Барак Обама - The Audacity of Hope

To help all workers adapt to a rapidly changing economy, it’s also time to update the existing system of unemployment insurance and trade adjustment assistance. In fact, there are a slew of good ideas out there on how to create a more comprehensive system of adjustment assistance. We could extend such assistance to service industries, create flexible education accounts that workers could use to retrain, or provide retraining assistance for workers in sectors of the economy vulnerable to dislocation before they lose their jobs. And in an economy where the job you lose often paid more than the new job you gain, we could also try the concept of wage insurance, which provides 50 percent of the difference between a worker’s old wage and his new wage for anywhere from one to two years.

Finally, to help workers gain higher wages and better benefits, we need once again to level the playing field between organized labor and employers. Since the early 1980s, unions have been steadily losing ground, not just because of changes in the economy but also because today’s labor laws — and the make-up of the National Labor Relations Board — have provided workers with very little protection. Each year, more than twenty thousand workers are fired or lose wages simply for trying to organize and join unions. That needs to change. We should have tougher penalties to prevent employers from firing or discriminating against workers involved in organizing efforts. Employers should have to recognize a union if a majority of employees sign authorization cards choosing the union to represent them. And federal mediation should be available to help an employer and a new union reach agreement on a contract within a reasonable amount of time.

Business groups may argue that a more unionized workforce will rob the U.S. economy of flexibility and its competitive edge. But it’s precisely because of a more competitive global environment that we can expect unionized workers to want to cooperate with employers — so long as they are getting their fair share of higher productivity.

Just as government policies can boost workers’ wages without hurting the competitiveness of U.S. firms, so can we strengthen their ability to retire with dignity. We should start with a commitment to preserve Social Security’s essential character and shore up its solvency. The problems with the Social Security trust fund are real but manageable. In 1983, when facing a similar problem, Ronald Reagan and House Speaker Tip O’Neill got together and shaped a bipartisan plan that stabilized the system for the next sixty years. There’s no reason we can’t do the same today.

With respect to the private retirement system, we should acknowledge that defined-benefit pension plans have been declining, but insist that companies fulfill any outstanding promises to their workers and retirees. Bankruptcy laws should be amended to move pension beneficiaries to the front of the creditor line so that companies can’t just file for Chapter 11 to stiff workers. Moreover, new rules should force companies to properly fund their pension funds, in part so taxpayers don’t end up footing the bill.

And if Americans are going to depend on defined-contribution plans like 401(k)s to supplement Social Security, then the government should step in to make them more broadly available to all Americans and more effective in encouraging savings. Former Clinton economic adviser Gene Sperling has suggested the creation of a universal 401(k), in which the government would match contributions made into a new retirement account by low-and moderate-income families. Other experts have suggested the simple (and cost-free) step of having employers automatically enroll their employees in their 401(k) plans at the maximum allowable level; people could still choose to contribute less than the maximum or not participate at all, but evidence shows that by changing the default rule, employee participation rates go up dramatically. As a complement to Social Security, we should take the best and most affordable of these ideas and begin moving toward a beefed-up, universally available pension system that not only promotes savings but gives all Americans a bigger stake in the fruits of globalization.

As vital as it may be to raise the wages of American workers and improve their retirement security, perhaps our most pressing task is to fix our broken health-care system. Unlike Social Security, the two main government-funded health-care programs — Medicare and Medicaid — really are broken; without any changes, by 2050 these two entitlements, along with Social Security, could grow to consume as large a share of our national economy as the entire federal budget does today. The addition of a hugely expensive prescription drug benefit that provides limited coverage and does nothing to control the cost of drugs has only made the problem worse. And the private system has evolved into a patchwork of inefficient bureaucracies, endless paperwork, overburdened providers, and dissatisfied patients.

In 1993, President Clinton took a stab at creating a system of universal coverage, but was stymied. Since then, the public debate has been deadlocked, with some on the right arguing for a strong dose of market discipline through Health Savings Accounts, others on the left arguing for a single-payer national health-care plan similar to those that exist in Europe and Canada, and experts across the political spectrum recommending a series of sensible but incremental reforms to the existing system.

It’s time we broke this impasse by acknowledging a few simple truths.

Given the amount of money we spend on health care (more per capita than any other nation), we should be able to provide basic coverage to every single American. But we can’t sustain current rates of health-care inflation every year; we have to contain costs for the entire system, including Medicare and Medicaid.

With Americans changing jobs more frequently, more likely to go through spells of unemployment, and more likely to work part-time or to be self-employed, health insurance can’t just run through employers anymore. It needs to be portable.

The market alone can’t solve our health-care woes — in part because the market has proven incapable of creating large enough insurance pools to keep costs to individuals affordable, in part because health care is not like other products or services (when your child gets sick, you don’t go shopping for the best bargain).

And finally, whatever reforms we implement should provide strong incentives for improved quality, prevention, and more efficient delivery of care.

With these principles in mind, let me offer just one example of what a serious health-care reform plan might look like. We could start by having a nonpartisan group like the National Academy of Science’s Institute of Medicine (IOM) determine what a basic, high-quality health-care plan should look like and how much it should cost. In designing this model plan, the IOM would examine which existing health-care programs deliver the best care in the most cost-effective manner. In particular, the model plan would emphasize coverage of primary care, prevention, catastrophic care, and the management of chronic conditions like asthma and diabetes. Overall, 20 percent of all patients account for 80 percent of the care, and if we can prevent diseases from occurring or manage their effects through simple interventions like making sure patients control their diets or take their medicines regularly, we can dramatically improve patient outcomes and save the system a great deal of money.

Next, we would allow anyone to purchase this model health-care plan either through an existing insurance pool like the one set up for federal employees, or through a series of new pools set up in every state. Private insurers like Blue Cross Blue Shield and Aetna would compete to provide coverage to participants in these pools, but whatever plan they offered would have to meet the criteria for high quality and cost controls set forth by IOM.