Ripon Forum - September 2019 by The Ripon Society

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Mike Braun on his background in business and his new job in the Senate.

September 2019 Volume 53, No. 4

FACTS MATTER

Poppy MacDonald discusses the mission of USAFacts and the effort to combat misinformation heading into the 2020 election. Plus: What every American should know about the deficit, health care, foreign aid, immigration, and other key challenges facing America. With essays by Bill Hoagland, Gail Wilensky, George Ingram, & others www.riponsociety.org

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“Ideas that matter, since 1965.“ Volume 53, Number 4 Beyond the Beltway

Cover Story (cont’d)

On the Front Lines of the Fight Against Opioids By Christina Muryn The Mayor of Findlay, Ohio outlines the work her community has been doing to combat the drug scourge.

Politics and Perspective 6

What Medicare for All Would Mean for Us All By Charles Blahous

Why the Electoral College Should be Preserved By James Wallner

Cover Story 10

Facts Matter Q&A with Poppy MacDonald The President of USAFacts discusses the mission of her organzation and how the group plans to combat misinformation heading into the 2020 election.

What Every American Should Know About the Debt & Deficit By G. William Hoagland To erase the projected annual deficit of over $1.4 trillion in 2029, the economy would have to grow between 5 and 6 percent annually, more than double the current rate. What Every American Should Know about U.S. Foreign Aid By George Ingram Seventy-five years of U.S. foreign assistance has produced more fiction than fact when it comes to how American tax dollars are being spent around the world. Publisher The Ripon Society

Editor Lou Zickar

President Jim Conzelman

Deputy Editor Kyle Chance

Editorial Board Thomas Tauke Michael Castle Billy Pitts Pamela Sederholm Judy Van Rest Jim Murtha John Feehery

Editorial Assistant William Clutterbuck

What Every American Should Know about Our Health Care System By Gail Wilensky We spent $3.5 trillion on health care in 2017. This figure is up 3.9% from 2016, and represents more than 17% of our Gross Domestic Product. What Every American Should Know about the Immigration Crisis By Jacqueline Varas 760,000 people have been apprehended crossing the border illegally this year. This is more than twice the number apprehended at this point in 2018. What Every American Should Know about Education By Kyle Chance Budget cuts following the 2007-09 recession resulted in stagnant teacher salaries that are nearly 5% lower today than their high point in 2009/2010.

Debate 24

Free Speech is Not Perfect, but the Government as Censor is Worse By John Samples

The Positives & Pitfalls of Policing the Internet By Justin Sherman

Sections 3 29 32

In this Edition News & Events Ripon Profile - U.S. Sen. Mike Braun

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RIPON FORUM September 2019

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THE RIPON SOCIETY HONORARY CONGRESSIONAL ADVISORY BOARD U.S. Senators: Shelley Moore Capito - Senate Co-Chair Cory Gardner - Senate Co-Chair Marsha Blackburn Roy Blunt Richard Burr Bill Cassidy, M.D. Susan M. Collins Steve Daines Joni Ernst Deb Fischer John Hoeven Jerry Moran Pat Roberts Mike Rounds Thom Tillis Roger Wicker Todd Young U.S. Representatives: Susan W. Brooks - House Co-Chair Greg Walden - House Co-Chair Martha Roby - Vice Chair, South Darin LaHood - Vice Chair, Midwest Mike Kelly - Vice Chair, Northeast Dan Newhouse - Vice Chair, West Frank Lucas - Vice Chair, Southwest Mark Amodei Don Bacon Andy Barr Vern Buchanan Larry Bucshon, M.D. Michael C. Burgess, M.D. Ken Calvert Buddy Carter Tom Cole Doug Collins Paul Cook Rodney Davis Sean Duffy Tom Emmer Ron Estes Brian Fitzpatrick Bill Flores Kay Granger Sam Graves French Hill Bill Huizenga Bill Johnson Dave Joyce John Katko Adam Kinzinger Bob Latta Billy Long Kevin McCarthy Michael McCaul Cathy McMorris Rodgers Paul Mitchell John Moolenaar John Ratcliffe Tom Reed Tom Rice Steve Scalise John Shimkus Steve Stivers Glenn “GT” Thompson Mac Thornberry Mike Turner Fred Upton Jackie Walorski Brad Wenstrup Steve Womack

In this Edition Fake news. If there were a more loaded term in American politics today, it would be hard to find. For some, the term has come to represent the lament of a President who disagrees with stories and articles that do not suit his purpose. For others, the term represents the increasing bias and inaccuracy of modern reporting and all that is wrong with the state of mainstream media today. Regardless of one’s political leanings or affiliations, the fact remains that the veracity of the news is an increasing concern of the American people today. A report released this past June by Pew Research Center bears that out. “More Americans view made-up news as a very big problem for the country than identify terrorism, illegal immigration, racism and sexism that way,” the report revealed. “Additionally, nearly seven-in-ten U.S. adults (68%) say made-up news and information greatly impacts Americans’ confidence in government institutions, and roughly half (54%) say it is having a major impact on our confidence in each other.” Pew also asked Americans who they believe is responsible for this confusion and uncertainty: “Close to six-in-ten U.S. adults (57%) say political leaders and their staff create a lot of made-up news,” the report found, “and about half (53%) say the same thing of activist groups. About a third feel journalists (36%) or foreign actors (35%) create a lot, while about a quarter (26%) put the blame on the public.” With the 2020 general election just over a year away, we thought it was a good time to focus on the importance of finding accurate and reliable information in the current news environment, and an organization that is working to achieve that goal today. The organization is called USAFacts. Established in 2017 by former Microsoft CEO Steve Ballmer, the group has created a new online platform that provides Americans with an unprecedented amount of data and information about the state of our society and all levels of American government. We talk to USAFacts President Poppy MacDonald about this platform, the mission of the organization, and some of the key facts and other research the organization has uncovered over the past two years. We have also delved into some of those facts ourselves, with a range of experts offering their thoughts on what Americans should know about some of the key challenges facing our country in the coming year. The experts include Bill Hoagland of the Bipartisan Policy Center writing about the debt and deficit, George Ingram of the Brookings Institution writing about U.S. foreign aid, former Medicare Administrator Gail Wilensky writing about health care, Jackie Varas of the American Action Forum writing about education, and Forum Deputy Editor Kyle Chance writing about education. With a growing number of Democrats embracing “Medicare for all,” Charles Blahous of the Mercatus Center assesses some of the key elements of the proposal and what the plan would mean for us all if it were enacted. James Wallner of the R Street Institute examines the role of the Electoral College and whether it should be reformed or abolished. In our latest debate, John Samples of the Cato Institute and Justin Sherman of New America discuss whether content on the internet should be regulated. In our Beyond the Beltway feature, Findlay, Ohio Mayor Christina Muryn discusses how her community is fighting the opioid epidemic. And in our latest Ripon Profile, freshman Senator Mike Braun discusses his first year in office and how he is applying his experience in business to his new job on Capitol Hill. As always, we hope you enjoy this latest edition of The Ripon Forum, and welcome any comments or questions you may have. Lou Zickar, Editor louzickar@riponsociety.org RIPON FORUM September 2019

Beyond the Beltway

On the Front Lines of the Fight Against Opioids by CHRISTINA MURYN On January 10th, 2018, many citizens of Hancock the needs of our citizens. In 2013, we partnered with Dr. County, Ohio were surprised when President Trump Michael Flaherty, a clinical psychologist with more than 30 mentioned their community during his remarks at the years experience in the prevention, intervention, treatment, signing of H.R. 2142, the INTERDICT Act. But it very research, and policy development related to substance use, well may have been just the right community to mention. addiction, and recovery. As we now know all too well, no community is safe from Through this partnership, the Hancock County Opiate the opioid crisis – including, in this case, our own. Task Force has solidified our Recovery Oriented System First a little background… of Care, as well as put together a Hancock County is a relatively comprehensive strategic plan. Like quiet Midwestern community in the many things we do in our community, Northwest corner of the Buckeye State. we implemented the “Findlay With a population of approximately Formula,” a collaborative effort of the 75,000, the community is a mix of public, private, and nonprofit sectors rural and micropolitan, and is home to for the betterment of the community. the City of Findlay. The Findlay Formula has been Findlay – a community frequently implemented for years and has helped recognized for its thriving economy, earn the community such honors as restaurant scene, numerous large being named a Top Micropolitan corporations, and the University of five years in a row by Site Selection Findlay – has seemed largely insulated Magazine, being recognized as one from many of the challenges other of Ohio’s Best Hometowns, and communities have faced. As a native numerous other distinctions. of Findlay and the new Mayor, I have So what have we been doing? Christina Muryn watched over the past 10 years as our First, we established a communitycommunity has worked to wrap our wide philosophy with regard to the arms around this crisis. prevention and treatment of alcohol In 2017, our county Like many other communities, we and drug addiction and abuse. Called were hit hard by the growth in opioid “The Shared Philosophy on Medication overdose fatalities addiction and subsequent overdose Assisted Treatment and Recovery,” nearly doubled – from it is a guiding document which all deaths. In 2017, our county overdose fatalities nearly doubled – from 1.8% 1.8% in 2016 to 3.57%. providers and organizations related in 2016 to 3.57%. Correspondingly, alcohol, drug and mental health Correspondingly, our to our ER visits related to overdoses services use as a common guide. This ER visits related to also nearly doubled. Even though our ensures we are working together and community has been working for years thinking of the whole person, while overdoses also nearly to combat opioids and drugs, it has also promoting accountability as we doubled. often felt as if we were running up a undertake this mission as community. sand dune – taking one step forward Beyond that, we also established and sliding further back. It wasn’t for lack of trying. a strategic plan. The plan includes priorities geared Indeed, since 2010, through the leadership of the around community awareness, education, legislation, and Hancock County Board of Alcohol Drug and Mental medical services. The strategies related to those priorities Health Services (ADAMHS), our community has come include providing information, enhancing skills, providing together with an organized approach, regularly meeting to support, enhancing access, changing consequences, analyze and design local strategies and programs to meet physical design, and changing/modifying policies. 4

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By establishing these two items, we have had a clear recruit specialists to meet the needs of the community. roadmap that we can reference and ensure that everyone Third, we are going to continue to educate and build providing care is on the same page. Does that mean we community programs around prevention and treatment. don’t have disagreements? Certainly not. But one of the Finally, in all of this we are going to seek to strengthen guidelines in the shared philosophy is that, “Each agency or families. provider is to be respected What would I like to for its own philosophy see the federal government of treatment…” It also do as we pursue these goals? So what have we been doing? establishes that whatever one thing, federal First, we established a community- For approach is chosen for officials in Washington wide philosophy with regard to the could work to decrease the each patient needs to be justified, “and all persons delay in national data on prevention and treatment of alcoseeking treatment should drug utilization, overdose, hol and drug addiction and abuse. be considered for the and trends. They could also appropriateness of each work to increase access to approach within the ‘cycle’ behavioral health services of opioid treatment and justified in writing for the approach through the utilization of telehealth and educational waiver chosen.” programs. So where do we plan to go from here? There is hope for our communities. But it only will First, we are going to refocus resources to the areas of occur through continued collaboration between the public, prevention, recovery, and support that have proven most private, and nonprofit sectors. RF effective. Second, we are going to work as a community to Christina Muryn is the Mayor of Findlay, Ohio.

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RIPON FORUM September 2019

Politics & Perspective

What Medicare for All would Mean for Us All by CHARLES BLAHOUS Among the hottest topics of this political season is “Medicare additional health service consumption. Even aggressively for All” (M4A), a concept embraced by several current candidates optimistic assumptions for lower drug prices and insurance for president, and criticized by others. M4A is one of the most administration costs under M4A do not produce nearly consequential policy ideas ever put before the American electorate, enough potential savings to offset M4A’s projected spending and it is vital that we understand exactly what it is, what it isn’t, increases. and what its implications would be. This is where the issue of provider payment levels The name “Medicare for All” is a misnomer. These proposals becomes important. M4A legislation introduced in Congress would not expand current Medicare to cover all Americans, but specifies that health providers would be paid at Medicare rather create an entirely new program in which nearly everyone payment rates, averaging about 40% lower over M4A’s first – including today’s Medicare beneficiaries ten years than private insurance rates – would be enrolled. This new program (the cuts becoming steeper after that). would differ from Medicare in certain It seems implausible such cuts would fundamental ways. For example, parts of be enacted. Historically, Congress has Medicare are voluntary; its participants face been unwilling to impose much smaller premiums, deductibles and copayments and payment cuts on health providers. can opt to receive benefits through private For example, Medicare physician insurance; and certain Medicare benefits payment cuts under the Sustainable (e.g., hospital) are constrained so as to not Growth Rate formula were repeatedly exceed total participant contributions, plus overridden before being repealed interest. By contrast, under M4A there in 2015. Washington state recently would only be a single government-run enacted a public option that in its plan. Benefits would be more generous, initial draft form would have limited including dental, hearing and vision care, payments to Medicare rates; the final and participants would receive first-dollar enacted version raised these limits coverage of all health services without any to 160% of Medicare rates. Earlier deductibles, copayments, or cost-sharing. this year, CBO found that applying Charles Blahous M4A would involve an unprecedented Medicare rates under M4A would expansion of federal government likely dampen health service supply M4A would involve expenditures and tax burdens. My study at the same time M4A would increase found that new federal costs, above and demand—almost certainly disrupting an unprecedented beyond current expenditures (including Americans’ timely access to care. In expansion of federal health programs), would likely be short, history provides little evidence government expendi- M4A would set provider payments somewhere between $32.6 and $38.8 trillion over the first ten years. Such enormous consistent with health spending going tures and tax sums are difficult to grasp. Suffice it to say anywhere but up. burdens. that the lower-bound cost could not be fully Even if M4A left national health financed even by doubling all projected spending unchanged, this would not federal individual and corporate income taxes. necessarily make it affordable for the federal government. Many advocates believe that M4A is inherently affordable Shifting nearly all current private and state health care because Americans are already footing most of this health care spending onto the federal budget is not a trivial change, bill in other ways, including through private insurance, state any more than the federal government’s assuming all U.S. programs, and individual spending out of pocket. Some advocates spending on housing, food, or state and local government believe further that M4A would bring total national health costs functions would be. The additional federal costs would down. But M4A would more likely increase not only federal average roughly $10,000 per American at the outset, and but national health spending, because it would (intentionally) we have yet to hear a realistic proposal to finance them. expand coverage to the currently uninsured, as well as making Moreover, financing federal revenue needs of this magnitude current insurance coverage more generous, thereby inducing via progressive taxation (politically the most likely strategy) 6

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would produce economic deadweight loss in the trillions of amid political dynamics in which voters are often more conscious of what they would lose from change than what they would gain. dollars, leaving Americans poorer on balance. Even these daunting quantitative realities gloss over Advocates also deserve credit for transparency in declaring their important subjective value judgments, such as whether preferred end-state: a system in which all health care is provided Americans would be comfortable transferring so much health by the federal government and devoid of private insurance. spending from the private to the public sector. Imagine a family This straightforwardness compares favorably to proposals to of three that spends $30,000 on health care this year, between crowd out private insurance gradually and imperceptibly, via a so-called public option. M4A out-of-pocket payments would be no less costly if it and subtractions from their My study found that new federal were to emerge from gradual wages for health benefits. We cannot assume that this family costs would likely be somewhere displacement of private insurance rather than from would instead prefer to pay an between $32.6 and $38.8 trillion revolutionary change. additional $30,000 in annual While M4A introduces taxes, and lose their remaining over the first ten years. many thorny policy issues, discretion over how to spend much of its plausibility comes those dollars. One common analytical mistake is to assume that because down to whether its costs can be borne. These new federal costs another nation with a single-payer system has lower health would be an order of magnitude larger than Congress has ever costs than ours, our adoption of single-payer would lower our seriously considered. Unless and until someone produces an health costs to that level. This assumption lacks a sound basis. economically and politically viable program for financing A single-payer system in the U.S. would still buy health care M4A, it is irresponsible for any political candidate to promise RF from U.S. doctors, U.S. hospitals, and U.S. drug companies. the benefits it would purportedly bring. The fact that other nations have a different history simply does not provide useful predictive information as to how much a U.S. Charles Blahous is the J. Fish and Lillian F. Smith Chair and Senior Research Strategist at the Mercatus Center at George single-payer health care system would cost. M4A advocates deserve credit for challenging the status quo Mason University.

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Why the Electoral College Should be Preserved by JAMES WALLNER A “time bomb lodged near the heart of the nation.” That government’s legitimacy. They claim that the institution values is how the Pulitzer-Prize winning author, James A. Michener, voters who live in rural, sparsely populated states, more than described the Electoral College in his 1969 book, Presidential those who live in populated states such as California or densely Lottery. populated urban areas like Los Angeles. As Warren observed: Michener is not the only person in history who has been “We need to make sure that every vote counts…And the way concerned about the Electoral College. Indeed, the elaborate we can make that happen is that we can have national voting process stipulated in Article II, section 1, clauses 2 and 3 of and that means get rid of the Electoral College.” the Constitution, has been a perennial source of controversy This disparity, opponents of the Electoral College since it was ratified in 1788. argue, can delegitimize the new Nevertheless, opposition to the administration before it has even Electoral College has become more started. For example, consider a 1969 pronounced in recent years due to statement by Birch Bayh, a former the controversial outcomes of the Democratic senator from Indiana and 2000 and 2016 elections. In 2000, Al longtime opponent of the Electoral Gore lost to George W. Bush despite College: “When we have an Electoral winning approximately half a million College system which threatens to more votes nationwide. Hilary Clinton elect a man who has fewer votes similarly lost the 2016 election than his opponent, we tend to erode to Donald Trump despite having the confidence in the people of this won almost 3 million more votes country and their president and in nationwide. In both elections, Bush their form of government.” and Trump became president because Opposition to the Electoral they won more votes in the Electoral College is not universal. Its College. proponents, who are predominantly Earlier this year, Elizabeth Republican at present, counter that Warren, D-Mass., sparked renewed the institution, while complicated, James Wallner interest in the Electoral College nevertheless incentivizes presidential when she proposed abolishing the candidates to assemble superThinking about politics majority coalitions to win elections. institution during a presidential town hall. Warren’s announcement The institution’s proponents contend as a means to an end encouraged many of her rivals for the such coalitions are beneficial distorts our understand- that Democratic nomination to also call for because they resemble more closely ing of why the Electoral the country at large, thereby helping the Electoral College’s elimination. Many congressional Democrats also the successful candidate govern College matters. oppose the institution. In the Senate, effectively once in office. Brian Schatz, D-Hawaii, introduced a Notwithstanding the merits of constitutional amendment recently to their various claims, the Electoral abolish it. Steve Cohen, D-Tenn., submitted a similar proposal College’s opponents and proponents have more in common in the House. than they realize. That is, they both ignore the underlying role The Democrats’ opposition to the Electoral College played by the institution in American politics. The Electoral appears to be motivated at least in part by the fact that it College, along with the Constitution’s other institutional disadvantages them vis-a-vis their Republican competitors arrangements, exists to safeguard the space where Americans in presidential elections. Of course, Democrats do not participate in politics to make collective decisions based acknowledge that they base their opposition on narrow partisan on equality. Abolishing it would jeopardize that space and, calculations. They contend instead that the Electoral College is in the process, exacerbate the federal government’s current undemocratic and, consequently, that it undermines the federal dysfunction. 8

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That both sides in the debate have overlooked this crucial point suggests that Americans of all political stripes – Democrat, Republican, liberal, and conservative – increasingly think about politics in the same way. Americans, especially those active in partisan politics, often do not think about political institutions in ways that transcend their immediate partisan interests. They no longer see politics as an activity in which they participate. Instead, they see it as a means to an end. Put differently, they think about government in terms of progress, not in terms of specific forms (i.e., monarchy, aristocracy, democracy, etc.). This shift in thinking is evident in the emphasis both sides place on outcomes rather than process. For opponents and proponents, results are more important than the activity that takes place within specific forms of government. Their outcome-oriented understanding of politics causes them to rationalize their view of the Electoral College based on whether it serves as a means to their particular end. That is why today’s Democrats predominantly oppose the Electoral College and Republicans generally support it. The problem is that thinking about politics as a means to an end distorts our understanding of why the Electoral College matters. In contrast, thinking about politics as an activity forces us to acknowledge the space where that activity occurs. In the process, we gain a deeper appreciation of why the Electoral College matters. Take, for example, Warren’s claim that the Electoral College violates the one person, one vote standard. While Warren is no doubt sincere in her belief, she is nevertheless predisposed to oppose the institution because she thinks about it in terms of progress; as a means to an end. In short, the Electoral College makes it harder for her, or any other Democrat, to win a presidential election given present conditions. For Warren, abolishing the Electoral College is a means to achieving her end precisely because she believes that there are, at present, more Democratic voters nationwide than Republican voters. In making her argument, Warren overlooks the fact that her proposal, if successful, would change the very nature of the American regime. That is, abolishing the Electoral College and replacing it with a nationwide popular vote would create, for the first time in the nation’s history, a single common electorate. Admittedly, a national electorate may exist symbolically or culturally, presidents may claim nationwide mandates, and elections can be nationalized. But no government official is currently elected by citizens casting votes in one single national electorate. Likewise, no institution in the federal government represents a single, nationwide electorate directly. Many electorates organized by state instead comprise the American electorate. It is important to note that this is not an argument for states’ rights. Instead, it is evident in how John Marshall, the nationalist chief justice of the Supreme Court, described the Constitution’s ratification process in McCulloch v. Maryland: “It is true, they [the people] assembled in their several States,” he wrote, asking, “and where else should they have assembled? No political dreamer was ever wild enough to think of breaking down the lines which separate the States, and of compounding the American people into one common mass.

Of consequence, when they act, they act in their States.”’ According to Marshall’s logic, the existence of the Electoral College does not violate the one person, one vote standard because all votes count equally in the electorates, or states, where they are cast. Both the opponents and proponents of the Electoral College should acknowledge this fact in the debate over whether it should be abolished. That would require them to think about politics as an activity instead of as a means to an end. Doing so illuminates the fact that the Electoral College is part of a complex arrangement of constitutional institutions that, working together, ensure that no one group of people rules, whether that group comprises a majority or a minority of the population. To do this, the Constitution established a space that could not be conquered by the majority or the minority and where Americans could participate in politics. That space would not coexist very long with one sovereign people in a single national electorate who could step into the shoes of the king and destroy it, or rule, whenever a majority so chose. Fortunately for both sides in the debate over the Electoral College, the people as organized in different state electorates are sovereign in America. As Marshall observed: “From these [ratifying] conventions the Constitution derives its whole authority. The government proceeds directly from the people; is ‘ordained and established’ in the name of the people, and is declared to be ordained, ‘in order to form a more perfect union, establish justice, insure domestic tranquility, and secure the blessings of liberty to themselves and to their posterity.’” This simple fact is what differentiates the outcome of the American Revolution from that of the French Revolution. In the latter, royal rule was replaced with majority rule and freedom was destroyed. In the former, royal rule was replaced with majority decision and freedom of all citizens to participate in politics was ensured. In America, the majority decides in both houses of Congress, the Supreme Court, and, during elections, in each state. Acknowledging the underlying significance of the Electoral College does not mean that it cannot be reformed. Thinking about politics as an activity should not blind us to the fact that we can always do better. But it does force us to consider where we can do better. The longevity of the American Republic suggests that its citizens make things better in the space where politics occurs. In reforming that space, we should endeavor not to create a single national sovereign that will have the power to destroy it. Securing minority rights against tyranny in all its forms requires that we prevent any one group of people from ruling. RF James Wallner is a Senior Fellow for Governance at the R Street Institute. He also serves as a professorial lecturer in the Department of Government at American University and is a fellow at American University’s Center of Congressional and Presidential Studies.

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Cover Story

FACTS MATTER Poppy MacDonald discusses the mission of USAFacts and the effort to combat misinformation heading into the 2020 election.

RIPON FORUM September 2019

The internet has often been compared to having a library at one’s fingertips. And in many respects, it is. Never before in history have individuals had access to the amount of information they have today. But with all of this information has come a downside. When people walk into a library, they have a fair amount of confidence that the material they may read in a book or magazine is going to be accurate. With information on the internet, there is no such guarantee. To the extent that Americans are getting more and more of their news online, there are increasing concerns about whether all of this news is fact-based. There is no single arbiter of truth on the internet. But there are a growing number of organizations willing to step into the breach to perform this increasingly important role. One of those organizations is USAFacts. Founded in 2017 by former Microsoft CEO Steve Ballmer, the non-profit, non-partisan organization is not seeking to break new ground when it comes to finding new sources of information about our society. But it is seeking to break new ground when it comes to how this information is presented. Harnessing the power of computers and the internet – two areas where Ballmer has some expertise, to say the least -- USAFacts has created a one-of-a-kind online platform that examines existing data from every level of government in America, and explores how this data is impacting American lives. “The goal,” Ballmer told Time magazine, “was to use numbers — about government revenue, spending and outcomes — to create a common set of facts that can serve as a foundation for the type of informed debate that is essential to our democracy.” USAFacts is run on a day-to-day basis by former media executive Poppy MacDonald, who serves as the organization’s President. The Forum talked with MacDonald recently about the mission of USAFacts and how the group plans to combat misinformation heading into the presidential election next year.

* * * * * RF: Talk for a moment about USAFacts. What is to see trends or reach well-rounded conclusions. We bring together data from over 70 federal agencies, the mission of your group? PM: USAFacts’ mission is to make government data give it some context, and create visualizations, all with the available, accessible, and understandable to Americans. Our goal of making it easy to understand and use. goal is to ensure debates begin with an agreement on facts. RF: Washington is filled with think tanks and People may disagree on the solutions, but we can’t have real other research organizations. What sets USAFacts conversations without starting on the same footing. Ensuring easy access to the facts is a big job. apart? PM: We’re nonUSAFacts grew out of a partisan, non-profit, and simple question: “How ad-free. We are the most much do our combined Our goal is to ensure debates comprehensive single federal, state, and local begin with an agreement on source of government governments spend to facts. People may disagree on the data. That data comes help empower children from more than 70 and families to move out solutions, but we can’t have real federal agencies, 50 of poverty?” No single conversations without starting states, thousands of local government source government entities, provides that answer — on the same footing. and all of it is publicly and there’s no federal law available government that requires the reporting of data on what is being spent and what progress is being data. We don’t use projections or analysis because that could introduce bias; we only look back at what’s actually made. There are still a host of barriers to the average citizen, occurred and report that data. Also, we’re in the other Washington: Washington State. or even a reporter on deadline, to finding answers. Some government reports are only available as PDFs, so you can’t RF: What are some of the key facts about our do a quick search to find a figure. Other reports are simply spreadsheets. The IRS mailed us anonymized tax data on nation and our government that you believe every computer disks. These data sets are often difficult to find and American should know? PM: We produce an Annual Report that highlights are disconnected from other data or context, making it hard RIPON FORUM September 2019

some of our key observations about the state of our nation partisan and ideological differences by beginning with based on government data. the same set of facts. This year, we focused on demographic changes So, USAFacts will relaunch our Voter Center in the that policymakers and voters might want to know about new year to support the upcoming election. This is a before making big decisions. Like the fact that the free tool that allows voters to enter their zip code to see median age of Americans is rising. Seniors now make candidates running for office right where they live, plus up 16% of the population, up from 11% in 1980. And their positions on key policy issues. We’ll also show data America is becoming more diverse. Non-Hispanic White about how the nation is doing on that same issue. You people are 61% of the population today, 29 years ago may see that one candidate supports school vouchers or they were 76%. The population is growing nearly equally higher teacher pay to improve schools. Alongside that, from people moving to the U.S. (48% of population you’ll see that 36% of American children are proficient growth from 2017-2018) as in reading and 34% are it is from births exceeding proficient in math at the 8th deaths (52% of growth). grade level. You’ll be able Fourteen percent of people to look at trends in high in the population are firstschool graduation rates as generation immigrants, you consider the candidate which hasn’t been that high you support. since the early 1900s. The American RF: In that regard, household is shrinking. what is the role of the More people are living average person in all this? alone, a greater share of the The American public population is divorced, and has more information at there are more single-parent their fingertips than at families and households any other time in history. without children. What How do you get them to does that mean? Fewer use it? wage earners per household, PM: Data by itself USAFacts was founded by possibly pushing down isn’t always compelling, so median household income. we bring it to people in a former Microsoft CEO Steve All those trends way that is usable. We’re Ballmer, and we’re ad- and have implications for our always working on special government resources, reports to provide a databias-free thanks to his policies, and political and centric view of what’s in civic activism. cultural shifts. But you can the news, what people take any topic and what find interesting in their you’ll find in our reports are some of the facts that we own lives. We’ve seen a lot of interest in immigration think should at least be a starting point for our policy and data or how Social Security works. We create bite-sized political debates. pieces of information for social media that people can share. We’re always looking to present facts that may RF: Looking ahead to the 2020 election, how be counterintuitive. You probably assume that Medicaid are you planning to counter the misinformation and Medicare are more expensive on a per-person basis being spread online so people have the facts they than private insurance, but do you know that they’ve need to make an informed decision? both plateaued and have remained somewhat constant PM: We conduct an annual State of the Facts Poll while private insurance costs continue to climb? and this year it was illuminating on this very topic. From USAFacts was founded by former Microsoft CEO 2017 to 2018, an eight-point gap widened to a 22-point Steve Ballmer, and we’re ad- and bias-free thanks to his gap, with 61% of the public saying that using different civic activism. As we started collecting and analyzing facts causes more problems in the U.S. than political data, we realized that this monumental task of bringing differences. That’s concerning. It also reinforces our government data together in one place — data paid for mission to provide accurate, trusted data so Americans with more than $5.9 billion of taxpayer dollars each year can have conversations about where we want to go as — could help Americans who want to understand simply a country, even if different solutions emerge. It’s also what is going on in the country. Steve gets that we can’t encouraging that Americans see an opportunity to bridge just compile it, put it in context, make it look nice and 12

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RF: Finally, a question about your other role — as the mother of two young kids. What advice do you have for parents who want their children to be informed about the world and are concerned with how, and where, they get their news? PM: As a mother of two, and someone who worked in RF: What about the media and our elected leaders? Do they have a responsibility in making media (at POLITICO and Atlantic Media) before coming sure people get the facts and not simply the spin? to USAFacts, I truly appreciate the value and role of an informed democracy. My Or is that asking the advice to parents would impossible in this era be to encourage their of hyper-partisanship From 2017 to 2018, an eight-point children to seek multiple and ratings-driven sources of information reporting? gap widened to a 22-point gap, and discuss what they’re PM: Our State of with 61% of the public saying hearing with their the Facts Poll has clearly that using different facts causes families. shown that voters and news So many adults tell me consumers want to reward more problems in the U.S. than that when they turn on two politicians and journalists political differences. different media sources — who cite data. Yes, some Fox News and MSNBC, will say it’s human nature for example — they feel to cite facts that support your beliefs. Editorial writers and talk show commentators like they are hearing completely different versions of what’s do that. Partisans in our democratic system do that. But I happening in the world. Add social media and a proliferation think our poll shows that Americans expect there to be some of new information sources, it’s not surprising that both “bottom line” facts that our elected officials should agree on parents and their children are looking for something they as they debate solutions, and reporters should cite as they know they can trust. I’m hopeful that USAFacts, with a mission of just cover those debates and issues. We know it’s not always clear. Like do more acres of providing the data so people can form their own views wildfire burned say more about our fire suppression budgets, about how we are doing as a country and advocate for climate change, random droughts, or arson? We work to the changes they want, will help break through the noise. RF bring context — and hope the users of our data do as well. hope people find it. We have to be proactive in getting the information in front of them. We believe they’ll see its value and share it with their family, their community, their readers and listeners.

Pictured below: One of the many pages from the interactive website at USAFacts.org.

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Facts Matter:

What Every American Should Know About the Debt & Deficit by G. WILLIAM HOAGLAND For nearly a century, we’ve had a good system for or 4 percent deficits over time, and projected into the future, tracking how much the federal government spends and earns. create a troubling gross debt burden. Since the Budget and Accounting Act of 1921, the data of The cumulated $22.7 trillion gross debt today is around expenditures incurred and revenue raised have never been in the total size of our annual economy. But economists and doubt. However, there’s plenty of uncertainty when it comes budget experts prefer to exclude from the gross debt figure to projections about our fiscal future and there’s no shortage that portion of the debt already held in government accounts of opinions on what to do about it. such as the Social Security Trust Fund. Removing that debt To understand America’s fiscal situation, it’s important from the gross figure results in what is referred to as debt to lay out the facts. held by the public. Measured this The first and most basic thing way, public debt still totals nearly to know is the difference between $17 trillion. the deficit and the national debt. So, is this number something The deficit is the annual difference to be worried about? Yes. The $17 between what the government trillion of public debt is nearly 80 collects in taxes, fees, custom percent of America’s annual GDP, duties, and receipts and what it which is historically high. Only spends. Debt, on the other hand, during World War II did debt held is the cumulation of annual deficits by the public exceed today’s levels. from the founding of the nation For the last 50 years, debt held by offset by any years of surpluses. the public has averaged 42 percent. In the current year, the federal In a very short time period, since government collected $3.47 trillion 2010, this debt metric has exploded in revenues and spent $4.47 trillion, – more than doubled to 80 percent. G. William Hoagland resulting in an annual deficit for Left unaddressed, it is expected to 2019 of $1 trillion. However, this reach over 90 percent in 10 years deficit added to all previous deficits In the current year, under even the most optimistic has resulted in federal gross debt assumptions of economic growth. the federal government exceeding $22.7 trillion. An important point – this debt collected $3.47 trillion in Before going on August recess, is not held only by the American Congress passed a law that will public. During WWII, our debt was revenues and spent $4.47 allow the government to continue to held by Americans, mainly in the trillion, resulting in an borrow money. This new authority form of war bonds. Today, over 40 will result in debt reaching nearly annual deficit for 2019 percent of the debt is held by foreign $25 trillion by the middle of 2021. investors. This is not necessarily of $1 trillion. These are huge numbers a bad thing since it means foreign and difficult to absorb. To put investors see value in purchasing the numbers into some perspective, budget analysts and our government debt. As former CBO Director Rudy Penner economist compare them to the size of our national economy is fond of saying, “We are the best-looking horse in the glue (GDP). Our GDP was most recently measured at $21.3 factory.” trillion. Viewed as a percentage of GDP, our annual deficit However, it also means that more and more of the today is only about 4 percent. government’s interest payments are going overseas and not Is this high or low? back into the pockets of American investors. Relative to the last 50 years when the annual deficit Speaking of interest payments, the federal government has averaged less than 3 percent of GDP, one might conclude it is been fortunate over the last few years that yields on 3-month relatively low, and, therefore, not a problem. But persistent 3 Treasury bills and 10-year Treasury notes have been relatively 14

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low. But even with average interest rates on debt held by the public more government spending to improve infrastructure, protect at 2.6 percent in 2019, just paying the interest on the cumulative the borders, and boost our health and the environment. debt means an annual expenditure of over $380 billion. And To be sure, a growing economy can produce revenues as more of the debt is owned by foreign borrowers, fewer of to fund necessary public spending. However, a tax code that these interest payments are returned to domestic investors. Plus, does not result in increased investment and growth but merely should interest rates rise from their current levels—or revert to reduces taxes to spur current consumption will not address the mean as some would say—the fastest growing component deficits or debt. of federal spending will not be Social Security or Medicare Economic growth alone simply cannot solve our fiscal payments, but simply paying the problems. To erase the projected interest on the public debt. annual deficit of over $1.4 trillion Just to stabilize the current Which brings us back to deficits in 2029, the economy would have – the difference between what we to grow between 5 and 6 percent debt at 80% of GDP over take in and what we spend. It is basic annually, more than double the the next two decades would math. The fact is, the annual deficits current rate. That is not going to over recent years have been the result happen. require increasing revenues of too much spending unmatched While there’s plenty of by 11% or cutting spending by too few resources to pay for disagreement about how to by 10% starting tomorrow – that spending. Going forward, just solve our financial predicament, to stabilize the current debt at 80% it’s imperative that our elected a total of $400 billion. of GDP over the next two decades officials understand these basic would require increasing revenues facts about our economy. Tough by 11% or cutting spending by 10% starting tomorrow – a total choices will need to be made, but they should be made of $400 billion. based on real data. RF Finding that savings is a challenge since 70% of the spending in the federal budget is on automatic pilot in the form of benefits G. William Hoagland is a Bipartisan Policy Center senior promised by previous Congresses and presidents. These sovice president, helping to direct and manage fiscal, health, called entitlements, many tied to an aging demographic, portend and economic policy analyses. He previously served as continued increased spending into the future if left unchanged. vice president of public policy for CIGNA Corporation, So, only 30 percent is subject to the annual appropriation process. staff director at the Senate Budget Committee, and director Clearly, where there is wasteful spending, it should be of budget and appropriations in the office of former Senate eliminated. But, at the same time, the public increasingly demands Majority Leader Bill Frist.

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Facts Matter:

What Every American Should Know About U.S. Foreign Aid by GEORGE INGRAM Seventy-five years of U.S. foreign assistance has Reagan and Bush 43. Since the creation in the early 2000s of produced more fiction than fact when it comes to how President Bush’s signature popular and successful programs of the Millennium Challenge Corporation (MCC), the American tax dollars are being spent around the world. In the interest of providing taxpayers with information President’s Emergency Plan for AIDS Relief (PEPFAR), and about the value of their federal investment in this regard, it the President’s Malaria Program (PMI), foreign aid now also might be helpful to look at some of the top myths surrounding carries a Republican brand and has received overwhelming congressional support from both parties, including bipartisan foreign aid, and how these myths compare with reality. rejection of the 1/3 cuts to Myth #1: America spends too international spending proposed by much on foreign aid -- Opinion the Trump Administration. polls consistently report that Myth #4: Foreign aid goes to Americans believe foreign aid is corrupt, wasteful governments -in the range of 25% of the federal Only a minority of U.S. economic budget. When asked how much it assistance goes to governments. should be, they say about 10%. In In 2018, 21% of U.S. official fact, at $39.2 billion for fiscal year development assistance went to 2019, foreign assistance is less than governments, 20% to non-profit 1% of the federal budget. organizations, 34% to multilateral Myth #2: Others don’t do their organizations, and 25% elsewhere. fair share -- The U.S. provides Typically, when the U.S. wants to more assistance than any other support a country that is ruled by a country. As the world’s wealthiest corrupt, uncooperative, or autocratic nation, that’s appropriate. There is government, U.S. assistance goes a broad international commitment through private channels – NGOs or that wealthy countries should other private entities – or multilateral provide annually 0.7% (7/10ths George Ingram organizations. Accountability of of one percent) of GNP to assist U.S. economic assistance is high poor countries. Five countries -- the U.S. imposes stringent, (Norway, Sweden, Luxembourg, At $39.2 billion for some would say onerous, reporting Denmark, and the U.K.) exceed fiscal year 2019, foreign and accounting requirements on that benchmark. The average for assistance is less than 1% recipients of U.S. assistance, and all wealthy nations is around 0.4%. the office of the U.S. inspector The U.S. ranks near the bottom at of the federal budget. general (IG) investigates misuse. below 0.2%. Myth #5: Foreign aid goes to Myth #3: U.S. foreign aid is mainly backed by Democrats -- Foreign aid historically autocratic governments -- There was definitely truth to this has been viewed more as a Democratic than Republican during the Cold War, when foreign assistance was often program. The Marshall Plan was initiated by the Truman driven by the premise that “the enemy of my enemy is my Administration, and in the 1990s, when votes in the Congress friend” no matter what the nature of the government. That on foreign aid spending were close, the appropriations bill substantially changed in the 1990s following the demise of garnered more Democratic than Republican votes. But every the Soviet Union. However, there is reason to be concerned president, Democratic and Republican, until the current that obliviousness to autocracy is reappearing with the postoccupant of the White House, has been a strong proponent of 9/11 concern over terrorism. Myth #6: Foreign aid is wasted, inefficient, and produces foreign assistance. In fact, some of the most rapid increases in foreign aid no concrete results -- The U.S. government requires regular have come during Republican presidencies – the first term of monitoring and reporting on how and whether assistance 16

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programs are working, and periodic evaluations of results. There is hard evidence that development and humanitarian programs produce considerable results, less so for programs driven for foreign policy and security purposes. While U.S. assistance is by no means the sole driver, the record of global development results is impressive. These results include:  Extreme poverty has fallen dramatically over the past 30 years – from 1.9 billion people (36% of the world’s population) in 1990 to 736 million (10%) in 2015  Maternal, infant, and child mortality rates have been cut in half  Life expectancy globally rose from 65 years in 1990 to 72 in 2017  Small pox has been defeated; polio eliminated in all but two countries; deaths from malaria cut in half from 2000 to 2017  The U.S. PEPFAR program has saved 17 million lives from HIV/AIDS and enabled 2.4 million babies to be born HIV-free. Myth #7: Foreign aid is for the benefit of foreigners and not aligned with U.S. interests -- Assistance is provided to support security as well as economic and political development of recipient countries and people. However, that assistance also advances one or all of the following three overriding U.S. interests:

 Contributing to U.S. national security by supporting allies in promoting regional and global stability and peace  Reflecting the core U.S. value of caring for others in need – providing humanitarian assistance to victims of war, violence, famine, and natural disasters  Advancing U.S. and recipient economic interests by building economies and markets Myth #8: Foreign aid is unpopular -- While the term foreign aid is not popular and polling reveals that some feel our foreign policy is overextended, Americans support U.S. active engagement in the world. A substantial majority of those polled support working collaboratively with other nations. Assistance for humanitarian purposes receives overwhelming approval, and support is strong for specific purposes such as improving people’s health, helping women and girls, educating children, and helping poor countries develop their economies. What receives less support is assistance for strategic purposes. RF George Ingram is a senior fellow in the Global Economy and Development program at the Brookings Institution. He also serves as chair emeritus of the U.S. Global Leadership Coalition, and as co-chair of the Modernizing Foreign Assistance Network.

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Facts Matter:

What Every American Should Know About Our Health Care System by GAIL R. WILENSKY Most Americans know that the United States spends a To that end, it is worth noting that health care spending lot on health care. But in all likelihood, they do not know in the U.S. reflects the aggregate demand for health services how much we spend and how that amount compares to other from a wealthy and aging society — a society that has countries around the world. available to it many new technologies along with a large So, here are a few facts that might be helpful in that supply of sophisticated, well-trained medical specialists who regard… are generally available to most of our citizenry. Americans First, what we spend. The latest estimate is that we spent have long been eager to have access to the newest medicines, $3.5 trillion on health care in 2017. medical procedures, and technologies This figure is up 3.9% from 2016, as soon as they are deemed safe and and represents more than 17% of our effective, and have little patience GDP. It also represents more than for waiting or queueing, as is $10,700 for each person living in the commonplace in many other parts of United States. the world. Second, how that compares. Americans also expect to have The next highest-spending country easy access to physician generalists among the 32 countries in the OECD and specialists without having to is Switzerland, which spends about wait excessively to see them. In 12.3% of its GDP on health care. most parts of the world, the number Switzerland is followed by France, of specialists to generalists is far which spends 11.3% of its GDP in smaller than in the U.S. In most this regard. (It should be noted that cases, the generalist physician reliable data on health care is timeoutside of the U.S. is a general consuming to collect; therefore, that practitioner, whereas in the U.S., it is data usually lags a year or two behind usually an internist, gynecologist or in this regard.) pediatrician — physicians that other Beyond these two basic countries classify as specialists. Gail Wilensky benchmarks, Americans should also Some have questioned why know that health care spending in the the U.S. spends so much on health United States has grown substantially care when at least some of the most We spent $3.5 trillion over the last 60 years. In 1960, the basic health metrics in the U.S. are U.S. spent $146 per person on health not superior to and frequently not on health care in care, which at the time represented good as those of other countries 2017. This figure is up as about 5% of our GDP. The growth which spend far less. There are 3.9% from 2016, and in health care spending was not several responses to this question. substantially different from that of The most obvious is that mortality represents more than other countries until around 1980, statistics have little to do with health 17% of our GDP. but has grown more rapidly in the care use or health care spending. U.S. most years since then. Rather, they are much more reflective There are a variety of reasons of environmental factors and safety that have been given as to why this divergence in spending and life style risks than they are the use of health care, per se. rates occurred between the U.S. and other countries since that For example, violence-related deaths -- especially from time. For example, other countries tend to use direct limits guns -- are far more common in the U.S. than elsewhere. The on spending, whereas the U.S. does not. In addition, the easy availability of rifles and handguns, as well as rapid-fire period since the 1970s has been a fertile time for expensive and high-powered pistols and assault weapons, is an issue health care innovations. that has divided the country for decades. And therein lies 18

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another key, and tragic, fact when it comes to the health and well-being of the American public -- we have yet to reconcile the easy availability of guns with community concerns about violence-related deaths in the U.S. Despite these challenges, there have been very substantial gains in life expectancy since 1960. The deep recession and economic slowdown that began in 2008, along with the effects of the opioid epidemic and the resulting spike in “deaths of despair,” have impacted this progress over the last decade. In an important and interesting article in the New England Journal of Medicine in 2008, economist David Cutler of Harvard University compared gains in life expectancy with increased lifetime costs over the period 1960-2000. What he found is that life expectancy for newborns had increased about seven years and that, on average, the cost per lifetime year gained was just under $20,000 — less cost per year gained at age 15 ($31,000) than per year gained at age 65 ($84,700). Whether that is an acceptable level of cost for each year gained is up to the American public to decide. There are many other drivers of higher spending levels in the U.S. -- our tax system that encourages employers to provide more compensation as health insurance and other fringe benefits than as wages, our desire for easy access

to new pharmaceuticals and the latest technologies, and our aversion to waiting to access specialists or specialty hospitals. However, we could slow spending, if, as a country, we wished to do so. We could become more efficient in the provision of health care which may mean using more regionalization of specialists and specialty facilities, or we could adopt more responsible lifestyles than we have in the past. We just need to be more honest with ourselves than we sometimes are. If we are going to substantially slow the rate of spending or lower the level of spending on health care, we need to be willing to adopt lower cost ways of providing health care services or wait a little longer to use the newest technologies or limit their use to individuals who need them the most. We can spend less — we just cannot spend less and still have as easy an access to the open-ended, technically-advanced, sophisticated health care delivery system that we have had in the past. Something will need to change, and the citizens may not thank the politicians who make this happen. RF Gail Wilensky, Ph.D. is a Senior Fellow with Project HOPE. She ran the Medicare and Medicaid programs from 19901992, was the White House health advisor to President George HW Bush in 1992, and chaired the Medicare Payment Advisory Commission from 1997-2001.

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Facts Matter:

What Every American Should Know About the Immigration Crisis by JACKIE VARAS Immigration is one of the most important issues to voters in the lead-up to the 2020 election. The focus on immigration policy will likely only intensify as the crisis at the southern border persists, the federal government conducts large raids to remove undocumented immigrants, and the Trump Administration moves to restrict legal immigration. Given the national sense of urgency to fix our broken immigration laws, it is important to understand not only the magnitude of the problem, but why itâ&#x20AC;&#x2122;s occurring. To that end, the American people should be aware of two key facts that are helping to fuel the crisis we are experiencing today. The first fact is that the U.S. government has failed to adapt to the increasing number of families fleeing to the United States. The second fact is that the U.S. immigration system, as it is currently designed, incentivizes illegal immigration. Both need to change if we are going to solve the immigration crisis.

in their makeup, Congress passed an emergency federal aid bill providing $4.6 billion to federal agencies on the border. This funding is on top of the $4.7 billion allocated to U.S. Border Patrol in 2019, a ten-fold increase from the early 1990s. The additional aid is undoubtedly beneficial, but it will not solve the crisis; more immigration officers and judges are needed to alleviate the backlog of 913,000 immigration court cases currently pending. This backlog is responsible for an average two-year wait time before asylum seekersâ&#x20AC;&#x2122; cases are heard, contributing to the dangerous and overcrowded conditions at detention facilities in both the United States and Mexico. The Trump Administration has also sought to assuage the crisis by restricting eligibility for asylum with a slew of new regulations. Unfortunately, these regulations are riddled with problems and almost all have been overturned by federal courts. First, restricting asylum eligibility runs counter to U.S. obligations to hear asylum claims under both domestic and international law. The administrationâ&#x20AC;&#x2122;s strategy would just push the border crisis down Jackie Varas into Mexico, a country less equipped to handle it. Second, pulling back foreign aid from Central America 760,000 people have been exacerbates the poor conditions apprehended crossing the driving people toward the United border illegally this year. States. Instead, the administration should address the border crisis at its This is more than twice the root with investment that promotes number apprehended at stability and economic development this point in 2018. in the countries experiencing violence.

Fact #1: There are more families fleeing to the U.S. According to the latest available data, there were approximately 10.5 million undocumented immigrants in the United States in 2017. While this number is down from 11 million in 2015, 760,000 people have been apprehended crossing the border illegally this year. This is more than twice the number apprehended at this point in 2018. It is also a number which is driven by a swell of asylum seekers fleeing violence in Honduras, Guatemala, and El Salvador. While the number of illegal border crossers has certainly increased in 2019, it is on par with pre-2007 levels. It is also substantially lower than in 2000, when 1.4 million individuals were apprehended. The types of individuals crossing the border, however, have changed: two-thirds of border crossers this year have either been families or unaccompanied children compared to just 13 percent in 2013. In response to the increase in illegal crossers and the change 20

Fact #2: Our current system incentivizes illegal immigration In addition to the failure at the border, the failure of the legal immigration system is also driving illegal immigration. Unless you have a family member in the United States, the current system makes it incredibly difficult to immigrate legally. This is by design: Congress laid the foundation for modern day U.S. immigration policy back in 1965, when the immigration

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system was designed for family reunification. As a result, force participation rates than U.S.-born workers, are more likely two-thirds of green cards given out each year are awarded to start their own businesses, and boost both economic and through family sponsorship. The next-highest number of visas productivity growth. Immigrants are also necessary to prevent are to asylum seekers and refugees (13 percent), followed by economic decline: in the absence of immigration, low birth rates employer-sponsored immigrants (12 percent) and diversity would cause the U.S. population, and therefore the U.S. labor immigrants (5 percent). This stands in stark contrast with nations force, to shrink. such as Australia and Canada, where more than half of annual The American Action Forum proposes a new strategy that immigration flows is for economic reasons. focuses legal immigration on the economics of a productive labor In the United States, employer-sponsorship is largely force. Our proposal recognizes the value of both high-skilled the only avenue of legal and low-skilled workers immigration for individuals â&#x20AC;&#x201C; using a points system to Two-thirds of green cards given out each with no family ties and identify immigrants with who do not qualify for desirable characteristics by year are awarded through family sponsorrefugee status due to fear of education credentials, ship. This stands in stark contrast with na- their persecution. Only 140,000 English language ability, tions such as Australia and Canada, where and skills, or through proven economic visas are awarded each year, however, and work histories. Furthermore, more than half of annual immigration over half are given to the instead of relying on flows is for economic reasons. spouses and minor children arbitrary immigration limits of principal applicants, set by Congress, we propose leaving less than 70,000 for workers. This setup makes it nearly that the level of immigration should be equal to the number of impossible for individuals who want to move to the United qualified applicants seeking entry. This way, immigration policy States for work to legally do so â&#x20AC;&#x201C; even if they are qualified can be utilized as the vital economic tool that it is. to contribute to the economy â&#x20AC;&#x201C; incentivizing unauthorized The United States faces a new immigration challenge. To border crossings. It also incentivizes U.S. companies to hire overcome it, we must rethink our asylum processes at the border undocumented workers, especially in sectors like agriculture and our deficient legal immigration system. Both are working and construction that are facing labor shortages. against us during a time when immigration could not only be The best way to reduce unauthorized border crossings used for humanitarian purposes and family reunification, but moving forward would be to expand the pathways for legal also as a powerful force for economic growth. RF immigration. Moreover, the United States needs a new approach that recognizes immigration as a tool of economic Jackie Varas serves as the Director of Immigration and Trade growth. Research shows that immigrants have higher labor Policy for the American Action Forum.

Source: American Action Forum

RIPON FORUM September 2019

Facts Matter:

What Every American Should Know About Education by KYLE CHANCE One of the most crucial components of a prosperous nation is the quality education of its youth. Education is routinely cited as a predictor of better health, a means to promote social equity and mobility, and a precursor to higher lifetime earnings. Not only that, but a well-educated population better prepares a country to compete in a more globalized world. Like nearly all issues in American politics, education has become yet another topic where Americans are becoming more divided. Since the education and development of the next generation affects us all, it’s important to keep the facts in mind as we discuss what’s best for our children and for those who teach them.

Our Students Underperform Compared to the World Compared to other countries around the globe, students in the U.S. seem to be underperforming. According to the OECD, American students remain stuck in the middle of the pack for the core subjects of science, mathematics, and reading, where they ranked 25th, 38th, and 24th respectively. Though some analysts argue that these rankings may not be as bleak as they initially appear, the U.S., as the wealthiest country on earth, is still underperforming. Furthermore, despite efforts by individual states (through extensive standardized testing) and the federal government (through the introduction of Common School Funding is Down Core standards) to raise standards, the Although they are trusted with the U.S. has not improved on the OECD’s development of the next generation, assessments since the first round of America’s teachers are being squeezed international testing in 2000. by state and local funding. Budget As more countries develop and cuts following the 2007-09 recession advance into post-industrial economies, resulted in stagnant teacher salaries the U.S. is no longer an uncontested that are nearly 5% lower today than global power. Developing countries their high point in 2009/2010 despite are investing heavily in industry and teachers today being more educated education with the hopes of thriving Kyle Chance and older than they were ten years in the new hyper-connected world ago. As a result, 1 in 6 teachers across marketplace. As the U.S. seeks to catch the United States is working a second up, we must not only evaluate how to 1 in 6 teachers across job year-round – not just during the best teach students, but also what we the United States is summer months. need to teach students. The combination An element of this is that K-12 of each of the STEAM fields (science, working a second job education spending across the United technology, engineering, arts, and year-round – not just States is still down 5.5% from premathematics) serves as a foundation during the summer recession levels. These lingering cuts for students to equip themselves in leave the United States with 135,000 a century where innovations and months. fewer teachers than it had a decade breakthroughs have become the earlier while also having to deal with currency of development and power. 1.4 million more students in schools across the country. Beyond international comparison, here at home, Yet, at the same time, public schools across the country discrepancies can be seen in the quality of public education have seen the number of school administrators grow nearly students receive. School district by school district and state by three times more than positions for teachers since 1950— state, the quality of instruction and the performance of students further siphoning already sparse funds away from students’ varies wildly. While some of this can be explained through classrooms. disparities between tax bases and resources available to a given These attenuated working environments are taking a toll district, sometimes having enough money to spend isn’t the on our educators, and in turn the quality of their teaching. issue. 22

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Washington, DC, for example, is a perennial laggard when compared to other cities of similar population and socioeconomic compositions. Yet schools in our nation’s capital spend at one of the highest levels in the country. At $22,000 per pupil in 2018, the District spends nearly $10,000 more per student than the national average and – compared to all 50 states – performs dead last. Even when compared to cities with similar enrollment levels (e.g. Atlanta Public Schools), DC schools still spend twice as much to achieve similar results. Student Loan Debt is Up In the United States, student loans make up the largest portion of non-housing debt in the country – affecting 1 in 3 Americans aged 18-29. In 2019, student debt nationwide ballooned to nearly $1.5 trillion, and this means that, on average, young Americans today are now leaving college with a bachelor’s degree in one hand and $25,000 worth of student loans in the other. While the present situation certainly isn’t ideal, it is positioned to only worsen with the cost of attending college growing at a pace 8 times greater than national wages. These oppressive financial commitments are acting as a barrier to economic progress for Millennials, leading them to postpone marriage, home ownership, and parenthood to much later in life than prior generations. Mounting grievances on student loan debt have provided

fertile ground for the development of radical policies from the 2020 Democratic primary field, including the proposal of eliminating college tuition and cancelling the student loan debt for most or all Americans, and, in turn, financing it via new and higher taxes on most Americans – whether they are wealthy or not. Many research institutions across the ideological spectrum conclude that the root cause of the problem is the federal government granting loans to high-risk borrowers and students attending colleges with low rates of increased earning potential for degrees. Innovative solutions such as income-share agreements, where repayment for financial assistance is based on a student’s income after graduation for a set period, have the potential to revolutionize the current system of paying for college. This strategy would end the practice of shackling today’s youth to decades of financial burden and replace it with a system where universities and private entities can invest in students rather than profiting off their interest payments. Preparing the next generation of Americans for the future is in our nation’s greatest interest and is our society’s greatest investment, so as we debate as a country how best to improve the way we educate, the country should keep in mind the facts and realities of the challenges we face together. RF Kyle Chance is the Deputy Editor of The Ripon Forum.

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RIPON FORUM September 2019

1/8/2019 1:00:50 PM

Debate

Should Online Content Be Regulated?

Free Speech is Not Perfect, but the Government as Censor is Worse by JOHN SAMPLES Recently, someone created a distorted video of A few years ago, Ohio criminalized disseminating House leader Nancy Pelosi (D-CA) that suggested she false statements about a candidate. A congressman asked was drunk. She was not. The video warped her image a state commission set up to enforce the law to stop for political purposes (or perhaps, just for fun). More billboards criticizing his record on abortion. In striking bluntly, the speech in question – the edited video – was down the law, a federal judge said, “We do not want a lie. the government (i.e., the Ohio Elections Commission) During the 2016 election, teenagers in the city of deciding what is political truth — for fear that the Veles, North Macedonia made up government might persecute lies about the American presidential those who criticize it. Instead, in candidates, wholly fabricating “fake a democracy, the voters should news” which attracted attention from decide.” internet searches. Its creators made But can’t the federal significant sums from Google ads government protect us from lies tied to the searches. spread by a hostile foreign power? In February 2018, Robert S. The government can prohibit Mueller III, a special counsel to foreign nationals from buying ads the U.S. Department of Justice, advocating the election or defeat indicted 13 Russians for intervening of a candidate. But the Federal in the 2016 election by purchasing Election Commission notes that advertising, a criminal act for foreign this prohibition “does not restrain nationals. Russian agents posing as foreign nationals from speaking out American citizens also spoke out on about issues or spending money to the internet seeking to hurt Hillary advocate their views about issues. It John Samples Clinton’s effort and to divide the restrains them only from a certain nation on racial and other matters. form of expressive activity closely The identities of these speakers (and tied to the voting process...” Government can perhaps some of their speech) were The government may not restrict sometimes punish lies. speech by foreigners in general. As in life, so in politics: lies do Fifty years ago, the Supreme Court lies. But the First real harm. Individuals are worse off indicated an American had a First Amendment believing lies. Candidates may gain Amendment right to receive The sharply limits office with the support of a misled Peking Review free of even minor majority. Policies might become law government rules. Of course, this government based on falsehoods. What should be was a right of Americans to read restrictions on done? material, not a right of foreign Government can sometimes nationals to speak to Americans. “the freedom of punish lies. For example, libel The United States has mandated speech.” law sanctions speakers whose lies disclosure of the sources of speech damage the reputation of others. But by foreign nationals. Members of the First Amendment sharply limits Congress hear speech by foreign government restrictions on “the freedom of speech.” In agents almost every day. Would average citizens be United States v. Alvarez, the Supreme Court refused to beguiled by foreign arguments even if their source were recognize a general exception to the First Amendment disclosed? Keep in mind a television network funded for false speech. That decision seems wise in a polarized by Russia operates in the United States; at first without age. Partisans often see reasonable differences as lies. (cont’d on p. 27) 24

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Should Online Content Be Regulated?

The Positives and Pitfalls of Policing the Internet by JUSTIN SHERMAN For decades, many in the democratic world thought of the copyrighted content through the internet. South Korea has internet as an inherently “free and open” place, namely where implemented internet filtering mechanisms to block online information flows are unrestricted.1 Cyberspace, the popular gambling.5 refrain goes, does not respect national borders. Generally speaking, clearly articulated and evenly But that idealized vision of the global internet is enforced regulations on such online content as child increasingly clashing with reality: one where many countries pornography and intellectual property are widely accepted in exert control over internet architecture democratic countries. They’re often seen within their borders.2 While perhaps as in the public interest and, depending thought of as confined to autocracies like on the execution, in line with democratic China and Russia, questions of content principles. Further, for nations with regulation — in the face of online harms rule of law and with laws that more or like child pornography and copyright less reflect the will of the people, there violations, Russian disinformation and is also a general acceptance of taking terrorist propaganda — are cropping up laws previously established offline with greater frequency in democratic and enforcing them online, as in South nations. In the U.S. and elsewhere, the Korea’s online gambling block. question now lingers: should governments That said, countries are looking to regulate online content or intervene in pass content laws in new areas. Content some way to force private entities to regulation proposals are now being regulate their own? While too complex an expanded to restrict the creation and issue to capture everything in one article, distribution of everything from harmful Justin Sherman there are a few key points that should content writ large (i.e., self-harm videos) center this debate in the United States. to terrorist content to deliberately Contrary to First, it’s important to lay out misleading or outright fabricated news the broader landscape of online stories. popular belief, content regulation as it stands today. Australia recently passed a many democracies Because contrary to popular belief, regulation around online terrorist many democracies already have some content, for instance, in the wake of the already have some regulations on internet content. The United massacre in Christchurch, New Zealand regulations on States, through the Children’s Internet that left 50 dead and was live-streamed internet content. Protection Act, establishes guidelines on on social media.6 The United Kingdom, schools filtering out obscene or harmful to use another example, recently put online material.3 Section 230 of the U.S. forth a proposal for the regulation Communications Decency Act exempts online platforms of online harms, such as restricting the sharing of violent from the liability of traditional publishers, though disputes content. In both cases, critics expressed concerns about overexist about whether this should remain in place.4 Countries censorship on the part of companies.7 And in Australia’s case, from Canada to Israel have rules preventing the pirating of (cont’d on p. 26) 1--https://www.newamerica.org/cybersecurity-initiative/reports/idealized-internet-vs-internet-realities/ 2--https://www.newamerica.org/cybersecurity-initiative/reports/digital-deciders/ 3--https://www.fcc.gov/consumers/guides/childrens-internet-protection-act 4--https://slate.com/technology/2019/02/cda-section-230-trumpcongress.html

5--https://www.newamerica.org/cybersecurity-initiative/c2b/c2blog/analysis-south-koreas-sni-monitoring/ 6--https://www.aljazeera.com/news/2019/03/australia-planstough-social-media-law-christchurch-attacks-190330095345474. html 7--https://www.worldpoliticsreview.com/articles/27766/with-newlaws-to-filter-online-content-will-the-internet-remain-free-andopen

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Should Online Content Be Regulated? remove. Threat of punishment by the government may only (Sherman - cont’d from p. 25) there are notable concerns from citizens and tech watchdog encourage over-censorship by online platforms to avoid any groups that the government, in the wake of a national security chance of regulatory violation. Similarly, requiring deletion crisis, is committing the all-too-familiar knee-jerk legislative of certain content within narrow time frames might only overreach.8 encourage poor, rushed content reviews.13 Following evidence of Russian interference in the 2016 Requiring companies to build out legal and technical U.S. presidential election through social media bots and capabilities for content filtering, at scale, also means disinformation9 — and, again, in the 2018 U.S. midterms10 — constructing systems that can theoretically be expanded, there are calls from American policymakers and the public for repurposed, or redirected in the future. Shifts in political the federal government to regulate online content to prevent winds or calls for information control in the wake of a national the spread of fake news. Terrorist content and other harms, security crisis could lead to broad proposals that capitalize too, have contributed to public concern in the U.S. over the on existing legal regimes and technical architectures to negative impacts of free content flows. Nonetheless, even for implement even tighter, or more arbitrary, forms of online those who desire strong protection of the American electoral content regulation. It’s different from free speech in the system and strong mitigation of Russian influence operations, physical space in this way, since it is theoretically much many notable risks linger around the actual implementation of easier to scale up digital content regulation systems once online content regulation. they’re built. And in the United States, which has already For one, the United States obviously has the First seen its fair share of overly sweeping national security Amendment. This constitutional legislation, desires to block protection of free speech and free Russian fake news and other online Strengthening private assembly introduces a number of content must be balanced with the complexities when it comes to protection of civil liberties. regulations by enabling a regulating online content. Citizens Contrary to longstanding company to self-determine narratives may share Russian disinformation in certain policy circles, online, yes, but is that not their and censor what it deems there are many forms of online right? How do you differentiate content that should be carefully to be political fake news one person’s extremist speech from regulated in democracies, such as may be undesirable from another person’s revolutionary the criminalization and restriction content? What about sharing nudity? of creating and distributing child a First Amendment In 2016, for instance, Facebook pornography or terrorist recruiting perspective. came under fire for censoring a materials. The harms that can famous Vietnam War-era photo of a occur on and through the internet naked Vietnamese girl running from continue to grow in volume and severity. a napalm attack, before it reversed its decision.11 Yet the risk of government overreach and negative In a similar vein, there are already those who criticize consequences around content regulation is great — private social media companies for enforcing their own sets exemplifying that this is not just about election interference of regulations around online content, in what many see as or ISIS propaganda on the internet, but about whether and public spheres (i.e., Twitter, Facebook, etc.). Strengthening how the U.S. Constitution can be effectively applied to deal private regulations by enabling a company to self-determine with this 21st century problem. When the United States has and censor what it deems to be political fake news may be built its online brand on free flows of information, how can undesirable from a First Amendment perspective. Section 230 we manage the discourse space when that content violates of the Communications Decency Act, in exempting online rights or undermines democracy? The answer isn’t a platforms from traditional publisher liability, was arguably straightforward one, but these dialogue points should help meant to encourage platform self-management in this way.12 center the debate. RF Firms like Facebook and Twitter already face challenges when trying to quickly remove potentially offensive content, Justin Sherman is a Cybersecurity Policy Fellow at New and are subject to criticism for what content they do and do not America. 8--https://www.lawfareblog.com/australias-new-social-medialaw-mess 9--https://www.npr.org/2017/11/05/562058208/how-russia-weaponized-social-media-with-social-bots 10--https://arxiv.org/pdf/1902.00043.pdf 11--https://arxiv.org/pdf/1902.00043.pdf

12--https://slate.com/technology/2019/02/cda-section230-trump-congress.html 13--https://globalnetworkinitiative.org/gni-statement-draft-eu-regulation-terrorist-content/

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Should Online Content Be Regulated? (Samples - cont’d from p. 24) of care” that requires companies to protect users. disclosure of its owner, and now as a registered foreign U.S. politicians have made similar suggestions. These agent. Disclosure informs citizens without restricting proposals are risky. Social media managers might speech. suppress speech to please regulators and public officials. Much speech now takes place on the internet Government officials might thereby do indirectly what platforms owned by private companies. Both the Russian they may not do directly: censor speech. ads and the Pelosi video appeared on Facebook. Such In the end, “more speech” remains the best answer to private companies are not the government; no speaker “bad speech.” Critics rapidly identified and debunked the enjoys First Amendment Pelosi video. Russian efforts protections against being in 2016 have been disclosed removed from Facebook. and debunked; public opinion Free speech is not perfect. But Facebook has rules experts indicate the Russians the alternative – government as against setting up fake had little effect on voters. censor – will be worse. accounts, a trick often Free speech is not perfect. used by foreign actors. People lie and are sometimes The platform uses machine believed. But the alternative – learning to identify and government as censor – will be remove fake accounts; Facebook also mandates worse. Individuals and private enterprise are the proper extensive disclosure of ad buyers. At the same time, censors of bad speech. They remain our best responses to Facebook does not wish to become an “arbiter of truth” the coming challenges of the digital era. RF for its users. Facebook provided more information about the Pelosi video mentioned above, but did not take it John Samples is a vice president at the Cato Institute. down. This essay draws on his recent Cato Policy Analysis, Should government demand more from social Why the Government Should Not Regulate Content media? The U.K. government has proposed a “duty Moderation of Social Media.

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News & Events

2019 Roosevelt Leadership Awards Presented to Neal, Brady, Reed & Camp Jon Meacham delivers keynote remarks at this year’s awards celebration WASHINGTON, DC – At a dinner on at worst, if they fail, fail while daring of the Ways & Means Subcommittee on Thursday, September 12th, at the John greatly, so that their place shall never Social Security; and, former U.S. Rep. F. Kennedy Presidential Library & Mu- be with those cold and timid souls who Dave Camp (R-MI), who served as Ways seum in Boston, The Ripon Society and know neither victory nor defeat.’ & Means Chairman from 2011 to 2015. Franklin Center for Global Policy Ex“The four leaders we honor tonight Also receiving a Roosevelt Award change honored four leaders of the Ways embody these qualities and more. was Don Carlson, the longtime Chief of & Means Committee with the 2019 Roo- Between them, they have nearly 100 years Staff to former Ways & Means Chairman sevelt Leadership Award, an honor that is of service at every level of government. Bill Archer who was honored for his years given in the spirit of America’s 26th Presi- Individually, they have made their mark of service in Congress and his longtime dent and is intended to recogsupport of The Ripon Society nize leaders who today embody and Franklin Center. some of the same qualities that In addition to the Theodore Roosevelt displayed Roosevelt Leadership Awards throughout his life and career. dinner on Thursday night, “This award was Conzelman noted that this established with one premise year’s awards celebration in mind,” stated Ripon/ also featured a visit on Friday Franklin President & CEO Jim to John Adams’ presidential Conzelman in remarks to open birthplace and family estate the event. “Namely, there is a lot in Quincy. Conzelman added of good, thoughtful work being that the awards celebration done on Capitol Hill and in concluded with a dinner on Washington that people do not Friday evening that featured regularly hear about. With trust keynote remarks by Pulitzer in government at an all-time Prize winning author Jon low, we believe it is important Meacham, who spoke not that Americans not only learn only about his latest bestseller, about this work, but learn more The Soul of America, but about the individuals who are the founding of The Ripon responsible for getting it done. Society and its historic role “To that end, the Roosevelt as the first major Republican Leadership Award honors those organization to support leaders: passage of the Civil Rights Act “Who have a sense of duty in the 1960s. and service driven by a love of This is the fifth year the country. Roosevelt Leadership Awards Reed, Neal, Camp and Brady were presented with the “Who possess a desire to have been presented. Last 2019 Roosevelt Leadership Award at the John F. do what is in the best interests year’s awards dinner was Kennedy Presidential Library on Sept. 12th. of the American people – held at the Richard Nixon regardless of party, and regardless of who in many important ways. Presidential Library and Museum in gets the credit; and, This year’s Roosevelt Award Yorba Linda, California, while the 2017 “Who embody the qualities that honorees include: U.S. Rep. Richard Neal awards celebration was held in New Theodore Roosevelt spoke of when he (D-MA), who serves as the Chairman York and included visits to Theodore said: ‘The credit belongs to those who are of the Ways & Means Committee; U.S. Roosevelt’s historic home at Sagamore actually in the arena, who strive valiantly; Rep. Kevin Brady (R-TX), who served as Hill and Franklin Roosevelt’s estate who know the great enthusiasms, the Ways & Means Chairman from 2015 to and museum in Hyde Park. In 2016, great devotions, and spend themselves 2019 and currently serves as the panel’s the awards celebration was held at the in a worthy cause; who at best know the Ranking Member; U.S. Rep. Tom Reed George W. Bush Presidential Center triumph of high achievement; and who, (R-NY), who serves as Ranking Member in Dallas, Texas, while the inaugural RIPON FORUM September 2019

Roosevelt Awards in 2015 were held at the Ronald Reagan Presidential Library in Simi Valley, California, and included a visit to Rancho del Cielo, President Reagan’s historic ranch atop the Santa Ynez Mountain range northwest of Santa Barbara. According to Conzelman, holding this year’s awards dinner at the John F. Kennedy Presidential Library was especially fitting because JFK’s legacy has a special place not only in American history, but the history of The Ripon Society, as well. “The first public statement by The Ripon Society was written in the weeks following JFK’s tragic death,” Conzelman noted in his welcoming

remarks on Thursday night. “The statement was titled, ‘A Call to Excellence in Leadership: An Open Letter to the New Generation of Republicans.’ It read in part: ‘To all thinking Republicans, the meaning of November 22, 1963, should be clear. The Republican Party now has a challenge to seek in its future leadership those qualities of vision, intellectual force, humaneness and courage that Americans saw and admired in John F. Kennedy -- not in a specious effort to fall heir to his mantle, but because our times demand no lesser greatness ... Great government requires great men in government. In a complex age – when truth is relative and total solutions elusive

-- we can do no more than pledge the very best qualities of mind and soul to the endless battle for human dignity … All of us must now respond to the need for forceful leadership.’ “Clearly, a lot has changed since the founders of the Ripon Society wrote this statement 56 years ago,” Conzelman said. “But one thing that hasn’t changed is the importance of forceful leadership, and the need for great men – and great women – in government. “It is in that spirit of leadership and service that we meet here tonight in Boston at the John F. Kennedy Presidential Library. And it is in that spirit that we present the 2019 Roosevelt Leadership Awards.” RF

Jon Meacham

Richard Neal

Kevin Brady

Tom Reed

Dave Camp

Don Carlson & Jim Conzelman

RIPON FORUM September 2019

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Name: Mike Braun Occupation: U.S. Senator (IN) Previous jobs held: Previously the founder and CEO of Meyer Distributing, a company I built in my hometown of Jasper that employs hundreds of Americans across the country. Book(s) you’re recommending to friends: Skin in the Game: Hidden Asymmetries in Daily Life by Nassim Nicholas Taleb Challenge facing your state you’re working hard to address: The three things I’m working to address on behalf of Hoosiers are finding solutions to lower the cost of prescription drugs, addressing the opioid crisis, and workforce development that will keep our economy strong. How has your background in the private sector affected your work in the Senate: In the private sector, we need to achieve real results for the customer or you go out of business. While Congress is more gummed up than I ever imagined, we need solutions and that’s why I’ve worked on separate legislation with Republican Senator Rick Scott and Democrat Senator Tammy Baldwin that lowers the cost of healthcare. Finish this sentence: “If I could change one thing about American politics, it would be…”: How polarized and dysfunctional our political process has become. When President Obama was in office, Democrats supported border security but now oppose efforts by President Trump to address the humanitarian and security crisis on our southern border. Likewise, Republicans claim they’re for free market principals, but when it comes to healthcare we’ve become apologists for an industry that is opaque and cloaked in secrecy. 32

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