Ready for Hillary–What’s her Agenda?

New York

June 23, 2016

What Is Hillary Clinton’s Agenda?

She’s had so much to say on so many issues that voters may not know what she wants to accomplish.

by Paul Starr

Hillary Clinton Button 302

It is misleading, some observers have rightly pointed out, to treat the 2016 election as a contest between two candidates who are equally serious about policy. Donald Trump has been on both sides of many issues, contradicting himself from one day to the next. On occasion, he has given a speech written by advisers on a subject like energy where he seemed as surprised by the text as the audience was.  He has a core of symbolically important positions on such issues as immigration, but otherwise his views are murky. Much of what he says about foreign or domestic problems is all impulse and no thought, so when his impulse momentarily changes, his positions change too.

For Hillary Clinton, however, substance actually does matter. Her seriousness defines her. We have not reached the stage of gender equality when a woman candidate for president could get away with being as subject to changing moods and personal pique as Trump is. While no one would know what to expect from a Trump presidency in major areas of policy, Clinton has laid out plans in virtually every domain. That plenitude of nuanced and multilayered policies is both an asset and a limitation. It is valuable in signaling to different groups where her commitments lie, and it will be an asset in governing if she is elected. But it is a limitation in a political campaign for reasons that have been especially clear this year.

Whether voters love or hate Trump, they can name a few big things he says he would do as president: build a wall on the Mexican border, round up and deport illegal immigrants, ban Muslims from coming to America, and redo trade deals. Similarly, Democratic primary voters this year were able to identify Bernie Sanders with a few major promises: break up the banks, make public college free, and pass what he calls “Medicare for all.”

Despite Clinton’s ample detail—her website covers more than 30 different issue areas, each with bullet points about specifics—voters would probably be hard-pressed to come up with three or four big ideas they identify with her. Although it is hardly a weakness of a presidential candidate to be prepared for the scope of the job, her campaign has not had a clarifying focus on a few big themes or proposals that instantly communicate what she wants to do.

P Photo/Kathy Willens, Pool

Clinton talks with a youngster at an early childhood education center in New York in 2015.

The strategy that Clinton has adopted thus far this year may be partly to blame. Seeking to rally diverse constituencies, she has framed her candidacy in broad, progressive terms, often saying she wants to break down “all the barriers” facing people—not just economic barriers, but also those based on race, gender, sexual orientation, and other sources of disadvantage. She also says she wants to build on Barack Obama’s presidency, and since Obama has previously supported much of what she favors, those ideas do not have her own stamp—at least not yet. In contrast to Sanders, she has repeatedly said she doesn’t want to make unrealistic promises, and against both Sanders and Trump, she has cast herself as the candidate of responsibility and refused to call for huge programs or huge tax cuts that would balloon the federal deficit. In another presidential year, she might get credit for good judgment; this year, she gets criticized for lacking imagination.

Perhaps concerned about the media seizing on whatever issue she leaves out, Clinton has resisted indicating which of her proposals would have priority. In a profile this spring in New York Magazine, Rebecca Traister reports Clinton saying she doesn’t accept the premise that as president she would have to choose which issues to advance first, assuming a two-year window of opportunity to move legislation through Congress. “I want to take everything I’ve said I’m going to work on and be as teed up as possible from the very beginning. I want to give [Congress] every opportunity to move forward on several fronts.”

Of course, advances along those fronts depend on the outcome of the congressional election. If Democrats win control of the Senate as well as the presidency, it would help Clinton with both judicial and executive nominations, but not necessarily with epochal legislation if Republicans still hold their House majority. In the less likely scenario in which Democrats also win back the House, the legislative logjam since 2011 could break open—especially if Senate Democrats eliminate the filibuster (as they did for appellate court nominations in 2013). Even if the odds of full control of Congress are low, Clinton ought to be “teed up” to take advantage of that possibility. Both Bill Clinton and Obama had a two-year window at the beginning of their presidencies, and most of the progressive legislation of recent decades was enacted during those intervals—the only four years of unified Democratic government in the past 36.

Even if the odds of full control of Congress are low, Clinton ought to be “teed up” to take advantage of that possibility.

Before getting ahead of herself, however, Clinton has to win the election, and it is first of all for that purpose that she needs to define her priorities more sharply. Unlike Trump, she’s not going to go to extremes to make her case. But voters should know what to expect from her, and she needs to find ways to convey ideas that will stand out in their minds.

Focusing Clinton’s Economic Agenda

The economy and jobs usually top the list of voter concerns, so let’s begin there. Although Clinton’s approach to economic issues isn’t embodied in one or two signature policies, her agenda does have a thematic unity, summed up in a phrase she often uses, “giving working families a raise.”

A higher minimum wage is an unambiguous expression of that theme. In the Democratic primaries, the clash between Clinton and Sanders over the size of a minimum-wage increase obscured their agreement on a big jump. Raising the federal minimum from $7.25 to $12—the level Clinton has endorsed—would be the single largest increase in the history of the minimum wage in either percentage or absolute terms. (She also supports efforts in states and municipalities to raise their minimum wages to $15.) Clinton should be able to draw a sharp contrast on the issue with Trump, who has said that wages in America are “too high,” though in his customary style, he has also casually suggested he could support a minimum-wage increase, as if a Republican Congress would send him one.

Several other elements fit into Clinton’s overall theme, each of which articulates to other elements in her campaign. Like Obama, who increased infrastructure spending as part of the economic-recovery program soon after taking office, Clinton says that during her first 100 days she will call upon Congress to boost investment in roads, bridges, and other public works more than at any time since the development of the interstate highway system in the 1950s. Closely related are policies to increase investment in clean energy, including measures aimed at installing half a billion solar panels and generating enough power from alternative sources to run all of America’s homes in four years. In line with the effort to give working families a raise, she’s pledged not to increase taxes for those making less than $250,000 a year, proposing instead to finance investments in infrastructure and other measures by closing “corporate tax loopholes” and making “the most fortunate pay their fair share.”

If Democrats win big in November, the outcome may be seen, above all, as a mandate on immigration reform. Here, supporters of fair immigration reform gather in front of the Supreme Court in Washington, Monday, April 18, 2016. 

Here it is worth taking a moment to consider Clinton’s revenue and tax-fairness proposals in light of what Obama has done. Although you might never know it from discussion among progressives, the Obama years have seen a major shift in tax burdens from lower- and middle-income people to the rich. In 2009, Congress enacted three tax-credit increases that were later made permanent (the Earned Income Tax Credit, the Child Tax Credit, and the American Opportunity Tax Credit). Together, these have cut taxes for 24 million working- and middle-class families by an average of about $1,000. The subsidies for health-insurance premiums in the Affordable Care Act (ACA) represent another substantial benefit for those with low to middle incomes. At the median income, the federal income tax rate is now 5.3 percent, which is lower than the average in any presidential administration since the 1950s, indeed, less than half the rate during Jimmy Carter’s presidency (1977–1980).

The flip side of the Obama record on taxes has been higher taxation of upper-income households. In 2010, congressional Democrats and the president prevented the extension of the tax cuts for the rich enacted under George W. Bush, increasing the top marginal income tax rate back to its level during the Clinton administration (39.6 percent) and reducing tax cuts on investment income and estates. When these changes went into effect in 2013, the top 0.1 percent paid $50 billion in taxes more than they would have paid under the previous rules. Partly as a result of a provision in the ACA, the tax rate on capital gains has gone from 15 percent to 23.8 percent.

Clinton’s proposals move in the same progressive direction, raising taxes on top incomes and providing relief to the less affluent. To pay for her new initiatives, she is calling for a 4 percent surtax on people with incomes over $5 million and a new minimum tax of 30 percent on those with pre-deduction incomes of more than $1 million. Several of her tax proposals are aimed at promoting long-term investment within the United States. These include increases in capital gains taxes for assets held for less than six years and other changes in tax policy to discourage high-frequency trading and shifts of corporations, jobs, and investment abroad. One little-discussed idea she has endorsed is a tax credit to encourage corporations to adopt employee profit-sharing plans. According to an analysis by the nonpartisan Tax Policy Center, Clinton’s tax proposals would generate about $1.1 trillion over a decade: “Nearly all of the tax increases would fall on the top 1 percent; the bottom 95 percent of taxpayers would see little or no change in their taxes.”

Besides paying for infrastructure investments, much of the tax revenue Clinton proposes to raise would go to purposes that bear out her theme of “giving working families a raise.

Besides paying for infrastructure investments, much of the tax revenue Clinton proposes to raise would go to purposes that bear out her theme of “giving working families a raise.” Clinton would use some of the revenue to finance her proposal for paid family leave. In the same vein, she is proposing to move toward universal pre-K by providing new funds to states that expand access to preschool for all four-year-olds. She has also discussed limiting families’ child-care costs to 10 percent of income, and although she hasn’t yet spelled out the details, that idea could involve refundable tax credits. The proposals add up to a clear message, if Clinton and the Democrats can communicate it: tax fairness on behalf of families who are struggling to make ends meet.

On taxes, the contrast with Trump could hardly be more dramatic. Trump’s tax plan calls for sharp cuts in federal income tax rates, including a reduction in the top rate from 39.6 percent to 25 percent. According to the Tax Policy Center, the top 1 percent would see their taxes fall on average by more than $275,000, while the top 0.1 percent would enjoy a windfall averaging over $1.3 million. For the lowest-income households, the tax cut would amount to $128; for middle-income households, $2,700. In addition, Trump would also completely eliminate federal estate taxes—which currently apply only to estates worth more than $5.45 million—and reduce taxes on business. The total loss in federal revenue, conservatively estimated by the Tax Policy Center at $9.5 trillion over ten years, would lead to severe cuts in federal programs or massive increases in deficits, or both. (The estimate of lost revenue is conservative because it doesn’t take into account rising interest costs from rising deficits.) Trump has ruled out cuts in Social Security and Medicare. On that assumption, other federal spending—defense, transportation, health, education, and so on—would have to be cut by about 80 percent to balance the budget. Since cuts of that magnitude aren’t feasible, the deficit would likely grow explosively.

In the contest over economic policy, Trump benefits from the undeserved impression that he has been a business genius and, more generally, from gendered expectations about the two candidates. In contrast to Clinton’s family-centered economics, Trump offers a seemingly more muscular, nationalist alternative. He promises to get factories humming by slapping tariffs on foreign imports, undoing environmental and other regulations, and boosting production of fossil fuels, including coal. Deporting the 11 million unauthorized immigrants fits with the same approach. It’s a turn-back-the-clock agenda that may appeal especially to white, industrial workers who have lost ground in recent decades, even though the job losses in manufacturing over the past half-century primarily stem from long-term technological change that, especially with advances in robotics, will almost certainly continue regardless of Trump’s policies. Rather than helping workers, Trump’s threatened tariffs could set off a trade war that would cost jobs in export-oriented industries, and the mass deportations he calls for would be not only inhumane but also economically devastating to the regions in the United States where immigrants account for much of the workforce and consumer demand.

Hillary Clinton and her daughter Chelsea Clinton speak at a “No Ceilings” event dealing with women’s issues at the Clinton Presidential Center in Little Rock, Arkansas, November 15, 2014. 

Clinton isn’t conceding ground to Trump on industrial jobs. She is proposing to devote $10 billion to regional alliances called “Make it in America Partnerships,” aimed at strengthening industrial competitiveness and building on the National Network for Manufacturing Innovation established under legislation that Ohio Senator Sherrod Brown sponsored in 2014. The clean-energy proposals also aim at fostering manufacturing jobs. Acknowledging that trade has had mixed effects on manufacturing, she says new trade agreements have to meet “a high bar” and has backed away from supporting the Trans-Pacific Partnership.

But whereas Trump wants to wall America off from outsiders and revert to an unrecoverable past, Clinton’s agenda is fundamentally modernizing. She calls for more investment in science and technology, urges increased assistance to students to make college debt-free, accepts the facts of climate change, and generally favors trade and openness to the world. As against Trump’s “America First” foreign policy, she is committed to upholding America’s international agreements and leadership role on a planet that has become more interconnected than ever. Her support for paid family leave, universal pre-K, and assistance with child-care costs reflects a commitment to bring national policy in line with the contemporary realities of family life.

Clinton properly frames those family-centered economic policies as a foundation of general prosperity. “The movement of women into the American workforce over the past 40 years was responsible for more than $3.5 trillion in economic growth,” she argued in a speech last July. But whereas “the United States used to rank seventh out of 24 advanced countries in women’s labor force participation,” America dropped to 19th by 2013, partly because other countries are “expanding family-friendly policies like paid leave and we are not.” High-quality, affordable child care, she said, “is not a luxury. It’s a growth strategy.”

Clinton’s challenge is to persuade voters that her vision of what she calls a “growth and fairness economy” is rooted in today’s America, and Trump’s is stuck in yesterday’s.

Clinton’s challenge is to persuade voters that her vision of what she calls a “growth and fairness economy” is rooted in today’s America, and Trump’s is stuck in yesterday’s. “When he says, ‘Let’s make America great again,’” Clinton declared on June 7, “that is code for ‘Let’s take America backward.’” She needs to press the case that Trump has lied about who would benefit from his tax plan and that the tough-guy image is fake—he has no practical way of making American industry great again, either by muscling other countries in trade or by deporting millions of immigrants. But while framing Trump’s notions as backward-looking bombast, Clinton also has to fill in what are still blanks in many voters’ minds about her own program, spelling out how she would “give working families a raise.” A historic increase in the minimum wage, a big infrastructure program, tax fairness, and new policies centered on families and children can provide the substance behind that theme.

A Referendum on America

The priorities that emerge from an election and shape a presidency often depend on the conflicts that the election itself highlights, based on the identities and personalities of the candidates as well as the issues they campaign on. The 2016 election has become a referendum on the kind of society that the American people want. Eight years ago, Barack Obama’s candidacy put to the test how far Americans had come in accepting African Americans as full and equal citizens. This year’s election is also about diversity, but the conflict now focuses on immigrants because of Trump and on women because of Clinton—and Clinton has every reason, and shows every sign, of using the stark challenge that Trump poses as a call to arms to voters and, if she wins, a mandate for action.

By nominating Trump, Republicans have raised the stakes on immigration. Under George W. Bush and again in the wake of the 2012 election, Democrats thought they could reach agreement with Republicans on legislation to provide a path to citizenship for long-settled, law-abiding unauthorized immigrants. That era appears to be gone now that the GOP has a nominee threatening mass deportations. If Democrats win big in November, I expect the outcome will be seen, above all, as providing a mandate on immigration reform. A decisive rejection of Trump will be a vote for an open, diverse society, and both Clinton and congressional Democrats will be emboldened to confirm that choice. But if Democrats fall short and immigration reform fails again, Clinton has committed to maintaining and expanding the administrative actions that Obama has taken in protecting Dreamers and others among the undocumented (actions, however, that are pending before the Supreme Court).

Immigration reform—together with racial-justice issues—will likely receive priority for another reason: the political debt that Democrats, and Clinton in particular, owe to the black, Latino, and Asian American communities.

Immigration reform—together with racial-justice issues—will likely receive priority for another reason: the political debt that Democrats, and Clinton in particular, owe to the black, Latino, and Asian American communities. Clinton would not be the presumptive Democratic nominee if she hadn’t won overwhelming majorities among minority voters in the primaries. One of the first speeches she gave in the campaign was about ending the era of mass incarceration; she was also early to focus on the drinking-water crisis in Flint, Michigan, as an issue of environmental justice. She cannot afford to forget those commitments. Four years from now, minority voters could again be crucial to her re-election.

Gender-related concerns were bound to arise in the first presidential election with a woman at the head of a major-party ticket. But Trump’s sexist comments about women, open talk about the size of his penis, and peacock-like demeanor have put the politics of gender into the spotlight in an unprecedented way. Clinton couldn’t have picked a better foil for making her case for women’s rights and a vision of prosperity with families and children at the center. Just as with immigration, Clinton will have the basis for claiming a mandate on those issues if she wins in November.

IF THE REPUBLICAN PARTY hadn’t turned as far right as it has in recent years, there might well have been possibilities for bipartisan cooperation on other major issues besides immigration. Two of these, climate change and health care, have now become long-term reform projects identified with the Democratic Party, begun in earnest under Obama and necessarily of high priority to a Democratic successor.

Trump again makes the stakes exceptionally clear. While some Republicans at least acknowledge global warming, Trump once tweeted that the very idea is a Chinese conspiracy to dismantle American manufacturing. In May, as part of his energy speech, which could have been summed up as “fossil fuels forever,” he pledged to “cancel the Paris climate agreement” and rescind environmental regulations that cut carbon emissions.

Picking up where Obama leaves off, Clinton has primarily focused on using authority under existing law to promote clean energy and reduce carbon pollution. The failure of Senate Democrats in 2010 to pass a cap-and-trade program approved by the House showed how difficult it is for Democrats, even with a Senate majority, to get representatives from coal-dependent states to vote for any bill moving the country toward energy alternatives. Besides defending Obama’s executive actions—in particular, the Clean Power Plan, which effectively bars new coal-fired power plants—Clinton is calling for higher fuel-efficiency standards, changes in leasing practices on federal lands, and stricter regulation of methane emissions (and therefore of fracking). Democratic control of Congress would be necessary for some measures Clinton is supporting, such as new investments in clean-energy infrastructure and an end to tax subsidies to the oil and gas industries.

AP Photo/Doug Mills
Clinton testifies on health-care reform in 1993. Improving the ACA would be a top priority now.

On health care, there was some confusion last fall about where Trump stood. While calling for the repeal of Obamacare, he suggested that he might deviate from Republican orthodoxy and propose a program for universal coverage. But by February he backtracked, issuing a plan that would not only end coverage for about 20 million people who have gained it through the ACA but also effectively nullify state regulation of health insurance. The plan would allow insurance to be sold across state lines, enabling insurers to locate in states with the weakest laws.

Health-care reform has been the national issue most closely identified with Clinton, dating back to her role as the public advocate for her husband’s plan in 1993. She has a grasp of health policy few other public figures can match, and while continuing to carry out the ACA, she may now also have the opportunity to fix problems with the law, especially if Democrats secure a congressional majority.

In their early going, major reforms often need reforming themselves. After enacting Social Security in 1935, Democrats controlled both Congress and the presidency for more than a decade, which enabled them to amend and consolidate the program. Likewise, after passing Medicare and Medicaid in 1965, they were also able soon afterward to adjust those programs in amendments. But immediately after passing the ACA, Democrats lost control of Congress, and although Republicans have been unable to repeal the law, they have blocked constructive changes. The ACA, many Democrats initially said, would be a foundation they could build on, but they haven’t had the chance due to the gridlock in Washington.

Several problems now stand out as legitimate sources of dissatisfaction with health-care reform: high levels of patient cost-sharing in plans available in the insurance marketplaces; continued difficulties among low-income families in affording premiums; narrow networks (that is, lack of choice of physicians and other providers); and lack of competition among insurers in some states and regions. To help make coverage more affordable, Clinton is proposing a tax credit of up to $5,000 per family to offset a portion of the out-of-pocket and premium costs that exceed 5 percent of family income—another example of giving working families a raise. She would require insurers to limit out-of-pocket prescription drug costs to $250 per month for patients with chronic or serious conditions. She wants to increase incentives for states to expand Medicaid. And, as she did in her 2008 presidential campaign, she is supporting the establishment of a “public option” as a competitive alternative to private plans in the insurance marketplaces.

Considering Clinton’s long personal involvement in health-care reform, the issue should be a top priority of hers

A public option could come in different forms. One possibility endorsed by Clinton is a Medicare buy-in for people when they reach age 50 or 55. This is not a new idea; Bill Clinton proposed it for 55- to 64-year-olds in the late 1990s and Al Gore supported it in his 2000 presidential campaign. The difficulty then was the likely cost resulting from “adverse selection”; the people most likely to enroll would have been those in poor health with high medical costs. Although this problem won’t have disappeared, it should be more manageable because of the subsidized plans already available in the insurance marketplaces. In fact, by taking 50- or 55- to 64-year-olds out of the general risk pool, a Medicare buy-in could result in lower premiums (and therefore lower federal tax subsidies) for everyone else in the insurance marketplaces. Letting Medicare compete for middle-aged enrollees in the insurance exchanges could be an incremental step toward a general public option. Short of congressional action on the Medicare buy-in or a general public option at the national level, Clinton has said she will use the flexibility already provided by the ACA to help states establish their own public options. Considering Clinton’s long personal involvement in health-care reform, the issue should be a top priority of hers.

TO THE SHORT LIST OF REFORM projects that will likely rank high on Clinton’s agenda, we can add one more—democracy itself. Recent decisions by the Supreme Court and policies adopted by Republicans at the state level have increased the political importance of voting and campaign-finance rules. Whereas Republican-controlled state governments have sought to make voting more difficult, Clinton wants to make it easier. She favors automatic voter registration for 18-year-olds and a new national standard for early voting (allowing voting to begin 20 days or more before an election). She’s endorsed a small-donor matching program as part of campaign-finance reform and wants to reverse the Supreme Court’s weakening of a key provision of the Voting Rights Act, as well as the Court’s Citizens United decision.

Although Clinton would not be able to bring about many of these changes on her own authority without a Democratic Congress, she could have an enormous influence on the democracy agenda through Supreme Court and other judicial appointments. Assuming the Senate does not confirm Judge Merrick Garland during the lame-duck session after the election, Clinton—or for that matter Trump—could make as many as four Supreme Court appointments. Those choices could be the most important decisions the next president makes.

Ultimately, many people who cast their ballots for Clinton may vote more against Trump than for her, in part because they know enough about Trump to fear him, although they may be less clear about what Clinton would do. But Clinton has the basis for a stronger, positive case. She wouldn’t just make political history by becoming America’s first woman president; her family-centered economics provides the substance to make her presidency a milestone in American social life. After the long rise of inequality, it would not be a little thing to increase the minimum wage by 65 percent or to enact paid family leave and support for child care and universal pre-K. Affirming America’s commitment to an open and diverse society through immigration reform would also be a big deal. So would pushing ahead on the great energy transition and universal health care, as well as a revitalized democracy. The battle during the primaries left some Democrats feeling that Clinton wasn’t reaching high enough. But if she can accomplish half of her agenda, they may feel very different.

A Toast to the Right to Development

New York

June 22, 2016

A Toast to the Right to Development

by Martin Khor

Many problems threatening the world can be addressed through the lens of the Right to Development – that should be celebrated on its 30th anniversary.

THE Declaration on the Right to Development is 30 years old. Adopted by the United Nations General Assembly in 1986, it has had an illustrious history, having great resonance among and giving a boost to people fighting for freedom and more participation in national affairs, as well as to developing nations striving for a fairer world economic order.

It has been invoked by the leaders and diplomats of developing countries on numerous occasions, when they try to convince their counterparts of the developed countries to show more empathy for the needs of the poorer countries.

It has a central place in the Rio Principles of the 1992 Earth Summit, and most recently it was mentioned in the 2015 Paris Agreement on climate change.

On this 30th anniversary, it is fitting to recall the important elements of this right to development. It is human and people-centred, an inalienable human right “to participate in, contribute to, and enjoy economic, social, cultural and political development, in which all human rights and fundamental freedoms can be fully realized.”

Politicians and policy makers should take human beings as the central focus of their development policies, and ensure they can actively participate in the process of development and development policy, as well as benefit from the fruits of development. (Article 2.3).

But the Declaration also places great importance on the international arena. States have the duty to cooperate with each other in ensuring development and eliminating obstacles to development (Article 3.3).

And effective international cooperation is essential in providing developing countries with appropriate means and facilities to foster their comprehensive development (Article 4.2).

The right to development recognises that there are national and international obstacles to the realisation of the right to development, and it calls for states to take steps to eliminate these obstacles.

It is useful to identify some present global problems and how they affect the right to development.

First, the global economy in crisis. The economic sluggishness in developed countries has had adverse impact on developing economies.

They are facing low commodity prices, and reduced export earnings. They face great fluctuations in the inflow and outflow of funds, due to absence of controls over speculative capital flows and fluctuations in the value of their currencies due to lack of a global mechanism to stabilise currencies.

Some countries are on the brink of another debt crisis. There is for them no international sovereign debt restructuring mechanism and countries that do their own debt workout may well become victims of vulture funds.

Second, the challenges of implementing appropriate development strategies.

There are challenges in developing countries to have policies right in agricultural production, ensuring adequate incomes for small farmers, and national food security.

Industrialisation involves the challenges of climbing the ladder, moving from labour-intensive low-cost industries to higher technology industries and overcoming the middle-income trap.

There are the challenges to providing social services like health care and education and water supply, lighting and transport as well as developing financial services and commerce.

This policy-making is even more difficult due to premature liberalisation, some of which is due to loan conditionality and to trade and investment agreements which also constrain policy space.

In particular, many investment agreements enable foreign investors to take advantage of imbalanced provisions and shortcomings in the arbitration system that cause countries to lose a lot in compensation and also have a chill effect on their right to regulate and to formulate policies. A review is needed.

Third, climate change is an outstanding example of an environmental constraint to development and the right to development. There is an imperative to cut global emissions as sharply and quickly as possible. But which countries and which groups within countries should cut emissions, and by how much?

The danger is that the burden will mainly be passed on to developing and poorer countries and to the poor and vulnerable in each country.

The Paris Agreement of December 2015 was a success in terms of reaching a multilateral deal.

But it is not ambitious enough to save humanity, and it also failed to deliver confidence that the promised transfers of finance and technology will take place. Much more has to be done and within a few years.

Fourth, the crisis of anti-microbial resistance brings dangers of a post-antibiotic age. Many diseases are becoming increasingly difficult to treat because bacteria have become more and more resistant to anti-microbials.

The World Health Organisation Director General has warned that every antibiotic ever developed is at risk of becoming useless and that we are entering a post-antibiotic era.

The World Health Assembly in 2015 adopted a global plan of action to address anti-microbial resistance but the challenge is in the implementation.

Developing countries require funds and technology such as microscopes and diagnostic tools; they also need to have access to existing and new antibiotics at affordable prices.

Fifth, the challenges of implementing the Sustainable Development Goals, which are closely linked to the right to development.

For example, Goal 3 is “to ensure healthy lives and promote well-being for all at all ages”. One of the targets is to achieve universal health coverage, that no one should be denied treatment because they cannot afford it. But unless there are sufficient funds, this will remain an unfulfilled noble target.

The treatment for HIV/AIDS became more widespread only when generics were made available at cheaper prices, and since then millions of lives have been saved.

Many of the new cancer drugs and the new “biologics” are priced above US$100,000 (RM408,850) for a year’s treatment. Unfortu­nately, due to global patent rules, most patients have no access to cheaper generics.

For the SDGs to succeed, finance and technology have to be transferred to developing countries and some international rules on trade and intellectual property have to be altered if they are found to be obstacles to the right to development.

All the above global challenges have to be diagnosed as to where they comprise obstacles to realising the right to development, and the obstacles should then be removed.

That is easier said than done. But the Declaration has thrown light on the way ahead.

Martin Khor ( is executive director of the South Centre. The views expressed here are entirely his own.




The Extraordinarily Complicated Successes of President Barack Obama

June 11, 2016

The Extraordinarily Complicated Successes of President Barack Obama

by Paul Waldman

Paul Waldman is a senior writer with The American Prospect magazine and a blogger for The Washington Post. His writing has appeared in dozens of newspapers, magazines, and web sites, and he is the author or co-author of four books on media and politics.

When he was running for president in 2008, Barack Obama pointed to Ronald Reagan as a model for what kind of president he would like to be, not because he agreed with Reagan politically, but because Reagan “changed the trajectory of America in a way that, you know, Richard Nixon did not and in a way that Bill Clinton did not.” We won’t know about America’s long-term trajectory after the Obama years for some time, but as he begins his last year in office, it’s not too early to say that Obama will probably turn out to be one of the most consequential presidents in recent history, if not of all time. This will be true even though his most important victories are partial and incomplete.

I use the word “consequential” and not something like “great” because we usually assign greatness only to those whose achievements most of us can agree were positive — Lincoln holding the Union together, FDR guiding the country through the Great Depression and World War II — or to those we think were great because they succeeded in achieving our own partisan goals. In this most polarized age (and in the midst of the administration itself), no president could be judged great by all, at least not for long.

But even many of Obama’s opponents could probably agree that he has accomplished a great deal during his presidency. In October 2008, anticipating his victory, I wrote that he had four great tasks before him. “If he sees the country through the current economic crisis, brings the war in Iraq to an end, passes health-care reform that actually achieves something close to universal coverage, and sets the country on a course away from a reliance on fossil fuels, Obama would be considered the most important president since Franklin D. Roosevelt.”

To varying degrees he has done all four. He saw the country through the Great Recession, got us out of Iraq, passed health care reform, and is aggressively moving to address climate change. The trouble is that each victory has come with extraordinary complications.

Upon taking office, Obama quickly passed a large stimulus bill to mitigate the effects of the recession. Since the economy finally reached its bottom at the beginning of 2010, we’ve seen the creation of 14 million private sector jobs. In 2012, Mitt Romney confidently predicted that if he turned Obama out of office and we followed the Romney economic program, unemployment would plummet to 6 percent by the end of 2016.

Today under Obama’s policies unemployment stands at 5 percent. Yet wages remain stagnant and economic insecurity is still widespread, despite the availability of jobs. Obama wasn’t able (and arguably didn’t attempt) to reverse the decades-long trends that hamstring Americans’ economic fortunes.

On Iraq, Obama followed through on his promise to remove American troops and end George W. Bush’s catastrophic war, but the country has not released its hold on us. The corrupt sectarian government of Nouri al-Maliki (and his successors) alienated and oppressed its Sunni citizens, allowing ISIS to thrive. Obama is still struggling with the aftermath of the war, as will his successors.

On health care, by passing comprehensive reform, Obama did what Bill Clinton failed to do and what Democrats had spent decades trying to accomplish. But though the Affordable Care Act is a huge success in many ways, with millions of Americans newly insured and all people able to get coverage regardless of their health history, the fact that it was essentially a gigantic kludge — a complicated fix laid on top of an already absurdly complicated system — has limited its ability to provide universal coverage or eliminate the pathologies of a profit-driven health care system.

And on climate change, Obama got something of a late start, but he has moved aggressively, with new regulations on auto efficiency and power plant emissions, along with an historic agreement just signed in Paris which committed virtually every nation on earth to a common effort to reduce carbon emissions. While environmentalists disagree about the long-term impact of these moves, with many arguing that they won’t be sufficient to solve the problem, the administration has been taking strong action despite the objections of the opposition.

There are hundreds of other decisions and accomplishments one could point to over the period of the Obama Presidency seven years as being of great consequence, but any list would have to include the nuclear agreement with Iran, the normalization of relations with Cuba, new Wall Street regulations, saving the American auto industry, ordering the raid that killed Osama ben Laden, ending discrimination against gays in the military and pushing for the legalization of same-sex marriage, and avoiding the kind of major scandal that plagued so many of his predecessors.

That isn’t to say that there haven’t been plenty of mistakes, just as there are with any president. It remains to be seen what Obama can accomplish in his final year with a Congress that opposes him on virtually everything and in the midst of a race to determine his successor. And much depends on who that successor is; if it’s a Democrat (presumably Hillary Clinton), then what Obama achieved can be reinforced and expanded. Any Republican, however, would devote himself to reversing everything Obama did.

And we still don’t know how these partial victories will evolve. Perhaps we and our allies can make enough progress against ISIS that America won’t have to worry about Iraq anymore, and perhaps one day Republicans will stop trying to repeal the ACA and agree to make the changes that would improve it. Or it could all get worse. But the contours of the next presidency, and maybe even the one after that, will be determined by what happened between 2009 and 2016.

Whatever you think of him, it’s looking like Barack Obama did indeed change the country’s trajectory, by doing pretty much what he said he would.

Quality Healthcare in Singapore

March 9, 2016

How can we compete with Singapore and Bangkok in the provision of quality healthcare? I am pessimistic about our ability to match their medical and patient service quality. We spend loads on scarce tax ringgits on promoting medical tourism.Billions have been spent by the private sector to build modern hospitals and equip them with state of the art of facilities. Yet, we have found private healthcare wanting. Why? I will attribute this to the way we do things.It is our attitude and culture of mediocrity. We are brilliant at talking, but fall short on action.

I welcome your comments. Big talking Nazri Aziz, Minister of Tourism is also welcome to respond. His time and talent would be better used to deal with this issue than to defend our Prime Minister.–Din Merican

Quality Healthcare in Singapore

One of Farrer Park Hospital’s rooms. Photo: Farrer Park Hospital

The lobby reception at Mount Elizabeth Novena. Photo: Mount Elizabeth Novena

A concierge service, beautifully-plated meals, a personalised tablet with Wi-Fi access and ensuite bathroom complete with premium toiletries were some perks 47-year-old business owner Ms Wong Li Ping enjoyed during her five-night hospital “staycation” at Farrer Park Hospital (FPH) last December.

“The staff even went the extra mile to provide me with cranberry juice every day although it was not on the menu as a natural adjuvant to my therapy. I felt pampered, as if I was staying in a five-star hotel,” said Ms Wong, who was admitted for a renal condition that required intravenous treatment.

These five-star healthcare hospitality and frills are no longer reserved only for the uber-rich. Private hospitals that look and feel like upscale hotels are growing in numbers here, catering to a mix of local patients and medical tourists.

In 2012, Parkway Pantai Group launched Mount Elizabeth Novena Hospital (MNH) comprising only single-bedded rooms. Each room comes with standard hotel-styled features such as floor-to-ceiling windows, marble bathrooms, mini bar, coffee machines and luxury linen. Also available upon request – at no additional charges – are limousine transfer services and complimentary massages for maternity patients.

Slated to officially open its doors this month, FPH is the newest private hospital in town. The 220-bedded facility is part of Singapore’s first fully integrated healthcare-hospitality complex which links the hospital to a five-star One Farrer Hotel and Spa, restaurants and educational facilities.

Besides its upscale offerings, arrangements can be made for relatives of patients to have direct access into the hospital’s deluxe suites from the hotel, a boon for international patients travelling with family members.

Higher Expectations and Overseas Rivals

Single rooms significantly reduce the risk of hospital-acquired infections while the added privacy allow patients to recover in peaceful environment, said Mr Stephens Lo, Chief Executive Officer of MNH.

There are also higher patient expectations. “Even many of our hawker centres are now air-conditioned. What you would consider frills in the past is now the today’s norm,” said FPH’s spokesperson.

Recognising this, facilities providing maternity healthcare services have also jumped on the bandwagon, wooing patients with complimentary perks at no additional charges. Beyond clinical services, patients now look for value-added offerings, said Ms Mega Shuen, General Manager at Thomson Medical Centre.

For instance, TMC provides maternity patients with a complimentary massage service as well as post-discharge phone call services to ensure that mother and baby are coping well. Mothers who deliver there this year will also enjoy a specially commissioned luggage comprising a range of premium maternity and baby items.

Stiff overseas competition is also keeping the private healthcare sector here on their toes.

International patients form about 30 and 50 per cent of total patients seen at MNH and FPH respectively. MNH’s Mr Lo noted that regional competitors are catching up with Singapore on clinical competencies for standard medical procedures, often at a lower cost.


“In order to compete effectively, we have to move up the value chain, place greater focus on developing our capabilities, complex procedures and provide an overall superior patient experience through high service standards. At MNH, we seek to provide our patients with high quality of care at affordable prices,” he said. In 2013, MNH introduced Class A single rooms in 2013, priced at S$418, about 35 per cent less than rates for standard single rooms.

A 2015 BMI Research report has warned that Singapore will lose medical tourists as patients explore cheaper options to competing hubs in neighbouring cities. In 2013, medical expenditure generated from travellers was S$832 million, a decline of 25 per cent from 2012’s S$1.11 billion, according to figures from Singapore Tourism Board.

FPH’s spokesperson said significantly higher pricing premiums are “no longer sustainable for the private hospital sector given the changing economy and overseas competition”.

“Singapore continues to attract international patients who come to us for more complex medical procedures, such as heart surgery, due to our reputation for high quality of clinical care. Even so, we still hope to make high standard of care affordable for our target audience,” she added.


A check revealed competitive inpatient room rates between some restructured and private hospitals here.

For private patients, a Class A single bedded room in National University Hospital’s (NUH) general ward is around S$527 a night, with deluxe rooms in the same ward at around S$762. For private patients, a Class A single bedded room in National University Hospital’s (NUH) general ward is around S$527 a night, with deluxe rooms in the same ward at around S$762.

A Class A1 single bedded room at Khoo Teck Puat Hospital and Tan Tock Seng Hospital’s (TTSH) acute ward starts from $420 a night, while a deluxe room at TTSH’s acute ward starts from S$550 a night, according to the hospitals’ websites.

MNH’s Class A room is priced from S$418 per night while its single signature room, which comes with personalised nursing service, starts from S$710 per night. FPH, which offers four-bedded, single bedded and deluxe suites, charges S$562 per night for a single-bedded suite.

But while rooms charges are competitively priced, they are not indicative of overall hospital bill size, which vary with different medical procedures and doctors’ fees. For instance, the estimated 90th percentile bill size for cataract day surgery for private patients is S$9,073 and S$8,867 at FPH and MNH respectively; at NUH and Singapore National Eye Centre, it is S$6,598 and S$5,464 respectively, according to figures by Ministry of Health.

According to Mr Lo, a private integrated shield plan with riders often allows patients to enjoy full coverage during their private hospital stay. Some prenatal insurance plans in the market also offer health and financial protection for expectant mothers and their babies, added Ms Shuen.

For 34-year-old interior designer Ray Chua Chia Howe, a private integrated shield plan with a rider took care of a S$5,600 hospital bill incurred during a serious bout of salmonella poisoning last year. His three-day MNH stay included procedures such as a CT scan done at the Accident and Emergency department, blood and stool tests and injections.

“I knew that my shield plan allows me to be treated at a private hospital and I appreciate the comfort in knowing I don’t have to wait as long, or risked having very limited room options at the restructured hospitals,” he said.

Doing Malaysia Proud

February 26, 2016

Doing Malaysia Proud: A Malaysian Dentist who Learns, Unlearns and Relearns

Friends and associates,

I am naturally proud to feature my dear wife, Dr Kamsiah Haider who was recently interviewed by Dr. Howard Farran, a Dentist with MBA on his program Dentistry Uncensored. She tells us about her dedication to the practice of dentistry and what it took her to be a successful one.  You need passion and strong commitment to be respected by her patients and admired by those who know her.

Her dental ethos is summed up in these 3-words–Learn, Unlearn and Relearn.In terms of her attitude towards her profession, I consider her as one of a kind in Malaysia. For her, earning a decent income is the consequence of doing the right thing for one’s patients. –Din Merican



Cherry-picking the TPPA

November 25, 2015

Cherry-picking the TPPA

by Tan Siok Choo

Dato Mustapha Mohamed

Malaysia is fortunate that TPPA negotiations were led by International Trade and Industry Minister Datuk Seri Mustapa Mohamad – one of a handful of ministers who are intellectually competent, diligent and who are intellectually competent, diligent and without a whisper of corruption.-Tan Siok Choo

CONCLUDED on October 6 this year, the Trans-Pacific Partnership Agreement (TPPA) promises to usher in a new era of free trade among 12 countries that collectively contribute 40% of the world’s gross domestic product (GDP).

These countries include Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the United States and Vietnam.

TPPA signatories have promised to cut or eliminate 18,000 tariffs on a vast number of goods and services. Tariffs ranging from 2% to 11% will be abolished for Malaysian made exports including wood products, palm oil, rubber, car spare parts as well as electrical and electronic goods.

Services covered include information and communication technology, retailing, entertainment, electronic payments systems and software.

Comprising 4,500 pages and 30 chapters while weighing a hefty 100 pounds, the TPPA offers thousands of issues for proponents and opponents to cherry pick.

Malaysia is fortunate that TPPA negotiations were led by International Trade and Industry Minister Datuk Seri Mustapa Mohamad – one of a handful of ministers who are intellectually competent, diligent and without a whisper of corruption.

Mustapa announced MPs will debate and vote on the TPPA at a special sitting of the Dewan Rakyat in January 2016.

Underscoring the remote possibility the TPPA will be rejected, the first reading of Budget 2016 last Monday received 128 votes in favour, 74 against and seven abstentions by PAS members of Parliament.

Two PAS MPs weren’t present in the Dewan Rakyat, three PAS MPs voted against Budget 2016 while suspended DAP MP Lim Kit Siang was unable to vote.

Could dislike for some TPPA clauses prompt BN MPs to risk giving the opposition a victory on this issue? This is unlikely. Mustapa succeeded in ensuring bumiputras, small and medium enterprises and those from Sabah and Sarawak will continue to be preferential suppliers for up to 40% of state-owned enterprises’ (SOE’s) annual purchases.

SOEs include Permodalan Nasional, Tabung Haji and MARA.Similarly, Petronas can continue to give priority to Malaysian enterprises to supply goods and services up to 70% of its annual budget for upstream businesses in the first year of the TPPA and scaled down progressively to 40% in the 6th year of the trade pact.

A major contentious issue in the TPPA is pharmaceuticals. Leading generic medicine manufacturer Mylan has warned it would be prohibited from doing business in TPPA member countries. By disallowing generic drugs, the TPPA could keep prices of drugs in this country higher for a longer period until patents expire.

Malaysian AIDS Council’s policy manager Fifa Rahman said a 12-week treatment for Hepatitis C using the generic version of Sofosbuvir costs RM750.06 to RM1,579.07 compared with an exorbitant RM357,000.


Writing in The Malaysian Insider, Joseph Stiglitz, a Nobel laureate in economics, and Adam Hersh, senior economist at the Roosevelt Institute, said economists at the UN Conference on Trade and Development have forecast joining TPPA would make Malaysia a net loser because its trade balance would fall by US$17 billion annually.

Sectors that would be hurt by the TPPA include iron and steel, aluminium, mineral fuels, plastics and rubber, Stiglitz and Hersh say.

Challenging the belief that intellectual property rights promote research, Stiglitz and Hersh noted after the US Supreme Court invalidated Myriad’s patent on the BRCA gene, a burst of innovation resulted in better tests at lower costs.

Another controversy is the investor-state dispute settlement (ISDS) system. Using arbitration to settle disputes rather than the courts, foreign investors will have new rights to sue governments for instituting regulations that diminish investors’ profits.

Instead of forcing manufacturers of harmful products like asbestos to shut down and compensate their victims, the ISDS could hit taxpayers twice – paying for the illnesses caused and compensating manufacturers for their lost profits, Stiglitz and Hersh argue.

Although tariffs will be abolished for Malaysia’s major exports like electrical and electronic products, will Malaysians be the biggest beneficiaries in a sector dominated by US and Japanese multinationals?

For products like palm oil, the campaign alleging plantation companies destroy the habitat of orang utans is a bigger barrier than high tariffs.

Hopes the TPPA will reduce corruption could be stymied by Malaysia’s high threshold exempting construction companies from competitive bidding for five years for contracts valued under 63 million Special Drawing Rights (SDRs) or RM374 million. After 21 years, the threshold will decline to a still hefty SDR14 million (RM80 million).

Kelana Jaya MP Wong Chen noted other TPPA countries accepted a much lower threshold of 5 million SDRs (RM30 million); only Vietnam’s threshold of SDR 65.2 million (RM387 million) is higher than Malaysia’s.

In summary, TPPA’s benefits must be spelt out in greater detail and more convincingly.

Opinions expressed in this article are the personal views of the writer and should not be attributed to any organisation she is connected with. She can be contacted at