Longform – Anne Kim

Anti-Fluoride Activism Is Bad, and Not Just for Public Health

Originally published in Governing, July 2019.

In 1901, a Colorado Springs dentist named Frederick McKay noticed many of his patients had peculiarly mottled brown teeth — but far fewer cavities than the norm. The cause, Dr. McKay determined after years of investigation, was high levels of natural fluoride in the town’s water. His discovery eventually led to the widespread fluoridation of public water systems across America and a dramatic decline in tooth decay over the past 70 years.

Numerous studies have shown the protective effects of adding fluoride to water, especially for kids, and the Centers for Disease Control and Prevention hails community water fluoridation as one of the 20th century’s top 10 public health achievements. State and local budgets have benefited too, thanks to lower public expenditures for dental care.

Unfortunately, a significant number of localities are now undoing their investments in fluoridation, thanks to a small but vocal minority of anti-fluoride activists using pseudo-science to trump data. The result has been the spread of misinformation about fluoride’s benefits, as well as higher costs for both taxpayers and families.

According to the anti-fluoridation Fluoride Action Network (FAN), more than 200 communities in the United States and Canada have rejected public water fluoridation since 2010, from small towns such as Sheridan, Wyo., to bigger jurisdictions such as Bucks County, Pa. In Portland, Ore., residents have voted down fluoridation four times since 1956, most recently in 2013. In 2018, at least 13 communities put water fluoridation on the ballot, while many other localities debated the issue at the city council level without a public vote.

Like anti-vaccinators, anti-fluoride activists rely on spurious medical research to argue fluoridation’s hazards. FAN, for instance, blames fluoride in water for everything from cancer to diabetes to low IQ to, ironically enough, tooth decay. “I’ve got a list as long as your arm of different claims,” says dentist Johnny Johnson, president of the pro-fluoride American Fluoridation Society. None of these claims, however, is backed up by valid science or facts.

One thing that is backed up by facts? Fluoridation saves money — for consumers as well as governments. A 2016 Health Affairs study estimated the nation’s net savings from fluoridation to be nearly $6.5 billion a year from avoided dental costs. Conversely, ending fluoridation can be costly. One study in New York found that residents in non-fluoridated counties were 33 percent more likely to undergo dental procedures, while a Louisiana study found that Medicaid-eligible kids in non-fluoridated communities were three times more likely to get dental treatment than kids in fluoridated areas and at twice the cost.

Dentist David Logan witnessed these impacts firsthand in Juneau, Alaska, where voters ended fluoridation in 2006. The immediate effect, he says, was an increase in cavities among his adult patients, “specifically in older adults where the root surface gets exposed.” Today, his colleagues are seeing many more cavities in kids and at “levels they haven’t seen before in their practicing career.”

All of this is expensive. Logan, now executive director of the Alaska Dental Society, notes that simple fillings cost about $175 in his community, while crowns cost upward of $500. “It’s a very significant amount,” he says, “especially when that cost is disproportionately borne by the public through Medicaid.”

A 2018 study of Juneau’s Medicaid records found that since the end of fluoridation, Juneau’s kids undergo one more cavity-related dental treatment per year than before, at a cost of $300 per child on average. The study also found the highest costs among children under 7, who’ve had no exposure to fluoridated water.

Logan is hopeful this study will help bring fluoride back to Juneau. But he admits he was badly outgunned 12 years ago by the opposition. “You don’t have to have facts. All you need is something sexy to say,” he says. “We had people with lots of letters after their names, but we didn’t put a face on it and got crushed.”

Next time, he says, he’ll be ready, as should all localities where anti-fluoride activists have made a stand. At stake is not just the integrity of science but public budgets and public health.

Continue reading at Governing

When cities rely on fines and fees, everybody loses

They’re a tempting alternative to raising taxes, but their long-term costs far outweigh the revenue they bring in.

Originally published in Governing, September 2018.

Raising taxes is painful. That may be why, since 2010, 47 states and a number of cities have instead raised both civil and criminal fines and fees. These increases are often viewed as a conflict-free way to plug budget holes.

In the last decade, for example, New York City grew its revenues from fines by 35 percent, raking in $993 million in fiscal 2016 alone. The monies came largely from parking and red light camera violations, as well as stricter enforcement of “quality of life” offenses such as littering and noise. In California, routine traffic tickets now carry a multiplicity of revenue-boosting “surcharges.” As a result, the true price of a $100 traffic ticket is more like $490 — and up to $815 with late fees, according to the Lawyers’ Committee for Civil Rights of the San Francisco Bay Area.

This increasing reliance on fines and fees comes despite what we learned following the shooting in 2014 of Michael Brown by a police officer in Ferguson, Mo. A federal investigation of the city’s police department subsequently revealed that as much as a quarter of the city’s budget was derived from fines and fees. Police officers, under pressure to “produce” revenue, extracted millions of dollars in penalties from lower-income and African-American residents. In 2017, the U.S. Commission on Civil Rights issued a follow-up report finding that the “targeting” of low-income and minority communities for fines and fees is far from unique to Ferguson.

This potential for injustice is one reason why states and cities should be weaning themselves from fines and fees. Another is that these revenue boosters carry economic costs that far outweigh the short-term revenue gains.

Because the burden of these penalties falls disproportionately on people who can’t afford to pay, jurisdictions collect far less than expected and waste resources chasing down payments that won’t materialize. In California, increased fines and fees have resulted not in a treasury flush with cash but in $12.3 billion in uncollected court debt as of 2016. A 2014 study of Alabama court costs also found abysmal collection rates — under 10 percent on average — despite countless hours spent by staff pursuing payment.

States can further see net losses if driver’s licenses are suspended or residents are incarcerated for nonpayment. The report by the Commission on Civil Rights found that in some jurisdictions as many as one-fourth of local inmates were in jail for nonpayment of fines and fees. The fiscal impacts of this policy are obvious. In addition to its direct expenses, incarceration — even short stints in jail — can lead to costly outcomes, including unemployment, dependence on public benefits and greater risk of crime.

Nearly as damaging — and far more common — are driver’s license suspensions. The Washington Post reported that more than 7 million people nationwide may have had their licenses suspended because of traffic debts. These suspensions have economic consequences. “People can’t drive and go to work, which means they can’t pay the fines and fees or support their families,” says Joanna Weiss, co-director of the Fines and Fees Justice Center.

A few jurisdictions are rethinking these revenue generators. In the lead is San Francisco, which established the Financial Justice Project dedicated to fines and fees reform. Promising efforts are also afoot in cities and states, including California, Illinois, New York City, Philadelphia and Washington state. Some jurisdictions are working to end license suspensions — a trend that could accelerate after a federal judge recently ruled the practice unconstitutional in Tennessee. Other places are considering non-monetary penalties, such as community service or instituting so-called day fines or payment plans based on the ability to pay. In San Francisco, for instance, a newly instituted payment plan for low-income residents has already quadrupled the parking fines being paid.

The bottom line: Despite the short-term boosts civil and criminal fines and fees appear to bring, the long-term cost to cities, states and their residents is likely to be far greater.

An innovative fix for rural higher education deserts

Geography is a barrier to higher education for tens of millions of rural Americans. A few states have hit on an innovative solution.

Via Washington Monthly

After graduating from her rural Pennsylvania high school in 2005, Tesla Rae Moore did what many, perhaps most American high school seniors today expect to do: she left home for college with her sights set on a four-year degree. But when she was a sophomore in nursing school at the University of Pittsburgh at Bradford, the unexpected intervened: she became pregnant with her son.

“It was a high-risk pregnancy, and I decided to stop the program,” she said. Moore returned to her hometown of Kane, a community of about 3,500 nestled at the edge of the Allegheny National Forest in northwestern Pennsylvania. At first just intending to take a break, she ended up dropping out. “I was going to go back, and then it was just one of those things,” she said. “Life happened.”

Moore didn’t lose her desire to return to school; she just couldn’t figure out how to make it work as the years went by and her family grew. “I’m a single mom, and the only income earner, so I couldn’t quit my job to go to school,” she said. “And if I took classes all day, I’d have to work at night, and who would take care of the kids?” Given her work and family obligations, Moore couldn’t fit in college unless she could attend classes nearby. But getting to Pitt-Bradford, the nearest four-year school, required a round-trip commute of an hour and a half. The nearest community college, in Butler County, was a two-hour drive each way. Moore didn’t have that kind of time to spare. Online-only classes might have been a solution, but Moore felt she needed more structure to succeed. “Especially for somebody that’s been out of school, it takes a lot of discipline,” she said.

A surprising number of Americans face the same problem Moore did. According to the Urban Institute, nearly one in five American adults—as many as forty-one million people—lives twenty-five miles or more from the nearest college or university, or in areas where a single community college is the only source of broad-access public higher education within that distance. Three million of the Americans in these so-called “higher education deserts” lack broadband internet, as well.

Continue reading at Washington Monthly.

Cavity Country

Rural America has too few dentists – and too few patients who can pay.

Via the Washington Post.

Lynnel Beauchesne’s dental office hugs a rural crossroads near Tunnelton, W.Va., population 336. Acres of empty farmland surround the weathered one-story white building; a couple of houses and a few barns are the only neighbors. But the parking lot is full. Some people have driven hours to see Beauchesne, the sole dentist within 30 miles. She estimates that she has as many as 8,000 patients. Before the office closes at 7 p.m., she and her two hygienists will see up to 50 of them, not counting emergencies.

About 43 percent of rural Americans lack access to dental care, according to the National Rural Health Association, and West Virginia, among the poorest and most rural states, is at the center of the crisis.

For homeless youth, statistics and reality are miles apart

Via TalkPoverty.org

At the headquarters of Covenant House Washington in Southeast D.C., a nonprofit serving youth experiencing homelessness, ten twin-sized black canvas cots fill a white-tiled alcove on the main floor. The space serves as an emergency shelter for homeless young people, which Covenant House calls “The Sanctuary.” In keeping with its name, the walls are a deep, soothing blue.

Five of the cots are for women and five for men, which is far short of the demand. The room is empty now, in mid-afternoon, but by 6:00 p.m., when the shelter opens, young people will be lining up for a chance to snag a few square feet of space for the evening, and maybe a shower and a hot meal.

“We turn away at least 8 youth per night,” says Madye Henson, Covenant House Washington’s chief executive officer.

Henson has added extra beds for hypothermia season and is planning a permanent expansion to 20 beds this year. In combination with its other programs, that would bring Covenant House’s total emergency shelter capacity to 77, making it the city’s largest provider of emergency shelter for homeless youth. But compared with the D.C. General Family Shelter for families with children, with 264 beds, Covenant House is still tiny.

The shortage of shelter beds for homeless youth is endemic across the country. Youth homelessness has been a low priority for federal funding and largely an afterthought in communities’ efforts to fight homelessness. Instead, young adults have been thrown into the system for chronically homeless adults, despite their very different needs and the dangers they face in adult shelters.

Continue reading at TalkPoverty.org

The Dialysis Machine

Via Washington Monthly

On a sunny August day, an elderly, fragile-looking black man sits slumped in a wheelchair, eyes closed, outside the doors of a DaVita Dialysis center. The business takes up the corner of a run-down strip mall in Southeast D.C., in a heavily black neighborhood across the river from the Capitol. It’s next door to a liquor store and steps away from an ACE Cash Express check-cashing outlet, a barbershop, and a takeout place. A big sign on the glass warns visitors that firearms are not allowed inside. A handicapped-accessible public bus waits in the parking lot to take other patients home.

It’s midafternoon, but the shopping center is buzzing with knots of people hanging out by the takeout and the barbershop. Everybody seems to know someone on dialysis. One man in a barber’s smock out for a cigarette break says he had a friend who died at a dialysis center. He says ambulances are a constant presence at the DaVita clinic. It’s not unusual for people to die on dialysis: nationally, about one-fourth of patients die in the first year, and six in ten will be dead within five years.

As many as thirty million Americans have chronic kidney disease. If you’re one of them, and you’re white, well educated, and middle class or higher, odds are you’ll get the kind of medical care that will save your kidneys. You likely have private health insurance and get regular checkups. You probably caught your condition early and are taking medication to slow down the disease’s progression.

But if you are poor, less educated, and black, the odds are much greater that your disease will run unchecked and your kidneys will eventually fail. According to the National Institutes of Health, black people are nearly four times as likely to suffer kidney failure as whites. Then you will likely end up on dialysis, spending three days a week, four hours at a time, at a place like this one, as your blood is pumped out of your body, filtered, and pumped back in.

Farther down the sidewalk, waiting for her daughter at the takeout, is Sharon C., a soft-spoken sixty-two-year-old black woman in a sleeveless white dress and Jackie O sunglasses who doesn’t want to give her full name. She sits in a wheelchair, her left foot and ankle grotesquely swollen, the result of poor circulation caused by the diabetes she was diagnosed with in 2005.

Sharon goes to a different DaVita center for dialysis, one near Capitol Hill, where she spends every Tuesday, Thursday, and Saturday. “You can’t miss a treatment,” she says. “You can’t go anywhere.” She says she only got on dialysis two months earlier, when her one functioning kidney finally failed. She is not on the wait list for a transplant. “I need to find a donor,” she says, echoing what patient advocates say is a common misperception among dialysis patients: that you can’t get a transplant unless you find a donor for yourself. “I don’t want to be like this.”

The most tragic consequence of a system that incentivizes keeping people, especially poor people and minorities, on dialysis is that it also keeps them from getting what is beyond doubt the best treatment for kidney failure: a transplant.

Of the 661,000 Americans with kidney failure, about 468,000 people—more than a third of whom are black—are on dialysis. In the District of Columbia, where the prevalence of kidney failure is the highest in the nation, according to the Centers for Disease Control, there are twenty-three dialysis centers, mostly in Northeast and Southeast Washington, the predominantly black parts of the city that are also ground zero for diabetes and high blood pressure, the two conditions most linked to kidney disease. Another 100 dialysis centers are within a twenty-five-mile radius of the city, again concentrated in the suburbs with the largest minority and low-income populations. In District Heights, Maryland, a DaVita center dominates the busy intersection of Pennsylvania Avenue and Silver Hill Road. In a strip mall just across the street is a clinic run by U.S. Renal Care.

Like check-cashing outlets and payday lenders, dialysis centers—the vast majority of which are for-profit, like DaVita and U.S. Renal Care—are now fixtures in the urban commercial landscape. “We used to say there’s a liquor store on every corner,” said Clive Callender, a transplant surgeon and professor of surgery at Howard University. “Now we say there’s a dialysis unit on every corner.”

The prevalence of dialysis centers in minority neighborhoods is a reflection of policy failures that encourage—indeed institutionalize—class and racial disparities in American health care. These failures include more than just disparate access to the primary and preventive services that could help high-risk patients stave off kidney disease. Public policy effectively steers low-income and minority patients with kidney disease toward dialysis and away from superior options, particularly transplants.

Everyone with kidney failure, also called end-stage renal disease, is covered by Medicare. And Medicare guarantees payment for every dialysis session. As a result, the treatment of kidney failure is a volume-centered business aimed at keeping dialysis centers running. “You fill up a facility with so many stations, you make sure somebody is sitting in each of those chairs around the clock,” said Dennis Cotter, president of the Medical Technology and Practice Patterns Institute. “It’s the Henry Ford production model.”

This system creates an incentive for clinics to keep patients on dialysis until they die.

Continued at the Washington Monthly

One of These Governors Could Save Democrats in 2020

Via the American Interest

Under a clear blue sky in late summer, with the peaks of the Gallatin Mountains as a backdrop, Montana Governor Steve Bullock mingles with guests at a private event on a ranch just outside Bozeman. Holding a plate piled high with barbecue, Bullock is half a head taller than most of the people here. He is genial and relaxed, in jeans and battered brown shoes. His nametag reads, “Governor Steve.”

A young mother brings over two little girls in flowered sundresses, and Bullock immediately drops down to eye level. A few minutes later, the girls leave with their mother, smiles on their faces, their votes no doubt locked up for 15 years hence when the girls will be old enough to cast a ballot. In half the conversations that swirl around Bullock, there are joking references to 2020 and hints about the Governor’s ambitions. It’s an open secret here that the Bullock might be running for President.

Just this past fall, Bullock won re-election over GOP challenger billionaire Greg Gianforte by four percentage points—50 percent to 46 percent—in a state where only 35 percent of voters chose Democrat Hillary Clinton for President and Donald Trump won by 20 points. That victory is Bullock’s calling card into the Democratic presidential sweepstakes, along with the prairie populist credentials he has burnished. As the state’s Attorney General, he endeared himself to sportsmen by authoring a state opinion guaranteeing access to public lands. He also took on the Supreme Court’s decision in Citizens United, defending the state’s ban on corporate spending (he lost when the Court reaffirmed its decision).

But Bullock is not the only Democratic Governor with an eye on 2020. No fewer than five Governors (out of a field of only 15 Democratic Governors nationwide) are rumored to be or talked about as serious potential presidential contenders. Many of these, like Bullock, are governing in states that voted for Trump, or where the legislatures are controlled by Republicans, or both. And many, like Bullock, claim a pragmatic approach to policy that’s intentionally difficult to pigeonhole—by turns progressive, populist, and libertarian.

These governors join what is seemingly already a cast of thousands vying for the chance to take down Trump. In addition to liberal senatorial heavyweights Bernie Sanders and Elizabeth Warren and former Vice President Joe Biden, none of whom have (yet) officially revealed their intentions, there is a raft of younger Senators, House members, rising-star big-city Mayors, and an assortment of CEOs and celebrities, including Oprah Winfrey, Starbucks’ CEO Howard Schultz, and Facebook’s Mark Zuckerberg (though revelations of Facebook’s pre-election ad sales to the Russians might sink that candidacy before it begins).

But of all of these, a Governor might have the best shot at actually winning. Why is that? The simple answer is that Governors are not inherently Washington swamp creatures, and that’s what the Democrats need to fracture Trump’s stubbornly loyal coalition.

The Push for College Endowment Reform

Liberals and conservatives alike are taking action against inequalities in higher-education finances

Via The Atlantic and Washington Monthly

In 2015, a New York Times op-ed observed that Yale University had spent $480 million that year on fees for hedge-fund managers to grow the university’s already massive endowment—while spending just $170 million on tuition assistance and fellowships for its students.

“We’ve lost sight of the idea that students, not fund managers, should be the primary beneficiaries of a university’s endowment,” wrote the law professor Victor Fleischer, whose 2006 proposal to change the tax treatment of “carried interest” became a liberal cause célèbre. “The private-equity folks get cash; students take out loans.”

Though Fleischer’s screed was not the first to attack elite-college endowments—the progressive commentator and former Clinton administration Labor Secretary Robert Reich has also railed against them—it presaged a wave of criticism that has since become a storm. Shortly after Fleischer’s op-ed was published, the New Yorker writer Malcolm Gladwell grabbed the baton, launching what’s become an ongoing, high-profile crusade against fat-cat university fundraising. In 2016, he dedicated an entire podcast to the absurdity of billionaires donating millions in endowment dollars to schools that don’t need the money, and later waged a very public war against Stanford University for its fundraising appeals to alumni. “If Stanford, with $22 billion in the bank, still has needy undergraduates, how are they spending the billions they ALREADY have?” he tweeted in February.

It’s not just liberals like Gladwell who are outraged. The GOP-led Congress has held at least two separate hearings examining the taxpayer subsidies that support endowments, which are now potentially under scrutiny as part of tax reform (assuming Congress gets there). Even Donald Trump has weighed in. “Many universities spend more on private equity-fund managers than on tuition programs,” the then-presidential candidate last September, channeling Fleischer’s critique.

Observers of higher education have long known about the cash the nation’s elite schools have been accumulating, as well as the glaring inequality between these schools and their less-affluent kin. According to a 2016 analysisby the Education Trust, a nonprofit group that advocates for closing the achievement gap, 75 percent of the nation’s total college-endowment wealth was held by less than 4 percent of phenomenally wealthy schools as of 2013.

Continue reading at The Atlantic

Deconstricting the Administrative State

Donald Trump promises that his deregulatory agenda will lead to a boom in jobs. The real effect will be the opposite.

Via Washington Monthly

As Oklahoma’s attorney general, Scott Pruitt was a bitter opponent of the U.S. Environmental Protection Agency (EPA), which he sued repeatedly while in office. Now, as President Donald Trump’s pick to run this very agency, Pruitt has leaped at his chance to sabotage it from within.

Days after his confirmation as EPA administrator, Pruitt told the Wall Street Journal that the agency might lack authority under the Clean Air Act to regulate greenhouse gas emissions—something the EPA has been doing for most of the last decade. Soon thereafter, he halted pending rules requiring oil and gas producers to disclose their methane emissions, ordered a “review” of the EPA’s proposed Clean Power Plan, and declared an end to the “regulatory assault” on industry.

Pruitt’s efforts to hobble the EPA are in line with Trump’s broader vendetta against “job-killing regulation,” a signature initiative of both Trump’s campaign and presidency. “Excessive regulation is killing jobs, driving companies out of our country like never before,” said Trump in February.

But that’s not how the entrepreneurs at NBD Nano-technologies see it.

The Boston-area start-up (“NBD Nano,” as it calls itself) arguably got its first big break as a result of exactly the rules Pruitt is working so hard to undo. After the EPA announced, in 2009, its intention to regulate greenhouse gas emissions, including the emissions of coal-fired power plants, power companies started scrambling for ways to burn less coal.

One strategy companies began exploring is how to make the steam turbines that generate electricity more efficient. Much of what a power plant does is heat water into steam, and a major source of inefficiency is the time it takes to condense steam back into water before it’s reheated.

Enter NBD Nano.

In 2013, the company won a small grant from the National Science Foundation to see if its products—oil- and waterproof industrial coatings—could help power plants convert steam into water more quickly. The company found that using its materials to coat the thousands of copper tubes that line a power plant’s “condenser box,” where steam is captured and cooled, dramatically speeds up condensation by encouraging water droplets to form more quickly and at higher temperatures. That means power plants can use less fuel to reheat the water into steam.

After the company won a second grant in 2015 to help commercialize its technology, it began piloting its coatings at a power plant run by the Tennessee Valley Authority. So far, results have been good. “We’re now in the process of rolling it out globally to power plants around the world,” said Timothy Evans, NBD Nano’s vice president of sales.

Regulation, says company cofounder and president Deckard Sorensen, is the catalyst that prompted bigger companies to seek him out. “Large companies don’t necessarily have the capability to develop innovations in-house,” said Sorensen, who launched NBD Nano while still an undergraduate at Boston College. “So they look for entrepreneurs [to help them] align with regulations. It facilitates these larger companies being willing to work with small companies at an earlier stage.”

Now with twelve employees, NBD Nano’s early win has allowed it to set its sights on broader horizons. One of its products, a glass coating called RepelShell, could soon be standard on your car’s windshield and windows. Sorensen says the company is also working to produce smudge-proof touchscreens for smartphones and tablets (this writer will be first in line), and mud-proof soccer shoes are already in the works.

NBD Nano’s story is not a fluke. Federal regulation—especially when crafted with sensitivity to market needs—is the visible hand behind many new products, technologies, and industries benefiting both consumers and the U.S. economy.

Thinking about swapping your clunker for a Tesla? Electric cars would not be as readily availableas they are today without the tougher federal fuel economy standards that helped spur their development. Tesla is now America’s second most valuable car company, after GM, with a market value of $48 billion—testament to the potential investors see in this sector.

The same goes for the solar panels you might be contemplating for your roof. In 2007, as part of broader energy legislation, Congress passed a federal “renewable fuels standard” requiring renewables to replace a certain amount of traditional fossil fuel. The regulation has been a boon for solar and wind, as well as for nascent technologies such as bio-fuels, which could someday supplant coal, gas, and oil with fuels made from algae and garbage. In the solar energy sector, for example, the Solar Foundation estimates that 260,000 Americans held solar-related jobs in 2016, an increase of 25 percent over 2015.

Even the pieces of legislation most despised by the current GOP-controlled Congress—such as the Dodd-Frank Wall Street Reform and Consumer Protection Act and the Affordable Care Act (ACA)—have sparked a wave of innovation and entrepreneurship. For example, you may have noticed a surge of new offerings in your smartphone’s app store for money management tools, like Betterment, an automated investment app that charges lower fees than traditional mutual funds, or Digit, a savings app that automatically transfers small amounts of money into your savings account, depending on your spending patterns. One reason apps like these are increasingly available is because the big banks no longer have a monopoly on your bank account information—a provision in Dodd-Frank gives you the right to control that data, including the right to grant third-party companies like Betterment and Digit permission to access it. It’s the reason why the fast-growing financial technology (“fin-tech”) sector is now fighting to save Dodd-Frank.

The ACA, meanwhile, has helped launched such new firms as Zenefits, a San Francisco–based health insurance broker for small employers that grew to 900 employees in the two years following the passage of the law. The surge of new consumers created by the ACA, along with the law’s new mandates, helped create at least ninety new health-related companies, according to a 2015 report by PricewaterhouseCoopers (PwC), including firms that deliver telehealth services to patients and help doctors provide better care to people with chronic diseases, in addition to companies like Zenefits. According to the PwC report, venture funding for digital health start-ups also hit an all-time high in 2014, north of $4 billion.

All of these stories run counter to the dominant political narrative of regulation as a deadweight on the economy. This belief is gospel on the corporate-controlled free market right, and even liberals defending regulation seldom do so in terms of its broader positive economic impacts. With the sole exception of clean energy, where liberals have readily touted the link between regulation and jobs, you will look in vain for a progressive politician who more generally defends regulation as an instrument of innovation and economic growth. Rather, the prevailing frame is that of regulators as guardians of public safety and health. The same is true of the liberal advocacy community. “Public health, safety, pocketbook and environmental protections are being wiped out as payback to the GOP’s corporate donors,” warns the website of Rules at Risk, an umbrella campaign by progressive groups. This is true enough. But nowhere on the website does the group make a full-throated argument for how regulations benefit the economy as a whole. By ceding the economic argument, liberals have effectively allowed the debate on regulation to be framed as one of jobs versus safety, growth versus health. Voters are left believing that they have to choose between the two—a false choice that also gives the advantage to the GOP as the better champion of jobs and economic growth.

With Republicans now in control of both Congress and the executive branch (not to mention a renewed conservative majority on the Supreme Court), a reactionary assault on regulation that’s been contemplated for years could come to pass as early as this year. In fact, this hammer blow—part of what White House strategist Steve Bannon calls the “deconstruction of the administrative state”—is more likely to happen than the other high-profile priorities, such as tax reform or ACA repeal, that garner far more media attention.

While Trump has brandished a series of anti-regulation executive orders—such as a requirement that agencies get rid of two old regulations for every new rule issued—the real action is in Congress, which has moved aggressively to enact an agenda that could paralyze federal agencies and bring all regulatory work to a halt. And with Democrats defending twenty-five Senate seats next year, including ten in states won by Trump, the temptation for vulnerable senators to support these measures will be fierce. In North Dakota, for example, embattled Democratic Senator Heidi Heitkamp is among the three current cosponsors of the Regulatory Accountability Act, one of the principal proposals being advocated by congressional anti-regulationists.

Anti-regulation conservatives sell their agenda with the promise that it will help business and spur growth. What they—and many liberals—fail to acknowledge is that regulation, far from being a drag on economic growth and competitiveness, often provides the infrastructure necessary for growth and innovation to occur. It eliminates the uncertainty that can stifle investment, sets minimum standards for the smooth running of markets, and husbands the birth of new industries by setting goals that demand innovation to achieve. Gumming up the regulatory works and slowing or even stopping the rule-making process, on the other hand, raises risk and stifles innovation by erasing the market signals that industries need. Trump and his allies promise that their deregulatory agenda will lead to a boom in job creation. The real effect will likely be the opposite.

Continue reading at Washington Monthly

How cash bail keeps the poor in jail

Inability to pay bail is often the only reason a pretrial defendant stays behind bars.

Via the Atlantic and Washington Monthly

The row house on Cecil Avenue was just like any other in the rough-and-tumble East Baltimore neighborhood where Rafiq Shaw lives. But one chilly day in December 2015, he had the bad luck to be walking by right as the police were getting ready for a raid.

“All out of the blue a bunch of police cars pulled up and grabbed me,” Shaw told me in September. “They threw me to the wall and put cuffs on me.” The officers insisted he had come out of the house, which Shaw just as vehemently denied. “They thought I was someone else,” he said. “That’s what they thought the whole time. They called a name out that wasn’t me.”

Shaw is a tall, heavyset, 31-year-old black man with a booming voice and an easy smile. He told his story almost cheerfully, emphasizing the absurdity of the harrowing situation he was describing.

Over his protests, Shaw continued, the police dragged him into the house, where a woman inside told the officers she had no idea who he was. The officers pushed him onto a couch and went through his pockets, finding the keys to his mother’s car, parked nearby.

Later, at his trial, in August 2016, officers would testify that Shaw consented to a search of the car. (Shaw told me he didn’t.) They also claimed to smell marijuana, although the doors were shut and the windows were up. Shaw’s attorney, Maryland public defender Angela Oetting, said that’s a claim Baltimore cops often use to justify searches of her clients.

The police did not, in fact, find marijuana in the car. But they did claim to find a gun, stashed in the glove compartment. It was a discovery that stunned Shaw, who said he has never owned a gun. “And this was my mom’s car,” he added. He was arrested and charged with two offenses: illegal possession of a handgun and possession of a handgun in a vehicle on a public road, punishable by up to three years in prison.

Police had no evidence, such as fingerprints, to prove the gun was Shaw’s. He didn’t even have a key to the glove compartment; the cops had to smash it open. After less than a half-hour of deliberation, the jury found Shaw innocent on both counts.

But Shaw is still paying for the crime he never committed. He’s on the hook for the $10,000 his family agreed to pay the bail bondsman who got him out of jail two days after his arrest. In Maryland, as in the many other jurisdictions that rely on private bondsmen and a money bail system, bail arrangements are private contracts, unrelated to court outcomes. Innocent, guilty, or charges dropped—as often is the case—the bondsman still collects his fee. “It’s crazy,” Shaw said. But it’s the inevitable result of a privatized pretrial system dependent on a commercial bail-bond industry.

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