Former U.S. Surgeon General Vivek Murthy and former Doctors for America CEO Alice Chen dive into the state of healthcare in the United States, from the Trump administration’s recent moves to end cost-sharing subsidies, to finding ways to cut costs by focusing efforts on prevention. They also discuss the oft-neglected impact of loneliness and stress on health. Dr. Chen and Vice Admiral Murthy were on campus as guests of the Kennedy School’s Center for Public Leadership.

174 Stress: A Surgeon General's Warning

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Public policy has great power, both to improve people’s lives if it is planned and executed well and to cause significant suffering if it is not, says Harvard Kennedy School Dean Douglas Elmendorf, who will step back from his post this summer to rejoin the faculty. He joins PolicyCast host Ralph Ranalli in this episode to discuss the crucial role policy plays in everyday life, the often-imperfect ways it gets made, and the factors that shape it, including politics, values, education, and communication. He also addresses the issue of public distrust in policy advice and the vital role that values play in policy making and educating public leaders, even when those values—including economic justice and diversity and inclusion—are under attack by some in the political sphere. “Our job is to enunciate our values, and to explain how those values can help us serve the world,” he says. Elmendorf became dean of HKS in 2015 after a career steeped in policy research and formulation, mostly involving his chosen field of economics. He has worked as the director of the nonpartisan Congressional Budget Office, a senior fellow at the Brookings Institution, a deputy assistant director of the U.S. Treasury, an assistant director of research at the Federal Reserve Board, and a senior economist at the White House’s Council of Economic Advisers. As dean, he’s seen the school through a campus expansion, the COVID-19 pandemic, increasing polarization and attacks on government and higher education in the public sphere, and the current domestic political fallout from the conflict between Gaza and Israel—all while diversifying the school’s community of students and scholars and affirming the important role of training public leaders and developing workable policy solutions to big public challenges.

Public policy, values, and politics: Why so much depends on getting them right

HKS Senior Lecturer Linda Bilmes, an expert on public finance who has studied post-9/11 war costs for the past 20 years, says their staggering $5 trillion cost was enabled by what she calls “The Ghost Budget.” Using an unprecedented combination of borrowing, accounting tricks, and outsourcing, presidential administrations, Congress, and the Pentagon were able to circumvent traditional military budget processes in a way that kept war costs out of the public debate and resulted in trillions being spent with minimal oversight. The result: corporations and wealthy investors raking in huge profits, massive waste and fraud, and—combined with the Bush and Trump tax cuts—a shifting of the burden of the costs of war away from the wealthy and onto middle- and lower-income people and future generations. Of course by any metric, the United States-led wars in Afghanistan and Iraq were costly. Human life? At least 430,000 Iraqis, Afghans, and Pakistani civilians dead, along with more than 7,000 U.S. military personnel and thousands of civilian contractors. Democratic progress? Afghanistan is once again an authoritarian theocracy under the Taliban, and instead of transforming Iraq and the region, the U.S. invasion and occupation undermined popular sentiment toward democracy, unleashed sectarian violence, and strengthened autocratic regimes. But the budgetary problems are something we can address now, Bilmes says, with congressional reforms and planning prudently for the long-term costs of the wars, including caring for veterans. “The Ghost Budget” is also the title of Bilmes’ next book, which will be published next year.

The Ghost Budget: How U.S. war spending went rogue, wasted billions, and how to fix it

Harvard Kennedy School Professor Rana Mitter and Harvard Business School Associate Professor Meg Rithmire say that after decades of tremendous growth, an economically slowing China is the new normal. With a growing debt-to-GDP ratio, an aging population, a devastating real estate bubble, and a loss of confidence among both foreign investors and domestic consumers, Chinese President Xi Jinping and the Chinese Communist Party face a daunting array of thorny problems—including ones of their own making resulting from the One Child law policy and other home-grown policies. So how should the United States and other Western countries respond?  Is it a moment China's rivals can use to their advantage, or one where great power rivalry can give way to great power cooperation? And how will an economic slowdown affect China’s geopolitical ambitions, and is an annexation of Taiwan now more or less likely? Rana Mitter is a historian and the S.T. Lee Chair in U.S.-Asia relations at the Kennedy School and the former director of the China Center at Oxford University. Harvard Business School Associate Professor Meg Rithmire is a political scientist who studies the comparative political economy of development in Asia and China’s economic relations with the rest of the world, particularly the United States. They join host Ralph Ranalli to explore some of the underlying reasons behind for the country’s current malaise, and to offer some policy ideas to help create a positive outcome with relations with China moving forward.

The Great Creep Backward: Policy responses to China’s slowing economy

Former U.S. Ambassador to Israel Ed Djerejian says Israeli Prime Minister Yitzak Rabin once told him “There is no military solution to this conflict, only a political one.” Rabin was assassinated a few years later and today bullets are flying, bombs are falling, and 1,200 Israelis are dead after the Hamas terrorist attacks of October 7 and nearly 30,000 Gazans have been killed in the Israeli response. Yet Djerejain still believes that a breakthrough is possible even in the current moment, as horrible as it is. Djerejian, a senior fellow at Harvard Kennedy School’s Belfer Center for Science and International Relations, says the crisis has shaken the regional status quo to the point where—if the United States pursues diplomacy that includes principled pragmatism, coalition-building, and good old- fashioned backbone—a breakthrough may finally be possible. But in a recent paper he argues that any breakthrough will have to be built around a two-state solution, which he says is the only path to peace and stability not only in Israel and Palestine, but the wider Middle East. Djerejian’s career as a diplomat spanned eight U.S. presidential administrations beginning with John F. Kennedy’s, and he also served as U.S. Ambassador to Syria and Assistant Secretary of State for Near Eastern Affairs.

Two peoples. Two states. Why U.S. diplomacy in Israel and Palestine needs vision, partners, and a backbone

As our discourse and our politics have become both more polarized and paralyzed, Harvard Kennedy School faculty members Erica Chenoweth and Julia Minson say we need to refocus on listening to understand, instead of talking to win. In mid-2022, the School launched the Candid and Constructive Conversations initiative, based on the idea that frank yet productive discussions over differences are not only vital to democracy and a functioning society, but that the ability to have them was also an essential skill for students, staff, and faculty in the Harvard community and beyond to learn. The effort—which uses techniques and principles based on surveys and decision science—took on even greater urgency after the recent events in Israel and Gaza and their fallout in the U.S., including at Harvard and other universities. Erica Chenoweth is the Frank Stanton Professor of the First Amendment and the academic dean for faculty Engagement at HKS, as well as one of the world’s leading authorities on conflict and alternatives to political violence. Associate Professor of Public Policy Julia Minson is a decision scientist who studies the psychology of disagreement, and has developed research-based, practical methods that nearly anyone can use to make difficult conversations into productive ones.

174 Stress: A Surgeon General's Warning

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