Thoughts on American Exceptionalism

By Ellen Weaver, President of Palmetto Policy Forum

This week, Russian President Vladimir Putin took to the pages of The New York Times to counsel Americans about “what is in our best interest” as a nation.  He proceeded to chide President Obama for insinuating that there is something exceptional about America, ironically, picking up a theme with which President Obama himself is all too familiar.  Compare each man’s quote:

“I carefully studied his [President Obama’s] address to the nation on Tuesday. And I would rather disagree with a case he made on American exceptionalism, stating that the United States’ policy is “what makes America different. It’s what makes us exceptional.” It is extremely dangerous to encourage people to see themselves as exceptional, whatever the motivation. There are big countries and small countries, rich and poor, those with long democratic traditions and those still finding their way to democracy. Their policies differ, too. We are all different, but when we ask for the Lord’s blessings, we must not forget that God created us equal”.– Russian President Vladimir Putin in the 9/12/13 edition of The New York Times

"I believe in American exceptionalism, just as I suspect that the Brits believe in British exceptionalism, and the Greeks believe in Greek exceptionalism." – President Barack Obama at a G-20 press conference in 2009

This diminution of the idea of American exceptionalism has been a popular theme among many left-leaning thinkers for the last 50 years.  We hear that America is too assertive on the world stage.  Too arrogant.  Too rich.  Too dismissive of other nations.  None of this defines American exceptionalism; it  is a clever bait and switch.

American exceptionalism is not an opinion.  It is not a warm ‘n’ fuzzy feeling of patriotism or a conceit of brash Americans trying to make ourselves feel culturally superior.

It is the sacred trust of freedom that we have inherited.  It is the untold blessings of liberty in which we live each day.  It is as much a fact of history as the D-Day invasion in 1944;  it is the very foundation of our Republic.

Thousands of years of recorded history detail tyranny, despotism, and bare subsistence as the harsh reality of humanity.  Nowhere else in the history of the world has there been another country so “conceived in Liberty, and dedicated to the proposition that all men are created equal.”  Even in our darkest times, Americans of every generation have fought and died to maintain and expand this ideal.

Thanks to this exceptional founding, grounded in fundamental first principles such as the rule of law, we still stand today, shoulder to shoulder as neighbors and free Americans of every creed and color.  This idea of America is what makes it far greater than a mere sum of its parts.  This idea has been the lamp of hope lifted beside the golden door of opportunity that has beckoned millions to our shores.

If we ever cease to study, understand and defend this historic fact, we will have lost America’s exceptional essence...to the detriment of the entire world.

This September 11th

On this day, September 11, 2013, you might be transported back to the shocking horror of the Twin Towers falling in plumes of black fire and dust. Perhaps you are taken back to our Pentagon crumbling from Flight 77’s impact; maybe you hear an echo of the "Let's Roll!" bravery of the heroes of Flight 93. Wherever your mind takes you, the surrounding bustle will fade to solemn silence while thinking of so many fellow-Americans who lost their lives.

In the events that followed September 11, 2001, the world witnessed strangers, people from every walk of life as well as first responders, flooding the streets to carry the injured to safety and the fallen to a place of peace beyond the chaos.

We all remember where we were and what we were doing twelve years ago today and the love we freely offered our neighbors. The horrors of that infamous day should never be forgotten; neither should the acts of love that inspired hope when murderous malice sought to dim our nation’s outlook.

Today, may we unite once again, across every barrier that divides us, in loving memory of innocent life lost and exceptional acts of ennobling heroism. May we resolve that the ultimate sacrifices made will inspire us to strive to be the very best of who we are: blessed fellow-citizens of this "last best hope of man on earth."

May God bless America and our great state of South Carolina.

Hopeful Start for SC Special Needs Scholarship Program

By Dr. Oran P. Smith, Senior Fellow

Dr. Oran P. Smith, Senior Fellow

The word from the Statehouse is....pretty good!

The SC Senate hearing on our new Special Needs Scholarship earlier this week was notably calm and productive…a welcome change from the frayed nerves typically reserved for education freedom issues in the Palmetto State. 

The three entities charged with implementing the law – the Department of Revenue, the Department of Education, and the Education Oversight Committee – in their own official way told our State Senators that the Scholarship they crafted was indeed do-able. 

Though strictly factual in their assessment, it was clear that the hastily constructed budget proviso offered by Senator Kevin Bryant (R-Anderson) last spring faced no huge implementation barriers. 

Yes, three non-profit organizations could receive donations to send special needs children to private schools, and the donor could get a tax break for it...right here in South Carolina! 

As for next steps, the Senate Committee thought it best that the next meeting be dedicated to hearing from representatives of states where Special Needs Scholarships are working. This was music to the ears of Palmetto Policy Forum. 

Since our inception six short months ago, PPF has been in constant contact with the very best programs: Florida, Georgia, Arizona, and Louisiana. We also learned that a key player in one of those states was even educated right here in South Carolina!

There are many challenges facing South Carolina students, and the road is long if we are to catch up with our neighbors. But this year's small step could be a giant leap. Time will tell.

U.S. Probes Use of Antipsychotic Drugs on Children

Originally posted at wsj.com
By Lucette Lagnado

The effort applies to a newer class of antipsychotic drugs known as "atypicals," which include Abilify, the nation's No. 1 prescription drug by sales. The drugs were originally developed to treat psychoses such as schizophrenia, but some now have Food and Drug Administration approval for treatment of children with conditions such as bipolar disorder and irritability associated with autism.

In 2008, the most recent year for which complete data are available, Medicaid, the government health program for the poor, spent $3.6 billion on antipsychotic medications, up from $1.65 billion in 1999, according to Mathematica Policy Research, a Washington firm that crunches Medicaid data for HHS. The growth came even as pharmacy benefits for millions of Medicaid recipients shifted to Medicare in 2006.

Medicaid spends more on antipsychotics than on any other class of drugs. Abilify, made by Otsuka Pharmaceutical Co., appears on lists of the top 10 drugs paid for by Medicaid in various states.

Mark Duggan, a professor and health-policy expert at the University of Pennsylvania's Wharton School, says his analysis of 2010 data on five leading antipsychotics suggests that more than 70% of the cost of these drugs was paid for by Medicaid and other government programs.

Brandon Thibodeaux for The Wall Street Journal
Rebecca Green sorts through drugs for four of her foster children.

The number of people under age 20 receiving Medicaid-funded prescriptions for antipsychotic drugs tripled between 1999 and 2008, according to an analysis by Mathematica.

Dr. Stephen Cha, a chief medical officer at the Centers for Medicare & Medicaid Services, the HHS agency that foots some of the bill for drugs prescribed to Medicaid recipients, says the government wants to reduce what he termed "the unnecessarily high utilization of antipsychotics." He urges doctors to consider other approaches, including therapy to help children and families cope with psychological trauma that could be at the root of behavior issues.

A Foster Mother Struggles to Help Four
The drugs in question—in addition to Abilify, the brand names include Risperdal, Seroquel and Zyprexa—were developed to replace medications dating to the 1950s such as Haldol and Thorazine, which produced severe side effects such as uncontrollable muscle twitching. The atypicals, introduced in the 1990s and early 2000s, were hailed as safer and more tolerable, and sales grew rapidly.

The FDA's approval of some of the new drugs to treat certain pediatric conditions, coupled with concern about possible side effects on young people and growing off-label use by doctors to treat various forms of violent or aggressive behavior, has sparked debate about whether they are being dispensed too freely to troubled children.

Spokespeople for the makers of Seroquel, AstraZeneca AZN -0.30% PLC, and of Abilify said those drugs should be used for FDA approved indications. Janssen Pharmaceuticals Inc., a unit of Johnson & Johnson JNJ -0.36% that makes Risperdal, noted that the drug had been approved for a number of pediatric uses. Eli Lilly & Co., LLY -0.90% maker of Zyprexa, says the drug's label guides doctors to weigh the risks and consider therapy as part of the treatment. None commented on the government efforts to reduce antipsychotic use by children in the Medicaid system.

Dr. Fernando Siles, a pediatric psychiatrist in the Dallas area who treats many poor foster children, says he sometimes prescribes such medications to treat serious behavior problems. "A child that continues to be aggressive will be kicked out from his foster home," he says. "The antipsychotic is to stabilize the behavior of the child, to keep him from being moved and moved again."

Some doctors say there is too much emphasis on medicating children instead of working with them and their caregivers to understand what is triggering their behavior. Dr. Glenn Saxe, chairman of child and adolescent psychiatry at NYU-Langone Medical Center and a proponent of trauma-focused therapy, says psychiatry has missed "big opportunities to help children. This problem has led to kids being medicated more and more."

Dr. Siles agrees that lots of children could be helped by trauma-centered therapy, "but there is no budget for it."

Children on Medicaid are prescribed antipsychotics at four times the rate of privately insured children, according to a study by Stephen Crystal, a professor of health policy at Rutgers University, that looked at data from 2004 on 6- to 17-year-old children in seven states.

The probe by the inspector general, Daniel Levinson, has been under way for several months and focuses on the five largest Medicaid states: California, Florida, Illinois, New York and Texas. It covers a six-month period from January to June 2011, when 84,654 children age 17 and under in those states received prescriptions for antipsychotics paid for by Medicaid. Pediatric psychiatrists will examine about 700 cases, say people familiar with the effort.

"Through medical-record reviews, we will determine whether these prescriptions were medically indicated, and whether taxpayers were being billed for inappropriate, poor-quality care," says Mr. Levinson.

Government Medicaid data indicate that some of the prescriptions are being written for very young children. An analysis by Mathematica found that in 2008, 19,045 children age 5 and under were prescribed antipsychotics through Medicaid, 3% of recipients under 20, up from 7,759 in 1999, according to James Verdier, a senior fellow at the organization.

Data from the inspector general's five-state probe indicate that 482 children 3 and under were prescribed antipsychotics during the period in question, including 107 children 2 and under. Six were under a year old, including one listed as a month old. The records don't indicate the diagnoses involved.

All five states said they have guidelines to prevent the improper use of the drugs on children in Medicaid.

In New York, a spokesman for the state health department said some children between ages 1 and 2 received antipsychotics for conditions such as autistic disorder and attention deficit disorder with hyperactivity.

Texas said about five children under the age of 1 had been prescribed antipsychotics during the time period of the probe, including two who were five months old.

"No child is getting these drugs unless they're under a doctor's care, and the doctor has to be able to defend the use of the drug," said a spokeswoman for the Texas Health and Human Services Commission. "For infants, the drugs aren't being used for behavior. The infants most often have seizures or complex health issues like heart and respiratory problems, and these drugs can be prescribed to help with discomfort."

Of particular concern is use of the drugs on foster children in the Medicaid system. One study, based on 2007 Medicaid data in 13 states, found that 12.4% of children in foster care received antipsychotics, compared with 1.4% of Medicaid eligible children in general, according to Mr. Crystal, co-author of the study.

Bryan Samuels, head of the Administration on Children, Youth and Families, the agency within HHS that helps oversee the nation's foster children, is pushing states to adopt tougher rules on prescribing antipsychotics.

"The medications tend to be the stopgap measure," Mr. Samuels says. "We are making significant investments in medication that have limited evidence of effectiveness and rarely address the issues of trauma."

Write to Lucette Lagnado at lucette.lagnado@wsj.com

The $4 Million Teacher

By Amanda Ripley
Originally posted at wsj.com, August 6, 2013

South Korea's students rank among the best in the world, and its top teachers can make a fortune. Can the U.S. learn from this academic superpower?

SeongJoon Cho for The Wall Street Journal

Kim Ki-hoon earns $4 million a year in South Korea, where he is known as a rock-star teacher—a combination of words not typically heard in the rest of the world. Mr. Kim has been teaching for over 20 years, all of them in the country's private, after-school tutoring academies, known as hagwons. Unlike most teachers across the globe, he is paid according to the demand for his skills—and he is in high demand.

Mr. Kim works about 60 hours a week teaching English, although he spends only three of those hours giving lectures. His classes are recorded on video, and the Internet has turned them into commodities, available for purchase online at the rate of $4 an hour. He spends most of his week responding to students' online requests for help, developing lesson plans and writing accompanying textbooks and workbooks (some 200 to date).

"The harder I work, the more I make," he says matter of factly. "I like that."

Public Pensions & The Need For State & Local Action

By Cory Eucalitto
Originally posted by State Budget Solutions on July 12, 2013

Washington is beginning to take note of the funding crisis facing America’s states and municipalities. It calls attention to the inadequacy of the response to the crisis that has so far come from state governments themselves.

Last week, Senator Orrin Hatch (R-UT) unveiled a bill designed to give new flexibility to state and local public pension plans struggling to stay afloat. The Secure Annuities For Employee (SAFE) Retirement Act of 2013 would alter the tax code to allow plans to be transferred to life insurance companies and other annuity providers. State Budget Solutions published a summary of the bill’s key points here.

The pension funding crisis – a combined $4.6 trillion unfunded liability – is first and foremost a state and local government crisis that requires state and local solutions. Of course, those governments operate under the laws and tax code of the Federal government, so anything Washington can do to encourage solutions is a great step. Sen. Hatch’s bill may have potential as one of those steps, in a way that would signify healthy attentiveness on the part of Washington to the needs of the states.

Back down at the state level, though, the pension reform debate is often stale and recycled. True reform, which would involve a complete overhaul of the way public employees receive a secure retirement, modeled after the proven successes of defined contribution plans in the private sector, is left on the table in favor of half measures that end up stalled in a court room battle anyways.

The combination of leaders who still fail to recognize the magnitude of the crisis and entrenched interests desperate to make sure that the ignorance continues is toxic. Until more people in state capitals and city halls recognize what one Senator who has been stuck in the corridors of Washington for over 30 years has been able to, little will change. The pension crisis needs bold, innovative solutions that originate from the same source as the problem itself: the nation’s state and local governments.

Why does Milton Friedman matter?

Widely regarded as the groundbreaking leader of the Chicago School of monetary economics, Milton Friedman led a long and storied career, receiving the 1976 Nobel Prize for Economic Science, the Presidential Medal of Freedom in 1988 and the National Medal of Science the same year. 

But he is beloved because his academic brilliance was employed in the practical service of people.  Friedman’s observance of the facts led him to a passionate belief that people truly free to choose their course in life without the heavy hand of undue government interference is the surest way forward to create hope and opportunity – a rising tide of prosperity – for all.

This is especially true in the timeless work of education freedom to which he and his wife Rose devoted themselves.  As he once famously said:

Governments never learn.  Those words ring clear to the citizens of this country who know that Washington is fundamentally broken.  Those words ring clear to the people of South Carolina where we know that while the sunbeams of economic opportunity don’t shine as brightly in every county of the Palmetto State.

Only people learn.  South Carolina has the opportunity to enrich the lives of so many children and families by innovating policy to focus on students, empower parents and strengthen our education system.

Too many of our low income and minority children are falling behind in school and at incredibly high risk to drop out of school and be caught in a cycle of poverty.  A good education is the first step on the path to solving these problems.  But too many of these children are trapped in struggling schools that don’t fit their needs.  For these children and their frustrated parents, there are no other educational options.  

Time and again, we have seen that more money and Washington mandates are not the answer.  Rather, South Carolina must embrace the kind of education innovations that are passing in states all over the country, including ideas like Opportunity Scholarships that just passed in North Carolina last week.

This year, through heroic efforts in the South Carolina Senate, we took a small but important first step towards opening up this kind of opportunity for our children with disabilities.  But the work is never done.  2014 will be our golden opportunity to cement and build on that important gain. 

And if we do, we stand on the shoulders of giants like Milton Friedman whose policy innovation, founded on a compassion for people, have left a powerful example for us to follow.