EFTA01139679.pdf

From: Gregory Brown To: undisclosed-recipients:; Bce: [email protected] Subject: Greg Brown's Weekend Reading and Other Things.... 1/19/2014 Date: Sun, 19 Jan 2014 08:10:13 +0000 Attachments: The Hospital Is_No Place_for_the_Elderly_JONATHAN_RAUCH_The Atlantic_Novemb er_2—0,2013.crocx; M—ATH scores_per_country_2012.docx; Finland_map.docx; Socialism_101_Christian Lience_Monitor.docx; High- speed_raioading_The E—conomist Jul_22nd_2010.docx; America in 2013, as l'old in Chirts Steven Rattner_NYT_December_30,_2013.docx; ElizabetITWarrenc_licar- — — Two Focus,_Improving_The_Economic_Fortunes_Of_Ordinary_Americans_Steve_LeBlanc _Hurf_Post 01.11.2014.docx; Amiri BaraTca,_influential_African_American writer_and_firebrand,_dies_at_79_Matt_Sch udel tWP_01.11.2014.docx; Amiri_Baraka_bio.docx; No robs no benefits_and_lousy_pay_Editorial_Board_NYT_01.10.2014.docx; The Conservative_Response_to_the_War_on_Poverty_Discussion_Jared_Bernstein_Huff_P ost 54 1.13.2013.docx; WITo's_poor in_America,_50_years into_the_War_onfloverty,_a_data_portrait_Drew_Desi Iver_PEW_J—anuary_13,_2014.docx;—Bruce_Springsteen_bio.docx Inline-Images: image.png; image(1).png; image(2).png; image(3).png; image(4).png; image(5).png; image(6).png; image(7).png; image(8).png; image(9).png; image(10).png; image(11).png; image(12).png; image(13).png; image(14).png; image(15).png; image(16).png; image(17).png; image(18).png; image(19).png; image(20).png DEAR FRIEND FINLAND Gulf of Fella Portkaik ‘,. Between Christmas and New Year's I flew to Europe from Los Angeles for two days of business meetings and on my outbound flight I sat next to a wonderful American women who returning home to Finland, and since no one really lives in Finland by choice, I had to ask why? Her initial answer was EFTA01139679 that she married a Finn, who she met while working at Nokia. But what took me aback was how she has since become a huge fan of Finland and would live nowhere else other than in Australia when she and her husband retires in twenty years or so. My belief is that Finland was the extremely poor step- child in Scandinavia, sort of backwards with little opportunity, poor weather bland food and nothing to do. As a result, I couldn't imagine even visiting Finland and I definitely didn't believe that there was any way that Finland could serve as a role model to America or even the rest of Europe. Boy did she change that. First of all, Finnish students consistently place in the Top 10, if not in the Top 5 and some years in the Top 3 in the world. How could this be possible? Remember Finland is a dull backward socialist country with bad weather. My friend explained that one of the reasons why Finland works is that they have democratic socialism whereby the number one priority of almost every politician in the country is to do what is best for the maximum amount of people even if it doesn't benefit the market. In Finland, their social democracy doesn't encourage or prioritize capitalist competition but instead encourages and prioritizes democracy in its best sense. In America, on the other hand, capitalism has had a long history of undermining democracy and hence public good. It's not even that Finland is an absolute perfect example of socialism any more than America is an absolute perfect example of capitalism. Rather, the point is that America strives toward a more capitalist worldview and Finland strives toward a more socialist worldview. Two different strivings leading to two very different results. Since the 1980s, the main driver of Finnish education policy has been the idea that every child should have exactly the same opportunity to learn, regardless of family background, income, or geographic location. Education has been seen first and foremost not as a way to produce star performers, but as an instrument to even out social inequality. In the Finnish view, schools should be healthy, safe environments for children. This starts with the basics. Finland offers all pupils free school meals, easy access to health care, psychological counseling, and individualized student guidance. This point is almost always ignored or brushed aside in the U.S. seems especially poignant at the moment, after the financial crisis and Occupy Wall Street movement have brought the problems of inequality in America into such sharp focus. The chasm between those who can afford $35,000 in tuition per child per year — or even just the price of a house in a good public school district — and the other "99 percent" is painfully plain to see. In Finland every citizen has a right to a free education from k through PhDs and other advanced degrees. So a twenty-five year old engineer or twenty-eight year old doctor receives their complete education without incurring any debt. As a result, the society as a whole is much better educated then here in America with superior skill sets. Healthcare is the same. Totally free.... And for young families, maternity leave is three years (yes 3 yearsfrom the birth of your last child) making it easy for families to stay together as well as providing more family support for the children and the family unit as a whole. From the age of three to six both the state and large corporations offer free pre-school until 6pm and all companies allow employees to leave work at 5:3opm so that they can pick up the children and spend time to their families. And companies don't resist this because it adds to the quality of life for employees, the central tenet of Democratic Socialism. Obviously all of this comes at a price. The top tax bracket for Finns is 42%. But remember, education and healthcare is free and one can retire at 62 years old with three-quarters retirement income. And remember, in Finland you don't go broke if you have a medical condition that doesn't let you work. Hence the elderly in Finland don't have buy cans of cat food to survive and younger Finns can get retrained when they lose their jobs or need to develop a new skill set. But again the real difference EFTA01139680 between Finland and the US is that political decisions are based on the greater good of the mass, instead of the self-interest of a very few. With this said, I have never been to Finland and I really only have had interactions with a few Finns, so what I am describing is from what I have read. The Finnish model is not going to work in every county as all countries are different, and Finland is a small nation (5.4 million) with a much more homogeneous population than the United States. When Finnish policymakers decided to reform the country's education system in the 197os, they did so because they realized that to be competitive, Finland couldn't rely on manufacturing or its scant natural resources and instead had to invest in a knowledge-based economy. With America's manufacturing industries now in decline, the goal of educational policy in the U.S. — as articulated by most everyone from President Obama on down — is to preserve American competitiveness by doing the same thing. Finland's experience suggests that to win at that game, a country has to prepare not just some of its population well, but all of its population well, for the new economy. To possess some of the best schools in the world might still not be good enough if there are children being left behind. Remember that when President Kennedy was making his appeal for advancing American science and technology by putting a man on the moon by the end of the 1960's, many said it couldn't be done. But he had a dream. Just like Martin Luther King a few years later had a dream. Those dreams came true. Finland's dream was that we want to have a good public education for every child regardless of where they go to school or what kind of families they come from, and many even in Finland said it couldn'couldn't be done. Clearly, these people were wrong. It is possible to create equality. And perhaps even more important — as a challenge to the American way of thinking about education reform — Finland's experience shows that it is possible to achieve excellence by focusing not on competition, but on cooperation, and not on choice, but on equity. The problem facing education in America isn't the ethnic diversity of the population but the economic inequality of society, and this is precisely the problem that Finnish education reform addressed. More equity at home might just be what America needs to be more competitive abroad. Finland has proven that if politicians get together with the goal of working together for the common good of the masses based on policies that support free education and healthcare, and results should be based on more than monetary milestones and ideology purity — not only will more people and the country will prosper but more people will experience a better quality of life. As such, from what I have read, the Finish model of democratic socialism works. Yes capitalism works but not for everything and if the Finish model works for education, healthcare, etc., why not use it FINLAND Finland, officially the Republic of Finland, is a Nordic country situated in the Fennoscandian region of Northern Europe. It is bordered by Sweden to the west, Norway to the north, Russia to the east, and Estonia to the south across the Gulf of Finland. As of 2012, Finland's population was around 5.4 million, with the majority concentrated in its southern regions. In terms of area, it is the eighth largest county in Europe and the most sparsely populated county in the European Union. Finland is a parliamentary republic with a central government based in the capital of Helsinki, local governments in 336 municipalities and an autonomous region, the Aland Islands. About one million residents live in EFTA01139681 the Greater Helsinki area (consisting of Helsinki, Espoo, Kauniainen, and Vantaa), which also produces a third of the country's GDP. Other large cities include Tampere, Turku, Oulu, Jyvaskyla, Lahti, and Kuopio. From the 12th until the early 19th century, Finland was a part of Sweden, a legacy reflected in the prevalence of the Swedish language and its official status. It then became an autonomous Grand Duchy within the Russian Empire until the Russian Revolution. This prompted the Finnish Declaration of Independence, which was followed by a civil war where the pm-Bolshevik "Reds" were defeated by the pro-conservative "Whites" with support from the German Empire. After a brief attempt to establish a monarchy, Finland became a republic. Finland's experience of World War II involved three separate conflicts: the Winter War (1939-194o) and Continuation War (1941-1944) against the Soviet Union and the Lapland War (1944-1945) against Nazi Germany. Following the end of the war, Finland joined the United Nations in 1955 and established an official policy of neutrality. Nevertheless, it remained fairly active on the world stage, joining the Organisation for Economic Co- operation and Development (OECD) in 1969, the European Union in 1995, and the eurozone at its inception in 1999. Finland was a relative latecomer to industrialisation, remaining a largely agrarian country until the 195os. Thereafter, it rapidly developed an advanced economy while building an extensive Nordic-style welfare state, resulting in widespread prosperity and a nominal per capita income of over $46,000 as of 2012, among the highest in the world. Subsequently, Finland is a top performer in numerous metrics of national performance, including education, economic competitiveness, civil liberties, quality of life, and human development. Newsweek magazine ranked Finland as the overall "best country in the world" after summing various factors. The Christian Science Monitor ran a series on the economies of Europe. With Peter Ford doing the assessment on the Finnish "social model." Some fast facts: • Ranked #1 for press freedom by Reporters Without Borders (U.S.? #22) • Ranked #2 (after Sweden) in investment in research and development (M) • Free university education • Subsidized day care • Most competitive economy in the world by World Economic Forum ranking • Among the world's most egalitarian societies As is typical of anything you may learn of the successes of socialism through the U.S. media, the author —either by editorial requirement or acculturation—needed to find reasons why socialism may work in Finland but not here. Or why it might not be desirable. I really don't understand that sentence other than to say that we can probably learn for Finland's socialist programs and policies and where they don't apply to us disregard them.... But we have to start thinking differently and examining other successes is s good first step. EFTA01139682 Are government policies and business practices out of touch with the changing state of American families? A new survey, which is part of a broader examination of the role of women in society, shows that many Americans believe the answer to that question is yes. The survey was commissioned for the Shriver Report, the third study spearheaded by NBC News reporter Maria Shriver, in collaboration with the Center for American Progress, a progressive think tank. The report, which will be unveiled with a series of appearances and events beginning Sunday, notes that there has been "a seismic shift" in the structure of American families, including the rise of single-parent households and that the majority of children born to women under 3o have unmarried mothers. At the same time, the report argues that government and business have been slow to recognize the changes and adopt policies that recognize these new realities. The report asserts that this has been particularly hard on women, who carry burdens of being both breadwinners and principal caregivers to children, particularly those living on the financial brink. What the accompanying national survey of 3,50o adults shows is that more Americans think government and business should adapt to the changing reality of American families as compared with those who say government should do what it can to promote traditional marriage and two-parent households. The survey looked at attitudes of all Americans and particularly "women on the brink,"which the authors say account for one in three women in America, probing issues of financial well-being, government policy, and personal decisions that have affected individuals' lives. The polling was done by the Democratic firm of Greenberg Quinlan Rosner Research and the Republican firm TargetPoint Consulting. One section of the survey prefaced questions by noting the statistics on births to women under age 3o and asked people about the best role for government in these times. Far more Americans say government should address society as it now is rather than seeking to return to what it was. For example, the survey found that 64 percent of all respondents and 77 percent of women on the brink agreed with this statement: "Government should set a goal of helping society adapt to the reality of singleparentfamilies and use its resources to help children and mothers succeed regardless of their family status." In contrast, only a bare majority of Americans and of women on the brink agreed with this statement: "Government should set a goal of reducing the number of children born to single parents and use its resources to encourage marriage and two-parent-families." More Americans agreed that women raising children on their own face major challenges and that government, business and communities should help them financially than those who agreed with the statement that unmarried women who have children should take complete financial responsibility for those children. The contrasting choices framed what remains a broad political divide over the impact of cultural and demographic changes that have transformed the country in a matter of decades. Research has shown that children have a greater opportunity for success if they are raised in intact, two-parent households. But the answers to the survey indicate that many people, particularly financially stressed women who head single-parent households, say government should worry less about what has happened and do more to find ways to help their families succeed. Women and men expressed general optimism about their financial futures, though younger women were far more positive than older women. Almost nine in to women under age 3o said they believe their financial situation will get better during the next five years, while just a third of those over age 64 expressed that same view. One striking finding on this question was that there was no difference between women in households with annual incomes of less than $20,000 and those with incomes of more than $ioo,000. But those lower-income women were much more likely than wealthier women to express the view that the harder they work, the more they fall behind, and that even if they made the right choices in life, "I still could not get ahead because the economy doesn't workfor people like me." About seven in to lower-income women said they regretted not staying in school longer, and slightly higher percentages said their regrets included not making better financial decisions and not putting a higher priority on education and career. EFTA01139683 One thing that divorced women did not regret was getting out of their marriages. Only about a fifth of the lower-income women who also were divorced said they regretted not staying in their marriages longer. In contrast, the survey found that divorced men were far more likely to say they regretted not staying longer in their marriages than were women. When the survey turned to questions about what business could do, lower-income women put as high a priority on policies that provide greater flexibility to accommodate for family responsibilities as they did on increased pay and benefits. The policies that drew the highest responses were paid sick leave or leave to care for a seriously ill family member. Among the most popular governmental policy options were equal pay for women for equal work (popular among women and men) and protecting the right of pregnant women and new mothers to prevent them from being fired or demoted when they become pregnant or take maternity leave. One has to love Elizabeth Warren who recently announce that her next two-year focus will be to improve the economic fortune of ordinary Americans and addressing economic inequality. And then you have to wonder why this isn't every politicians emphasis instead of garnering television time to enhance a Presidential bid. For Warren, stabilizing the ordinary American family's finances rests on a number of pillars — from reining in student debt to easing what she calls the nation's retirement crisis to doubling funding for federal research programs. Warren has also positioned herself as a passionate defender of Social Security, even bucking Obama on changes she said would weaken a key protection for millions of older Americans. "Let me put it this way: I disagree with anyone who talks about cutting Social Security benefits," Warren said in a recent interview with The Associated Press. "This is a time when we need to talk about the hard decisions we have to make to make sure the Social Security system is stable and will pay benefits forever into the future." Warren said while adjustments to the program may be needed, calls from some Republicans to privatize Social Security or cut benefits are misguided. She said Americans are hitting their retirement years with more debt, less savings and fewer pension benefits than a generation ago. Given that, she said, this is the "absolute worst time" to talk about reeling in benefits. Web Site: EFTA01139684 Another issue Warren is fired up about is soaring student loans, which she said is leaving new graduates with suffocating debts that can stifle their futures. Warren has filed what she calls a "skin- in-the-game bill" that tries to pressure colleges to keep costs down for students and ensure they get a meaningful diploma when they graduate. As part of the bill, colleges that don't meet on-time graduation rates and other criteria must refund a portion of a student's loan. "Part of the problem we've got is that the federal government pumps billions of dollars into higher education through the federal loan program and grant program and yet asks for no accountability from the colleges," said Warren, a former Harvard Law School professor. Warren also said she wants to double spending for the National Institutes of Health and the National Science Foundation. Warren said money spent on finding new treatments and cures can not only improve people's health and lengthen lives but can also have economic benefits. She said a drug that would help delay the onset of the symptoms of Alzheimer's disease for five years would end up saving trillions in health care costs in the ensuing decades. Those kinds of breakthroughs need the support of federal tax dollars, she said. "That is our best chance going forward," she said. "This is one we have to get out there and fight for." Doubling the NIH and NSF budgets would also be a boost to Massachusetts, which gets a significant share of those funds. Although she's become a hero to the liberal wing of her party, Warren has no shortage of critics — and not just among conservatives and Republicans. She came under fire last year from the centrist think tank Third Way, whose leaders penned an opinion article for the Wall Street Journal that described her plans to expand Social Security benefits and delay Medicare reforms as part of a "we-can-have-it- all fantasy." Warren acknowledged that winning the support of at least some Republicans is important to helping move her agenda. She said she's already found common ground on individual issues with some GOP senators, including Arizona's John McCain, Florida's Marco Rubio and Alaska's Lisa Murkowski. Just this week, Warren teamed with Sen. Tom Coburn, a Republican from Oklahoma, on legislation to hold federal enforcement agencies accountable by increasing public transparency of confidential settlements. At the same time, Warren is working to aid Democratic re-election efforts, including raising hundreds of thousands of dollars for her political action committee — money she uses to support fellow Democrats. But Warren said it will take more than just senators talking to other senators to bring about change. She said the voices of citizens are critical to policy debates in Washington. "It's both halves here. It's talking one-on-one with senators here and bringing more people into the conversation — more students, more seniors, more scientists, all of us who care about the future of this country," she said. We could use more people like Elizabeth Warren in both major political parties in all levels of government because bettering the lot for the ordinary American should be our #1 priority. EFTA01139685 Last week a giant in American literature died — Amiri Barslut, influential African American writer and firebrand, dies in his hometown of Newark, New Jersey. Amiri Baraka, one of the most influential African American writers of his generation, who courted controversy as a poet, playwright and provocateur and who was a primary intellectual architect of the Black Arts movement of the 196os, died Jan. 9 at a hospital in Newark. He was 79. Mr. Baraka began writing in the 1950s under his original name, LeRoi Jones, as a poet and jazz critic on the fringes of Beat Movement in Greenwich Village. He later became a disciple of Malcolm X and an advocate of a militant black separatist movement built around African American cultural traditions, racial pride and defiance. He courted controversy throughout his life, first with confrontational plays in the 1960s, including "Dutchman"and "The Toilet,"that portrayed racial misunderstanding and violent encounters in explicit language. Closely identified with the rising Black Nationalist movement of the 196os, he later moderated his views and became an avowed Marxist. Yet he remained an unrepentant and polarizing symbol of radical indignation. "We want poems that kill,"he wrote in "Black Art," an influential 1965 poem that helped define the Black Arts movement. "Assassin poems. Poems that shoot guns. Poems that wrestle cops into alleys ... settingfire and death to whities " In a 1984 review of Mr. Baraka's "The Autobiography of LeRoi Jones" in The Washington Post, novelist John Edgar Wideman summed up his protean place in American culture: "Savior, clown, artist sold out to demagoguery, hero, menace." As much as anyone, Mr. Baraka helped define a modern, militant sense of self-identity and empowerment among African Americans seeking to break free of white cultural and social norms. The title of his 1967 one-act play became a catchphrase of the time: "Arm Yourself or Harm Yourself." In 1965, he founded the Black Arts Repertory Theatre in Harlem, •., which received funding from the U.S. Office of Economic Opportunity. When OEO Director R. Sargent Shriver Jr. tried to visit the cultural center, Mr. Baraka barred him at the door. "I don't see anything wrong with hating white people,"Mr. Baraka told U.S. News & World Report at the time. "Harlem must be takenfrom the beast and gain its sovereignty as a black nation." EFTA01139686  Mr. Baraka's forthright use of black vernacular, slang and profanity in an improvisatory style became an influence on later writers, hip-hop musicians and playwrights. Arnold Rampersad, the biographer and literary critic, once wrote that Mr. Baraka's bold writings, coupled with his vibrant social activism, made him one of the most historically significant figures in African American life, alongside Frederick Douglass, Langston Hughes, Zora Neale Hurston, Richard Wright and Ralph Ellison. "More than any other black poet," Rampersad wrote, 'he taught younger black poets of the generation past how to respond poetically to their lived experience, rather than to depend as artists on embalmed reputations and outmoded rhetorical strategies derivedfrom a culture often substantially different from their own." Mr. Baraka's detractors considered him a reckless agitator whose inflammatory rhetoric contained elements of anti-Semitism and misogyny and constituted a reverse form of hate speech. In 2002, cultural critic Stanley Crouch ridiculed Mr. Baraka's writing as "an incoherent mix of racism, anti- Semitism, homophobia, black nationalism, anarchy and ad hominem attacks relying on comic book and horrorfilm characters and images that he has used over and over and over." In later years, Mr. Baraka continued to issue incendiary pronouncements, including the poem "Somebody Blew Up America,"written soon after the terrorist attacks of Sept. 11, 2001. In the poem, he maintained that Israeli and U.S. leaders had advance knowledge of the attacks. After reciting a litany of wrongs committed against the poor and powerless, Mr. Baraka wrote: "Who knew the World Trade Center was gonna get bombed/ Who told 4,000 Israeli workers at the Twin Towers / To stay home that day / Why did [Israeli Prime Minister Ariel] Sharon stay away?" The passage was widely condemned as anti-Semitic and factually untrue and led to a public outcry to have Mr. Baraka fired from his $10,000-a-year position as poet laureate of New Jersey. "I will not apologize, I will not resign,"Mr. Baraka said. The state's governor at the time, James McGreevey, discovered that he didn't have the authority to dismiss Mr. Baraka. The legislature eventually passed a measure to abolish the post of poet laureate. His lawsuit against state officials was ultimately turned down by the U.S. Supreme Court. In a wry moment of self-promotion, Mr. Baraka said, "No poet laureate has ever made poetry thisfamous." Everett LeRoy Jones was born Oct. 7, 1934, in Newark. His father worked for the post office, and his mother was a social worker. He attended Rutgers University in New Jersey and Howard University without getting a degree and began to go by LeRoi Jones. He then served in the Air Force, which he found an alienating experience, marked by racial prejudice and conformity to rules he could not abide. By the mid-1950s, he landed in Greenwich Village, where he befriended poet Allen Ginsberg, a fellow Newark native, and other writers of the Beat Movement. He soon gained a following for his own poetry and writings on jazz. After writing several volumes of poetry, Mr. Baraka published "Blues People: Negro Music in White America" (1963), which placed black musical traditions in the broader social context of African American life. In 1964, he wrote several short plays, most notably "Dutchman," that challenged accepted views of black-white relations. In "Dutchman,"which won an Obie award for best off-Broadway play, a EFTA01139687 bohemian white woman and a well-dressed black man have an encounter on a subway that ends in violence. After the assassination of Malcolm X in 1965, Mr. Baraka said he "began tofocus on my own identity." He divorced his first wife, Hettie Cohen, with whom he had two children, moved to Harlem and later to Newark. In the late 1960s, he adopted the name Amiri Baraka. Mr. Baraka became a tenured professor at the State University of New York at Stony Brook and taught at many other colleges, including George Washington University. In 1980, he published an essay in the Village Voice in 1980, "Confessions of a Former Anti-Semite," in which he renounced the overt anti-Semitism of some of his writings from the 1960s. But he hardly retired from the cultural battlefield. He quarreled with prominent black mayors of Newark, including Kenneth Gibson and Cory Booker, and in the early 199os had a well-publicized dispute with director Spike Lee, then making a film about the life of Malcolm X. He feared the effort would be tainted by the money and tastes of Hollywood. "Who appointed Baraka chairman of the African American arts committee?" Lee retorted. "Nobody tells him what poems and plays to write, so why is he trying to tell me what kind of film to make?" Mr. Baraka's survivors include his wife of 47 years, Sylvia Robinson, who later changed her name to Amina Baraka; two daughters from his first marriage and four children from his second, including Newark city council member Ras Baraka. Amiri Baraka's daughter Shani and her companion were killed in 2003; the ex-husband of Shani's sister was later convicted of the murders. Mr. Baraka's writings became more fragmented over the years, but he earned good reviews with his collected poems, "Transbluency," in 1995 and with his 1984 autobiography. In that book, he described his early life and seemed to come to reluctant terms with the world around him. "I realized,"he wrote, "that the U.S. was my home. As painful and complicated as that was." Having first met Amiri Baraka in the 196os in Greenwich Village and later in Harlem when a friend of mine was working with him I like to describe him as a cross between Prince and Huey Newton with the artistic swagger ofArchie Shepp because like most young men who realized that they possessed a type of genius the was difficult and opinionated and would make outrageous comments to satisfy his own self-interest. But much like Prince, he had a special gift that was undeniable. I am told that after moving back to Newark in the late 6os/early 7os he played an instrumental part in helping Ken Gibson become Newark's first black mayor and finally ridding the city of the corrupt politicians who had run the New Jersey's largest city for decades. And in his 7os even though he had mellowed a bit he maintained the swagger to the end. Whatever his faults, Amiri Baraka was one of the most important literary voices of his generation whose contributions changed the world for us all Please see Margalit Fox's New York Time's obituary: playwright-dies-at-79.html?cmc=eta I ****** One of the big uglies in America is the growing economic inequality which last week the Editorial Board of the New York Times focused on, as it is now bordering on a national embarrassment, that in the richest country on the planet tens of millions of Americans live in poverty with the Middle-Class being squeezed more and more as the rich are taking a larger and larger slice of the country's economic pie. With this said, I invite you to read the editorial below. No Jobs, no benefits and lousy pay. By THE EDITORIAL BOARD: January to, 2014 EFTA01139688 There is nothing good to say about the December employment report, which showed that only 74,000 jobs were at last month. But dismal as it was, the report came at an opportune moment. The new numbers review the Republican arguments that the jobless benefits be not be renewed, and that the current minimum wage is adequate. At the same time, they are the score of the need, only recently raised to the top of the political agenda, to combat poverty and inequality. The report showed that average monthly job growth in 2013 was 182,000, basically unchanged from 2012. Even the decline in the jobless rate last month, from 7 percent in November to 6.7 percent, was a sign of weakness: It mainly reflects a shrinking labor force - nothing new hiring - as the share of workers employed are looking for work fell to the lowest level since 1978. That's a tragic waste of human capital. It would be comforting to ascribe when the dwindling labor force mainly to retirements or other long-term changes, but most of the decline is due to weak job opportunities and weak labor demand since the Great Recession. One result is that the share of jobless workers who have been unemployed for 6 months or longer has remained stubbornly high. In December, it was nearly 38 percent, still higher by far than at any time before the Great Recession, and the records going back to 1948. And yet, nearly 1.3 million of those long term unemployed had their federal jobless benefits abruptly cut off at the end of last year, after Republicans refused to renew the federal unemployment program and the latest budget deal. Each week the program is not reinstated, another 72,000 jobless people who otherwise would have qualified for benefits will find that there is no longer a federal program to turn to. Worse, in the Senate this week, after a showing of willingness to discuss renewing the benefits, .Republicans objected to a bill to do just that. They had demanded that a renewal be paid for, but they didn't like how Democrats proposed to do that - with spending cuts at the end of the budget window in 2024 in exchange for relief today. There was no need to pay for the benefits, which have a crucial and positive effect - on families, the economy and poverty - that it would be sound to renew them even if the government barn to do so. But Republicans would rather criticized President Obama's handling of the economy then help those left behind. A similar dynamic is developing around the drive for a higher minimum wage. In December jobs report, the average hourly wage for most workers was $20.35. That means that the minimum wage, at $7.25 an hour, is one-third the average, rather than one-half, as was the case historically. Raising the wage to $10.10 an hour, as Democrats have proposed, with help to restore the historical relationship. But even that would fall far short of the roughly $17 an hour that workers at the bottom of the wage scale would be earning increased labor productivity were reflected in their pay, rather than in corporate profits, executive compensation and shareholder return. Republicans, however, are opposed to any increase, as if the numbers don't speak for themselves. Their stance also dismisses research, and common sense, which says that raising the wages of low and moderate income workers is essential for lessening both poverty and inequality. EFTA01139689 Instead, in the past week, they have introduced ostensibly "antipoverty" ideas, most prominently Senator Marco Rubio's plan to transform federal safety net programs into state block grants, another of the shopworn Republican ideas that include privatizing federal services and slashing domestic spending. Block grants have allowed States to disregard the needs of the least fortunate. The proposal would set that the debate on wages, poverty and inequality. The December jobs report is telling Congress what it needs to do. Unfortunately, that will not lead to action anytime soon. THIS WEEK's READINGS Last week while researching an article on Alzheimer, I came across a reference in The Atlantic Magazine by Jonathan Rauch - The Hospital Is No Placefor the Elderly — that sparked my interest having spent three stays in the Intensive Care Unit in two hospitals in Los Angeles over the last six plus years, as well as witnessed several elderly friends try to hang on to life, at great suffering only to carve out several more months, and those last months were spent in hospitals, away from family and often at great expense. I also remember witnessing my own mother who fifteen years ago, decided that she no longer wanted to live even though modern medicine could have kept her alive possibly for another two to three years. And I wonder about the Jahi McMath's family in Oakland, CA who insisted on keeping her alive even though a slew of medical specialist have concluded that she is brain-dead. But back to my initial premise, maybe hospitals are not the best place for the elderly especially in last stage/stages of life when medical treatment for aging chronically ill patients is costly and often ineffective. Rauch's article centers around Brad Stuart who in 1976 in his third year of medical school at Stanford, doing his first clinical rotation witnessed a supervising oncologist order an extremely toxic chemotherapy for a elderly patient with advanced lymphoma. The patient is feeble and near death, his bone marrow eviscerated by cancer. The supervising oncologist has ordered a course of chemotherapy using a very toxic investigational drug. Stuart knows enough to feel certain that the treatment will kill the patient, and he does not believe the patient understands this. Like a buck private challenging a colonel, he appeals the decision, but a panel of doctors declines to intervene. Well, Stuart thinks, if it must be done, I will do it myself. He mixes the drug and administers it. The patient says, "That hurts!" A few days later, the man's bed is empty. What happened? He bled into his brain and died last night. Stuart leaves the room with his fists clenched. To this day, he believes he killed the patient. "I walked out of that room and said, 'There has got to be a better way than this. " "I was appalled by how we care for—or, more accurately, fail to care about—people who are near the end of life. We literally treat them to death." Here is a puzzling fact: From 1970 until 2009, spending on health care in this country rose by more than 9 percent annually, creating fiscal havoc. But in 2009, 2010, and 2011, health-care spending increased by less than 4 percent a year. What explains the change? The recession surely had something to do with it. But several recent studies have found that the recession is not the whole story. One such study, by the Harvard University economists David Cutler and Nikhil Sahni, estimates that "structural changes" in our health-care system account for more than half of the slowdown. In a sense, Brad Stuart is one of those changes. He is a leader in a growing movement advocating home- based primary care, which represents a fundamental change in the way we care for people who are chronically very ill. The idea is simple: rather than wait until people get sick and need hospitalization, you build a multidisciplinary team that visits them at home, coordinates health-related services, and EFTA01139690 tries to nip problems in the bud. For the past 15 years, at Sutter Health, a giant network of hospitals and doctors in Northern California, Stuart has devoted himself to developing home-based care for frail, elderly patients. For years, many people in medicine have understood that late-life care for the chronically sick is not only expensive but also, much too often, ineffective and inhumane. For years, the system seemed impervious to change. Recently, however, health-care providers have begun to realize that the status quo is what Stuart calls a "burning platform": a system that is too expensive and inefficient to hold. As a result, new home-based programs are finally reaching the market, such as one launched about five years ago at Sutter, called Advanced Illness Management. "It's much morefeasible now to make a program like this work than it was a few years ago." "There are a lot of new payment schemes in the pipeline that are going to make this kind ofprogram much easier to support." This is good news. Generalizing from a small sample is always perilous, but if what is happening at Sutter is any indication, a more humane, effective, and affordable health-care system is closer than we think. The problem that home-based primary care addresses has been well understood for years. Thanks to modern treatment, people commonly live into their 7os and 8os and even 9os, many of them with multiple chronic ailments. A single person might be diagnosed with, say, heart failure, arthritis, edema, obesity, diabetes, hearing or vision loss, dementia, and more. These people aren't on death's doorstep, but neither will they recover. Physically (and sometimes cognitively), they are frail. Joanne Lynn, the director of the Altarum Institute's Center for Elder Care and Advanced Illness, says that this "frailty course," a gradual and medically complicated downslide, was once exceptional but is now the likely path for half of today's elders. Seniors with five or more chronic conditions account for less than a fourth of Medicare's beneficiaries but more than two-thirds of its spending—and they are the fastest- growing segment of the Medicare population. What to do with this burgeoning population of the frail elderly? Right now, when something goes wrong, the standard response is to call 911 or go to the emergency room. That leads to a revolving door of hospitalizations, each of them alarmingly expensive. More than a quarter of Medicare's budget is spent on people in their last year of life, and much of that spending is attributable to hospitalization. "The dramatic increase in costs in the last month o lie is lar el driven by inpatient hospital stays," Helen Adamopoulos recently reported on "On average, Medicare spends $20,87) per beneficiary who dies while in the hospital." Hospitals are fine for people who need acute treatments like heart surgery. But they are very often a terrible place for the frail elderly. "Hospitals are hugely dangerous and inappropriately used,"says George Taler, a professor of geriatric medicine at Georgetown University and the director of long-term care at MedStar Washington Hospital Center. "They are a great place to be if you have no choice but to risk your life to get better." For many, the worst place of all is the intensive-care unit, that alien planet where, according to a recent study in the Journal of the American Medical Association, 29 percent of Medicare beneficiaries wind up in their last month of life. "Thefocus appears to be on providing curative care in the acute hospital,"an accompanying editorial said, "regardless of the likelihood of benefit or preferences ofpatients." Taler can attest to one of the more peculiar elements of this situation, which is that a better model—namely, providing care and support at home—has been known and used for decades. Taler himself pioneered an interdisciplinary house-call model in Baltimore in 1980, and in 1999 he co-founded a home-based primary-care program at Washington Hospital Center that has served almost 3,000 people. In the 1970s, the Veterans Administration (now the Department of Veterans Affairs) began building a home-based primary-care program, which now operates out of nearly every VA medical center and serves more than 31,000 patients a day. This is not newfangled, untested stuff. EFTA01139691 Home-based primary care comes in many varieties, but they share a treatment model and a business model. The treatment model begins from the counterintuitive premise that health care should not always be medical care. In Sutter's Advanced Illness Management program, known as AIM, each patient is assigned to a team of nurses, social workers, physical and occupational therapists, and others. The group works under the direction of a primary-care physician, and meets weekly to discuss patient and family problems—anything from a stroke or depression to an unexplained turn for the worse or an unsafe home. Rauch sat in on several of these team meetings. A social worker and a nurse talked over a case and decided they needed to make a home visit together; a doctor suggested a medication change; the various members of the group compared notes on one patient's hospitalization while discussing whether another's 911 call might have been averted. Strikingly, patients were presented not as bundles of syndromes—as medical charts—but as having personal goals, such as making a trip or getting back on their feet. The team tries to think about meeting patients' goals rather than performing procedures. An advantage of the multidisciplinary approach is that over time, as clients' conditions change, the group can recalibrate the mix of services and providers, to avoid jarring transitions. "Once in AIM, always in AIM," one coordinator told a patient's family. Over several years, a person might move from independence and occasional social-worker visits to hospice care and finally death, all within AIM, and mostly at home. Sutter figures that the program, by keeping patients out of the hospital whenever possible, saves Medicare upwards of $2,000 a month on each patient, maybe more. The VA, for its part, says its program reduces hospital days for its patients by more than a third and reduces combined costs to the VA and Medicare by about 13 percent. But now we come to the business model, which has been problematic. For doctors, nurses, health systems, and insurers, providing in-home service costs money. Medicare pays for hospitalization, but it does not pay for much by way of in-home care, or for social workers, or for time spent coordinating complex cases and traveling to homes and talking with caregivers. Where in-home primary care has existed, it has tended to be a foundation-funded experiment, or a charitable project, or part of a vertically integrated system like the VA, which can capture any savings. The home-care program at Washington Hospital Center runs at a 3o percent loss. Meanwhile, hospitals lose "heads in beds," and therefore revenue. Medicare—which is to say, taxpayers—may save money, but it has no mechanism either to track savings or to pay providers and insurers for hospitalizations that do not happen. This is why Brad Stuart was frustrated for so many years. He could see the path forward, and others could see it, but it was blocked. Today, though, he's feeling optimistic. The path is clearing. The elderly flock to Phoenix, Arizona. Not surprisingly, the city is home to one of the country's biggest nonprofit hospice organizations, Hospice of the Valley. Better than most people in the medical system, hospice providers understand the trouble with hospitals. In the early 2000s, Hospice of the Valley began experimenting with an in-home program designed to bridge the frailty gap—that is, the gap between hospital and hospice . That experiment led to the development of a team-based approach in which nurses, nurse-practitioners, social workers, and sometimes physicians visit clients' homes, provide and coordinate care, and observe people outside the context of the medical system. "Thatface time is wh