Never Waste a Crisis: Creating a New Government for a New Economy

While the outlines of the soon-to-be-trillion dollar stimulus program are not firm, some of the key elements are becoming more visible: repairing roads and expanding transit systems, upgrading the energy grid and weatherizing structures, bigger children’s health programs and new health care information systems, fixing school facilities as well as creating new teacher training and early childhood programs, and providing assistance to low-income families. While implementing any one of these is daunting enough in scale to keep a boatload of bureaucrats busy, in this case, they all need to be pressed simultaneously if the flow of new dollars is to work quickly enough to keep the frightened economy from heading into a pure panic.

Yet the real opportunity presented by all of these ambitious initiatives may well lie in their collective interaction as much as in their individual implementation. Investment of this scale offers a once-in-a generation opportunity to change the way government works, not just make it bigger, and the potential impact on families and communities is far greater if we think about these programs collectively and leverage them against each other.

Some examples of the potential for leveraging are easy to imagine. There is little question among those familiar with the challenges of teaching low-income children that health concerns are a big part of their challenge. Attendance is poorer for these kids, their nutrition is often inadequate, and many illnesses are more common and less well treated in kids lacking a decent community-based physician. A major investment in school-based health care systems needs to be tied directly to the massive investment in education we are considering as part of this program – nurses and school-based health clinics in every school, nutrition programs for the poorest kids, linkages between the school nurses and kids’ health care providers to maximize coordination of care so kids stay in school.

Or take our concern about using the opportunity this stimulus presents to decrease our dependence on foreign oil. Of course weatherizing old buildings makes sense, but why not use the big transportation spending we are planning to get drivers off the roads and into mass transit systems?In fact, we should think even bigger, forcing communities that are receiving the new dollars to create deep incentives for denser development near transit stations so we can end the enormous sprawl that has increased our commutes, driving up gasoline bills and with it, the CO2 we’re sending into the atmosphere. And new inter-city rail systems should be targeted to cities with over-crowded airports to cut back ground delays that waste fuel – and our time.

The vast infrastructure program we are planning can do more than create jobs for construction workers – though that’s plenty important right now – but can be leveraged in a host of other ways. We should make sure to use some of the dollars for infrastructure spending to re-train workers in declining industries for closely aligned jobs in the building business (think auto workers). We can create high schools and community colleges with curricula that reflect the needs of a modern infrastructure, using school construction money to create facilities for new science programs focused on telecommunications and energy technologies. We can make sure we buy raw materials for new projects from companies minimizing the damage they do to the environment and thereby encourage the development of greener supply chains

If we could only learn to see problems from the perspective of humans rather than laws, we could create a government that works for people it serves rather than the leaders they select. Families know that sick kids don’t go to school, that high housing costs drive people to locate far from their jobs, that laid-off workers need new skills to get good paying jobs. Business people know that in the absence of fast reliable train service they have to fly even short distances, that it is increasingly hard to find well-trained young workers in mid-skill level jobs, that housing is worth more when built near train stations, and that the dirtiest raw materials are often the cheapest.  It’s just the government that somehow sees roads as the provenance of one department, housing another, and energy yet another – no matter how intertwined they are in solving global warming. Meetings of educators and community health providers, when they happen at all, are too often held despite institutional and funding divisions, not because of the need to bridge them

In fact, what these linkages tell us is that a new kind of thinking is required, one that crosses the traditional boundaries between the various silos of bureaucracy and interest groups that prevent us from getting the most from our investments.  Instead of just funneling money into existing funding mechanisms that make these kinds of leveraging strategies so difficult, the powerful new policy offices in the White House should use this opportunity to create broader and more flexible mechanisms that will encourage inter-disciplinary thinking. The new Congress should find ways to think about revising the traditional authorization and appropriation committee structures to help get us beyond last century parochialism towards more sophisticated approaches to economic revitalization. We don’t have to use exactly the same government structure we have had for centuries – there are lessons to be learned from our competitors who link programs together differently than we do: Germany’s Transport, Building and Urban Development agency, Singapore’s National Development department, Britain’s Ministry for Children, Schools and Families, China’s State Development Planning Council, or France’s Ecology, Sustainable Planning and Development cabinet post. The problems we face are those of a new century, and now is the moment to seize the opportunity created by this challenge to create a government that will be ready to face them.

Comments

[Divya Mohan]

All children and adolescents in the United States should have an equal opportunity to be healthy. Such was the premise when Congress created the national Medicaid program to ensure this opportunity for low-income families. I am so glad you mentioned school-based health care as a way to bridge the gap between health and education and to help our nation's youth succeed. School-based health centers play an important and complementary role by assuring that health care is available, appropriate and affordable for underserved school-aged youth. Each year these programs provide access to nearly two million children, most of whom go to schools where more than half the student population is eligible for free and reduced lunch.

Medicaid and its complementary SCHIP counterpart are a critical source of revenue (indeed, the largest source of non-grant funding) for school-based health centers, and a key component toward their long-term fiscal stability. Yet, barriers to Medicaid and SCHIP reimbursement exist for too many school-based health centers, and this important source of revenue is often not fully realized.

The National Assembly on School-Based Health Care, in consideration of the important role school-based health centers play in meeting Medicaid and SCHIP access goals for children and adolescents, urges policy makers to protect and promote this essential component of the children’s safety net.

In the new economic stimulus package, we hope that children and adolescents will not be forgotten. Mandating reimbursement for SCHIP/Medicaid covered services provided at SBHCs would be a good starting point. A federal authorization for SBHCs would be another way to sustain this essential health care delivery model. If we truly believe in "no child left behind," we need to ensure that kids are learning and achieving to their fullest potential. Keeping them healthy in schools is one of the best ways to ensure that happens.

Divya Mohan
National Assembly on School-Based Health Care