“Although less than half of 1 percent of the U.S. population resides in nursing homes, they account for nearly 40 percent of all Covid deaths. Nursing homes are supposed to help residents remain safe and healthy, but the opposite turned out to be the case: When it came to the coronavirus, residents in nursing homes were more vulnerable, not less.”
…
“rebuilding nursing home facilities is an expensive and long-term solution to an immediate crisis. I’ve been studying long-term care settings for many years, and I think there’s a quicker and possibly even more effective approach we can take in the short term to ensure better care for our seniors in the post-Covid era: improve staffing.
It’s no secret that nursing home staff are paid relatively poorly for incredibly demanding work. Certified nurse aides who provide over 90 percent of direct resident care are often paid at or near minimum wage — the same wages as entry-level workers in retail establishments or fast-food chains. Nursing staff are also underpaid; registered nurses and licensed practical nurses who work in nursing homes are often paid below their counterparts who work in hospitals and other health care settings.
What’s more, nursing home staff often lack essential benefits, like health insurance and paid sick leave. That means nursing home workers are incentivized to come to work even when sick — how does that make sense when they are caring for medically vulnerable residents during a pandemic?
Nursing homes are also very hierarchical workplaces with lower-level staff having little autonomy and control in their jobs. Not surprisingly, being undervalued and unempowered makes it hard to recruit and retain individuals to work in nursing homes.
The result is that many facilities around the country often have dangerously low levels of staffing. Additionally, the average U.S. nursing home was recently found to have an annual staff turnover rate of 128 percent. This suggests an average facility’s staff completely changes over the course of a year, and many nursing homes have even higher turnover rates — as much as 300 percent — suggesting the staff changes every four months. If some part of good nursing home quality depends on the relationship between staff and residents, it’s hard to see how those relationships can develop when staff keep changing.”
…
“There are a number of things we can do to improve this situation. Here are a few ideas”
…
“One solution would be to increase the number of direct care workers by raising the federal minimum staffing standards in nursing homes. The federal standards are relatively low and have not been updated in over 30 years. Many states set staffing levels above the federal standards and these state policies have generally been found to increase staff.”
…
“Another idea is to raise minimum wages to increase nursing home staff pay. Many certified nurse aides would see their hourly wages increase under the $15 minimum wage proposed by the Biden administration. In the absence of a broader minimum wage hike, policymakers could also increase wages specifically for nursing home and other long-term care workers.”
…
“The elephant in the room is what additional Medicaid or other public funding would be necessary to pay for greater staffing and higher wages. The nursing home industry will inevitably push back against any “unfunded mandates.” The Medicare Payment Advisory Commission has found overall nursing home operating margins are currently thin based on the Medicare cost reports. However, there is quite a bit of variability in profitability across facilities. It is also unclear whether some facilities are accurately reporting their costs. Resident advocates have questioned whether a sufficient amount of existing public nursing home funds are spent on staffing. Thus, higher Medicaid funding will be necessary to improve staffing levels and wages, but it needs to be paired with the next suggestion.”
…
“We currently lack transparency in how nursing homes spend public dollars on staffing and other areas. Nursing homes are required to submit Medicare cost reports each year to detail their revenues and spending, but these data are known to be incomplete, especially in the context of increasingly complicated corporate ownership arrangements. A series of financial reporting and oversight steps need to be taken to tighten the requirements for facilities. The bottom line is that regulators need to be able to follow the public’s money and ensure it is being spent on staffing as policymakers intended.”
…
“Beyond putting more money into wages, policymakers might also consider ways in which they could provide financial support to allow additional education and training to certified nursing assistants and licensed practical nurses seeking upward mobility within a facility. For example, some nursing homes currently have ladder programs that provide nursing assistants with financial support in seeking nursing degrees. These programs could be expanded through direct reimbursement via Medicare and Medicaid.”
…
“Improving wages and benefits is a necessary but insufficient step towards valuing nursing home caregivers; we also need to begin to value the work these individuals do and the individuals that do it. If you can believe it, this might be harder than increasing staffing standards and wages. Finding additional money is one thing — changing the culture around nursing home staffing is another.”
https://www.npr.org/2021/01/05/952883116/objecting-to-electoral-votes-in-congress-recalls-bitter-moments-in-history
“since the collapse of the Soviet Union, the reason that brought forth US global supremacy has ceased to exist. There was an original argument for the United States shouldering the immense burdens of global military dominance: Without it, totalitarian powers would conquer much of the Earth. That would be terrible for the world, the thinking went, and it could be bad for the United States.
The problem, though, is the pursuit of military dominance since then has created a lot of enemies of the US that didn’t need to be enemies of the US. We’ve engaged in bad behavior ourselves and stimulated it in others.
I worry that — in a world where the foremost threats to the American people are pandemic disease and climate change — America will continue to define its biggest threats in military terms, even if they aren’t.”
…
“Since 1991, I think almost everybody has lost out, aside from the major defense firms and some ruling elites. America’s strategy has been incredibly destructive for people throughout the greater Middle East, and of course, the Iraq War resulted in the deaths of hundreds of thousands of civilians.
And I don’t think the American people have won out, either. I think that we have gotten less safe and more fearful as a society as a result of constantly being told by leaders of both parties that the whole world is out to kill us and that that’s why we’ve got to go to war to kill them first.
Look, the argument that US military power contributed to world order was very real. The Bretton Woods system played an important role in stabilizing global capitalism. But since the 1970s, and especially the 1990s, I think it’s hard to argue that US military dominance somehow underpins everything else.
It’s very difficult to see how applying sanctions on dozens of countries and waging continual warfare in the greater Middle East somehow serves the general interest of capitalism. Maybe it serves the interests of particular firms, but not the system of capitalism.”
…
“What I’m opposed to, first and foremost, is military dominance as an end in itself. That’s what I think it has become in our own time, and I don’t think it began that way. That doesn’t prohibit the US from being a robust power: It’s going to be a great power and it’s going to have a strong military. We should absolutely be able to defend ourselves. I’m not even closing the door on things like humanitarian intervention, either.
What we have to ask, though, is if the US has used all this power wisely and judiciously. It’s clear that we haven’t, and it’s making all of us in America and around the world less safe. Just think of this: Roughly 80 percent of all US military interventions have occurred after 1991. Can we really say the millions at home and abroad have had their lives improved by that? I don’t think so.”
…
“I’d lead a systematic policy of disentangling the US from regions where its interests are either not vital, as in the Middle East, or not really imperiled, like Europe. I absolutely believe in the capacity of Europeans to manage their own affairs. The United States does not need to be the protector of Europe.”
…
“we have to be cautious in observing how China continues to rise and how it behaves. It has not had a record of territorial conquest with anything like the record of past US adversaries, like the Axis powers or the Soviet Union. That’s a good thing, though you wouldn’t know it from all the cries about China’s desire to dominate the world emanating from Washington, DC.
A President Wertheim — and please let your readers know I’m rolling my eyes as I say that — would recognize the US has an opportunity to cautiously retrench its position militarily in certain regions as it ramps up cooperation on the issues that really matter. I’d encourage allies and partners in the region to step up to counterbalance China. We still have time to allow that process to happen, and that’d be a good thing since it takes two great powers to make a great-power war.”
…
“What I am fearful of right now is that it’s almost impossible for many people in the foreign policy community to envision circumstances in which the United States could ever pull back from a region. I worry about the United States putting itself on the front lines of any potential conflict, which could mean a great-power war. We should avoid being in that situation in the first place if we possibly can.”
“According to the BBC, a minimum of 350,000 illegal abortions occur annually in Argentina, a figure that some activist groups feel is undercounting the real number. Illegal abortions can lead to health complications and even death for the people who experience them — the World Health Organization estimates that up to 13.2 percent of maternal deaths worldwide can be attributed to unsafe abortions.
Argentina has seen adherence to Catholicism decline in recent years, according to a study from the National Scientific and Technical Research Council (CONICET). The Buenos Aires Times reports that in 2019, 62.9 percent of the population identified as Catholic, a 13.6 percentage point drop since 2008. Simultaneously, while evangelicals gained new adherents, the share of people identifying with no religion grew the most, reaching nearly 20 percent of the population.”
…
“While Argentina is still a largely Catholic country, this decline could explain why Pope Francis’s comments opposing legalizing abortion did not have an overwhelming effect on the outcome of this vote. Francis, who was born and worked in Argentina for much of his life, has referred to abortion as being part of a “throwaway culture” and has rooted his opposition to the medical procedure as being based in science, according to Crux, a Catholic online newspaper.
According to France 24, Catholics weren’t alone in opposing the measure; they joined forces with the country’s growing evangelical wing to mobilize against abortion. They will likely fight to overturn this measure, especially as this change exposes Argentina’s religious fault lines.
But the victorious activists are the abortion rights feminists who have spent years fighting for abortion legalization.”
…
“Argentina became the biggest country in Latin America to legalize elective abortion”
https://www.vox.com/the-goods/22245223/black-middle-class-racism-reparations
“The US did succeed at flattening the curve — at least at first. Businesses closed and most states issued stay-at-home orders; later research concluded those lockdown measures helped prevent tens of millions of Covid-19 cases.
But America failed to take advantage of that window to ramp up its virus testing and tracing capabilities, and states quickly faced intense pressure to relax their policies to alleviate the economic costs of the shutdowns. Reopening began earlier than public health experts believed it should. The political will to impose new lockdowns had evaporated by the time cases spiked again.
At the end of 2020, with more than 20 million Covid-19 cases and nearly 350,000 deaths in the US, it is evident that trying to flatten the curve was not sufficient to end the pandemic. That doesn’t mean it failed entirely. Slowing the spread of Covid-19 was meant to buy time to figure out what came next. But the US never did.”
…
“Multiple studies have found that mitigation measures suppressed the virus’s spread and likely prevented millions of cases — and with them many deaths. A study published in Health Affairs in May found that social distancing policies, particularly stay-at-home orders and closing bars and restaurants, had staved off as many as 35 million cases in the US by the end of April. More recent research published in Science concluded that closing schools and businesses, as well as limiting the size of private gatherings, reduced spread considerably.
“NYC flattened the curve. Other places delayed it,” William Hanage, an epidemiologist at Harvard University, told me. “But that ought to provide an opportunity to ramp up testing and health care and prepare people for the long haul. You know that did not happen.”
Experts came up with roadmaps for how to proceed once the initial curve was flattened. A proposal from the American Enterprise Institute set specific thresholds for case numbers, hospital capacity, and testing that were designed to allow states to safely begin relaxing their lockdown measures once the virus had been sufficiently suppressed and the health system’s capacity had been expanded.
But the Trump administration never embraced those plans. Instead, the president often said that the cure (lockdowns) could not be worse than the disease (Covid-19). The White House eventually settled on a message that the US would need to learn to live with the virus.”
…
“many US states that had avoided the worst of Covid-19 in the spring saw the lack of an outbreak as a sign that they could push ahead with reopening. Once the curve was flat, the political will to keep it that way began to crumble.
America wasn’t the only place to struggle with figuring out how to move forward from its spring lockdown; many European countries saw their own second waves over the summer. But the missed opportunity still set the course for the rest of the pandemic.”
…
“In some ways, flattening the curve did work as intended.
…
“Hospitals have not — yet — been overwhelmed, as they were in the dire situation in Lombardo, Italy, in the spring. But today, with cases and hospitalizations still rising, US hospitals warn they are again nearing a breaking point.
Slowing the spread of the disease in the spring also gave scientists a chance to learn more and more about the virus.
Among other things, they learned that people were the most infectious before they showed symptoms. They figured out the virus primarily spread through respiratory droplets, not through touch or surfaces. The elevated fatality risk to the elderly became more apparent. Researchers quickly began to figure out which treatments worked (putting patients in a prone position, administering remdesivir and dexamethasone) and which ones didn’t (the Trump-favored hydroxychloroquine).
With this information, the US could have used the time it bought by flattening the curve to figure out whether more targeted interventions would work better than lockdowns, as the Science study suggested, and whether individual cities or counties could best manage their own outbreaks.”
…
“in other ways, flattening the curve still failed to accomplish its goal of preserving health care access. While hospitals have not yet been completely overwhelmed, some people aren’t getting the care they need. ProPublica reported that over the summer in Houston, medical examiners saw a spike in the number of people found dead in their homes. Some of those deaths were from Covid-19; some were from heart attacks, strokes, and other conditions. Either way, the news of the virus’s rapid spread in the area may have kept people from seeking medical assistance, with deadly consequences.”
…
“330 million Americans were left to make their own risk assessments — or not.
Given the research that shows a small percentage of infected people account for a very large share of the transmission, that was a recipe for disaster. And rather than take proactive measures as infection rates first ticked up, which public health experts say are most important given the pre-symptomatic spread of Covid-19 and its slow gestation, governors seemed to be paralyzed and waited to act until the crisis was already upon them.
“Every American’s personal definition of Covid-caution is completely unique, with some holed up at home for weeks at a time and others traveling the country to visit friends,” Kumi Smith, an epidemiologist at the University of Minnesota, told me over email. “While the institutional level measures may seem extreme, if they had been more uniformly implemented around the country for longer, we might have been able to achieve low enough community transmission to the point that a careful reopening coupled with other measures like contact tracing and widespread testing and isolation would have been possible.””
“If you’re a corrupt foreign official or drug trafficker, there’s a pretty easy way to protect your illicit cash: create an anonymous shell company.
You form a shell company — meaning a business that exists only on paper, with no employees, no products it makes or sells, no revenue, nothing except maybe a bank account and some assets — but you do it without disclosing your (the owner’s) real name, offering a convenient way to launder your money and evade law enforcement in the United States.
Except that might now be a lot harder to do in the US. A provision in the National Defense Authorization Act (NDAA), the $741 billion defense bill, will effectively ban anonymous shell companies.
The NDAA passed with bipartisan support in Congress. Trump vetoed the package, but Congress voted overwhelmingly to override the president’s veto for the first time during Trump’s tenure.
That means that now, when someone opens a shell corporation, they’ll be required to provide the owner’s name and some basic identifying information. This simple step will give law enforcement and national security officials a powerful tool to crack down on corruption.”
“Several past presidential administrations have relied on two authorizations for the use of military force — known as AUMFs — to carry out military operations from Iraq to Afghanistan to Somalia to Syria. The 2001 version greenlit the fight against al-Qaeda in Afghanistan after 9/11, and the 2002 iteration gave Bush Congress’s blessing to invade Iraq — a measure then-Senator Biden voted for.
Since then, Republican and Democratic administrations have broadly interpreted those authorizations as giving the US permission to, among other things, hunt down terrorists around the world, including assassinating Iranian Gen. Qassem Soleimani in Iraq. However, presidents still said they still held the ultimate authority to wield the military as needed in their role as commander in chief.
Concerned about the ever-widening use of force based on these authorizations, lawmakers from both parties have for years wanted to repeal the current AUMFs and replace them with updated and more limited versions, but rarely received enough congressional or White House support.”
…
“Now Biden, according to his team, agrees the AUMFs behind decades of war should go.
“We are committed to working with Congress to ensure that the authorizations for the use of military force currently on the books are replaced with a narrow and specific framework that will ensure we can protect Americans from terrorist threats while ending the forever wars,” White House press secretary Jen Psaki said in a Friday statement to Politico later posted to Twitter.”
…
“Experts and activists cite two main concerns about what comes next after the White House’s announcement.
First, it’s unclear that a new authorization will actually limit what Biden might want the military to do in the region.
If a new AUMF “is truly narrowly crafted and contains a sunset clause, then it could be a really important step in the right direction,” said Oona Hathaway, a professor of international law at Yale Law School. “But if it simply formalizes the forever war by creating a set of rules for using force in the Middle East in perpetuity, it’s not clear that’s an improvement.”
The new measure, then, must be written in a way that truly limits the president’s ability to interpret the law expansively.”
…
“Second, as mentioned above, Biden didn’t cite previous AUMFs for his Syria strike. He leaned on his Article II powers in the Constitution, which names the president as the commander in chief, thereby giving him ultimate authority over all military matters.
“I directed this military action consistent with my responsibility to protect United States citizens both at home and abroad and in furtherance of United States national security and foreign policy interests, pursuant to my constitutional authority to conduct United States foreign relations and as Commander in Chief and Chief Executive,” he wrote to congressional leaders in a letter last week.
This means a more specific, limited AUMF might not necessarily lead Biden to always seek Congress’s approval for a military attack. He might still feel legally justified in launching an operation if he feels such a move is needed.
The White House’s announcement, therefore, hasn’t ended a roiling debate about war powers. If anything, Biden’s stance has kicked it into overdrive.”
“At first glance, Georgia’s law requiring majorities for an outright victory seems inoffensive — the person who wins has to be chosen by most of the people who cast their votes. In theory, this would force candidates to appeal to more voters instead of winning with a large plurality of votes while holding views anathema to the majority of the electorate.
But Georgia’s runoff system has a darker origin: Many historians say it was designed to make it harder for the preferred candidates of Black voters to win, and to suppress Black political power.”
…
“It effectively began in 1962, when the Supreme Court struck down Georgia’s old electoral system. That older system, called a “county-unit system,” was created 45 years prior to amplify rural voters’ power while disadvantaging Black voters’, and was “kind of a poor man’s Electoral College,” University of Georgia political science professor Charles Bullock told Vox.
Forced to come up with a new system, Georgia created one intended to continue undermining Black voters’ influence. That was the runoff system”
…
“”In 1963, state representative Denmark Groover from Macon introduced a proposal to apply majority-vote, runoff election rules to all local, state, and federal offices. A staunch segregationist, Groover’s hostility to black voting was reinforced by personal experience. Having served as a state representative in the early 1950s, Groover was defeated for election to the House in 1958. The Macon politico blamed his loss on “Negro bloc voting.” He carried the white vote, but his opponent triumphed by garnering black ballots by a five-to-one margin.
Groover soon devised a way to challenge growing black political strength. Elected to the House again in 1962, he led the fight to enact a majority vote, runoff rule for all county and state contests in both primary and general elections. Until 1963, plurality voting was widely used in Georgia county elections””
…
“Groover wanted to stop Black Georgians from voting as a “bloc” — that is, overwhelmingly for one candidate or party — while white Georgians split their votes among many candidates. In a plurality system, if Black voters were able to keep a coalition behind one candidate, they wouldn’t need the support of many white voters for their preferred candidate to win elections.
The method was popular across the former Confederacy: Alabama, Arkansas, Georgia, Mississippi, Oklahoma, South Carolina, and Texas all have general election runoffs. As the Washington Post reported, just two non-Southern states have runoff rules, and those “almost never matter””
…
“There are some, like Bullock, who don’t believe this was designed to be a racially discriminatory institution, pointing out that the use of runoffs began at a time when Black voters had already been largely eliminated from the voter rolls. Others have said there were good governance reasons for implementing the runoff system.
However, Cal Jillson, a professor at Southern Methodist University, told the Washington Post that most of the states that adopted runoff systems did it to “maintain white Democratic domination of local politics. Letters and speeches that survive from the period show race was very much on the minds of those Democrats who advocated the primary-runoff process. ‘People had no misgivings about stating their real intentions and stating them in racial terms,’” Jillson told the paper.”
…
“As if to simplify the historical record, decades after Groover fought to institute run-off elections, he admitted: “I was a segregationist. I was a county unit man. But if you want to establish if I was racially prejudiced. I was. If you want to establish that some of my political activity was racially motivated, it was.”
Groover also confirmed that he “used the phrase ‘bloc voting’ as a racist euphemism for Negro voting.” A DeKalb County representative who supported Groover “remembered Groover saying on the House floor: ‘[W]e have got to go the majority vote because all we have to have is a plurality and the Negroes and the pressure groups and special interests are going to manipulate this State and take charge if we don’t go for the majority vote.””