In what has now become an iconic statement about American politics, and maybe politics everywhere, former White House Chief of Staff Rahm Emanuel (now Chicago Mayor) declared that “a crisis is a terrible thing to waste.” He was making the point that it is always hard to summon the will to enact big, new policy ideas, even when they appear perfectly logical. Until some dramatic development galvanizes people to act, they sit on the shelf. And what a pity it is if that dramatic moment passes, and there they still sit, perhaps never to be put into law or regulation.
Thinking about that phenomenon, you’d be wise to wonder: what transformative ideas are sitting on the shelf right now? Three of the biggest, I would argue, come from the work of economists. They address very specific problems in very smart ways. But they might only be adopted when concern about the federal government’s deficit is again at a fever pitch.
Multiple studies have shown what all Americans can see: in many places of the country, especially on too many of our nation’s bridges, our infrastructure is either crumbling or excessively crowded. By some accounts, the bills for just public facilities (excluding additional privately funded broadband investments) could run into trillions of dollars. In principle, even with huge federal budget deficits, such investments could be funded through a special “capital budget” as they are at the state level. But past proposals for a capital budget have gone nowhere, so the only politically realistic way of funding them instead is through some kind of public infrastructure bank, which at this writing has some bipartisan support, but still not enough to get the bank created and adequately funded.
Even if this should happen, however, many economists have argued for years that before much construction of additional roads in particular is undertaken, existing roads, which are less than full during off-peak hours, could be more rationally used, reducing somewhat the need for potentially hundreds of billions of dollars in new roads. That rational way is by charging drivers more during congested periods when their presence on the road generates “negative externalities” for other drivers.
However much congestion pricing may make sense to an economist, the politics make it all but a non-starter: people accustomed to driving on public roads for free are not likely to embrace these charges, even if they are told it will mean less taxes required for building new roads. The regressive nature of the charges only complicates the politics.
A very different result may be possible, however, as more states and localities authorize the construction of roads that are privately owned and financed, or even sell off existing roads and other infrastructure in order to relieve their own budgetary pressures. Private owners are likely to have greater freedom in how they set tolls than is the case for governments. Private ownership of roads and infrastructure raises a host of other issues — such as whether certain roads are deemed to be so essential that their rates are regulated to prevent monopoly exploitation — but in our “new normal” age of austerity, taxpayer funding of roads seems less and less likely, leaving private financing and ownership as the principal way to rebuild and expand a good portion of America’s aging physical infrastructure.
Another idea waiting for implementation at some point that will have major implications for the entire health care industry is vouchers (euphemistically and for political reasons probably called “premium support”) for Medicare, and possibly Medicaid, as a replacement, or at least an option, for those over 55, in lieu of the current fee-for-service reimbursement system. Under such a system, beneficiaries would purchase health care insurance on their own (without regard to preexisting conditions, of course), with insurers receiving a support payment.
In some versions of this idea, initially proposed in the 1990s by Brookings Institution scholars Henry Aaron and Robert Reischauer, the supports would be geographically based, and in all versions would increase with the growth of the economy, and perhaps with the cost of medical care itself. Clearly, the lower the escalation factor for the voucher, the greater would be the incentives of premium support for medical care cost control, but also the greater risk that beneficiaries would have to pay more for care out of pocket (which for many seniors would translate into receiving less care).
Another long-time Brookings Senior Fellow (and public policy servant extraordinaire) Alice Rivlin briefly agreed on a premium support plan several years ago with Rep. Paul Ryan, the current chairman of the House Budget Committee, but the two later parted ways over the magnitude of the escalation factor. Even though medical cost inflation has slowed in recent years, economists have not agreed on how much of the slowdown is cyclical and how much is likely to be permanent.
Whatever the facts, the continued aging of the population means that Medicare spending will continue to rise, and it is because of this fact that federal policymakers eventually may be driven to adopt some kind of premium support plan. When then happens, look for even more pressure for medical cost control than exists now including downward pressure on provider earnings. Also look for more cost-effective medical delivery models, such as Minute-clinics in pharmacies, and also innovation and entrepreneurship aimed at cutting the growth of health care spending.
Tax on carbon
A third policy idea that has been on the shelf for some time and which has many intellectual “fathers” and “mothers” is a carbon tax, which has two rationales. One is to correct an “externality,” namely the contribution of carbon dioxide emissions to climate change (though the magnitude of that contribution continues to be hotly disputed, pun partially intended). A second benefit of a carbon tax is that its revenues could make a significant contribution toward long-term deficit reduction. For example, a tax of $20/ton on carbon, would raise roughly $1 trillion over a decade, though the net increase in revenue would be somewhat smaller to the extent that some of this amount would (as it should) be rebated to lower income households because of the tax’s regressive nature. A potentially more politically palatable way of introducing a carbon tax is to trade it for a reduction in the social security tax and thus keep the whole package revenue neutral, but at least tax a “bad” (pollution) while encouraging a “good” (the supply of and possibly the demand for more labor).
Any one of these ideas, if implemented, would change the economic environment for firms and compel them to respond strategically. The thinkers behind them would join the pantheon of the trillion dollar economists whose ideas have transformed business. For now, they’re on the shelf, still in waiting for their crisis.