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Improving Public Policy for Children
Robert H. Pantell, MD Professor of Pediatrics Emeritus
UCSF [email protected]
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