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Improving Public Policy for Children

Robert H. Pantell, MD Professor of Pediatrics Emeritus

UCSF pantellr@peds.ucsf.edu

GOALS

  To appreciate barriers to better child policy

  To become aware of several innovations with potential to transform child policy

  To understand how PL 111-148 funding could translate into better child services

  To propose a new paradigm to improve child policy: intergenerational equity

What we know

US INTERNATIONAL RANKINGS Gross Domestic Product # 1 Childhood Poverty # 16 Infant Mortality # 33

High School Graduation Rate # 19 Reading # 21 Math # 26 Science # 33

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Why?

Percent of Social Welfare Spending

Consequences

Percent Living in Poverty

FY 2006-2007

  Economy + 2.9%   Elderly programs + 5.3%   Children’s programs + .7%

• Health +4.5% Training - .5% • Housing +1.5% Soc, serv. - 1.5% • Nutrition + .1% Education - 2.1%

  Working families - 8.9%   Source: The Urban Institute

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Budget 2010 (in $)

  Medicare 453 billion   PL 111-148 <93 billion   PL 111-148 Medicaid/CHIP 45 billion   Goldman Sachs Profit 13.8 billion   CHIPRA 10 billion   Child Share Medicaid 9 billion   PL 111-148 Childhood Obesity 5 million

What needs to be done

  Improved child public policy based on proven innovations

  Improved funding of child policies   Improved access to funded programs   Increased stability of funded programs

that work   Change paradigm to improve

intergenerational equity

What is being (and could be) done? Innovation #1

  Conditional Cash Transfer • Social contract rewarding individual behavior • Opportunity NYC 2007 pilot • Effective in Mexico and Brazil • Programs: Chile, Colombia, Honduras,

Jamaica, Malawi, Zambia, Indonesia • Expand target population and rewarded

behaviors: immunizations, school attendance, parenting classes

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Innovation #2

  Turbo-Child-Benefits • Many eligible children/parents not enrolled in

Medicaid, SCHIP, public housing, food stamps, educational benefits, EITC(20-70%)

• Estimated $65 billion left on table annually • Separate offices, locations, qualifications, time

requirements, non-transportable • Single Stop USA

• 40 sites; 93,000 subjects, $12 million secured $320 million in increased benefits

Problem   Democracy does not always yield fair results,

especially when important segments of the population are disenfranchised from the voting process.” Newacheck 2004

  “The failure to enfranchise children has substantial effect on public policy outcomes.” Bennett 2000

  “Little is new in the advocacy toolbox. Child advocacy strategies have remained remarkably constant over time.” Imig 2006

Towards Intergenerational Equity: Changing the Paradigm

  “We cannot solve the problems we have created with the same thinking that created them.” Albert Einstein

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A New Approach?   “…to lay the foundation for ending widespread

poverty among children”.. “will require giving children the right to representation.”Lindsay 1991

  “…given the country’s propensity to eat its future, it may avoid making decisions tantamount to enacting Swift’s own proposal only by giving children the right to vote.” Peterson 1992

  “…serious consideration should be given to the suggestion that parents be given the right to vote on behalf of their children.” Hewlett & West 1999

An Approach

  “Giving proxies to parents to vote on behalf of their children is consistent with current law, which presumes that parents act in the best interest of their children.” Rutherford 1998

  “I can think of no other single act which, if achieved, would more dramatically change the ‘political economy’ of children’s issues than to enable parents/legal guardians to vote for their children.” Aber, 2008

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“One person, one vote”

  “Despite the slogan, the apportionment decisions were not about the assignment of a single vote to each voter.” Bennett 2000

  “If, however, children are viewed as persons with a right to be represented in the political process, then the principle of one person, one vote authorizes, if not requires, such proxies.” Rutherford 1998

True or False?   The US Constitution guarantees the rights of its

citizens to vote   Only citizens can vote   Incarcerated felons cannot vote   Age 21 was established to guarantee voter maturity

and judgment   The 26th Amendment was passed giving 18 year olds

the right to vote during the Viet Nam War   Persons less than 18 cannot vote -- nor can they

make monetary contributions due to the Bipartisan Campaign Reform Act

One Person One Vote???

  The Census Conundrum •  District A: 50 adults (0 kids) 50 adults (2 kids) •  District B: 100 adults (0 kids)

  Presidential Elections •  Wyoming: Texas 4:1

  US Senate Elections •  Wyoming: California 90:1

  US House Elections •  Rhode Island: Montana 1.8:1

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Persons under 18 can

  Assent to participate in research at 7   Obtain a hunting license at 12   Obtain a drivers license at 14   Be executed at 16 (until 2004)   Marry at 16 (with parental permission,13)   Serve in the military at 17   Receive medical treatment for STIs   Pay local, state and federal taxes

Parental Proxy Already Exists

  Signing contracts   Medical decisions   Permission to marry at age 13   Placement in mental hospital   Educational decisions based on finance

Proposed   Parents should have the right to represent

children through proxy voting   The voting age should be lowered to 16 or

completion of high school   Voting should be facilitated for parents

(schools/daycare centers)   Monetary consequences for

disenfranchisement (“No taxation without representation”)

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17 yo voting/proxy voting

  States with 17yo voting in primaries: 17   States with bills to lower voting age: 12   Countries with voting age 17 or less: 14   Countries with proxy voting: 1   Countries with bills for proxy voting: 1

Armed Conflict

  Revolutionary War US Constitution   Civil War Amend. 13, 14, 15   Civil Rights Amend. 24   Viet Nam War Amend. 26

Sentinel Events

• Rosa Parks

• Stonewall Inn

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Summit

  Seneca Falls, NY 1848

  19th Amendment 1920

  “One Child One Vote” Summit -- ???

Acknowledgments   Laura Rosenbury, Wash. U. School of Law   Phil Lee, Asst. Secy. Health (66-70,90-94), Chancellor Emeritus   John Takayama, UCSF   Michael Wald, Stanford Law School   Paul Peterson, Institute for Educational Policy, Harvard   Paul Newacheck, IHPS, UCSF   Neal Halfon, UCLA   Larry Horowitz, Chief of Staff US Senate Health Subcommittee (1978-1988)   Howard, American Bar Assocition   Peter Budetti, University of Oklahoma   Duncan Lindsay, UCLA   Jane Rutherford, DePaul University School of Law   National Youth Rights Organization   Bruce Lesley, First Focus

References   Thomas Z. Freedman and Michael Weinstein. Towards a

National Single Stop Policy and More Effective Poverty Fighting. The New Democratic Leadership Council. March 2010 http://www.dlc.org/documents/SingleStop.pdf

  Robert Pantell and Maureen Shannon. Improving Public Policy for Children: A Vote for Each Child. Intergenerational Justice Review Vol 9 Issue 4 December 2009 attached

http:// www.intergenerationaljustice.org

  Big Ideas For Children: Investing in our Nation’s Future. First Focus.Washington DC http:// www.firstfocus.net/download/bigideas.pdf

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