Dear Mr. President
The nation has just weathered another presidential election, and no matter what our politics are, we can agree that our leaders must do better. As President Barack Obama gets ready to assume four more years in office, the Bulletin asked Bryn Mawr alumnae and faculty experts to write letters of advice on some of the most pressing challenges he will face.
Dear Mr. President:
Please, be a problem solver! This bitter election has left Americans wondering if their democracy is too polarized to deal with the serious issues facing our society. You can restore their faith if you start solving problems right away.
Painting the opposition as mean-spirited, incompetent, and untrustworthy may win elections, but it won’t solve problems. Problem solving requires people with different solutions listening to each other, finding common ground, and hammering out pragmatic compromises that are nobody’s first choice.
Start with the double challenge of accelerating economic recovery and reducing the growth of public debt. This sounds like two problems but is really one. Leaders of both parties know that reining in the debt is necessary to future prosperity, but that it can’t be done so abruptly that we fall back into recession. Avoiding a debt crisis will take bipartisan compromise and neither party will get its preferred plan. Several bipartisan blueprints—Simpson-Bowles, Domenici-Rivlin—offer sensible choices. Kicking the can down the road won’t work much longer. You have to broker a deal that gradually slows the growth of Medicare spending, makes Social Security sustainable, and raises more revenues from a fairer tax system. The options are known; what’s missing is presidential leadership to close the deal. Go for it!
But don’t stop there, Mr. President. Immigration reform also requires bipartisan compromise and will fester with inattention. Leaders of both parties know that a workable solution includes border enforcement and compliance with employment laws. It also includes incentives for undocumented immigrants to register, so that we can distinguish criminals from hard-working, law-abiding folks and offer the latter a responsible path to citizenship. We need you to cut a deal that will continue to attract talent to our workforce, while reducing uncertainty, fear, and exploitation.
And one more, please! Climate change cries out for your leadership. You can get us out of denial and into a dialogue about actions to slow the growth of greenhouse gases. A few years ago we were discussing whether a carbon tax was better than cap and trade. Now we stand paralyzed while the problem worsens—perhaps to a point of no return. Resuming serious discussion of what to do and how to do it is the first step to regaining leadership at home and abroad.
And good luck, Mr. President!
Alice M. Rivlin ’52
Alice M. Rivlin, a senior fellow in the Economic Studies Program at the Brookings Institution in Washington D.C. and visiting professor at Georgetown University, was the founding director of the Congressional Budget Office. She served as director of the White House Office of Management and Budget in the first Clinton Administration and as vice chair of the Federal Reserve Board.
Dear Mr. President:
It has been useful over the past several months to hear the debate from both sides of the aisle about health insurance and the government role, or lack thereof, in promoting access to health insurance. At the same time, the goal of health insurance is not coverage for coverage’s sake, but instead insurance is a mechanism to make access to effective health care affordable. Whatever role government ultimately plays in health insurance, we are still left with escalating and unaffordable health care costs.
While both sides of the aisle agree that more needs to be done to control costs, there is little consensus about the best way to address the looming crisis. Our historical unwillingness to impose any kind of structure on the health care delivery system has given us a system where providers are paid to provide more care, not necessarily the right care. A recent Institute of Medicine report estimated that 30 percent of health spending in 2009, approximately $750 billion, was wasted in unnecessary services, excessive administrative costs, and fraud. In addition to cost inefficiencies, roughly 75,000 deaths might have been prevented in 2005 if every state had delivered care at the quality level of the best-performing state.
Simply making cuts across the board to hospitals, physicians, and pharmacies, for example, meets budget targets but does nothing to promote high-quality health care. Alternatively, we have an opportunity to change the payment system to one that rewards health care providers for delivering effective care—the right care to the right patient at the right time. There is a lot of evidence both locally and internationally that better-coordinated care can improve quality of life and lower health care costs. It doesn’t require a government takeover of health care; it does require a willingness to pay for health care differently. Bundling payments gives providers a fixed sum to work together, providing care for patients over time and across sites of care. Supporting the adoption of information technology facilitates more effective sharing of test results and medical history, reducing both duplications and errors.
These approaches require new ways to pay for and deliver health care in the United States but support higher-quality, affordable health care and avoid the consequences of continuing business as usual.
Kimberly Rask ’80
Kimberly Rask is an associate professor in the Rollins School of Public Health at Emory University and a medical director at the Georgia Medical Care Foundation, a nonprofit dedicated to improving the quality, safety, and value of health care in Georgia. Her research focuses on access to health care, health promotion, and outcomes measurement.
Dear Mr. President:
No matter the election result, the U.S. needs to build political resilience. Political resilience means citizens who have heard and understood what every terrorism expert has agreed: the next big terrorist attack in the U.S. is a question of when, not if. In other words, it is beyond the capacity of government or angels to prevent the next terrorist attack. Enemies who are willing to give their lives to kill U.S. citizens will sooner or later succeed. Two implications of “when not if” need to be more broadly recognized.
First, we do not have time or money to do everything that can possibly be done to prevent terrorist attacks. Terrorist ingenuity is infinite; securing all possible attack scenarios is not even conceivable let alone practical. The value of the concept of resilience is that it moves the problem from prevention of one rare form of threat—terrorism—to system adaptations that will improve response to all forms of threat and disruption.
Second, we do not want to give terrorists the status and satisfaction of ever-greater reactions to terrorism. Terrorists want us to pay attention to them and their cause, and they want to coerce our policies in directions that we don’t want to go. But we are no less coerced if we change our society, our politics, and our government to fight terrorists than if we change our society, politics, and government to appease terrorists. Osama bin Laden’s right-hand man, Ayman al-Zawahiri, boasted that 9/11 brought U.S. troops into Muslim countries where they would incite jihad against the West. Before he died, Bin Laden boasted of putting the U.S. on the road to bankruptcy. The lesson from our enemies is that our reactions to terrorism can be as dangerous as the terrorists.
An American public that understands these implications will be politically resilient. We will not see a new terrorist attack as a requirement for new security measures. We will be suspicious of anyone whose first order of business after a terrorist attack is to assign blame. We will be resistant to promises of more security if only we surrender new powers and new tax monies to government.
If we recognize the value of political resilience, how are we to develop it? One approach will surely fail. We cannot wait until the next terrorist attack to begin work on political resilience. Imagine the U.S. president or the secretary of the Department of Homeland Security trying to talk about resisting overreaction with the relatives of terrorist victims at the door. Identified victims are compelling news, and the timing would make this an argument of weakness.
Rather, political resilience—like other forms of individual and community resilience—must be built before it is called on. Political leadership must draw the implications of “when, not if” for Americans before the next terrorist attack. Since 9/11, U.S. security forces have achieved a remarkable record of uncovering and blocking potential terrorists. Their successes are evidence that our security system is strong; an occasional terrorist success should not be allowed to push us in directions we don’t want to go.
Clark McCauley is the Rachel C. Hale Professor of Mathematics and the Sciences and co-director of the Solomon Asch Center for the Study of Ethnopolitical Conflict at Bryn Mawr. His research interests include the psychology of radicalization and terrorism, and the psychological foundations of ethnic conflict and genocide.
Dear Mr. President:
Greetings from Bryn Mawr’s Graduate School of Social Work and Social Research! As you prepare to set an agenda for your term in office, I hope you’ll keep a core principle of the profession of social work in mind. While we don’t know what the future will bring, we do know it will be shared with those whose lives we touch, and those who move us, or aid us in times of need. In your role as president, it is my hope that you’ll attend to strategies that keep us connected and in relationship with each other—especially in the face of hardship.
The profession of social work believes deeply in the power of relationships. In fact, our ethical code states that relationships “among and between people are an important vehicle for change.” Relationships connect us to resources, provide tangible and emotional support, help us to know who we are, provide us with mentors, and generally give us a reason to exist. Social workers, through direct service work and advocacy, strive to be in relationship with and give voice to those who are silenced in their isolation—those on the fringe of the places we gather and those at the center of society’s discourse on who is worthy and unworthy of being known.
As such, in our efforts toward social justice, social workers work hard to discourage social and economic policies that restrict access to needed resources; that overtly focus on punishing perceived moral failures in lieu of responding to basic human needs through connection; and that don’t allow us the space and freedom to interact with our communities, build productive organizations, and find meaningful intersections and time to be with our chosen families. These kinds of policies have the intended and unintended consequence of creating greater separation from each other and thus inhibit collective efforts toward the common good.
So, Mr. President, I urge you to connect with some social workers over the next four years. We represent one of this nation’s most valuable natural resources; our energy is unlimited.
Sara Bressi Nath
Sara Bressi Nath is an associate professor at Bryn Mawr’s Graduate School of Social Work and Social Research. Her research interests include exploring the quality of care offered to persons with psychiatric disorders as well as end-of-life care among frail elders. She is also a licensed social worker who has worked with a variety of vulnerable populations.
Dear Mr. President:
You need to find a way to lead the country back onto a path of collaboratively solving the climate change challenge. The scientific community is united on the reality of the devastating consequences of inaction for future generations, and the current bill for past failures to act is becoming harder to ignore.
Equally manifest are the obstacles to action, largely the result of a well-orchestrated and well-funded campaign to convince the electorate that climate change is a shibboleth. I’m sure your political advisors have told you that direct policies to address climate change—cap and trade quotas, carbon taxes, and the like—are non-starters, sure to burn up huge reserves of your political capital with little chance of success. That’s a shame and perhaps even a crime against humanity.
But you must take steps within the constraints facing you to harness the creative energies of the American people to address this looming catastrophe for our economy and way of life, the well-being of billions of people around the world, and the viability of a host of animal and plant species.
There are concrete steps you can take now, even if only to lay the groundwork for more aggressive action by your successor.
Break the rhetorical connection between recognizing climate change as a problem and imposing unacceptably high costs on members of our community. Mischief-makers have associated the idea of doing something about climate change with needless pain today and a lower standard of living. Humans are ingenious problem solvers. Climate change is just another opportunity for us to demonstrate our capacity to overcome obstacles.
Fund research to identify and harvest the low-hanging fruit. There are many steps that can be taken to reduce the growth of carbon emissions that are virtually costless. Implement them and spotlight the benefits of these achievements.
Look for ways to incorporate responding to climate change into tax-reform conversations. Basic economics tells us to lower taxes on goods and activities we favor and increase taxes on bads and activities we wish to curtail. Tax carbon emissions (not coal) and penalize environmentally destructive and unsafe mining practices, and you create incentives for industry to find beneficial ways to harness our ample coal reserves.
I understand that each day on your calendar is filled with decisions that are both urgent and vital to our well-being. A modest investment of your time and energy on climate change today will dramatically lower the costs of coping with this looming catastrophe in the future.
David R. Ross
David R. Ross is chair and associate professor of economics at Bryn Mawr. The co-author of a classic textbook on industrial organization, his recent scholarship has focused on environmental and other governance problems facing ex-urban communities.
Dear Mr. President:
You can lead the nation in strengthening our resilience to disasters, thus saving lives, livelihoods, and heartache. I write as someone who has worked in emergency preparedness for 14 years and served on the National Academy of Sciences’ (NAS) Committee on Increasing National Resilience to Hazards and Disasters. By resilience, I mean the capacity to withstand and to recover quickly from a natural or technological calamity or a terrorist attack. Resilience also means the ability to anticipate future incidents and to reshape the physical and social world in ways that blunt, if not completely avert, mass tragedy.
To be resilient, we need to shift our mindset about disasters. Rather than God’s will or nature’s wrath, disasters and their reverberating effects are due to bad human decisions—willfully locating homes and businesses in flood plains; failing to adopt and enforce building codes that mitigate wind and earthquake damage; impeding access to health care and to knowledge about local hazards and protective actions; allowing our natural defenses to hurricane storm surge, such as coastal wetlands, to degrade; and thinking that disasters never happen (and if they do, it is to other people). Recognizing the human hand in seemingly arbitrary events is essential if we genuinely want to reduce disaster impacts.
As calculated by the committee and others, the cost of reacting to disasters—and not altering behavior in advance—is high and getting higher. In 2011 alone, economic damages from natural disasters in the U.S. exceeded $55 billion, with 14 events producing over $1 billion in damages each. Such numbers leave out unquantifiable losses of death, injury, social distress, and mental anguish. Given present trends, society’s bill for disasters will rise: More people are locating to coastal areas and into the pathway of hurricanes; aging infrastructure is running up against design limits. Climate change is tipping the scale toward more extreme weather. The population is increasing, growing older, and showing complex medical and social needs—making emergency responders’ job of protecting people more difficult.
Sticking to the status quo does not make ethical or economic sense. Your administration can encourage communities to strengthen their resilience to disasters, not their resignation. With input from local/state government and academic, private, and nonprofit sectors, the federal government can lead development of a National Resilience Scorecard so communities can gauge their baseline resilience, establish priorities for raising it, and track improvements over time. Moreover, federal, state, and local governments can nurture private-public resilience coalitions that engage all sectors of the community in the tasks of assessing risk exposure and vulnerability, educating and communicating about risk reduction methods, and expanding the community’s capacity to confront risks.
The NAS report outlines these and other suggestions more fully. You can lead in their implementation, making the nation safer.
Monica Schoch-Spana ’86
Monica Schoch-Spana is a senior associate at the Center for Biosecurity of the University of Pittsburgh Medical Center and an assistant professor in the School of Medicine Division of Infectious Diseases. Schoch-Spana has briefed numerous federal, state, and local officials, as well as medical, public health, and public safety professionals, on critical issues in biosecurity and public health emergency preparedness.
Illustrations by Jon Krause