Paul Starr

Paul Starr is co-founder and co-editor of the The American Prospect. and professor of sociology and public affairs at Princeton University. A winner of the Pulitzer Prize for General Nonfiction and the Bancroft Prize in American history, he is the author of seven books, including most recently Remedy and Reaction: The Peculiar American Struggle over Heath Care Reform (Yale University Press, revised ed. 2013). Click here to read more about Starr.

Recent Articles

Troubled States

The recession will take its biggest toll on the states this year. We could fix that.

The Arizona state Capitol, which together with the governor's office was put up for sale last year to plug the state's budget deficit (AP/Matt York)
This year, with unemployment still at recession levels, one state after another will lay off teachers, reduce health care for people on Medicaid, defer maintenance on roads and bridges, and make other assorted cuts to balance their budgets. Even though these policies will hinder economic recovery, venerable observers will say the cutbacks are preferable to higher taxes, and some Republicans will relish the chance to slash programs they never liked in the first place. Even liberal Democratic governors and legislators, compelled by balanced-budget requirements in state constitutions, will have no politically feasible alternative except to reduce spending. Although state revenues have begun to grow again, they are still well below 2007 levels, and federal stimulus aid to the states -- perhaps the least appreciated part of an ill-appreciated program -- ends with the new fiscal year (beginning in most states on July 1). This whole experience ought to be a lesson in the limits of stimulus...

The Republicans' Senior Moment

Seniors depend more on federal spending than any other group, but that did not deter a majority of them from voting for candidates who deplored "big government" and "socialized medicine."

Fred Linsenmeyer of Phoenix at a health-care town hall meeting held by Sen. John McCain (AP Photo/Ross D. Franklin)
One reason the electoral map turned red in November was that the electorate turned gray. Older Americans went to the polls in droves to vote Republican, while young people stayed home. And one big question about 2012 is whether the elderly will still vote Republican if the GOP can be forced to spell out the implications of its political agenda for Medicare and Social Security. The magnitude of the age shift and the degree to which it favored Republicans in 2010 were remarkable. In 2008, voters 65 years of age and older represented a smaller share of the total (16 percent) than did voters aged 18 to 29 (18 percent). But in 2010, elderly voters outnumbered the young by more than 2-to-1 -- 23 percent compared to 11 percent. While the young still favored Democrats, the old swung massively to the Republicans, voting for them by a 21-point margin, 59 percent to 38 percent. Throughout the year, polling found that of all age groups, the elderly leaned the most toward the Republicans and were...

Back to Deadlock

Come next January, the great American impasse will be back in all its toxic splendor.

President Obama calls on Senate Republicans to stop filibustering campaign-finance legislation, July 2010 (AP/J. Scott Applewhite)
The voters often surprise us, but this fall's midterm election seems nearly certain to have at least one consequence. For the next two years, Congress will be unable to make any significant headway on the great challenges facing our country. The Republicans may win one or both houses, or they may fall a bit short, but their gains will be enough to stymie substantial legislation to deal with climate, immigration, the economy, and long-term fiscal challenges. A majority of the electorate may think those problems need urgent attention, but when the votes are tallied, they will likely add up to paralysis. Impediments to large-scale policy innovation are built into the structure of American government, but recent developments have made legislative change even more difficult. Use of the Senate filibuster has become routine in an era when bipartisanship has become nearly impossible. With the advent of a tea-stained Republican Party, it will be no small feat even to get the congressional...

La Próxima Campaña de Reforma de Salud

Los partidarios de la reforma sabían que tenían que luchar para lograr su aprobación. Ahora necesitan llevar a cabo otra lucha para cumplir las promesas de la ley.

La Campaña de implementación Las perspectivas de una nueva campaña para la reforma de salud -- en esta ocasión para llevarla a cabo-- pueden sorprender a algunos que pensaban que la batalla había terminado cuando el Congreso votó. Lo imperativo, sin embargo, es claro para los líderes de las organizaciones que lucharon por la promulgación de la ley y a los funcionarios claves en la administración del Presidente Obama. Ellos se están preparando para defender las reformas y ayudar a hacer realidad su promesa en los 50 estados. Así como lo hicieron durante la campaña legislativa, los grupos que apoyan a la campaña de implementación independientemente de la Casa Blanca pueden ser clasificados en uno de dos grupos de coaliciones que se superponen. Uno de ellos está compuesto por grupos de trabajo y organizaciones de base, reunidos bajo el término abarcativo de Health Care for America Now (HCAN). Según Ethan Rome, su director ejecutivo, HCAN continuará con su organización local para "...

The Preventive Turn in Health-Care Reform

Promoting preventive care and public health carries both promise and risk.

When health insurance developed in the United States in the 1930s, it covered hospital and later major medical bills, not preventive services. Insurance also had nothing to do with public health. And when Medicare was enacted in 1965, it too made no provision for preventive and public-health services. The Affordable Care Act is different. Culminating a long shift in thinking, it incorporates preventive care into health insurance and seeks to promote public health through provisions aimed at reducing obesity and smoking and encouraging participation in wellness programs. The changes in insurance coverage are straightforward to implement. New private insurance policies -- that is, all but "grandfathered" plans in existence at the time the president signed the law on March 23 -- will have to cover 100 percent of the cost of a list of preventive services that have met standards for effectiveness set by the U.S. Preventive Services Task Force. (Clinical preventive services include...