Immediate concerns over swine flu might be waning, but public health and government officials continue their fight against the illness, directing people with flu symptoms to see their doctor. But advice like this takes for granted a well-functioning health care system. Many Americans don't have a doctor to contact, either because they don't have health insurance or because primary-care physicians are in seriously short supply.

This commentary suggests ways of making the upcoming debate on Social Security reform more productive than some past efforts. Participants must be open to a range of solutions, financing must be transparent, and effects on disabled workers must be addressed. Reform efforts must acknowledge the changing economic environment, including increasing wage inequality, and shifting individual and family demographics. Guaranteed inflation-protected benefits are crucial, and the sacrifices necessary to balance the system should be shared across generations

Local governments sit at the confluence of formal and informal governance systems in Pakistan. Law and order, service delivery, and citizen interaction with the state take place in villages, towns, and cities, where families, tribes, political parties, religious organizations, and government officials share dominion. In 2001, then-President Pervez Musharraf called for the creation of local governments better attuned to citizen preferences and adept at providing improved services. Today, this autonomy initiative is up for grabs as Pakistan’s provinces reconsider the role of local government and the nation readies for fall elections.

Automated enrollment strategies have achieved remarkable results with many public and private benefit programs, dramatically increasing program participation while lowering administrative costs and reducing erroneous eligibility determinations. The recently passed Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) should make such steps much easier for states to take in covering eligible but uninsured children. Following CHIPRA's enactment, states have both new tools and new incentives to use automated strategies in fulfilling four key functions: identifying uninsured children; determining their eligibility for health coverage; enrolling eligible children into coverage; and retaining eligible children.

This report examines more than 100 programs through which the federal government spends money on children and calculates the amount spent on children under three. These first time expenditure estimates provide a place to start in gauging the priority the nation places on investing in very young children and in comparing expenditure patterns to researchers’ findings about investments that work. For example, despite extensive child development research underscoring the importance of quality early care and education programs for infants and toddlers, especially those in poverty, just 7 percent of federal funding for children between birth and age 2 went toward these efforts in 2007.

Extensive research shows investing in very young children can help build a strong future workforce, improve children's educational success and health, and potentially reduce some of the social ills that drain the nation’s resources and will. What investments does the United States currently make in infants and toddlers?

Despite extensive research documenting the benefits of investing in young children, infants and toddlers are underrepresented in the federal budget. The nation's 12.5 million children under age 3 are 4.2 percent of the population, but they received just 2.1 percent-$44.1 billion-of federal domestic spending in 2007.

Current health insurance markets suffer from many shortcomings. Comprehensive health care reform will be necessary to address them. Insurance market reforms and subsidies to make coverage affordable for the modest-income population within the context of a more organized health insurance market are essential strategies. A health insurance exchange can be developed to organize the insurance market and to provide guidance and oversight in achieving reform goals. Making a public health insurance plan option available to purchasers can further promote competition in insurance markets and could be an effective strategy for slowing health care cost growth.

Mary Cunningham, author of "Preventing and Ending Homelessness—Next Steps," answers five questions about how to combat homelessness. Evidence-based approaches have cut homelessness among chronically homeless single adults and new strategies are now being adopted to help homeless families. Investing in proven strategies is crucial as the economic crisis puts more people at risk of ending up in shelters and threatens to reverse the progress communities have made toward ending and preventing homelessness.

A health insurance exchange can make it possible to organize health insurance markets more efficiently and effectively than takes place today. Because so many different problems must be addressed in the insurance marketplace in order for all to have meaningful and affordable coverage, an entity like an exchange is needed to coordinate tasks and guide markets to comply with consumer protections and compete in cost-efficient ways. While not a panacea for all that ails the health system, carefully designed, an exchange can be a vehicle that facilitates and monitors the movement of the system toward many national health reform goals.