 By: Sophia Halloran, Emma Kiesling, and Daniel Ohiri
On Friday Nov. 1st the GW Roosevelt Institute held a Fireside chat entitled “Can the Blue Wave Fix the Opioid Crisis?” We were so excited to host Kate Werely, Health Policy Advisor for Representative Mike Doyle (D-PA18); Osa Imadojemu, Deputy Committee Director, Committee on Health at Council of the District of Columbia; and German Lopez, senior Vox correspondent on our campus (watch it here). Our discussion of policy solutions was wide ranging, covering past, present, and future solutions to the opioid crisis. The focus rested on policies the government can enact to help the healthcare community get treatment to people, as well as policies the healthcare community is enacting itself. The tension between the powerful PHARMA industry, lawmakers, doctors, and nurses is causing unnecessary and preventable deaths. The actors listed as well as the American people know that action needs to be taken especially as the crisis is waning from public attention, despite families still being torn apart. The following is a list of ways to begin approaching the Opioid Crisis: What is the progressive response to the Opioid Crisis?
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 By Daniel Ohiri
Let me begin with a story. During my entire summer break, every Thursday at 3:00 pm I’d get a call. Each time the call would devolve into shouting matches and veiled threats. Who was calling me? A debt collector by the name of Medical Revenue Service (MRS). This firm has a negative history of buying old hospital debt, harassing consumers daily, and making threats. MRS had been calling me about an old GW Hospital bill that I had received during last semester. Without going into specifics, I was in dispute with GW Hospital and my insurance company over the cost of this bill. During the time of that dispute, GW Hospital sold my debt, probably for pennies on the dollar, to MRS. There is a debate within the world of consumer financial protection as to whether selling debt to third-party firms is in the best interest of the consumer. Looking past that debate, we can acknowledge that our current system allows for the existence of third-party debt collectors and promotes their ability to buy debt. Therefore, I believe we should be able to agree that this industry needs to be regulated. MRS would call me weekly trying to flip the debt they had bought from the hospital. Now, as a general rule, I tend not to give my debit card information to third-party firms of any type. Instead, I moved to deal with the bill through the GW Hospital billing department. After the dispute between the hospital and my insurance had ended and the debt had been settled, MRS continued making their weekly calls, becoming more and more aggressive. Even though my insurance and I had jointly paid GW Hospital directly, the MRS collector continued to call and verbally abuse me: she didn’t believe that my debts had been paid. She relied on her “gut” and not the record, commenting, “people like you don’t pay bills, I don’t believe you paid anything.” After that, I requested to have my name taken off their call list and I blocked their number. I wondered how and why a debt collection agency could be so unprofessional. I did some research on MRS and found that their holding company was Medical Data Systems (MDS). I found that MDS houses its collection agencies in Florida and Alabama—states with lax regulations on debt collection. Florida doesn’t require background checks or even force debt collectors to register with the state. Alabama also doesn’t require background checks for debt collectors. I was being harassed by people that were not accountable to public authority. They weren’t even accountable to GW Hospital. Their only focus was to turn a profit on a debt that they had bought. This needs to change. Actions need to be taken on the statewide level to better regulate this industry. ACTION ITEMS:
 Testimony given by Roosevelt @ GW Member Sean Ruddy before the Budget Oversight Committee, DC City Council: Hello, my name is Sean Ruddy and I am speaking on behalf of the Roosevelt Institute at The George Washington University regarding affordable housing in the upcoming DC Budget. Housing affordability is important to our community because we understand the tremendous value of our city’s diversity, and we believe that anybody who wants to live in our vibrant city should have the ability to do so. Without sufficient affordable housing spending, we expose our fellow Washingtonians to heightened risk of displacement. Housing is a fundamental right, and by failing to secure that right in an equitable way, we lose a myriad of voices in our community, along with their charm, their stories, and their ideas and wisdom. I fear that this budget marginalizes low-income DC residents who have never called any other place home
As you are aware Mayor Bowser recently released her budget for fiscal year 2019. We demand that her budget reflect a commitment to fight the increasingly dire need for affordable housing in the District in a way that significantly addresses the crisis at-hand. Instead the proposal only provides $217.4 million of a $14.5 billion budget to affordable housing; thus, the entirety of the District’s spending on housing programs constitutes a measly 3% of the budget, nowhere near enough to address the persistent issues related to housing and displacement. As D.C. residents, we want our city to offer equitable economic opportunities to all its citizens and we express disappointment in the Mayor’s failure to adequately address these concerns. The Fair Budget Coalition recommends $423.97 million in annual funding to address these problems, almost double the amount of the Mayor's proposal. In addition, only a small amount of the $217.4 million directs funds to increase housing opportunities for the city’s residents at 0-30% area median income (AMI), the sector of the population most likely to face the threats of displacement and homelessness. Three-fourths of DC families who face severe housing challenges fit within this income range, but only 29.4% of the funds under the Bowser plan target programs for this group. Having affordable and consistent housing is a vital component to living a healthy and productive life, and the District has a powerful opportunity to provide their citizens with this necessity. Without provisioning adequate funds for access to the right to housing, it will be virtually impossible for low-income residents to escape poverty and improve their economic outcomes. The Fair Budget coalition said that the District needs to build a minimum of 26,000 units over 10 years (beginning in fiscal year 2019) to accommodate the housing demands of the most low-income residents amidst the District’s ongoing economic growth. Half of these units must come from units available through local rent supplement vouchers and the other half from new housing production, locally owned public housing, and enforcement of existing inclusive zoning provisions. Much of this second half is funded through the Housing Production Trust Fund but the Mayor’s plan only offers an additional $100 million in spending for the Trust Fund, thereby fails to provide enough funds to meet the Fair Budget Coalitions recommendation. The DC Fiscal Policy Institute also found that the District often fails to enforce the 40% statutory requirement for extremely low-income households in Trust Fund spending. In the coming year, we appropriately address this crisis by allocating at least $300 million to the Trust Fund as well as enforce elements of its statute that secure housing for 0-30% AMI Washingtonians. The Mayor's plan also provides no new funds for tenant-based vouchers despite the large number of residents on waitlists, some of which have been on the list for 10 or more years. Adjusting for inflation the voucher program will actually experience a 2.2% cut in funding. This is unacceptable, as cuts to this vital and necessary program means more families will not be able to access affordable. The Council has the opportunity to revise this plan, promoting adequate funding to address this crisis of housing and equitable economic development. As a group of actively involved DC student, we want our local government to pursue policies that represent our values and work to sustain a dignified quality of life for all Washingtonians, including the essential right to housing. However, if you accept Mayor Bowser’s proposal the District will fail to provide for its citizens most susceptible to the negative effects of rapid economic growth. We urge the Council to match the The Fair Budget Coalition recommendation of $423.97 million in annual funding for housing affordability and that the council heeds our call to do better for the whole of Washington, DC. March 24, 2018 We, as a coalition of student organizations at The George Washington University, must ask ourselves, “How many more lives must be lost before lawmakers realize they cannot hide from the issue of gun violence?” Constant heartbreak and despair cannot be answered with thoughts and prayers alone. No American, no child, should have to pray to avoid being killed in their schools, workplaces, or their homes. This is not acceptable. The March for our Lives represents a call to action. The only way we can hope to mitigate these atrocities is for our leaders to pass and enforce comprehensive gun violence prevention legislation. Such legislation must include, but should not be limited too:
We call on Congress to speedily pass these measures, and we call on the Student Association and the administration of The George Washington University to echo our demands. In addition, we call upon our university leaders to elevate our local power in response to this national crisis by doing the following:
The students at GW and students across the US have a responsibility to ensure that our fellow Americans are not being gunned down in places that should be safe. Our actions must begin this Saturday, by taking part in the March for our Lives. We must march hand in hand with the students of Marjory Stoneman Douglas High School and students all across the country and we must make our voices heard loud and clear to make it known that we won’t go away any time soon. However, Saturday cannot and must not be the end of our actions. We must continue to pressure our leaders at both the state and the federal level to take action to prevent gun violence. And if they refuse, we must hold them accountable at the ballot boxes this November, voting for candidates who will heed our call. Sincerely, Roosevelt Institute Colonials Demand Action By Emma Kiesling, Roosevelt at GW Member
The National Institute of Justice found that within five years of release, about three-quarters of released prisoners are re-arrested. The District of Columbia’s rate of over 60% isn’t much better. Recidivism is a problem communities have long struggled with; returning citizens are often released from jail the first or second time without any prospects for employment. The DC inmate population is 89% black, and over half of it of it comes from the wards you’d expect if you’ve been in DC for long enough: wards 7 and 8. In these districts, poorer, African American residents are quickly surrounded by the same environment that drove them to crime in the first place, the mostly African-American jail population is arrested over and over again. Lacking college degrees, high school diplomas, and even GEDs, employment options are slim to none. A criminal record is liable to cut of up to 60% of the job market from a returning citizen. Employment has been shown to significantly reduce recidivism to rates of less than 10%--give people a steady income and they have opportunities to change their patterns of behavior. However, fifty percent of the District’s returning citizens are unemployed. In fact, the relationship between crime and incarceration is actually pretty complicated. New dealers and offenders quickly take the place of drug offenders who are incarcerated, and much of the District’s jail population is arrested for failure to appear in court or parole violations. The landscape seems pretty bleak—it seems like we must be struggling to find a solution for the quantity of repeat offenders and the frequency of their repetition. However, over the past few years, a pretty clear picture has emerged of exactly what solutions exist to help conquer recidivism anywhere. It’s a long list of possibilities—the kind of list a district or city can tailor to its specific desires. Programs range from the highly effective educational and vocational training to substance abuse treatment to effective re-entry assistance. The District already offers convicts the opportunity to get their GED while incarcerated, which has as of yet failed to significantly drop recidivism rates. It is important to keep in mind that the goal of all of these programs from the government’s point of view is fewer inmates. Fewer inmates mean lower costs and a more appealing budget: the ultimate win-win for districts pinched for cash and worried about crime rates. Ronald Reagan boasted about the 34% reduction in California’s state prison population during his tenure as governor, despite his reputation as a hard-liner on crime. The District can and should implement any or all of these programs to reduce recidivism; they vary in scope and cost but they all have the same goal. When listed, it is evident that thought has been put into just how many ways returning citizens might get help—organizations like ReThink Justice, The Sentencing Project, and the Justice Policy Institute are currently working in the District to educate the public and promote the long list of policies that can reduce recidivism in the District. How effective are the various programs the District has at its disposal? Educational training, the best-documented form of recidivism reduction, produces a 20% reduction in recidivism on average. Models vary in scope: some train convicts in vocational skills or for their GED, and some go further, providing college courses, since it is challenging for returning citizens to get jobs even if they do have their GED. Some of the nation’s most effective programs combine educational and vocational training with housing aid and additional assistance after imprisonment, while returning citizens search for a job. The Last Mile operates out of the San Quentin prison in California and teaches prisoners about technology and business, achieving a stunningly low recidivism rate of 7.1%. With the goal of employment, many programs focus on strengthening the resources and capabilities of halfway houses--one of the most fundamental forms of re-entry assistance. Additional re-entry assistance reforms include helping returning citizens obtain government-issued ID’s and instituting sealing provisions that will protect people who finish their sentence from employment discrimination based on the past offense. There are numerous policy-side ways to make the re-entry process easier for returning citizens: probation eligibility and parole procedures can have huge effects on the actual incarcerated population. Yes, the list of solutions is long. One of the most effective forms of recidivism reduction is mental health treatment. Mental health treatment programs often take more commitment than other programs, but they make up for it in cost-saving. Mental health treatment has a success rate of 60-80% when applied as preventative care—effective early intervention. Types of mental health treatment range from crisis intervention teams (CIT)—a type of coordinated community policing across public services—to modified therapeutic communities—an intense, closely monitored version of rehabilitation. Similarly, treatment for substance abuse is also highly effective. Substance abuse treatment programs have yielded up to 30% recidivism reductions in a state context; rather than locking up drug offenders, these programs ensure that individuals are healthy and fit to return to society in a humane, conscientious way that is much more successful than incarceration. Another approach to drug cases is drug courts, which operate in nearly every state. They are costly up-front but save big in the long run by reducing recidivism in drug cases by keeping individuals in treatment longer and out of jail. In this way, bureaucracy works best when expediency meets effectiveness: drug courts work directly with substance abuse treatment to reduce the incarcerated population and the recidivism rate. With such an army of solutions at their disposal, why aren’t governments driving down their prison populations in droves? The answer is that many are trying to—they don’t want all those inmates in their jails. But without an insistent public push for reform, progress is slow, clumsy, and prone to helping entities (like governments and private contractors) other than the inmates and returning citizens at the center of this debate. If we speak up about the need for humane solutions to recidivism, the government will listen; it is their win-win. Let’s place the spotlight on recidivism and all the things that can be done about it. BY NOAH WEXLER, ECONOMIC DEVELOPMENT POLICY BOARD
On September 22nd, members of Roosevelt Institute at GW met with Ed Lazere of the DC Fiscal Policy Institute (DCFPI), a chapter of the Center for Budget and Policy Priorities’ State Policy Project. As the Director of DCFPI, Ed researches the effects of the District of Columbia’s (the District) fiscal decisions and advocates for progressive revenue allocation. Ed graciously offered his time to discuss an overview of the District’s fiscal processes and how politics affects and shapes the municipal policy. He also provided his insight into contentious local policies and issues. Ed began the conversation by explaining the unique complexity of the District’s fiscal policy process. He noted that the District is a political anomaly in the nation; its City Council and Mayor essentially take on otherwise federal, state, and local duties. Furthering this unique situation, Congress has purview over the District’s fiscal allocations. Ed emphasized that up until two years ago, Congress actively reviewed every piece of legislation that went through the District’s City Council. If Congress did not review a bill, it was tacitly approved. The spectre of federal involvement still looms large in local fiscal processes. The imposition of a Federal Control Board over the District’s allocation process in response to the District’s fiscal crisis in the 1990s created a stigma against spending. Ed explained that the Chief Financial Officer of the District of Columbia consistently pushes for a budgetary surplus because of a fear of fiscal insolvency. The result: the District consistently generates a multi-million dollar surplus year after year, but the money is seldom invested into local initiatives that benefit low-income citizens. Ed highlighted how this lack of desire to invest fiscally results in effective programs being underfunded. One effective policy that goes underfunded is the District’s housing voucher program, a policy he feels is a politically palatable solution to the District’s affordable housing crisis. According to Ed, providing more vouchers that fund for rent payments in excess of 30% of residents’ income would effectively ensure accessible housing without angering DC’s politically influential development industry. Ed summed up the entire discussion bluntly and poignantly, saying that when it comes to affordable housing and development, so much would be fixed if “DC just put up the money.”  The Soviet Union launched Sputnik 1 on October 4, 1957 at 7:28pm. It was the world's first artificial satellite launched into space. That same month, the U.S. Defense Department approved funding for its own American satellite project. KATIE ALLISON, INTERNATIONAL AFFAIRS POLICY BOARD On this day in 1957, the Soviet Union launched the first satellite into orbit, inciting panic into the American public and demanding a response from President Eisenhower. Ignoring what has been learned in the past fifty nine years, there were a variety of policy options available to President Eisenhower at the time of the launch. This post will evaluate the policy options available to the United States government and their effectiveness—as though it were still 1957. Following the policy recommendation is a brief analysis of how this significant event, 59 years ago, still impacts both foreign and space policy today. Response Options to the Launch of Sputnik I On October 4, 1957, the Soviet Union became the first nation to successfully launch an object into orbit with their satellite, Sputnik.[i] The United States now faces the issue of determining an appropriate response. There will be psychological implications to this launch, especially in the United States and those countries currently fighting against Communism.[ii] Plans existed in both countries to put a satellite into orbit as part of the International Geophysical Year (IGY). The United States is now second in this race which will, undoubtedly, damage the nation’s pride and incite some amount of fear in its citizens. The public response will unquestionably ask for an increase in funding for space programs to close any perceived gap in technology. Contrary to public perceptions of a technological gap, the Army’s Redstone program, in September of 1956, successfully launched a Jupiter-C missile to an altitude of 682 miles, and achieved sufficient speed to launch a satellite into orbit, had one been on board.[iii] Therefore, there is only a perceptual gap in technology . The current source of fear is in Soviet military applications of this new missile technology. The USSR has shown no signs of developing a viable reentry vehicle or shield for any warhead, so these fears are, for the moment, baseless. The United States has multiple agencies tasked with Research and Development (R&D) of space launch and satellite technologies (the Air Force, Navy, Army and the National Advisory Committee for Aeronautics) which are cooperatingcompeting with each other. The USSR has established the precedent of the “Freedom of Space”, since their satellite went into orbit without backlash from the international community. Scientific satellite launches were agreed to as part of the IGY, therefore the United States will have no issue with the legality of future scientific satellite launches under this precedent. Intelligence gathering satellites may raise objections. Sputnik demonstrated that space is free to all countries because of the lack of objections from the international community over Sputnik’s radio signals differing from those agreed to under the IGY.[iv] Here are the following policy options for consideration: Option 1: The President will address the nation publicly and accelerate the planned launch date of the first US satellite by increasing funding to agencies involved in space/launcher R&D. Benefits:
Option 2: The President should address the nation publicly and inform them that the United States will not be frightened by the actions of another nation, and will launch a scientific satellite by the end of the IGY. The President will create a new committee to increase information sharing between agencies involved in space R&D, so that these agencies begin cooperative efforts. Benefits:
Option 3: The President will address the nation as he would in option two. He should then create a new government agency that would take over all space related R&D and instruct Congress to move all space-related funding to this agency. He will then instruct the agency to continue working on the Army’s Jupiter-C missile as a launcher. Benefits:
Seeing that the President has a plan and is calm in the face of crises will have a psychologically beneficial effect on the American public. Addressing the nation is a crucial part of all these options. Options 2 and 3 are the most highly recommended, as the information sharing aspects they create have the greatest potential for increased efficiency of space technology without dramatically increasing the economic costs of these endeavors. Option 3 is preferable to Option 2, as it would concentrate space technology under one agency, making R&D economically feasible and faster in the future and utilize technology that has worked in the past. Though the launch of Sputnik occurred 59 years ago, its implications are still visible in modern foreign and space policy. Despite the criticism President Eisenhower received for apparent inaction in response to Sputnik, his ability to maintain a calm demeanor throughout the period of public panic that followed the launch of the satellite is an example of demeanor that future presidents facing crisis should follow. The President resisted pressure to immediately increase the budgets of those working on a launch vehicle for spaceflight (NACA (the predecessor to NASA), the Air Force, the Navy and the Army), despite public and Congressional outcry. He relied on his knowledge of the technical capabilities of the United States and counted on those working on the space programs to meet the set deadline for a United States satellite launch as part of the International Geophysical Year. In the end, everything went according to plan—the United States launched Explorer 1 on January 31, 1958, and Eisenhower set a lasting example of remaining composed under pressure. The Soviet Union, unaware they incited panic throughout the public of the United States by its satellite launch, settled a legal argument that had been raging within the United States government for months about the freedom of space, which remains a key aspect of space policy to this day. Before the launch of Sputnik, international implications of spaceflight were and any negative repercussions of a satellite obritting above another sovereign nation was unknown. The Soviet Union set a precedent for the freedom of space that still exists today, and gives any sovereign nation the right to utilize outer space in a responsible manner. This precedent has allowed technologies that are now commonplace to be developed. Global Positioning Systems, advanced weather tracking, and satellite television, would be difficult to conceive if the freedom of space had not been established. [i] Diamond Edwin and Stephen Bates. 1997. "SPUTNIK - Forty years ago this month the Soviet Union orbited a "man-made moon" whose derisive chirp persuaded Americans they'd already lost a race that had barely begun". American Heritage. 48 (6): 84.
[ii] Executive Secretary of the National Security Council. 1955. Note by the Executive Secretary to the National Security Council on U.S. Scientific Satellite Program. [iii] McDougall, Walter A. 1985. The Heavens and the Earth: A Political History of the Space Age. New York: Basic Books. [iv] Quarles, Donald. 1957. Memorandum of Conference with the President.  Photo: Alzheimer's Association of Central and Western Virginia, c-ville.com NORA HENNESSEY, PUBLIC HEALTH PAC Three thousand walkers, each holding a flower or two that spun in the fierce morning wind, came together recently on the National Mall to memorialize the widespread effects of Alzheimer’s disease. The flowers we held came in four colors: blue flowers were given to those who have Alzheimer’s themselves, yellow for those supporting or caring for someone affected by the disease, purple for those who lost a loved one to the disease, and orange for those who supported the cause and vision of the walk we were participating in—a world without Alzheimer’s.
Lydia and Mia, the two girls with whom I was walking, each held one of these yellow flowers. In this moment it occurred to me that their flowers would eventually match the purple flower I gripped tightly in my hand. More than five million people are currently diagnosed with Alzheimer’s in the United States. This number is expected to increase greatly over the next ten years, with predictions putting Alzheimer’s patients in the U.S. at 13.8 million by 2050. Alzheimer’s is the sixth-leading cause of death in United States, currently costing the nation $230 billion. These expenses are expected to balloon to $1.1 trillion in 2050. In the District of Columbia alone, around 9,000 patients were diagnosed with Alzheimer’s in 2014, costing caregivers a total of $26 million. In December 2010, Congress unanimously passed the National Alzheimer's Project Act, which was officially made law a month later with President Obama’s signature . This legislation provided the United States with a much-needed framework for addressing Alzheimer’s and its effects on those with the disease and their caregivers. The main goals of this legislation are to evaluate the effectiveness and outcomes of federal funding of Alzheimer’s research, care, and facilities, and to create yearly recommendations on how to better the lives of those affected by the disease—both physically and financially. A council created specifically to advise on the issues surrounding Alzheimer’s oversees the implementation of these recommendations, and while the framework has provided a large step forward for the Alzheimer’s community, there is still more to be done. To help bridge the gap between the national outlines and local implementations, many states—including the District of Columbia—have made their own plans using the federal recommendations. Local policies need to be multifaceted and encourage increased research and medical treatments to address these issues. D.C.’s policy and plan for Alzheimer’s is, for the most part, well thought-out and comprehensive in this aspect. While the policy tackles Alzheimer’s most pressing issues, the plan is reliant on an inefficient system that lacks incentives for those involved to begin this process. In order for this plan to be properly executed, each goal depends upon roughly ten identified “responsible parties”. These parties take the form of governmental institutions, non-profit organizations, and advisory councils, as well as caregivers and those affected by the disease themselves. These constituents must therefore balance the responsibilities of each of these goals, fulfill their own duties, and hold the other parties responsible for their own roles in the achievement of these goals. To encourage cooperation, D.C. residents will need to speak out and encourage these organizations to actively engage and work on the implementation of this plan. While we may hope that these stakeholders would do this without prompting, the combination of bureaucracy and the lack of consequences for non-participation makes unlikely that this plan will be fulfilled in its five-year time frame without active incentivization. These incentives could include direct phone calls to the responsible organizations to encourage action, calls to the D.C. Office on Aging expressing the need for the consistent governmental oversight of the issue, volunteering in committees dedicated to addressing Alzheimer's, contacting local nursing homes and hospitals to convey the need for active research and investment in finding a cure, and encouraging local community and religious organizations to host coordinated group petitions for increased governmental action on the Alzheimer’s agenda. Alzheimer’s does not yet have a cure. There are only five experimental drugs to fight the illness after it has been diagnosed, and only one experimental treatment has been created to slow or potentially avoid the disease before it takes hold. In Colombia, an extended family with hereditary early-onset Alzheimer’s – one of eleven of its kind in the world – has consented to try the latter drug, but as it is a relatively new undertaking, its effectiveness is still unclear. Across the board, organizations that work on Alzheimer’s express the need for more money and for more patients to become involved in experimental treatments. Alzheimer’s policy that has been put in place is a step in the right direction if only we can agree to stick to it, to follow through on national recommendations and have our communities reach out to local states to initiate and pursue their own plans. Amongst a sea of purple flowers, and more that will one day likely be replaced by purple flowers, the orange flower projected more than any other. The orange flower is the hope that one day a an Alzheimer’s diagnosis will not mean inevitable death by dementia. The orange flower is the hope that gives people the strength to fight against the fading of yellow flowers into purple. We need more orange flowers. In the words of fellow walker Lydia Igna, “This is when your faith in humanity is restored: when you are in this giant group of people who come out to walk together in this frigid weather to support one another against this disease that affects so many.” |
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