For a long time, major federal policies in the US have been relatively fixed, with modest changes that are treated as apocalyptic by politicians. But now everything is coming unglued and we’ll see what major policy change is really like. That could be terrible, or the unsticking that is happening now may make it possible to push things to much better place, say ten or fifteen years from now. I am a congenital optimist, so take that bias into account, but I think there is hope.

To see what one talented and powerful individual can do at the right moment in history, consider Frances Perkins. As Charlotte Gray’s review of Rebecca Brenner Graham’s book Dear Miss Perkins in the February 4, 2025 Wall Street Journal notes:

[Frances Perkins’s] legacies include the 40-hour work week, unemployment insurance, Social Security and the end of child labor.

She did a lot as secretary of labor! Without her, Franklin Delano Roosevelt would have had less of an effect on our daily life today.

Dear Miss Perkins is primarily about how Frances Perkins tried to overcome the antisemitism of many others to let more European Jews come to the United States. The strong efforts that she made make it clear the heavy guilt that others bore for the deaths of a huge number of European Jews who could have been saved if they had been allowed to come to the United States. (Of course, we today are in great danger of bearing guilt for keeping others out of the United States who will fair much, much worse in the places they are in now.)

As another example of an individual who made a difference, consider Loretta Ford, the pioneer of the role of nurse practitioner who died January 22 this year. Loretta did a lot to reduce the baleful effects of monopolization of medicine by doctors restricting supply. Quoting from James Hagerty’s obituary in the February 6, 2025 Wall Street Journal (bullets added to mark off distinct quotations):

• The problem was that physicians regarded themselves as the “lords of health,” as she put it. They were, and remain, determined to defend their turf.

• Rather than seeking approval from boards of medicine, she said, “We went to tell them what we were doing.”

• About 385,000 nurse practitioners are working in the U.S., more than triple the total two decades ago.

• In the early days, Ford met resistance not just from physicians but from nursing professors wary of what seemed like radical change. Some colleagues stopped talking to her. “I’ve been kissed and kicked and reviled and revered and crucified and credited,” Ford often quipped.

• Ford saw no need for physicians to fret. “There’s enough work to go around for everybody,” she told Modern Healthcare in 1995. “The patient needs team care.”

I think we are again in a time of great policy possibility—both for bad and for good. Even just limiting ourselves to the areas Frances Perkins and Lorretta Ford worked on, we could

1. Further loosen “scope of practice”, as more and more of medicine becomes routinized, reserving to MD’s the most difficult diagnostic questions and the most difficult types of surgery. On this, I am inspired by Clay Christensen, Jerome Grossman and Jason Hwang’s book The Innovator's Prescription: A Disruptive Solution for Health Care. (If you put “Hwang” in the search box above, you’ll find many posts I have written about insights from this book.)

2. Work toward a four-day workweek. On this, I was inspired by a seminar here at the University of Colorado Boulder by the economist Pedro Gomes, author of Friday is the New Saturday, who is working hard to make the four-day workweek a reality, starting in Europe.

The way to make political hay in the world today, I maintain, is to propose things that will make people’s lives better that have not even been part of the political discussion.