Marc Brazeau on Podesta
Marc Brazeau at Blogonaut Has begun a forum for topics of interest to Progressives and Democrats, initially focusing on a new think tank project driven by John Podesta. I've been invited to participate and have accepted in the interest of broadening the discussion of the major issues facing America today/ Only through discovery that we are stronger than we have been told we are by the Right can we realize our goals.
Marc Brazeau at Blogonaut has selected the Matt Bai article in the New York Times Magazine on John Podesta's new Center for American Progress think tank as the initial discussion topic to a new forum he's starting. After following his links to his site, this Bai article, and his response to the Bai article, I chose to participate.
This post looks at Brazeau's thoughts, with my comments preceeded by '*'
Marc Brazeau's thoughts
Tuesday, October 21, 2003 An Open Letter to John Podesta
FIVE CONCEPTS FOR A RENEWED LIBERALISM
1 Citizen Citizens
I think the Democrats need to help Americans identify themselves as Citizens. It is impossible for the Democratic Party to pull the nation together behind the broad goals of liberalism effectively without a strong feeling of Civitas. The organized constituencies of the left can only play defense unless the Party puts across a galvanizing, forward looking vision for the nation. It was the kind of opportunity that Kennedy made with the New Frontier and the challenge to put a man on the moon.
* Nothing to add here.
2 Service, Activism and Entrepreneurialism
Looking back at the Civic accomplishments of this country ... calls the question, what are we poised to accomplish as a nation today?
* Cuts to the chase here by making a simpler, more direct statement. We DO have to keep it simple stupid for all the soon-to-be-ex-Dittoheads out there.
One could imagine the Small Business Administration beginning a program to encourage micro-lending as part of welfare to work programs.
* As this has worked in India, there is no good reason why it couldn't work in America as well.
Where ever possible Democrats must champion dynamic activist solutions over bureaucratic entitlement oriented solutions.
* Let's change this to :
Where ever possible Democrats must champion dynamic activist solutions like service, activism and entrepreneurialism over bureaucratic entitlement oriented solutions. Reawakening a spirit of Civitas will capture the imagination and the American character in a way that entitlements never can.
Examples of programs along these lines include the WPA and CCC, Vista and Legal Services, the Army Corps of Engineers and DARPA. New versions of the WPA and the CCC are only a synapse away. Let's get those neurons firing.
* A better example than the Army Corps of Engineers or DARPA, both originally created with military values in mind, would be the Tennesse Valley Authority. All of these things directly benefit individuals, while the CoE and DARPA had to be "declassified" for use, and still benefit commerce far more than individuals.
3 Institutionalizing Constituencies
By this I am not referring to driving your constituents crazy. I'm talking about bringing back an old idea well understood by old party machine pols and New Deal reformers alike.
Democrats have ignored for far too long the need to create constituencies. FDR's support of unions, the GI Bill of Rights and the role of Legal Services in the 70's best illustrate what I'm getting at. These programs served liberal goals but they also created liberals as they were put into practice. Democrats haven't done anything to breed liberals in a long time.
* Propose some example of a constituency that would benefit Americans today. Too many current constituencies are called spacial interests, and have a bad reputation. Should a constituency of the majority be creatable, there would need to be a change in the impression such constituency would generate in the public. Otherwise, it would appear to be the same old funny business as usual to someone.
Medicare and Social Security have made a handful of seniors licking stamps a fixture at countless Democratic campaign headquarters. Legal Services socialized many money grubbing trial lawyers to be quite civic minded in their support of the Democratic Party. The hypnotizing effect of the 1965 Voting Rights Act is starting to wear off. There is simply no institutional reason for anyone born after 1950 to identify as a Liberal or a Democrat unless they qualify for the Earned Income Tax Credit.
* This Earned Income Credit doesn't exist anymore. It was phased out a few years ago because those luck-ducky poor working folks weren't paying their fair share of the taxes.
As far as younger people identifying with the Democratic Party, what has the Party done since 1965? Nothing to generate the loyalty you expect. The Party lost its focus once Nixon resigned, and the momentum slowed enough for Ronald Reagan to reverse the direction of the country without too much resistance. The Democrats have yet to deal with this situation. In fact, they have been actively abetting GOP effort all too often. Ergo, what is there to be proud of?
4 Regulation Not Constipation
OK, so it's not a bumpersticker. But neither was "It's the economy, stupid". It's still an effective underlying theme against which policy decisions should be judged.
Democrats should be striking a bargain between business and the organized constituencies that act as countervailing forces. The bargain is this: Less regulation - More enforcement. Simpler, less nitpicky laws in exchange for bigger budgets for enforcement and real penalties for non-compliance - ball busting fines and in appropriate cases: jail time.
I've always thought that shitty DMV experiences made people ripe for drilling in the Arctic Preserve, but living in Portland, OR has brought that insight has come to life. The business climate in this town borders on the Kafkaesque. It is threatening to turn someone with volatile mix of European Social Democrat, Anarcho-Syndicalist and Neo-Liberal politics into an Ayn Rand libertarian. Example: When Adidas wanted to build a headquarters here, the city required them to plant a certain kind of tree on the site. Punchline: that kind of tree wasn't available in Portland.
* This is a lame excuse. Rancho Cucamonga in California demands the same sort of thing, and yet businesses willingly flock there in spite of the local appearance ordinances. It has more to do with the local economic demographics than anything else.
Here's another: A friend of mine opened a bar this summer. He was only going to permit smoking in the back patio. The Oregon Liquor Control Commission didn't approve that space for drinking for three months, just in time for the rains and as his start up capital was dwindling. They had had months to evaluate the space before he opened. The OLCC just gets off on jerking people around. You see people around town wearing "Fuck the OLCC" T-shirts. I've never seen a government agency vilified like that anywhere. And I've lived or worked in at least sixteen cities across the country.
* This certainly is a good example of government regulators gone bad, but why is this so? Was their budget cut so deeply that they don't have enough inspctors to do the work and thus fall behind? Are they mandated to do too many things for the budget they do have? There has to be an explanation.
* This issue calls up the idea that it may very well be time to review regulations. There must be many that can be discarded or combined with others, and there has to be a way to improve efficiency in regulation. Are the regulators required to create reams of inspection reports from scratch when a form could be created for use? Could there be computerization improvement? Swinging the reulation axe indiscriminately is not a wise thing, for valuable regulations will be lost with the bad ones.
I could delight you with more stories of the anti-business climate in Portland, but I won't. Suffice it to say, the tax burden on business in Oregon is very light relative to other states (About two thirds of Oregon's corporations, or 23,000 corporations, pay just the $10 corporate minimum tax.) and we still have trouble attracting business.
* Taxes are a Trojan Horse. All local taxes are write-offs against Federal taxes. The real issue is whether or not the local workers will accept exploitation. Follow the employment money here. The jobs are going to Right to Work for Less states, where unions are almost illegal. Oregon, like California, is not one of these.
Democratic politicians should be mercilessly flogging unrepentant bureaucrats to get over themselves and process permits, approve the approveable etc. because ultimately the Democrats pay the price for long lines at the DMV.
* This refers again to the idea that it is time to review the regulations with an eye toward discarding those no longer valuable. With specific examples, a Democrat could win, provided s/he followed through with corrections.
This is difficult. Where business sees a death by a thousand cuts, advocacy groups see a thousand regulations with little to no consequences. Every regulation on the books sprang up in response to some adverse outcome in the real world. No one wants to be the one to take some toothless codicil off the books and end up with a preventable death on their hands. Nevertheless...
* A toothless codicil will not prevent a preventable death. Only a codicil with teeth can do this, provided there is funding for the jaws. All too often, there is no provision for enforcement, and this is no accident. If there is provision for enforcement, there often is no provision for funding. IF there is provision for funding, then there may be no allocation approved, etc. There are many ways to stifle enforcement of even good regulations.
Let me say it again: Less regulation - More enforcement. Simpler, less nitpicky laws in exchange for bigger budgets for enforcement and real penalties for non-compliance - ball busting fines and in appropriate cases: jail time.
* Basic strategy is fine - tactics need some work.
5 A Corporation Is Not A Citizen
This is a fundamental misconception that has mistakenly accepted as law in this country. The Boston Tea Party was fought in response to the actions of a commercial monopoly that had undue political influence. The East India Trading Company had lobbied Parliament to levy taxes on all other tea companies in the Colonies. Later Jefferson and others fought to put "Freedom from Commercial Monopoly" into the Bill of Rights. Until 1886 corporations were considered 'artificial persons'. They had limited rights. Their charters were written for a limited purpose and a limited time. They didn't have the rights of actual persons. They could not influence politics like an actual person.
In 1886 the court reporter in the case 'Santa Clara County v. Southern Pacific Railroad' added the statement "Corporations are persons" to the headnotes of the decision. This has been accepted as a legal principle ever since even though it was not part of the judge's decision. Our ability effectively reform campaign finance and overcome countless other obstacles are dead on arrival unless corporations are stripped of their personhood.
* The issue here is: how can this be accomplished? As long as corporatism runs this land, it won't ever happen.
WHAT COULD A THINK TANK DO?
In addition to the boilerplate functions of a think tank I would create these functions:
INSTITUTE FOR PUBLIC SERVICE
I would organize an institute dedicated to excellence in public administration. Beyond setting up a number of fellowship positions, the institute would act as a clearinghouse for information on effective work in public administration. The institute would be able to feed the press a steady stream of turnkey "can do" stories about effective government. It would fund and organize retreat and sabbaticals for the country's most effective public administrators. Through awards and grants it would shine a spotlight on the nation's most effective public administrators. I could envision grants along the lines of the MacArthur genius awards.
* Better: seminars for public officials demonstrating how to accomplish worthwhile goals by the example of other public officials. Sabbaticals and retreats and fellowships are fine for the thoretical, but all solutions require practical action. As all technical people know, all theories have to be shaped to the practical problem at hand. It is no different with public works.
Deep thinking about new solutions on how to govern is as likely or more likely to come from career administrators as from academics, if they are given the time and resources to develop and propagate their ideas.
* The Chatauqua model rises here. This could work with the proper sponsorship. It would fit in with the concepts cited above.
The public perception of public administration sorely needs rehabilitation. The goals of the institute would be to improve public perception, attract high caliber people to public administration and substantial improvement in the effectiveness of government. Liberalism cannot thrive in an environment where even liberals think of government as ineffective bureaucracy.
* Agreed. Today, thanks to the sound bite, image is all. Unfortunately, the public at large tends to nod off if one tries to get into the details. Until the public demands more of their officials, then nothing is going to change.
The media center would be equipped with television and radio studios and a documentary video crew. The first priority of the media center would be to use the video crew to shoot footage to be used in conjunction with the stories that the think tank is pitching to the media. The reason a new box for french fries at McDonalds is news is that McDonalds gives the news stations video footage that they can use. Now they have 45 seconds of airtime covered at no cost. If the Institute for Public Service gives an award to a DMV director who cut waiting times in half and they can hand over footage of long lines, short lines, the director receiving the award, someone saying something good about the director and the director saying something about their work - then you are on the news - piece of cake.
As well, the TV and Video studios would at first be used so that Fellows could participate in interviews. Other opportunities will spring up. The infrastructure needs to be there first.
* And where is the Internet in all of this???? All of these ideas could be available at any time for anyone with Web access. It will then not be necessary to plead for time on any commercial media outlet for presentation to the public. You also might find you have this problem to deal with.
A) Allow people to deduct TIME SPENT VOLUNTEERING FOR NON-PROFIT ORGANIZATIONS from their taxes. It could be valued at: 1) Their hourly rate 2) 125% of their hourly rate 3) simply according to the market rate of what the NP would pay for those services.
* This opens up a lot of room for abuse. All out-of-pocket expenses for charitable or non-profit activities are already deductable. To add any calculation of one's hourly earnings rate would require the creation of an entire bureaucracy whose function would be solely to verify all such claims. What ever happened to regulatory efficiency? Would it be fair to allow someone like Bill Gates, who makes thousands of dollars a second, to deduct this much from his income taxes for his Gates Foundation activities? There has to be another way of compensating for this sort of work.
B) Corps of corps
I would propose a raft of National Service Corps
I think we should go beyond a quaint program like Americorp and think big, along the lines of WPA and CCC. Bigger. One of the most frustrating things in current American life is that we seem unable to muster the political will to solve any of our problems even when we have social consensus on their importance. Everyone is agreed that we have crises in education and healthcare yet we are paralyzed to address them. Democrats must be able to say we can solve these problems and we will solve these problems and this is how.
* Good strategy. But how to muster the political will if the public expects the other guy to take the first step? The last leader America had who inspired a lot of volunteerism from the American People was John Kennedy. Until we have such a leader, and right now I don't see his successor, this isn't going to change.
Some of these programs already exist. I would argue that their funding has been so anemic and their profile so low that championing them in a renewed and principled broad program elevates them from being merely warmed over policy proposals and creates the oportunity to create vital and dynamic new policy.
* This isn't accidental. Such anemic funding is to demonstrate that the public sector cannot handle the job, which should then be turned over to the private sector. Check out the Philadelphia School system for a perfect example.
Champion and support the Army Reserve and National Guard.
* Considering Bush's abuse of both, this isn't going to be easy. One good way to support both would be to prohibit job loss due to service. This is not currently the case. Too many Reservists and Guardsmen will return from Iraq to have to job hunt because their employers "couldn't wait for them to return to their jobs".
What is more American than a citizen army?
* This opens the door to Mandatory Universal Service. Are you ready to go there? The sort of warfare that the US will be facing is not going to be like storming Festung Europa in 1944. The ear of the large army vs large army model is just about ended.
* Another aspect to look at is: if we had such a system in place, how many more wars would Bush be waging? Might we not already be at war with Iran, Syria, and North Korea if enough forces were available?
The importance of older, more experienced and highly skilled Reservists has been brought into sharp focus by the war in Iraq. A multilateral defense and foreign policy that embraces nation building will put them at the center.
* Historically, America will rise to the challenge presented no matter how ill-prepared they are. While the military certainly needs re- alignment to meet the modern challenges it faces, I'm not yet convinced that this is the answer. In addition, considering how much is asked of them in return for the little given them in return is going to make retention of experienced personnel most difficult.
This is an important and unassailable backdoor for providing education opportunity and retirement security to large numbers of Americans. Democrats should scream bloody murder when Republicans send our troops into combat while cutting their benefits.
* Agreed, but funding certainly is an issue. How will this be paid for? Americans are in a "Don't raise my taxes" mood.
HealthCorp: Need financial aid for med school or nursing school? We'll trade you for four years of service in the nation's toughest public hospitals and county health departments for modest wages. Over time this will produce a more civic-minded breed of doctor as well as providing a shot in the arm for our healthcare system.
* Basic concept is fine. Issues: funding and administration. If the government hospitals and medical services were the initial employer of all graduates, this might lessen the load. Otherwise, without sufficient funding, the heavy administrative load will collapse the financial support, leaving us in the same mess we now have.
* Anti-socialists won't like this idea, but why do so many countries we don't like, Cuba for instance, have better medical systems than we have? Sure, maybe not so high-tech, but there's no shortage of doctors.
EdCorp: Need financial aid for a degree in Education? We'll trade you for four years of service in the nation's toughest public schools. This could also be used to close the gap in math and science teachers by trading four years of teaching for financial aid towards degrees in math and science.
* Teachers are not Indiana Jones! Adventurism isn't naturally a part of a teacher's make up. Forcing teacher candidates to only work in the toughest schools will only drive them out of the profession. One of the main reasons so many teachers have gone into private industry has been bettter wages and working conditions. One of the worst working conditions is the mass crowding of schools.
* Bill Gates has an educational plan being implemented where the size of the individual school is reduced, with more schools being created. There would be some specialization of the curriculum at each school. I tend to support these ideas as being realistic, provided that the choices aren't limited exclusively to a certain curriculum once chosen.
This is a perfect example of why these programs cannot be floated piecemeal. The AFT and NEA would never stand for what I've proposed. Recent grads working for less than prevailing wages and benefits, outside the bargaining unit? Forget about it. But if it was tied to a major paradigm shift in the platform of the party with broad support and their input in developing implementation...
* Talk to teachers and you might be surprised. Many would rather educate than teach to a mandated test standard as many now do. There wouldn't be an issue over loss of jobs, because any truly educational change would actually create positions. The ones who would not like this would be the administrators, most of whom are completely useless to the educational porcess. They would lose control, status, power - and very high remuneration packages.
GreenCorp: This could range from physical conservation work to research and theoretical work or inspection work. Also tied to financial aid. These could also function as starter jobs the way Americorps does.
* Specifics would be needed here. There would also be a lot of opposition from corporations who wouldn't want anyone in a position to see how they are raping the land.
BizCorps: Perhaps a mix of recent BBA's, MBA's and retirees, this group could be working in targeted communities helping start up businesses. Example: when you get a minority loan you are assigned someone from the BizCorp who has a caseload of 3 or 5 or 10 start ups who works as an adviser or as an assistant, depending on their experience and the businesses need. If we had this, they could be in Iraq right now helping Iraqi companies bid for reconstruction work, etc.
* Basic strategy excellent. Specifics could be worked out if the will and the means were there. Certainly one incentive would be to reduce the taxable amount of income earned once retirement begins, provided there was participation in such a program. One problem that arises is that trust issues will have to be dealt with. I doubt the community will easily accept direction from the very personality and demographic types that won't hire them now.
Arrangements could be made for top execs to take sabbaticals to consult with government agencies to improve delivery of services.
* Isn't this what we have now? Cheney still receives money from Halliburton, and all he did was provide them with some no-bid contracts. Is this where we want to go? Don't corporations already take enough through such means?
CopCorps: I wish I could find the excellent New Yorker article on the National Academy that has been established for police. CopCorps could function in many ways. Financial aid for criminal justice degrees could be traded for a training period at the academy and time spent in the nations toughest precincts.
* You would be throwing the sheep to the wolves by doing this. Better that they can work the less-intensive police jobs, such as traffic control, freeing up more experienced officers to deal with the hard-core in the toughest precincts. Besides - they would want a better, more forceful moniker.
Exemplary officers could be given sabbaticals of sorts to act as instructors. The academy could also act as a clearinghouse for effective techniques and for departments around the nation to trade exceptional officers in an exchange program. I personally would like to see more mentoring and sponsoring stuff like nighttime youth basketball. I also thought that Tucson's bike cops were way cooler than the car cops.
* All good plans, but when does such an officer have a life? This has been one of the reasons such programs have collapsed in my area. Only so many cops can participate, and they get burned out. There is also the cut backs in staff funding, forcing the termination of programs like DARE because the officers involved are required for street duty. There might be better means of providing staffing for such programs than to use cops.
1) PRINCIPALS: If I had to choose one point in our educational system as a fulcrum to try to gain leverage, I would choose PRINCIPALS. Given limited resources I believe that bolstering excellence in our school principals will go farther than anything else in bolstering excellence in our schools. Their ability to interact with students, effect discipline, ciriculum and mentor teachers puts them in a unique position of multiplying their talents.
* Too many of these are really bureaucrats in teacher's clothing. Principals already have a huge workload, requiring that they give short shrift to everything each time some crisis arises. Even if all the routine duties could be performed by assistants, there is still a great deal that would require their attention more than they now can provide.
* Education has to be rethought entirely. Locking a student's progress to the group, paced by the slowest learners, is one of the reasons education is not as effective as it might be. There is far too much technology (becoming more affordable all the time) and enough computer-literate educators out there (and not all of these are teachers!) for things to remain in the mold of the past. Large, inaccurate text books and boredom-inducing rote education must be replaced by CD-ROM and DVD technologies filled with the latest, most-accurate information. Such resources must be implemented in an independently-tracked curriculum, where a student can learn at his own pace. Tie performance to rewards like field trips and free cultural events and see what kind of an improvement can be achieved!
People closer to these issues than I could tell us how to support principals through policy. However, if I was running a well-funded think tank I would give awards every year to exceptional and effective principals. I would publicize these awards and use them to amplify the efforts of these folks. I would publicize their efforts to re-value the public service that they render and hold up their profession as noble and desirable in order to attract more and better candidates to the field. I would host retreats for exceptional principals in the summers and sponsor revolving fellowships so that they can engage in deeper thinking about what they do, why they are effective and how it can be done better.
* Will we Leave No Principal Behind?
Obviously it would be great to do these same things with teachers and superintendents. But given limited resources, I would start with principals.
2) TEACHERS: Pay for Play. In the interests of space I'll ask you to read Matthew Miller's recent piece in the Atlantic. He makes the case for paying teachers a lot more in exchange for making it easier to fire ineffective teachers. He also proposes paying Math and Science teachers more than Gym teachers.
* And how does one measure performance in such a system? Such measurement is currently defined through compulsory testing. This is why so many school systems are teaching to the test - this is the sole metric upon which Federal subsidies are based. As these subsidies are vital to any functioning school system, there is little incentive to go beyond the minimum necessary because of lack of time or other resources. Another standard needs to be in place before this has any chance of succeeding.
3) EDCORP: See Above
4) FEED ME: Kids don't learn if they are hungry. We need to revamp cafeterias and serve healthy meals for breakfast and lunch. They should be either free for everyone or served at the same nominal fee for everyone and not as an entitlement for poor kids only. This program serves double duty on my proposals for healthcare. As a principle, I'm in favor of a few simple universal programs over many complex targeted programs.
* The probelm here is in the execution. Make the food attractive and tasty, and kids will eat it. But how many gourmet chefs are willing to work in a high-volume environment for low pay?
* Example: I hate the taste of liver, and yet I once sampled a pate by a wold-famous gourmet chef that I liked. This is the sort of knowledge and experience that would make this goal work as far as the kids are concerned.
* Another problem that has to be faced is the effects of fast-food on kids. Go to a school cafeteria after lunch and see how much perfectly good food ends up in the trash completely untouched. The school food workers know about this waste, but they are mandated to continue to serve food in this manner. Far better it would be to only provide the foods kids ask for, but too many of these are of the fast food variety. Is one to abolish the advertising rights of fast-food corporations becuase they create an unfair advantage to the promotion of healthful diets? Surely this won't stand up to the avalanche of reaction this would cause! Do we have the political will? Would we not be accused of inhibiting the free practice of commerce?
* There is a lot of thought required, along with a lot of research and experimentation, to find the right combination to get kids to eat the good foods provided and to cut back on the junk. But in order to accomplish this, one has to begin to to counter the media bombardment from the huge fast food giants.
5) GO SEE THE SCHOOL NURSE: We should bolster school clinic's role in preventive healthcare. Whenever possible parents should be present when bi-annual physicals are given. County health systems should set up shop in the schools and reach out to families through the clinics. (See HealthCorps above).
Annual physicals should be provided free of charge to all parents and programs like flu shots can be run out of school clinics. Prenatal care and counseling could be provided through schools. Every bit of pre-natal care pays off big dividends to society and we should go beyond making it available to all but forcing it down people's throats.
* This isn't a new idea, but maybe its time has come again. Preventable infectious diseases like Tuberculosis are on the rise again, and must be checked before they can become epidemic. Whooping caugh is again on the rise. Will we also soon see the return of Polio? The issue is primarily funding.
6) DAYCARE: Before and after school and during the summer. Schools have underutilized resources for giving relief to working parents. This should be tied in to any welfare to work program.
* And who is to staff these programs? Are there not numerous instances of institutional child abuse? There is much to be thought out here.
7) COMMUNITY COLLEGES, TECHNICAL COLLEGES AND VOCATIONAL HIGHSCHOOLS: If I had the resources to open another front in the fight to improve education, I would work to bolster and legitimate these three delivery systems.
* These are very expensive. Who is to pay for such things? Far more importantly, where are the jobs for such graduates? They went away thanks to NAFTA and GATT to lower-wage countries, which are now interestingly facing the loss of these very jobs to still lower-wage countries! We need to halt the race to the bottom, and change our philosophy toward the working class, before there is any chance of this succeeding.
I'm in favor of Single Payer. I think that trying to extend universal coverage through employer mandated coverage is misses to many of the needy AND is anti-entrepreneurial. Providers competing for the payments funneled through consumers will create a system which is MORE competitive than the one we currently have. It also fits with the idea of simple universal programs. Making a program universal cuts a whole layer of bureaucracy dedicated to determining who is not eligible.
My own choice to practice a sort of agnostic Christian Science in order to pursue art and writing notwithstanding, our country's net creative power is limited by the career choices that creative people make in order to have access to healthcare. In terms of creating constituencies universal programs by their nature are more broadly supported. Social Security isn't the third rail of American politics for nothing buddy.
In the short to medium term I endorse what I call the Dean extensions:
1) Universal coverage of everyone under 25 through Medicaid and the State Children's Health Insurance Program.
2) Adults earning up to 185% of the poverty level -- $16,613 -- will be eligible for coverage through the already existing Children Health Insurance Program.
* Your Healthcorps idea would be a better choice for the indigent.
3) Opening the federal employee health system to small employers and individuals and COBRA relief.
* Single payer would eliminate all of these options. If the market forces were to truly be allowed to act, then medical care would come down in cost. People could have medical care early when it could do the most good, reducing the likelihood of a condition worsening to the point of expensive care being necessary. This also reduces the possibility of malpractice entering the picture.
Opening the federal employee health system acknowledge the current role of employment based coverage and extends it with out trying to game the market through mandates and tax breaks. The Dean extensions move us along a spectrum towards a jumping off point for single payer in a way that other proposals don't. What they don't do is address any of the themes that we've laid out to strengthen our sense of Civitas or activist and entrepreneurial programs.
Here are some proposals that work address that:
HealthCorps and School Clinics and Improved Cafeteria Nutrition: Early detection, prevention and pre-natal care could go a long way to reducing system costs while increasing net wellness. I've described above how a HealthCorps and robust local health departments working through school clinics could tackle many problems. As childhood obesity becomes a great public concern and growing problem, the school should become the focal point for the public response.
* Education of the parents has to be an element of the program for it to have any chance of success.
A Modest Proposal: Medicare prescription drug coverage should be traded for the intensive acute care that is fruitlessly spent in the last days of life. Medicare should provide hospice care for chronically ill elderly. It would be far better to pay for twenty five years of prescription coverage than to cover three months of acute care including heroic measures and invasive resucitations. That kind of coverage could be offered in a supplemental coverage that recipients have to pay for.
* This is a good proposal.
Regional Health Authorities: This is an idea that I think should be looked at any rate. They could coordinate HealthCorps operations, work as a clearinghouse for effective programs amongst public hospitals and county health departments. They could bargain for prescription drugs.
They could also work to reduce redundancies in mega-technology investments among competing hospitals. If a city has ten hospitals and a demand for three MRI machines, then a hospital wanting to add a fourth to the region may be adding a $5-10 million expense to the health system for a machine that is expected to be in use for 5 years with little benefit to the public. I'm not sure what the precise form of input that the authority should have in the decision to make such purchases but something along these lines should be considered.
* Suppose these expensive technologies were paid for by this program? It would then have the ability to ensure that such a facility was needed, convenient, and utilized to the maximum. It could then ask for operational bids from hospitals in a region not yet covered by such technology to locate such a facility. There would also have to be a system of transportation for such patients located at facilities not so equipped so that they could also utilize the technology.
ENERGY AND INFRASTRUCTURE
I will be doing a long analytical post on energy next week. I've been wanting to do something after the black out. I wanted to wait until some better researched analyses turned up.
I will say this. I think that these two areas present our leaders with opportunities to call on the best spirit of the American people the way John F. Kennedy challenged the nation to explore space and put a man on the moon.
Americans are nothing if not a can do people. No one has challenged our imagination and determination in a long, long time. The only challenge that we have risen to as a people in the last thirty years was to build a military power the size of the next 15 largest militaries combined.
I was a kid in the seventies and every year for my birthday my grandmother would get me a subscription to World magazine, the kid's magazine that National Geographic published. Every month I was tantalized by a future of foam houses that could be heated and cooled by gerbils. There were articles on wind and solar power, new kinds of cars, new kinds of building materials.
Well now I'm thirty six, its 2003 and we have Tyvek. It is astonishing and disgraceful to me that we still drive gas combustion engines. It is astonishing and disgraceful to me that we still rely on COAL to generate electricity (nevermind lowering pollution standards). We use COAL in 2003. COAL?...COAL!!! That is the most chickenshit example of this country's inability to summon the political will to surmount any real challenge beyond building up our military and leading the world in shopping and eating.
The two most obvious places to start are research and development and the replacement, through attrition of all public fleets with alternative fuel vehicles, electric, natural gas and hybrids. It may be the case that all public works construction should be using Bio-Diesel for their heavy machinery.
* The military is reported to be VERY interested in this, to the point of buying up the bulk of available stocks of Bio-Diesel to avoid a possible oil embargo over Iraq.
These are challenges that could spark the public's sense of imagination, civic pride and social will if presented in an inspiring and forward looking way.
* We have a serious problem here - corporate ownership of patents covering much of this technology! For example Arco, now a subsidiary of British Petroleum, holds the bulk of the solar technology patents issued during the '70s and later. These are being sat on waiting for the time that petroluem is no longer an economic viability. Meanwhile, in Europe companies are developing exciting new technologies that will revolutionize renewable energy. As I see it, Europe will become the dominant player in this market while the US will be allowed to wallow in Dino Swamp muck. There have been lots of news articles on breakthroughs in technology in Europe lately, all concerning sciences America once dominated. Because the only science we as a nation care about anymore is military science, we have lost our technological edge, and may never regain it.
FOREIGN AND TRADE POLICY
Clearly the Democrats need to develop a coherent vision of an activist multilateral foreign policy that puts a premium on providing support to pro-democracy dissident movements inside repressive regimes (I would suggest George Soros' Open Society Foundation as a starting point on how to do this), uses forces as a last resort and has principled criteria for military intervention: ongoing or imminent human rights abuses resulting in large scale loss of human life or the threat of invasion.
On trade they are already moving towards a globalism that embraces labor and environmental standards in any and all trade agreements. They should move towards phasing out subsidies and tariffs that hurt third world countries. This needs to be done unilaterally without any demands of quid pro quo.
* We will be forced to adapt to these conditions only after the rest of the world has abandoned us to our militaristic fate. The 22 countries who walked out of Cancun are the seed which is germinating as we speak, creating the next model of world trade that doesn't involve the military-industrial economic complex. The Democrats have to wean themselves from reliance on corporate donations before they will be free to act toward this goal.
WHERE TO START
In writing this, I realized that for the most part I have covered ground that I have thought about and already had proposals for. What really needs to be done is to identify the problems facing the country and develop responses accordingly. I would propose HEALTHCARE, ENVIRONMENT, ECONOMIC OPPORTUNITY, CRIME AND SECURITY & DEFENSE as policy problems. I believe that the fundamental problem facing the country is our inability to summon the political will and imagination to solve any of these problems.
* You might also begin to think about the crumbling infrastructure of the nation. Our roads, bridges, dams, waterways, airports, railroads, all need a massive amount of work - and all it looks like we can do as a nation is build new weapons systems.