Last week on the blog, Luke Herrine suggested that on the other side of the Trump-Musk hellscape – whose reforms might be so broadly unpopular as to “serve as a catalyst to productive mobilization” – there could be an opportunity for a more fundamental, ambitious rebuild of our policies and institutions. “A time of unpredictable politics is a time for non-reformist reforms,” he argued, and leftists should be “prepared to contest for the proper approach to doing so.”
While the Biden Administration attempted many meaningfully progressive policy changes – for example, via Lina Khan’s Federal Trade Commission – many of these efforts were not bold enough in their approach, swift enough in their impact, or legible enough in their description to land with voters. Rather than throwing the baby out with the bathwater, however, those interested in systemic policy change might instead use the lessons of the Biden Administration as a springboard towards a more transformative vision for the party platform of the future.
In that spirit, we asked former members of the Biden Administration to identify a policy they worked on during the Administration, reflect on why it might not have landed with voters, and imagine what a more ambitious, progressive, and ultimately successful policy alternative might look like going forward.
Elizabeth Wilkins
President Biden’s executive order on promoting competition issued a clarion call to federal agencies: To protect American workers, businesses, and consumers against excessive corporate concentration, the administration would take an aggressive, whole-of-government approach. Some agencies—particularly those responsible for antitrust enforcement—rose to the challenge, driving huge successes. Agencies serving as industry regulators, meanwhile, fell prey to cramped imagination and limited political will, conceding significant opportunities to show the American public they could deliver on issues that mattered to them. The administration’s efforts to regulate pharmacy benefit managers (PBMs) illustrate the tools left on the table and the cost of that choice.
Health care markets are where the effects of consolidation and anticompetitive behavior are perhaps most acutely felt not just in terms of cost, or even of livelihood, but as a threat to life itself. As just one piece of the puzzle, over the past two decades the top three PBMs—middlemen that negotiate drug prices with manufacturers, define the bundles of drugs insurers will cover, and reimburse pharmacies for prescriptions—have grown to control 80 percent of all prescriptions in the U.S., and are vertically integrated with health insurers and pharmacies in ways that incentivize self-dealing. A major Senate study had already found that PBMs increase the cost of insulin significantly. And independent pharmacists deluged the Federal Trade Commission (FTC) with stories of how unfair PBM contracts were underpaying them and driving them out of business. Early in her tenure, FTC Chair Lina Khan decided to study these behemoths.
Studies have their place in the arc of policy change. But while FTC studied the myriad effects of PBMs on all market participants, a more immediate tool lay in wait to address pharmacists’ specific concerns. The Centers for Medicare and Medicaid Services (CMS) has a regulatory mandate to ensure that contract terms for pharmacies are “reasonable and relevant,” a clear hook to remedy one of the most urgent problems independent pharmacists faced—that PBMs reimburse them less than the cost of dispensing a drug; that is, PBMs force pharmacies to lose money on each transaction. But HHS was unwilling to upset powerful interests and intervene.
Policymakers talk a lot about the risk of overreach. As we look to rebuild faith in government, we need to talk more about the risk of under-reach. Policy solutions must be commensurate to the urgency of the problem the public faces. Where people face imminent threat to their livelihood, a study isn’t enough. People need to see their frustrations channeled through a government that is fighting for them, even in the face of powerful pushback. A whole-of-government approach means acting with the ambition Americans want from every agency, and rebuilding our muscle for doing big things.
Chiraag Bains
Joe Biden put fighting racism and inequality at the core of his presidency. Coming off four years of Trump and nationwide protests after George Floyd’s murder, Biden announced a “whole-of-government equity agenda” in his first executive order. The order defined equity as “the consistent and systematic fair, just, and impartial treatment of all individuals.” It covered race and went further. Agencies had to examine how government had failed all “underserved communities”—whether through redlining in Black neighborhoods, disinvestment in rural areas, neglect of persistently poor communities, or otherwise—and devise strategies to advance equal opportunity for all.
That mandate had real impact. We cut Black child poverty in half. Black and Latino ACA enrollment tripled and the overall uninsured rate hit a record low. We invested billions to connect rural Americans to high-speed internet. We fought bias in home appraisals, prosecuted hate crimes, defended LGBT and disabled workers, and protected the vote.
And yet, a disinformation campaign continuously distorted our work. Right-wing think tanks and social media provocateurs denied the existence of systemic racism and falsely claimed that by “equity” we meant penalizing white people and men to force equal outcomes. They sued to stop financial support for Black farmers whom USDA had discriminated against, and to hobble programs for minority-owned businesses. They lied about the civil service, saying agencies were directed to hire based on race and gender. Today, Trump and Elon Musk are using these lies not just to reverse Biden’s achievements, but to justify dismantling agencies and freeze grants they don’t like.
We need to be much more forceful in explaining our equity agenda: (1) We have to foreground evidence of discrimination and structural disadvantage. Progressives tend to assume people know discrimination exists and focus their energy on solutions. When we do that, it’s easy for opponents to cast our remedial efforts as preferential treatment for favored groups rather than removing barriers to equal opportunity. (2) We must show that fighting inequality doesn’t have to be zero-sum. Policies like better health care coverage or the Child Tax Credit cut racial disparities and benefit all groups. (3) We have to vigorously beat back disinformation. That includes calling out the right’s manufactured outrage as a strategy to prevent social progress. (4) We must do all of this across the fragmented media ecosystem.
Racial justice advocates should make the case now. Trump and Musk are firing people who attended diversity trainings. They are enforcing a massive censorship regime, scrubbing words like “inclusion” and “gender” from federal documents (leading to some truly boneheaded redactions). They use “DEI” as a slur against women, people of color, and people with disabilities, blaming them for everything from the L.A. wildfires to the flight collision in DC. Meanwhile, they’ve installed officials who support eugenics and believe “competent white men must be in charge if you want things to work.” All of this exposes the dishonesty of their attacks and the urgency of our work.
Bharat Ramamurti
The rising cost of housing is a pressing concern for many families across the United States, but the most common ideas for addressing the problem are frustratingly long term. America has a decades-long shortage of affordable housing units, which drives up costs for renters and homebuyers. Following the economics, the Biden Administration proposed massive new investments in affordable housing supply. But it can take years for new investments in housing supply to begin reducing costs. As we saw in November, it is not very effective to tell voters facing 20% rent hikes or back-breaking potential mortgage payments that the government is trying to help them mostly by giving developers tax credits to build more units in their area over the next ten years.
There are popular alternatives that offer more short-term relief to renters and homebuyers, but they carry real risks. When supply is limited, options that subsidize demand for housing, like tax credits that defray rental costs or down payment assistance for first-time homebuyers, may drive up prices, transferring most of the value of the government assistance to the landlord or seller. Rent control polls well and may be a viable option for some cities, but it can discourage new construction and thereby worsen the problem in the long run – a frustrating outcome for people looking for sustainable solutions.
Policymakers should pursue more creative options to reduce costs in the short run while continuing to push for supply investments that will help in the long run. With interest rates likely to remain high for at least another year or more, it is worth exploring ways to defray costs for potential homebuyers, such as by allowing buyers to assume the existing lower-rate mortgage on a home when they purchase it. And for renters, big new investments in affordable public housing could create livable options that help drive down prices across the market. Whether it is these ideas or others, voters will reward politicians who are taking thoughtful and ambitious steps to address the cost of the biggest line item in their monthly budget.
Samuel Bagenstos
For decades, Americans have complained about the crushing cost of prescription drugs. President Biden’s signature law, the Inflation Reduction Act (IRA), finally responded to those complaints. It capped Medicare recipients’ out-of-pocket costs for insulin at $35 per month, guaranteed that, as of this year, people on Medicare would pay no more than $2,000 per year out of pocket for prescription drugs, and created a process in which the government would negotiate with manufacturers directly over the price Medicare would pay for the highest-cost drugs.
Helping to set up the negotiation program, defend against Big Pharma’s lawsuits opposing it, and negotiate the first round of covered drugs will forever remain a true highlight of my career. I am incredibly lucky to have been able to have played a role in something so important to so many people’s lives.
And yet … when voters took to the polls in 2024, President Biden and Vice President Harris seemed to get no meaningful credit for their efforts to lower the burden of drug costs on consumers. There are many reasons why these efforts did not break through. But I suspect one reason is that, as ambitious as they were, it was difficult for ordinary people to see the effects of those actions.
Part of this is a sadly familiar story – the back-loading of benefits of Democratic policy initiatives. The $2,000 cap on out-of-pocket expenses – which will be an enormous benefit for people who take the most expensive drugs – did not come into effect until January 1 of this year, after the election. And the first round of negotiated drug prices will not come into force until 2026. It’s hard to get people to understand the benefits of legislation that isn’t going to help them until some time in the future.
But another big part of the problem is the complex and privatized way the Medicare drug benefit is designed. Medicare beneficiaries get their drug coverage not from the government, but from a private insurance company that the government pays. And the private insurance company makes its own decisions about what out-of-pocket costs to charge for particular drugs, how hard it will be for beneficiaries to get access to those drugs, and so forth. And the insurance company makes that decision based on its own negotiation with the drug company, which offers rebates to the insurance company to encourage it to make its drugs more available. The result is a system where drug companies and insurance companies profit, but the effects of the IRA’s massive legal reforms are attenuated and hard for ordinary people to see as the work of the government generally and the Biden Administration specifically.
A more ambitious effort would have provided a public health insurance option for prescription drugs on Medicare so that people could see precisely what the government was providing them – without multiple opaque layers of negotiation – and so that we could take the profit of the insurance company out of the equation. Such a proposal certainly would not have passed Congress as part of the IRA. But the Centers for Medicare & Medicaid Services could have set up a public option through assertive use of its statutory demonstration authority. Given the administrative, legal, and political complexity of setting up the drug negotiation program, I fully understand why we in the Biden Administration did not take on this additional burden. But I can’t help thinking that a more aggressive approach would also have been more popular in the end.
Shilpa Phadke
To ensure the middle class remains within reach for millions of Americans and to strengthen both economic stability and growth, addressing the caregiving crisis is essential. Care work is the foundation that enables all other work. The absence of affordable and accessible child care, elder care, and home care – combined with a lack of work-family policies like paid family and medical leave – has had a significant, deleterious impact on American families.
The care sector is often recognized as a priority for social progress and for battling inequality. To make meaningful care policy a reality, however, we must prioritize care as a vital economic issue, positioning it as a catalyst for economic growth and national security. Actively supporting this sector – through a comprehensive set of government policies akin to those utilized in other industries – requires a shift in perspective. Government investment should not only stabilize and promote care work but also further elevate it as an industry that drives the broader economy. Industrial policy can be a powerful vehicle for advancing this care agenda. Just as we invest in defense or clean energy, similar support is necessary to strengthen the care sector. This is not a quick fix, nor is it a substitute for the transformative, longer-term investments in care that are urgently needed. This vision will require new policy tools and a sustained, whole-of-government approach building on the foundation laid by the Biden Administration’s Care Executive Order, which among other things, mobilized key economic agencies to coordinate efforts and drive meaningful action across the caregiving sector.
For example, by directing resources, regulation, and enforcement towards care industries where workers have historically been undervalued and exploited, industrial policy can be a tool for empowering care workers. At the same time, federal resources can be put towards expanding the supply of skilled child care and direct care providers, while simultaneously creating and ensuring that these jobs are sustainable and high quality. And, an industrial policy frame can enable government to creatively stimulate private investment, for example through local economic development and small business collaborations.
Addressing the caregiving crisis through an industrial policy framework is not just a necessary step to support working families, but a critical investment in the long-term economic health and security of the nation. By leveraging the tools of industrial policy – along with the necessary investments to ensure care is a public good – we can transform the care sector into a thriving, well-supported industry that creates good jobs, ensures quality care, and strengthens our economy.
K. Sabeel Rahman
As the Trump-Musk administration goes about systematically dismantling the federal government, particular ire has been concentrated on those institutions most directly charged with the task of building a more inclusive economy and society. The attack on civil rights and equity initiatives, for example, is essentially an effort to restore hierarchies of race and gender. Similarly, the attempt to zero out the Consumer Financial Protection Bureau (CFPB) is the latest example of an attack on those governmental authorities centrally focused on counteracting domination and unequal power relations in the market.
The scale of these attacks highlights a critical agenda for progressives seeking to defend and reimagine the administrative state. While there have been a number of important reforms and experiments in economic regulation in the last few years – from the renewed interest in anti-monopoly, to the efforts at centering equity, to new experiments in industrial policy and various regulatory process reforms – a forward-looking agenda should set its sights even bigger, imagining the formation and reformation of agencies themselves, looking to create anew their authorities, missions, jurisdictions, and structures.
Historically, agencies have been created in part to forge a new institutional structure empowered to tackle a set of social and economic harms that required dedicated attention. The early twentieth-century concern with dominant economic power in the forms of monopoly power and workplace power led to the formation of agencies like the Federal Trade Commission (FTC) and the National Labor Relations Board, among others. Similarly, in the aftermath of the 2008 financial crisis, the systemic disregard of financial product engineering and marketing in consumer markets led to the initial creation of the CFPB itself. In response to systemic patterns of racial and gender discrimination, we created dedicated agencies like the Equal Employment and Opportunity Commission, and embedded within existing agencies new resources and authorities to tackle issues of discrimination and civil rights, such as through Title VI of the Civil Rights Act.
In each of these instances, endowing a new institutional structure with broad authorities, dedicated resources (both in terms of budget and staff), and with a clear mission and mandate not only enabled new forms of public-protecting regulations, but also altered the broader political economy of policymaking by establishing new centers of policymaking activity and new discourses in which public harms could be discussed and remedied. This is not to say each of these prior interventions are faultless and completely successful. But it is to remind us that creating new administrative regimes is a potentially transformative, structural strategy for addressing deeper forms of domination and inequity. Further, the history of agency formation shows us that the success of such interventions turns on how powerful, resourced, and mission-driven this new institution might be, and on how much it succeeded in catalyzing a new form of interest-group politics around the issues and discourses it foregrounds. Thus, the mere existence of a CFPB or an FTC or something like Title VI obligations enables a different kind of advocacy, public discourse, and politics that puts questions of economic and social equality in the foreground.
In the current moment, we face many challenges in the realm of social and economic domination. We see new kinds of private economic power evolving and establishing novel forms of unaccountable control over communities and workplaces alike – from the continued proliferation of new types of financial engineering and financialization, to the spread of invasive digital surveillance that concentrates knowledge and control with bosses or market-dominant firms. And these political economic structures are recreating durable forms of geographic, vocational, and economic segregation and ‘opportunity-hoarding.’ Simply restoring administrative regimes to their pre-2025 status quo ante is almost assuredly going to be insufficient to meet the real needs many communities have for greater protection and support – in addition to being politically unsatisfying amidst a widespread disaffection for the status quo.
To be sure, considerable good policy can be made through simpler and less structurally-transformative mechanisms like more engaged forms of presidential coordination and agenda-setting. But a bolder and more ambitious approach would push for the creation of new agencies altogether, with clear mandates and modern tools to better advance some of these objectives under contemporary conditions.
