Counsel for the Second Term
Harris Berman, dean, School of Medicine; professor of public health and community medicine
Make health care affordable. The Affordable Care Act provides vital access to insurance for millions of Americans who would not have it otherwise. Making health care affordable is the next step, and an even more difficult one. You will face many opponents, as one person’s costs are another person’s income. There is much at stake here. You will need to be resolute in finding ways to control costs, or affordability will surely undermine the extraordinary gains we have made in expanding coverage.
Massachusetts is attempting to harness the cost issue with innovative legislation on payment reform. Watch our successes and our failures—they can serve as guidelines for a federal program. Use the strategy that worked so well for you last time: you provide the direction, and let others provide the detail. Let local groupings of hospitals and doctors—known as accountable care organizations—figure out how to divide up the payment pie. Once they are on a fixed budget, they will have no choice.
Make primary care more attractive. Paying primary-care physicians better and shifting resources from highly paid specialty physicians will go a long way toward increasing the number of physicians training to be primary-care physicians (PCPs). Since medical school tuitions are becoming prohibitive, tuition-remission programs for physicians choosing primary care would help solve the PCP shortage quickly.
Use the tragedy of Newtown to force the issue of gun control. It is hard to imagine any sporting use for automatic weapons. Ban them! And ban the sale of automatic ammunition. Nothing good comes from having these instruments of warfare in the homes of America. How many more tragedies do we need to prove the point?
James M. Glaser, dean of academic affairs, School of Arts and Sciences; professor of political science
There is no time like the present. This is the moment for President Obama’s boldest moves. His best legislative opportunities lie in the months ahead. Why is that?
This is the “mandate moment.” Well, there actually is no such thing as a mandate. The argument that voters are sending a statement about any particular issue or direction is fallacious. Voters have many varied reasons for supporting a candidate. And only half of 60 percent of the population voted for the president. That said, mandates exist if politicians think that they exist. Presidents claim them, and they can do so as the only official elected by the entire country. It means that presidents have some enhanced influence right after an election, particularly one that has been bathed in meaning, as this one was. For instance, this is the best opportunity in decades for immigration reform because of how the election and the influence of Hispanics have been interpreted, not just by Democrats and journalists, but by Republicans.
The political arithmetic in Congress is unlikely to get any better than it is now. It will get worse after the next election, when Republicans will most certainly gain ground. The midterm electorate will be a lot smaller, and it will be filled with people who care more about politics. Conservative intensity, an intensity heightened by being “on the outs,” matters more in the off years. And in the Senate, Democrats will be defending far more seats. So the window of opportunity is open now, and there is enough time to do some meaningful things. Particularly if…
Republicans are less unified than in the past several years. In the president’s first term, the Republican strategy was to resist everything and anything coming out of the administration. It was a strategy that the Republican leadership devised shortly after the 2008 election, one they have stuck with in a disciplined way, and one enhanced by the arrival of hyper-principled Tea Party members in 2010. But at this moment, there are opportunities for the administration to frame issues in ways that can divide Republicans. This happened last month on the legislation to raise taxes on the wealthy to avoid the fiscal cliff. In my view, Republican unity can be challenged by reasonable gun-control measures, the debt ceiling and disaster relief, among other issues.
Michael Klein, the William L. Clayton Professor of International Economic Affairs, Fletcher School
The economy has recovered substantially from the situation the president faced at his first inaugural. But challenges remain. The recovery from the Great Recession that began in 2008 has been slower than the recovery from the other recessions over the past three decades, largely because the source of this recession, a major financial upheaval, differs from the sources of recessions of the past.
The first and primary economic goal is to keep the recovery on track. This is important so unemployment will continue to decline. It will also bring down the government budget deficit by raising tax revenues and decreasing social safety net expenditures. The president is typically blamed (or credited) too much for the macroeconomic performance of the country, however. Many important factors are outside the president’s control. For instance, one of the biggest threats to the U.S. recovery now is events in the Euro-area, something over which the president has very limited influence. The recovery could be derailed by ongoing uncertainty due to political fights over tax-and-spending policy. Congress needs to work with the president on this, putting the needs of the nation ahead of narrow partisan goals.
The political fights about the fiscal cliff have raised the issue of tax and entitlement reform. These are difficult political issues. Everyone is for reforming the tax system and reforming entitlements, except for those parts that are essential to the American way of life—that is, those features that they benefit from, such as mortgage interest deductions, farm subsidies, low rates for carried interest, etc. A major reformation of taxes and entitlements would be difficult to obtain; then again, health-care reform eluded past presidents as well.
For sustained, widely shared, long-run growth, the nation needs both better infrastructure and an expansion of opportunities to those who have not benefitted from the economic growth before the crisis and have been particularly hard hit by the events of the past five years. Investing in our future at a time when borrowing costs are low makes sense, not least because important infrastructure projects can help sustain the recovery, but also because improved roads, bridges, airports and so on will lay the groundwork for future prosperity. Likewise, this is a good time to offer educational and skill-building assistance to people who would like to improve their opportunities, but because of the tough times over the past five years, might not be able to afford it.
Helen B. Marrow, assistant professor of sociology and Latin American studies, School of Arts and Sciences
President Obama needs to help shift the focus of our current immigration policy away enforcement to integration. Doing so would benefit legal immigrants, unauthorized immigrants and U.S. society as a whole.
Legal immigrants: Three quarters of immigrants are here legally, despite public opinion to the contrary. The U.S. has no national immigrant integration policy, even for legal immigrants. The record shows immigrants become much better economically and socially situated, as well as culturally and politically attached, to receiving countries that welcome them. This means we need to value immigrants more strongly and back up better policies with more resources. For example, we often demand that immigrants learn to speak English. But our funding to ESL programs is extremely limited, there are long waiting lines for classes, and few advanced language programs are available.
Unauthorized immigrants: Unauthorized immigrants have become a more vulnerable group, arguably at risk of becoming a new underclass. First, our attempt to “get tough” on unauthorized immigration through enforcement has been counterproductive. Compared to 30 years ago, the Mexican Migration Project shows that now, once unauthorized Mexican immigrants arrive, they are more likely to stay, less likely to go home, more likely to bring their families to settle with them and more likely to be in debt. This means a larger unauthorized population living here under harsher circumstances and for a longer period of time than before.
Second, we’ve gotten tougher domestically. A hodgepodge of federal programs now target unauthorized immigrants, including ones who have committed only minor infractions or the civil offense of residing here without official permission. In 2012, the United States deported a record high 409,849 individuals, and more immigrants languish in detention facilities. States and localities around the country have passed anti-immigrant measures in the realms of employment, schooling, health care, driver’s licenses and law enforcement. Deportees are often stigmatized and not faring well in their origin countries. Many immigrants here are turning inward, refraining from everyday forms of social and civic participation in order to survive.
Advice: President Obama must get serious about integrating both legal and unauthorized immigrants. The latter will be most difficult, since the enforcement regime has polarized our political atmosphere to the point that it is nearly impossible to speak about unauthorized immigrants progressively, and without demonizing them as unworthy “illegals.” Moreover, any serious proposal to bring this group into the fold must specify a pathway to U.S. citizenship. Offering them temporary deferral from deportation, work permits, temporary guestworker status or even permanent legal status without citizenship is simply not enough.
The son of an immigrant himself, President Obama is poised to bring comprehensive immigration reform back to the table before the 113th Congress. The last time it was there, in 2006–07, Republicans stymied it, and the enforcement regime won out. But with re-election concerns gone, renewed support from Hispanic and Asian voters alienated by Mitt Romney’s enforcement-only message, and several promising coalition players waiting in the wings, 2013 could be a year when immigration issues are truly addressed.
Chris Swan, associate dean for undergraduate curriculum development, School of Engineering; associate professor of civil and environmental engineering
In my mind, the key challenge—and one that has existed for some years now—is the renewal of our nation’s infrastructure. It is well known that an excellent physical infrastructure supports and sustains a thriving economy. But today, our infrastructure is aging and needs repair. I speak not only of items like roads, bridges, railways, airports, water and wastewater systems and housing, but of such items as electric power systems, telecommunications and computational networks and hardware. Numerous “report cards” by the American Society of Civil Engineers have found that all of these physical systems are at, if not beyond, capacity, and many of the existing mechanisms to perform the work that needs to be done are outdated and/or not in step with current fiscal and social realities. Continuous band aids will not meet our needs. Therefore, our efforts to repair the physical infrastructure must be holistic and thorough, or we will risk falling behind and having our economy suffer, both nationally and globally.
In addition to the physical infrastructure, we need to pay attention to our educational infrastructure. It is time for the United States to expand our literacy beyond the three R’s and equally value literacy in STEM disciplines (science, mathematics, engineering and technology). STEM is often seen as unapproachable or exclusionary, available or reserved for a chosen few—some might erroneously say the nerdy few. Far too often STEM is seen as an extra, something that, unlike reading and writing, society really doesn’t need to know.
However, the future of our physical infrastructure demands society’s literacy in STEM. Renewal of our educational infrastructure will require a more holistic approach to education, not only changing what we teach, but how we teach it. Advances in recognizing the different ways that people learn need to be connected to recognizing that a STEM-educated society is a more thriving society. I look forward to the president’s continued, in fact, strengthened support towards creating a STEM-literate society.
My third point revolves around the first two—the power of unity. Lincoln said that “a country divided against itself cannot stand.” While the news media constantly play up our nation’s divisions, we cannot be divided on the issue of infrastructure renewal. Unity on this issue is vital to the nation’s success. So fixing our physical systems will make us strong, but we will become even stronger if we strengthen our STEM education system as well.
Parke Wilde, associate professor, Friedman School of Nutrition Science and Policy; author of the forthcoming book Food Policy in the United States: An Introduction (Routledge/Earthscan)
As a nation, we face important challenges related to food and agriculture. We hope for environmentally sustainable farming and meat production, we wish for less hunger and poverty, and we want better protection from chronic diseases and unsafe food. I know that these things are beyond the president’s power to accomplish alone. For example, I know it was mainly our broken Congress, and not the administration, that dropped the ball and left the Farm Bill uncompleted in 2012. Looking ahead, here are some priorities:
Improve agricultural policy. Traditionally, U.S. policymakers have worried that food prices are too low, and farmers are less prosperous than non-farm households on average. Now environmental constraints and a growing world population have increased prices and raised concerns about food scarcity. This scarcity is mostly a challenge, but it does also present an opportunity to reform U.S. agricultural policy. Support reforms to traditional crop subsidies, limit payments to high-income farmers, and resist the temptation to use subsidized crop insurance and corn-based biofuels incentives as a back door to maintaining outdated subsidies.
Improve the healthfulness of food retail and marketing. Continue to support the First Lady’s Let’s Move campaign, including promoting local retail access to healthy foods using moderate budgetary support, taking some care to avoid unnecessary supermarket subsidies. If some health-promotion measures are too bold for legislators to support today, such as soda taxes or marginal changes to Supplemental Nutrition Assistance Program benefits, then conduct pilot programs with strong evaluation designs to collect the information for sensible future policy decisions.
Protect food safety and the environment. Vigorously implement the new Food Safety Modernization Act. Raise awareness of the role of the food system in water scarcity, soil loss and climate change. Americans are a decent people. We might be willing to get along with less meat, less packaging, less energy intensity and less waste if we have the right price signals and a clear vision of how to do so.