Article 43

 

Friday, October 11, 2019

Solutions to Save Our Nation II

image: 99 percent

In the 1930s the New Deal put construction workers on the job building infrastructure we have used ever since. Much of that network is at the end of its life, so lets do it again, but this time with “green” planning built in.

Roosevelt proposed to recruit thousands of unemployed young men, enlist them in a peacetime army, and send them to battle the erosion and destruction of the nation’s natural resources.

Roosevelt’s Tree Army, was credited with renewing the nations decimated forests by planting an estimated three billion trees from 1933 to 1942.

In the 1930s white collar workers with college degrees were unemployed. The New Deal hired many of them into the regulatory bodies it set up to control the worst excesses of capitalism and to regulate private industry.

- New Deal 2.0

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THE NEXT SYSTEM PROJECT is an initiative of The Democracy Collaborative aimed at bold thinking and action to address the systemic challenges the United States faces now and in coming decades.

Deep crises of economic inequality, racial injustice and climate change - to name but three - are upon us, and systemic problems require systemic solutions. Working with a broad group of researchers, theorists and activists, we are using the best research, understanding and strategic thinking, on the one hand, and on-the-ground organizing and development experience, on the other, to promote visions, models and pathways that point to a next system, radically different in fundamental ways from the failed systems of the past and present and capable of delivering superior social, economic and ecological outcomes.

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Richard Wolff on Curing Capitalism

Bill Moyers
March 22, 2013

Richard Wolffs smart, blunt talk about the crisis of capitalism on his first Moyers & Company appearance was so compelling and provocative, we asked him to return. This time, the economics expert answers questions sent in by our viewers, diving further into economic inequality, the limitations of industry regulation, and the widening gap between a booming stock market and a population that increasingly lives in poverty.

“We ought to have much more democratic enterprise,” Wolff tells Bill, in response to a question from a viewer in Oklahoma. ҔWe ought to have stores, factories and offices in which all the people who have to live with the results of what happens to that enterprise participate in deciding how it works.

Addressing a question about capitalism and climate change, Wolff says, “Capitalism is a system geared up to doing three things on the part of business: get more profits, grow your company and get a larger market share If along the way they have to sacrifice either the well-being of their workers or the well-being of the planet or the environmental conditions, they may feel very bad about it - and I know plenty who do but they have no choice.”

Wolff taught economics for 35 years at the University of Massachusetts and is now visiting professor at The New School University in New York City. His books include Democracy at Work: A Cure for Capitalism and Capitalism Hits the Fan: The Global Economic Meltdown and What to Do About It.

Transcript

BILL MOYERS: It’s not only our banking system that remains questionable and shaky - its the whole of our economy - that complex mix master of capital and labor, prices and production, goods and services, rewards and punishments, largely driven by private decisions in what has been defined, mythologically, as the “free market.” Which brings us back to Richard Wolff. I say “back” because as many of you will recall, this provocative and imaginative economist was here just about a month ago to lay out, in his words, how CAPITALISM HAS HIT THE FAN. Heres the centerpiece of his argument:

RICHARD WOLFF on Moyers & Company: For the majority of people, capitalism is not delivering the goods. It is delivering, arguably, the bads. And so we have this disparity getting wider and wider between those for whom capitalism continues to deliver the goods by all means, but a growing majority in this society which isn’t getting the benefit, is in fact, facing harder and harder times. And that’s what provokes some of us to begin to say its a systemic problem.

BILL MOYERS: My conversation with Richard Wolff opened such a world of ideas that on the spot I asked him to return - and I asked you to send us the questions youd like to put to him. Your response was as overwhelming as it was smart and informed. Just take a look at some of the letters we printed out from our website, billmoyers.com. Thanks to everyone who wrote. We’ll get to some of these in just a minute and to even more of them with Richard Wolff in a live chat next Tuesday at our website, billmoyers.com.

Richard Wolff taught economics for 35 years at the University of Massachusetts and is now a visiting professor at the New School University here in New York City teaching a special course on the economic meltdown. His books include Democracy at Work: A Cure for Capitalism and Capitalism Hits the Fan: The Global Economic Meltdown and What to Do About It. Welcome back, Richard.

RICHARD WOLFF: Thank you Bill.

BILL MOYERS: Let’s move on to questions from the viewers who tuned into our conversation three weeks ago, hundreds of them responded.

Here֒s Michael from Tulsa, Oklahoma.

MICHAEL: Professor Wolff, what can we as individuals in communities do to regain control of our economic destiny?

RICHARD WOLFF: We have an old tradition in the United States of doing things in a cooperative way. We celebrate it with phrases like team spirit or team effort. It’s the idea that a project will be better done if everybody has an equal stake and an equal say in the decisions that will determine the outcome. I like that idea, I believe it has a lot to do with our commitment to democracy.

So my answer to the question is we ought to have much more democratic enterprise. We ought to have stores, factories and offices in which all the people who have to live with the results of what happens to that enterprise participate in deciding how it works.

BILL MOYERS: That’s the subject of your book, “Democracy At Work: A Cure for Capitalism.” And we will come back to it in a few minutes. Here is Jose from Naples, Florida and Kristin from Joplin, Missouri.

JOSE: Professor Wolff. On the last show you mentioned how you were against regulation. I agree with you on the most part that regulation has been a failure. What would be your alternative to regulation?

KRISTIN: Without regulation how do we respond to widening economic disparity in our society?

BILL MOYERS: You said last time you were skeptical about regulation because the regulated found ways to evade, overcome or negate it.

RICHARD WOLFF: Yes, skepticism is the politest way I know how to say this. I think that we have now learned in our society that regulating big corporations and regulating wealthy folks is an exercise in futility. It’ll work for a while, but those folks have the incentive and the resources to work around it, to evade them.

BILL MOYERS: The hearings last week. JPMorgan--

RICHARD WOLFF: Morgan, yeah.

BILL MOYERS: --Chase continuing to--

RICHARD WOLFF: Stunning.

BILL MOYERS: --take these risks.

RICHARD WOLFF: Stunning. It’s as if the whole meltdown of 2008 and ‘09 hadn’t happened, as if all the risk-taking can continue and all the massaging of the internal rules of the banks can be manipulated, all of that. It seems to me we’ve learned the lesson that regulation is usually coming too late after, in a sense, the disaster has happened. And then it is evaded and avoided and watered down. It doesn’t work. And we have to learn the lesson.

So I would respond by saying, we have to make a more basic change. Instead of constantly coming too late to the regulation activity let’s change the way decisions are made so we don’t have to be constantly after people regulating them in this kind of sad effort that never quite succeeds. Let’s change the basic decisions.

BILL MOYERS: I thought Glass-Steagall worked fairly well from the time it was enacted in the depression with Roosevelt to 1999 when Bill Clinton and Congress repealed it.

RICHARD WOLFF: Well, I don’t want to get into a dispute with you, Bill. I think--

BILL MOYERS: Go right ahead, everybody else does.

RICHARD WOLFF: I think there was a long history of evasion. In other words ways were found in the ‘60s and ‘70s long before the repeal, ways were found by banks setting up investment banks, setting up new financial institutions to get around if not the letter then certainly the intent of that kind of regulation.

When it was found possible politically first to weaken Glass-Steagall and then eventually to repeal it, well, that was even better. But basically the minute the regulation was set the regulated industries took it as a problem to be solved. Then they hired the economists like me, the accountants, the lawyers and all the other specialists to figure out how to get around it.

BILL MOYERS: And armies of lobbyists, let’s face it.

RICHARD WOLFF: Armies of lobbyists to make sure that the laws get massaged and the rules get adjusted so that they can get around it. That’s why we keep having financial scandal after financial scandal, hearings after hearings. After a while when you keep doing this you realize that even if you get some benefit (and I see your point), from a regulation for a while, it’s only a matter of time. And now that the corporations have gotten really good at getting around it the time for them has been reduced and so we’re back to the question isn’t there a better way than letting them do their thing and coming late to the table with another regulation?

BILL MOYERS: Okay, here’s Martha from Natick, Massachusetts.

MARTHA: I see a perfect storm coming. Capitalism is predicated on unlimited growth, but we live in a finite environment and we seem to have a dysfunctional democracy unable to resolve that contradiction. How do you see climate change and our diminishing natural resources such as fossil fuels and water impacting this crisis in capitalism?

RICHARD WOLFF: Capitalism is a system geared up to doing three things on the part of business: get more profits, grow your company and get a larger market share. Those are the driving bottom line issues. Corporations are successful or not if they succeed in getting these objectives met. That’s what their boards of directors are chosen to do, that’s what their shareholders expect. That’s the way the system works.

If along the way they have to sacrifice either the well-being of their workers or the well-being of the planet or the environmental conditions, they may feel very bad about it, and I know plenty of them who do. But they have no choice. And they will explain if they’re honest that that’s the way this system works. So we have despoiled our environment in a classic way. That’s why we have huge cleanup funds, that why we have so many problems. That’s why we have to impose all kinds of costs on companies now to deal with this problem.

So I’m not very hopeful. I don’t think this is a system that has a place in it for us to seriously deal with the limits to growth, with the need to preserve our environment, to take care of our health as a people because we have a system that pushes forward with a kind of intensity that pushes those issues to the side.

BILL MOYERS: Janet from Woolwich, Maine.

JANET: If you could be president with a cooperative Congress, what are the three most critical things you would do to ensure that we have a healthy economy that is sustainable, particularly in light of a growing aging population? Thank you.

RICHARD WOLFF: I would pick the following three. Number one, solve the unemployment problem. In a sense it’s the most urgent one we have. If the private sector-- and here I’m paraphrasing Franklin Roosevelt in the ‘30s.

If the private sector either cannot or will not provide the work for millions of Americans who want the work, then it’s the job of the government to do it because no one else is. And if I were president, I would follow Roosevelt and immediately create and fill millions, millions-- I’m talking 15 to 20 million jobs in the United States right away.

Number two, I would make it would some have called a “green New Deal,” that is the major thing these people would be doing would be to deal with the environmental crisis that we have, to change the way we use energy. For example (just to give one), to give us the proper mass transportation system that advanced countries in other parts of the world already have that we ought to have.

Millions of people could go to work producing that system and give us a way to move our goods and move our people around the society using less oil and gas with less damage of injury and death the way our car-driven system has, with less pollution of our environment. Here’s a way to benefit people on many scales while we put to work those who want to work with the raw materials and tools that are available.

And the third thing I would do is take a page from Italy, yes, Italy who passed a law in 1985 called the Marcora Law which said the following wonderful thing. If you want employment you have a choice in Italy. You don’t just have to collect your weekly unemployment check the way we do here in the United States, you have an option.

If you get together with ten other unemployed workers and you agree to do the following thing, the government will give you three years of your unemployment payments upfront, right now, in a lump sum. What you have to agree to is that together with at least ten other people you’re going to start your own cooperative business which you all together work.

The feeling in Italy was if you give people a chance to own and operate their own business collectively they’ll be more committed to it, more invested in it, more likely to make a go of it than simply collecting a check. And meanwhile they’ll be producing things and they’ll feel better about themselves. And they’ll have a more productive role in the community. If you give everybody a vested interest in their enterprise, they work harder, they work better, because its theirs. They’re not just working for the man, they’re working for themselves, which is a dream Americans have had, way back from the beginning.

Sixty years ago the United States was less unequal than the capitalism’s in Europe. Now we are more unequal. So yes, it is possible to have capitalism with a much more human face than the ones we have here in the United States and in Britain particularly where we have allowed things to go in a very different direction.

BILL MOYERS: But isn’t Italy in a mess today? We all know about the euro crisis. Those governments are in trouble, austerity’s being imposed throughout the Mediterranean area. We had this explosion with Cyprus-- explosion of fear with CYPRUS being bailed out and the depositors in the banks having to contribute to the cost of bailing out. A tiny island threatens to bring the euro system down again.

RICHARD WOLFF: Absolutely, and that Cyprus story is extremely important. Even though it’s a very small country and people might not pay attention because it is small. Here is the austerity program of raising taxes and cutting government spending, taking a qualitative new step to help bail out a capitalism that hasn’t worked in Europe and that has crippled this little country of Cyprus.

The step taken to try to fix the problem is to literally reach into the private, insured bank accounts of people in the local banks in Cyprus and take money out of it to pay for fixing this broken system. For all working people, and not just in Europe, here in the United States, too, this should be a wakeup call if you still need one that we’re in a situation where the most dire, unexpected, unimaginable steps are being taken to fix a system that keeps resisting being fixed so that we are required now to dip into people’s checking accounts and literally take the money away.

BILL MOYERS: Richard, one of our viewers, Antonia Murrero asks, “Student loan debts are overwhelming me and many others. What does Professor Wolff think would happen to the economy if those debts could be forgiven in personal bankruptcy? Is that even possible?” he asks.

RICHARD WOLFF: Well, the law in the United States specifically prevents you from using bankruptcy to erase your student loans. Bankruptcy does allow you to erase other kinds of debts if you can’t pay them. But the student loan system was set up to prevent that. So students are in a very specially bad place by virtue of this.

We’ve never before done this. In our history as a nation we’ve never before required college students to take anything remotely like this level of debt. We’re still-- we’re requiring students to accumulate huge amounts of debt to get bachelor’s degree, let alone more advanced degrees, at the same time that we offer the graduates the poorest job market and prospects in a generation. That’s a one-two punch.

You have to borrow more than you can afford to face a job which will not allow you to ever pay it off, hence this person’s very intelligent question. How is this going to work? We’ve solved a problem in our society, how to educate the next generation. And let me tell you, this is an important matter. We economists believe that the single most important factor shaping the future of any economy in the world including the United States is the quality and the quantity of the educated trained labor force it produces.

College and universities are where we do that. If we’re crippling an entire generation with debts they cannot support and jobs that will not encourage them to continue in their studies we are as a nation shooting ourselves in the foot going forward. It’s a demonstration of the dysfunctionality of our system.

And then the question comes could we forgive the students’ debts? Well, it’s an interesting idea. But how then do you go to the people who can’t afford their credit card debts or their home debts or their mortgage debts-- they’re all hurting. And the students have a special claim, I give them that. And we need those students, I understand it.

But we have to go at the root of a society which allows unspeakable wealth to accumulate in the hands of a tiny minority while condemning an entire generation of students to a set of burdens. We don’t want them to have those burdens. We need what they can produce for us as a society.

BILL MOYERS: But what does this young woman do who says she’s overwhelmed by her debt?

RICHARD WOLFF: Many students are not aware that they actually have some ways to help them. But the more broad answer I would give you is you need a social movement. If there were masses of students saying, “This is intolerable,” and saying it loudly and saying it publicly, peacefully for sure, but making it clear, then the powers that be would begin to realize that there are millions of students, upward of 15, 16 million people go to colleges and universities in the United States. You’re talking about a very well educated constituency. If they were organized and mobilized you would begin to get the response of dealing with their crises much more effectively than what we have now.

BILL MOYERS: Here’s a synopsis, Richard, of a lot of similar questions that bring us to your book, Democracy at Work: A Cure for Capitalism. A viewer who identifies himself as a longtime fan of Dr. Wolff writes, “You’re passionate about workers self-directed enterprises. Can you explain briefly why you think these are the way to save capitalism? Critics say your alternative may work in theory but not in practice.”

RICHARD WOLFF: My point is that workers ought to be-- all of us who work in an office, a factory or a store - ought to be in the position of participating in the decisions governing that enterprise. And I do that not only because I believe in democracy. And let me say that if you do believe in democracy, it’s always been a mystery to me why that democracy that you believe in doesn’t apply to the place where you work. After all, five out of seven days of every week, most of your adult life, you’re at work.

So if democracy’s an important value it ought to be at your job because that’s where you are most of the time. And democracy at the job means the following. If you have to live with the decisions that are made in a job, what you’re producing, what technology’s being used, what the health conditions of your workplace are, what’s done with the fruits of your labor, literally whether your factor or your office continues, since you have to live with those decisions you ought to participate, the basic idea of democracy.

So I like the idea of cooperative enterprises because it fulfills my value commitment to democracy. Whereas a capitalist enterprise doesn’t because it keeps all the decision making in a tiny minority. We all who go to work have to live with their decisions, but we don’t participate in them, not even to speak of the community that has to live with the decisions.

But the second reason is I see concrete results coming from an enterprise that was run by the workers collectively, and let me give you a few examples. First, most of us believe that if the workers themselves made a decision that they would close the enterprise and move it to China, I don’t think so.

I think that the whole running away of enterprises out of the United States was made possible because the decisions to close enterprises here and to open them in another part of the world where you could get away with paying workers much less was a decision that was very good for the folks who make the decisions, but not for the average workers there.

So if we had decision making made by the workers in place they wouldn’t undo their own jobs and they wouldn’t move. And that would make a very different economic system from the one we have today. Second example, suppose a technology was being considered by the corporate heads who make the decision, the board of directors, and it was one that wasn’t safe, it created too much noise, too much air pollution, despoiled the water, whatever. If it’s a bottom line decision of the typical sort the board of directors and the shareholders seeing profit using that technology might go ahead and use it because it’s profitable and that’s what they’re called upon to do, make profits.

If the workers collectively made the decision knowing that they had to breathe that air, they had to hear that noise, they had to live with that water and so did their spouses and their children and their neighbors, I bet you you’d get a different decision because they would weigh the costs and benefits of that decision differently. And my third example, although I could give you many, Bill, if you want them.

The third example, when it comes to deciding what to do with the profits, suppose instead the workers themselves made that decision democratically, how do we divide the profits?

You think they would give a handful of top officials wild sums of money to buy $40 million apartments on Fifth Avenue while everybody else was having to borrow money to get their kids through school? I don’t think so. I think that people collectively would distribute the wealth more to some than others for all kinds of reasons, but they would do it in a much less unequal way than we have in a capitalist system.

So I challenge all of those who are concerned with a more equal system, with less inequality, to come up with a better way of achieving it than having workers be in a position to make the decisions as to how we divide the profits because that is the single most important determinant of the inequality of income in our society.

BILL MOYERS: But how do you answer this viewer? “In 1994 when United Airlines was on the brink of financial collapse a deal was made creating the biggest employee-owned company in the US. In 2002 the airline filed for bankruptcy.”

RICHARD WOLFF: My answer is the following and it’s very important. For workers to own something is one thing. For workers to become the directors of their own enterprise is something else. Worker ownership means for example, and we have lots of examples both in the United States and around the world, that the workers become in a sense shareholders. They are the technical owners.

But if the workers who become owners, and I’m not against that, but if the workers who become owners don’t change the way the enterprise is operated it remains a capitalist enterprise. It still has a board of directors, a handful of people who make all the decisions. It’s true that the workers may vote for who those people are, but they’ve left the structure of the enterprise in the old form, hierarchical, top-down. That’s what was done in United Airlines. I was involved in that. I actually know.

BILL MOYERS: How so?

RICHARD WOLFF: They called me in at a couple points to participate in some of the discussions, the International Association of Machinists, which was the union that was part of that. So they left the old capitalist structure, they weren’t willing to go beyond saying, “We, the workers, become owners, but we leave the running of the enterprise, the directing of it, the day to day decisions in the old form made by the old experts.” Part of a movement away from capitalism to a cooperative enterprise requires that the people of the United States stop believing that the folks at the top have some magical entitlement to give them that position.

BILL MOYERS: I think most of them have, if journalism and the social science surveys are reporting what’s actually going on out there.

RICHARD WOLFF: Yeah, and I think that there has to be a change. I think most Americans have to recognize that the folks who run our enterprises, they had to learn how to do that. And we can all learn how to do that. It’s the old argument in a sense that comes out of our history.

BILL MOYERS: Here’s a viewer named Jeff chiming in. “Dr. Wolff, can you please give a concrete, not academic or theoretical explanation, of how you would apply your employee-run business model to a McDonald’s, Wal-Mart, a hospital or JPMorgan Chase?”

RICHARD WOLFF: Well, the answer is best given not as a hypothetical but to describe an enterprise which is large like all of those are, which has done this.

BILL MOYERS: There’s a film called SHIFT CHANGE, about the cooperative efforts. And we’ll provide a link to that.

RICHARD WOLFF: Well, the example I’m going to give is a company in Spain. It’s called Mondragon, the Mondragon Cooperative Corporation. And a little history may interest folks. It was started in the middle of the 1950s by a Catholic priest in the north of Spain in the Basque area just south of the Pyrenees Mountains.

It was a time of terrible privation in Spain after the World War II and the Spanish Civil War. There was terrible unemployment in this area and the Catholic priest decided that one way to deal with unemployment was not to wait for a capitalist employer to come in and hire people but to set up cooperatives. And he began with six parishioners in his Roman Catholic church to start a co-op.

Okay, this is 1956. Let’s fast forward to 2013. That corporation now has over 100,000 employees. It has been a success story of gargantuan proportions. It is a family of co-ops, within this large corporation. In most of these co-ops the workers make the decisions of how this cooperative works.

So let me give you an idea of how successful they’ve been. They partner with Microsoft and General Motors in their research labs because Microsoft and General Motors want to tap into their creative way of running a business. They have a rule that nobody can get more than six times what the lowest paid worker in an enterprise gets.

The typical situation in a major American corporation is that the top executives gets 300 or 400 times what their lowest paid worker does. So they have solved the equality problem in a dramatic way for 120, roughly, thousand people. There’s a concrete example of how you can make a cooperative democratically run enterprise successful, growing and becoming a powerful community force.

There is Arizmendi, the name of that priest in Spain, there’s the Arizmendi Bakeries, six of them in the Bay Area that are all run as cooperatives. And they run it as a worker-directed enterprise. They’ve been very successful. Their commitment, number one, is not profit. Their commitment, number one, is not growth. Their commitment, number one, is to their people.

BILL MOYERS: Which brings me to a question from another viewer. “How do you move to this alternative you’re talking about and writing about without strong unions? Union membership is down to its lowest level since 1936 when Franklin Roosevelt was president. And can you do this without increased strength among unions?”

RICHARD WOLFF: A union in its negotiations with an employer currently is limited in most cases to asking for better wages, better working conditions. Imagine with me for a moment what it would mean if the unions developed a new strategy. Let’s call it a two-track strategy.

On the one hand you continue bargaining with your workers for better conditions from your employer. But on the other hand you do something else. You begin to train workers to become able to run their own enterprises and to have a whole new bargaining chip when you confront an employer. Many unions over the last 30 years have been confronted by a company that basically comes and says the following. “We’re thinking of leaving Cincinnati, Sheboygan, Detroit, whatever. We need to get some concessions from you.

“We won’t leave if you give us wage give backs, lower benefits, all the usual things, or else we’ll leave.” The union doesn’t know what to do, is terrified, doesn’t want to call the bluff because not sure it is a bluff, et cetera, et cetera, so eventually the union caves. That has been the history over and over again.

Imagine a union that had been able to say to these folks, “Okay, if you leave rather than coming to a reasonable accommodation with us, we are going to set up an enterprise right here. The factory you leave we will occupy. The jobs you don’t pay us to do we will do for ourselves. And you will be located in China bringing goods back here, but we’ll continue to produce goods here and let’s see which goods the American working people will buy.”

BILL MOYERS: But they will need capital to do that.

RICHARD WOLFF: Yes. And the question is where would the capital come from?

BILL MOYERS: The question is where will the capital come from?

RICHARD WOLFF: Good. The answer is, where the capital come from, there are several possibilities. The first possibility is the United States government. The United States government has the money, needs to do something for our unemployment problem and here’s a way to do it because as the Marcora Law in Italy that I mentioned earlier illustrates there’s a governmental and a social interest in doing this. This is a better way to solve the unemployment problem than giving people a dole for months or years at a time during which time they lose their job connections, they often lose their skills.

This is a much better solution, giving them the startup money to begin small, medium size enterprises that they will have a great interest in making successful because it’s their future, it’s their wellbeing that’s at stake and it’s their collectively owned and operated enterprise.

Well, why in the world don’t we have a cooperative business administration providing startup money and technical help so that these kinds of enterprise, particularly helping unemployed people, could begin not only to help them and to help our economy but again to provide that freedom of choice for Americans so we can all see how these enterprises work and make a collective decision whether we’d rather have an economy more of them than of the old capitalist type. And again I think that the capitalists would be surprised by how many of us would choose that other route. And that would be a way to get it going.

BILL MOYERS: This is all very provocative and very controversial. And very imaginative. We’ll have you back at this table before the season is over. But in the meantime I look forward to our live chat on BillMoyers.com this coming Tuesday at 1:00pm Eastern Time.

RICHARD WOLFF: Good. I look forward to it as well.

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California Just Legalized Public Banks. Will the Rest of the Nation Follow Suit?
The new law promises to take taxpayer money back from Wall Street and reinvest it in communities.

By Ananya Garg
Yes Magazine
October 3, 2019

The Standing Rock movement in 2016 brought together Indigenous activists from across the nation to fight against the Dakota Access Pipeline. One of the demands of this movement included divestment from Wells Fargo, a bank that was funding development of the pipeline. This brought into the spotlight one of the biggest issues concerning economic justice in the United States: big banks. More specifically, big for-profit banks that the government uses to invest public money into Wall Street, rather than local communities. Some of those investments include the fossil fuel industry, private prisons, immigrant detention centers, and more.

The divestment movement is mostly about getting those government investmentspublic employee pension funds, for exampleחout of the big banks. The question then becomes where to put them. Some economic justice activists say the answer is public banking.

In September, the California State Legislature passed Assembly Bill 857, a law that would allow a regulatory framework for public banking in the state. This would allow the establishment of banks that hold the governments money and include socially responsible charters, anti-corruption clauses, transparency, a board that includes community development professionals, and prohibitions on retail locations and on competing with community banks and credit unions. On Oct. 2, Gov. Gavin Newsom SIGNED IT INTO LAW. Newsom has been a supporter of public banking since his 2018 campaign. ItҒs expected to take one or two years, at least, to set up a charter for such a bank.

The only public bank in the contiguous United States today is in North Dakota. This public bank is not a new phenomenon; it was established during a populist movement in 1919. The credit system during the time was not set up in a way that supported farmers, so for them to be able to receive farming loans, the state created what is now known as the Bank of North Dakota.

“North Dakota was the only state that escaped the credit crisis,” says Ellen Brown, founder and president of the Public Banking Institute. “It never went in the red, [had] the lowest unemployment rate in the country, the lowest foreclosure rate at that time.”

According to THE BANK’S 2018 ANNUAL REPORT, it recorded its 15th consecutive year of record profit in 2018, with $159 million in income and $7 billion in assets. It maintains an investment portfolio of $1.9 billion.

Opponents of public banking have said that public banks are too risky and could waste taxpayer dollars. That was the position of the Los Angeles Times editorial board AGAINST A 2018 PIBLIC INITIATIVE that would have allowed public banking charters in that city. (Voters later rejected the measure.) The Times also said public banks would compete with smaller private banks.

But the Bank of North Dakota, widely seen as a model for successful public banks, only competes with Wall Street as a repository of government funds. It instead partners with local private banks when small businesses need big loans, and steps in to secure the larger loans.

At the time of the Standing Rock protests and the clamor for divestment, many individuals were able to switch their personal accounts to nonprofit credit unions. But larger entities, such as governments, have fewer options. While credit unions are an excellent alternative to privately owned banks for individual accounts, they don’t have the capacity to handle the large government accounts of cities and states. To begin, credit unions are owned by their members, while public banks are owned by a government. Credit unions also have a less capital to issue loans.

For example, in February 2017, the Seattle City Council voted to divest the citys banking services from Wells Fargo because of its ties with the Dakota Access Pipeline, but in the end was unable to find an alternative that could process about $3 billion a year in government revenue. Three months later, the city renewed its banking relationship with Wells Fargo.

While few historical examples of public banking exist, one stands out. The FreedmanҒs Savings Bank was originally founded for freed former slaves and African American veterans to have a place to build their savings. The Oxford African American Studies Center writes that the bank served its purpose for a short time, but then moved its headquarters from New York to Washington, D.C. After a change in leadership and several dubious investments, the Freedmans Bank went into debt and was forced to shut down.

Debbie Notkin, who works with the California Public Banking Alliance, says that by law, all corporations, which includes private banks, are legally obligated to maximize profit. Public banks are not held to this expectation, however, and are instead mandated to serve their communities.

Public banks are run like nonprofits in that they have boards made up of members of the community. Those board members are people with clear credit and experience in business. While this raises the question about who might end up on these boards, Notkin says that advocates like her are :committed to wide representation,” uplifting marginalized voices, and staying true to their values, such as fighting against fossil fuels and Wall Street.

Therefore, Notkin says, community investments have unlimited possibilities, including affordable housing, saving people from foreclosure, making student loans more affordable, and creating more infrastructure to defend against the effects of climate change, such as more dikes and dams for coastal areas.

The Public Banking Institute;s Ellen Brown has been referred to as the godmother of the public banking movement. She is the author of The Public Bank Solution: From Austerity to Prosperity and runs The Web of Debt blog. She sees the Bank of North Dakota as a model for public banking systems across the nation.

Public funds are currently invested in Wall Street banks and deposited in Wall Street banks. ItӒs not the government that keeps our money, its private banks,Ҕ Brown says. Furthermore, these public funds are not used to improve communities. For example, many large private banks might be more interested in putting $5 billion into a Wall Street investment bank and reaping the profits from that arrangement, rather than making a $50,000 loan to a local business. Private banks often choose Wall Street, because it is where they can maximize their returns on investments. Connections to their local communities arent a consideration.

The community implications of public banking could be huge.

Los Angeles-based public banking advocate Trinity Tran is the co-founder and lead organizer for three volunteer groups that support public banking in Los Angeles: Public Bank LA, Revolution LA, and Divest LA.

“Our current banking model is based on extraction,” she says. She also spoke on the Bank of North Dakota, saying that it has existed for 100 years, and it is currently in its 15th consecutive year of profit even though it is not mandated to be profitable, but to serve the community.

Sushil Jacob, a senior staff attorney for economic justice with the LawyersԒ Committee for Civil Rights of the San Francisco Bay Area, was instrumental in drafting the bill Gov. Newsom just signed.

Jacob says that while it is important to pressure the federal government, the real changes are going to take place at the state and local level, which is where public banks come into play. Theyll be necessary to provide funding for local projects as the economy transforms from one based on extractive industries to one that supports democracy, the environment, and community well-being, especially in low-income communities of color and other marginalized groups.

In addition to supporting that transformation to what is called the Just Transition framework, public banking would also be necessary to provide capital for projects under the proposed Green New Deal.

“By creating a mechanism in which cities and counties can divest from their current banks and put them into new banks, and have those banks be tasked with only lending to things that are going to be a part of the new economy, that creates a local financing mechanism for a just transition,” Jacob said.

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Wednesday, October 09, 2019

The Villages Medicare Advantage

image the villages florida

They’re Retired. They’re Insured. The Government Pays for It. And Trump Loves It.

Trump talks Medicare in a retirement enclave where doctors are a golf-cart ride away.

By Akilah Johnson
ProPublica
October 3, 2019

It was happy hour on a typical Thursday, and Debi Hahn was twisting and shouting with the rest of the M-T Heads (pronounced: empty heads) at a bar on the main town square. Today, her right hand was wrapped in a purple bandage matching her colorful top.

She and a friend were talking about surgeries, cancer and rising treatment costs, even in a community with a health care model seen as an innovative - and frugal - alternative to traditional Medicare. I have a lot of squamous cells,Ӕ the 67-year-old confided, detailing her string of past, present and future skin cancer treatments and her $95-a-month cost for an experimental chemotherapy cream.

“Cocktails make it better,” said her friend, whose hand was bandaged too.

Welcome to The Villages, one of Americas largest retirement communities, a sprawling Central Florida haven that bills itself as “Florida’s friendliest hometown” and has a vision to become America’s healthiest.

This is not a place where seniors idly watch the world go by. Instead, think Fort Lauderdale spring break circa 1985, except all the revelers are over 55. It’s a place where friends meet in bars to dance, drink and maybe puff medical marijuana vape pens and celebrate softball outcomes with cans of cold Bud Light.

It was happy hour on a typical Thursday, and Debi Hahn was twisting and shouting with the rest of the M-T Heads (pronounced: empty heads) at a bar on the main town square. Today, her right hand was wrapped in a purple bandage matching her colorful top.

She and a friend were talking about surgeries, cancer and rising treatment costs, even in a community with a health care model seen as an innovative - and frugal - alternative to traditional Medicare. “I have a lot of squamous cells,” the 67-year-old confided, detailing her string of past, present and future skin cancer treatments and her $95-a-month cost for an experimental chemotherapy cream.

“Cocktails make it better,” said her friend, whose hand was bandaged too.

Welcome to The Villages, one of America’s largest retirement communities, a sprawling Central Florida haven that bills itself as Florida’s friendliest hometown and has a vision to become “Americas healthiest.”

This is not a place where seniors idly watch the world go by. Instead, think Fort Lauderdale spring break circa 1985, except all the revelers are over 55. It’s a place where friends meet in bars to dance, drink and maybe puff medical marijuana vape pens and celebrate softball outcomes with cans of cold Bud Light.

Advantage plans were initially billed as a way to contain costs, but it’s unclear if that actually happened. Some studies found the average annual costs were about the same between the two programs, while others have said Medicare Advantage is actually more expensive.

The Villages, experts say, is exactly the kind of well-to-do, relatively healthy community that MEDICARE ADVANTAGE insurers have focused on and it’s where Trump will sell his approach before an invitation-only crowd.

Billed as an official White House visit, the president can expect a supportive political audience in a pocket of Florida an hour northwest of Orlando where seniors like Hahn praise Trump for his efforts to, as she puts it, “straighten this country out.”

“I love Donald Trump,” Hahn said. “I wouldn’t care if we had Trumps from now until eternity.”

Hahn’s enthusiasm is mainstream in The Villages, with its mostly white, middle-class, Republican residents set amid pastureland and billboards selling semi-automatic rifles. It has a 2,000-member Villagers for Trump club.

“President Trump is doing a phenomenal job,” 68-year-old Dr. Rosalind Gamba, a naturopathic medical doctor, said just before The Villages Republican Club meeting began last month. She and her husband waited to marry until he was eligible for Medicare because his insurance costs were too expensive. Now, they are both covered by The Villages privately run Medicare Advantage plan.

“Like Trump says, we should be taking care of our own first,” Gamba said. “We shouldn’t keep paying for people who don’t belong here.”

Trump was supposed to visit The Villages in August, but he had to reschedule after back-to-back mass shootings in Texas and Ohio.

While there is a growing number of independent voters here like Randy Fritts, who says, “I don’t discuss religion or politics with my friends because I still want them to be my friends,” The Villages is a GOP stronghold in a critical swing state that Trump needs to carry.

There’s a lot of old folks, and there are a lot of his supporters in the three counties that make up The Villages,” Daniel A. Smith, a political science professor at the University of Florida, said of Lake, Sumter and Marion counties. “That’s why he’s going there.”

More importantly, Smith said, these supporters show up at the polls. In 2016, he said, at least 8 out of 10 Republicans voted in Lake, Sumter and Marion counties, with turnout in Sumter at 87.5%.

“That’s insane,” he said. “There aren’t any Republicans who are anti-Trump in Sumter County.”

The county has one of the highest population growth rates in the state, which demographers and political science experts say is largely thanks to retirees from the Midwest and Northeast flocking to The Villages, with its 50 golf courses and 100 pickleball courts.

“They find that people there think a lot like they do on social and political issues, particularly a preponderance of people who favor limited government in all its forms,” said the late David Colburn, history professor and provost emeritus at the University of Florida. (ProPublica interviewed Colburn a week before his death.)

But, he said, political loyalty could wane should a candidate proposed an initiative that undermined or reduced Medicare benefits.

“These folks down there are not wealthy,” he said. “They’ve done pretty well in life, but they are not like people who live in really plush retirement communities in Florida. So they would be significantly disadvantaged if Medicare should be modified in a way that provides less coverage.”

Like traditional Medicare, Medicare Advantage is part of the current federal health insurance program for most adults over 65 and young people who meet federal disability requirements. The idea of allowing private insurers to offer Medicare benefits has been around since the 1970s but wasn’t christened with the name until 2003.

Many Advantage plans bring together the various parts of Medicare - hospital care and doctor visits, prescription drug coverage into a single package that usually offers additional benefits such as dental and vision coverage. They differ in how the government pays for those benefits, paying by the service in traditional Medicare versus giving insurance companies a lump sum per person annually with Medicare Advantage. Another difference is that beneficiaries are restricted to a defined network of providers like an HMO or preferred provider organization.

Today, more than one third of all Medicare beneficiaries, or about 22 million people, opt for privately managed health care plans, a dramatic increase from 5.3 million at the advent of the program in 2003.

The growth is fueled, in part, by sophisticated lobbying campaigns organized by the insurance industry. For example, major insurance companies quietly funded a coalition of more than a quarter-million seniors who support the program, according to The Associated Press.

דMedicare Advantage has been able to grow because insurers see this as a profitable marketplace, said Tricia Neuman, senior vice president and director of Medicare policy at the Kaiser Family Foundation. ԓThey are making money.

Medicare paid private insurers about $210 billion in 2017. Insurance companies, Neuman said, need to sell their products to a large community to make money.

Like The Villages.

“There’s an abundance of Medicare-qualified people for a particular area,” Shanna Kurpe, director of marketing and sales at The Villages Health, said about The Villages. It’s denser than in most populations.

The Villages Health Medicare Advantage plan was created about six and a half years ago when the retirement community decided to expand.

In a customer satisfaction survey, residents were asked where they went for health care, and the response was someplace besides The Villages, she said. The Villages planned to build a second hospital in response to the survey until, Kurpe said, a friend asked the late CEO of The Villages Gary Morse, “If your mission is to make The Villages Americas healthiest town, why would you build another building dedicated to sick people?”

His solution was to create The Villages Health, a neighborhood, primary-care-based health system, and two Medicare Advantage Plans, an HMO and PPO run by UnitedHealthcare. The goal was to ensure residents could access convenient health care facilities at a lower cost.

The Villages Health had 75 employees when it began. Today, there are more than 500, including more than 60 board-certified physicians, working in 15 specialities at eight health centers caring for 46,000 patients, mostly residents or employees and their families. Doctors see half as many patients, about 1,250, as those who serve traditional Medicare, and each visit save for the first lasts 30 minutes, The Villages Health officials said. That first visit? Its 60 minutes.

As of last month, federal data from the Centers for Medicare and Medicaid Services showed 33,889 people were enrolled in UnitedHealthcare;s The Villages MedicareComplete plans, up from 7,561 in 2014 when the program began.

The 2020 estimated annual costs for The Villages Medicare Advantage plans are $3,786 to $4,638. Meanwhile, the estimated annual costs for traditional Medicare with added drug coverage and a supplemental plan are $2,690 to $6,503. Part of the reason costs are so high for Medicare with a supplemental plan is that some supplemental plans cover most if not all - out of pocket costs.

Our care model is set up to be primary care driven,Ӕ Kurpe said, adding that it is designed to serve Medicare Advantage enrollees. WeӒre incentivized to keep you healthy. Were not compensated enough if you go into the hospital.Ҕ

And The Villages Health is growing.

Construction is underway on the Advanced Center for Healthcare at Brownwood, a 285,000-square-foot outpatient facility that will be connected by a covered walkway to the Brownwood Hotel & Spa (also under construction), described as a rustic chic 150-room hotel. It will keep some guest rooms in reserve for patients having procedures next door.

The Villages Health, according to its website, only accepts three Medicare Advantage plans its own, one through AARP and, as of January 2020, Florida Blue - and private insurance. (Specialists at The Villages Health accept traditional Medicare.)

Ahead of this years open enrollment period, which begins Oct. 15, Villages Health has began offering free one-hour classes that quickly fill to capacity called ғMedicare Simplified: How to Choose Worry-Free Health care in The Villages.

“Our goal with The Villages Health is to keep you healthy and heal you quickly so you can enjoy this lifestyle here,” Debra Siwinski, a patient service representative - and patient - at The Villages Health, told a recent group taking her class. Siwinski, a retired widow from Illinois, applied for the job as a way to stave off boredom - and loves it.

“Anybody in the room aging in?” she asked the class of 14. “You get a lot of clutter right now. There’s a lot that you’re getting hit with between the mail, the radio, TV advertisements. Hopefully, [this] will help get through a lot of that clutter.”

She spent the first half of class going over the “who, what, where, when, why and how” of the differences between traditional Medicare and Medicare Advantage. And the next half was dedicated to explaining the courses second goal - choosing worry-free health care by steering the conversation toward this conclusion: Medicare Advantage, though she did emphasize that a third-party, licensed insurance agent was nearby to answer specific questions about Medicareגs various options.

“With traditional Medicare,” Siwinski said, “doctors have waiting lists of patients: that undergo more tests and more procedures because that’s how they get paid. They do better if the patients are sick. “Some people have told me that they’ve waited an hour or longer to get into their doctor to only be seen on average seven to 12 minutes.”

And, she continued, “because one doctor doesn’t know what the other doctor is doing, a lot of times the patients get the runaround.”

Not everyone in The Villages has embraced the advent of Villages Health. Limiting care to those with Medicare Advantage plans caused some backlash because it meant people like Jerry Prince and his wife would have to switch doctors. And that was a sacrifice he said they were unwilling to make.

“My wife had three heart attacks, and her cardiologist is outside of that plan,” said Prince, 72 and president of The Villages Republican Club. “He’s done great things for her, and I’m not changing.”

Blurred Lines

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which labeled Medicare Advantage as such, was one of the most significant overhauls of Medicare since the program was created in 1965. Some Democrats criticized it even then as a Republican scheme to privatize - and eventually eliminate Medicare.

It was the stamp of approval from the “liberal lion” from Massachusetts, the late Sen. Edward Kennedy, that opened the door to compromise and helped pushed the 2003 law beyond years of political gridlock. He endorsed the proposal that added prescription drug coverage to Medicare. The coverage, though, is only available through private insurers.

This, health care experts and advocates say, has opened the door for a growing private industry fueled by taxpayer dollars that has delivered mixed results.

There’s been little comprehensive research comparing the performance and value of Medicare Advantage with traditional Medicare by taking into account such things as utilization, access, cost of care, quality and outcomes.

The studies that have been done are limited in scope. For example, a recent report by the Medicare Payment Advisory Commission found that people in traditional Medicare are no more likely to report problems getting into see a doctor than those with private insurance.

No one has taken all of these different studies and put them into one single narrative,Ӕ said Lori Gonzalez, a faculty member at Florida State Universitys Claude Pepper Center. She added that the lack of a systematic review comparing Medicare Advantage and traditional Medicare means “its very hard to say to you that one, according to research, is better” than another.

She’s currently working on an issue brief to rectify that, saying what she’s discovered so far is that Medicare Advantage beneficiaries tend to be healthier. The reason, she said, is twofold: They seemed to be kind of cherry-picked or Medicare Advantage plans take the money they get to advertise in areas where they know there are these healthier older folks.Ӕ

Since taking office, Trump has largely left untouched Medicare and other programs heavily used by seniors, but that changed this year. Trumps 2020 budget proposal requested $845 billion in Medicare cuts over the next 10 years, proposing to achieve this largely by changing payments to hospitals and doctors and renewing efforts to lessen fraud and abuse.

But Medicare advocates say the Trump administration has made some changes favoring private insurers that administer Medicare Advantage plans. They say recent rule changes have blurred the lines between program education and marketing of specific plans.

“They are treating traditional Medicare as a plan option rather than saying, This is what Medicare is supposed to be, and we have this secondary choice,” said Matt Shepard of the Center for Medicare Advocacy. “It entices people to sign up for something that then doesn’t work with them. Do you think for-profit, private companies are going to be worried about profit or help?”

But People Love It and Trump

For Will Statom, the answer is simple.

“Health care is a business, said the 67-year-old, who has a framed personal photo of Vice President Mike Pence in his living room. (We’ve known each other so long, we’ve known each other since our hair was jet black, he said of Pence.)

Statom has been a member of The Villages’ Medicare Advantage plan since moving to Florida from Indiana in January 2017. He loves it because there are no monthly payments, and he likes his doctor. What he doesn’t understand is the notion that health care coverage is a human right.

“I read the Constitution and I’m not a scholar,” he said, “but it doesn’t say in there that everyone should get it.”

Can the nation’s health care system stand some improvements? Sure. The problem, he said, is that there are people who would complain if you gave them a $1 million worth of pennies [but] told them they had to roll ‘em up.

Hannah Fresques and Moiz Syed contributed to this report.

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Thursday, September 26, 2019

Ageism

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Is Ageism the Last Socially Acceptable Ism? A New Book Argues Yes

By Nicole Cardos
WTTW
April 25, 2019

As many as 25,000 complaints claiming age discrimination have been filed each year since 2008, according to the U.S. EQUAL EMPLOYMENT OPPORTUNITY COMMISSION.

That’s one of the reasons why PATTI TEMPLE ROCKS, a senior partner and head of client engagement at marketing agency ICF Next, calls ageism the last socially acceptable “ism” in our culture.

“We should talk about it. It’s the one ‘ism that will ultimately affect us all,” she said. “We’re all going to get old, were all going to age.”

Temple Rocks makes the case for increased awareness about ageism and age discrimination in her new book, I’M NOT DONE: IT’S TIME TO TALK ABOUT AGEISM IN THE WORKPLACE

The book details stories of employees in their 40s, 50s and 60s who’ve experienced ageism in the workplace, and tips for business leaders who wish to address it.

Temple Rocks joins us in discussion. 

Below, an excerpt from “I’m Not Done”

Chapter 4: The Dollars & Sense of Ageism in the Workplace

The other type of age discrimination claim turns on wrongful termination. Wrongful termination isn’t always a clearly identifiable firing or layoff. More commonly, its the “make them so miserable they will quit” approach, which I’ve discussed previously. This can take many forms, such as excluding an older worker from some meetings all of a sudden, giving younger workers plum assignments, better sales territories, or better technology, and making an older worker feel forced to accept a role that isn’t a good fit. If there is a pattern of such behavior, it can be interpreted as age discrimination.

Employers take this approach because they don’t want to fire the older worker and hope that either the older worker will solve the problem for them by quitting. Sometimes they use the “miserable job” as a place to put a worker they deem disposable. More often than not, this is an older employee. One gentleman I spoke with had this happen to him; in the back of his mind, he knew the company wanted him to leave for financial reasons, but he needed the job. As such, when he was asked to take the “miserable job,” he said yes. After many months, he asked for a change, and he was told by HR, “Well, you lasted a lot longer than we thought you would!” That was followed by HR telling him there was no other suitable role, so they would accept his resignation.

This type of ageism is often preceded by psychological damage and general diminishment of the person. Back to my ever-so-wise attorney friend Sue Ellen, who observed:

All of sudden, once-valued employees feel less valued they are forced into a role that no longer utilizes their strengths, they aren’t invited to key meetings, they are literally and figuratively being muted if not silenced, and it can become a self-defeating cycle because the natural reaction when this happens is to doubt yourself when in reality nothing has changed about your abilities as much as the organization’s natural inclination to gravitate towards the next shiny thing. And once that starts to happen to someone it can really wear them down, so this idea of leaving either voluntarily or not - starts to sound like a plausible idea.

This is essentially what is meant by the infamous phrase “put out to pasture,” and it happens much more often to older workers. They are just not involved in the way that they used to be involved, so it becomes this self-defeating cycle of yuck. Because if you’re not in the thick of things, your opinions are not going to be as well-informed. Then when you do get the chance to participate or give an opinion, it might not be as savvy or as spot-on as it used to be because you have started to doubt yourself and your ability to deliver value.

As humans, we are at our happiest when we feel involved, valued, and needed. When you no longer feel that in your workplace, particularly as an older worker who has been invested in a career for 30 or 40 years, it feels almost like a loss of identity. It’s almost like the stories you hear of one spouse dying followed quickly by the other. And after interviewing dozens of people, I can confirm that it hurts. A lot. Their hurt was palpable in each and every one of my interviews.

It’s a real ego blow to be treated this way. It’s hurtful. These are people who have spent most of their careers being highly valued, and then they all of a sudden get to a place where they start to wonder, when did I become invisible?

I think that’s partly why I opted to move on when I experienced this myself. I got some really good advice from a senior-level recruiter who I’ve known for a long time: he said, “The minute it [staying in the job] starts to erode your self-confidence, you have to get out of there.”

“I’m blessed with a fair degree of self-confidence, and it’s a lot easier for me than I think it is for a lot of people. I was also in a position where I could quitthat’s not true for everyone.”

Age discrimination also takes a heavier toll than other forms of discrimination on the health of victims. Boomers who want to keep working often need the income and health insurance that comes with full-time employment. Taking that away from them places a greater burden on public resources. In a statistic that shocked and horrified me, according to the AARP, those who lose their jobs past age 58 are at the greatest health risk, and on average, lose three years of life expectancy if they dont find another job.

A work study conducted by AARP in 2017 found that age is the leading reason for negative treatment by an employer. Participants were asked: “Thinking about how you are personally treated in the workplace, would you say the following generally caused your employer to treat you better, worse or no differently: age, race/ ethnicity, gender, disability, sexual orientation, religion, veteran status? Notably, age was the leading reason, and it was nearly double race and more than double gender. This underscores the negative psychological and physical effects experienced by older workers subject to age discrimination.

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Has the Law Evolved Enough To Combat Pervasive Age Discrimination?
While #MeToo has become a large focus in corporate America, the law surrounding age discrimination and the HURDLES TO LITIGATION are largely ignored.

By Kathryn Barcroft
Law Dot Com
September 11, 2019

Activist organizations have been hard at work studying the pervasiveness of age discrimination in corporate America and have noted the difficult legal standards to prove it, which leave many workers without options in the workplace after a certain age. While #MeToo has become a large focus in corporate America, the law surrounding age discrimination and the hurdles to litigation are largely ignored. The issue is of particular importance as employees are living longer and choose or need to work later in life, rather than having the means to retire with a sizeable pension. The realities of age discrimination are a real concern for all races and genders in the workforce as they plan their careers and are sometimes illegally forced to leave a company due to age discrimination.

Ageism is a worldwide problem that can affect the employment status of older workers. The issue has garnered the attention of the World Health Organization (WHO), an organization that has noted in relation to their upcoming study on ageism that “age discrimination is an incredibly prevalent and insidious problem.” Paula Spain, Ageism: A Prevalent and Insidious Health Threat, New York Times (April 26, 2019). Further, unlike other forms of discrimination - [it] is socially accepted and usually unchallenged, because of its largely implicit and subconscious nature. Alana Officer and VԢnia de la Fuente-Nuez, A global campaign to combat ageism, World Health Organization (March 9, 2018). A full report on WHO’s findings is anticipated in 2020.

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Wednesday, September 18, 2019

Your MRI

image: hippa

Maybe this explains why:

The treatment consent form included text that gives the hospital the ok to share any medical and personal information with any third party they wish, without restriction.
- Florida Hospital insists I let them do whatever they want with my medical records

Millions of Americans Medical Images and Data Are Available on the Internet. Anyone Can Take a Peek.
Hundreds of computer servers worldwide that store patient X-rays and MRIs are so insecure that anyone with a web browser or a few lines of computer code can view patient records. One expert warned about it for years.

ByJack Gillum, Jeff Kao and Jeff Larson
ProPublica
September. 17, 2019

Medical images and health data belonging to millions of Americans, including X-rays, MRIs and CT scans, are sitting unprotected on the internet and available to anyone with basic computer expertise.

The records cover more than 5 million patients in the U.S. and millions more around the world. In some cases, a snoop could use free software programs or just a typical web browser - to view the images and private data, an investigation by ProPublica and the German broadcaster Bayerischer Rundfunk found.

We identified 187 servers - computers that are used to store and retrieve medical data in the U.S. that were unprotected by passwords or basic security precautions. The computer systems, from Florida to California, are used in doctors’ offices, medical-imaging centers and mobile X-ray services.

“It’s not even hacking. It’s walking into an open door,” said Jackie Singh, a cybersecurity researcher and chief executive of the consulting firm Spyglass Security. Some medical providers started locking down their systems after we told them of what we had found.

Our review found that the extent of the exposure varies, depending on the health provider and what software they use. For instance, the server of U.S. company MobilexUSA displayed the names of more than a million patients all by typing in a simple data query. Their dates of birth, doctors and procedures were also included.

Alerted by ProPublica, MobilexUSA tightened its security last week. The company takes mobile X-rays and provides imaging services to nursing homes, rehabilitation hospitals, hospice agencies and prisons. “We promptly mitigated the potential vulnerabilities identified by ProPublica and immediately began an ongoing, thorough investigation,” MobilexUSA’s parent company said in a statement.

Another imaging system, tied to a physician in Los Angeles, allowed anyone on the internet to see his patients echocardiograms. (The doctor did not respond to inquiries from ProPublica.)

All told, medical data from more than 16 million scans worldwide was available online, including names, birthdates and, in some cases, Social Security numbers.

Experts say it’s hard to pinpoint who’s to blame for the failure to protect the privacy of medical images. Under U.S. law, health care providers and their business associates are legally accountable for securing the privacy of patient data. Several experts said such exposure of patient data could violate the Health Insurance Portability and Accountability Act, or HIPAA, the 1996 law that requires health care providers to keep Americans’ health data confidential and secure.

Although ProPublica found no evidence that patient data was copied from these systems and published elsewhere, the consequences of unauthorized access to such information could be devastating. Medical records are one of the most important areas for privacy because they’re so sensitive. Medical knowledge can be used against you in malicious ways: to shame people, to blackmail people, said Cooper Quintin, a security researcher and senior staff technologist with the Electronic Frontier Foundation, a digital-rights group.

“This is so utterly irresponsible,” he said.

The issue should not be a surprise to medical providers. For years, one expert has tried to warn about the casual handling of personal health data. Oleg Pianykh, the director of medical analytics at Massachusetts General Hospital’s radiology department, said medical imaging software has traditionally been written with the assumption that patients data would be secured by the customer’s computer security systems.

But as those networks at hospitals and medical centers became more complex and connected to the internet, the responsibility for security shifted to network administrators who assumed safeguards were in place. “Suddenly, medical security has become a do-it-yourself project,” Pianykh wrote in a 2016 research paper he published in a medical journal.

ProPublicas investigation built upon findings from Greenbone Networks, a security firm based in Germany that identified problems in at least 52 countries on every inhabited continent. GreenboneҒs Dirk Schrader first shared his research with Bayerischer Rundfunk after discovering some patients health records were at risk. The German journalists then approached ProPublica to explore the extent of the exposure in the U.S.

Schrader found five servers in Germany and 187 in the U.S. that made patients’ records available without a password. ProPublica and Bayerischer Rundfunk also scanned Internet Protocol addresses and identified, when possible, which medical provider they belonged to.

ProPublica independently determined how many patients could be affected in America, and found some servers ran outdated operating systems with known security vulnerabilities. Schrader said that data from more than 13.7 million medical tests in the U.S. were available online, including more than 400,000 in which X-rays and other images could be downloaded.

The privacy problem traces back to the medical professions shift from analog to digital technology. Long gone are the days when film X-rays were displayed on fluorescent light boards. Today, imaging studies can be instantly uploaded to servers and viewed over the internet by doctors in their offices.

In the early days of this technology, as with much of the internet, little thought was given to security. The passage of HIPAA required patient information to be protected from unauthorized access. Three years later, the medical imaging industry published its first security standards.

Our reporting indicated that large hospital chains and academic medical centers did put security protections in place. Most of the cases of unprotected data we found involved independent radiologists, medical imaging centers or archiving services.

One German patient, Katharina Gaspari, got an MRI three years ago and said she normally trusts her doctors. But after Bayerischer Rundfunk showed Gaspari her images available online, she said: “Now, I am not sure if I still can.” The German system that stored her records was locked down last week.

We found that some systems used to archive medical images also lacked security precautions. Denver-based Offsite Image left open the names and other details of more than 340,000 human and veterinary records, including those of a large cat named ԓMarshmellow, ProPublica found. An Offsite Image executive told ProPublica the company charges clients $50 for access to the site and then $1 per study. ԓYour data is safe and secure with us, Offsite ImageԒs website says.

The company referred ProPublica to its tech consultant, who at first defended Offsite Images security practices and insisted that a password was needed to access patient records. The consultant, Matthew Nelms, then called a ProPublica reporter a day later and acknowledged Offsite ImageҒs servers had been accessible but were now fixed.

“We were just never even aware that there was A POSSIBILITY that could even happen,” Nelms said.

In 1985, an industry group that included radiologists and makers of imaging equipment created a standard for medical imaging software. The standard, which is now called DICOM, spelled out how medical imaging devices talk to each other and share information.

We shared our findings with officials from the Medical Imaging & Technology Alliance, the group that oversees the standard. They acknowledged that there were hundreds of servers with an open connection on the internet, but suggested the blame lay with the people who were running them.

Even though it is a comparatively small number,Ӕ the organization said in a statement, it may be possible that some of those systems may contain patient records. Those likely represent bad configuration choices on the part of those operating those systems.Ӕ

Meeting minutes from 2017 show that a working group on security learned of Pianykhs findings and suggested meeting with him to discuss them further. That ғaction item was listed for several months, but Pianykh said he never was contacted. The medical imaging alliance told ProPublica last week that the group did not meet with Pianykh because the concerns that they had were sufficiently addressed in his article. They said the committee concluded its security standards were not flawed.

Pianykh said that misses the point. ItԒs not a lack of standards; its that medical device makers donҒt follow them. Medical-data security has never been soundly built into the clinical data or devices, and is still largely theoretical and does not exist in practice,Ӕ Pianykh wrote in 2016.

ProPublicas latest findings follow several other major breaches. In 2015, U.S. health insurer Anthem Inc. revealed that private data belonging to more than 78 million people was exposed in a hack. In the last two years, U.S. officials have reported that more than 40 million people have had their medical data compromised, according to an analysis of records from the U.S. Department of Health and Human Services.

Joy Pritts, a former HHS privacy official, said the government isn’t tough enough in policing patient privacy breaches. She cited an April announcement from HHS that lowered the maximum annual fine, from $1.5 million to $250,000, for whats known as “corrected willful neglect” - the result of conscious failures or reckless indifference that a company tries to fix. She said that large firms would not only consider those fines as just the cost of doing business, but that they could also negotiate with the government to get them reduced. A ProPublica examination in 2015 found few consequences for repeat HIPAA offenders.

A spokeswoman for HHS Office for Civil Rights, which enforces HIPAA violations, said it wouldn’t comment on open or potential investigations.

“What we typically see in the health care industry is that there is Band-Aid upon Band-Aid applied to legacy computer systems,” said Singh, the cybersecurity expert. She said it’s a “shared responsibility: among manufacturers, standards makers and hospitals to ensure computer servers are secured.

“It’s 2019,” she said. “There’s no reason for this.”

How Do I Know if My Medical Imaging Data is Secure?

If you are a patient:

If you have had a medical imaging scan (e.g., X-ray, CT scan, MRI, ultrasound, etc.) ask the health care provider that did the scan - or your doctor - if access to your images requires a login and password. Ask your doctor if their office or the medical imaging provider to which they refer patients conducts a regular security assessment as required by HIPAA.

If you are a medical imaging provider or doctor’s office:

Researchers have found that picture archiving and communication systems (PACS) servers implementing the DICOM standard may be at risk if they are connected directly to the internet without a VPN or firewall, or if access to them does not require a secure password. You or your IT staff should make sure that your PACS server cannot be accessed via the internet without a VPN connection and password. If you know the IP address of your PACS server but are not sure whether it is (or has been) accessible via the internet, please reach out to us at “medicalimaging at propublica.org.”

SOURCE

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FDA informs patients, providers and manufacturers about potential cybersecurity vulnerabilities for connected medical devices and health care networks that use certain communication software

FDA
October 1, 2019

Today, the U.S. Food and Drug Administration is informing patients, health care professionals, IT staff in health care facilities and manufacturers of a set of cybersecurity vulnerabilities, referred to as URGENT/11,Ӕ thatif exploited by a remote attackerחmay introduce risks for medical devices and hospital networks. URGENT/11 affects several operating systems that may then impact certain medical devices connected to a communications network, such as wi-fi and public or home Internet, as well as other connected equipment such as routers, connected phones and other critical infrastructure equipment. These cybersecurity vulnerabilities may allow a remote user to take control of a medical device and change its function, cause denial of service, or cause information leaks or logical flaws, which may prevent a device from functioning properly or at all.

To date, the FDA has not received any adverse event reports associated with these vulnerabilities. The public was first informed of these vulnerabilities in a July 2019 advisory sent by the Department of Homeland Security. Today, the FDA is providing additional information regarding the source of these vulnerabilities and recommendations for reducing or avoiding risks the vulnerabilities may pose to certain medical devices.

While advanced devices can offer safer, more convenient and timely health care delivery, a medical device connected to a communications network could have cybersecurity vulnerabilities that could be exploited resulting in patient harm,Ӕ said Amy Abernethy, M.D., Ph.D., FDAs principal deputy commissioner. ғThe FDA urges manufacturers everywhere to remain vigilant about their medical productsto monitor and assess cybersecurity vulnerability risks, and to be proactive about disclosing vulnerabilities and mitigations to address them. This is a cornerstone of the FDAגs efforts to work with manufacturers, health care delivery organizations, security researchers, other government agencies and patients to develop and implement solutions to address cybersecurity issues that affect medical devices in order to keep patients safe.

The URGENT/11 vulnerabilities exist in a third-party software, called IPnet, that computers use to communicate with each other over a network. This software is part of several operating systems and may be incorporated into other software applications, equipment and systems. The software may be used in a wide range of medical and industrial devices. Though the IPnet software may no longer be supported by the original software vendor, some manufacturers have a license that allows them to continue to use it without support. Therefore, the software may be incorporated into a variety of medical and industrial devices that are still in use today.

Security researchers, manufacturers and the FDA are aware that the following operating systems are affected, but the vulnerability may not be included in all versions of these operating systems:

VxWorks (by Wind River)
Operating System Embedded (OSE) (by ENEA)
INTEGRITY (by GreenHills)
ThreadX (by Microsoft)
ITRON (by TRON)
ZebOS (by IP Infusion)

The agency is asking manufacturers to work with health care providers to determine which medical devices, either in their health care facility or used by their patients, could be affected by URGENT/11 and develop risk mitigation plans. Patients should talk to their health care providers to determine if their medical device could be affected and to seek help right away if they notice the functionality of their device has changed.

The FDA takes reports of vulnerabilities in medical devices very seriously and todayԒs safety communication includes recommendations to manufacturers for continued monitoring, reporting and remediation of medical device cybersecurity vulnerabilities. The FDA is recommending that manufacturers conduct a risk assessment, as described in the FDAs cybersecurity postmarket guidance, to evaluate the impact of these vulnerabilities on medical devices they manufacture and develop risk mitigation plans. Medical device manufacturers should work with operating system vendors to identify available patches and other recommended mitigation methods, work with health care providers to determine any medical devices that could potentially be affected, and discuss ways to reduce associated risks.

Some medical device manufacturers are already actively assessing which devices may be affected by URGENT/11 and are identifying risk and remediation actions. In addition, several manufacturers have already proactively notified customers of affected products, which include medical devices such as an imaging system, an infusion pump and an anesthesia machine. The FDA expects that additional medical devices with one or more of the cybersecurity vulnerabilities will be identified.

ғWhile we are not aware of patients who may have been harmed by this particular cybersecurity vulnerability, the risk of patient harm if such a vulnerability were left unaddressed could be significant, said Suzanne Schwartz, M.D., MBA, deputy director of the Office of Strategic Partnerships and Technology Innovation in the FDAԒs Center for Devices and Radiological Health. The safety communication issued today contains recommendations for what actions patients, health care providers and manufacturers should take to reduce the risk this vulnerability could pose. ItӒs important for manufacturers to be aware that the nature of these vulnerabilities allows the attack to occur undetected and without user interaction. Because an attack may be interpreted by the device as a normal network communication, it may remain invisible to security measures.

The FDA will continue its work with manufacturers and health care delivery organizationsԗas well as security researchers and other government agenciesto help develop and implement solutions to address cybersecurity issues throughout a device’s total product lifecycle.

The FDA will continue to assess new information concerning the URGENT/11 vulnerabilities and will keep the public informed if significant new information becomes available.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nationגs food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

SOURCE

Posted by Elvis on 09/18/19 •
Section Privacy And Rights • Section Dying America
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Tuesday, September 17, 2019

Suicide Redux

image: causes of death 2017

Researchers say there’s a simple way to reduce suicides: Increase the minimum wage

By Andrew Van Dam
Washington Post
April 30, 2019

Since 2000, the suicide rate in the United States has risen 35 percent, primarily because of the significant increase in such deaths among the WHITE population.

There are hints that these deaths are the result of worsening prospects among less-educated people, but there are few immediate answers. But maybe the solution is simple: pursue policies that improve the prospects of working-class Americans.

Researchers have found that when the minimum wage in a state increased, or when states boosted a tax credit for working families, the suicide rate decreased.

Raising the minimum wage and the earned-income tax credit (EITC) by 10 percent each could prevent about 1,230 suicides annually, according to a WORKING PAPER circulated by the National Bureau of Economic Research this week.

The EITC was designed to boost the wages of low-income workers, particularly families with children. Many states have supplemented or expanded the credit.

Raising the minimum wage and increasing the tax credit help less-educated, low-wage workers who have been hit hardest by what are now known as DEATHS OF DESPAIR according to the analysis of 1999-2015 death data from the Centers for Disease Control and Prevention by University of California at Berkeley economists Anna Godoey and Michael Reich, as well as public-health specialists William Dow and Christopher Lowenstein.

Deaths of despair, a phrase popularized by Princeton economists Anne Case and Angus Deaton in a pair of widely cited 2015 and 2017 papers, typically refers to rising death rates among middle-aged white non-Hispanic Americans.

In 2017, Case and Deaton wrote that those rising death rates can be attributed to “drug overdoses, suicides, and alcohol-related liver mortality particularly among those with a high school degree or less.”

To evaluate how policy choices could affect those deaths, the Berkeley team identified states that had raised their minimum wage or EITC between 1999 and 2015. They also included states whose wages were affected by federal minimum-wage increases. The researchers then measured the change in the rate for such deaths before and after the policies took effect.

To control for national trends, they compared the changes with states that hadn’t changed their minimum wage or EITC.

The researchers looked at suicides and drug overdoses. Unlike degenerative liver disease linked to alcohol abuse, those events can be connected to a single point in time.

The team found little change in drug overdoses, whether intentional or accidental, after the new policies took effect. This falls in line with the growing consensus that, unlike other deaths of despair, drug overdoses probably are linked to increased availability of addictive (and lethal) drugs.

But the number of suicides that weren’t related to drugs dropped noticeably. Among adults without a college education, increasing the EITC by 10 percent appears to have decreased non-drug suicides by about 5.5 percent. Raising the minimum wage by 10 percent reduced suicides by 3.6 percent.

“When they implement these policies, suicides fall very quickly,” Godoey said in an interview.

Although raising the minimum wage led to an immediate decrease in suicides, raising the EITC had a delayed effect, resulting in fewer suicides the following year, once the tax change came into force. In both cases, it appears as though taking home more money had a positive effect.

The effect was strongest among young women and others who were most likely to have minimum-wage jobs. Among men, black and Hispanic Americans saw the largest effect.

A March study in the American Journal of Preventive Medicine also found that a one-dollar increase in the minimum wage was associated with a 1.9 percent decrease in suicides, and that the association was strongest between 2011 and 2016, the most recent year studied.

Leading minimum-wage scholar Arindrajit Dube of the University of Massachusetts at Amherst, who shows in a forthcoming publication in the American Economic Journal: Applied Economics that higher minimum wages increase incomes for the poorest families, said the two studies provide important additional evidence on the possible impact of a higher minimum wage on the standard of living - or living at all.

The scholars are contributing to a larger body of work that links health, particularly mental health, with economic policy and outcomes.

In a 2014 analysis in American Economic Journal: Economic Policy, William Evans of the University of Notre Dame and Craig Garthwaite of Northwestern’s Kellogg School of Management found that mothers who received a higher EITC reported better mental and physical health.

In a paper to be published in American Economic Review: Insights, David Autor of the Massachusetts Institute of Technology, David Dorn of the University of Zurich and Gordon Hanson of the University of California at San Diego drew on data from between 1990 and 2014 to find that the death rate among men tended to rise in cities where jobs were vanishing because of competition from cheap foreign goods.

SOURCE

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Economic hardship tied to increase in U.S. suicide rates, especially in rural areas

By Melissa HealyStaff Writer
LA Times
Sep. 6, 2019

Whether they are densely populated or deeply rural, few communities in the United States have escaped a shocking increase in suicides over the last two decades. From 1999 to 2016, suicide claimed the lives of 453,577 adults between the ages of 25 and 64 enough to fill more than 1,000 jumbo jets.

Suicides reached a 50-year peak in 2017, the latest year for which reliable statistics are available. The vast majority of those suicides happened in the countryגs cities and suburbs, where 80% of Americans live.

But a new study shows that the nations most rural counties have seen the toll of suicide rise FURTHEST AND FASTEST during those 18 years.

The new research ties high suicide rates everywhere to the unraveling of the social fabric that happens when local sports teams disband, beauty and barbershops close, and churches and civic groups dwindle. But in rural counties, especially, it finds a powerful link between suicide and economic deprivation a measure that captures poverty, unemployment, low levels of education and reliance on government assistance.

The study also finds that in counties where health insurance is lacking, and in those where military veterans represent a larger proportion of the population, suicide rates were higher over the 18-year period studied.

And in all but the most rural counties, the more stores there are selling firearms, the higher the suicide rate ח a finding that underscores the risk that goes hand-in-hand with having easy access to guns.

At a time when surging suicide rates have contributed to a sustained decline in life expectancy in the United States, the study results suggest that efforts to rescue Americans from SELF-DESTRUCTIVE DESPAIR must focus on combating loneliness, revitalizing downtrodden communities, broadening access to healthcare and narrowing access to guns.

And it suggests that economic decline in the nations rural outposts has generated a hopelessness that must not be overlooked.

“Suicide rates in rural counties are especially susceptible to deprivation,” a team led by researchers from Ohio State University wrote in Friday’s edition of the journal JAMA Network Open. “Rural counties present special challenges and deserve targeted suicide-prevention efforts.”

Whether they are densely populated or deeply rural, few communities in the United States have escaped a shocking increase in suicides over the last two decades. From 1999 to 2016, suicide claimed the lives of 453,577 adults between the ages of 25 and 64 enough to fill more than 1,000 jumbo jets.

Suicides reached a 50-year peak in 2017, the latest year for which reliable statistics are available. The vast majority of those suicides happened in the country’s cities and suburbs, where 80% of Americans live.

But a new study shows that the nation’s most rural counties have seen the toll of suicide rise furthest and fastest during those 18 years.

The new research ties high suicide rates everywhere to the unraveling of the social fabric that happens when local sports teams disband, beauty and barbershops close, and churches and civic groups dwindle. But in rural counties, especially, it finds a powerful link between suicide and economic deprivation - a measure that captures poverty, unemployment, low levels of education and reliance on government assistance.

The study also finds that in counties where health insurance is lacking, and in those where military veterans represent a larger proportion of the population, suicide rates were higher over the 18-year period studied.

And in all but the most rural counties, the more stores there are selling firearms, the higher the suicide rate a finding that underscores the risk that goes hand-in-hand with having easy access to guns.

At a time when surging suicide rates have contributed to a sustained decline in life expectancy in the United States, the study results suggest that efforts to rescue Americans from self-destructive despair must focus on combating loneliness, revitalizing downtrodden communities, broadening access to healthcare and narrowing access to guns.

And it suggests that economic decline in the nationגs rural outposts has generated a hopelessness that must not be overlooked.

Suicide rates in rural counties are especially susceptible to deprivation,Ӕ a team led by researchers from Ohio State University wrote in Fridays edition of the journal JAMA Network Open. ғRural counties present special challenges and deserve targeted suicide-prevention efforts.

The Centers for Disease Control and Prevention has reported that the age-adjusted suicide rate rose from 10.5 deaths per 100,000 people in 1999 to 14.0 per 100,000 in 2017 - a 33% increase. SUICIDE IS NOW THE TENTH LEADING CAUSE OF DEATH FOR PEOPLE OF ALL AGES IN THE UNITED STATES. While rural counties have long led urban ones in suicide rates, the gap became even wider during those years.

Across the country, the new study found that counties whose suicide rates exceeded the national average by the greatest amount tended to be in Western states (particularly Colorado, New Mexico, Utah and Wyoming), in Appalachia (including Kentucky, Virginia and West Virginia), and in the Ozarks (Arkansas and Missouri).

A time-lapsed series of snapshots of suicide rates since the turn of this century reveals a spreading geography of despondency thats broken up by just a few islands җ virtually all of them urban where suicide rates have risen only moderately.

In a series of maps, elevated suicide rates first appear from 2002 to 2004 in pockets scattered across the American Southwest, the inter-mountain West, Appalachia and the farthest reaches of Alaska.

By 2008 to 2010, above-average suicide rates darkened much of the mountainous West and extended across Oregon and Northern California to the Pacific Coast. And they gained a solid foothold in the Midwestern heartland and in counties of the industrial Upper Midwest.

By 2014 to 2016, increased suicide rates spread across the vast expanse of the American West, sparing only most of the counties hugging the California coast from Sonoma County to San Diego. They also covered the industrial Midwest and appeared in rural counties in southern Mississippi and Louisiana, the mid-Atlantic states and New England.

Danielle L. Steelesmith, the studyגs lead author, said the findings on guns warrant further scrutiny. But she noted that this isnt the first time researchers have seen that where access to firearms is greater, so too is the number of suicides committed with a gun.

The exception was in the 20% of counties classified as rural җ those lacking a town with a population greater than 2,500. Steelesmith said the fact that the density of gun shops there was not linked with an increase in suicide risk may reflect a central fact of rural life: Most homes already have a gun, so the availability of a gun retailer may not necessarily increase gun access.

But in counties that include towns larger than 2,500, the added access that comes with more gun shops may make a difference.

ItӒs relatively small as an association, Steelesmith said. ԓIn a large metropolitan county, one additional gun shop would increase suicides by one to two people. But at the national level, thats potentially a lot of people.Ҕ

The new analysis helps explain why suicides, drug overdoses and other so-called deaths of despair have ravaged rural white populations while touching more lightly upon African Americans and Latinos, said Brookings Institution research analyst Carol Graham.

In more metropolitan counties, the long-entrenched poor including communities of color ח appear able to fend off despair by accessing shared resources like city parks, neighborhood barbershops and community churches, and by tapping into the social networks that have sustained them through generations of hardship, Graham said. Plus, they are closer to a wider range of employment opportunities.

Even in rural counties dominated by minorities, such shared institutions have long existed, helping blacks and Latinos to weather long-standing poverty, she said.

In rural counties hollowed out by more recent economic decline, the shared communities of religious congregations, Grange meetings and even high school football games have dwindled. And as residents fled, those left behind have become increasingly isolated from one another, said Graham, who studies the geography of happiness and despair as well as the social, economic and political factors that contribute to population health.

These are the places that used to be thriving rural places, near enough to cities and manufacturing hubs,Ӕ she said. TheyӒre places that accord with a stereotypical picture of stable blue-collar existence and a quite nice existence ח for whites in the heartland.

With the collapse of extractive industries such as coal mining, the departure of manufacturing jobs, and a strapped agricultural economy, “these communities just got flipped on their head,” Graham observed. “And the people in those places became unhinged. You’d have a sense of places where everything has left. And among those who stay, you see no optimism for the future.”

Steelesmith said that one of the studys findings - that social capital 0 in the form of clubs, churches, schools and group activities was associated with lower rates of suicide offers hope to rural populations reeling from economic deprivation.

Maintaining friendships and building connections with others “are something that residents can do themselves,” she said.

SOURCE

Posted by Elvis on 09/17/19 •
Section Dying America
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