6 Economic Steps to a Better Life and Real Prosperity for All
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2. Move to Universal Healthcare
That austerity and failing reform might open the way to "evolutionary reconstructive" institutional change is also suggested by emerging developments in healthcare.
Cost pressures are also building up—and, critically, in ways that will continue to undermine U.S. corporations facing global competitors, forcing them to seek new solutions. The federal Center for Medicare and Medicaid Services projects that healthcare costs will go up from the 2010 level of 17.5 percent of GDP to 19.6 percent in 2019. It has long been clear that over the long-haul cost pressures are ultimately likely to force development of some form of single-payer system —the only serious way to deal with the underlying problem.
A national solution may come about either in response to a burst of pain-driven public outrage, or more slowly through a state-by-state build-up. Massachusetts already has a near universal plan. In Hawaii, health coverage (provided mostly by nonprofit insurers) reaches 91.8 percent of adults in part because of a 1970s law mandating low-cost insurance for anyone working 20 hours a week. In Vermont, Governor Peter Shumlin signed legislation in May 2011 creating “Green Mountain Care.” Universal coverage, dependent on a federal waiver, would begin in 2017 and possibly as early as 2014. In Connecticut, the legislature in 2011 authorized a “SustiNet” non-profit public health insurance program, which it aims to launch in 2014. In all, bills to create universal healthcare have been introduced in nearly 20 states.
3. Build Community Wealth
“Social enterprises” that undertake businesses in order to support specific social missions now increasingly comprise what is sometimes called a "fourth sector” (different from the government, business and non-profit sectors). Roughly 4,500 not-for-profit community development corporations are largely devoted to housing development. There are now also more than 10,000 businesses owned in whole or part by their employees; nearly 3 million more individuals are involved in these enterprises than are members of private sector unions. Another 130 million Americans are members of various urban, agricultural and credit union cooperatives. In many cities, “land trusts” are underway using an institutional form of nonprofit or municipal ownership that develops and maintains low- and moderate-income housing.
In Cleveland, Ohio, an integrated group of worker-owned companies has been developed, supported in part by the purchasing power of large hospitals and universities. The Cleveland effort, which is partly modeled on the 85,000-person Mondragón cooperative network, based in the Basque region of Spain, is on track to create new businesses, year by year, as time goes on. The goal is not simply worker ownership, but the democratization of wealth and community building in general. Linked by a community-serving non-profit corporation and a revolving fund, the companies cannot be sold outside the network; they also return 10 percent of profits to help develop additional worker-owned firms.
A critical element of the strategy points to what is essentially a quasi-public sector planning model: Hospitals and universities in the area currently spend $3 billion on goods and services a year—none, until recently, from the immediately surrounding neighborhoods. The “Cleveland model” is supported in part by decisions of these substantially publically financed institutions to allocate part of their procurement to the worker-co-ops in support of a larger community-building agenda. Numerous other cities are now exploring efforts of this kind, including Atlanta; Pittsburgh; Amarillo, Texas; and Washington, DC. Related institutional work is now underway, too, through the leadership of United Steelworkers, a union that has put forward new proposals for a co-op-union model of ownership.
Another innovative enterprise is Market Creek Plaza in San Diego, a $23.5 million, mixed-use, commercial-retail-residential development. The project was conceived, planned and developed by teams of community members working with the Jacobs Center for Neighborhood Innovation. Market Creek Plaza is also a green project, and aims to expand to become a transit-oriented village with 800 units of affordable housing and extensive facilities for nonprofit organizations. The project has restored 1,400 linear feet of wetlands, while generating 200 permanent jobs (70 percent filled by local residents), provided 415 residents with a 20-percent ownership stake in the project, and generated $42 million in economic activity (in 2008).