Category Archives: Articles

The Importance of Questions in Public Policy: A Conversation with Phil Bennett

Bennett speaks to Sanford students.
Photo: SJPP, 2017

According to Phil Bennett, questions are more important than answers. On November 28th, the Emmy-award winning journalist and Sanford professor spoke with students about the importance of asking the right questions.

Bennett has the experience to back up his claim. He has worked with The Lima Times in Peru, The Boston Globe, The Washington Post, and is now Special Projects Editor for FRONTLINE, an investigative public affairs program from PBS.

Questions drive investigative journalism.

Bennett explained with an example from his time at The Washington Post. The attacks on September 11th, 2001 ignited a massive change in U.S. foreign policy. Out of these horrific acts rose the questions “How did this happen?’ and “How will the U.S. respond?” The Post’s leadership recognized these questions would frame much of their reporting for the foreseeable future. Focusing their agenda to pursue specific stories allowed them to try to unravel how these events would impact the United States.

Over a decade later, important stories continue to flow from these questions.

But asking the right questions, and continuing to pursue them, can be difficult.

An increasing obsession with likes, retweets, and trending topics can divert attention away from the necessary questions journalists should be asking. In politics and policy, language and superficial statements can dominate the conversation, blinding reporters, and the rest of us, to actions occurring beneath the guise of speech.

For example, many trending stories involve President Trump’s speech, but not the actions his administration is taking. Trump’s comments about the NFL, administration staff, and the FBI take center stage. Less recognition is given to actions taken by federal agencies and changes in policy.

But Bennett suggested that there are still reporters asking the right questions. In a series of articles in Vanity Fair, Michael Lewis, author of The Big Short, the 2008 bestseller exploring the financial crisis, unveils the inner workings of the Department of Energy and the U.S.D.A. under the Trump Administration.

Journalists have also started to uncover the Environmental Protection Agency’s shift toward valuing the research and opinions of corporations and industry over those of its own scientists. These changes have had a profound impact on policies issued from the agency and the administration. In March, President Trump issued an executive order to review, and possibly rescind, regulations “that potentially burden the development or use of domestically produced energy resources.” As of this summer, under the guidance of Scott Pruitt, the EPA has acted to change more than 30 environmental rules.

Effective evaluation of public policy mirrors effective journalism. Questions allow us to clearly define problems, conduct evidence-based research, efficiently present possible solutions to current policy problems, and make decisions.

So what are some questions public policy students can ask themselves as they begin internships and jobs, take on projects, and engage in meaningful work?

  • What group or groups are we trying to help with a policy proposal? What group or groups will bear unintended consequences?
  • Is the present policy problem a symptom of a larger problem in society?
  • Can the present policy issue be subdivided into smaller issues?
  • What are the interdependencies between this policy problem and others?
  • Is the desired change going to play out incrementally or all at once?
  • What is the value of further researching an area as compared to the costs?

Whether assessing tax law, health or education policy, energy regulations, or national security, it is important to take a step back and ask the key questions. Rather than letting politics or the influence of social media guide research, we need to think critically, delve into the details, and implement evidence-based policies.

Gabrielle Murphy is a first-year MPP student interested in tax policy and public finance.

Education and Violent Extremism in Africa: The Importance of Evidence-based Interventions for National Security

The international development sector, especially in the United States, is facing an uncertain future. Long considered to be both a virtuous endeavor and a crucial mechanism for achieving US foreign policy aims, development assistance is struggling to remain relevant. Both politicians and citizens are skeptical of development aid and are increasingly focused on more traditional strategies to ensure national security, particularly in the face of the growing threats of terrorism and violent extremism. Shifts in spending priorities call into question the longevity of US investments in education and women’s empowerment, as well as the continued existence of the US Agency for International Development (USAID) and State Department in their current forms.

Education, Workforce Development, and Violent Extremism in Africa

However, as US military leaders have argued, development assistance can be just as important as defense spending to ensuring our national security. Clear connections can be drawn between expanding access to education and workforce development—areas in which USAID has built expertise—and countering violent extremism (CVE), a top foreign policy priority of the Trump administration. Violent extremist groups often recruit from the young, poor, disenfranchised, and marginalized populations of a society, which include many of the same individuals targeted by education and workforce development programs.

These connections are especially clear in sub-Saharan Africa. Africa’s youth population is growing far more quickly than the number of jobs available, leading to high rates of youth unemployment across the continent. Ten to twelve million African youth enter the workforce each year, but governments struggle to create opportunities for them in economies that are often still largely agricultural. Between 2000 and 2007, the working-age population in Africa grew by 96 million; only 63 million jobs were created during the same period.

In the absence of quality education and gainful employment, African youth may be more susceptible to recruitment by the extremist organizations gaining influence on the continent. Helping African governments figure out how to break the link between unemployed youth and extremist organizations will be a crucial policy issue for the US government as Africa’s power and population grow.

A  constructed classroom by USAID.
Abdulaziz Bashir, USAID (2017)

Education and Violent Extremism: The Evidence

 It is easy to imagine increased US support for education and workforce development programs in Africa as one solution to this problem – if African youth have access to education and jobs, courtesy of USAID-funded programs, they will be less susceptible to recruitment by extremist groups. However, reliable evidence on the relationship between education and violent extremism is actually quite scarce.  An evaluation published last year by US-based NGO MercyCorps of the impact of access to education and civic engagement programs on political violence in Somalia suggests the story is more complicated than it might seem.

The MercyCorps-led impact evaluation, which examined the effects of a USAID-funded program in Somaliland called the Somali Youth Leaders Initiative (SYLI), suggested that education can make youth either more or less likely to become involved in political violence, depending on both education quality and the larger context. It found that while increased access to secondary education reduced youth participation in political violence by 16%, it increased youth support for political violence by 11%. However, when access to education was combined with opportunities for youth to become more civically engaged in their community, participation and support for political violence dropped by 14% and 20%, respectively.

Impact of Youth Leader Initiative on Stability
Mercy Corps (2016)

While additional evaluations are necessary to confirm these results, the story they tell makes sense. Educated youth living under repressive or inept governments with no access to meaningful work opportunities may become increasingly frustrated with their situations. They may then be more likely to turn to political violence as a way to affect change. However, if youth are given positive strategies for changing their lives and communities along with access to education, and see their education as linked to a better future, they may become less likely to resort to violence than their uneducated peers.

The Impact of Education Quality

 Especially in sub-Saharan Africa, the relationship between education and violence is further complicated by the question of the quality of education youth can access. Over the past decade African governments (with support from funders like USAID) have successfully increased the percentage of African children enrolled in school. However, in many cases this increased access has come with lower quality; children are now attending school, but are not learning.

MercyCorps’ study shows evidence of this trend. It found that youth with access to education had a much less favorable view of government performance in providing education – probably because they were receiving low-quality education. African governments, and their international partners like USAID, need to be worried not just about whether youth are in school and engaged in their communities, but also about whether poor-quality education is adding fuel to the fire.

Implications for Funding and Policy

As MercyCorps’ research illustrates, US policymakers concerned about the rise of extremism in Africa should think twice before abandoning US investments in education on the continent. While proposed budget cuts to USAID have yet to be approved by Congress, general consensus within the Agency is that education, environment, and gender programs are likely to be scaled back, while spending on health is likely to be maintained. Advocates for education within USAID, the State Department, and their partner organizations need to focus their message to ensure elected officials and the public understand the links between education and extremism and continue funding education interventions.

More research is needed to fully understand the relationship among education, civic engagement, and violence. However, evidence from the MercyCorps study suggests that even if funding for education is cut, prioritizing education quality, workforce development, and civic engagement will maximize the effect of US education spending on violent extremism. USAID and its partners should prioritize these strategies now, but especially if anticipated budget cuts come to pass. While the international education sector needs to tailor its advocacy message to align with the US government focus on CVE to minimize budgetary impacts on its work, it should also focus on incorporating empirical evidence like MercyCorps’ study into project design to improve learning outcomes and decrease violence.

Increasing access to quality education in Africa should be a central component of the US government’s CVE efforts on the continent. However, evidence also suggests that USAID must consider the larger context in which education takes place to ensure their programs actually increase the opportunities available for youth, rather than just their frustrations.

Sarah Maniates is a second year MPP student at Sanford concentrating in international development and education policy. She spent the summer interning with USAID’s Bureau for Africa.

Congressman Schiff’s Call to Action

Congressman Adam Schiff gave the Terry Sanford Distinguished Lecture on October 30, 2017 at Penn Pavilion. The conversation was moderated by Professor Bruce Jentleson.
Photographer: Jackie Park

Representative Adam Schiff spoke at Duke University as part of the Terry Sanford Distinguished Lecture Series on October 30th, the same day Special Counsel Robert Mueller handed down the first indictment in the Trump-Russia investigation.

Schiff is the U.S. representative from California’s 28th district and the ranking Democrat on the House Intelligence Committee. As a member of the committee tasked with investigating Russia’s interference in the 2016 presidential election, Representative Schiff addressed questions about President Trump’s former campaign manager, Paul Manafort, who had been indicted earlier that day, and former Trump aide, George Papadopoulos, who was currently cooperating with federal investigators. Schiff spoke to the difficulty in measuring the cumulative effect of advertisements, tweets, and cultural messages propagated by Russia prior to and continuing after the election. He spoke with concern about the weaponization of language, the polarization of the media, and the fear that democracy itself could be dismantled “brick by brick.”

And while Schiff has lived and breathed the particulars of the House investigation for nearly a year, he still challenged those in the audience to take a step back from it:

“What’s the bigger picture here? For everyone in this room, we’ve lived in a world that was ever expanding in its freedoms. And each year, more of us lived in democratic societies, and more of us had a free press, and more of us had the right to practice our faith and associate with who we would, but we may now be at a point where we cannot say that will be true next year.”

As Representative Schiff responded to each of moderator Bruce Jentleson’s questions, it became increasingly clear why he’d been chosen to speak as part of The Terry Sanford Distinguished Lecture Series which focuses on bringing “men and women of the highest personal and professional stature” to Duke University. Schiff’s answers felt larger than the questions themselves. He didn’t just address the possible collusion, or the constitutional crisis the country might face were Trump to fire Mueller, he cut to the core of democracy itself—and to the individual role of every American within it.

Speaking passionately, but with his characteristic calm, Schiff made clear his belief in America as more than just a country, but an idea, too. “It’s incumbent on all of us, to be champions of that idea”.

Schiff said that growing up in Boston, President John F. Kennedy’s famous words, “Ask not what your country can do for you” was so much a cultural touchstone that it inspired him to a life of public service. But at the lecture he wondered aloud:

“Why would anyone want to get involved in something so crass, so ugly as our political environment right now? I feel like everyone in my generation should apologize in everyone in your generation for handing off a piece of work.”

But Schiff did more than apologize, he put out a call to action:

“We need you,” he said, looking out at the Duke students, faculty, and staff assembled. “We need you more than ever. With the incredible array of things going wrong, it’s tempting to say I’m not going to begin at all. And I would just say to you, don’t try to do it all. Just decide in the next year, or two years, or however long it takes, I’m going to make a difference on the thing I care most about.”

Congressman Schiff then paused, “We’re all going to be held to answer for what we do right now.” He returned to Washington D.C. the next day. 

 Meg Fee is a first-year student at the Duke Sanford School of Public Policy focusing on food policy.

Taxing the Digital Economy: Challenges in the European Union

Tax policy reform specifically targeting the digital economy has become a hotly debated subject in the European Union (EU). In recent years, several EU member states have faced issues in taxing digital technology giants like Amazon, Facebook, and Google. Supporters of reform, such as the governments of Germany and France, argue that companies operating in the digital arena profit unfairly of their internet-based operations. Others, such as the governments of Ireland and Luxembourg worry that tax reform could lead to double taxation and higher prices. While reform on corporate tax policy for the digital economy at the global level is far from reaching a consensus, the European Commission (EC) is calling for immediate change. Just last month, in a report prepared for the European Parliament and the Council, the EC called for reform in the corporate tax framework within the EU.

Corporate Tax Climate in the EU

Corporate tax rates in the EU are already low when compared to other groups and regions, despite the common belief that Europe taxes corporations heavily. The average statutory corporate tax rate in Europe is 18.35%, the lowest among all other regions in the world. As shown in Figure 1, the average statutory corporate tax rate in the EU’s 28 member states is 21.85%, making it the third lowest rate after Europe as a whole—all 49 countries—and Asia. If we look at tax policy reforms from this comparison, it would not be unreasonable to think that there is room for increasing the corporate tax rate within the EU.

Figure 1. Average Statuary Corporate Tax Rate by Region or Group

Growth of Digital Technology Companies in the EU

In the last decade, digital technology companies have significantly outperformed traditional brick-and-mortar companies. In 2006, only one digital technology company was among the top twenty companies in the EU, accounting for 7% of the market share among these high performers. Today, nine digital technology companies are in the top 20, accounting for a far more substantial 54% of market share.

Between 2008 and 2016, the revenue of the entire retail sector in the EU grew 1% on average. In the same period, the revenue of the top five e-retailers grew 32%. Yet, due to the virtual nature of business conducted by these digital technology companies, tax loopholes were invariably created, preventing many EU member states from collecting taxes on profits from such companies.

Difficulties in Taxing the Digital Economy

Unlike traditional companies, where profits are taxed at value creation, digital technology companies conduct most transactions electronically. This makes it challenging to capture where value is created, what it is, and how to measure it.

Additionally, companies are taxed through permanent establishment rules. The report published for the European Parliament and Council specifies that these rules are “used to determine the threshold of activity that needs to be carried out in a country in order for a business to be taxable in that country and are largely based on physical presence”. So, while digital technology companies operate virtually all over Europe, their profits are taxed only in the state where they have a physical establishment.

Last summer, France lost a case against Google, which has a “permanent establishment” in Ireland, and consequently did not have to pay a 1.11 billion Euro tax bill to France. The EC expressed concern regarding the fairness of this rule, arguing that such companies have access to markets, infrastructure and regulatory institutions all over the EU, but “are not considered present for tax purposes.”

The issue becomes more complex when considering that even when taxes are collected, the average tax rate for digital companies ends up being much lower than that for non-digital, traditional companies. The Centre for Economics and Business Research found that in the United Kingdom, Amazon pays 11 times less corporation tax than traditional booksellers. Differences on effective average corporate tax rates between digital technology companies and traditional ones, within the EU, are shown in Figure 2.

Figure 2. Effective Average Corporate Tax Rate by Business Model in EU-28

The fact that there are different corporate tax rates in different EU member states is another implication. Differences in corporate tax rates indicate that states with lower rates might benefit more from the “permanent establishment” rules since many digital technology companies are physically headquartered there, as in the case of Ireland.  At 12.5%, Ireland offers one of the lowest corporate tax rates within the EU, as shown in Figure 3. Many digital giants have set up their headquarters in Ireland as it is also considered to have an overall better business environment. However, the EC has raised questions on the magnitude of benefits that these low tax-rate states receive from tax collection. Last year, the EC found that in 2014 Apple paid an effective tax rate of only 0.005% to Ireland, leaving an unpaid tax bill of around 13 billion Euros.

Figure 3. Corporate Tax Rates by EU Member States

In Defense of Digital Technology Companies

Arguably, the attitude of the European Commission, especially of Margrethe Vestager, who is the EU’s competition commissioner, has sometimes been described as openly belligerent against these digital giants. Some have argued that the changes in corporate tax policy outline would create a “hostile work environment” for US businesses. Uncertainties among consumers may also arise since such reforms could lead to changes in prices, which could directly affect consumers within the EU. Finance Ministers from Ireland and Luxembourg, who are not in support of proposed changes, have raised the issue of double taxation as another concern. Moreover, the framework of the international tax rules would need to be re-written in case different countries and regions start to neglect or redraw rules concerning permanent establishment or transfer pricing.

EU’s Policies Forward

The report released by the European Commission addresses some of the abovementioned concerns. While in the long run, the EU is planning to move towards an integrated Digital Single Market (DSM), where rules regarding digital economy would be harmonized among all EU member states through policies such as Common Consolidated Corporate Tax Base (CCCTB) – “a single set of rules to calculate companies’ taxable profits in the EU,” as a short-term measure, the report suggests an “equalization tax on turnover of digitalized companies.” This, the EC believes, would address the issue of fairness within the EU member states, since taxes would no longer depend on “permanent establishment” but rather on “income generated from all internet-based business activities.”

Unlike traditional companies, digital companies already operate virtually all over the EU, while maintaining a “permanent establishment” in the countries with the lowest tax rates. Some believe that low tax rates helped states such as Ireland or even the UK, but as in the case of Apple in Ireland, even these countries do not always generate revenues from their already-low rates. Targeting digital technology companies would narrow the current gap in tax rates between these companies and non-digital, traditional companies.

Finally, we need to bear in mind that the EU is not the only region considering tax policy reforms for the digital economy. Along with numerous countries around the world, major international bodies such as the OECD have joined the discussion to resolve challenges of taxing the digital economy. Indeed, issues related to rules such as “permanent establishment” go beyond the EU borders. Although EU member states have not reached a consensus on joint policies forward—often a challenge in the EU—the need for reform regarding the taxation of the digital economy seems to be imperative at the global level today.

Edison Jakurti is a second-year Master of International Development Policy (MIDP) student at Duke University focusing on applied economics.

Combatting the Effects of Climate Change and Global Disparities in Energy Access through Solar Electrification

 

Climate Change: Current State

Source: NASA

Climate change discussions are nothing new. Fossil fuels and alternative energy discussions have been in place since before Al Gore’s Inconvenient Truth in 2006, and will continue long after this year. NASA reported that 2016 was the warmest year globally, and 2015 was the warmest before that, illustrating gradual increases in temperature. In turn, rising temperatures have contributed to increased intensity of weather related threats such as hurricanes, like the devastating Hurricane Matthew in North Carolina last year. Rising temperatures have also contributed to warmer water and air around the Antarctic, which recently resulted in a large iceberg, the size of Delaware, breaking off from Antarctica and “fundamentally changing the landscape of the Antarctic peninsula.” As the landscape around us reacts to changes in the environment, what does the future hold?

David Wallace-Wells, a journalist focusing on climate change and the environment, recently outlined his vision to this question in a New York Magazine article “The Uninhabitable Earth.”  He paints a bleak future where disease burden increases, increased violence erupts, economic instability rises, and humanity faces the consequences of the resulting turmoil. Wallace-Wells warns “parts of the Earth will likely become close to uninhabitable, and other parts horrifically inhospitable, as soon as the end of this century.”

Global Disparities in Energy Access

Source: USAID

In order to feel the gravity of climate change consequences, one should first understand the disproportionality of electricity access and energy consumption. In the United States, virtually everyone has access to electricity. At the same time, the U.S. is also one of the highest contributors of greenhouse gas emissions. The country produced 6.587 million metric tons of Carbon Dioxide in 2015, with 29% from electricity use.

Compare this to the 1.2 billion people (16% of the global population) who lack access to electricity. Nearly 95% of this energy-poor population resides in rural Sub-Saharan Africa or Asia, revealing one of the largest development challenges of our time. The world’s population is expected to increase to 9.7 billion by 2050, with half the growth occurring in Africa. If these individuals were to gain access to electricity via natural gas or coal, given the expected population growth, it is likely that the Wallace-Wells perspective of climate change will be a quickly emerging reality.

So how are businesses tackling both the development challenge of increasing global electricity access while simultaneously understanding the importance of sustainability and limited resources?

Sustainable Developments in Solar Electrification 

Source: Matthieu Young, USAID

Enterprising companies have been creating alternate sources of renewable energy to bring electricity to individuals in Sub-Saharan Africa and Asia. By moving straight to clean technology and renewable energy in the form of solar and wind powered electricity initiatives, these companies are “leapfrogging” past the detrimental effects of natural gas and coal. This is right in line with the United Nations Sustainable Development Goal number seven to “ensure access to affordable, reliable, sustainable and modern energy for all.”

Electrifying Sub-Saharan Africa is important – not just for those living in the region but also for the world. Increased access to affordable and reliable electricity will help poverty alleviation, as there are increased opportunities for business growth, longer hours of operation, and the ability to integrate technology into daily life. Hospitals are able to treat patients in better conditions, leading to overall health improvements. Schools are able to increase students’ access to education through different information communication technologies leading to increased teacher retention and student completion rates.

The main push, as described by Bill McKibben in the New Yorker, has been a “Race to Solar-Power Africa.” McKibben describes how both American and African led businesses are using innovative and affordable mechanisms to supply electricity though affordable off-grid solar kits in Sub-Saharan Africa and South Asia.

Off-grid solar power systems do not require the same cumbersome and expensive infrastructure that currently exist in the United States. As a result, these innovative systems help cut labor and capital costs in bringing electricity to regions previously without access. These systems also help lower long-term costs as they are affordable – essentially the same cost, if not lower, as traditional kerosene – and provide clean electricity lasting up to four times longer.

Both the affordability and increased duration of electricity are partially due to the drop in prices of solar panels, coupled with technology advances enabling the creation of more efficient light bulbs.

Innovative Solar Companies

Several solar companies and entrepreneurs are entering the electrification space in Sub-Saharan Africa because it is relatively nascent and not yet monopolized. Companies are entering the market through different avenues including as a solar panel providers, solar panel installers, as utility companies, or as wholesalers or retailers of solar products.

One American company, Off-Grid Electric, sells a starter kit including “a panel, a battery, a few L.E.D. lights, a phone charger, and a radio” priced at just $8 a month for three years. After the three years have passed, the family or individual then owns the kit.

Black Star Energy, a Ghanaian company offers solar power in the guise of a utility company. Black Star installs solar micro-grids in communities needing electricity. Unlike Off-Grid Electric where individuals pay for the physical equipment, Black Star users “will always pay bills, but the charges start at only two dollars a month.” They are essentially paying for the utility of electricity, and therefore, will never own the technology themselves.

These personal home solar kits are one sustainable method by which to electrify Africa. Innovations, such as Off-Grid Electric, have gained traction due to venture capital support from Silicon Valley and USAID’s Power Africa mechanism which pledged four million dollars to solar start-ups focusing on African off-grid energy.

The benefits from electrification will help Sub-Saharan African nations close the gap in energy poverty while rising against several existing development challenges. Leadership from these nations benefitting from renewable energy initiatives will be essential in curbing global climate change threats, and can perhaps alter the way we currently think about development and growth.

Rohini Ravi is a second year Master of Public Policy focusing on international development and global health.

 

 

The Intrinsic Durability of Obamacare

Source: Quora

Despite having control of the Senate, House, and Presidency, Republicans have been repeatedly unsuccessful in their attempts at repealing the Affordable Care Act and replacing it with an alternative. The fight drags on; on Tuesday, the Senate narrowly voted to advance to floor debate, and needed Vice President Mike Pence to cast a tie-breaking vote. An economic concept called loss aversion provides some insight into the uphill battle Republicans are facing with a healthcare replacement. It also indicates that voters are even less likely to support a “repeal-now, replace-later” plan.

Introduced by behavioral economists Daniel Kahneman and Amos Tversky, loss aversion refers to the idea that people feel more pain when they lose something than pleasure when they gain something.

Kahneman explains the phenomenon in this way: Let’s say I told you that I was going to toss a coin; If it lands tails, you pay $10. How much money would you need to gain if you won, before you took the bet? “People want more than $20 before it is acceptable,” says Kahneman, “And now I’ve been doing the same thing with executives or very rich people, asking about tossing a coin and losing $10,000 if it’s tails. And they want $20,000 before they’ll take the gamble.”

Companies use this glitch to influence our behavior, too. Would you pursue a $10 rebate as doggedly as you would avoid a $10 surcharge? Gaining something is only about half as enjoyable as losing something is painful, according to empirical studies. So in the world of politics the threat of losing something, be it a part of your income or a service you’ve become accustomed to, can have a heavy impact.

This became the case with the Affordable Care Act. Initially, and for many years, the ACA was opposed by the majority of Americans. It was not until serious discussion of losing the act became part of the public discourse that the ACA gained majority approval in Gallup polls.

While it is the Republican Party’s general consensus that Obamacare should be repealed, the Congressional Budget Office’s well-publicized projections of coverage loss, Medicare loss, and insurance regulation loss have made their proposals deeply unpopular to the public. In June, the CBO forecasted that the Senate’s plan would leave 22 million more people uninsured. The gains that they tried to sell, like decreasing taxes and lowering the deficit, have not been very effective. In an unexpected move last Tuesday, Republican Senators Mike Lee and Jerry Moran joined Senators Susan Collins and Rand Paul in announcing they would vote against the Senate’s latest bill. Because Republicans have only 52 seats in the Senate, losing any more than two votes is fatal. These defections sank the bill, which was only narrowly supported.

Finding consensus between the moderate and hard-right wings of the party has proven to be extremely difficult. “This has been a very, very challenging experience for all of us,” McConnell told reporters following the bill’s collapse. “It’s pretty obvious that we don’t have 50 members who can agree on a replacement.”

Once something becomes the status quo, it becomes more difficult to do away with because of loss aversion. It is this phenomenon that makes it difficult to alter welfare and service programs once they have been put in place, and it is one reason why Social Security is a third rail in Washington.

Politically, Obamacare is inherently difficult to repeal. Obamacare sought and succeeded at creating a rapid expansion of coverage over the course of President Obama’s tenure. An expansion in the economy that, once in place, created a new status quo; not only for individuals, but for health-related businesses. Interestingly, many at the far right of the Republican party came to power during the Tea Party movement. It was a movement that began in response to the threat of a different loss from the status quo; the increase in taxes that came with Obamacare.

The Senate’s latest proposal, to repeal parts of the Affordable Care Act with no required replacement until two years down the line, would increase the number of uninsured by 17 million next year and 32 million by the end of a decade. Immediately after its introduction, this idea was opposed by three Republican Senators, Shelley Capito of West Virginia, Lisa Murkowski of Alaska, and Susan Collins of Maine, who announced they would vote against it.

This plan is likely to generate and even stronger sense of loss aversion. Supporting Senator McConnell’s plan to repeal now is essentially a choice between keeping the status quo, and rolling the dice with the hopes of getting a better outcome in the future. This will be an even harder sell than the one from last week.

Political rhetoric about loss is common and effective. “Loss” was something that President Trump used to great effect in the election, by saying that people will lose their guns, lose their money (through higher taxation), or lose their job to globalization. Rhetoric is not reality however. Should Congress pass a bill that takes away people’s healthcare, voters will feel the losses directly. Despite Tuesday’s vote, repealing Obamacare is still a long shot.

Neil Browning is a 2017 Master of Public Policy graduate interested in public health, development, and international affairs. He was the editor-in-chief of the Sanford Journal from 2016-17.