President Donald Trump has correctly identified two big challenges that Americans want him to tackle this year – the opioid epidemic and the country’s dilapidated and overstretched infrastructure.
Trump promised to address these vexing issues last year, too, but made almost no progress. Perhaps this year he will take them seriously because he and his party want to impress voters before the November elections. If so, there are many good ideas the White House and Congress ought to consider.
– The Opioid Crisis
This is a daunting epidemic that has steadily gotten worse. Drug overdose deaths nearly doubled in 10 years, to more than 64,000 in 2016, a large majority of them from heroin and other opioids.
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“My administration is committed to fighting the drug epidemic and helping get treatment for those in need, for those who have been so terribly hurt,” Trump said in his State of the Union address. “The struggle will be long, and it will be difficult – but, as Americans always do, in the end, we will succeed, we will prevail.”
Trump doesn’t have to look far to figure out what has to be done. His Commission on Combating Drug Addiction and the Opioid Crisis released a detailed report in November on this very issue. One recommendation was for the government to increase access to substance abuse treatment. The administration could do so by demanding that health insurance companies cover such care. Federal law already requires insurers to cover addiction treatment and other mental health services, but many do not include those services in their networks of doctors and hospitals, according to a recent report. The commission said the administration and Congress should give the Department of Labor the authority to penalize insurance companies that do not adequately cover addiction treatment.
The president should also ask Congress to dedicate more money for treatment. But that’s unlikely since the White House is reportedly considering slashing the budget of the Office of National Drug Control Policy, which coordinates the federal government’s activities in this area.
The commission also called on the government and insurers to encourage greater use of opioid alternatives like physical therapy and nonaddictive painkillers. Some doctors and hospitals have been moving in this direction. But experts say many health care providers are still prescribing opioids when they ought to be using alternative treatments. That’s because government programs and private insurers do not cover these alternative services and drugs. Other areas the government ought to focus on include cracking down on drug trafficking and the delivery of potent opioids, like fentanyl, through the postal system.
But will Trump pursue any of these ideas? His record gives little cause for optimism. One indication of how seriously the White House has taken this issue was its appointment last month of a 24-year-old campaign volunteer with no experience in drug policy as the deputy chief of staff of the drug policy office. Outrage followed, and his tenure was cut mercifully short.
– Fixing Infrastructure
Most Americans agree that the United States needs to substantially increase investments in transportation, energy, water and other public works. The American Society of Civil Engineers estimates that the country needs to increase infrastructure spending by $2 trillion to be globally competitive. In his State of the Union speech, Trump said he wanted to increase investment by $1.5 trillion. But leaked copies of the administration’s infrastructure proposal show that it will include only $200 billion in federal spending. And White House officials have said that this money could come from cutting existing infrastructure spending on things like public transit and Amtrak.
There is no dearth of important public works projects that could benefit from federal investment. At the top of the list is the plan to build new rail tunnels under the Hudson River. Known as the Gateway Program, this project would greatly expand capacity for commuter and long-distance trains on the East Coast. Highways, bridges and transit systems across the country desperately require repairs and upgrades to meet current and future needs. The lead crisis in Flint, Michigan, has highlighted the sad state of water utilities.
Some Republican lawmakers are already arguing that the government cannot afford a big infrastructure package. It’s strange to hear them say that after they just passed a huge tax cut that will raise the federal deficit by $1.5 trillion over a decade. Congress could easily come up with money for transportation. Here are two suggestions: Raise the federal gas tax, which lawmakers last increased in 1993. Even the U.S. Chamber of Commerce supports raising this tax. Or Congress could enact a carbon tax, which would have the added benefit of cutting greenhouse gas emissions.
Administration officials appear to think they can fix U.S. infrastructure by giving developers tax incentives, moving some money around and eliminating environmental regulations, a favorite target for Trump and his cronies. These changes, they argue, will be enough to encourage the private sector and state and local governments to do what needs to be done. This is not credible because many states and cities will find it impossible to raise revenue after the Republican tax cuts reduce the deductibility of state and local taxes on federal tax returns. As for the private sector, it’s only likely to invest in projects that come with a lucrative stream of revenue, like toll roads, which have not proved as successful as their promoters had hoped.
Trump has an opportunity to save and improve the lives of millions of people if he puts in place plans to end the opioid epidemic and upgrade the country’s infrastructure. He needs to start taking action, instead of talking about it.