Improved access to health care is essential if we are to fill the striking gaps between how healthy Americans are and how healthy they could be. But access alone is not enough. Health and longevity are also profoundly influenced by where and how Americans live, learn, work, and play. Recognizing this, the Robert Wood Johnson Foundation's Commission to Build a Healthier America has identified concrete, feasible actions outside of medical care that constitute an urgent agenda for improving America's health. These recommendations require action at all levels of society to promote development and health in childhood, good nutrition, and communities conducive to good health.
If you like your social science balanced and objective ("on the one hand, on the other hand") you will find this book infuriating. But you may be applying an irrelevant standard. This book does not pretend to be part of the tradition of balanced, objective social science in which the scholar hides (or claims to hide)his personal biases, and attempts to present all the evidence on both sides of a set of questions so that the reader may judge for himself. Rather it is part of what may be emerging as a new tradition of forensic social science in which scholars or teams of scholars take on the task of writing briefs for or against particular policy positions. They state what the position is and bring together all the evidence that supports their side of the argument, leaving to the brief writers of the other side the job of picking apart the case that has been presented and detailing the counter evidence.
T his lecture brings together two subjects that are not often discussed together: national economic policy and the structure of American federalism. My thesis is that the policies needed to improve the health of the U.S. economy over the next decade or two require a new look at the division of responsibilities between the federal government and the states. In particular, I will argue that the states should have much clearer responsibility for most kinds of public investment, especially for improving the skills of the labor force and upgrading public infrastructure. The federal government should concentrate on a different set of missions, including interaction with the rest of the world, strengthening social insurance, and contributing to national saving by running a surplus in the unified federal budget.This line of reasoning suggests devolution to the states of federal spending programs for education, housing, training and most other types of investment -a move that would clarify which level of government is accountable for performance in these areas and make a federal surplus easier to achieve. The added responsibilities would require the states to find more effective ways of financing their activities. I will argue for a new approach to state taxation, called "uniform shared taxes." The idea is that the states, with the support of the federal government, should move toward greater uniformity in business and consumption taxation, by enacting one or more common taxes and sharing the proceeds on a formula basis.• Alice M. Rivlin is Senior Fellow, The Brookings Institution, Washington, D.C.
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