Improve, maintain and rationalise infrastructure. Public infrastructure provision is not keeping pace with the evolving economy and the poor co-ordination of decisions across jurisdictions is contributing to congestion, urban sprawl, and environmental degradation.
Actions taken: No action taken. Plans have been announced to boost public spending and encourage private spending on infrastructure, although the legislative details and associated appropriations have not been developed.
Recommendations: Boost investment in, and maintenance of, infrastructure. Promote mass transit, and use federal programmes to encourage co-ordination across state and local jurisdictions. Implement user fees based upon distance travelled and congestion, to help fund transportation and to encourage users to internalise the broader costs of congestion, emissions such as carbon and particulate matter, and pavement damage. Expand federal programmes designed to improve access to fixed broadband.
Strengthen active labour market policies. Some displaced workers no longer possess skills that are in high demand by employers and are likely to suffer long bouts of unemployment or exit the labour market.
Actions taken: No action taken. The Department of Labor is working to expand the use of apprenticeships.
Recommendations: Expand funding for reskilling, building on programmes that, in the past, have shown effectiveness in facilitating reemployment.
Improve equality of opportunity and strengthen outcomes in education. Some segments of the population – including children from poor families, females with young children, and persons with criminal records – still lack opportunities to acquire skills valued highly by employers and to sustain employment.
Actions taken: Under the implementation of the Every Student Succeeds Act, peer reviews of plans developed by State education agencies in 2017 are underway.
Recommendations: Use targeted federal funding to reduce disparities in student opportunities and encourage States to be ambitious in lifting educational attainment. Require paid parental leave and improve access to quality childcare to help reduce wage gaps and improve career prospects. Expand earned income tax credits. Reduce pre-screening for employment to increase the employability of those with criminal records.
Improve the efficiency of the health care sector. The US devotes a much larger share of its resources to healthcare than other OECD countries, and these resources can be used more productively.
Actions taken: In 2017 the U.S. Food and Drug Administration has taken steps to increase competition in the market for prescription drugs and facilitate entry of low-cost alternatives.
Recommendations: Continue to conduct pilot programmes of Medicare provider payment systems, utilise research by the Patient-Centered Outcome Research Institute and others that compares the effectiveness of different prescription drugs and treatments. Ensure that cost-saving measures thus identified are rolled out, and monitor their impact. Monitor developments in the increase of coverage.
1Reduce the burden of regulation, zoning and licencing. Regulatory burdens and federal, state and local government restrictions hinder the business environment.
