  The strong implementers on this index are states that reported full implementation of CCSS-ELA by 2013.  Their larger gain in 2011-2013 (1.08 points) distinguishes them from the strong implementers in the previous table.  The overall advantage of 1.51 points over non-adopters represents about 0.04 standard deviations of the 2009 NAEP reading score, not a difference with real world significance.  Taken together, the 2011 and 2013 indexes estimate that NAEP reading gains from 2009-2013 were one to one and one-half scale score points larger in the strong CCSS implementation states compared to the states that did not adopt CCSS.

As noted above, the 2013 implementation index is based on when states scheduled full implementation of CCSS in classrooms.  Other than reading achievement, does the index seem to reflect changes in any other classroom variable believed to be related to CCSS implementation?  If the answer is “yes,” that would bolster confidence that the index is measuring changes related to CCSS implementation. 

Let’s examine the types of literature that students encounter during instruction.  Perhaps the most controversial recommendation in the CCSS-ELA standards is the call for teachers to shift the content of reading materials away from stories and other fictional forms of literature in favor of more non-fiction.  NAEP asks fourth grade teachers the extent to which they teach fiction and non-fiction over the course of the school year (see Figure 2-1). 

Historically, fiction dominates fourth grade reading instruction.  It still does.  The percentage of teachers reporting that they teach fiction to a “large extent” exceeded the percentage answering “large extent” for non-fiction by 23 points in 2009 and 25 points in 2011.  In 2013, the difference narrowed to only 15 percentage points, primarily because of non-fiction’s increased use.  Fiction still dominated in 2013, but not by as much as in 2009.

The differences reported in Table 2-3 are national indicators of fiction’s declining prominence in fourth grade reading instruction.  What about the states?  We know that they were involved to varying degrees with the implementation of Common Core from 2009-2013.  Is there evidence that fiction’s prominence was more likely to weaken in states most aggressively pursuing CCSS implementation? 

Table 2-3 displays the data tackling that question.  Fourth grade teachers in strong implementation states decisively favored the use of fiction over non-fiction in 2009 and 2011.  But the prominence of fiction in those states experienced a large decline in 2013 (-12.4 percentage points).  The decline for the entire four year period, 2009-2013, was larger in the strong implementation states (-10.8) than in the medium implementation (-7.5) or non-adoption states (-9.8).  

This section of the Brown Center Report analyzed NAEP data and two indexes of CCSS implementation, one based on data collected in 2011, the second from data collected in 2013.  NAEP scores for 2009-2013 were examined.  Fourth grade reading scores improved by 1.11 scale score points in states with strong implementation of CCSS compared to states that did not adopt CCSS.  A similar comparison in last year’s BCR found a 1.27 point difference on NAEP’s eighth grade math test, also in favor of states with strong implementation of CCSS.  These differences, although certainly encouraging to CCSS supporters, are quite small, amounting to (at most) 0.04 standard deviations (SD) on the NAEP scale.  A threshold of 0.20 SD—five times larger—is often invoked as the minimum size for a test score change to be regarded as noticeable.  The current study’s findings are also merely statistical associations and cannot be used to make causal claims.  Perhaps other factors are driving test score changes, unmeasured by NAEP or the other sources of data analyzed here. 

The analysis also found that fourth grade teachers in strong implementation states are more likely to be shifting reading instruction from fiction to non-fiction texts.  That trend should be monitored closely to see if it continues.  Other events to keep an eye on as the Common Core unfolds include the following:

1.  The 2015 NAEP scores, typically released in the late fall, will be important for the Common Core.  In most states, the first CCSS-aligned state tests will be given in the spring of 2015.  Based on the earlier experiences of Kentucky and New York, results are expected to be disappointing.  Common Core supporters can respond by explaining that assessments given for the first time often produce disappointing results.  They will also claim that the tests are more rigorous than previous state assessments.  But it will be difficult to explain stagnant or falling NAEP scores in an era when implementing CCSS commands so much attention.   

2.  Assessment will become an important implementation variable in 2015 and subsequent years.  For analysts, the strategy employed here, modeling different indicators based on information collected at different stages of implementation, should become even more useful.  Some states are planning to use Smarter Balanced Assessments, others are using the Partnership for Assessment of Readiness for College and Careers (PARCC), and still others are using their own homegrown tests.   To capture variation among the states on this important dimension of implementation, analysts will need to use indicators that are up-to-date.

3.  The politics of Common Core injects a dynamic element into implementation.  The status of implementation is constantly changing.  States may choose to suspend, to delay, or to abandon CCSS.  That will require analysts to regularly re-configure which states are considered “in” Common Core and which states are “out.”  To further complicate matters, states may be “in” some years and “out” in others.

A final word.  When the 2014 BCR was released, many CCSS supporters commented that it is too early to tell the effects of Common Core.  The point that states may need more time operating under CCSS to realize its full effects certainly has merit.  But that does not discount everything states have done so far—including professional development, purchasing new textbooks and other instructional materials, designing new assessments, buying and installing computer systems, and conducting hearings and public outreach—as part of implementing the standards.  Some states are in their fifth year of implementation.  It could be that states need more time, but innovations can also produce their biggest “pop” earlier in implementation rather than later.  Kentucky was one of the earliest states to adopt and implement CCSS.  That state’s NAEP fourth grade reading score declined in both 2009-2011 and 2011-2013.  The optimism of CCSS supporters is understandable, but a one and a half point NAEP gain might be as good as it gets for CCSS.

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Hypocrisy is not scarce in the world of politics. But the current House and Senate budget resolutions set new lows. Each proposes to cut about $5 trillion from government spending over the next decade in pursuit of a balanced budget. Whatever one may think of putting the goal of reducing spending when the ratio of the debt-to-GDP is projected to be stable above investing in the nation’s future, you would think that deficit-reduction hawks wouldn’t cut spending that has been proven to lower the deficit.

Yes, there are expenditures that actually lower the deficit, typically by many dollars for each dollar spent. In this category are outlays on ‘program integrity’ to find and punish fraud, tax evasion, and plain old bureaucratic mistakes. You might suppose that those outlays would be spared. Guess again. Consider the following:

Medicare. Roughly 10% of Medicare’s $600 billion budget goes for what officials delicately call ‘improper payments, according to the 2014 financial report of the Department of Health and Human Services. Some are improper merely because providers ‘up-code’ legitimate services to boost their incomes. Some payments go for services that serve no valid purpose. And some go for phantom services that were never provided. Whatever the cause, approximately $60 billion of improper payments is not ‘chump change.’

Medicare tries to root out these improper payments, but it lacks sufficient staff to do the job. What it does spend on ‘program integrity’ yields an estimated $14.40? for each dollar spent, about $10 billion a year in total. That number counts only directly measurable savings, such as recoveries and claim denials. A full reckoning of savings would add in the hard-to-measure ‘policeman on the beat’ effect that discourages violations by would-be cheats.

Fat targets remain. A recent report from the Institute of Medicine presented findings that veritably scream ‘fraud.’ Per person spending on durable medical equipment and home health care is ten times higher in Miami-Dade County, Florida than the national average. Such equipment and home health accounts for nearly three-quarters of the geographical variation in per person Medicare spending. Yet, only 4% of current recoveries of improper payments come from audits of these two items and little from the highest spending locations.

Why doesn’t Medicare spend more and go after the remaining overpayments, you may wonder? The simple answer is that Congress gives Medicare too little money for administration. Direct overhead expenses of Medicare amount to only about 1.5% of program outlays—6% if one includes the internal administrative costs of private health plans that serve Medicare enrollees. Medicare doesn’t need to spend as much on administration as the average of 19% spent by private insurers, because for example, Medicare need not pay dividends to private shareholders or advertise.

But spending more on Medicare administration would both pay for itself—$2 for each added dollar spent, according to the conservative estimate in the President’s most recent budget—and improve the quality of care. With more staff, Medicare could stop more improper payments and reduce the use of approved therapies in unapproved ways that do no good and may cause harm.

Taxes. Compare two numbers: $540 billion and $468 billion. The first number is the amount of taxes owed but not paid. The second number is the projected federal budget deficit for 2015, according to the Congressional Budget Office.

Collecting all taxes legally owed but not paid is an impossibility. It just isn’t worth going after every violation. But current enforcement falls far short of practical limits. Expenditures on enforcement directly yields $4 to $6 for each dollar spent on enforcement. Indirect savings are many times larger—the cop-on-the-beat effect again. So, in an era of ostentatious concern about budget deficits, you would expect fiscal fretting in Congress to lead to increased efforts to collect what the law says people owe in taxes.

Wrong again. Between 2010 and 2014, the IRS budget was cut in real terms by 20%. At the same time, the agency had to shoulder new tasks under health reform, as well as process an avalanche of applications for tax exemptions unleashed by the 2010 Supreme Court decision in the Citizens United case. With less money to spend and more to do, enforcement staff dropped by 15% and inflation adjusted collections dropped 13%.

One should acknowledge that enforcement will not do away with most avoidance and evasion. Needlessly complex tax laws are the root cause of most tax underpayment. Tax reform would do even more than improved administration to increase the ratio of taxes paid to taxes due. But until that glorious day when Congress finds the wit and will to make the tax system simpler and fairer, it would behoove a nation trying to make ends meet to spend $2 billion to $3 billion more each year to directly collect $10 billion to 15 billion a year more of legally owed taxes and, almost certainly, raise far more than that by frightening borderline scoff-laws.

Disability Insurance. Thirteen million people with disabling conditions who are judged incapable of engaging in substantial gainful activity received $161 billion in disability insurance in 2013. If the disabling conditions improve enough so that beneficiaries can return to work, benefits are supposed to be stopped. Such improvement is rare. But when administrators believe that there is some chance, the law requires them to check. They may ask beneficiaries to fill out a questionnaire or, in some cases, undergo a new medical exam at government expense. Each dollar spent in these ways generated an estimated $16 in savings in 2013.

Still, the Social Security Administration is so understaffed that SSA has a backlog of 1.3 million disability reviews. Current estimates indicate that spending a little over $1 billion a year more on such reviews over the next decade would save $43 billion. Rather than giving Social Security the staff and spending authority to work down this backlog and realize those savings, Congress has been cutting the agency’s administrative budget and sequestration threatens further cuts.

Claiming that better administration will balance the budget would be wrong. But it would help. And it would stop some people from shirking their legal responsibilities and lighten the burdens of those who shoulder theirs. The failure of Congress to provide enough staff to run programs costing hundreds of billions of dollars a year as efficiently and honestly as possible is about as good a definition of criminal negligence as one can find.

The eurozone has three problems: national debt obligations that cannot be met, medium-term imbalances in trade competitiveness, and long-term structural flaws.

The short-run problem requires more of the monetary easing that Germany has, with appalling shortsightedness, been resisting, and less of the near-term fiscal restraint that Germany has, with equally appalling shortsightedness, been seeking. To insist that Greece meet all of its near-term current debt service obligations makes about as much sense as did French and British insistence that Germany honor its reparations obligations after World War I. The latter could not be and were not honored. The former cannot and will not be honored either.

The medium-term problem is that, given a single currency, labor costs are too high in Greece and too low in Germany and some other northern European countries. Because adjustments in currency values cannot correct these imbalances, differences in growth of wages must do the job—either wage deflation and continued depression in Greece and other peripheral countries, wage inflation in Germany, or both. The former is a recipe for intense and sustained misery. The latter, however politically improbable it may now seem, is the better alternative.

The long-term problem is that the eurozone lacks the fiscal transfer mechanisms necessary to soften the effects of competitiveness imbalances while other forms of adjustment take effect. This lack places extraordinary demands on the willingness of individual nations to undertake internal policies to reduce such imbalances. Until such fiscal transfer mechanisms are created, crises such as the current one are bound to recur.

Present circumstances call for a combination of short-term expansionary policies that have to be led or accepted by the surplus nations, notably Germany, who will also have to recognize and accept that not all Greek debts will be paid or that debt service payments will not be made on time and at originally negotiated interest rates. The price for those concessions will be a current and credible commitment eventually to restore and maintain fiscal balance by the peripheral countries, notably Greece.

Medicare Hospital Insurance and Social Security would not add to deficits because they can’t spend money they don’t have.

The dog days of August have given way to something much worse. Congress returned to session this week, and the rest of the year promises to be nightmarish. The House and Senate passed budget resolutions earlier this year calling for nearly $5 trillion in spending cuts by 2025. More than two-thirds of those cuts would come from programs that help people with low-and moderate-incomes. Health care spending would be halved. If such cuts are enacted, the president will likely veto them. At best, another partisan budget war will ensue after which the veto is sustained. At worst, the cuts become law.

The putative justification for these cuts is that the nation faces insupportable increases in public debt because of expanding budget deficits. Even if the projections were valid, it would be prudent to enact some tax increases in order to preserve needed public spending. But the projections of explosively growing debt are not valid. They are fantasy.

Wait! you say. The Congressional Budget Office has been telling us for years about the prospect of rising deficit and exploding debt. They repeated those warnings just two months ago. Private organizations of both the left and right agree with the CBO’s projections, in general if not in detail. How can any sane person deny that the nation faces a serious long-term budget deficit problem?

The answer is simple: The CBO and private organizations use a convention in preparing their projections that is at odds with established policy and law. If, instead, projections are based on actual current law, as they claim to be, the specter of an increasing debt burden vanishes. What is that convention? Why is it wrong? Why did CBO adopt it, and why have others kept it?

CBO’s budget projections cover the next 75 years. Its baseline projections claim to be based on current law and policy. (CBO also presents an ‘alternative scenario’ based on assumed changes in law and policy). Within that period, Social Security (OASDI) and Medicare Hospital Insurance (HI) expenditures are certain to exceed revenues earmarked to pay for them. Both are financed through trust funds. Both funds have sizeable reserves — government securities — that can be used to cover short falls for a while. But when those reserves are exhausted, expenditures cannot exceed current revenues. Trust fund financing means that neither Social Security nor Medicare Hospital Insurance can run deficits. Nor can they add to the public debt.

Nonetheless, CBO and other organizations assume that Social Security and Medicare Hospital Insurance can and will spend money they don’t have and that current law bars them from spending.

One of the reasons why trust fund financing was used, first for Social Security and then for Medicare Hospital Insurance, was to create a framework that disciplined Congress earmarked to earmark sufficient revenues to pay for benefits it might award. Successive presidents and Congresses, both Republican and Democratic, have repeatedly acted to prevent either program’s cumulative spending from exceeding cumulative revenues. In 1983, for example, faced with an impending trust fund shortfall, Congress cut benefits and raised taxes enough to turn prospective cash flow trust fund deficits into cash flow surpluses. And President Reagan signed the bill. In so doing, they have reaffirmed the discipline imposed by trust fund financing.

Trust fund accounting explains why people now are worrying about the adequacy of funding for Social Security and Medicare. They recognize that the trust funds will be depleted in a couple of decades. They understand that between now and then Congress must either raise earmarked taxes or fashion benefit cuts. If it doesn’t raise taxes, benefits will be cut across the board. Either way, the deficits that CBO and other organizations have built into their budget projections will not materialize.

The implications for projected debt of CBO’s inclusion in its projections of deficits that current law and established policy do not allow are enormous, as the graph below shows.

If one excludes deficits in Social Security and Medicare Hospital Insurance that cannot occur under current law and established policy, the ratio of national debt to gross domestic product will fall, not rise, as CBO budget projections indicate. In other words, the claim that drastic cuts in government spending are necessary to avoid calamitous budget deficits is bogus.

It might seem puzzling that CBO, an agency known for is professionalism and scrupulous avoidance of political bias, would adopt a convention so at odds with law and policy. The answer is straightforward—Congress makes them do it. Section 257 of the Balanced Budget and Emergency Deficit Control Act of 1985 requires CBO to assume that the trust funds can spend money although legislation governing trust fund operations bars such expenditures. CBO is obeying the law.

No similar explanation exonerates the statement of the Committee for a Responsible Federal Budget, which on August 25, 2015 cited, with approval, the conclusion that ‘debt continues to grow unsustainably,’ or that of the Bipartisan Policy Center, which wrote on the same day that ‘America’s debt continues to grow on an unsustainable path.’ Both statements are wrong.

To be sure, the dire budget future anticipated in the CBO projections could materialize. Large deficits could result from an economic calamity or war. Congress could abandon the principle that Social Security and Medicare Hospital Insurance should be financed within trust funds. It could enact other fiscally rash policies. But such deficits do not flow from current law or reflect the trust fund discipline endorsed by both parties over the last 80 years. And it is current law and policy that are supposed to underlie budget projections. Slashing spending because a thirty-year old law requires CBO to assume that Congress will do something it has shown no sign of doing—overturn decades of bipartisan prudence requiring that the major social insurance programs spend only money specifically earmarked for them, and not a penny more—would impose enormous hardship on vulnerable populations in the name of a fiscal fantasy.

Editor's Note: This post originally appeared in Fortune Magazine.

Led by presidential candidate Bernie Sanders, one-time supporters of ‘single-payer’ health reform are rekindling their romance with a health reform idea that was, is, and will remain a dream.  Single-payer health reform is a dream because, as the old joke goes, ‘you can’t get there from here.

Let’s be clear: opposing a proposal only because one believes it cannot be passed is usually a dodge.One should judge the merits. Strong leaders prove their skill by persuading people to embrace their visions. But single-payer is different. It is radical in a way that no legislation has ever been in the United States.

Not so, you may be thinking. Remember such transformative laws as the Social Security Act, Medicare, the Homestead Act, and the Interstate Highway Act. And, yes, remember the Affordable Care Act. Those and many other inspired legislative acts seemed revolutionary enough at the time. But none really was. None overturned entrenched and valued contractual and legislative arrangements. None reshuffled trillions—or in less inflated days, billions—of dollars devoted to the same general purpose as the new legislation. All either extended services previously available to only a few, or created wholly new arrangements.

To understand the difference between those past achievements and the idea of replacing current health insurance arrangements with a single-payer system, compare the Affordable Care Act with Sanders’ single-payer proposal.

Criticized by some for alleged radicalism, the ACA is actually stunningly incremental. Most of the ACA’s expanded coverage comes through extension of Medicaid, an existing public program that serves more than 60 million people. The rest comes through purchase of private insurance in “exchanges,” which embody the conservative ideal of a market that promotes competition among private venders, or through regulations that extended the ability of adult offspring to remain covered under parental plans. The ACA minimally altered insurance coverage for the 170 million people covered through employment-based health insurance. The ACA added a few small benefits to Medicare but left it otherwise untouched. It left unaltered the tax breaks that support group insurance coverage for most working age Americans and their families. It also left alone the military health programs serving 14 million people. Private nonprofit and for-profit hospitals, other vendors, and privately employed professionals continue to deliver most care.

In contrast, Senator Sanders’ plan, like the earlier proposal sponsored by Representative John Conyers (D-Michigan) which Sanders co-sponsored, would scrap all of those arrangements. Instead, people would simply go to the medical care provider of their choice and bills would be paid from a national trust fund. That sounds simple and attractive, but it raises vexatious questions.

• How much would it cost the federal government? Where would the money to cover the costs come from?
• What would happen to the $700 billion that employers now spend on health insurance?
• How would the $600 billion a year reductions in total health spending that Sanders says his plan would generate come from?
• What would happen to special facilities for veterans and families of members of the armed services?

Sanders has answers for some of these questions, but not for others. Both the answers and non-answers show why single payer is unlike past major social legislation.

The answer to the question of how much single payer would cost the federal government is simple: $4.1 trillion a year, or $1.4 trillion more than the federal government now spends on programs that the Sanders plan would replace. The money would come from new taxes. Half the added revenue would come from doubling the payroll tax that employers now pay for Social Security. This tax approximates what employers now collectively spend on health insurance for their employees...if they provide health insurance. But many don’t. Some employers would face large tax increases. Others would reap windfall gains.

The cost question is particularly knotty, as Sanders assumes a 20 percent cut in spending averaged over ten years, even as roughly 30 million currently uninsured people would gain coverage. Those savings, even if actually realized, would start slowly, which means cuts of 30 percent or more by Year 10. Where would they come from? Savings from reduced red-tape associated with individual insurance would cover a small fraction of this target. The major source would have to be fewer services or reduced prices. Who would determine which of the services physicians regard as desirable -- and patients have come to expect -- are no longer ‘needed’? How would those be achieved without massive bankruptcies among hospitals, as columnist Ezra Klein has suggested, and would follow such spending cuts? What would be the reaction to the prospect of drastic cuts in salaries of health care personnel – would we have a shortage of doctors and nurses? Would patients tolerate a reduction in services? If people thought that services under the Sanders plan were inadequate, would they be allowed to ‘top up’ with private insurance? If so, what happens to simplicity? If not, why not?

Let me be clear: we know that high quality health care can be delivered at much lower cost than is the U.S. norm. We know because other countries do it. In fact, some of them have plans not unlike the one Senator Sanders is proposing. We know that single-payer mechanisms work in some countries. But those systems evolved over decades, based on gradual and incremental change from what existed before. That is the way that public policy is made in democracies. Radical change may occur after a catastrophic economic collapse or a major war. But in normal times, democracies do not tolerate radical discontinuity. If you doubt me, consider the tumult precipitated by the really quite conservative Affordable Care Act.

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

Health reform (aka Obamacare) is entering a new stage. The recent announcement by United Health Care that it will stop selling insurance to individuals and families through most health insurance exchanges marks the transition. In the next stage, federal and state policy makers must decide how to use broad regulatory powers they have under the Affordable Care Act (ACA) to stabilize, expand, and diversify risk pools, improve local market competition, encourage insurers to compete on product quality rather than premium alone, and promote effective risk management. In addition, insurance companies must master rate setting, plan design, and network management and effectively manage the health risk of their enrollees in order to stay profitable, and consumers must learn how to choose and use the best plan for their circumstances.

Six months ago, United Health Care (UHC) announced that it was thinking about pulling out of the ACA exchanges. Now, they are pulling out of all but a “handful” of marketplaces. UHC is the largest private vendor of health insurance in the nation. Nonetheless, the impact on people who buy insurance through the ACA exchanges will be modest, according to careful analyses from the Kaiser Family Foundation and the Urban Institute. The effect is modest for three reasons. One is that in some states UHC focuses on group insurance, not on insurance sold to individuals, where they are not always a major presence. Secondly, premiums of UHC products in individual markets are relatively high. Third, in most states and counties ACA purchasers will still have a choice of two or more other options. In addition, UHC’s departure may coincide with or actually cause the entry of other insurers, as seems to be happening in Iowa.

The announcement by UHC is noteworthy, however. It signals the beginning for ACA exchanges of a new stage in their development, with challenges and opportunities different from and in many ways more important than those they faced during the first three years of operation, when the challenge was just to get up and running. From the time when HealthCare.Gov and the various state exchanges opened their doors until now, administrators grappled non-stop with administrative challenges—how to enroll people, helping them make an informed choice among insurance offerings, computing the right amount of assistance each individual or family should receive, modifying plans when income or family circumstances change, and performing various ‘back office’ tasks such as transferring data to and from insurance companies. The chaotic first weeks after the exchanges opened on October 1, 2013 have been well documented, not least by critics of the ACA. Less well known are the countless behind-the-scenes crises, patches, and work-arounds that harried exchange administrators used for years afterwards to keep the exchanges open and functioning.

The ACA forced not just exchange administrators but also insurers to cope with a new system and with new enrollees. Many new exchange customers were uninsured prior to signing up for marketplace coverage. Insurers had little or no information on what their use of health care would be. That meant that insurers could not be sure where to set premiums or how aggressively to try to control costs, for example by limiting networks of physicians and hospitals enrollees could use. Some did the job well or got lucky. Some didn’t. United seems to have fallen in the second category. United could have stayed in the 30 or so state markets they are leaving and tried to figure out ways to compete more effectively, but since their marketplace premiums were often not competitive and most of their business was with large groups, management decided to focus on that highly profitable segment of the insurance market. Some insurers, are seeking sizeable premium increases for insurance year 2017, in part because of unexpectedly high usage of health care by new exchange enrollees.

United is not alone in having a rough time in the exchanges. So did most of the cooperative plans that were set up under the ACA. Of the 23 cooperative plans that were established, more than half have gone out of business and more may follow. These developments do not signal the end of the ACA or even indicate a crisis. They do mark the end of an initial period when exchanges were learning how best to cope with clerical challenges posed by a quite complicated law and when insurance companies were breaking into new markets. In the next phase of ACA implementation, federal and state policy makers will face different challenges: how to stabilize, expand, and diversify marketplace risk pools, promote local market competition, and encourage insurers to compete on product quality rather than premium alone. Insurance company executives will have to figure out how to master rate setting, plan design, and network management and manage risk for customers with different characteristics than those to which they have become accustomed.

Achieving these goals will require state and federal authorities to go beyond the core implementation decisions that have absorbed most of their attention to date and exercise powers the ACA gives them. For example, section 1332 of the ACA authorizes states to apply for waivers starting in 2017 under which they can seek to achieve the goals of the 2010 law in ways different from those specified in the original legislation. Along quite different lines, efforts are already underway in many state-based marketplaces, such as the District of Columbia, to expand and diversify the individual market risk pool by expanding marketing efforts to enroll new consumers, especially young adults. Minnesota’s Health Care Task Force recently recommended options to stabilize marketplace premiums, including reinsurance, maximum limits on the excess capital reserves or surpluses of health plans, and the merger of individual and small group markets, as Massachusetts and Vermont have done.

In normal markets, prices must cover costs, and while some companies prosper, some do not. In that respect, ACA markets are quite normal. Some regional and national insurers, along with a number of new entrants, have experienced losses in their marketplace business in 2016. One reason seems to be that insurers priced their plans aggressively in 2014 and 2015 to gain customers and then held steady in 2016. Now, many are proposing significant premium hikes for 2017.

Others, like United, are withdrawing from some states. ACA exchange administrators and state insurance officials must now take steps to encourage continued or new insurer participation, including by new entrants such as Medicaid managed care organizations (MCOs). For example, in New Mexico, where in 2016 Blue Cross Blue Shield withdrew from the state exchange, state officials now need to work with that insurer to ensure a smooth transition as it re-enters the New Mexico marketplace and to encourage other insurers to join it. In addition, state insurance regulators can use their rate review authority to benefit enrollees by promoting fair and competitive pricing among marketplace insurers. During the rate review process, which sometimes evolves into a bargaining process, insurance regulators often have the ability to put downward pressure on rates, although they must be careful to avoid the risk of underpricing of marketplace plans which could compromise the financial viability of insurers and cause them to withdraw from the market. Exchanges have an important role in the affordability of marketplace plans too. For example ACA marketplace officials in the District of Columbia and Connecticut work closely with state regulators during the rate review process in an effort to keep rates affordable and adequate to assure insurers a fair rate of return.

Several studies now indicate that in selecting among health insurance plans people tend to give disproportionate weight to premium price, and insufficient attention to other cost provisions—deductibles and cost sharing—and to quality of service and care. A core objective of the ACA is to encourage insurance customers to evaluate plans comprehensively. This objective will be hard to achieve, as health insurance is perhaps the most complicated product most people buy. But it will be next to impossible unless customers have tools that help them take account of the cost implications of all plan features and report accurately and understandably on plan quality and service. HealthCare.gov and state-based marketplaces, to varying degrees, are already offering consumers access to a number of decision support tools, such as total cost calculators, integrated provider directories, and formulary look-ups, along with tools that indicate provider network size. These should be refined over time. In addition, efforts are now underway at the federal and state level to provide more data to consumers so that they can make quality-driven plan choices. In 2018, the marketplaces will be required to display federally developed quality ratings and enrollee satisfaction information. The District of Columbia is examining the possibility of adding additional measures. California has proposed that starting in 2018 plans may only contract with providers and hospitals that have met state-specified metrics of quality care and promote safety of enrollees at a reasonable price. Such efforts will proliferate, even if not all succeed.

Beyond regulatory efforts noted above, insurance companies themselves have a critical role to play in contributing to the continued success of the ACA. As insurers come to understand the risk profiles of marketplace enrollees, they will be better able to set rates, design plans, and manage networks and thereby stay profitable. In addition, insurers are best positioned to maintain the stability of their individual market risk pools by developing and financing marketing plans to increase the volume and diversity of their exchange enrollments. It is important, in addition, that insurers, such as UHC, stop creaming off good risks from the ACA marketplaces by marketing limited coverage insurance products, such as dread disease policies and short term plans. If they do not do so voluntarily, state insurance regulators and the exchanges should join in stopping them from doing so.

Most of the attention paid to the ACA to date has focused on efforts to extend health coverage to the previously uninsured and to the administrative stumbles associated with that effort. While insurance coverage will broaden further, the period of rapid growth in coverage is at an end. And while administrative challenges remain, the basics are now in place. Now, the exchanges face the hard work of promoting vigorous and sustainable competition among insurers and of providing their customers with information so that insurers compete on what matters: cost, service, and quality of health care.

Editor's note: This piece originally appeared in Real Clear Markets. Kevin Lucia and Justin Giovannelli contributed to this article with generous support from The Commonwealth Fund.

If you’re reading this article, chances are you know people who are still getting married. But it’s getting rarer, especially among the youngest generation and those who are less educated. We used to assume people would marry before having children. But marriage is no longer the norm. Half of all children born to women under 30 are born out of wedlock. The proportion is even higher among those without a college degree.

What’s going on here? Most of today’s young adults don’t feel ready to marry in their early 20s. Many have not completed their educations; others are trying to get established in a career; and many grew up with parents who divorced and are reluctant to make a commitment or take the risks associated with a legally binding tie.

But these young people are still involved in romantic relationships. And yes, they are having sex. Any stigma associated with premarital sex disappeared a long time ago, and with sex freely available, there’s even less reason to bother with tying the knot. The result: a lot of drifting into unplanned pregnancies and births to unmarried women and their partners with the biggest problems now concentrated among those in their 20s rather than in their teens. (The teen birth rate has actually declined since the early 1990s.)

Does all of this matter? In a word, yes.

These trends are not good for the young people involved and they are especially problematic for the many children being born outside marriage. The parents may be living together at the time of the child’s birth but these cohabiting relationships are highly unstable. Most will have split before the child is age 5.

Social scientists who have studied the resulting growth of single-parent families have shown that the children in these families don’t fare as well as children raised in two-parent families. They are four or five times as likely to be poor; they do less well in school; and they are more likely to engage in risky behaviors as adolescents. Taxpayers end up footing the bill for the social assistance that many of these families need.

Is there any way to restore marriage to its formerly privileged position as the best way to raise children? No one knows. The fact that well-educated young adults are still marrying is a positive sign and a reason for hope. On the other hand, the decline in marriage and rise in single parenthood has been dramatic and the economic and cultural transformations behind these trends may be difficult to reverse.

Women are no longer economically dependent on men, jobs have dried up for working-class men, and unwed parenthood is no longer especially stigmatized. The proportion of children raised in single-parent homes has, as a consequence, risen from 5 percent in 1960 to about 30 percent now.

Conservatives have called for the restoration of marriage as the best way to reduce poverty and other social ills. However, they have not figured out how to do this.

The George W. Bush administration funded a series of marriage education programs that failed to move the needle in any significant way. The Clinton administration reformed welfare to require work and thus reduced any incentive welfare might have had in encouraging unwed childbearing. The retreat from marriage has continued despite these efforts. We are stuck with a problem that has no clear governmental solution, although religious and civic organizations can still play a positive role.

But perhaps the issue isn’t just marriage. What may matter even more than marriage is creating stable and committed relationships between two mature adults who want and are ready to be parents before having children. That means reducing the very large fraction of births to young unmarried adults that occur before these young people say they are ready for parenthood.

Among single women under the age of 30, 73 percent of all pregnancies are, according to the woman herself, either unwanted or badly mistimed. Some of these women will go on to have an abortion but 60 percent of all of the babies born to this group are unplanned.

As I argue in my book, “Generation Unbound,” we need to combine new cultural messages about the importance of committed relationships and purposeful childbearing with new ways of helping young adults avoid accidental pregnancies. The good news here is that new forms of long-acting but fully reversible contraception, such as the IUD and the implant, when made available to young women at no cost and with good counseling on their effectiveness and safety, have led to dramatic declines in unplanned pregnancies. Initiatives in the states of Colorado and Iowa, and in St. Louis have shown what can be accomplished on this front.

Would greater access to the most effective forms of birth control move the needle on marriage? Quite possibly. Unencumbered with children from prior relationships and with greater education and earning ability, young women and men would be in a better position to marry. And even if they fail to marry, they will be better parents.

My conclusion: marriage is in trouble and, however desirable, will be difficult to restore. But we can at least ensure that casual relationships outside of marriage don’t produce children before their biological parents are ready to take on one of the most difficult social tasks any of us ever undertakes: raising a child. Accidents happen; a child shouldn’t be one of them.