Newt Gingrich, former Speaker of the House

Newt Gingrich is the former Speaker of the US House of Representatives and former Representative of Georgia’s 6^th Congressional District. He helped draft the “Contract with America,” which led the Republican Party to gain control of the House after four decades, and earned him the honor of Time Magazine’s Person of the Year. He was recently a candidate for the Republican presidential nomination in 2012.

You were a major contender in the Republican primaries last year. What would you say was the biggest lesson you learned from that experience?

I think there were three really big lessons. One is that money matters on a scale I had underestimated. The second is that it was much, much harder to take new ideas and move them into the political process than I thought it would be. And the third is that it is a much bigger organizational problem than I realized.

I had helped in the Contract with America, and we had candidates in 430-some congressional districts, and I had run ’94, ’96 and ’98 national campaigns. These were totally different experiences – congressional races are like franchises. Presidential campaigns are single hierarchical systems. We screwed up in Virginia, for example, and didn’t get on the ballot. Totally stupid. And it just turned out it was a much bigger challenge organizationally than we expected. I also found out why most successful candidates run twice. The first time around you go, “Wow, this is a really big system,” and you learn a lot of lessons.

As Speaker of the House you were a major political force responsible for bringing the Republican Party together to accomplish many things. Today’s Republican party seems fractured. Is this ideological divide bridgeable and if so, what should the party do to come together to accomplish its policy goals?

I actually believe that you bring people together by momentum not by mediation. If they’re going somewhere they’ll all fall into a general direction, if they’re sitting and doing nothing they’ll start fighting each other.

I think one of the great challenges – and I failed at this in the presidential primary last year – I think we’re on the edge of an extraordinary breakthrough in new public policies and in things that are so exciting it is almost impossible to discuss them in the news media, because nobody knows how to write about it. I think you could have a very dynamic Republican Party in another few years, offering an extraordinary range of innovations that will change things.

If you look at Udacity for example, which Sebastian Thrun has created, it’s stated public goal is to reduce tuition by 90%. Now when you’re trying to talk about student loan problems, if you could reduce tuition – let’s assume he’s off by half and he only reduces it by 50% – a 50% reduction in tuition would lead to an extraordinarily different student loan environment. And there are all sorts of things being developed right now that are comparable to that, that will, I think, lead to a new generation of ideas and a new generation of policies. But, it is extraordinarily hard to get them into the political process and into the news media process because they don’t fit what people think they should be covering.

There has been a lot of discussion surrounding stringent immigration policies favored by Republicans. What direction do you see the party moving on the issue of immigration, and do you think this is actually one of the primary issues concerning the Latino voter?

I think Republican National Committee Chairman Reince Priebus had it right when he said that immigration is never the number one issue unless the issue’s immigration. So if you say to the average Latino American, “What do you care about?” they’re going to say, “Jobs, education, and healthcare.” On the other hand, if you say, “We’re going to deport your grandmother,” then it’s the number one issue.

I felt very strongly last year that we had to have a rational policy and a humane policy towards the people who are already here. That doesn’t mean you have to ignore the fact that they broke the law to get here. But to pretend that we’re going to wave a magic wand and 11 million people or more are going to disappear is dishonest, and it’s both bad public policy and bad politics.

I’m encouraged by Jeb Bush, and I’m encouraged by people that are moving in the right direction – Marco Rubio, for example. I know that the house Republicans have reached out and have a bipartisan working group on immigration that is working with a number of Democrats. The interesting question will be whether the president will accept a bill or whether he wants the issue for 2014.

I think the real break points are going to be: can we find a path to legality that is distinct from a path to citizenship? Do we draw a difference between people who came here as minors? If you were brought here at three years of age, you probably ought to be eligible for citizenship faster than if you came knowingly as an adult and deliberately broke the law. Do we find a technique for having a guest worker program, which the unions deeply oppose? Should we have, as the Canadians do, a bias in favor of high-tech and entrepreneurial personalities? I do think you have a growing part of the Republican Party willing to find a solution, and I think the odds are that in the next two years we’ll actually get to something.

You wrote an Op-Ed for the Chicago Tribune about gun versus gang violence. What work have you done in violence prevention and why should the city take your advice?

The great case study is Bill Bratton’s “Turnaround.” Bratton was the police chief in New York City with Giuliani, and then he went on to Los Angeles. Giuliani’s book “Leadership” captures a good bit of this and there’s a guy named Dennis Smith, at NYU who has studied the application of metrics to public policy.

It’s an objective fact that New York City is radically safer today than New York City was 25 years ago. It’s a pretty clear fact that there’s a pattern that works. It’s essentially policing to preempt rather than policing to follow up. Why hasn’t Chicago simply brought in someone like Bratton as an advisor? He took the same model and applied it in Los Angeles. I think you would reduce the number of murders dramatically. I think murder is down over 75 percent in New York from the pre-Giuliani era. Bloomberg told me one time that Staten Island is so safe, that it is statistically off the charts for communities its size. There are almost no murders.

Your previous views on climate change were once at odds with those of the Republican majority. Climate change has become such a politically charged issue, what path, if any, should be taken going forward?

My view is that we actually don’t know. The so-called scientific consensus is comparable to the consensus that the sun goes around the Earth, which disappeared with Copernicus. I am a student of paleontology, and what we do know is that the Earth’s temperature has changed very dramatically over time – even in the last 11,000 years.

My instinct is to say two things to people who are fanatics over climate change. The first is: tell me what the right climate is. What should the correct temperature be? Because, the fact is they don’t have a correct temperature, they just know that now is the correct temperature. For example, there are people who talk about the “great storm in the northeast” this year; well, the greatest blizzard in Northeastern history is 1888. Now it was almost certainly not caused by carbon. It was just an enormous blizzard. So you start with, how certain are you that you know a pattern? The very same scientists told you in the ’70s that we’re on the edge of a real ice age. Second, the odds are pretty good that we are on the edge of a real ice age, but it’s probably 1,000 years off. But we’re clearly at the late phase of the interglacial if you just look at the numbers. Somebody once pointed out, global warming may slow down the ice age by about a century, but it won’t slow it down more than that if there’s an ice age coming. And ice ages come really fast and are much more terrifying than warming, because this all ends up covered by a glacier.

The other point I’d make to people is, if you thought it was a serious problem, why is no one willing to talk about adaptation rather than prevention? Prevention is extraordinarily expensive and requires enormous government-centered decisions. Adaptation is dramatically cheaper. The example I’ll give is, to the best of my knowledge, when the Dutch began building breaks there was no Al Gore available to say, “What you need to do is lower the ocean.” But prevention of Dutch flooding by lowering the ocean would be the equivalent of the current talk.

I find this is a topic about which it is almost impossible to have a rational conversation. The deniers won’t be rational, and the people who believe it won’t be rational, they both just stand there chanting their slogans.

Is there a Cap and Trade policy that could get a political foothold?

I’d be very surprised. Part of the reason is – it’s truly ironic – nobody in the wealthy liberal wing is willing to look at the cost to the very poor and policies that inherently make energy more expensive. Which is why I think adaptation is probably a dramatically easier, more humane strategy. And to say okay, let’s assume a worst case: what would you actually have to do? What would it cost to build better sea walls in New York?

Can you talk a little bit about how academia – how the literature – should fit into those discussions, and into the formation of public policy?

It requires people who are ready to break with the norm. Einstein said quite explicitly, that if he had gotten a job, he would’ve never developed the theory of relativity because the social pressure of being normal would have cut off that avenue of thinking. Because he was so isolated as a patent clerk, he really couldn’t get hired, he had the luxury of thinking, with no one to correct him. One of our challenges is going to be, how do you knit together deviant personalities who are prepared to stand up and say, “I have a new idea and I’m willing to approach this in a new way”?

If you were in the Speaker’s chair today, how would you manage the dynamics between the two parties? How would you approach policy in the chambers right now?

I would do four things. I would reach out to House Democrats. Something I’ve actually helped launch was with the black caucus agreeing to swap districts with the Republicans and spend time with each other in their districts, which I think could be very helpful.

Second, I would look for Democratic bills that shared our values and I’d pass them. So we’d have a deliberate passing of bipartisan bills.

Third, I would go through, for example – and we’re doing this for one of my newsletters – I’d go through the State of the Union and I would pick all the things Obama said that we could agree on enough to start down that road. There are a lot of things ­– at least seven or eight things out of the State of the Union – that begin to be a conversation.

And fourth, I would slow the dialogue with the administration down and make it quietly very painful for them. And say look, if you want to deal with us as a serious part of the constitutional process, fine. We’ll sit and talk. I went 35 days negotiating with Clinton. But we did that after we closed the government twice, because then we had his attention. No Speaker of the House can match a President in a one-on-one fight in the media. But what you do have is the enormous power of the purse, to not give him money. And you can say, “Look, you’re not going to have any money. If you want some money, let’s talk. Call when you need money.” That’s what the Magna Carta was all about.

Predictions for 2016?

No idea.

Feature Photo & Headshot: Harris School of Public Policy Communications Office

is the Z. Smith Reynolds Professor of Public Policy Studies and Professor of Economics and Law at the Sanford School of Public Policy at Duke University. He is also the Director of the Center for the Study of Philanthropy and Voluntarism and a Research Associate at the National Bureau of Economic Research. He is the author of several books, most recently

What has led to the transition of college athletics into big-time, revenue building sports entities?

It has actually been this way for 80 or 90 years. You look at some of the crowds for football games—even at your institution, the University of Chicago—you can probably go back to 1905 or 1912. There is more money today. That’s really the big change. College sports were really big back when Michigan was playing the University of Chicago. There is a national report about college athletics published in 1929 by the Carnegie Foundation. It documents everything going on today, except the money. They didn’t have TV. That is probably the single biggest contributor.

Give us a sense of the abuses committed by universities in the realm of big-time sports.

They range from quiet compromises in academics to outright cheating. They go across the board. Most universities don’t appear to cheat. All universities that have commercial sports under their umbrella compromise their academic standards.

What else happens?

Some of these cheating scandals have come up at our neighboring institution, the University of North Carolina at Chapel Hill. Football and basketball players were not only taking easy courses, which is something that you see often, but they were also getting more help than the rules permit. Some of these courses were sham courses. You don’t really want to see that anywhere.

Reform groups defend big-time sports by saying that these universities are too weak to resist commercialism. Why might this be true?

I don’t think they are so weak. I believe universities are fine with what is going on now. It is more important that they claim to do well in sports. That’s the reason they don’t stop doing it. These are smart institutions. They have plenty of muscle.

The University of Chicago is what I call the exception that proves the rule. It is very rare for an American university with big-time sports to step back and not do it in an all-out way. Really, only two universities that were big in 1920 and stayed national universities other than the Ivy League schools were Washington University in St. Louis and the University of Chicago. Seven of the current Ivy League schools were also in the top 100 football powers in 1920. They joined the Ivy League, and they then took a step back.

You have said that reforming college athletics would need to begin in the trustees’ boardrooms. What might be accomplished here to address abuses?

In the boardroom, anything is possible. One thing that a board might decide is that we don’t want to have athletic scholarships and we want to only have scholarships that are based on merit—something like the University of Chicago these days. That could be done. It could be done at the next trustee meeting. Pretty much all things are possible, except the trustees can’t decide to have a national championship. That takes a lot of work and money. Trustees usually meet four times per year, so they have four chances to decide to get out of this business. But they don’t do it.

In 1939, the President of the University of Chicago, Robert Hutchins, succeeded in getting the board of trustees to drop out of what was then the equivalent of the Big Ten Conference and stop playing big-time sports. Even though he was making this point in national publications, he was not able to garner support from trustees until the football team had some bad seasons. During the 1939 season, I believe they were shut out by one team 85 to nothing; another outing was 50 to nothing. They were beaten by Michigan. They were beaten by Virginia. Just look at Chicago’s 1939 season record. That will make your eyes water.

So the conditions were ripe for the board to honor Hutchins’ suggestion.  

Right, there need to be two conditions for change. The first is a college president who makes it clear that he does not like sports, but that does not happen these days. That kind of thing will get you fired. The second is a team that is doing horribly. Those are the perfect conditions for getting rid of abuses.

NCAA by-laws stipulate that student athletes may not receive compensation, even though schools benefit enormously from what these student athletes do on the basketball court or football field. Why is this an issue?

Researchers have estimated the marginal revenue product of an additional player on your football team who is going to eventually be drafted by the NFL. For each of those, it is a half-million dollars. In basketball, the number is $1.6 million. That is what the university gets by having just one more of these star recruits. Now look at what the student athletes get. There is going to be an inequality in the middle of those two numbers.

Some folks would say that not paying student athletes preserves the amateur status of college sports.

One of the points that Taylor Branch has made in The Atlantic on “The Shame of College Sports” is that amateur status is not something you foist onto people. I think that is a nice way of putting it. You are not giving these student athletes a choice. In tennis or golf, you can choose to be an amateur or a professional. But making them have no choice but to be an amateur is not the same thing.

Photo credit: Archival Photographic Files, apf4-00661, Special Collections Research Center, University of Chicago Library

Steven C. LaTourette, McDonald Hopkins Government Strategies

Steven C. LaTourette served as the 19th and then 14th district of Ohio’s US Representative from 1994-2013, where he served on the House Appropriations Committee, among others. Currently, Mr. LaTourette is a fellow at the University of Chicago’s Institute of Politics and is the President of the recently created McDonald Hopkins Government Strategies, a lobbying and government relations firm in Washington DC. Prior to his time in office, Mr. LaTourette served as Lake County Prosecutor for seven years. He studied at the University of Michigan and the Cleveland Marshall School of Law.

This week, David Levine speaks with former US Representative Steve LaTourette on what he accomplished during his two decades in Congress, his new opportunities outside of the Capitol, and how polarization in Washington and the growing debt go hand in hand.

This podcast was produced by Claire O’Hanlon and David Levine.

Feature photo: cc/Kay Gaensler

Patrick Meier, Computing Research Institute

Patrick Meier is an expert on the application of new technologies to crisis earlywarning, humanitarian response and resilience. He currently serves as Director of Social Innovation at the Qatar Foundations’ Computing Research Institute and blogs at www.iRevolution.net. He co-founded the Harvard Humanitarian Initiative’s Program on Crisis Mapping and Early Warning, CrisisMappers, Digital Humanitarians, and the award-winning Standby Task Force. He served as Director of Crisis Mapping at Ushahidi and has consulted extensively for many international organizations and programs. He received his PhD from the Fletcher School.

While a fast and comprehensive means of reporting breaking news, social media brings with it the risk of misreporting, which in some cases can be quite dangerous, as with Reddit’s misidentification of the Boston bombing culprit. How can authorities determine what’s credible? What is the relationship between law enforcement and social media?

So the first thing to keep in mind is that the need to verify information is not new: 911 is a crowdsourcing system. And just because some people either misdial the number or play a hoax and abuse the system does not mean that the system itself is not useful.

In the UK, only 25 percent of 999 calls are actually relevant. But the system is still very important because of that 25 percent for whom it will make a difference between life and death. So it is a question of how you manage this as best as possible, even with current traditional systems.

One issue is whether you can apply some of the legal issues around current traditional systems to social media. It is illegal to make hoax calls to 911. There is no reason why that shouldn’t happen in the case of Twitter as well. Not for everything you tweet, obviously, but if you are tweeting at the Boston Police with information, and they have solicited that information, then the same law should apply.

The London Fire Brigade, in December, publicly announced that they would add Twitter as a communication channel for people to report fires, and what’s really interesting about that is that London was also the first in the world to set up the emergency phone number. And now, 80 plus years later, you have the London Fire Brigade saying it’s time to upgrade the system and allow people to report via Twitter. In the US, we are also seeing a move to using mobile technology. In fact, people will be able to report by SMS to 911 by 2014. So this move to mobile technology is new, but the crowd-sourcing is not new.

Part of the problem is the sheer amount of data and the small proportion of it that is actually relevant. How can the process be managed in order to pull out the relevant and accurate parts?

Long story short, the technologies needed to determine relevance already exist, but they’re usually highly proprietary. It is very expensive to obtain licenses, and they are usually really complicated to use. What we at the Qatar Computing Research Institute want to do is make this technology free, open sourced, and easy to use.

One of my favorite quotes by William Gibson is, “The future is already here, it’s just not evenly distributed yet.” We know a big data solution is possible and now it’s about democratizing access to those technologies so that end users in the field can also make use of this technology in order to understand what’s happening around them, and hopefully to make better decisions.

One of the projects we’re working on to do this kind of verification is trying to crowdsource critical thinking during crises on social media. We need to find a way to crowdsource more critical thinking during disasters so that people think twice before tweeting. One way we’re doing this is by developing a platform called Verily, with some colleagues at the Masdar Institute, based on the red balloon DARPA challenge. We think that if you can do that for an entire country, surely you can do that in a far more geographically bounded area like Boston, where the social networks are even more interwoven so that the degrees of separation between individuals is very small.

We see more and more from disaster to disaster that there are these, what I call good digital Samaritans, who take it upon themselves to try and verify content. We saw three or four main individuals during Hurricane Sandy doing that, but they did this on their own and completely disconnected. What if instead of these individuals, we could open it up to the crowd and provide a platform that rationalizes the collection of evidence for and against a particular rumor? We systematize it, and we try and design the interaction with the platform in order to lend some more rigorous thinking about the kind of content.

It is almost an educational platform at the same time as it is a platform for time-critical crowdsourcing of evidence. The way that the platform would be triggered is by a verification request. Somebody who has heard about something or has a question would pose a verification request in the form of a yes or no question, such as “has this bridge been destroyed due to the earthquake”, and then they invite their social network to post any evidence that they might have.

The idea is that for any piece of content that somebody posts, you are invited to add a few sentences to describe why they might think it might be authentic or why they think it might not be, and then crowdsource to do this.

Private companies and individuals have been the primary users of this technology in crises, informing people about evacuation routes, medical assistance, etc. Should this timely dissemination of information be the government’s responsibility or is it best left to the “crowd”?

Can you stop the crowd from tweeting what they want? I think that you are best off assuming the crowd will continue sharing content, and what we need to do is find a way to encourage responsible sharing during disasters.

Before the bombings in Boston, the number of Boston Police Department followers was around 30 or 40 thousand. I checked again a couple days ago and there were a quarter of a million. There’s clearly a lot of interest for information from a trusted source. That has always been the case, but now there are different communication channels that one can use in order to obtain that information.

The Boston Police Force was also very on top of things in terms of regularly sharing information through social media channels to support their own efforts. I think it’s not necessarily an either/or; I think you want both of them to learn how to better use these technologies systems, to use better strategies to encourage more responsible use of social media during disasters.

How do you think we’ll be employing technology and social media in crisis management in the future, say, 15 years from now?

I don’t even know a year from now! One of my overarching goals is to try and build more resilient communities through the use of global technologies and social media. By resilience I mean the capacity for self-organization. We know that in disasters, the real first responders are the disaster-affected communities themselves. I want to find a way to empower the crowd to help itself during these disasters, get out of harm’s way, and mitigate the impact of the disaster. I hope that technology will go into the hands of those on the streets in the next year or two so that they are more empowered to survive a crisis.

In the future, I think there will be real-time content, real-time information, and real-time analysis specifically catered to where you are. We already have a “check in” system on social media. What about emergency “check-in”? When you check in, you would get highly customized information to you such as your medical history, where you live, and more.

How can government agencies or humanitarian responders better use social media and technology in emergency situations? Does public policy in its current form impede or promote innovation in this field?

I think what usually happens is that policy and regulation lag far behind innovation. That will probably always be the case, but we do need to update our policy to catch up with today’s world. There is a hugely important role for policy here to make better use of social media during disasters. We need to enlighten leadership to fully grasp the potential of these new technologies.

There is a very strong and important role for policy to educate the public. At schools, students are taught to duck and cover in case of an earthquake. Now we need to know how to tweet in case of an earthquake. There’s a responsibility that comes with tweeting during a crisis, and people need to understand what’s appropriate to tweet, what’s not appropriate to tweet, and especially what’s not appropriate to re-tweet. That all has to become part of our educational system moving forward.

We also need to look at what other countries are doing with respect to disasters and social media. I already mentioned the London Fire Brigade using Twitter. Another example is the Philippines. During the typhoon in the Philippines last December the government actually used Twitter and even suggested hashtags for people to use. Now that is brilliant. That is the kind of enlightened leadership that we need.

Another policy that I think is particularly enlightened is in Australia. The police in Queensland set up a hashtag called “mythbusters” in order to manage and respond to rumors. Every time they came up with a false piece of information or rumor, they would tweet that information out with the hashtag mythbusters. Then if people had any questions about a tweet that they saw, they could go to the hashtag and see if the police have mentioned it as a rumor.

There are some very clever ways that we have seen disaster and emergency services use technology, from the UK to the Philippines to Australia. It then becomes a matter of taking these really interesting innovations and turning them into standard operating procedures in the US.

Feature Photo: cc/gailjadehamilton

Jennifer Sullivan, Enroll America

Jennifer Sullivan is the Director of the Best Practices Institute at Enroll America, a nonprofit, nonpartisan organization whose mission is to ensure that all Americans are enrolled in and retain health coverage. The Best Practices Institute identifies, develops, and disseminates information on policies that will promote American enrollment in health coverage. Prior to joining Enroll America, Ms. Sullivan was a Project Officer in the Division of Children’s Health Insurance Programs (CHIP) at the Centers for Medicare and Medicaid Services, where her work focused on crafting CHIP eligibility regulations for the Affordable Care Act. Ms. Sullivan holds an M.H.S. in Health Policy from the Johns Hopkins Bloomberg School of Public Health and a B.A. in Sociology from Kalamazoo College.

The recent national survey that Enroll America conducted with Lake Research Partners outlines the difficulties ahead in convincing people of the affordable and high-quality health insurance options available for them through the Affordable Care Act. Did any of the survey results surprise you?

We had seen similar surveys completed before our survey was fielded that suggested a real public knowledge gap in terms of the new coverage that is coming, so I wouldn’t say that it was necessarily surprising to us. I think there were a lot of things in the survey that were comforting to know.

I would say the first is that the vast majority of the folks we surveyed recognize the value of health insurance. And they wanted it. If you think about our campaign as a marketing campaign, people want our product. That is a huge positive step in the right direction; you might not know it’s available or how to buy it, and you might want help learning how to buy it, but you want the product. And that is a tremendous hurdle we have overcome that we otherwise would have really struggled with.

The last thing was how much we could move the dial about the affordability of coverage when we did not talk about how much the coverage would cost out of pocket for somebody. We instead gave them the cost of coverage in the exchange as compared to the amount per month if there was no exchange. When you compare it with what they would have been faced with in the private market absent the health insurance exchange and premium tax credits, you really were able to significantly increase the percentage of respondents who thought that coverage was now affordable. This is key because affordability is the number one barrier they have encountered when trying to get health insurance in the past.

As you explain to the general public (or advise others in their attempts to educate the general public) about the pending changes, what are the key messages you are trying to convey?

I think the overarching message is extremely simple: there is new coverage available and there is help with the cost of it. When we try to dig deeper to lure folks in and get them interested in and intrigued to apply, the four messages are:

• All insurance plans will have to cover doctor visits, hospitalization, maternity care, emergency room care, and prescriptions.
• If you have a preexisting condition, insurance plans cannot deny coverage.
• You might be able to get financial help to pay for a plan.
• All insurance plans will have to show the cost and what’s covered in simple language and no fine print.

From the survey, we saw that 89 percent of the population, regardless of geography, income, race/ethnicity, educational background, and gender, hears the most important motivator to them from one of these four messages.

How do you employ family and friends in the outreach strategies you recommend to other groups? Furthermore, how is Enroll America utilizing this group in the large campaign you announced in January?

We are very much still in the creative process of figuring out how the campaign is going to look, but you can check out a preview at our newly launched campaign website, Get Covered America. When we look at the research results, people do want to hear from a family member. So there are different ways for us to think about what that means for the campaign. Does that mean that the voice in the advertisement or article is somebody that is a relatable family member? Or do we make sure that we cast a wide net and communicate with as many people and members of the community as possible?

Although there is a question about who the messenger should be, when we ask people in the survey where they are going to go for information, most folks say online. So even though they might want to hear about it from a family member or partner, when it actually comes to taking that step, they are probably going to go online.

Which items on Enroll America’s checklist, Seven Things to Do in 2012 to Keep Enrollment Progress on Track, have been most difficult for states to carry out?

We created the list with the idea of helping every stakeholder that might have a place in the outreach effort. For example, there are roles for state agencies, hospitals, health educators, and consumer advocates. Hopefully they can see themselves in that list somewhere.

When I think about which one is the most challenging to execute, it is probably the auto-enrollment piece for Medicaid and the Children’s Health Insurance Program (CHIP) because that usually requires legislative authority. The authority is not just from the state legislative level, but possibly also at the federal level, depending on what a state wants to do.

The federal government has been very supportive of  novel approaches to this, but there are still a lot of hoops to jump through to make auto-enrollment something that a state can actually do. Auto-enrollment is on the list is because it is such a powerful tool: it could possibly connect the largest volume of folks to coverage. It allows you to potentially reach thousands of people if every parent of a child already on Medicaid or CHIP should automatically be connected to the coverage option that is available and suits them.

Are there any elements on the checklist you feel have not been given adequate attention? Are there any low hanging fruit of which stakeholders should be aware?

First, we recently submitted a round of comments to the federal government on the model, streamlined application they are creating for every state. The idea with this new application is that your family or the household fills out one application and then everybody in the household gets connected to the coverage programs for which they are eligible.

The federal government has done a good job with their model application, but of course there is always room for improvement. We have encouraged them to do as much usability testing as possible because it is one of the best ways to catch problems and correct them.

We are also making sure there is as much collaboration as possible. We have tried to convene large and inclusive groups of stakeholders at the national level and in a number of states, but there are always groups that are late to the table. All of these perspectives, whether it’s consumer groups, tax preparers, hospitals, health centers, health insurance companies, pharmaceutical companies, or drug stores, are relevant. If the messages aren’t consistent or if the referrals don’t work, consumers could get lost in the system and fail to enroll. We know that bad news travels much more quickly than good news. If somebody has a problem with the process, they are going to go tell ten friends. But it might take ten successful processes for one person to tell one friend that it went well.

In terms of more general challenges, we also cannot overestimate the need for assistance. As simple as the new process will be, people are still going to need a lot of help. They think they are going to need help, they expect it, and they are going to be looking for help enrolling. Making sure that states and the federal government are able to leverage enough resources to get enough really well-trained folks on the ground and be able to provide that assistance is one of our number one challenges right now. Thinking about the role for private philanthropies and funding, outreach efforts, and training actual on the ground assistors is really important because I think we are going to need a lot of private efforts to augment what the states and federal government are going to be able to do.

Feature Photo: cc/Luca Rossato

Kei Koizumi, White House Office of Science and Technology Policy

Kei Koizumi is the Assistant Director for Federal Research and Development at the White House Office of Science and Technology Policy (OSTP). Prior to joining OSTP, Koizumi was on the Obama transition team’s Technology, Innovation & Government Reform Policy Working Group, before which he was the longtime Director of the R&D Budget and Policy Program at the American Association for the Advancement of Science (AAAS). He received his Masters in International Science and Technology Policy from George Washington University and his Bachelors in Comparative Political Economy from Boston University.

The US R&D system is decentralized relative to many other countries, with many different agencies funding R&D. Within that context, how do you coordinate priorities for R&D funding? What are the highest priority funding areas for science and technology?

You’re right that the United States has a highly decentralized R&D funding system. We don’t have a Department of Science, instead we have two dozen departments and agencies supporting R&D because they need science and technology to carry out their missions.

But there are several science and technology areas that cut across agency missions and have broad benefits for meeting the nation’s challenges. We want to be sure that, as a nation, we support the funding areas that have great promise for meeting multiple agencies’ needs. These priority areas do change from year to year, because of changing scientific and technical opportunities, changing economic conditions, and changing national political priorities.

To identify these priority areas, my office (OSTP) collaborates with the Office of Management and Budget annually on an interagency R&D priorities memo that identifies key interagency science and technology (S&T) priorities for the coming year.

The latest memo, released June 2012, is available on the White House web site and identifies the following highest priority funding areas: advanced manufacturing; clean energy; global climate change; R&D for informed policymaking and management; information technology R&D; nanotechnology; biological innovation; STEM (Science, Technology, Engineering, and Mathematics) education; and innovation and commercialization. The memo explains in more detail what the opportunities are in each of these areas.

OSTP has minimal budget power relative to similar agencies in other countries. What mechanisms does the OSTP have to promote the President’s R&D agenda?

It’s true that OSTP has minimal budget power. OSTP itself doesn’t fund research, we’re a policy office with a small budget of less than $5 million. But we do advise the President, senior White House officials, and other White House offices (including the Office of Management and Budget) on how the Federal R&D funding agencies might best promote the President’s R&D agenda, and we try to formulate and implement R&D funding policies across the Federal government.

OSTP also has the convening power to bring the Federal agencies together to implement the R&D agenda. We rely heavily on informal conversations inside the Federal government, but we also rely on policy documents such as the R&D priorities memo, interagency reports on science and technology, engagement with the US science and engineering community and the broader public to build support for R&D funding policies, and expert advice from the science and engineering community.

What countries have good models for funding science and technology? How much does the OSTP look at how other countries allocate R&D funding?

OSTP does look at how other countries allocate R&D funding for lessons, but we find that in most cases the unique character of the US system means we have to craft our own models. That said, time and time again we find that the US has been and continues to be the model for other nations in S&T funding.

The US S&T funding system is built on competitively-awarded research grants distributed to investigators with the best ideas identified through peer review, and this system has helped to build US leadership in science. That competitive model is a US invention that is now being copied around the world, from the European Union to Japan to China. The US funding system is also diverse enough and flexible enough to take in Federal labs, industry labs, universities, national labs (contractor-operated labs), and nonprofits with many links between them, including steady flows of talented people.

The result is a system in which bright ideas make the transition from the laboratory to the marketplace more smoothly and quickly than other nations; other nations are trying to learn from US technology transfer policies and other policies that make this system possible.

I’ll also add that US universities are the world-leading institutions for combining research, education, and economic development because of US S&T funding policies encouraging a tight linkage between research and education; other nations are trying to learn from these policies. But we are always trying to learn, too! For example, you may have noticed that in his recent State of the Union address the President commended Germany for its education system, which does an excellent job of preparing high-school graduates for technical careers. So the Federal government is working with high schools, community colleges, and companies to figure out what the right Federal policies are for US high school students to have similar skills when they graduate.

Amid federal budget cuts, how do you determine what areas of S&T research get funded and which get cut? How can you be sure funding is being spent effectively?  

These are always very difficult decisions. When resources are scarce, as they are now and are likely to be in the future, we try to rely first on the science and technology community’s judgments about the most important research areas.

The Federal government periodically asks the science community, through the National Academy of Sciences, to tell policymakers what the most important scientific opportunities are in a field and to rank science projects by importance. These reports, which we call decadal surveys, are important guides for policymakers because they give us the science community’s best judgment as to which areas or projects to cut first and which investments to protect when budgets are tight. There are many other similar prioritization exercises undertaken by the community through scientific advisory boards, the National Science Board, and other groups of scientists and engineers.

Once research projects are underway, we rely on many mechanisms for tracking progress. Federal agencies and their Inspectors General keep an eye on spending efficiency, to make sure that Federal research funds are being spent appropriately and efficiently. But there are many other ways in which we try to ensure that Federal research projects are making progress toward science and policy outcomes.

Just to give a few examples, OSTP asks the President’s Council of Advisors on Science and Technology (PCAST), a group of Presidentially-appointed scientists and engineers, to review periodically our nanotechnology and our IT research programs to make sure that they continue to answer the right scientific questions and that they make progress toward solving problems. Federal agencies have put in place scientific advisory boards for their programs; they meet periodically to look at research portfolios to judge how well they are meeting scientific and policy goals, and they often recommend changes in research funding and policies to improve their performance.

We, PCAST, and advisory boards rely on data that Federal agencies collect about their research programs, everything from scientists supported to papers published to new inventions and companies created. And we look at the scientific literature within a field and studies about a field to ensure that the US research effort is world-leading and productive. If the US effort is not what it could be then we can work with Federal agencies to try to improve performance through follow-up policies.

Feature Photo: cc/estherase

Dr. Rachel Johnston, Chapin Hall

Dr. Rachel Johnston directs the Violence Inquest for Solutions and Alliance (VISA) project at Chapin Hall at the University of Chicago. Dr. Johnston conducts research on law enforcement policy, the prevention of violence, and surveillance. She holds a Ph.D. from the University of Illinois at Chicago Department of Criminology, Law, and Justice, as well as a master’s degree from the UIC College of Urban Planning and Policy and a bachelor’s degree from Cornell College.

Are we about to see a change in our nation’s gun violence policies? Is this national debate relevant to Chicago, or are there different issues at stake for Chicago communities and families?

Gun policy matters—think about smoking with regard to advertising or on television. The way smoking is perceived in our culture now is much different than it was 25 years ago. It takes time to make cultural changes. Many people are anxious for a change in gun violence rates, which can be perilous because people get disheartened when they want something to change immediately and it does not. Change will have to be achieved by slowly chipping away at violence from many, many different angles. It is very complicated, and although no one wants it to be a long, slow process, it is.

The national debate is certainly relevant to Chicago. There are many things that could be done on the national level that would have an impact on Chicago (many of President Obama’s gun violence prevention proposals, for example). I certainly hope we are at a tipping point with regard to gun policy, but I cannot say that I believe that is the case. It is a very complicated issue and there is very little common ground between opposing perspectives. There is so much fear on both sides of the debate. It is a highly emotional issue that seems to prevent sensible, realistic, and rational debate. There has been a lot of digging in of the heels and unrealistic demands.

In addition to the tragedy of losing a loved one, what are some of the effects that gun violence has on children and families? What, if anything, can policy do to mitigate those effects?

There is a lot of research on the effects of exposure to violence, especially on children. There is evidence that violence in the community can compromise feelings of safety and security, leading to emotional scars or even PTSD, higher levels of anger and aggression, sleep disruptions, or withdrawal. In children, these effects can impact brain development and create additional problems. Exposure to violence can lead young people to believe that they must arm themselves, increasing the opportunities for violence, as does desensitization to violence.

Public policy is simply about targeting resources. Changes in policy can impact public safety by creating an environment that fosters and supports healthy individuals and communities. For example, policies that implement screening at the court level can divert individuals from the criminal system into mental health or substance abuse treatment. Education policy can create programming to teach young people how to experience conflict and develop a non-violent response. Employment policies can create opportunities for individuals who are returning to communities from incarceration and thus impact recidivism. Policy can direct resources into any number of areas that can positively impact individuals, communities, and public safety.

The Violence Inquest for Solutions and Alliance (VISA) program strives to increase collaboration among the agencies that provide support to at-risk youth in Chicago. How will this collaboration reduce incidences of violence? What are the challenges or barriers to coordinating service among these different agencies?

It is no secret that there are inefficiencies in service delivery between public agencies. Public agencies provide services to young people without knowing how other agencies are working with those individuals. Coordination means that services can be much more comprehensive (such as one referral to counseling rather than separate referrals to different providers from multiple agencies) and monitoring can be more efficient (such as a single point of contact rather than multiple individuals who do not know about the others).

What kind of data will the VISA program collect? How will analyzing that data lead to improved policies?

Currently, anonymous reviews of fatal and non-fatal shooting incidents involving school-aged people are conducted monthly. Data are not recorded about the specific events. Rather, practitioners and policy experts are presented with details about the individuals involved (their criminal histories, school involvement, etc.) with an ear for identifying the opportunities that exist to enhance collaboration, coordination, or communication among public agencies. The core belief is that individuals who are involved with one public agency often have multiple “touch points” across public agencies. The group asks, “What changes would have had to occur to have potentially changed the outcome in these cases?” Often, the answer is that public agencies should do a better job of communicating about individuals and coordinating services. We are looking to turn those opportunities into policy recommendations.

It is our intention, after we secure the appropriate data sharing agreements, to link records about individuals across agencies to understand how individuals who are involved in shootings interact with governmental agencies. We also want to use the information to develop a more detailed picture of the context and characteristics of fatal and non-fatal shootings among youth in Chicago.

What sorts of simultaneous programs or policies are needed in order to make VISA effective?

Data sharing is the biggest issue we are addressing right now. There are existing guidelines—like the Family Educational Rights and Privacy Act, the Illinois Juvenile Court Act, internal policy, etc.—that must be reviewed and discussed in order to ensure the protection of juveniles’ information while allowing agencies to collaborate and operate more efficiently. I believe that improving information sharing will go a long way toward improving outcomes for individuals, and I also believe that once that piece has been sorted out, we can go much deeper into uncovering other opportunities to impact public safety.

Feature Photo: cc/wakalani

Richard M. Daley

 Richard M. Daley recently finished his tenure as the longest-serving mayor of Chicago, Illinois. Serving from 1989 to 2011, he earned an international reputation as a leader in urban development, fiscal policy, and government stewardship. Currently, he is engaged in a variety of projects, including as a Distinguished Senior Fellow at the University of Chicago’s Harris School of Public Policy and as chair of the new “Global Cities Initiative.”  The Initiative is a joint project of JP Morgan Chase and the Brookings Institution that aims to help cities identify and leverage their greatest economic development resources.

This week, Julie Cooper speaks with former Chicago Mayor Richard M. Daley about his partnership with the University of Chicago and the City of Gary, Indiana. Mayor Daley shares his perspectives on how to solve urban issues and how to build vibrant cities.

Special thanks to Carol Brown and Marnie Van Der Voort.

This podcast was produced by Julie Cooper.

Feature photo: cc/Payton Chung

Joel Benenson, Benenson Strategy Group

Joel Benenson is a Founding Partner and President of Benenson Strategy Group. He was Chief Pollster and a Senior Strategist on both of President Obama’s presidential campaigns. He has also done polling for a diverse range of organizations, from AARP and Clean Energy Works to ESPN and Paramount.

As we move out of the most recent presidential election cycle and begin President Obama’s second term, how does your job transition from the campaign to the White House?

When you’re in a campaign, there are a lot more moving strategic pieces. You have one Election Day and your job is to get to 51 percent of the vote. When you’re working for an office holder, on the other hand, your focus becomes whatever their focus is. I’ll never tell anybody what position to take on an issue; that’s their decision. My job as the pollster is to tell them how to persuade the greatest number of people to their side of the argument. I always tell anyone I work for that from the time they hire me.

Whether you’re debating immigration or tax policy, deficits or gun control issues, you have to have a clear argument. You need to find the most persuasive argument you can make to get the greatest number of people to agree with you. So it becomes – I don’t want to say a little less proactive because that’s not really true – it’s just proactive in a different way. You have different goals and you change how you define winning changes. You’re not focused on 51 percent on Election Day anymore. Outside a campaign, winning is ultimately about persuading the greatest number of people to your side of a given argument.

Does your polling work play a big role in the president’s major speeches, like the State of the Union for instance?

I rarely talk about specific processes, but typically my work is less focused around a specific speech and more around a set of topics that are going to be the issues of the day being debated in Washington. The messaging work we do is to make sure that the president is using his most persuasive argument. He has any number of reasons why he’s supporting something. Whatever issue you poll, whether it’s early childhood education or raising the minimum wage, he has reasons why he’s doing it. He needs to know what the strongest argument he could be making is. Knowing that is valuable.

You recently received a great deal of publicity surrounding a climate change poll you did for the League of Conservation Voters. The president also emphasized climate change in his State of the Union address. Did those results prompt the president to emphasize climate change in his speech, or did they just strengthen a point he already planned to make?

No, the report certainly didn’t drive it. It was not related to the president’s decision to emphasize climate change in the speech. There may have been a common interest, but climate change and energy are issues that the president has been talking about for a long time; this period in 2013 is not the first time he’s addressed it. Climate change is an issue for which he has well-formed views and for which he has been making persuasive arguments.

Obviously the fight isn’t over yet. We’ll continue to, if asked, work to keep strengthening the argument for climate change legislation. The League of Conservation Voters had its own reasons to examine public opinion on climate change. They’ve got a constituent desire to create a sense of urgency around this issue, and their messaging serves that purpose well.

Just after the Newtown, Connecticut shootings, national support for changes to gun control laws seemed to gain traction. However, public outcry seems to have died down in the months since. Do you believe the tragedy caused a temporary shift in public opinion, or do you see the potential for a more permanent change in national attitudes about guns?

I don’t think the issue is dying down; I think people are asking some of the wrong questions in polls. I think there is a misperception on the part of a lot of American voters about what a lot of the current gun control laws actually say and do, and how the proposals being suggested would actually change gun policy. There’s broad support for what the President has put on the table. However, there’s also confusion; a lot of people in America actually believe that we already have laws that require background checks on every gun sale, and the fact is we don’t. So I don’t think the support for those reforms has ebbed at all. I think the support is pretty palpable, but people are unsure how to direct that support. Furthermore, the issue of the day can change rapidly, for instance – as the president mentioned in his speech – we’re certainly going to be headed toward another big fiscal and budgetary debate in a matter of weeks, so some of the debate will shift to that.

Do your polls tend to focus more on the policy angle or the political angle of specific issues?

Both. You have to understand what is beneath the surface that is shaping the opinions, beliefs, and attitudes of the American voters in order to persuade them. So you have to consider both policy and politics; you have to look at it through the voter’s prism, from their perspective, to understand them. You’re not going to persuade them if you’re not addressing what they’re bringing to the table. So you poll with both in mind, and try not only to take the public’s temperature, but to really understand their opinions on some deeper level. You can do that by asking meaningful questions and trying to quantify the answers, but you have to be sure that what you learned qualitatively is backed by accurate data analysis. Your most persuasive arguments should be well informed by that.

Feature photo: cc/Rhodes

Dr. Lainie Ross, MacLean Center for Clinical Medical Ethics

Dr. Lainie Ross is the Associate Director of the MacLean Center for Medical Ethics at the University of Chicago. She is also the Carolyn and Matthew Bucksbaum Professor of Clinical Ethics, the Co-Director of the Institute for Translational Medicine, and a practicing clinician and professor in the Departments of Pediatrics, Medicine, and Surgery. She serves on the Department of Health and Human Services’ Secretary Advisory Committee on Human Research Protection (SACHRP) and as the chair of the American Academy of Pediatrics Section on Bioethics Executive Committee. She previously served on the ethics committee for the United Network for Organ Sharing (UNOS). Dr. Ross has both her MD and PhD in Philosophy. Some of her work in the field of medical ethics aims to ensure the equity of the kidney allocation system.

In your U.S. News & World Report op-ed, “New Kidney Allocation Proposal is Ethically Unacceptable,” you assert that the Kidney Committee’s 20/80 proposal is unethical. Could you tell our readers why you’ve taken this stance?

Since that article was published, the Kidney Transplantation Committee’s proposal has been modified but is, nonetheless, still unethical. The original proposal aimed to classify the top 20 percent of deceased donor kidneys as the best kidneys, and match these kidneys to the top 20 percent of candidates. They were going to use an age-matching program for the other 80 percent of kidneys and candidates.

Their newer proposal still includes the component that the top 20 percent of kidneys will go to the top 20 percent of candidates. However, in this newer proposal, the other 80 percent of patients will receive kidneys based on a revised “point system.”

The first ethical problem regards their measurements. How do you distinguish the top 20 percent of candidates and the top 20 percent of kidneys? A 19.5 percent kidney looks a lot like a 20.5 percent kidney. In fact, a 19.5 percent kidney looks a lot like a 30 percent kidney.

A kidney’s “ranking” is determined by KDPI (kidney donor profile index). The accuracy of the KDPI in distinguishing the top 20 percent of kidneys from the next 20 percent of kidneys has a c-statistic of approximately .68, which means that the KDPI classifies kidneys correctly only 68 percent of the time. Additionally, candidates are ranked by estimated post-transplant survival (EPTS), a measure that also has a weak c-statistic. It also only includes one health condition (diabetes) when long-term survival is more closely correlated with cardiac disease. It only includes diabetes because it is easier to measure. So, one reason this method of allocation is unethical is that the measurements are too arbitrary.

On the upside, their new proposal modifies the current point system, which is based on how long a person has been on the kidney waiting list. The current system heightens health disparities, as minorities are oftentimes not immediately put on the waiting list after beginning dialysis, whereas wealthier, more health-sophisticated individuals manage to get on the waiting list before they even need dialysis. So, for these health-sophisticated individuals, they’re accruing points even if they’re not on dialysis.

The Kidney Committee’s new proposal allocates points based on both dialysis time and the amount of time a patient has had a Glomerular filtration rate (GFR) score less than 30. Individuals who are not on the waiting list, but who have been receiving dialysis, will retrospectively receive points, which will undoubtedly reduce disparities. However, I don’t believe that factoring in time with a GFR score below 30 is ethical. Patients do not need dialysis until their GFR is below 15, but the Kidney Committee decided to include a “GFR less than 30” measure because they don’t want to stop preemptive transplants—the transplant of somebody before they go on dialysis. This is because if you’ve never had dialysis, or you’ve been on dialysis less that a year, your transplant results are better than if you’ve been on dialysis for many years. However, this heightens disparities, because whites and people of higher socioeconomic status are more likely to be preemptively transplanted. I wish they utilized pure dialysis time as their measure, because pure dialysis time would be the fairest.

In your article, you mention that a change in the allocation system must benefit the worst off, such as individuals who have had type-1 diabetes since their childhood. How does the 20/80 system affect individuals with co-morbidities like type-1 diabetes? 

In the Kidney Committee’s proposal, diabetics will never be in the top 20 percent. When I sat on the UNOS committee, one model to revise kidney allocation used a measurement called LYFT: Life years following transplant. This model would have been great for diabetics. Diabetics do really poorly on dialysis—they actually have the highest mortality rate per year of patients on dialysis. The LYFT proposal would allocate kidneys by subtracting the number of years a patient could live on dialysis from the number of years a patient would be expected to live with a transplant. A diabetic, who does really poorly on dialysis, will have a higher LYFT. Black patients, on the other hand, tend to do really well on dialysis and, as a result, have lower LYFT scores. Thus, their chances of receiving a kidney are harmed by the LYFT system. I was against LYFT because I thought it unfairly discriminated against minorities. Nevertheless, it would have helped the type-1 diabetics.

Now, their new proposal will exclude type-1 diabetics from the top 20 percent—so I have asked them point blank: What is your ethical theory about type-1 diabetics? Should they be treated like everyone else? Should they be given special privileges? In one proposed system they would have received priority and in another, they are disadvantaged—how can we justify this? UNOS is required under NOTA—the National Organ Transplant Act—to consider both equity and efficiency. However, the new proposal tends to focus on efficiency exclusively. In fact, in their report, they fail to even mention equity.

How would you change the kidney allocation process?

I think you have to start with equity. Our demand for kidneys is so much greater than our supply—about 700,000 people are on dialysis, yet only 100,000 are on the deceased donor waiting list. Some of the 600,000 on dialysis could benefit from a transplant but have not yet gone through the work-up and may not even know the advantages of a transplant. We shouldn’t ignore the 600,000. Although some may not be eligible for transplantation, who gets on the waiting list is not random: men, whites, and those of higher socioeconomic status are more likely to be on the waiting list than the dialysis numbers would anticipate. But for the 100,000 on the waiting list, they all want a fair chance at getting the optimal renal replacement therapy, which is transplant. However, 70-year-olds don’t need a kidney that’s going to last for 30 years.

So in my proposal, the Equal Opportunity supplemented by Fair Innings (EOFI) model, we offer a two-step multi-principled approach to allocation. In the first step, we ensure that regardless of age, all waiting list candidates have an equal chance of getting a kidney, which is based on the equity principle of equal opportunity. In the second step, we use age as a proxy for quality of both candidates and kidneys on the basis of the equity principle fair innings, which says that younger people need kidneys that will last longer so that they can achieve a full lifespan (some would call this equity principle “prudential life span equity”). We would allocate younger kidneys to younger people and older kidneys to older people, and we would ignore all co-morbidities like diabetes.

This means that, although younger people don’t necessarily have a longer life expectancy and some younger kidneys are not better than older kidneys, younger individuals will still get the younger kidneys. We don’t deny the inaccuracies of our measurements in determining longevity, but rather, we acknowledge that there is variation in kidneys and candidates, and we accept that there is some randomness. This means that part of the allocation system is a “lottery”—where most younger kidneys are better than older kidneys. And lotteries are another equity principle that we endorse. In our minimalistic modeling of EOFI, we show it is more equitable and more efficient than the current system, although not as efficient as the 20/80 model.

Switching gears, what do you feel is the most pressing ethical issue in medicine today?  

Disparities and access issues. The Affordable Care Act (ACA) will address this, at least by improving the number of people who have health insurance. So, from a medical ethics perspective, that’s fabulous.

There’s another pressing and interesting issue: learning health systems. We’re moving in a direction where every hospital will be expected to have electronic medical records. It will be easy to conduct quality improvement research with all of this data without patients even knowing that their data are being used. All of us are going to be patients and research subjects at the same time, all the time. Why is this ethical? Because while it is your data in the clinical context, once it is de-identified (stripped of your identity), it is data about a young female with problem X and then we aggregate your data with other young females with problem X to see which treatments worked and what are best practices.

When patients hear this, some become angry that they are research subjects without their permission. Hospitals, doctors, schools, and the government all need to educate the public that it is to everyone’s benefit to allow and encourage the use of de-identified health data for advancing medical knowledge. When our health data are de-identified, no one knows if it is you or your classmate who has problem X, but only a young female with problem X. And the data are aggregated so that the information is presented about groups of people.

In contrast, patients are right that they need to be informed when research is being done to them—whether it is the use of a new medication or new device. When we do such research, we clearly need to involve the patients who are then active participants in the research and we need to get their informed consent, to educate them about their right to refuse to participate or even to withdraw.

I serve on the Department of Health and Human Service’s Secretary Advisory Committee on Human Research Protection, so I take the issues of human subjects protections very seriously. But the public must be educated that health care is evolving into a learning system—we take care of patients and use the data to determine if what we did was best practice. And we do this by aggregating de-identified data pulled from medical records.

In your opinion, what is the impact of the ACA on medical ethics?

I am not an expert on the ACA, but I appreciate that the ACA incentivizes the use of medical records and is leading us towards the learning health system. As I mentioned, the ACA will also improve access for at least 10 million people, which is a step in the right direction. However, it is only a step, as many millions will still be without access to affordable health care.

Access is the first step; and hopefully we will all use our access to obtain good preventive medicine and primary care. If people have good primary care, we could prevent the person with diabetes from developing kidney failure, we could prevent the person with high blood pressure from developing kidney failure, and so on. I think access is the most important step from a medical ethics perspective, and that’s why I’m excited by the ACA.

Feature Photo: cc/(NomadicEntrepreneur)