There are a number of causes of the financial crisis that has devastated the U.S. economy and spread globally. Weakness in financial sector regulation was one of the causes and the proliferation of different regulators is, in turn, a cause of the regulatory failure. There is a bewildering, alphabet soup variety of regulators and supervisors for banks and other financial institutions that failed in their task of preventing the crisis and, at the same time, created an excessive regulatory burden on the industry because of overlapping and duplicative functions.

We can do better. This paper makes the case for a single micro prudential regulator, that is to say, one federal agency that has responsibility for the supervision and regulation of all federally chartered banks and all major non-bank financial institutions. There would still be state-chartered financial institutions covered by state regulators, but the federal regulator would share regulatory authority with the states.

The Objectives Approach to Regulation

The Blueprint for financial reform prepared by the Paulson Treasury proposed a system of objectives-based regulation, an approach that had been previously suggested and that is the basis for regulation in Australia. The White Paper prepared by the Geithner Treasury did not use the same terminology, but it is clear from the structure of the paper that their approach is essentially an objectives-based one, as they lay out the different elements of regulatory reform that should be covered. I support the objectives approach to regulation.

There should be three major objectives of regulation, as follows.

• To make sure that there is micro-prudential supervisions, so that customers and taxpayers are protected against excessive risk taking that may cause a single institution to fail.

• To make sure that whole financial sector retains its balance and does not become unstable. That means someone has to warn about the build up of risk across several institutions and perhaps take regulatory actions to restrain lending used to purchase assets whose prices are creating a speculative bubble.

• To regulate the conduct of business. That means to watch out for the interests of consumers and investors, whether they are small shareholders in public companies or households deciding whether to take out a mortgage or use a credit card.

In applying this approach, it is vital for both the economy and the financial sector that the Federal Reserve has independence as it makes monetary policy. Experience in the United States and around the world supports the view that an independent central bank results in better macroeconomic performance and restrains inflationary expectations. An independent Fed setting monetary policy is essential.

An advantage of objectives-based regulation is that it forces us to consider what are the “must haves” of financial regulation—those things absolutely necessary to reduce the chances of another crisis. Additionally we can see the “must not haves”—the regulations that would have negative effects. It is much more important to make sure that the job gets done right, that there are no gaps in regulation that could contribute to another crisis and that there not be over-regulation that could stifle innovation and slow economic growth, than it is that the boxes of the regulatory system be arranged in a particular way. In turn, this means that the issue of regulatory consolidation is important but only to the extent that it makes it easier or harder to achieve the three major objectives of regulation efficiently and effectively.

For objectives-based regulation to work, it is essential to harness the power of the market as a way to enhance stability. It will never be possible to have enough smart regulators in place that can outwit private sector participants who really want to get around regulations because they inhibit profit opportunities or because of the burdens imposed. A good regulatory environment is structured so that people who take risks stand to lose their own money if their bets do not work out. The crisis we are going through was caused by both market and regulatory failures and the market failures were often the result of a lack of transparency (“asymmetric information” in the jargon of economics). Those who invested money and lost it often did not realize the risks they were taking. To the extent that policymakers can enhance transparency, they can make market forces work better and help achieve the goal of greater stability.

Having a single micro prudential regulator would help greatly in meeting the objectives of regulation, a point that will be taken up in more detail below. It is not a new idea. In 1993-94, the Clinton and Riegle proposals for financial regulation said that a single micro prudential regulator would provide the best protection for the economy and for the industry. In the Blueprint developed by the Paulson Treasury, it was proposed that there be a single micro prudential regulator. 

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When my wife and I relocated from D.C.’s Logan Circle to Capitol Hill five years ago, the most tumultuous change in our lifestyle (aside from my not being able to walk to Brookings every day) concerned the much farther distance we’d have to travel to the nearest supermarket. We had the luxury of shopping at a very nice, if spendy, grocery store about two blocks from our home, which meant that we often did “just-in-time” dinner shopping on the way home from work. Now we were moving to a house where the distance to the nearest supermarket was 1.5 miles, not so walkable at 7 pm.

Did we live in a “supermarket desert?” On the one hand, Capitol Hill is a pretty densely populated part of D.C., so 1.5 miles felt like a long way. And while the Hill is an economically diverse area, it’s large with significant pockets of affluence. On the other hand, like a lot of our neighbors, we own a car. So while nightly trips to the supermarket were out, it was hardly an onerous trip on the weekends.

There are, however, many communities nationwide in which that trip to the supermarket is a long one, and most have much lower incomes than the Hill. That’s the conclusion from new research we conducted with help from The Reinvestment Fund (TRF), a community development financial institution and research organization based in Philadelphia. TRF played a lead role in designing and implementing the Pennsylvania Fresh Food Financing Initiative, a program that provides grants and low-cost capital to facilitate the location of new supermarkets and fresh food retailers in that state’s underserved communities. That initiative is now the model for several other state and local programs, as well as the inspiration for a major new federal budget initiative that seeks to improve community health and economic development outcomes through supermarket attraction and expansion.

With TRF, we looked at 10 metro areas across the country, ranging in size from Jackson, Miss. to Los Angeles. Unlike a lot of previous research that attempted to identify “food deserts,” TRF’s analysis looks at factors beyond distance to a supermarket that matter for access, including a community’s population density and level of car ownership. And it uses household income and expenditure data to help pinpoint the communities that have a significant untapped local demand for supermarkets.

Across the 10 metro areas, about 1.7 million people (5 percent of total population) live in low- and moderate-income communities that are significantly underserved by supermarkets. African Americans, children, and very low-income families are over-represented in these areas. Greater Los Angeles alone accounts for half a million of the underserved; and in the Cleveland metro, more than one in nine residents lives in a low-supermarket-access community. Estimates suggest that upwards of $2.6 billion annually in grocery expenditures may “leak” out of these communities due to a lack of nearby supermarkets.

The real upside of this research project is that all of the results are viewable online, through TRF’s PolicyMap service. So local economic development officials, neighborhood-based organizations, retailers, and others can examine the location and characteristics of low-supermarket-access areas in their own communities. On Capitol Hill, the analysis suggests that we’re pretty well served. Lots of car owners, and it’s really not that far to the store. Cross the Anacostia River, however, and it’s another story altogether. Pinpointing and describing the untapped opportunities for supermarket development is hopefully a first step toward reducing market obstacles to higher-quality, lower-cost food options for residents of communities like Ward 7 and Ward 8 nationwide.

The Brookings Metropolitan Policy Program and The Reinvestment Fund (TRF) performed a detailed analysis of supermarket access in 10 metropolitan areas, and the results are discussed in a new video, “Getting to Market."

Results from the analysis encourage users to view the locations of, and generate reports about, low-supermarket-access communities within the 10 metropolitan areas. This is highly useful data for those working at the national and local levels to tackle the problem of inadequate access through public policy and private investment. You can also access these data alongside any of PolicyMap’s 10,000 data indicators and full functionality at www.policymap.com

For those interested in other metropolitan areas, TRF has made available a nationwide analysis of low-supermarket-access communities at www.trfund.com.

Media Memo »


Profiles of 10 Metropolitan Areas (PDFs)

Video

• Supermarket Access in Metro Areas

Editor's Note: This blog post is part of The Primaries Project series, where veteran political journalists Jill Lawrence and Walter Shapiro, along with scholars in Governance Studies, examine the congressional primaries and ask what they reveal about the future of each political party and the future of American politics.

Even though they have come to dominate political campaigns, Super PACs and their shadowy counterparts are barely old enough to qualify for pre-kindergarten. Since these big-bucks independent groups have only been legal since 2010, we are still groping to understand the long-term role that Super PACs are apt to play in congressional politics—especially primaries.

With the demonization of the Koch Brothers by the Democrats and the attacks on liberal givers like Tom Steyer from the right, it is easy to assume that Super PAC donors are ideologues. Scorched-earth contests like the Mississippi Republican Senate primary further fuel this impression. Thad Cochran versus Chris McDaniel could be viewed as a proxy war between the GOP establishment (personified by Karl Rove's Super PAC American Crossroads) and the Tea Party (working through groups like Club for Growth Action).

But there is another very important, but far less publicized, role that Super PACs are playing in this year's congressional primaries. And when the internecine warfare in the Republican Party dies down, this type of Super PAC involvement in party primaries may become the norm.

Two recent GOP House primaries in winnable districts in New York illustrate this alternative model. In both cases, Super PACs took on the role—once left to the political parties—of vetting the candidates. Super PAC donors and their campaign consultants made their own decisions about who is electable and who has the right political pedigree. And in these New York primary contests without any clear ideological markers, heavy spending by Super PACs made all the difference.

Twenty-nine-year-old Elise Stefanik was a major beneficiary of Super PAC spending in her primary in New York's rural 21st District that runs from the Saratoga racetrack to the Canadian border. Stefanik has never run for public office before, but she boasts all of the right credentials to appeal to Washington Republican politicos. Even though she calls herself a "small businesswoman" in her TV ads, Stefanik served on the White House domestic policy staff under George W. Bush and was in charge of 2012 debate preparation for Paul Ryan.

Small wonder that American Crossroads and Karl Rove invested heavily in Stefanik's primary race, spending  $772,000 in attack ads excoriating her GOP rival, Matt Doheny. This was, by the way, the only House primary in the nation in which American Crossroads has made a significant investment to distinguish between Republicans. And the Super PAC's involvement was certainly not motivated by ideology. As the Watertown Daily Times put it on the eve of the Stefanik-Doheny primary, "It's difficult to point to a single issue on which a big divide exists between the two."

Yes, Doheny—a largely self-funding investment banker who had lost two prior races for the House—was a flawed Republican candidate. And Stefanik was the embodiment of the kind of message discipline beloved by campaign consultants. But it is hard to believe that electability alone prompted attack ads with tag lines like: "Matt Doheny—it would be a big mistake to send him to Congress."

American Crossroads, which spent more than either the Stefanik or Doheny campaigns, prevailed in the June 24th primary. Stefanik romped home with 61 percent of the primary vote.

The same pattern emerged in the Republican primary in New York's 1st District on the tip of Long Island. The major player this time was the US Jobs Council, which is heavily funded by hedge-fund mogul Robert Mercer, whose home is in the district. As Mother Jones reported in an article by Molly Redden, Mercer's Ahab-like obsession has been defeating Democratic incumbent Tim Bishop ever since the congressman voted for the Dodd-Frank financial reform legislation.

Both candidates in the Republican primary to oppose Bishop had their weaknesses in appealing to a conservative electorate. State Senator Lee Zeldin carried the burden of votes in Albany that could be interpreted as raising taxes. George Demos, a former SEC lawyer, was heavily supported by his wife's in-laws who, in normal times, are liberal California Democrats.

In truth, there were scant philosophical differences between the two conservative Republicans. Newsday columnist Lane Filler wrote, "Both oppose abortion, think taxes are too high, support gun rights, hate Common Core, favor a strong national defense, are against 'amnesty' for immigrants here illegally...I have not turned up any meaningful difference between them on policy."

But that didn't prevent the US Jobs Council from spending more than $200,000 on attack ads that portrayed Demos, who had been endorsed by Rudy Giuliani and George Pataki, as a creature of "Nancy Pelosi's people." A typical ad charged that Demos "is trying to use the Pelosi cash machine to buy a seat in Congress."

Even though Demos donated $2 million to his own campaign, it was not enough to hold off the onslaught of Super PAC attacks. In the end, Zeldin defeated Demos in the primary by a 62-to-38 percent margin.

Politico reporter Ken Vogel in his praiseworthy new book, Big Money, likens Super PAC donors to meddlesome "sports junkies who plunk down hundreds of millions of dollars to buy a professional team." Often the motivation of these mega-givers is the arrogant belief that because they are rich, they know more about politics than the pros. With it comes the certainty that they can pick winners and losers in primaries just like they do with stocks on Wall Street.

And that is why the heavy Super PAC influence in these two little-covered New York House primaries may represent the wave of the future in party politics.

Super PACs and other lightly regulated political organizations are dumping hundreds of millions of dollars into American elections. What should be done about it? Unlike many candidates for federal or state office, so-called independent expenditure groups face no restrictions on how much individuals and groups can give to them. And thanks to several federal court decisions, including Citizens United v. Federal Election Commission, independent groups can spend unlimited amounts to influence elections. The public understandably worries about the political clout of wealthy groups—especially since donors often can hide their identities.

Reformers have proposed various remedies: disclosure rules, the appointment of a liberal Supreme Court justice to reverse Citizens United, even a constitutional amendment to overturn that decision. Those long-shot strategies, however, are unlikely to create the kind of small-donor democracy that many reformers seek. Money, like water, will inevitably flow into the political system. Laws can’t do much to reduce the amount of money in politics; what they can change is where the money goes.

An easier path to improving politics

In our new Brookings paper, The State of State Parties, we suggest an easier path to improving politics—one that is right under our nose. Strengthening state political parties can help offset the clout of super PACs.

Our study, based on a survey of 56 state-party organizations plus detailed interviews with 15 of their leaders, points to the distinctive and constructive role that state parties play in American politics. In an era when politics seems to be spinning out of control, party organizations are among the few actors that seek to integrate and balance interests—for instance, by recruiting candidates with broad appeal, by playing honest broker among contending partisan factions, and by building coherent strategies among campaigns up and down the ticket. Party organizations also generate a lot of grassroots activity to mobilize volunteers and voters.

How regulations on parties increase super PAC spending

State parties are among the most heavily regulated entities in American politics, a situation that diminishes their influence relative to non-party groups. For instance, the vast majority of state parties face restrictions on the source and size of donations, and some contribution limits are unrealistically low. In Massachusetts, no donor can give more than annual aggregate of $5,000 to all local and state parties. That’s a paltry sum in statewide elections that can easily cost $55 million, including $20 million in independent expenditures.

Super PACs and other groups naturally fill the vacuum because they do not have to contend with limits on raising and spending money. Often, outside groups effectively drown out the parties. In our survey, only half the parties said they advertise on TV and radio sometimes or often, usually because they lack the resources to do more.

The figure below shows that parties’ independent spending is miniscule compared to the growing expenditures of non-party groups over the past five election cycles. In the 2014 election cycle, the parties accounted for just six percent of total independent spending in the states for which we had good data.

An especially significant finding is that restraints on political parties seem to amplify the activities and influence of outside groups. As illustrated in the table below, 65 percent of respondents in states with contribution limits to parties said that independent groups sponsor more than half or almost all political ads, compared to only 23 percent in states without contribution limits. 

In other words, independent spending is significantly lower when parties are not limited. These differences translate into electoral clout. In states with contribution limits, 65 percent of respondents said independent spending is often a key factor in gubernatorial elections, while fewer than half said the same in states with no limits.

Correlation does not prove causality, but our findings provide strong circumstantial evidence that when you restrict the parties, you get more independent expenditures by non-party groups.

It’s not hard to strengthen state parties

We recommend changes to strengthen state parties and restore them to a place of prominence in campaigns. First, state governments should raise or eliminate contribution limits so the parties can acquire sufficient resources to compete with outside actors. This would allow state parties to serve as clearinghouses for campaign money, which would bring more “dark money” toward accountability and transparency.

Second, parties should be allowed full freedom to coordinate their activities with their candidates and allied groups. This would make them more valuable to candidates and would allow the parties to perform their irreplaceable role of supporting candidates across the party ticket.

We also suggest giving parties favorable tax treatment so that donors are more likely to give to parties than candidate-sponsored super PACs or interest groups. We also recommend other regulatory changes that would encourage parties to do more grassroots work with voters.

Loosening the constraints on state parties would not stop the flow of money into politics (nothing can do that), but would channel more of the money to accountable actors. That’s why we think of this solution as building canals, not dams. And the incremental steps we propose require no sea-changes in public opinion or heroic legislation. In fact, they command support in both parties’ establishments, making them a good starting point for reform. That’s why we conclude that strengthening state parties is a realistic path toward a better balanced, more effective, and more accountable political system.

While antibiotics are necessary and crucial for treating bacterial infections, their misuse over time has contributed to a rather alarming rate of antibiotic resistance, including the development of multidrug-resistance bacteria or “super bugs.” Misuse manifests throughout all corners of public and private life; from the doctor’s office when prescribed to treat viruses; to industrial agriculture, where they are used in abundance to prevent disease in livestock. New data from the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) confirm that rising overuse of antibiotics has already become a major public health threat worldwide.

As drug resistance increases, we will see a number of dangerous and far-reaching consequences. First, common infections like STDs, pneumonia, and “staph” infections will become increasingly difficult to treat, and in extreme cases these infections may require hospitalization or treatment with expensive and toxic second-line therapies. In fact, recent estimates suggest that every year more than 23,000 people die due to drug-resistant infections in the U.S., and many more suffer from complications caused by resistant pathogens. Further, infections will be harder to control. Health care providers are increasingly encountering highly resistant infections not only in hospitals – where such infections can easily spread between vulnerable patients – but also in outpatient care settings.

Incentivize appropriate use of antibiotics. Many patients and providers underestimate the risks of using antibiotics when they are not warranted, in part because these drugs often have rapid beneficial effects for those who truly need them.  In many parts of the world the perception that antibiotics carry few risks has been bolstered by their low costs and availability without a prescription or contact with a trained health care provider. Education efforts, stewardship programs, and the development of new clinical guidelines have shown some success in limiting antibiotic use, but these fixes are limited in scope and generally not perceived as cost-effective or sustainable. Broader efforts to incentivize appropriate use, coupled with economic incentives, may be more effective in changing the culture of antibiotic use. These options might include physician or hospital report cards that help impact patient provider selection, or bonuses based on standardized performance measures that can be used to report on success of promoting appropriate use.  While these might create additional costs, they would likely help control rates of drug resistant infections and outweigh the costs of treating them.

Reinvigorate the drug development pipeline with novel antibiotics. There has not been a new class of antibiotics discovered in almost three decades, and companies have largely left the infectious disease space for more stable and lucrative product lines, such as cancer and chronic disease. Antibiotics have historically been inexpensive and are typically used only for short periods of time, creating limited opportunities for return on investment. In addition, unlike cancer or heart disease treatments, antibiotics lose effectiveness over time, making them unattractive for investment. Once they are on the market, the push to limit use of certain antibiotics to the most severe infections can further constrict an already weak market.

Late last year, H.R. 3742, the Antibiotic Development to Advance Patient Treatment (ADAPT) Act of 2013, was introduced and referred to the House Energy and Commerce Subcommittee on Health. If enacted, the ADAPT Act would create a streamlined development pathway to expedite the approval of antibiotics that treat limited patient populations with serious unmet medical needs. This could potentially reduce costs and development time for companies, thereby encouraging investment in this space. Regulators have indicated that they would also welcome the opportunity to evaluate benefits and risk for a more selective patient subpopulation if they could be confident the product would be used appropriately. The bill has received a great deal of support and would help address a critical public health need (I cover this topic in more detail with my colleagues Kevin Outterson, John Powers, and Mark McClellan in a recent Health Affairs paper).

Advance new economic incentives to remedy market failure. Innovative changes to pharmaceutical regulation, research and development (R&D), and reimbursement are necessary to alleviate the market failure for antibacterial drugs. A major challenge, particularly within a fee-for-service or volume-based reimbursement system, is providing economic incentives that promote investment in drug development without encouraging overuse.  A number of public and private stakeholders, including the Engelberg Center for Health Care Reform and Chatham House’s Centre on Global Health Security Working Group on Antimicrobial Resistance, are exploring alternative reimbursement mechanisms that  “de-link” revenue from the volume of antibiotics sold. Such a mechanism, combined with further measures to stimulate innovation, could create a stable incentive structure to support R&D.

Improve tracking and monitoring of resistance in the outpatient setting. There is increasing concern about much less rigorous surveillance capabilities in the outpatient setting, where drug-resistant infections are also on the rise. Policymakers should consider new incentives for providers and insurers to encourage a coordinated approach for tracking inpatient and outpatient resistance data. The ADAPT Act, mentioned above, also seeks to enhance monitoring of antibiotic utilization and resistance patterns. Health insurance companies can leverage resistance-related data linked to health care claims, while providers can capture lab results in electronic health records. Ultimately, this data could be linked to health and economic outcomes at the state, federal, and international levels, and provide a more comprehensive population-based understanding of the impact and spread of resistance. Current examples include the Food and Drug Administration’s (FDA) Sentinel Initiative and the Patient-Centered Outcomes Research Institute’s PCORnet initiative. 

Antibiotic resistance is an urgent and persistent threat. As such, patients and providers will continue to require new antibiotics as older drugs are forced into retirement by resistant pathogens. Stewardship efforts will remain critical in the absence of game-changing therapies that parry resistance mechanisms. Lastly, a coordinated surveillance approach that involves diverse stakeholder groups is needed to understand the health and economic consequences of drug resistance, and to inform antibiotic development and stewardship efforts.

Editor's note: This blog was originally posted in May 2014 on Brookings UpFront.

While antibiotics are necessary and crucial for treating bacterial infections, their misuse over time has contributed to a rather alarming rate of antibiotic resistance, including the development of multidrug-resistance bacteria or “super bugs.” Misuse manifests throughout all corners of public and private life; from the doctor’s office when prescribed to treat viruses; to industrial agriculture, where they are used in abundance to prevent disease in livestock. New data from the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) confirm that rising overuse of antibiotics has already become a major public health threat worldwide.

As drug resistance increases, we will see a number of dangerous and far-reaching consequences. First, common infections like STDs, pneumonia, and “staph” infections will become increasingly difficult to treat, and in extreme cases these infections may require hospitalization or treatment with expensive and toxic second-line therapies. In fact, recent estimates suggest that every year more than 23,000 people die due to drug-resistant infections in the U.S., and many more suffer from complications caused by resistant pathogens. Further, infections will be harder to control. Health care providers are increasingly encountering highly resistant infections not only in hospitals – where such infections can easily spread between vulnerable patients – but also in outpatient care settings.

Incentivize appropriate use of antibiotics. Many patients and providers underestimate the risks of using antibiotics when they are not warranted, in part because these drugs often have rapid beneficial effects for those who truly need them.  In many parts of the world the perception that antibiotics carry few risks has been bolstered by their low costs and availability without a prescription or contact with a trained health care provider. Education efforts, stewardship programs, and the development of new clinical guidelines have shown some success in limiting antibiotic use, but these fixes are limited in scope and generally not perceived as cost-effective or sustainable. Broader efforts to incentivize appropriate use, coupled with economic incentives, may be more effective in changing the culture of antibiotic use. These options might include physician or hospital report cards that help impact patient provider selection, or bonuses based on standardized performance measures that can be used to report on success of promoting appropriate use.  While these might create additional costs, they would likely help control rates of drug resistant infections and outweigh the costs of treating them.

Reinvigorate the drug development pipeline with novel antibiotics. There has not been a new class of antibiotics discovered in almost three decades, and companies have largely left the infectious disease space for more stable and lucrative product lines, such as cancer and chronic disease. Antibiotics have historically been inexpensive and are typically used only for short periods of time, creating limited opportunities for return on investment. In addition, unlike cancer or heart disease treatments, antibiotics lose effectiveness over time, making them unattractive for investment. Once they are on the market, the push to limit use of certain antibiotics to the most severe infections can further constrict an already weak market.

Late last year, H.R. 3742, the Antibiotic Development to Advance Patient Treatment (ADAPT) Act of 2013, was introduced and referred to the House Energy and Commerce Subcommittee on Health. If enacted, the ADAPT Act would create a streamlined development pathway to expedite the approval of antibiotics that treat limited patient populations with serious unmet medical needs. This could potentially reduce costs and development time for companies, thereby encouraging investment in this space. Regulators have indicated that they would also welcome the opportunity to evaluate benefits and risk for a more selective patient subpopulation if they could be confident the product would be used appropriately. The bill has received a great deal of support and would help address a critical public health need (I cover this topic in more detail with my colleagues Kevin Outterson, John Powers, and Mark McClellan in a recent Health Affairs paper).

Advance new economic incentives to remedy market failure. Innovative changes to pharmaceutical regulation, research and development (R&D), and reimbursement are necessary to alleviate the market failure for antibacterial drugs. A major challenge, particularly within a fee-for-service or volume-based reimbursement system, is providing economic incentives that promote investment in drug development without encouraging overuse.  A number of public and private stakeholders, including the Engelberg Center for Health Care Reform and Chatham House’s Centre on Global Health Security Working Group on Antimicrobial Resistance, are exploring alternative reimbursement mechanisms that  “de-link” revenue from the volume of antibiotics sold. Such a mechanism, combined with further measures to stimulate innovation, could create a stable incentive structure to support R&D.

Improve tracking and monitoring of resistance in the outpatient setting. There is increasing concern about much less rigorous surveillance capabilities in the outpatient setting, where drug-resistant infections are also on the rise. Policymakers should consider new incentives for providers and insurers to encourage a coordinated approach for tracking inpatient and outpatient resistance data. The ADAPT Act, mentioned above, also seeks to enhance monitoring of antibiotic utilization and resistance patterns. Health insurance companies can leverage resistance-related data linked to health care claims, while providers can capture lab results in electronic health records. Ultimately, this data could be linked to health and economic outcomes at the state, federal, and international levels, and provide a more comprehensive population-based understanding of the impact and spread of resistance. Current examples include the Food and Drug Administration’s (FDA) Sentinel Initiative and the Patient-Centered Outcomes Research Institute’s PCORnet initiative. 

Antibiotic resistance is an urgent and persistent threat. As such, patients and providers will continue to require new antibiotics as older drugs are forced into retirement by resistant pathogens. Stewardship efforts will remain critical in the absence of game-changing therapies that parry resistance mechanisms. Lastly, a coordinated surveillance approach that involves diverse stakeholder groups is needed to understand the health and economic consequences of drug resistance, and to inform antibiotic development and stewardship efforts.

Editor's note: This blog was originally posted in May 2014 on Brookings UpFront.

Event Information

From “American Crossroads” to “Americans for a Better Tomorrow, Tomorrow,” so-called "super PACs" have emerged as the dominant new force in campaign finance. Created in the aftermath of two landmark court decisions and regulatory action and inaction by the Federal Election Commission (FEC), these independent spending-only political action committees are collecting unlimited contributions from individuals, corporations and unions to advocate for or against political candidates. The legal requirements they face—disclosure of donors and non-coordination with the candidates and campaigns they are supporting—have proven embarrassingly porous. Increasingly, super PACs are being formed to boost a single candidate and are often organized and funded by that candidate’s close friends, relatives and former staff members. Their presence is most visible in presidential elections but they are quickly moving to Senate and House elections.

On March 1, on the heels of the FEC’s February filing deadline, the Governance Studies program at Brookings hosted a discussion exploring the role of super PACs in the broader campaign finance landscape this election season. Anthony Corrado, professor of government at Colby College and a leading authority on campaign finance, and Trevor Potter, nonresident senior fellow at the Brookings Institution, a former chairman of the FEC and lawyer to Comedy Central’s Stephen Colbert, presented. 

After the panel discussion, the speakers took audience questions. Participants joined the discussion on Twitter by using the hashtag #BISuperPAC.

Video

• Full Video: The Rise of Super PACs
• Why Corporations Spend on Elections
• GOP Likely to Benefit Most from Super PACs

Audio

• Campaign Finance in the 2012 Elections: The Rise of Super PACs

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20120301_super_pacs

Super PACs have already spent tens of millions of dollars in the race for the GOP presidential nomination, with more to come. Expert Anthony Corrado says that the unlimited spending by the PACs, made possible by two Supreme Court decisions, is giving wealthy individuals unprecedented influence in the 2012 elections.

Video

• The Influence of Super PACs on the 2012 Elections

Audio

• @Brookings Podcast: The Influence of Super PACs on the 2012 Elections

The Syndrome, the villain in the 2004 animated movie “The Incredibles,” is an ordinary guy who has a plan to put an end to superheroes by making everyone a superhero.

Syndrome’s evil machinations came to fruition on Tuesday, Feb. 5, 2008.

The political parties permit states to hold their presidential nominating contests as early as the first Tuesday in February, with familiar states such as Iowa and New Hampshire given exemptions. Other states jealous of the attention lavished on those early states plotted to make their primaries or caucuses sooner, sometimes even violating party rules and suffering a penalty as a consequence.

To quote Syndrome, when everyone is a super, no one is a super. And so it was with the Super Tuesday states.

Although not intended, a national primary emerged as 24 states fell over one another in a Keystone Kop spectacle by moving up their primaries and caucuses to Feb. 5.

Some argued that this would be good for the political parties in the general election since only a candidate who could run a national campaign would win the nomination.

Ironically, the candidates acted just like they do in a general election, where they concentrate on the competitive battleground states. On Super Tuesday they decided where they could be competitive, where they could pick up delegates, and targeted their scarce resources to those states.

States that thought they would be relevant found themselves irrelevant safe states that the candidates passed by and simply helped run up delegate totals for their favored candidate.

A year ago, the campaigns were focused on building organizations and cultivating supporters in the early contest states of Iowa and New Hampshire. Some candidate strategies were solely focused on jump-starting their campaigns by winning these early states, and others hoped that decisive wins would quickly seal the nomination. Some of the better-financed campaigns could be forward-looking, but they still would not want to spend time and money on Super Tuesday states unless they were sure they would need to.

By the time the nomination process was whittled down to the remaining players and the campaigns could start their Super Tuesday planning, little time was left to advertise, send direct mail and build volunteer organizations. Even where the campaigns decided they could be competitive, too many states were in play for the campaigns to pour in the same resources they did in Iowa and New Hampshire.

The resulting dynamic had a twofold effect on voter participation in this year of high voter interest.

Lack of competition drove down turnout in states such as New York, where Sens. Hillary Rodham Clinton (D-N.Y.) and John McCain (R-Ariz.) were expected to win big victories. Only 19 percent of eligible New Yorkers voted, compared with 53 percent in New Hampshire.

Lack of organization and campaigning drove turnout down across the board, as all primary states combined averaged a turnout rate of 29 percent. Poor organization particularly afflicted the caucuses, which require campaign organizations to mobilize supporters to give up an entire evening. While 16 percent of eligible Iowans attended caucuses, the combined attendance rate for the four states holding caucuses for both political parties was a meager 6 percent.

The silver lining is that continued voter interest buoyed participation where competition and organization failed. Turnout likely would have been much worse if the nominees already had been decided.

As we move forward from Super Tuesday, those states that did not crowd to the front of the line will now find themselves being courted a little more graciously and intensely by the campaigns. This should help increase voter participation. However, the nomination battles are still coming rather fast and furiously, so the campaigns still can’t give the extended engagement they do for the early states. Some campaigns are now facing hard choices as to where they can spend their limited remaining resources. Except for perhaps a few intensely fought competitive states remaining, voter turnout has thus likely peaked in this election cycle.

We expected Super Tuesday to soar into the stratosphere. Instead, it was more of a flop, a cheap imitation of Iowa and New Hampshire. When the dust settles after this primary season and we look back at how the parties nominate their candidates, we will still be searching for a way to have more equitable involvement by voters in all states.