April 2, 2021
Dear Interested Readers,
The President’s Big Bill Addresses The Social Determinants of Health
The president is determined to build back America to be more equitable and productive than it has ever been before. He formally presented his ideas and the reasons that support acting boldly now when he delivered a very convincing speech in Pittsburgh late Wednesday afternoon. I was eager to hear what he had to say and heard the speech in its entirety on CNN. if you click on the link you can read his words. This president may not have the eloquence of a JFK or Barack Obama but many of his words and most of his reasoning bear repeating. A few of the phrases in this speech may stand the test of time and be repeated as wisdom decades from now.
If you continue to read what follows, my first objective is that you will be convinced that we should all work hard to support the ideas that the president sets forth. There is no question that our infrastructure has deteriorated over the years since Ronald Reagan advanced the case that the government was a plague on society and that the best policy was a small government that stayed out of the lives of its citizens while asking for the lowest taxes possible. The president noted that our infrastructure is not number one in the world as many Americans may imagine. We are 13th, and moving down in the rankings.
The name that Biden has given this proposal should indicate that he believes that rebuilding our infrastructure requires more than replacing old bridges. His belief is that aggressively repairing and rebuilding the infrastructure and creating new infrastructure that better serves people and the environment will create jobs that can build opportunities for people. The bill will not be called something like the American Infrastructure Repair bill. It will be called “The American Jobs Plan.”
My second objective is to present the case to you that if passed as presented this will be as important as a healthcare bill as it is a “traditional” infrastructure bill. I hope that point becomes clear as the analysis goes forth. This is a bill that has as one of its objectives the improvement of the social determinants of health which are currently creating healthcare inequities that lead to things like the disproportionately greater impact of the pandemic on the poor and minorities. If this law is passed as presented or as something close to it, the health of the nation will improve and there will be a more equitable distribution of the opportunity for health that everyone deserves.
The first point that President Biden made was that he was the product of working-class America, and not Washington or Wall Street.
…today I return as your President to lay out the vision of how I believe we do that, rebuild the backbone of America. It’s a vision not seen through the eyes of Wall Street or Washington, but through the eyes of hard working people like the people I grew up with, people like Mike and his union family, union workers, from the carpenter’s training center, people like the folks I grew up with in Scranton and Claymont, Delaware, people would get up every day, work hard, raise their family, pay their taxes, serve their country, and volunteer for their communities.
He then referenced the 547,296 lives lost to that moment from the pandemic and why his first job had been to get the 1.9 trillion dollar “American Rescue Act” passed. Now that the American people, businesses, and communities have been given some breathing room from the financial pressures of the pandemic it is time to build back America. He promised that after this “jobs/infrastructure” bill was passed he would be back with a third bill that would be more directly focused on helping people, “The American Families Plan.” My presumption is that this third bill for families will be focused on housing, education, job training, daycare, and improving mental health, and the many other ways that government support could be used to improve the lives of its people and families. But it is one step at a time, and time will tell how far he will be able to go with the grand plan. He tells us where we are, and what time it is. We are getting better, and it is the right time to go further.
Leading economists are now predicting our economy will grow 6% this year. That’s a rate we haven’t seen in years and years. We can cut child poverty in half this year with the American Rescue Plan we’re meeting immediate emergency. Now it’s time to rebuild.
His next point was that the pandemic had been quite good for the rich and a disaster for many other hard-working and deserving Americans and their families. He did not leave any room for doubt or mince his words. Our economy is not fair. Our tax structure favors the rich and large corporations and he plans to try to lead an improvement that will rectify some of the reasons for the inequities that the pandemic has demonstrated are borne by the most disadvantaged people.
Millions of Americans lost their jobs last year, while the wealthiest 1% of Americans saw their net worth increase by $4 trillion. Just goes to show you how distorted and unfair our economy has become. It wasn’t always this way. Well, it’s time to change that.
Joe believes in equity and knows that it has been in short supply. He also believes in the ability of unions to help ordinary people get a fairer share of what they helped to build. It was no accident that he was speaking at a union hall. Revitalizing his relationship with unions will be key to gaining the political margins he needs to get his bill passed. Here is how he said it:
We all will do better when we all do well. It’s time to build our economy from the bottom up and from the middle out. Not the top down, it hadn’t worked very well. For the economy overall it hadn’t worked, because Wall Street didn’t build this country. You, the great middle class, built this country. And unions built the middle class. And it’s time. And this time, when we rebuild the middle class, we’re going to bring everybody along. Regardless your background, your color, your religion, everybody gets to come along.
It is worth noting that while the president is emphasizing that huge investments in American infrastructure have been the historical norm and the engine that created a middle class, in the future, it should also be extended to minorities to create equity. Most living Americans have never seen an American government that invested in infrastructure, jobs, and people. The last forty-fifty years have been the exception in American history, perhaps in reaction to expanding civil rights and voter rights and the fears of a “welfare state,” we have substantially reduced our investments in infrastructure and people during the lifetime of most American workers.
It is my opinion that Grover Norquest’s captivation of the minds of conservative politicians and their voters has been the equivalent of a racial “dog whistle.” The concept that “private” investment is more “American” and effective than tax-supported public investment seems to me to be inconsistent with American history from 1933 until 1968 and consistent with the desire to maintain a separate and unequal society to the advantage of the more deserving “white” population. Racial and economic inequity is the outcome of those biases and policies as Heather McGhee argues in her book, The Sum of Us: What Racism Costs Everyone And How We Can Prosper Together. Biden agrees. Public investment was important in the creation of the strong middle class that emerged after World War II, and this lack of public investment and the associated tax cuts are a likely cause of the growing inequities that have become so much more obvious over the last fifty years.
In the middle of the speech, the president describes all of the things that have been neglected and now need repair. His emphasis is less on the cost of the repair than on the cost of not doing the work and the collateral benefits that will accrue to us if we agreed to the plan. A major point in this part of the speech is his expansion of the idea of what infrastructure is. Infrastructure is roads, bridges, airports, and a reliable electrical grid. It is also effective home health care, universally available inexpensive high-speed intranet connections in every American hamlet and home. Building infrastructure includes saving the environment and cleaning up our water supply. I have heard commentators say that the president really likes to say “transformational.” I think that his vision is transformational.
Here is how the president expanded “infrastructure.”
The American Jobs Plan will lead to a transformational progress in our effort to tackle climate change with American jobs and American ingenuity. Protect our community from billions of dollars of damage from historic super-storms, floods, wildfires, droughts year after year, by making our infrastructure more secure and resilient. And creating incredible opportunities for American workers and American farmers in a clean energy future. Skilled workers, like one we just heard from, building a nationwide network of 500,000 charging stations. Creating good paying jobs by leading in the world in the manufacturing and export of clean electric cars and trucks.
He has more to his vision:
…we’ll buy the goods we need from all of America. Communities that have historically been left out of these investments, Black, Latino, Asian American, Native Americans, rural, small businesses, entrepreneurs across the country.
He spent time talking about our poor water supply and its lead contamination. There will be plenty of work for plumbers if we really want our children to grow up without damage from lead in the water.
Joe Biden is a famously empathetic man. Empathy is a major driver of his redefined concept of infrastructure.
Even before the pandemic, millions of working families faced enormous financial and personal strain trying to raise their kids and care for their parents at the same time, the so-called sandwich generation, or family members of disability. You’ve got a child at home, you can’t stay home from work to take care of that child unless you’re going to put the child at risk or you lose your job, or you have an elderly parent you’re taking care. Seniors and people with disabilities living independently feel that strain as well, but we know if they can remain independently living, they live longer.
The American Jobs Plan is going to help in big ways. It’s going to extend access to quality, affordable home and community-based care. Think of expanded vital services, like programs for seniors, or think of home care workers going into homes of seniors and people with disabilities, cooking meals, helping them get around their homes, and helping them be able to live more independently. For too long, caregivers who were disproportionately women and women of color and immigrants- This plan, along with the American Families Plan, changes that, with better wages, benefits and opportunities for millions of people who will be able to get to work in an economy that works for them.
I can’t wait to hear if Mitch McConnell, Ted Cruz, and Rand Paul think homecare and childcare are infrastructure issues. Having redefined “infrastructure’” to include equity, the environment, clean energy, homecare, and much more, Joe gave us some statistics. We have been coasting on past investments and performance and we are falling off the pace of the rest of the world.
Now, decades ago, the United States government used to spend 2% of its GDP, its gross domestic product, on research and development. Today, we spend less than 1%. I think it’s 7/ 10ths of 1%. Here’s why that matters. We’re only a few major economies in the world whose public investment in research and development as a share of GDP has declined constantly for the last 25 years, and we fall back.
So where is the money to do all of this coming from? The short form of the answer is from people making over 400K, the reversal of part of the Trump tax cuts for the rich, and by preventing big companies from hiding assets overseas, but his emphasis is not on whether we can afford it, but on who must be included and why we can’t afford not doing it:
This plan is important, not only for what and how it builds, but it’s also important to where we build. It includes everyone, regardless of your race, your zip code. Too often, economic growth and recovery is concentrated on the coast. Too often, investments have failed to meet the needs of marginalized communities left behind. There’s talent innovation everywhere and this plan connects that talent through cities, small towns, rural communities, through our businesses and our universities, through our entrepreneurs, union workers, all across America. We have to move now, because I’m convinced that if we act now, in 50 years, people are going to look back and say this was the moment that America won the future.
… failing to make these investments adds to our debt and effectively puts our children at a disadvantage relative to our competitors. That’s what crumbling infrastructure does, and our infrastructure is crumbling. It ranked 13th in the world.
It’s a bold plan. It may be bolder still to expect to finance it by increasing taxes. Some economists like Paul Krugman believe we could do it without raising taxes. He gives us a long review of how we have used public money to build America’s infrastructure going back to the Erie Canal. In yesterday’s New York Times he wrote:
So when Republicans denounce the American Jobs Plan as an “out-of-control socialist spending spree,” remember, large-scale public investment is the American way.
We can say much the same thing about Biden’s tax proposals.
Actually, given extremely low borrowing costs it’s not obvious that we would even need a tax hike if infrastructure spending were the end of the story. But we will need more revenue to pay for the whole Biden program, which everyone expects will eventually include another round of spending targeted on families. So it makes sense to tie tax hikes to the jobs plan; polling suggests that paying for public investment with taxes on corporations and the rich increases support for an infrastructure plan, and that something along the lines of the Biden proposals will command very high public approval.
The key concept for success in that analysis is a new definition of “bipartisan” when he writes “something along the lines of the Biden proposals will command very high public approval.”
Don’t for a moment count on getting even one Republican senator to vote for this plan as proposed. The president offers negotiations and hopes the bill gains bipartisan support in the Senate, but I doubt he thinks that he will get even one Republican vote. A lesson learned from the American Rescue Plan is that there are other expressions of bipartisanship. Outside of Washington, there was broad bipartisan support for the American Rescue Plan that got no votes from Republican senators. A huge number of Republican voters (54%) and small-town politicians are quite happy with the American Rescue Plan even though Mitch McConnell made sure it got no Republican votes in the Senate.
I said that there were two objectives to this letter:
- That you will be convinced that we should all work hard to support the ideas that the president sets forth.
- To present the case to you that if passed as presented this will be as important as a healthcare bill as it is a “traditional” infrastructure bill.
I hope that both points have been evident when you think about the healthcare implications of reducing the inequities that define the social barriers to good health. Just lifting people out of poverty and into the middle class creates momentum toward better health, fewer deaths of despair, less domestic strife, and a better opportunity for children. In a post almost two years ago I also argued that the “Green New Deal” was a healthcare proposal.
So how will the deal get done? I think the president will begin with honest efforts to gain ten Republican senators as supporters. He may be willing to modify the deal around the edges in that effort. His offer to them probably will not work. I think that he will have more success demonstrating bipartisan support in the nation. Out in the country, this bill will have the same support that strong gun control legislation, the new voter rights initiatives, and the American Rescue Plan have. All those issues that Republicans fight in Congress get majority support from the public.
He may try the “budget reconciliation” path again. Maybe that will work for this bill and the American Families Bill as it did for most of the American Rescue Plan but I have my doubts since it did not protect the $15 minimum wage. In the end, I hope that the president doesn’t let the filibuster kill this bill, the voting bill, or bills to improve gun control. The majority of Americans including significant numbers of Republicans favor these actions. That should be the new definition of bipartisan! These bills are important enough to warrant modification or elimination of the filibuster. It will be interesting to see how this all evolves. As we watch the hearings and deliberations unfold I hope that we will be encouraged that there is really going to be a new day dawning for us all. We are rich enough, we are smart enough, and I believe that we care about one another and our communities enough to bless each other with a future that is better for everyone. Joe has a plan and cares enough to lead the way against the resistance that is likely to arise. I vote to give him and his plan a chance to help us all.
Baseball Is Back!
I had a plan. I was going to write this letter to you while I watched the Opening Day festivities at Fenway Park and use a screenshot from the game as the picture for today’s header. That plan as well as the game were canceled by rain. Yesterday was a reversion to winter that included a little snow even as there is a little open water between my beach and the ice that is still covering most of the lake despite a week with some warm rain that has taken away most of the snow.
Today’s header comes from another warmer Opening Day at Fenway. I-phones record the time and location of the pictures you take. The time stamp on this photo is 2:06, April 5, 2018. The official start of the game was 2:05 PM. It was a gorgeous day that opened a very exciting season that now seems so long ago. It was the most recent Opening Day I have enjoyed at Fenway. Boston beat Tampa Bay 3-2 that day and went on to win the World Series from the Dodgers. The season was tarnished just a bit when Manager Alex Cora was discovered to have gained some advantage for the team by “stealing signs.” Cora has been gone for a year primarily because of his role in the sign-stealing that enabled the 2017 Houston Astros to win the World Series.
2020 was an awful year for baseball and the Red Sox just as it was an awful year for everything. I was so disgusted by the Sox letting Mookie Betts get away to LA that I came close to giving up my tickets for 2021. It was hard to let go because I have been sharing season tickets since 1977, and I have been with them win or lose. I am still waiting to learn which games I will get to see since only a few thousand spectators will be allowed to get into each game. I was not one of the few to land a ticket for today.
Today at 2:05 I will be listening to the game with my wife in a line of cars at a community college in Claremont, New Hampshire as we wait for our second Pfizer shot which will give me confidence when I finally do get to go back to Fenway. We have a list of things we are hoping to do again besides going to see the Sox after we are vaccinated. Friends will visit us at the lake. We will hug grandchildren. I will get my haircut for the first time since March 11, 2020.
I hope that you have been, or will soon be, vaccinated. It is time for us to start exploring the new normal and begin our movement to a more equitable and healthier America where we can sing “Take me out to the ballgame!”
Be well,
Gene
