This paper aims to set out some key alternative macroeconomic policy ideas for further debate and research in the context of the multi-disciplinary approach of the Wits Inequality Project. We ask what kind of macroeconomic policy interventions will be essential for growth and employment generation and to a successful struggle against rising income and wealth inequality in South Africa, and elsewhere. My assertion is that that unless we have a supportive macroeconomic framework, many other economic and social policy interventions for addressing growth and inequality will likely fail to gain much traction or purchase for budgetary and related reasons. I draw on both history and theory to demonstrate the early and respectable roots of heterodox economic thinking and support for a more activist state-led macroeconomic policy. Those supportive of alternative heterodox policy ideas are often and quickly labelled macroeconomic populists or madmen and I aim to show that such heterodox, state led approaches to growth and development also have a rich history and respectable pedigree behind them. I comment briefly on the American New Deal and the recommendations of the South African Macroeconomic Research Group. Both were examples, in very different eras, of progressive macroeconomic policy interventions based on a state-led investment and ‘crowding in’ approach to development in direct contrast to a private finance, market led and ‘crowding out’ neoclassical orthodoxy. The paper then reviews some key ideas underlying a post-Keynesian approach, and ends with some specific proposals for macroeconomic reform in South Africa.