 If we want to, we can structure the market differently. Inequality that we get from the market is a result of the way we structure the policy decisions. And what I want to argue is that we could have different policy decisions to structure the market differently and produce outcomes that are more equal. First off, I want to say that we have to learn how to slice and dice big proposals into manageable chunks, of which might be doable, and at the end of the day get us where we want to be. Second point, if you could do something at a local level, you could do something at the state level, do it. And if it's successful, other states, other cities will do it, and then ideally it will be done nationally. Third, private foundations can be useful. You do have foundations that are committed to progressive policies in different areas. We should figure out how to use them effectively. Last point, think like a Republican or a conservative, however you want to put it. The other side's been very effective in designing piecemeal policies that have advanced conservative genders, undermined institutions that we might support. So, for example, Medicare, they've adopted changes to Medicare that have gone a long way towards undermining the purpose of the program. We could point to the periods of big change in the United States in the last century. The New Deal and the Great Society stand out. The New Deal, of course, came about in the Great Depression. So we had a massive depression, massive unemployment. We also had a militant labor movement, and those are not sort of reproducible conditions. First of all, we don't really want to see a Great Depression, so arguing that we need a Great Depression have changed. That's not a really good story. Militant labor movement, that would be great. I mean, if we had millions, tens of millions of people looking to organize, and they're very militant about that, that would be fantastic. But that doesn't just come out of the air. So there were very specific circumstances that gave us the political force to implement the New Deal policies similarly with the Great Society. The Democrats had super majorities in 64-66 coming in the wake of John F. Kennedy's assassination. And it gave the Democrats, gave progressives a rare opportunity to implement changes that we really haven't seen since. So it's just not realistic to think that we're going to have a political situation where you could implement big progressive changes all at once. That's my argument for why we need to think piecemeal, how we can construct big policies from a lot of smaller, more incremental moves. Okay, so just to take a couple examples, Medicare for All. There's certainly been a lot of talk, a lot of progressives have been pushing for a universal Medicare program for several decades. We're not about to get Congress to pass a Medicare for All program. But what we reasonably hope to do is interim steps. This will seem trivial to people. I know I've raised it with people and it seems trivial. Lower the Medicare age to 64, okay? It's 65 now, lower it to 64. All right, that might not seem like a big deal. But to my view, it is a big deal for two reasons. One is you will directly help people. So for a lot of people who are of health issues, they might not get health care insurance to their employer. The idea of qualifying for Medicare a year earlier will mean a lot. But the other and more important part of this story is, well, if you could lower it to 64 and that works, people will say, well, why don't we lower it to 63? Why don't we lower it to 62? Why don't we lower it to 60? Get a foot in the door. And it will also have the benefit that we'll see problems. Inevitably, there will be problems. So if we're tomorrow to say, okay, let's have universal Medicare, well, there will be problems. I'll guarantee that. If we lower it to 60, there'd be problems. So if we lower it to 64, we'll minimize the size of those problems. We'll know what they are. And that means we'll have a more open door. If a year or two, three years out, we want to lower it to 62 or 60. So it's a really, really big first step. I think it's something that's doable and it gets us on the path to where we want to be. Second, a public option buy-in. So again, there's been a lot of talk about this over the years. This isn't wholly transforming the system. It means allowing people to buy into Medicare. Now there's other issues we have to bring down the cost of healthcare more generally because the idea of paying for the current healthcare system through Medicare isn't very feasible. But the point is if we're looking to get to some sort of universal Medicare program, we have to think of incremental ways to do it. Free market drugs, that's another story. We could have drugs sold in a free market without patent or related protection. So they could all be cheap. Okay, well, we're not going to get there all at once. But what you could look to do is try and do it in specific areas. So say you did it for diabetes, researching new diabetes drugs, treatments, cancer drugs, treatments. You may be able to get the funding. It wouldn't be that much additional funding that would be needed to do that. And then it would offer an opportunity where you could set an example. So imagine that you had a great breakthrough, you had a new cancer drug, and it was selling for $300 for a year's treatment instead of $300,000 for a year treatment. That would be a great example. It would show the benefits of direct public funding, open source research, and generic pricing for drugs the day they came on the market. So if we could do that for diabetes or we could do that for cancer, then people will say, well, why don't we do this for heart disease? Why don't we do it for other areas? Get a foot in the door. The last point along these lines, price controls on patented drugs. The United States is the only country that we, on the one hand, give drug companies a monopoly. People say, you're interfering with the free market. We have a monopoly. And then we say you could charge whatever you want. Other countries, they have patents as well, but they don't tell the drug companies they could charge whatever they want. They negotiate a price. They set a price. That's a good thing to do. So again, it gets people with the idea that we don't have to pay ridiculously high prices for drugs. And also it fits well with the idea of more public funding for the research because the drug companies, if they have lower prices, they have less money for research, you go, fine, we don't need you to pay for research. We're going to pay for the research. There are policies that go really well together. And of course the idea of controlling drug prices, that has law support and even some bipartisan support. So that's not a far out idea. Okay, policies being implemented at the state or local level, long history of this, unemployment insurance, it was experimented with at the state level for many years before eventually it was adopted at the federal level. You had 40-hour work week laws being passed in many states before you had the Fair Labor Standards Act in 1937, which set up a national policy. Whereas 40-hour work week and people got overtime, premium pay, if they worked more than 40 hours a week. You had minimum wage laws in many states before you had the federal minimum wage. But currently we have many states and many cities that have raised their minimum wages well above the national minimum wage. In some cases double the national minimum wage. And again, it provides a great example that you could have a $15 an hour minimum wage in California, New York, other places. And in pretty much all cases there's been a lot of research. It hasn't led to large scale unemployment. So you're both directly helping people with these policies, but also setting the example. So again, it's not that the other states will sit down and go, oh yeah, you're right, or get it passed at the federal level. But that's a very, very powerful argument. Okay, states could take the lead in lowering drug prices and promoting free market drugs. Well, you have states, certainly the larger ones, a state like California, they could actually pay for a lot of research. So to my view a big mistake, and a lot of people I think are thinking along these lines is you might have California pay for more research, and then they would let private companies, private individuals own the patents, and then sell the drugs at the same price as everyone else. That would be, to my view, a very bad policy because you're basically paying them twice. We've done that sometimes. But if you had a case where California paid for the development of a cancer drug, and at least for the people in California, made it available as a cheap generic, that would be really a great model for the country. And a great model for extending it even in California. Also states can lower drug prices. Some states, even my state of Utah, its public employee health system pays people to go to Mexico to get drugs at lower prices. You wouldn't do that for every drug, but when you're talking about drugs that cost tens of thousands or even hundreds of thousands of dollars, a trip across the border might well be worth it. So these are steps that can be done at the state, local level, and can be great examples. They teach people in addition to directly saving money. Cities could experiment with creative work tax credits, or journalism, because again, this has been a big issue with the decline of newspapers. There's a lot of proposals to have tax credits or some sort of system of subsidizing journalism at either the state or even local level. That's something that can be done at a state, local level, doesn't require a huge amount of money, but it could have a big impact in both in increasing the availability, whether it's creative work more generally or journalism more narrowly, increasing the availability there and setting an example for other states. And another area states can innovate in is the corporate income tax. We have an incredibly inefficient wasteful corporate income tax system. That's not a secret. We have to find massive ways to avoid or outright evade the corporate income tax as it is. My proposal along these lines has always been to tax companies based on the return to shareholders, because that's what they care about at the end of the day. You just have to look in the paper and you can see what the shareholders got by way of dividends and their capital gains over the year. States could experiment with that. And again, it would both be efficient, beneficial to a state that had a corporate income tax to make it as simple as possible. That would also be a great example for other states and ideally at some point the federal government. There are many, many areas where states and in many cases even cities could experiment with innovative progressive policies that offer both immediate benefit for their residents but also set an example for other states and in principle at the end of the day the federal government. Private foundations have all sorts of different agendas but many are ostensibly committed to progressive policies enhancing progressive cause, progressive equality and we should try and take advantage of that. Try to get their funding going for productive purposes. You could get the money to finance some open source drug research at least in principle from a private foundation because the amount of money involved isn't necessarily massive, so a few billion dollars of research for cancer, a particular type of cancer. That's not in principle an undueable task for a major foundation or set of foundations if it were the case that their research proved successful, had a new drug developed and it was an effective treatment it sold for a few hundred dollars rather than hundreds of thousands of dollars it would set a really powerful example. So again, there are foundations that have money that are committed to improving public health committed to equality that's the sort of thing that in principle could have a very, very big impact and I'll just mention the Gates Foundation is going the exact opposite direction Bill Gates is not a secret he made his money off of patent and copyright monopolies and they've been very conscious to resist any efforts at open source research. They're about protecting patents and to my view they've been a very, very poor influence in the public health arena particularly in the developing world because of that. Also part of the story when we think of how private foundations could be more effective in promoting progressive change they could partner with state and local governments so I was just talking about the idea of a creative or tax credit or make it a journalism tax credit again there are foundations that are committed to supporting journalism having more diversity of voices in our public debates you could have a tax credit put in place at either the state or local level where much of the funding came from a foundation that claims this is their interest this is their concern so again we're not talking about huge amounts of money say 25-50 million that could go very, very far for providing for a tax credit that could be put in place in a large state, a mid-sized state that could have a very big impact on the journalism that's produced there if that's the issue we're talking about so if we need 50 million dollars to have a journalism tax credit in Illinois well if you can get 25 million of that from a foundation that cares about promoting journalism then you've made it that much easier in the state of Illinois to raise the other 25 million from tax revenue so again think how we could partner state and local governments with private foundations that ostensibly are committed to the same cause the same purpose okay the last point thinking like a republican thinking like conservative the conservatives have been very effective in finding ways to get the camel's nose into the tent and they've been on top of things Medicare Advantage referred to that earlier that was a really, really big deal that dates back to the Reagan years what they did is allow private insurers in effect into the Medicare program and it was quite deliberately designed to undermine the program so people who don't have major health conditions they're not seeing all sorts of different doctors all the time very often Medicare Advantage will actually be a better program so this is the story of adverse selection that fragment the market so rather than having everyone in the same Medicare pool what they're trying to do is say okay we're going to have an option that's more attractive for people in good health that makes the expenses of the traditional Medicare pool that much harder to meet so you can envision a story where enough people go into Medicare Advantage that the traditional program either deteriorates in quality or just ends up be very, very expensive on a per person basis as it stands now close to 40% of new beneficiaries opt for Medicare Advantage and that's largely because it's a better deal for many of them a lot of it is probably because people don't really understand the issues because who wants to read through insurance pamphlets but in any case they managed to get a very large share of current and new enrollees in Medicare and you can envision a point where the traditional program really has a hard time making ends meet 401k plans you know define benefit contribution plans these came into existence in the late 70s they were a clause in the tax code that I suspect no one in congress understood what they were doing but in any case these have largely eliminated traditional defined benefit pensions so if you get back to the 70s you had around 40% of the workforce had a traditional defined benefit pension those are almost gone you sell them in the public sector but in the private sector there's very few private companies that still offer traditional defined benefit pension a lot of people 401ks and of course it's not better than nothing but for most people they would almost certainly prefer saying okay I'm getting a thousand fifteen hundred two thousand a month from my pension I'm going to have that as long as I live as opposed to a 401k plan that often times people don't put enough money in they often have high expenses and again those don't typically give you an annuity that guarantees you money through your lifetime so if you happen to live a very long life which most of us probably want to do you might find that the money in your 401k is really good for you die so defined benefit pension plans have a lot of advantage but for companies 401ks are much easier they don't carry the same risk basically they dump it off on their workers so from the standpoint of people who don't like defined benefit pension plans they'd rather have workers take the risk than the company 401ks were really great and they were very very successful but I give the conservatives a lot of credit for designing ways in which you can have a piecemeal and never have to confront them head on and as I say they thought that way we should think that way one way to reverse their movement into 401ks IRAs give low cost public plans and a number of states have taken steps in this direction so you could take advantage of the fact that the states already have public employee retirement plans piggyback on those and offer the people working for private the option to join those plans and pay much lower administrative cost than workers currently pay with a 401k or an IRA you could also offer annuities which you don't generally have with a 401k or IRA so that's an option could be done at the state level and as I say several states have looked to do that public option Medicare plan again I mentioned that earlier same sort of story so if you say oh you know we don't want to get rid of private insurance we just want to give people an option for private insurance okay we could adopt their same terminology and use it to undermine private insurers rather than having them use private insurers to undermine Medicare okay last point just basic principles markets a tool we should think of the market like the wheel it doesn't make sense to say the wheel is bad you know people can be run over by a car and that's bad but the wheel isn't bad okay so what we have to do is figure out how the market works how we could structure it how we like the rich have done that they structure the market to benefit themselves we have to flip that around and structure a market so that it leads to greater equality same story with corporations corporations exist to make money so sometimes people talk about greedy corporations I think that's almost definitional that's why the corporations there it's there to make money so that's not a secret and again is that good is that bad well it's our job to make sure that there are productive ways so they can make money producing clean energy to my view that's a good thing they can make money producing good affordable housing to my view that's a good thing it's our job to make sure the ways in which they make money are serving social ends we don't do a very good job of that now you're welcome to not like corporations but they're there to make money so saying that they make money they're profitable they're greedy that's aside the point of course they do about what the market is what the institutions are and try to structure them to serve progressive ends rather than the answer