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Where Should You Buy Your Food: Whole Foods or Walmart?

Posted by steveneidman on March 4, 2010

The Great Grocery Smackdown

By Corby Kummer

Buy my food at Walmart? No thanks. Until recently, I had been to exactly one Walmart in my life, at the insistence of a friend I was visiting in Natchez, Mississippi, about 10 years ago. It was one of the sights, she said. Up and down the aisles we went, properly impressed by the endless rows and endless abundance. Not the produce section. I saw rows of prepackaged, plastic-trapped fruits and vegetables. I would never think of shopping there.

Not even if I could get environmentally correct food. Walmart’s move into organics was then getting under way, but it just seemed cynical—a way to grab market share while driving small stores and farmers out of business. Then, last year, the market for organic milk started to go down along with the economy, and dairy farmers in Vermont and other states, who had made big investments in organic certification, began losing contracts and selling their farms. A guaranteed large buyer of organic milk began to look more attractive. And friends started telling me I needed to look seriously at Walmart’s efforts to sell sustainably raised food.

Really? Wasn’t this greenwashing? I called Charles Fishman, the author of The Wal-Mart Effect, which entertainingly documents the market-changing (and company-destroying) effects of Walmart’s decisions. He reiterated that whatever Walmart decides to do has large repercussions—and told me that what it had decided to do since my Natchez foray was to compete with high-end supermarkets. “You won’t recognize the grocery section of a supercenter,” he said. He ordered me to get in my car and find one.

He was right. In the grocery section of the Raynham supercenter, 45 minutes south of Boston, I had trouble believing I was in a Walmart. The very reasonable-looking produce, most of it loose and nicely organized, was in black plastic bins (as in British supermarkets, where the look is common; the idea is to make the colors pop). The first thing I saw, McIntosh apples, came from the same local orchard whose apples I’d just seen in the same bags at Whole Foods. The bunched beets were from Muranaka Farm, whose beets I often buy at other markets—but these looked much fresher. The service people I could find (it wasn’t hard) were unfailingly enthusiastic, though I did wonder whether they got let out at night.

During a few days of tasting, the results were mixed. Those beets handily beat (sorry) ones I’d just bought at Whole Foods, and compared nicely with beets I’d recently bought at the farmers’ market. But packaged carrots and celery, both organic, were flavorless. Organic bananas and “tree ripened” California peaches, already out of season, were better than the ones in most supermarkets, and most of the Walmart food was cheaper—though when I went to my usual Whole Foods to compare prices for local produce, they were surprisingly similar (dry goods and dairy products were considerably less expensive at Walmart).

Walmart holding its own against Whole Foods? This called for a blind tasting.

I conspired with my contrarian friend James McWilliams, an agricultural historian at Texas State University at San Marcos and the author of the new Just Food: Where Locavores Get It Wrong and How We Can Truly Eat Responsibly. He enlisted his friends at Fino, a restaurant in Austin that pays special attention to where the food it serves comes from, as co-conspirators. I would buy two complete sets of ingredients, one at Walmart and the other at Whole Foods. The chef would prepare them as simply as possible, and serve two versions of each course, side by side on the same plate, to a group of local food experts invited to judge.

I started looking into how and why Walmart could be plausibly competing with Whole Foods, and found that its produce-buying had evolved beyond organics, to a virtually unknown program—one that could do more to encourage small and medium-size American farms than any number of well-meaning nonprofits, or the U.S. Department of Agriculture, with its new Know Your Farmer, Know Your Food campaign. Not even Fishman, who has been closely tracking Walmart’s sustainability efforts, had heard of it. “They do a lot of good things they don’t talk about,” he offered.

The program, which Walmart calls Heritage Agriculture, will encourage farms within a day’s drive of one of its warehouses to grow crops that now take days to arrive in trucks from states like Florida and California. In many cases the crops once flourished in the places where Walmart is encouraging their revival, but vanished because of Big Agriculture competition.

Ron McCormick, the senior director of local and sustainable sourcing for Walmart, told me that about three years ago he came upon pictures from the 1920s of thriving apple orchards in Rogers, Arkansas, eight miles from the company’s headquarters. Apples were once shipped from northwest Arkansas by railroad to St. Louis and Chicago. After Washington state and California took over the apple market, hardly any orchards remained. Cabbage, greens, and melons were also once staples of the local farming economy. But for decades, Arkansas’s cash crops have been tomatoes and grapes. A new initiative could diversify crops and give consumers fresher produce.

As with most Walmart programs, the clear impetus is to claim a share of consumer spending: first for organics, now for locally grown food. But buying local food is often harder than buying organic. The obstacles for both small farm and big store are many: how much a relatively small farmer can grow and how reliably, given short growing seasons; how to charge a competitive price when the farmer’s expenses are so much higher than those of industrial farms; and how to get produce from farm to warehouse.

Walmart knows all this, and knows that various nonprofit agricultural and university networks are trying to solve the same problems. In considering how to build on existing programs (and investments), Walmart talked with the local branch of the Environmental Defense Fund, which opened near the company’s Arkansas headquarters when Walmart started to look serious about green efforts, and with the Applied Sustainability Center at the University of Arkansas. The center (of which the Walmart Foundation is a chief funder) is part of a national partnership called Agile Agriculture, which includes universities such as Drake and the University of New Hampshire and nonprofits like the American Farmland Trust.* To get more locally grown produce into grocery stores and restaurants, the partnership is centralizing and streamlining distribution for farms with limited growing seasons, limited production, and limited transportation resources.

Walmart says it wants to revive local economies and communities that lost out when agriculture became centralized in large states. (The heirloom varieties beloved by foodies lost out at the same time, but so far they’re not a focus of Walmart’s program.) This would be something like bringing the once-flourishing silk and wool trades back to my hometown of Rockville, Connecticut. It’s not something you expect from Walmart, which is better known for destroying local economies than for rebuilding them.

As everyone who sells to or buys from (or, notoriously, works for) Walmart knows, price is where every consideration begins and ends. Even if the price Walmart pays for local produce is slightly higher than what it would pay large growers, savings in transport and the ability to order smaller quantities at a time can make up the difference. Contracting directly with farmers, which Walmart intends to do in the future as much as possible, can help eliminate middlemen, who sometimes misrepresent prices. Heritage produce currently accounts for only 4 to 6 percent of Walmart’s produce sales, McCormick told me (already more than a chain might spend on produce in a year, as Fishman would point out), adding that he hopes the figure will get closer to 20 percent, so the program will “go from experimental to being really viable.”

Michelle Harvey, who is in charge of working with Walmart on agriculture programs at the local Environmental Defense Fund office, summarized a long conversation with me on the sustainability efforts she thinks the company is serious about: “It’s getting harder and harder to hate Walmart.”

“We support local farmers,” read a sign at an Austin Walmart. I didn’t see any farm names listed in the produce section, but I did find plastic tubs of organic baby spinach and “spring mix” greens with modern labeling that looked like it could be at Whole Foods. My list was simple to the point of stark, for a fair fight. Some ingredients seemed identical to what I’d find at Whole Foods. Organic, free-range brown eggs. Promised Land all-natural, hormone-free milk. A bottle of Watkins Madagascar vanilla for panna cotta. I couldn’t find much in the way of the seasonal fruit the restaurant had told me the chef would serve with dessert. But I did find, to my surprise, a huge bin of pomegranates, so I bought those, and some Bosc pears. The sticking points were fresh goat cheese, which flummoxed the nice sales people (we found some Alouette brand, hidden), and chicken breasts. I could find organic meat, but no breasts without “up to 12 percent natural chicken broth” added—an attempt to inject flavor and add weight. I wasn’t happy with the suppliers, either: Tyson predominated. I bought Pilgrims Pride, but was suspicious. The bill was $126.02.

At the flagship Whole Foods, in downtown Austin, the produce was much more varied, though the spinach and spring mix looked less vibrant. The chicken was properly dry, a fresh ivory color—and more than twice as expensive as Walmart’s. My total bill was $175.04; $20 of the extra $50 was for the meat.

Brian Stubbs, the tall, genial young manager of Fino, and Jason Donoho, the chef, were intrigued as they helped me carry bag after bag into the restaurant’s kitchen. They carefully segregated the bags on two shelves of a walk-in refrigerator. The younger cooks looked surprised by the Whole Foods kraft-paper bags, and slightly horrified by the flimsy white plastic ones from Walmart.

The next night 16 critics, bloggers, and general food lovers gathered around a long, high table at the restaurant. Stubbs passed out scoring sheets with bullets for grades of one (worst) to five (best) for each of the four courses, and lines for comments.

The first course, bowls of almonds and pieces of fried goat cheese with red-onion jam and honey, was a clear win for Walmart. The Walmart almonds were described as “aromatic,” “mellow,” “pure,” and “yummy,” the Whole Foods almonds as “raw,” though also more “natural”; they were in fact fresher, though duller in flavor. (Like the best of the food I saw at the Austin Walmart, the packaging for the almonds had a homegrown Mexican look.) The second course, mixed spring greens in a sherry vinaigrette, was another Walmart win: only a few tasters preferred the Whole Foods greens, calling them fresher and heartier-flavored. And only one noticed the little brown age spots on a few Walmart leaves, but she was a ringer—Carol Ann Sayle, a local farmer famous for her greens.

So far Walmart was ahead. But then came the chicken, served with a poached egg on a bed of spinach and golden raisins. A woman whose taste I already thought uncanny—she works as an aromatherapist—compared the broth-infused meat to something out of a hospital cafeteria: “It’s like they injected it with something to make it taste like fast food.” I thought it was salty, damp, and dismal. The spinach, though, was another story: even the most ardent brothy-breast haters thought the Walmart spinach was fresher.

Dessert was the most puzzling. I had thought that Walmart’s locally sourced milk and exotic-looking vanilla would be the gold standard, but the Whole Foods house brands slaughtered them (“Kicks A’s ass,” one taster wrote). People couldn’t find enough words to diss the Walmart panna cotta (“artificial, thin”) and praise the Whole Foods one (“like a good Christmas”). I wished I’d bought the identical Promised Land milk at Whole Foods, to see if there is in fact a difference in the branded food products that suppliers give Walmart, as there is in the case of other branded products. The pomegranate seeds, sadly, were wan, with barely any flavor, particularly compared with the garnet gems from Whole Foods. But Walmart got points from the chef, and from me, for carrying pomegranates at all.

As I had been in my own kitchen, the tasters were surprised when the results were unblinded at the end of the meal and they learned that in a number of instances they had adamantly preferred Walmart produce. And they weren’t entirely happy.

In an ideal world, people would buy their food directly from the people who grew or caught it, or grow and catch it themselves. But most people can’t do that. If there were a Walmart closer to where I live, I would probably shop there.

Most important, the vast majority of Walmarts carry a large range of affordable fresh fruits and vegetables. And Walmarts serve many “food deserts,” in large cities and rural areas—ironically including farm areas. I’m not sure I’m convinced that the world’s largest retailer is set on rebuilding local economies it had a hand in destroying, if not literally, then in effect. But I’m convinced that if it wants to, a ruthlessly well-run mechanism can bring fruits and vegetables back to land where they once flourished, and deliver them to the people who need them most.

Correction: The article originally stated, incorrectly, that the Agile Agriculture partnership included the National Sustainable Agriculture Coalition.

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Posted by steveneidman on February 26, 2010

  An In-Depth Look At the Federal Budget

by Hale “Bonddad” Stewart

This week, the president announced the creation of a panel to look at the federal budget. As such, it seems appropriate to look at the federal budget in detail to get a sense of what’s there. All of the information contained in the graphs that follow is available from the CBO. Please click on all images to see a larger image. Also, all data starts in 1970 and goes through fiscal 2009.
The US has run a surplus 4 years since 1970, or about 10% of the time. Over those 39 years we’ve had Republican and Democratic control of both the White House and Congress. This leads to a very simple conclusion: no party can make a legitimate claim to being fiscally responsible.
Above is a chart of the total deficit for each year going back to 1970. First, note (again) only four years show a surplus. This means that for 35 years (and in fact for a longer period) the US has issued debt on a continuing basis to pay for its revenue shortfall. This means the US — like most US corporations — has to manage its Treasury operations. All this means is the US Treasury has to decide what maturity of Treasury bond to issue, how much of a particular Treasury bond to issue and when to issue it. Again, this is standard procedure from a corporate finance perspective.$12.4 trillion and total US GDP is approximately $14.4 trillion. That makes the debt/GDP ratio 86%. While that is not good, it is not fatal.
Above is a chart of total federal outlays as a percent of GDP. Notice the number has been remarkably constant since 1970, fluctuating right around 20% for most of that time.
Personal income taxes (the top blue line) comprise the largest percentage of federal tax receipts. In addition, these have continually comprised about 45%-50% of total federal receipts. The biggest change since 1970 has occurred in social insurance taxes (the yellow line), which have increased from a little over 20% to about 35%-40% over the last 10 years. Corporate taxes (the light purple line) have also been consistently responsible for about 10% of total tax receipts. Finally, note that estate and gift taxes (the light blue line at the bottom of the graph) overall contribution is more or less negligible on a percentage basis.
The above chart looks at federal receipts from a percent of GDP basis. Fist, note the percentages have been fairly consistent since 1970. Personal income taxes total between 8%-10% of GDP, corporate taxes total about 2% of GDP and estate and gift taxes account for less than 1% of GDP. The only big change has been an increase in social insurance taxes, which have increased to about 6% of GDP.
The above chart breaks federal spending down into mandatory, discretionary and interest payments. Mandatory spending has increased from a little under 40% of the federal budget in 1970 to right around 60% over the last few years. Discretionary spending has decreased from right around 60% in 1970 to a little under 40% over the last few years. The progression of mandatory spending is at the center of much of the budgetary concern in Washington and the public.
Above is a chart of the 10-year CMT (constantly maturing treasury). Interest rates have been dropping for about 20 years. While there is considerable debate regarding the possibility of this continuing, we’ll have to wait and see how that plays out.
Above is a chart of mandatory and discretionary spending as a percent of GDP. Interestingly enough, despite the increase in the dollar amount of discretionary spending, it has remained more or less constant on a percent of GDP basis. The recent spike may be the result of the extraordinary budgetary circumstances the country is currently in. Additionally, discretionary spending actually dropped until the beginning of the decade when it started to rise again. Finally, interest payments are under control for now.

Let’s start with a chart of government revenues and expenditures, starting in 1970:

Currently, total US debt is approximately

Let’s take a look at the components of federal revenue.

Finally, note that interest payments are in fact pretty much under control. The primary reason for this is the near 20 year downward trajectory in interest rates:

Finally, the chart above shows the percentages of SS, Medicaid and Medicare of mandatory spending. The big issue here is clear: note the increase of medicare as a percentage of mandatory spending. It’s been increasing for some time.

So, what does all of this tell us about the US budget?

1.) The total federal debt/GDP ratio and interest rate payments (both on a percent to total expenditures and percent of GDP) are manageable at current levels. All of this has been aided by a two decade long decrease in interest rates. It’s doubtful that will continue given the current pace of expenditures. Most importantly, given the current rate of spending and debt growth, changes will have to be made once we are out of the recession for sure. And that’s where the real political problem lies.

2.) While mandatory spending has remained constant as a percent of GDP, it’s increase to about 60% of the current federal budget is perhaps the biggest problem the US faces going forward. And as the percentage increase in medicare payments indicates, medical payments are a primary reason for the problems the country faces at the federal fiscal level.

3.) The argument that the US is taxed to death is wrong. On a percent of GDP basis the US is taxed at moderate rates.

4.) I’m surprised how unimportant estate and gift taxes are to the overall scheme of things. Even before the generous estate tax credit of the last few years (essentially exempting estates worth less than $3.5 million), estate and gift taxes are remarkably unimportant from a total revenues perspective. It’s obvious they serve another purpose such as the theoretical prevention of dynastic wealth transfer.

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The Problem With Political Reporting

Posted by steveneidman on February 22, 2010

The Quest for Innocence and the Loss of Reality in Political Journalism

by Jay Rosen of PressThink

This is a post about a single line in a recent article in the New York Times: Tea Party Lights Fuse for Rebellion on Right.

Before I get to the line that interested me, I need to acknowledge that the investigation the Times undertook for this article is wholly admirable and exactly what we need professional journalists to be doing. Reporter David Barstow spent five months—five months!—reporting and researching the Tea Party phenomenon.

He went to their events. He talked to hundreds of people drawn into the movement. He watched what happens at their rallies and the smaller meetings where movement politics is transacted. He made himself fully literate, learning the differences between the Tea Party and the Patriot movements, reading the authors who have infuenced Tea Party activists, getting to know local leaders and regional differences, building up a complex and layered portrait of a political cohort that doesn’t fit into party politics as normally understood.

This is original reporting at a very high level of commitment to public service; it is expensive, difficult, and increasingly rare in a news business suffering under economic collapse.

So I want to make it absolutely clear that I treasure this kind of journalism and indeed devoured Barstow’s report when it came online. (Although I wish it had been twice as long.) And I have no problem with his decision to confine himself to description of the Tea Party movement, rather than evaluating its goodness or badness. The first task is to understand, and that is why we need reporters willing to go out there and witness the phenomenon, interview the participants, pore over the texts and struggle with their account until they feel they have it right.

“A narrative of impending tyranny.”

As Barstow said in an interview with Columbia Journalism Review, “If you spend enough time talking to people in the movement, eventually you hear enough of the same kinds of ideas, the same kinds of concerns, and you begin to recognize what the ideology is, what the paradigm is that they’re operating in.” The key words are spend enough time and begin to recognize.

Now to the part that puzzles me:

It is a sprawling rebellion, but running through it is a narrative of impending tyranny. This narrative permeates Tea Party Web sites, Facebook pages, Twitter feeds and YouTube videos. It is a prominent theme of their favored media outlets and commentators, and it connects the disparate issues that preoccupy many Tea Party supporters — from the concern that the community organization Acorn is stealing elections to the belief that Mr. Obama is trying to control the Internet and restrict gun ownership.

Running through it is a narrative of impending tyranny…That sounds like the Tea Party movement I have observed, so the truth of the sentence is not in doubt. But what about the truth of the narrative? David Barstow is a Pulitzer Prize winning investigative reporter for the New York Times. He ought to know whether the United States is on the verge of losing its democracy and succumbing to an authoritarian or despotic form of government. If tyranny was pending in the U.S. that would seem to be a story. The New York Times has done a lot of reporting about the Obama Administration, but it has been silent on the collapse of basic freedoms lurking just around the corner. Barstow commented on the sentence that disturbed me in his interview with CJR:

The other thing that came through was this idea of impending tyranny. You could not go to Tea Party rallies or spend time talking to people within the movement without hearing that fear expressed in myriad ways. I was struck by the number of people who had come to the point where they were literally in fear of whether or not the United States of America would continue to be a free country. I just started seeing that theme come up everywhere I went.

It kept coming up, but David… did it make any sense? Was it grounded in observable fact, the very thing that investigative reporters specialize in? Did it square (at all) with what else Barstow knows, and what the New York Times has reported about the state of politics in 2009-10? Seriously: Why is this phrase, impending tyranny, just sitting there, as if Barstow had no way of knowing whether it was crazed and manipulated or verifiable and reasonable? If we credit the observation that a great many Americans drawn to the Tea Party live in fear that the United States is about to turn into a tyranny, with rigged elections, loss of civil liberties, no more free press, a police state… can we also credit the professional attitude that refuses to say whether this fear is reality-based? I don’t see how we can.

As a matter of reported fact

Now we can predict, with a reasonable degree of confidence, what the reply would be from the reporter, his editors (who are equally involved here, as the Times is a very editor-driven newspaper) and his peers in the press. The reply is the reply that is given by the common sense of pro journalism as it is practiced in the United States. “This was a news story, an attempt to report what’s happening out there, as accurately and fairly as possible. Which is not the place for the author’s opinion.” Or: “I was trying to describe the Tea Party movement, and to understand it, which is hard enough; I’ll let others judge what to make of it.”

Sounds good, right? But this distinction, between fact and opinion, description and assessment, is not what my question is about. It may appear to be responsive, but it really isn’t. The price of liberty is eternal vigilance, but… as a matter of reported fact, is the United States actually on the verge of tyranny? That is my question. Would a fair description of the American political scene by the Washington bureau and investigative staff of the New York Times lend support to the “impending tyranny” narrative that Barstow observed as a unifying theme in the Tea Party movement?

It’s a key point, so let me state it again: Based not on a subjective assessment of the Tea Party’s viability or his opinion of its desirability but only on facts he knows about the state of politics and government since Obama’s election, is there any substantial likelihood of a tyranny replacing the American republic in the near future?

I think it’s obvious—not only to me but to Barstow and the journalist who interviewed him for CJR—that the answers are “no.” For if the answers were “yes” it would have been a huge story! No fair description of the current scene, nothing in what the Washington bureau and investigative staff of the New York Times has picked up from its reporting, would support a characterization like “impending tyranny.”

In a word, the Times editors and Barstow know this narrative is nuts, but something stops them from saying so— despite the fact that they must have spent over $100,000 on this one story. And whatever that thing is, it’s not the reluctance to voice an opinion in the news columns, but a reluctance to report a fact in the news columns, the fact that the “narrative of impending tyranny” is ungrounded in any observable reality, even though the sense of grievance within the Tea Party movement is truly felt and politically consequential.

A faltering sense of reality

My claim: We have come upon something interfering with political journalism’s “sense of reality” as the philosopher Isaiah Berlin called it (see section 5.1) And I think I have a term for the confusing factor: a quest for innocence in reportage and dispute description. Innocence, meaning a determination not to be implicated, enlisted, or seen by the public as involved. That’s what created the pattern I’ve called “regression to a phony mean.” That’s what motivated the rise of he said, she said reporting.

I explained the quest for innocence in a 2008 essay on campaign coverage for tomdispatch.com. (It also ran in Salon.)

But the biggest advantage of horse-race journalism is that it permits reporters and pundits to play up their detachment. Focusing on the race advertises the political innocence of the press because “who’s gonna win?” is not an ideological question. By asking it you reaffirm that yours is not an ideological profession. This is experienced as pleasure by a lot of mainstream journalists. Ever noticed how spirits lift when the pundit roundtable turns from the Middle East or the looming recession to the horse race, and there’s an opportunity for sizing up the candidates? To be manifestly agenda-less is journalistic bliss. Of course, since trying to get ahead of the voters can affect how voters view the candidates, the innocence, too, is an illusion.

The quest for innocence in political journalism means the desire to be manifestly agenda-less and thus “prove” in the way you describe things that journalism is not an ideological trade. But this can get in the way of describing things! As it did in Barstow’s account. Now let’s speed up the picture and imagine how this interference in truth-telling happens routinely, many times a day over years and years of reporting on politics. What’s lost is that sense of reality Isaiah Berlin talked about. In its place is savviness, the dialect of insiders trying to persuade us that they know how things really work. Nothing is more characteristic of the savvy style than statements like “perception is often reality in politics.”

“For some reason, American political coverage is exempt.”

And in fact frustrated observers of political journalism have complained about this loss of the real. The latest to groan about it is George Packer in the New Yorker. He was commenting on how David Broder of the Washington Post, the dean emeritus of political reporters, had written a surreal column about Sarah Palin that nonetheless seemed entirely normal if you know the genre:

Broder wasn’t analyzing Palin’s positions or accusations, or the truth or falsehood of her claims, or even the nature of the emotions that she appeals to. He was reviewing a performance and giving it the thumbs up, using the familiar terminology of political journalism. This has been so characteristic of the coverage of politics for so long that it doesn’t seem in the least bit odd, and it’s hard to imagine doing it any other way.

Italics mine. Packer’s point becomes clearer when he transplants this kind of reportng to Afghanistan with the sense of reality dropped out. “Imagine Karzai’s recent inaugural address as covered by a Washington journalist,” he writes:

“Speaking at the presidential palace in Kabul, Mr. Karzai showed himself to be at the top of his game. He skillfully co-opted his Pashtun base while making a powerful appeal to the technocrats who have lately been disappointed in him, and at the same time he reassured the Afghan public that his patience with civilian casualties is wearing thin. A palace insider, who asked for anonymity in order to be able to speak candidly, said, “If Karzai can continue to signal the West that he is concerned about corruption without alienating his warlord allies, he will likely be able to defuse the perception of a weak leader and regain his image as a unifying figure who can play the role of both modernizer and nationalist.” Still, the palace insider acknowledged, tensions remain within Mr. Karzai’s own inner circle.

This sounds like politics the way our journalists narrate it, but as Packer notes, “A war or an economic collapse has a reality apart from perceptions, which imposes a pressure on reporters to find it. But for some reason, American political coverage is exempt.” Exactly. That’s the exemption Barstow was calling on when he wrote. “… running through it is a narrative of impending tyranny.” Somehow the reality that this narrative exists as a binding force within the Tea Party movement is more reportable than the fact that the movement’s binding force is a fake crisis, a delusion shared.

I leave you with a question: how the hell could this happen?

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Posted by steveneidman on February 16, 2010

How a New Jobless Era Will Transform America

 

Image credit: Fredrik Broden

By Don Peck

 

 

 

 

 

 

 

 

 

How should we characterize the economic period we have now entered? After nearly two brutal years, the Great Recession appears to be over, at least technically. Yet a return to normalcy seems far off. By some measures, each recession since the 1980s has retreated more slowly than the one before it. In one sense, we never fully recovered from the last one, in 2001: the share of the civilian population with a job never returned to its previous peak before this downturn began, and incomes were stagnant throughout the decade. Still, the weakness that lingered through much of the 2000s shouldn’t be confused with the trauma of the past two years, a trauma that will remain heavy for quite some time.

The unemployment rate hit 10 percent in October, and there are good reasons to believe that by 2011, 2012, even 2014, it will have declined only a little. Late last year, the average duration of unemployment surpassed six months, the first time that has happened since 1948, when the Bureau of Labor Statistics began tracking that number. As of this writing, for every open job in the U.S., six people are actively looking for work. 

All of these figures understate the magnitude of the jobs crisis. The broadest measure of unemployment and underemployment (which includes people who want to work but have stopped actively searching for a job, along with those who want full-time jobs but can find only part-time work) reached 17.4 percent in October, which appears to be the highest figure since the 1930s. And for large swaths of society—young adults, men, minorities—that figure was much higher (among teenagers, for instance, even the narrowest measure of unemployment stood at roughly 27 percent). One recent survey showed that 44 percent of families had experienced a job loss, a reduction in hours, or a pay cut in the past year. 

There is unemployment, a brief and relatively routine transitional state that results from the rise and fall of companies in any economy, and there is unemployment—chronic, all-consuming. The former is a necessary lubricant in any engine of economic growth. The latter is a pestilence that slowly eats away at people, families, and, if it spreads widely enough, the fabric of society. Indeed, history suggests that it is perhaps society’s most noxious ill. 

The worst effects of pervasive joblessness—on family, politics, society—take time to incubate, and they show themselves only slowly. But ultimately, they leave deep marks that endure long after boom times have returned. Some of these marks are just now becoming visible, and even if the economy magically and fully recovers tomorrow, new ones will continue to appear. The longer our economic slump lasts, the deeper they’ll be. 

If it persists much longer, this era of high joblessness will likely change the life course and character of a generation of young adults—and quite possibly those of the children behind them as well. It will leave an indelible imprint on many blue-collar white men—and on white culture. It could change the nature of modern marriage, and also cripple marriage as an institution in many communities. It may already be plunging many inner cities into a kind of despair and dysfunction not seen for decades. Ultimately, it is likely to warp our politics, our culture, and the character of our society for years. 

The Long Road Ahead

 

Since last spring, when fears of economic apocalypse began to ebb, we’ve been treated to an alphabet soup of predictions about the recovery. Various economists have suggested that it might look like a V (a strong and rapid rebound), a U (slower), a W (reflecting the possibility of a double-dip recession), or, most alarming, an L (no recovery in demand or jobs for years: a lost decade). This summer, with all the good letters already taken, the former labor secretary Robert Reich wrote on his blog that the recovery might actually be shaped like an X (the imagery is elusive, but Reich’s argument was that there can be no recovery until we find an entirely new model of economic growth). 

No one knows what shape the recovery will take. The economy grew at an annual rate of 2.2 percent in the third quarter of last year, the first increase since the second quarter of 2008. If economic growth continues to pick up, substantial job growth will eventually follow. But there are many reasons to doubt the durability of the economic turnaround, and the speed with which jobs will return. 

Historically, financial crises have spawned long periods of economic malaise, and this crisis, so far, has been true to form. Despite the bailouts, many banks’ balance sheets remain weak; more than 140 banks failed in 2009. As a result, banks have kept lending standards tight, frustrating the efforts of small businesses—which have accounted for almost half of all job losses—to invest or rehire. Exports seem unlikely to provide much of a boost; although China, India, Brazil, and some other emerging markets are growing quickly again, Europe and Japan—both major markets for U.S. exports—remain weak. And in any case, exports make up only about 13 percent of total U.S. production; even if they were to grow quickly, the impact would be muted. 

Most recessions end when people start spending again, but for the foreseeable future, U.S. consumer demand is unlikely to propel strong economic growth. As of November, one in seven mortgages was delinquent, up from one in 10 a year earlier. As many as one in four houses may now be underwater, and the ratio of household debt to GDP, about 65 percent in the mid-1990s, is roughly 100 percent today. It is not merely animal spirits that are keeping people from spending freely (though those spirits are dour). Heavy debt and large losses of wealth have forced spending onto a lower path. 

So what is the engine that will pull the U.S. back onto a strong growth path? That turns out to be a hard question. The New York Times columnist Paul Krugman, who fears a lost decade, said in a lecture at the London School of Economics last summer that he has “no idea” how the economy could quickly return to strong, sustainable growth. Mark Zandi, the chief economist at Moody’s Economy.com, told the Associated Press last fall, “I think the unemployment rate will be permanently higher, or at least higher for the foreseeable future. The collective psyche has changed as a result of what we’ve been through. And we’re going to be different as a result.” 

One big reason that the economy stabilized last summer and fall is the stimulus; the Congressional Budget Office estimates that without the stimulus, growth would have been anywhere from 1.2 to 3.2 percentage points lower in the third quarter of 2009. The stimulus will continue to trickle into the economy for the next couple of years, but as a concentrated force, it’s largely spent. Christina Romer, the chair of President Obama’s Council of Economic Advisers, said last fall, “By mid-2010, fiscal stimulus will likely be contributing little to further growth,” adding that she didn’t expect unemployment to fall significantly until 2011. That prediction has since been echoed, more or less, by the Federal Reserve and Goldman Sachs. 

The economy now sits in a hole more than 10 million jobs deep—that’s the number required to get back to 5 percent unemployment, the rate we had before the recession started, and one that’s been more or less typical for a generation. And because the population is growing and new people are continually coming onto the job market, we need to produce roughly 1.5 million new jobs a year—about 125,000 a month—just to keep from sinking deeper. 

Even if the economy were to immediately begin producing 600,000 jobs a month—more than double the pace of the mid-to-late 1990s, when job growth was strong—it would take roughly two years to dig ourselves out of the hole we’re in. The economy could add jobs that fast, or even faster—job growth is theoretically limited only by labor supply, and a lot more labor is sitting idle today than usual. But the U.S. hasn’t seen that pace of sustained employment growth in more than 30 years. And given the particulars of this recession, matching idle workers with new jobs—even once economic growth picks up—seems likely to be a particularly slow and challenging process. 

The construction and finance industries, bloated by a decade-long housing bubble, are unlikely to regain their former share of the economy, and as a result many out-of-work finance professionals and construction workers won’t be able to simply pick up where they left off when growth returns—they’ll need to retrain and find new careers. (For different reasons, the same might be said of many media professionals and auto workers.) And even within industries that are likely to bounce back smartly, temporary layoffs have generally given way to the permanent elimination of jobs, the result of workplace restructuring. Manufacturing jobs have of course been moving overseas for decades, and still are; but recently, the outsourcing of much white-collar work has become possible. Companies that have cut domestic payrolls to the bone in this recession may choose to rebuild them in Shanghai, Guangzhou, or Bangalore, accelerating off-shoring decisions that otherwise might have occurred over many years. 

New jobs will come open in the U.S. But many will have different skill requirements than the old ones. “In a sense,” says Gary Burtless, a labor economist at the Brookings Institution, “every time someone’s laid off now, they need to start all over. They don’t even know what industry they’ll be in next.” And as a spell of unemployment lengthens, skills erode and behavior tends to change, leaving some people unqualified even for work they once did well. 

Ultimately, innovation is what allows an economy to grow quickly and create new jobs as old ones obsolesce and disappear. Typically, one salutary side effect of recessions is that they eventually spur booms in innovation. Some laid-off employees become entrepreneurs, working on ideas that have been ignored by corporate bureaucracies, while sclerotic firms in declining industries fail, making way for nimbler enterprises. But according to the economist Edmund Phelps, the innovative potential of the U.S. economy looks limited today. In a recent Harvard Business Review article, he and his co-author, Leo Tilman, argue that dynamism in the U.S. has actually been in decline for a decade; with the housing bubble fueling easy (but unsustainable) growth for much of that time, we just didn’t notice. Phelps and Tilman finger several culprits: a patent system that’s become stifling; an increasingly myopic focus among public companies on quarterly results, rather than long-term value creation; and, not least, a financial industry that for a generation has focused its talent and resources not on funding business innovation, but on proprietary trading, regulatory arbitrage, and arcane financial engineering. None of these problems is likely to disappear quickly. Phelps, who won a Nobel Prize for his work on the “natural” rate of unemployment, believes that until they do disappear, the new floor for unemployment is likely to be between 6.5 percent and 7.5 percent, even once “recovery” is complete. 

It’s likely, then, that for the next several years or more, the jobs environment will more closely resemble today’s environment than that of 2006 or 2007—or for that matter, the environment to which we were accustomed for a generation. Heidi Shierholz, an economist at the Economic Policy Institute, notes that if the recovery follows the same basic path as the last two (in 1991 and 2001), unemployment will stand at roughly 8 percent in 2014. 

“We haven’t seen anything like this before: a really deep recession combined with a really extended period, maybe as much as eight years, all told, of highly elevated unemployment,” Shierholz told me. “We’re about to see a big national experiment on stress.” 

The Recession and America’s Youth

 

“I’m definitely seeing a lot of the older generation saying, ‘Oh, this [recession] is so awful,’” Robert Sherman, a 2009 graduate of Syracuse University, told The New York Times in July. “But my generation isn’t getting as depressed and uptight.” Sherman had recently turned down a $50,000-a-year job at a consulting firm, after careful deliberation with his parents, because he hadn’t connected well with his potential bosses. Instead he was doing odd jobs and trying to get a couple of tech companies off the ground. “The economy will rebound,” he said. 

Over the past two generations, particularly among many college grads, the 20s have become a sort of netherworld between adolescence and adulthood. Job-switching is common, and with it, periods of voluntary, transitional unemployment. And as marriage and parenthood have receded farther into the future, the first years after college have become, arguably, more carefree. In this recession, the term funemployment has gained some currency among single 20-somethings, prompting a small raft of youth-culture stories in the Los Angeles Times and San Francisco Weekly, on Gawker, and in other venues.

Most of the people interviewed in these stories seem merely to be trying to stay positive and make the best of a bad situation. They note that it’s a good time to reevaluate career choices; that since joblessness is now so common among their peers, it has lost much of its stigma; and that since they don’t have mortgages or kids, they have flexibility, and in this respect, they are lucky. All of this sounds sensible enough—it is intuitive to think that youth will be spared the worst of the recession’s scars. 

But in fact a whole generation of young adults is likely to see its life chances permanently diminished by this recession. Lisa Kahn, an economist at Yale, has studied the impact of recessions on the lifetime earnings of young workers. In one recent study, she followed the career paths of white men who graduated from college between 1979 and 1989. She found that, all else equal, for every one-percentage-point increase in the national unemployment rate, the starting income of new graduates fell by as much as 7 percent; the unluckiest graduates of the decade, who emerged into the teeth of the 1981–82 recession, made roughly 25 percent less in their first year than graduates who stepped into boom times. 

But what’s truly remarkable is the persistence of the earnings gap. Five, 10, 15 years after graduation, after untold promotions and career changes spanning booms and busts, the unlucky graduates never closed the gap. Seventeen years after graduation, those who had entered the workforce during inhospitable times were still earning 10 percent less on average than those who had emerged into a more bountiful climate. When you add up all the earnings losses over the years, Kahn says, it’s as if the lucky graduates had been given a gift of about $100,000, adjusted for inflation, immediately upon graduation—or, alternatively, as if the unlucky ones had been saddled with a debt of the same size. 

When Kahn looked more closely at the unlucky graduates at mid-career, she found some surprising characteristics. They were significantly less likely to work in professional occupations or other prestigious spheres. And they clung more tightly to their jobs: average job tenure was unusually long. People who entered the workforce during the recession “didn’t switch jobs as much, and particularly for young workers, that’s how you increase wages,” Kahn told me. This behavior may have resulted from a lingering risk aversion, born of a tough start. But a lack of opportunities may have played a larger role, she said: when you’re forced to start work in a particularly low-level job or unsexy career, it’s easy for other employers to dismiss you as having low potential. Moving up, or moving on to something different and better, becomes more difficult. 

“Graduates’ first jobs have an inordinate impact on their career path and [lifetime earnings],” wrote Austan Goolsbee, now a member of President Obama’s Council of Economic Advisers, in The New York Times in 2006. “People essentially cannot close the wage gap by working their way up the company hierarchy. While they may work their way up, the people who started above them do, too. They don’t catch up.” Recent research suggests that as much as two-thirds of real lifetime wage growth typically occurs in the first 10 years of a career. After that, as people start families and their career paths lengthen and solidify, jumping the tracks becomes harder. 

This job environment is not one in which fast-track jobs are plentiful, to say the least. According to the National Association of Colleges and Employers, job offers to graduating seniors declined 21 percent last year, and are expected to decline another 7 percent this year. Last spring, in the San Francisco Bay Area, an organization called JobNob began holding networking happy hours to try to match college graduates with start-up companies looking primarily for unpaid labor. Julie Greenberg, a co-founder of JobNob, says that at the first event, on May 7, she expected perhaps 30 people, but 300 showed up. New graduates didn’t have much of a chance; most of the people there had several years of work experience—quite a lot were 30-somethings—and some had more than one degree. JobNob has since held events for alumni of Stanford, Berkeley, and Harvard; all have been well attended (at the Harvard event, Greenberg tried to restrict attendance to 75, but about 100 people managed to get in), and all have been dominated by people with significant work experience. 

When experienced workers holding prestigious degrees are taking unpaid internships, not much is left for newly minted B.A.s. Yet if those same B.A.s don’t find purchase in the job market, they’ll soon have to compete with a fresh class of graduates—ones without white space on their résumé to explain. This is a tough squeeze to escape, and it only gets tighter over time. 

Strong evidence suggests that people who don’t find solid roots in the job market within a year or two have a particularly hard time righting themselves. In part, that’s because many of them become different—and damaged—people. Krysia Mossakowski, a sociologist at the University of Miami, has found that in young adults, long bouts of unemployment provoke long-lasting changes in behavior and mental health. “Some people say, ‘Oh, well, they’re young, they’re in and out of the workforce, so unemployment shouldn’t matter much psychologically,’” Mossakowski told me. “But that isn’t true.” 

Examining national longitudinal data, Mossakowski has found that people who were unemployed for long periods in their teens or early 20s are far more likely to develop a habit of heavy drinking (five or more drinks in one sitting) by the time they approach middle age. They are also more likely to develop depressive symptoms. Prior drinking behavior and psychological history do not explain these problems—they result from unemployment itself. And the problems are not limited to those who never find steady work; they show up quite strongly as well in people who are later working regularly. 

Forty years ago, Glen Elder, a sociologist at the University of North Carolina and a pioneer in the field of “life course” studies, found a pronounced diffidence in elderly men (though not women) who had suffered hardship as 20- and 30-somethings during the Depression. Decades later, unlike peers who had been largely spared in the 1930s, these men came across, he told me, as “beaten and withdrawn—lacking ambition, direction, confidence in themselves.” Today in Japan, according to the Japan Productivity Center for Socio-Economic Development, workers who began their careers during the “lost decade” of the 1990s and are now in their 30s make up six out of every 10 cases of depression, stress, and work-related mental disabilities reported by employers. 

A large and long-standing body of research shows that physical health tends to deteriorate during unemployment, most likely through a combination of fewer financial resources and a higher stress level. The most-recent research suggests that poor health is prevalent among the young, and endures for a lifetime. Till Von Wachter, an economist at Columbia University, and Daniel Sullivan, of the Federal Reserve Bank of Chicago, recently looked at the mortality rates of men who had lost their jobs in Pennsylvania in the 1970s and ’80s. They found that particularly among men in their 40s or 50s, mortality rates rose markedly soon after a layoff. But regardless of age, all men were left with an elevated risk of dying in each year following their episode of unemployment, for the rest of their lives. And so, the younger the worker, the more pronounced the effect on his lifespan: the lives of workers who had lost their job at 30, Von Wachter and Sullivan found, were shorter than those who had lost their job at 50 or 55—and more than a year and a half shorter than those who’d never lost their job at all. 

Journalists and academics have thrown various labels at today’s young adults, hoping one might stick—Generation Y, Generation Next, the Net Generation, the Millennials, the Echo Boomers. All of these efforts contain an element of folly; the diversity of character within a generation is always and infinitely larger than the gap between generations. Still, the cultural and economic environment in which each generation is incubated clearly matters. It is no coincidence that the members of Generation X—painted as cynical, apathetic slackers—first emerged into the workforce in the weak job market of the early-to-mid-1980s. Nor is it a coincidence that the early members of Generation Y—labeled as optimistic, rule-following achievers—came of age during the Internet boom of the late 1990s. 

Many of today’s young adults seem temperamentally unprepared for the circumstances in which they now find themselves. Jean Twenge, an associate professor of psychology at San Diego State University, has carefully compared the attitudes of today’s young adults to those of previous generations when they were the same age. Using national survey data, she’s found that to an unprecedented degree, people who graduated from high school in the 2000s dislike the idea of work for work’s sake, and expect jobs and career to be tailored to their interests and lifestyle. Yet they also have much higher material expectations than previous generations, and believe financial success is extremely important. “There’s this idea that, ‘Yeah, I don’t want to work, but I’m still going to get all the stuff I want,’” Twenge told me. “It’s a generation in which every kid has been told, ‘You can be anything you want. You’re special.’” 

In her 2006 book, Generation Me, Twenge notes that self-esteem in children began rising sharply around 1980, and hasn’t stopped since. By 1999, according to one survey, 91 percent of teens described themselves as responsible, 74 percent as physically attractive, and 79 percent as very intelligent. (More than 40 percent of teens also expected that they would be earning $75,000 a year or more by age 30; the median salary made by a 30-year-old was $27,000 that year.) Twenge attributes the shift to broad changes in parenting styles and teaching methods, in response to the growing belief that children should always feel good about themselves, no matter what. As the years have passed, efforts to boost self-esteem—and to decouple it from performance—have become widespread. 

These efforts have succeeded in making today’s youth more confident and individualistic. But that may not benefit them in adulthood, particularly in this economic environment. Twenge writes that “self-esteem without basis encourages laziness rather than hard work,” and that “the ability to persevere and keep going” is “a much better predictor of life outcomes than self-esteem.” She worries that many young people might be inclined to simply give up in this job market. “You’d think if people are more individualistic, they’d be more independent,” she told me. “But it’s not really true. There’s an element of entitlement—they expect people to figure things out for them.” 

Ron Alsop, a former reporter for The Wall Street Journal and the author of The Trophy Kids Grow Up: How the Millennial Generation Is Shaking Up the Workplace, says a combination of entitlement and highly structured childhood has resulted in a lack of independence and entrepreneurialism in many 20-somethings. They’re used to checklists, he says, and “don’t excel at leadership or independent problem solving.” Alsop interviewed dozens of employers for his book, and concluded that unlike previous generations, Millennials, as a group, “need almost constant direction” in the workplace. “Many flounder without precise guidelines but thrive in structured situations that provide clearly defined rules.” 

All of these characteristics are worrisome, given a harsh economic environment that requires perseverance, adaptability, humility, and entrepreneurialism. Perhaps most worrisome, though, is the fatalism and lack of agency that both Twenge and Alsop discern in today’s young adults. Trained throughout childhood to disconnect performance from reward, and told repeatedly that they are destined for great things, many are quick to place blame elsewhere when something goes wrong, and inclined to believe that bad situations will sort themselves out—or will be sorted out by parents or other helpers. 

In his remarks at last year’s commencement, in May, The New York Times reported, University of Connecticut President Michael Hogan addressed the phenomenon of students’ turning down jobs, with no alternatives, because they didn’t feel the jobs were good enough. “My first word of advice is this,” he told the graduates. “Say yes. In fact, say yes as often as you can. Saying yes begins things. Saying yes is how things grow. Saying yes leads to new experiences, and new experiences will lead to knowledge and wisdom. Yes is for young people, and an attitude of yes is how you will be able to go forward in these uncertain times.” 

Larry Druckenbrod, the university’s assistant director of career services, told me last fall, “This is a group that’s done résumé building since middle school. They’ve been told they’ve been preparing to go out and do great things after college. And now they’ve been dealt a 180.” For many, that’s led to “immobilization.” Druckenbrod said that about a third of the seniors he talked to that semester were seriously looking for work; another third were planning to go to grad school. The final third, he said, were “not even engaging with the job market—these are the ones whose parents have already said, ‘Just come home and live with us.’” 

According to a recent Pew survey, 10 percent of adults younger than 35 have moved back in with their parents as a result of the recession. But that’s merely an acceleration of a trend that has been under way for a generation or more. By the middle of the aughts, for instance, the percentage of 26-year-olds living with their parents reached 20 percent, nearly double what it was in 1970. Well before the recession began, this generation of young adults was less likely to work, or at least work steadily, than other recent generations. Since 2000, the percentage of people age 16 to 24 participating in the labor force has been declining (from 66 percent to 56 percent across the decade). Increased college attendance explains only part of the shift; the rest is a puzzle. Lingering weakness in the job market since 2001 may be one cause. Twenge believes the propensity of this generation to pursue “dream” careers that are, for most people, unlikely to work out may also be partly responsible. (In 2004, a national survey found that about one out of 18 college freshmen expected to make a living as an actor, musician, or artist.) 

Whatever the reason, the fact that so many young adults weren’t firmly rooted in the workforce even before the crash is deeply worrying. It means that a very large number of young adults entered the recession already vulnerable to all the ills that joblessness produces over time. It means that for a sizeable proportion of 20- and 30-somethings, the next few years will likely be toxic. 

No young people were present at a seminar for the unemployed held on November 4 in Reading, Pennsylvania, a blue-collar city about 60 miles west of Philadelphia. The meeting was organized by a regional nonprofit, Joseph’s People, and held in the basement of the St. Catharine’s parish center. All 30 or so attendees, sitting around a U-shaped table, looked to be 40 or older. But one middle-aged man, one of the first to introduce himself to the group, said he and his wife were there on behalf of their son, Errol. “He’s so disgusted that he didn’t want to come,” the man said. “He doesn’t know what to do, and we don’t either.” 

I talked to Errol a few days later. He is 28 and has a gentle, straightforward manner. He graduated from high school in 1999 and has lived with his parents since then. He worked in a machine shop for a couple of years after school, and has also held jobs at a battery factory, a sandpaper manufacturer, and a restaurant, where he was a cook. The restaurant closed in June 2008, and apart from a few days of work through temp agencies, he hasn’t had a job since. 

He calls in to a few temp agencies each week to let them know he’s interested in working, and checks the newspaper for job listings every Sunday. Sometimes he goes into CareerLink, the local unemployment office, to see if it has any new listings. He does work around the house, or in the small machine shop he’s set up in the garage, just to fill his days, and to try to keep his skills up. 

“I was thinking about moving,” he said. “I’m just really not sure where. Other places where I traveled, I didn’t really see much of a difference with what there was here.” He’s still got a few thousand dollars in the bank, which he saved when he was working as a machinist, and is mostly living off that; he’s been trading penny stocks to try to replenish those savings. 

I asked him what he foresaw for his working life. “As far as my job position,” he said, “I really don’t know what I want to do yet. I’m not sure.” When he was little, he wanted to be a mechanic, and he did enjoy the machine trade. But now there was hardly any work to be had, and what there was paid about the same as Walmart. “I don’t think there’s any way that you can have a job that you can think you can retire off of,” he said. “I think everyone’s going to have to transfer to another job.” He said the only future he could really imagine for himself now was just moving from job to job, with no career to speak of. “That’s what I think,” he said. “I don’t want to.” 

Men and Family in a Jobless Age

 

In her classic sociology of the Depression, The Unemployed Man and His Family, Mirra Komarovsky vividly describes how joblessness strained—and in many cases fundamentally altered—family relationships in the 1930s. During 1935 and 1936, Komarovsky and her research team interviewed the members of 59 white middle-class families in which the husband and father had been out of work for at least a year. Her research revealed deep psychological wounds. “It is awful to be old and discarded at 40,” said one father. “A man is not a man without work.” Another said plainly, “During the depression I lost something. Maybe you call it self-respect, but in losing it I also lost the respect of my children, and I am afraid I am losing my wife.” Noted one woman of her husband, “I still love him, but he doesn’t seem as ‘big’ a man.” 

Taken together, the stories paint a picture of diminished men, bereft of familial authority. Household power—over children, spending, and daily decisions of all types—generally shifted to wives over time (and some women were happier overall as a result). Amid general anxiety, fears of pregnancy, and men’s loss of self-worth and loss of respect from their wives, sex lives withered. Socializing all but ceased as well, a casualty of poverty and embarrassment. Although some men embraced family life and drew their wife and children closer, most became distant. Children described their father as “mean,” “nasty,” or “bossy,” and didn’t want to bring friends around, for fear of what he might say. “There was less physical violence towards the wife than towards the child,” Komarovsky wrote. 

In the 70 years that have passed since the publication of The Unemployed Man and His Family, American society has become vastly more wealthy, and a more comprehensive social safety net—however frayed it may seem—now stretches beneath it. Two-earner households have become the norm, cushioning the economic blow of many layoffs. And of course, relationships between men and women have evolved. Yet when read today, large parts of Komarovsky’s book still seem disconcertingly up-to-date. All available evidence suggests that long bouts of unemployment—particularly male unemployment—still enfeeble the jobless and warp their families to a similar degree, and in many of the same ways. 

Andrew Oswald, an economist at the University of Warwick, in the U.K., and a pioneer in the field of happiness studies, says no other circumstance produces a larger decline in mental health and well-being than being involuntarily out of work for six months or more. It is the worst thing that can happen, he says, equivalent to the death of a spouse, and “a kind of bereavement” in its own right. Only a small fraction of the decline can be tied directly to losing a paycheck, Oswald says; most of it appears to be the result of a tarnished identity and a loss of self-worth. Unemployment leaves psychological scars that remain even after work is found again, and, because the happiness of husbands and the happiness of wives are usually closely related, the misery spreads throughout the home. 

Especially in middle-aged men, long accustomed to the routine of the office or factory, unemployment seems to produce a crippling disorientation. At a series of workshops for the unemployed that I attended around Philadelphia last fall, the participants were overwhelmingly male, and the men in particular described the erosion of their identities, the isolation of being jobless, and the indignities of downward mobility. 

Over lunch I spoke with one attendee, Gus Poulos, a Vietnam-era veteran who had begun his career as a refrigeration mechanic before going to night school and becoming an accountant. He is trim and powerfully built, and looks much younger than his 59 years. For seven years, until he was laid off in December 2008, he was a senior financial analyst for a local hospital. 

Poulos said that his frustration had built and built over the past year. “You apply for so many jobs and just never hear anything,” he told me. “You’re one of my few interviews. I’m just glad to have an interview with anybody, even a magazine.” Poulos said he was an optimist by nature, and had always believed that with preparation and hard work, he could overcome whatever life threw at him. But sometime in the past year, he’d lost that sense, and at times he felt aimless and adrift. “That’s never been who I am,” he said. “But now, it’s who I am.” 

Recently he’d gotten a part-time job as a cashier at Walmart, for $8.50 an hour. “They say, ‘Do you want it?’ And in my head, I thought, ‘No.’ And I raised my hand and said, ‘Yes.’” Poulos and his wife met when they were both working as supermarket cashiers, four decades earlier—it had been one of his first jobs. “Now, here I am again.” 

Poulos’s wife is still working—she’s a quality-control analyst at a food company—and that’s been a blessing. But both are feeling the strain, financial and emotional, of his situation. She commutes about 100 miles every weekday, which makes for long days. His hours at Walmart are on weekends, so he doesn’t see her much anymore and doesn’t have much of a social life. 

Some neighbors were at the Walmart a couple of weeks ago, he said, and he rang up their purchase. “Maybe they were used to seeing me in a different setting,” he said—in a suit as he left for work in the morning, or walking the dog in the neighborhood. Or “maybe they were daydreaming.” But they didn’t greet him, and he didn’t say anything. He looked down at his soup, pushing it around the bowl with his spoon for a few seconds before looking back up at me. “I know they knew me,” he said. “I’ve been in their home.” 

The weight of this recession has fallen most heavily upon men, who’ve suffered roughly three-quarters of the 8 million job losses since the beginning of 2008. Male-dominated industries (construction, finance, manufacturing) have been particularly hard-hit, while sectors that disproportionately employ women (education, health care) have held up relatively well. In November, 19.4 percent of all men in their prime working years, 25 to 54, did not have jobs, the highest figure since the Bureau of Labor Statistics began tracking the statistic in 1948. At the time of this writing, it looks possible that within the next few months, for the first time in U.S. history, women will hold a majority of the country’s jobs. 

In this respect, the recession has merely intensified a long-standing trend. Broadly speaking, the service sector, which employs relatively more women, is growing, while manufacturing, which employs relatively more men, is shrinking. The net result is that men have been contributing a smaller and smaller share of family income. 

“Traditional” marriages, in which men engage in paid work and women in homemaking, have long been in eclipse. Particularly in blue-collar families, where many husbands and wives work staggered shifts, men routinely handle a lot of the child care today. Still, the ease with which gender bends in modern marriages should not be overestimated. When men stop doing paid work—and even when they work less than their wives—marital conflict usually follows. 

Last March, the National Domestic Violence Hotline received almost half again as many calls as it had one year earlier; as was the case in the Depression, unemployed men are vastly more likely to beat their wives or children. More common than violence, though, is a sort of passive-aggressiveness. In Identity Economics, the economists George Akerloff and Rachel Kranton find that among married couples, men who aren’t working at all, despite their free time, do only 37 percent of the housework, on average. And some men, apparently in an effort to guard their masculinity, actually do less housework after becoming unemployed. 

Many working women struggle with the idea of partners who aren’t breadwinners. “We’ve got this image of Archie Bunker sitting at home, grumbling and acting out,” says Kathryn Edin, a professor of public policy at Harvard, and an expert on family life. “And that does happen. But you also have women in whole communities thinking, ‘This guy’s nothing.’” Edin’s research in low-income communities shows, for instance, that most working women whose partner stayed home to watch the kids—while very happy with the quality of child care their children’s father provided—were dissatisfied with their relationship overall. “These relationships were often filled with conflict,” Edin told me. Even today, she says, men’s identities are far more defined by their work than women’s, and both men and women become extremely uncomfortable when men’s work goes away. 

The national divorce rate fell slightly in 2008, and that’s not unusual in a recession: divorce is expensive, and many couples delay it in hard times. But joblessness corrodes marriages, and makes divorce much more likely down the road. According to W. Bradford Wilcox, the director of the National Marriage Project at the University of Virginia, the gender imbalance of the job losses in this recession is particularly noteworthy, and—when combined with the depth and duration of the jobs crisis—poses “a profound challenge to marriage,” especially in lower-income communities. It may sound harsh, but in general, he says, “if men can’t make a contribution financially, they don’t have much to offer.” Two-thirds of all divorces are legally initiated by women. Wilcox believes that over the next few years, we may see a long wave of divorces, washing no small number of discarded and dispirited men back into single adulthood. 

Among couples without college degrees, says Edin, marriage has become an “increasingly fragile” institution. In many low-income communities, she fears it is being supplanted as a social norm by single motherhood and revolving-door relationships. As a rule, fewer people marry during a recession, and this one has been no exception. But “the timing of this recession coincides with a pretty significant cultural change,” Edin says: a fast-rising material threshold for marrying, but not for having children, in less affluent communities. 

Edin explains that poor and working-class couples, after seeing the ravages of divorce on their parents or within their communities, have become more hesitant to marry; they believe deeply in marriage’s sanctity, and try to guard against the possibility that theirs will end in divorce. Studies have shown that even small changes in income have significant effects on marriage rates among the poor and the lower-middle class. “It’s simply not respectable to get married if you don’t have a job—some way of illustrating to your neighbors that you have at least some grasp on some piece of the American pie,” Edin says. Increasingly, people in these communities see marriage not as a way to build savings and stability, but as “a symbol that you’ve arrived.” 

Childbearing is the opposite story. The stigma against out-of-wedlock children has by now largely dissolved in working-class communities—more than half of all new mothers without a college degree are unmarried. For both men and women in these communities, children are commonly seen as a highly desirable, relatively low-cost way to achieve meaning and bolster identity—especially when other opportunities are closed off. Christina Gibson-Davis, a public-policy professor at Duke University, recently found that among adults with no college degree, changes in income have no bearing at all on rates of childbirth. 

“We already have low marriage rates in low-income communities,” Edin told me, “including white communities. And where it’s really hitting now is in working-class urban and rural communities, where you’re just seeing astonishing growth in the rates of nonmarital childbearing. And that would all be fine and good, except these parents don’t stay together. This may be one of the most devastating impacts of the recession.” 

Many children are already suffering in this recession, for a variety of reasons. Among poor families, nutrition can be inadequate in hard times, hampering children’s mental and physical development. And regardless of social class, the stresses and distractions that afflict unemployed parents also afflict their kids, who are more likely to repeat a grade in school, and who on average earn less as adults. Children with unemployed fathers seem particularly vulnerable to psychological problems. 

But a large body of research shows that one of the worst things for children, in the long run, is an unstable family. By the time the average out-of-wedlock child has reached the age of 5, his or her mother will have had two or three significant relationships with men other than the father, and the child will typically have at least one half sibling. This kind of churning is terrible for children—heightening the risks of mental-health problems, troubles at school, teenage delinquency, and so on—and we’re likely to see more and more of it, the longer this malaise stretches on. 

“We could be headed in a direction where, among elites, marriage and family are conventional, but for substantial portions of society, life is more matriarchal,” says Wilcox. The marginalization of working-class men in family life has far-reaching consequences. “Marriage plays an important role in civilizing men. They work harder, longer, more strategically. They spend less time in bars and more time in church, less with friends and more with kin. And they’re happier and healthier.” 

Communities with large numbers of unmarried, jobless men take on an unsavory character over time. Edin’s research team spent part of last summer in Northeast and South Philadelphia, conducting in-depth interviews with residents. She says she was struck by what she saw: “These white working-class communities—once strong, vibrant, proud communities, often organized around big industries—they’re just in terrible straits. The social fabric of these places is just shredding. There’s little engagement in religious life, and the old civic organizations that people used to belong to are fading. Drugs have ravaged these communities, along with divorce, alcoholism, violence. I hang around these neighborhoods in South Philadelphia, and I think, ‘This is beginning to look like the black inner-city neighborhoods we’ve been studying for the past 20 years.’ When young men can’t transition into formal-sector jobs, they sell drugs and drink and do drugs. And it wreaks havoc on family life. They think, ‘Hey, if I’m 23 and I don’t have a baby, there’s something wrong with me.’ They’re following the pattern of their fathers in terms of the timing of childbearing, but they don’t have the jobs to support it. So their families are falling apart—and often spectacularly.” 

In his 1996 book, When Work Disappears, the Harvard sociologist William Julius Wilson connected the loss of jobs from inner cities in the 1970s to the many social ills that cropped up after that. “The consequences of high neighborhood joblessness,” he wrote, 

are more devastating than those of high neighborhood poverty. A neighborhood in which people are poor but employed is different from a neighborhood in which many people are poor and jobless. Many of today’s problems in the inner-city ghetto neighborhoods—crime, family dissolution, welfare, low levels of social organization, and so on—are fundamentally a consequence of the disappearance of work.

 

In the mid-20th century, most urban black men were employed, many of them in manufacturing. But beginning in the 1970s, as factories moved out of the cities or closed altogether, male unemployment began rising sharply. Between 1973 and 1987, the percentage of black men in their 20s working in manufacturing fell from roughly 37.5 percent to 20 percent. As inner cities shed manufacturing jobs, men who lived there, particularly those with limited education, had a hard time making the switch to service jobs. Service jobs and office work of course require different interpersonal skills and different standards of self-presentation from those that blue-collar work demands, and movement from one sector to the other can be jarring. What’s more, Wilson’s research shows, downwardly mobile black men often resented the new work they could find, and displayed less flexibility on the job than, for instance, first-generation immigrant workers. As a result, employers began to prefer hiring women and immigrants, and a vicious cycle of resentment, discrimination, and joblessness set in. 

It remains to be seen whether larger swaths of the country, as male joblessness persists, will eventually come to resemble the inner cities of the 1970s and ’80s. In any case, one of the great catastrophes of the past decade, and in particular of this recession, is the slippage of today’s inner cities back toward the depths of those brutal years. Urban minorities tend to be among the first fired in a recession, and the last rehired in a recovery. Overall, black unemployment stood at 15.6 percent in November; among Hispanics, that figure was 12.7 percent. Even in New York City, where the financial sector, which employs relatively few blacks, has shed tens of thousands of jobs, unemployment has increased much faster among blacks than it has among whites. 

In June 1999, the journalist Ellis Cose wrote in Newsweek that it was then “the best time ever” to be black in America. He ticked through the reasons: employment was up, murders and out-of-wedlock births down; educational attainment was rising, and poverty less common than at any time since 1967. Middle-class black couples were slowly returning to gentrifying inner-city neighborhoods. “Even for some of the most persistently unfortunate—uneducated black men between 16 and 24—jobs are opening up,” Cose wrote. 

But many of those gains are now imperiled. Late last year, unemployment among black teens ages 16 to 19 was nearly 50 percent, and the unemployment rate for black men age 20 or older was almost 17 percent. With so few jobs available, Wilson told me, “many black males will give up and drop out of the labor market, and turn more to the underground economy. And it will be very difficult for these people”—especially those who acquire criminal records—“to reenter the labor market in any significant way.” Glen Elder, the sociologist at the University of North Carolina, who’s done field work in Baltimore, said, “At a lower level of skill, if you lose a job and don’t have fathers or brothers with jobs—if you don’t have a good social network—you get drawn back into the street. There’s a sense in the kids I’ve studied that they lost everything they had, and can’t get it back.” 

In New York City, 18 percent of low-income blacks and 26 percent of low-income Hispanics reported having lost their job as a result of the recession in a July survey by the Community Service Society. More still had had their hours or wages reduced. About one in seven low-income New Yorkers often skipped meals in 2009 to save money, and one in five had had the gas, electricity, or telephone turned off. Wilson argues that once neighborhoods become socially dysfunctional, it takes a long period of unbroken good times to undo the damage—and they can backslide very quickly and steeply. “One problem that has plagued the black community over the years is resignation,” Wilson said—a self-defeating “set of beliefs about what to expect from life and how to respond,” passed from parent to child. “And I think there was sort of a feeling that norms of resignation would weaken somewhat with the Obama election. But these hard economic times could reinforce some of these norms.” 

Wilson, age 74, is a careful scholar, who chooses his words precisely and does not seem given to overstatement. But he sounded forlorn when describing the “very bleak” future he sees for the neighborhoods that he’s spent a lifetime studying. There is “no way,” he told me, “that the extremely high jobless rates we’re seeing won’t have profound consequences for the social organization of inner-city neighborhoods.” Neighborhood-specific statistics on drug addiction, family dysfunction, gang violence, and the like take time to compile. But Wilson believes that once we start getting detailed data on the conditions of inner-city life since the crash, “we’re going to see some horror stories”—and in many cases a relapse into the depths of decades past. “The point I want to emphasize,” Wilson said, “is that we should brace ourselves.” 

The Social Fabric

 

No one tries harder than the jobless to find silver linings in this national economic disaster. Many of the people I spoke with for this story said that unemployment, while extremely painful, had improved them in some ways: they’d become less materialistic and more financially prudent; they were using free time to volunteer more, and were enjoying that; they were more empathetic now, they said, and more aware of the struggles of others. 

In limited respects, perhaps the recession will leave society better off. At the very least, it’s awoken us from our national fever dream of easy riches and bigger houses, and put a necessary end to an era of reckless personal spending. Perhaps it will leave us humbler, and gentler toward one another, too—at least in the long run. A recent paper by the economists Paola Giuliano and Antonio Spilimbergo shows that generations that endured a recession in early adulthood became more concerned about inequality and more cognizant of the role luck plays in life. And in his book, Children of the Great Depression, Glen Elder wrote that adolescents who experienced hardship in the 1930s became especially adaptable, family-oriented adults; perhaps, as a result of this recession, today’s adolescents will be pampered less and counted on for more, and will grow into adults who feel less entitled than recent generations. 

But for the most part, these benefits seem thin, uncertain, and far off. In The Moral Consequences of Economic Growth, the economic historian Benjamin Friedman argues that both inside and outside the U.S., lengthy periods of economic stagnation or decline have almost always left society more mean-spirited and less inclusive, and have usually stopped or reversed the advance of rights and freedoms. A high level of national wealth, Friedman writes, “is no bar to a society’s retreat into rigidity and intolerance once enough of its citizens lose the sense that they are getting ahead.” When material progress falters, Friedman concludes, people become more jealous of their status relative to others. Anti-immigrant sentiment typically increases, as does conflict between races and classes; concern for the poor tends to decline. 

Social forces take time to grow strong, and time to dissipate again. Friedman told me that the phenomenon he’s studied “is not about business cycles … It’s not about people comparing where they are now to where they were a year ago.” The relevant comparisons are much broader: What opportunities are available to me, relative to those of my parents? What opportunities do my children have? What is the trajectory of my career? 

It’s been only about two years since this most recent recession started, but then again, most people hadn’t been getting ahead for a decade. In a Pew survey in the spring of 2008, more than half of all respondents said that over the past five years, they either hadn’t moved forward in life or had actually fallen backward, the most downbeat assessment that either Pew or Gallup has ever recorded, in nearly a half century of polling. Median household income in 2008 was the lowest since 1997, adjusting for inflation. “On the latest income data,” Friedman said, “we’re 11 years into a period of decline.” By the time we get out of the current downturn, we’ll likely be “up to a decade and a half. And that’s surely enough.” 

Income inequality usually falls during a recession, and the economist and happiness expert Andrew Clark says that trend typically provides some emotional salve to the poor and the middle class. (Surveys, lab experiments, and brain readings all show that, for better or worse, schadenfreude is a powerful psychological force: at any fixed level of income, people are happier when the income of others is reduced.) But income inequality hasn’t shrunk in this recession. In 2007–08, the most recent year for which data is available, it widened. 

Indeed, this period of economic weakness may reinforce class divides, and decrease opportunities to cross them—especially for young people. The research of Till Von Wachter, the economist at Columbia University, suggests that not all people graduating into a recession see their life chances dimmed: those with degrees from elite universities catch up fairly quickly to where they otherwise would have been if they’d graduated in better times; it’s the masses beneath them that are left behind. Princeton’s 2009 graduating class found more jobs in financial services than in any other industry. According to Princeton’s career-services director, Beverly Hamilton-Chandler, campus visits and hiring by the big investment banks have been down, but that decline has been partly offset by an uptick in recruiting by hedge funds and boutique financial firms. 

In the Internet age, it is particularly easy to see the bile that has always lurked within American society. More difficult, in the moment, is discerning precisely how these lean times are affecting society’s character. In many respects, the U.S. was more socially tolerant entering this recession than at any time in its history, and a variety of national polls on social conflict since then have shown mixed results. Signs of looming class warfare or racial conflagration are not much in evidence. But some seeds of discontent are slowly germinating. The town-hall meetings last summer and fall were contentious, often uncivil, and at times given over to inchoate outrage. One National Journal poll in October showed that whites (especially white men) were feeling particularly anxious about their future and alienated by the government. We will have to wait and see exactly how these hard times will reshape our social fabric. But they certainly will reshape it, and all the more so the longer they extend. 

A slowly sinking generation; a remorseless assault on the identity of many men; the dissolution of families and the collapse of neighborhoods; a thinning veneer of national amity—the social legacies of the Great Recession are still being written, but their breadth and depth are immense. As problems, they are enormously complex, and their solutions will be equally so. 

Of necessity, those solutions must include measures to bolster the economy in the short term, and to clear the way for faster long-term growth; to support the jobless today, and to ensure that we are creating the kinds of jobs (and the kinds of skills within the population) that can allow for a more broadly shared prosperity in the future. A few of the solutions—like more-aggressive support for the unemployed, and employer tax credits or other subsidies to get people back to work faster—are straightforward and obvious, or at least they should be. Many are not. 

At the very least, though, we should make the return to a more normal jobs environment an unflagging national priority. The stock market has rallied, the financial system has stabilized, and job losses have slowed; by the time you read this, the unemployment rate might be down a little. Yet the difference between “turning the corner” and a return to any sort of normalcy is vast. 

We are in a very deep hole, and we’ve been in it for a relatively long time already. Concerns over deficits are understandable, but in these times, our bias should be toward doing too much rather than doing too little. That implies some small risk to the government’s ability to continue borrowing in the future; and it implies somewhat higher taxes in the future too. But that seems a trade worth making. We are living through a slow-motion social catastrophe, one that could stain our culture and weaken our nation for many, many years to come. We have a civic—and indeed a moral—responsibility to do everything in our power to stop it now, before it gets even worse. 

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Posted by steveneidman on February 8, 2010

America: A fearsome foursome

By Edward Luce

The team seen most often in the Oval Office
David Axelrod, senior adviser A former journalist on the Chicago Tribune who quit to set up a political advertising firm, Mr Axelrod, 54, is Barack Obama’s longest-standing mentor, from his days in Chicago politics. Always at the candidate’s side during the election campaign, he is the chief defender of the Obama brand. Still a journalist at heart, he describes himself as having been “posted to Washington”.

Robert Gibbs, communications chief

The most visible face of the White House for his sardonic daily briefings. Mr Gibbs, 38, is perhaps the least likely member of the circle – he is a career Democratic press officer from Alabama who quit John Kerry’s 2004 presidential campaign and shortly afterwards went to work for Senator Obama. A constant presence during the campaign, he is also seen as a keeper of the flame.

Rahm Emanuel, chief of staff

The best story about Mr Emanuel, 50, concerns the dead fish he delivered to a pollster who displeased him. The least honey-tongued politician in Washington, he is also one of the most effective. Friends say he is relentlessly energetic, critics that he has attention deficit disorder. He has enemies but even detractors concede he may well achieve his aim of becoming the first Jewish speaker of the House of Representatives.

Valerie Jarrett, senior adviser

An old friend of the Obamas, having hired Michelle to work in Chicago politics in the early 1990s, Ms Jarrett, 53, is probably the first family’s most intimate White House confidante. A former businessperson and aide to Richard Daley, mayor of Chicago, she was briefly considered as a candidate to fill Mr Obama’s Senate seat. She was part of the circle he consulted before running for president.

At a crucial stage in the Democratic primaries in late 2007, Barack Obama rejuvenated his campaign with a barnstorming speech, in which he ended on a promise of what his victory would produce: “A nation healed. A world repaired. An America that believes again.”

Just over a year into his tenure, America’s 44th president governs a bitterly divided nation, a world increasingly hard to manage and an America that seems more disillusioned than ever with Washington’s ways. What went wrong?

Pundits, Democratic lawmakers and opinion pollsters offer a smorgasbord of reasons – from Mr Obama’s decision to devote his first year in office to healthcare reform, to the president’s inability to convince voters he can “feel their [economic] pain”, to the apparent ungovernability of today’s Washington. All may indeed have contributed to the quandary in which Mr Obama finds himself. But those around him have a more specific diagnosis – and one that is striking in its uniformity. The Obama White House is geared for campaigning rather than governing, they say.

In dozens of interviews with his closest allies and friends in Washington – most of them given unattributably in order to protect their access to the Oval Office – each observes that the president draws on the advice of a very tight circle. The inner core consists of just four people – Rahm Emanuel, the pugnacious chief of staff; David Axelrod and Valerie Jarrett, his senior advisers; and Robert Gibbs, his communications chief.

Two, Mr Emanuel and Mr Axelrod, have box-like offices within spitting distance of the Oval Office. The president, who is the first to keep a BlackBerry, rarely holds a meeting, including on national security, without some or all of them present.

With the exception of Mr Emanuel, who was a senior Democrat in the House of Representatives, all were an integral part of Mr Obama’s brilliantly managed campaign. Apart from Mr Gibbs, who is from Alabama, all are Chicagoans – like the president. And barring Richard Nixon’s White House, few can think of an administration that has been so dominated by such a small inner circle.

“It is a very tightly knit group,” says a prominent Obama backer who has visited the White House more than 40 times in the past year. “This is a kind of ‘we few’ group … that achieved the improbable in the most unlikely election victory anyone can remember and, unsurprisingly, their bond is very deep.”

John Podesta, a former chief of staff to Bill Clinton and founder of the Center for American Progress, the most influential think-tank in Mr Obama’s Washington, says that while he believes Mr Obama does hear a range of views, including dissenting advice, problems can arise from the narrow composition of the group itself.

Among the broader circle that Mr Obama also consults are the self-effacing Peter Rouse, who was chief of staff to Tom Daschle in his time as Senate majority leader; Jim Messina, deputy chief of staff; the economics team led by Lawrence Summers and including Peter Orszag, budget director; Joe Biden, the vice-president; and Denis McDonough, deputy national security adviser. But none is part of the inner circle.

“Clearly this kind of core management approach worked for the election campaign and President Obama has extended it to the White House,” says Mr Podesta, who managed Mr Obama’s widely praised post-election transition. “It is a very tight inner circle and that has its advantages. But I would like to see the president make more use of other people in his administration, particularly his cabinet.”

This White House-centric structure has generated one overriding – and unexpected – failure. Contrary to conventional wisdom, Mr Emanuel managed the legislative aspect of the healthcare bill quite skilfully, say observers. The weak link was the failure to carry public opinion – not Capitol Hill. But for the setback in Massachusetts, which deprived the Democrats of their 60-seat supermajority in the Senate, Mr Obama would by now almost certainly have signed healthcare into law – and with it would have become a historic president.

But the normally liberal voters of Massachusetts wished otherwise. The Democrats lost the seat to a candidate, Scott Brown, who promised voters he would be the “41st [Republican] vote” in the Senate – the one that would tip the balance against healthcare. Subsequent polling bears out the view that a decisive number of Democrats switched their votes with precisely that motivation in mind.

“Historians will puzzle over the fact that Barack Obama, the best communicator of his generation, totally lost control of the narrative in his first year in office and allowed people to view something they had voted for as something they suddenly didn’t want,” says Jim Morone, America’s leading political scientist on healthcare reform. “Communication was the one thing everyone thought Obama would be able to master.”

Whatever issue arises, whether it is a failed terrorist plot in Detroit, the healthcare bill, economic doldrums or the 30,000-troop surge to Afghanistan, the White House instinctively fields Mr Axelrod or Mr Gibbs on television to explain the administration’s position. “Every event is treated like a twist in an election campaign and no one except the inner circle can be trusted to defend the president,” says an exasperated outside adviser.

Perhaps the biggest losers are the cabinet members. Kathleen Sebelius, Mr Obama’s health secretary and formerly governor of Kansas, almost never appears on television and has been largely excluded both from devising and selling the healthcare bill. Others such as Ken Salazar, the interior secretary who is a former senator for Colorado, and Janet Napolitano, head of the Department for Homeland Security and former governor of Arizona, have virtually disappeared from view.

Administration insiders say the famously irascible Mr Emanuel treats cabinet principals like minions. “I am not sure the president realises how much he is humiliating some of the big figures he spent so much trouble recruiting into his cabinet,” says the head of a presidential advisory board who visits the Oval Office frequently. “If you want people to trust you, you must first place trust in them.”

In addition to hurling frequent profanities at people within the administration, Mr Emanuel has alienated many of Mr Obama’s closest outside supporters. At a meeting of Democratic groups last August, Mr Emanuel described liberals as “f***ing retards” after one suggested they mobilise resources on healthcare reform.

“We are treated as though we are children,” says the head of a large organisation that raised millions of dollars for Mr Obama’s campaign. “Our advice is never sought. We are only told: ‘This is the message, please get it out.’ I am not sure whether the president fully realises that when the chief of staff speaks, people assume he is speaking for the president.”

The same can be observed in foreign policy. On Mr Obama’s November trip to China, members of the cabinet such as the Nobel prizewinning Stephen Chu, energy secretary, were left cooling their heels while Mr Gibbs, Mr Axelrod and Ms Jarrett were constantly at the president’s side.

The White House complained bitterly about what it saw as unfairly negative media coverage of a trip dubbed Mr Obama’s “G2” visit to China. But, as journalists were keenly aware, none of Mr Obama’s inner circle had any background in China. “We were about 40 vans down in the motorcade and got barely any time with the president,” says a senior official with extensive knowledge of the region. “It was like the Obama campaign was visiting China.”

Then there are the president’s big strategic decisions. Of these, devoting the first year to healthcare is well known and remains a source of heated contention. Less understood is the collateral damage it caused to unrelated initiatives. “The whole Rahm Emanuel approach is that victory begets victory – the success of healthcare would create the momentum for cap-and-trade [on carbon emissions] and then financial sector reform,” says one close ally of Mr Obama. “But what happens if the first in the sequence is defeat?”

Insiders attribute Mr Obama’s waning enthusiasm for the Arab-Israeli peace initiative to a desire to avoid antagonising sceptical lawmakers whose support was needed on healthcare. The steam went out of his Arab-Israeli push in mid-summer, just when the healthcare bill was running into serious difficulties.

The same applies to reforming the legal apparatus in the “war on terror” – not least his pledge to close the Guantánamo Bay detention centre within a year of taking office. That promise has been abandoned.

“Rahm said: ‘We’ve got these two Boeing 747s circling that we are trying to bring down to the tarmac [healthcare and the decision on the Afghanistan troop surge] and we can’t risk a flock of f***ing Canadian geese causing them to crash,’ ” says an official who attended an Oval Office strategy meeting. The geese stood for the closure of Guantánamo.

An outside adviser adds: “I don’t understand how the president could launch healthcare reform and an Arab-Israeli peace process – two goals that have eluded US presidents for generations – without having done better scenario planning. Either would be historic. But to launch them at the same time?”

Again, close allies of the president attribute the problem to the campaign-like nucleus around Mr Obama in which all things are possible. “There is this sense after you have won such an amazing victory, when you have proved conventional wisdom wrong again and again, that you can simply do the same thing in government,” says one. “Of course, they are different skills. To be successful, presidents need to separate the stream of advice they get on policy from the stream of advice they get on politics. That still isn’t happening.”

The White House declined to answer questions on whether Mr Obama needed to broaden his circle of advisers. But some supporters say he should find a new chief of staff. Mr Emanuel has hinted that he might not stay in the job very long and is thought to have an eye on running for mayor of Chicago. Others say Mr Obama should bring in fresh blood. They point to Mr Clinton’s decision to recruit David Gergen, a veteran of previous White Houses, when the last Democratic president ran into trouble in 1993. That is credited with helping to steady the Clinton ship, after he too began with an inner circle largely carried over from his campaign.

But Mr Gergen himself disagrees. Now teaching at Harvard and commenting for CNN, Mr Gergen says members of the inner circle meet two key tests. First, they are all talented. Second, Mr Obama trusts them. “These are important attributes,” Mr Gergen says. His biggest doubt is whether Mr Obama sees any problem with the existing set-up.

“There is an old joke,” says Mr Gergen. “How many psychiatrists does it take to change a lightbulb? Only one. But the lightbulb must want to change. I don’t think President Obama wants to make any changes.”

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Posted by steveneidman on February 4, 2010

It’s the Phenome and Not the Genome: Put Your Money on Mortal Flesh

by Abraham Verghese

doctor-David McNew-big.jpg

Strong is your hold O mortal flesh . . .

From The Last Invocation, Walt Whitman

Is it just me, or are you also getting a bit tired of all the hype about the genome? Don’t get me wrong– it’s pretty incredible that in my lifetime we have mapped out the 25,000 plus genes in our DNA. What’s even more amazing is that the price for that chart of the human genome has gone from millions to less than $50,000 and now it takes only a few weeks. I bet by next year it might be a few hundred dollars and take a day! Companies like 23andMe (an innovative venture with a great marketing plan) offer to check you for genetic markers that predict your risk for certain diseases for just a few hundred dollars.

But the fact remains that for most of us, the genotype is much less relevant than the phenotype. What is phenotype? It is the things we can see, the outward or observable physical or biochemical characteristics and they are determined by both your genetic makeup and environmental influences. Your blond hair, your weight, your strange nose, green eyes and that funky shaped little toe of yours –all examples of phenotype.

So what do I mean when I say phenotype is more relevant than genotype? Well, let’s say a new patient, a male, walks into my office and he is in his fifties. Let’s say he happens to have the outline of a pack of cigarettes showing in his front pocket. As a male he already has one risk factor for coronary artery disease–just being male, alas. The cigarettes tell me that he is four times more likely to have a heart attack than his peers who don’t smoke. His risk of sudden death is at least doubled. Let’s say I notice he happens to be carrying more than 30 pounds of extra poundage above the belt line: that allows me to predict he has a higher chance of being at risk for diabetes, if he is not already frankly diabetic. Let’s say that I notice too the pale outline of a recently-removed wedding ring (I can’t help it, my eyes are always looking at the body as text–even when I am out of the hospital), then I know that his risk of death as a  recently divorced man can be double that of his married peers.

At this point, before he has even said a word or before I have examined him, I already know so much about his risk of death and disease. Once we talk and I learn more about his job, his stress, his heredity, his habits, his past illnesses, then my predictions get more accurate. Once he disrobes and I examine him, I might find other phenotypic markers that predict risk (such as yellow plaques related to high cholesterol on his eyelids or elbows; high blood pressure; skin tags and velvety darkened areas of skin that predict diabetes; narrowed blood vessels when I look into the back of his eye . . . the list could go on for pages). In short, I’ll have an excellent sense of my patient’s risk for death or disease. At that point, mapping his whole genome, sexy as it might seem, won’t tell me much more than I know and will probably matter much less than getting him to quit smoking, exercise and lose weight.

The famous Whitehall Study of British Civil Servants ranging in ages from 20 to 64 found that the lower grades of civil service had higher mortality rates from heart disease and from all causes than did people in higher grades, even after accounting for risk factors like obesity and smoking. (Yes, it was counterintuitive and that is why we do studies).  Stress was thought to be the factor responsible for this disparity.

The Whitehall studies are ongoing and one of the latest reports from that study made me think of Walt Whitman and reminded me that the phenotype is so relevant. In their report (titled, “Utility of genetic and non-genetic risk factors in prediction of type 2 diabetes: Whitehall II prospective cohort study” and appearing in the British Medical Journal, 2010 Jan 14;340:b4838), the scientists compared a panel of genetic tests for diabetes (common single nucleotide polymorphisms) with non-genetic or phenotypic findings like age, sex, drug treatment, family history of type 2 diabetes, body mass index, smoking status, HDL, triglycerides, fasting glucose.

What they found was that the phenotypic tests did better. Indeed the gene tests added little to the risk already determined by phenotypes. In their own words, “the addition of genotypes to phenotype based risk models produced only minimal improvement in accuracy of risk estimation  . . .”  Translation: use your eyes, take a good history, weight the patient and get a few simple blood tests, and you can predict risk far better than a panel of genetic tests. 

I am not a Luddite (I find I say that a lot) and indeed, I do think the genome studies will help us eventually understand more about causes of disease, and perhaps even point to particular treatments. But utill then the message for us in the trenches is: Strong is your hold O mortal flesh and that’s where the money (speaking diagnostically) is.

Posted in Healthcare, Law, Medicaid, Politics, Steven Eidman, abortion, business, culture, economics, economy, gender, physics, psychology, tehcnology | Tagged: , , , , , , | Leave a Comment »

Posted by steveneidman on January 27, 2010

 Covering Haiti: When the Media Is the Disaster

By Rebecca Solnit

Soon after almost every disaster the crimes begin: ruthless, selfish, indifferent to human suffering, and generating far more suffering. The perpetrators go unpunished and live to commit further crimes against humanity. They care less for human life than for property. They act without regard for consequences.

I’m talking, of course, about those members of the mass media whose misrepresentation of what goes on in disaster often abets and justifies a second wave of disaster. I’m talking about the treatment of sufferers as criminals, both on the ground and in the news, and the endorsement of a shift of resources from rescue to property patrol. They still have blood on their hands from Hurricane Katrina, and they are staining themselves anew in Haiti.

Within days of the Haitian earthquake, for example, the Los Angeles Times ran a series of photographs with captions that kept deploying the word “looting.” One was of a man lying face down on the ground with this caption: “A Haitian police officer ties up a suspected looter who was carrying a bag of evaporated milk.” The man’s sweaty face looks up at the camera, beseeching, anguished.

Another photo was labeled: “Looting continued in Haiti on the third day after the earthquake, although there were more police in downtown Port-au-Prince.” It showed a somber crowd wandering amid shattered piles of concrete in a landscape where, visibly, there could be little worth taking anyway.

A third image was captioned: “A looter makes off with rolls of fabric from an earthquake-wrecked store.” Yet another: “The body of a police officer lies in a Port-au-Prince street. He was accidentally shot by fellow police who mistook him for a looter.”

People were then still trapped alive in the rubble. A translator for Australian TV dug out a toddler who’d survived 68 hours without food or water, orphaned but claimed by an uncle who had lost his pregnant wife. Others were hideously wounded and awaiting medical attention that wasn’t arriving. Hundreds of thousands, maybe millions, needed, and still need, water, food, shelter, and first aid. The media in disaster bifurcates. Some step out of their usual “objective” roles to respond with kindness and practical aid. Others bring out the arsenal of clichés and pernicious myths and begin to assault the survivors all over again.

The “looter” in the first photo might well have been taking that milk to starving children and babies, but for the news media that wasn’t the most urgent problem. The “looter” stooped under the weight of two big bolts of fabric might well have been bringing it to now homeless people trying to shelter from a fierce tropical sun under improvised tents.

The pictures do convey desperation, but they don’t convey crime. Except perhaps for that shooting of a fellow police officer—his colleagues were so focused on property that they were reckless when it came to human life, and a man died for no good reason in a landscape already saturated with death.

In recent days, there have been scattered accounts of confrontations involving weapons, and these may be a different matter. But the man with the powdered milk? Is he really a criminal? There may be more to know, but with what I’ve seen I’m not convinced.

What Would You Do?

Imagine, reader, that your city is shattered by a disaster. Your home no longer exists, and you spent what cash was in your pockets days ago. Your credit cards are meaningless because there is no longer any power to run credit-card charges. Actually, there are no longer any storekeepers, any banks, any commerce, or much of anything to buy. The economy has ceased to exist.

By day three, you’re pretty hungry and the water you grabbed on your way out of your house is gone. The thirst is far worse than the hunger. You can go for many days without food, but not water. And in the improvised encampment you settle in, there is an old man near you who seems on the edge of death. He no longer responds when you try to reassure him that this ordeal will surely end. Toddlers are now crying constantly, and their mothers infinitely stressed and distressed.


Rebecca Solnit.jpg
So you go out to see if any relief organization has finally arrived to distribute anything, only to realize that there are a million others like you stranded with nothing, and there isn’t likely to be anywhere near enough aid anytime soon. The guy with the corner store has already given away all his goods to the neighbors. That supply’s long gone by now. No wonder, when you see the chain pharmacy with the shattered windows or the supermarket, you don’t think twice before grabbing a box of PowerBars and a few gallons of water that might keep you alive and help you save a few lives as well.

The old man might not die, the babies might stop their squalling, and the mothers might lose that look on their faces. Other people are calmly wandering in and helping themselves, too. Maybe they’re people like you, and that gallon of milk the fellow near you has taken is going to spoil soon anyway. You haven’t shoplifted since you were 14, and you have plenty of money to your name. But it doesn’t mean anything now.

If you grab that stuff are you a criminal? Should you end up lying in the dirt on your stomach with a cop tying your hands behind your back? Should you end up labeled a looter in the international media? Should you be shot down in the street, since the overreaction in disaster, almost any disaster, often includes the imposition of the death penalty without benefit of trial for suspected minor property crimes?

Or are you a rescuer? Is the survival of disaster victims more important than the preservation of everyday property relations? Is that chain pharmacy more vulnerable, more a victim, more in need of help from the National Guard than you are, or those crying kids, or the thousands still trapped in buildings and soon to die?

It’s pretty obvious what my answers to these questions are, but it isn’t obvious to the mass media. And in disaster after disaster, at least since the San Francisco earthquake of 1906, those in power, those with guns and the force of law behind them, are too often more concerned for property than human life. In an emergency, people can, and do, die from those priorities. Or they get gunned down for minor thefts or imagined thefts. The media not only endorses such outcomes, but regularly, repeatedly, helps prepare the way for, and then eggs on, such a reaction.

If Words Could Kill

We need to banish the word “looting” from the English language. It incites madness and obscures realities.

“Loot,” the noun and the verb, is a word of Hindi origin meaning the spoils of war or other goods seized roughly. As historian Peter Linebaugh points out, “At one time loot was the soldier’s pay.” It entered the English language as a good deal of loot from India entered the English economy, both in soldiers’ pockets and as imperial seizures.

After years of interviewing survivors of disasters, and reading first-hand accounts and sociological studies from such disasters as the London Blitz and the Mexico City earthquake of 1985, I don’t believe in looting. Two things go on in disasters. The great majority of what happens you could call emergency requisitioning. Someone who could be you, someone in the kind of desperate circumstances I outlined above, takes necessary supplies to sustain human life in the absence of any alternative. Not only would I not call that looting, I wouldn’t even call that theft.

Necessity is a defense for breaking the law in the United States and other countries, though it’s usually applied more to, say, confiscating the car keys of a drunk driver than feeding hungry children. Taking things you don’t need is theft under any circumstances. It is, says the disaster sociologist Enrico Quarantelli, who has been studying the subject for more than half a century, vanishingly rare in most disasters.

Personal gain is the last thing most people are thinking about in the aftermath of a disaster. In that phase, the survivors are almost invariably more altruistic and less attached to their own property, less concerned with the long-term questions of acquisition, status, wealth, and security, than just about anyone not in such situations imagines possible. (The best accounts from Haiti of how people with next to nothing have patiently tried to share the little they have and support those in even worse shape than them only emphasize this disaster reality.) Crime often drops in the wake of a disaster.

The media are another matter. They tend to arrive obsessed with property (and the headlines that assaults on property can make). Media outlets often call everything looting and thereby incite hostility toward the sufferers as well as a hysterical overreaction on the part of the armed authorities. Or sometimes the journalists on the ground do a good job and the editors back in their safe offices cook up the crazy photo captions and the wrongheaded interpretations and emphases.

They also deploy the word panic wrongly. Panic among ordinary people in crisis is profoundly uncommon. The media will call a crowd of people running from certain death a panicking mob, even though running is the only sensible thing to do. In Haiti, they continue to report that food is being withheld from distribution for fear of “stampedes.” Do they think Haitians are cattle?

The belief that people in disaster (particularly poor and nonwhite people) are cattle or animals or just crazy and untrustworthy regularly justifies spending far too much energy and far too many resources on control—the American military calls it “security”—rather than relief. A British-accented voiceover on CNN calls people sprinting to where supplies are being dumped from a helicopter a “stampede” and adds that this delivery “risks sparking chaos.” The chaos already exists, and you can’t blame it on these people desperate for food and water. Or you can, and in doing so help convince your audience that they’re unworthy and untrustworthy.

We live and die by words and ideas, and it matters desperately that we get them right.

Back to looting: of course you can consider Haiti’s dire poverty and failed institutions a long-term disaster that changes the rules of the game. There might be people who are not only interested in taking the things they need to survive in the next few days, but things they’ve never been entitled to own or things they may need next month. Technically that’s theft, but I’m not particularly surprised or distressed by it; the distressing thing is that even before the terrible quake they led lives of deprivation and desperation.

In ordinary times, minor theft is often considered a misdemeanor. No one is harmed. Unchecked, minor thefts could perhaps lead to an environment in which there were more thefts and so forth, and a good argument can be made that, in such a case, the tide needs to be stemmed. But it’s not particularly significant in a landscape of terrible suffering and mass death.

A number of radio hosts and other media personnel are still upset that people apparently took TVs after Hurricane Katrina hit New Orleans in August 2005. Since I started thinking about, and talking to people about, disaster aftermaths I’ve heard a lot about those damned TVs. Now, which matters more to you, televisions or human life? People were dying on rooftops and in overheated attics and freeway overpasses, they were stranded in all kinds of hideous circumstances on the Gulf Coast in 2005 when the mainstream media began to obsess about looting, and the mayor of New Orleans and the governor of Louisiana made the decision to focus on protecting property, not human life.

A gang of white men on the other side of the river from New Orleans got so worked up about property crimes that they decided to take the law into their own hands and began shooting. They seem to have considered all black men criminals and thieves and shot a number of them. Some apparently died; there were bodies bloating in the September sun far from the region of the floods; one good man trying to evacuate the ruined city barely survived; and the media looked away. It took me months of nagging to even get the story covered. This vigilante gang claimed to be protecting property, though its members never demonstrated that their property was threatened. They boasted of killing black men. And they shared values with the mainstream media and the Louisiana powers that be.

Somehow, when the Bush administration subcontracted emergency services—like providing evacuation buses in Hurricane Katrina—to cronies who profited even while providing incompetent, overpriced, and much delayed service at the moment of greatest urgency, we didn’t label that looting.

Or when a lot of wealthy Wall Street brokers decide to tinker with a basic human need like housing… Well, you catch my drift.

Woody Guthrie once sang that “some will rob you with a six-gun, and some with a fountain pen.” The guys with the six guns (or machetes or sharpened sticks) make for better photographs, and the guys with the fountain pens not only don’t end up in jail, they end up in McMansions with four-car garages and, sometimes, in elected—or appointed—office.

Learning to See in Crises

Last Christmas a priest, Father Tim Jones of York, started a ruckus in Britain when he said in a sermon that shoplifting by the desperate from chain stores might be acceptable behavior. Naturally, there was an uproar. Jones told the Associated Press: “The point I’m making is that when we shut down every socially acceptable avenue for people in need, then the only avenue left is the socially unacceptable one.”

The response focused almost entirely on why shoplifting is wrong, but the claim was also repeatedly made that it doesn’t help. In fact, food helps the hungry, a fact so bald it’s bizarre to even have to state it. The means by which it arrives is a separate matter. The focus remained on shoplifting, rather than on why there might be people so desperate in England’s green and pleasant land that shoplifting might be their only option, and whether unnecessary human suffering is itself a crime of sorts.

Right now, the point is that people in Haiti need food, and for all the publicity, the international delivery system has, so far, been a visible dud. Under such circumstances, breaking into a U.N. food warehouse—food assumedly meant for the poor of Haiti in a catastrophic moment—might not be “violence,” or “looting,” or “law-breaking.” It might be logic. It might be the most effective way of meeting a desperate need.

Why were so many people in Haiti hungry before the earthquake? Why do we have a planet that produces enough food for all and a distribution system that ensures more than a billion of us don’t have a decent share of that bounty? Those are not questions whose answers should be long delayed.

Even more urgently, we need compassion for the sufferers in Haiti and media that tell the truth about them. I’d like to propose alternative captions for those Los Angeles Times photographs as models for all future disasters:

Let’s start with the picture of the policeman hogtying the figure whose face is so anguished: “Ignoring thousands still trapped in rubble, a policeman accosts a sufferer who took evaporated milk. No adequate food distribution exists for Haiti’s starving millions.”

And the guy with the bolt of fabric? “As with every disaster, ordinary people show extraordinary powers of improvisation, and fabrics such as these are being used to make sun shelters around Haiti.”

For the murdered policeman: “Institutional overzealousness about protecting property leads to a gratuitous murder, as often happens in crises. Meanwhile countless people remain trapped beneath crushed buildings.”

And the crowd in the rubble labeled looters? How about: “Resourceful survivors salvage the means of sustaining life from the ruins of their world.”

That one might not be totally accurate, but it’s likely to be more accurate than the existing label. And what is absolutely accurate, in Haiti right now, and on Earth always, is that human life matters more than property, that the survivors of a catastrophe deserve our compassion and our understanding of their plight, and that we live and die by words and ideas, and it matters desperately that we get them right.

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Supreme Court Decision Warps Corps’ Electoral Muscle

Posted by steveneidman on January 26, 2010

The “Devastating” Decision

Ronald Dworkin

David Bosse, president of Citizens United, posing with the group’s advocacy videos (Lucian Perkins/Washington Post/Getty Images)

Against the opposition of their four colleagues, five right-wing Supreme Court justices have now guaranteed that big corporations can spend unlimited funds on political advertising in any political election. In an opinion written by Justice Anthony Kennedy and joined by Chief Justice John Roberts and Justices Samuel Alito, Antonin Scalia, and Clarence Thomas, the Court overruled established precedents and declared dozens of national and state statutes unconstitutional, including the McCain-Feingold Act which forbade corporate or union television advertising that endorses or opposes a particular candidate.

This appalling decision, in Citizens United v. Federal Election Commission, was quickly denounced by President Obama as “devastating”; he said that it “strikes at our democracy itself.” He is right: the decision will further weaken the quality and fairness of our politics.

The Court has given lobbyists, already much too powerful, a nuclear weapon. Some lawyers have predicted that corporations will not take full advantage of it: they will want to keep their money for their business. But that would still permit carefully targeted threats. What legislator tempted to vote for health care reform or Obama’s banking reorganization would be indifferent to the prospect that his reelection campaign could be swamped in a tsunami of expensive negative advertising? How many corporations fearful of environmental or product liability litigation would pass up the chance to tip the balance in a state judicial election?

On the most generous understanding the decision displays the five justices’ instinctive favoritism of corporate interests. But some commentators, including The New York Times, have suggested a darker interpretation. The five justices may have assumed that allowing corporations to spend freely against candidates would favor Republicans; perhaps they overruled long-established laws and precedents out of partisan zeal. If so, their decision would stand beside the Court’s 2000 decision in Bush v. Gore as an unprincipled political act with terrible consequences for the nation.

We should notice not just the bad consequences of the decision, however, but the poor quality of the arguments Justice Kennedy offered to defend it. The conservative justices savaged canons of judicial restraint they themselves have long praised. Chief Justice Roberts takes every opportunity to repeat what he said, under oath, in his Senate nomination hearings: that the Supreme Court should avoid declaring any statute unconstitutional unless it cannot decide the case before it in any other way. Now consider how shamelessly he and the other Justices who voted with the majority ignored that constraint in their haste to declare the Act unconstitutional in time for the coming mid-term elections.

Citizens United, a small nonprofit corporation almost entirely financed by individual contributions, had made a very negative film about Hillary Clinton. It asked the Court only to rule that its method of distributing that film, on a video-on-demand service, was not outlawed by the Act. It offered several arguments, some of them plausible, for interpreting the Act that way. So the Court did not have to decide whether to overrule the Act: it could have agreed with Citizens United while reserving that larger question. But after they first heard arguments in the case, the five justices declared that they wanted, on their own initiative, to consider declaring the Act unconstitutional. They introduced that unnecessary issue themselves and then scheduled an emergency special hearing during the summer so that they could strike down the statute as quickly as possible.

Justice Kennedy, in his opinion for the 5-4 majority, tried to explain why that was necessary. It would have been possible, he conceded, to interpret the McCain-Feingold Act’s prohibition of corporate “broadcast, cable, or satellite” electioneering that is “publicly distributed” as not applying to video-on-demand TV. But he declined this strategy because transmission technology could be expected to change so that the Court would be required to revisit the issue time and time again. He did not explain why the Court could not have drafted a general principle interpreting the statute to guide future decisions as technology develops, as it has in so many other cases. For example, the court’s doctrine of “reasonable expectation of privacy” is designed to adapt to evolving technology of surveillance and spying.

The conservative justices also had to overrule two of the Court’s prior decisions—its 1990 Austin and 2003 McConnell decisions. In his Senate hearings, Roberts declared his great respect for judicial precedent: he said that just because he thought that an earlier Court decision had been wrongly decided or poorly argued would be no reason to overrule it. It would have to have proved unworkable or its basis in principle would have to have been eroded by other intervening decisions. Kennedy offered no evidence that restrictions on corporate electioneering had proved unworkable, which is not surprising because such restrictions had been in place since 1907.

Instead he argued that the two decisions were themselves inconsistent with other precedent. But as Justice John Paul Stevens pointed out in his long and impressive dissenting opinion, Kennedy was able to cite only one past decision actually to that point: the Court’s 1978 Bellotti decision, in which it in fact denied what Kennedy takes it to have held. “Our consideration of a corporation’s right to speak on issues of general public interest,” the Court stated in that case, “implies no comparable right in the quite different context of participation in a political campaign for election to public office.” Kennedy disregarded that clear statement because, he said, it occurred in “a single footnote.” But that is a natural place for a clarification; and Kennedy’s suggested distinction between text and note is entirely novel. Some of the Court’s footnotes have proved much more important than the decisions to which they were attached.

The main theoretical flaw in Kennedy’s opinion is different, however. The opinion announces and perpetuates a shallow, simplistic understanding of the First Amendment, one that actually undermines one of the most basic purposes of free speech, which is to protect democracy. The nerve of his argument—that corporations must be treated like real people under the First Amendment—is in my view preposterous. Corporations are legal fictions. They have no opinions of their own to contribute and no rights to participate with equal voice or vote in politics.

Kennedy’s opinion left Americans very little room to protect themselves against this further degradation of their democracy. But it did leave some. He acknowledged that the ruling does not prevent Congress from requiring reasonable disclosures and disclaimers in corporate advertising. I believe Congress should require a prominent statement in every such ad disclosing any corporate sponsors and declaring that their support represents the opinion of the corporation’s officers, who have a duty to promote the corporation’s own interests, and not necessarily the opinion of any of their shareholders who are actually paying for the ad.

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Cost Control and the Healthcare Reform Bill- It’s In There

Posted by steveneidman on November 25, 2009

A Milestone in the Health Care Journey

by Ronald Brownstein

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. “The bottom line,” Nichols says, “is the legislation is sending a signal that business as usual [in the medical system] is going to end.”

Both the Senate bill’s priority on controlling long-term health care costs, and its strategy for doing so, represents a validation for Senate Finance Committee chairman Max Baucus (D-MT). When Baucus released his health reform proposal last September, after finally terminating months of fruitless negotiations with committee Republicans, Democratic liberals excoriated his plan as a dead end. And on several important fronts–such as subsidies for the uninsured, the role of a public competitor to private insurance companies, and the contribution required from employers who don’t insure their workers–Reid moved his product away from Baucus toward approaches preferred by liberals.

But the Reid bill’s fiscal strategy, and its vision of how to “bend the curve,” almost completely follows Baucus’ path from September. Baucus’ bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that’s the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas’ for shifting the medical payment system away from today’s fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus’ most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that’s just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.) Most of the other big ideas for controlling costs (such as medical malpractice reform) tend to draw support primarily among Republicans. And since virtually, if not literally, none of them plan to support the final health care bill under any circumstances, the package isn’t likely to reflect much of their thinking.

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end “Cadillac” insurance plans; to pursue “aggressive” tests of payment reforms that will “provide incentives for physicians and hospitals to focus on quality” and provide “care that is better coordinated”; and establish an independent Medicare commission that can continuously develop and implement “new efforts to improve quality and contain costs.” Finally, they said the Congressional Budget Office “must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter.”

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.)  “Let’s use the metric of that letter,” said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. “Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar.”

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag’s assessment of it. “It has got all four of those elements in it,” McClellan said in an interview. “They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go.”

Reid gave ground on one Baucus proposal that the economists identified as a priority-taxing high-end insurance plans. Like many health reformers, the economists who wrote Obama argue that such a tax “will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount.” Amid intense opposition from unions, Reid raised the thresholds at which family plans would face that excise tax from $21,000 to $23,000. But given all the pressure from labor, the more striking thing may have been that Reid didn’t increase the thresholds even more; the CBO calculated the proposal, which the House excluded from its bill, would still raise $35 billion annually by 2019. “They held pretty strong,” said one administration health care expert. “It’s not like unions haven’t been making the case that it shouldn’t have been a much higher number.”

On delivery reform, Reid stayed even closer to the Baucus blueprint. The Finance bill laid out a series of measures to change the way providers are paid for delivering care to Medicare recipients; the hope was that once Medicare instituted these reforms, private insurers would also adopt many of them. “The goal here is that the things we do in Medicare will translate over into the private sector, and there is quite a bit of historical precedence for that,” said one Democratic aide involved in drafting the package.

The Baucus delivery reform ideas revolved around two central aims. One was to reward Medicare providers who deliver care more efficiently and penalize those that don’t. The Reid bill upholds the major proposals Baucus offered to advance that goal. For instance, hospitals under current law must report on their performance in treating patients for common conditions like heart problems and pneumonia; under the bill, their Medicare payments, for the first time, would be affected by their ranking on those reports. Hospitals would also be penalized if they readmit too many patients after surgery or allow too many to acquire infections while in the hospital itself. Another provision would begin the process of applying such “value-based purchasing” toward other providers like hospice providers and inpatient rehabilitation facilities.

With physicians, the Reid plan takes a step back from the Finance Committee bill but still a long step beyond current law. The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as “a death panel by proxy”-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a “values based payment modifier” that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. “It will, we believe, have the same net effect [as the original proposal],” said the Democratic aide. “It should change behavior around that threshold.”

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led “accountable care organizations” to more comprehensively manage patients’ care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of “bundled” payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.

Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that’s attracted the most attention is an independent “Medicare Advisory Board.” Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or “ration care,” and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry). Given the limitations imposed on the commission, an equally important means to expand these reforms might be a second institution the legislation creates: a Center for Medicare and Medicaid Innovation in the Health and Human Services Department. Though this center has received much less attention than the Medicare Commission, it could have a comparable effect. It would receive $1 billion annually to test payment reforms; in a little known provision, the bill authorizes the HHS Secretary to implement nationwide, without any congressional action, any reform that department actuaries certify will reduce long-term spending. While the House bill omitted the Medicare Commission (a top priority for Obama) it included the innovation center.

No one can say for certain that these initiatives will improve efficiency enough to slow the growth in health care spending. Some are only pilots; others would affect only a small portion of providers’ revenue from Medicare. CBO typically evaluates them skeptically: it generally scores little or no savings from most of them. Former CBO director Robert Reischauer, who signed the November 17 letter, says that’s not surprising. “CBO is there to score savings for which we have a high degree of confidence that they will materialize,” says Reischauer, now president of the Urban Institute. “There are many promising approaches [in these reform ideas] but you…can’t deposit them in the bank.” In the long run, Reischauer says, it’s likely “that maybe half of them, or a third of them, will prove to be successful. But that would be very important.”

While generally supportive of Reid’s approach, McClellan, the former Medicare administrator under Bush, offered several specific ideas for strengthening it. He says the Senate should improve the capacity of HHS to more quickly evaluate whether the payment reforms are working, and also to provide data and technical assistance to new physician groups like the accountable care organizations that will be attempting to better coordinate care. “Ideally you’d both be able to tell the organizations involved and Congress what is working or not, and give the organizations the feedback and data they need to know whether they are doing a good job,” he says. McClellan also believes that the plan needs sharper sticks-tougher penalties on providers who don’t provide efficient and effective care. “There are a lot of carrots and not so many sticks,” he maintains. Of course, tougher penalties might provoke more opposition from provider groups like hospitals and physicians now tenuously supporting the legislation.
[[McClellan stands at the forefront of centrist Republican thinking on health. Even the more ideologically conservative health care thinkers to his right generally don’t oppose long-term reform ideas like bundling payments (John McCain promoted that during his presidential campaign). But they tend to view them as insufficient or tangential to the real problem. Their view highlights a fundamental difference between the parties’ on health care. To save costs, Democrats mostly want to change the incentives for providers. Republicans mostly want to change the incentives for patients by shifting toward a model where insurance covers only catastrophic expenses and people pay for more routine care from tax-favored health savings accounts. In essence, the Republican view is that the best way to hold down long-term costs is to directly expose patients to more of them. Few Democrats accept that logic though and it has little influence on either chamber’s legislation.

Another Republican cost-containment priority missing from the bill is meaningful medical malpractice reform. (The bill only encourages states to think about it.) Nichols, of the centrist New America Foundation, would like to see that included as well. Its omission is one reason he says he gives the plan a “b” rather than an “a”; the other is he’d like to see mechanisms to more quickly diffuse into the private insurance system reforms that show promise in Medicare. Democratic sources say a group of centrist Democrats led by Virginia Senator Mark Warner is trying to devise a package designed to do just that, perhaps by expanding the role of the independent Medicare advisory commission.

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn’t able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. “One never knows whether we’re turning the corner or if this is just playing the same old game for another inning,” he says. “But I sense there’s something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve.” If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

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Sports Dentistry, Steeler Style

Posted by steveneidman on October 8, 2009

Sports Dentistry

By Bill Modoono

When a professional wrestler has a toothache just before a big match in Pittsburgh, who’s he going to call, even if it’s New Year’s Eve? Well, a local sports dentist, of course.

What! You say pro wrestling is not a real sport? Well, that’s OK. You could say sports dentistry is not a real dental specialty, either.

No matter. When a wrestling superstar has chipped his tooth during a match in Japan and is flying into Pittsburgh for an upcoming main event, he knows he has to go with someone he can trust, even if it is someone he has never met.

At least that’s how the story played out several years ago. Tom Green – who practices dentistry in Washington, Pa., and is listed in the Academy for Sports Dentistry’s registry of recommended practitioners – got the call from this wrestler, literally out of the blue. The wrestler – whom Green had never heard of – was still in the air over Pittsburgh when he placed the call to Green for emergency dental work. For privacy reasons, Green is unable to reveal the wrestler’s name, although he does say that he was a big enough wrestling star to merit having his own comic book at the time. Back then, the World Wrestling Federation was in its glory, and this man was a headline performer for the WWF. Green also will admit that he was one of the largest human beings he had ever seen.

But mostly what Dr. Green thought was that he was the subject of some sort of elaborate prank. Even when the wrestler showed up in his office later that day wearing a leather jacket and suede pants, Green still didn’t know who he was. The man was even reluctant to sign a release form. “Do you know how much my autograph is worth?” he asked Dr. Green.

He eventually signed and got into the chair, and then made one more request. He did not want Novocain. No needles, he insisted. “I’m tough,” he said.

Actually, he wasn’t all that tough. As soon as he heard the sound of Green’s drill, he started to scream: “Numb me!”

That experience gave Green a good story to share, even if it also earned him a fair amount of ribbing from his family for not getting an autograph from a celebrity he had in his chair. (It wasn’t until days later when he was watching a WWF event on TV that Green realized who the wrestler was and how big a star he was at that time.)

Just another day in the life of a sports dentist? Hardly. More often than not, their work is more routine.

The Academy for Sports Dentistry defines sports dentistry as something that “involves the prevention and treatment of orofacial athletic injuries and related oral diseases as well as the collection and dissemination of information on dental athletic injuries and the encouragement of research” in the prevention of such injuries.

What that means is for dentists who practice sports dentistry is that most of their time is spent making, fitting and advocating the use of mouth guards. Even when they have athletes – famous and nonfamous – in their chairs, chances are they are doing the same sorts of procedures that they would for a nonathlete.

Dr. Rick Gottlieb, who has been practicing sports dentistry in Oakland for 30 years, says treating a fractured front tooth caused by a sports injury is really no different from treating a fractured front tooth for an elderly person who may have slipped and fell. Both patients need immediate attention and the procedure is essentially the same. And trauma-related mouth injuries are no more complex because they took place during a sporting event rather than, say, a car accident, Gottlieb says.

The lack of glamour in the profession could be one reason the term “sports dentistry” isn’t a common one, even among sports fans. Sports medicine, of course, is a different animal. Sports fans can tell you the name of the surgeon who has saved so many pitching careers by creating the famous “Tommy John surgery” (Dr. Frank Jobe). And, many Pittsburgh sports fans know about Dr. Freddie Fu, orthopedic surgeon and founder of the UPMC Center for Sports Medicine, and can even recognize him when he sits courtside at University of Pittsburgh basketball games. By contrast, sports dentists go essentially unnoticed. Not even the American Dental Association recognizes sports dentistry as a specialty.

Which is as it should be, most sports dentists will tell you. Dennis Ranalli, a professor and senior associate dean of the University of Pittsburgh Dental School and a past president of the Academy of Sports Dentistry, doesn’t even try to make a case for singling out sports dentistry as dental specialty. What sports dentists deal with are “not identified necessarily as sports-dentistry issues,” he says. Ranalli considers himself simply, a “pediatric dentist who does sports dentistry.”

  There are sports dentists who do get to get a bit closer to the action, however. The National Football League, for instance, requires that two dentists (one for each team) be assigned to each game. At games at Heinz Field, the Steelers are responsible for meeting that requirement. The sports dentists may be sitting in the stands during games, but they’re ready in case of emergency.

The Pittsburgh Penguins have a dentist assigned to games to inspect players’ mouth guards in between periods, or, to act faster in emergencies. The Pirates don’t have specific dentists on site at games, but the trainers have the names and numbers of trusted sports dentists to go in case of oral trauma.

But most sports dentists spend a majority of their time trying to help players avoid dental injuries rather than reacting to dental crises on site. The primary task of most sports dentists is making or fitting mouth guards, as well as advocating their use in more sports than just football, boxing and hockey.

The National Youth Sports Foundation for Safety says dental injuries are the most common orafacial injury sustained during sports and notes that most dental injuries are preventable. The Foundation estimates that an athlete is 60 times more likely to damage his or her teeth if he is not wearing a protective mouth guard.

“Sports dentistry deals with the prevention of trauma to the oral structures and treatment after injuries during athletic events or endeavors,” says Dr. Green of Washington. “It can be any sport.” Properly fitted mouth guards not only protect the teeth, Green says, but they also help absorb the impact of the blow, which could possibly protect the brain from concussion in some cases.

As a Pitt faculty member actively involved in Pitt sports, Dr. Ranalli gets involved in all sorts of issues most dentists do not deal with, one of which is educating athletes about the negative effects of chewing tobacco on the mouth. Seems collegiate wrestlers like to chew tobacco to suppress their appetites in order to make weight before a match. And all college athletes need to be reminded on occasion to go easy on the Gatorade, a drink that’s loaded with sugar and can cause decay.

Pitt is sort of an unofficial center of sports dentistry in Western Pennsylvania, which is appropriate because Pitt is connected with one of the most famous “sports” dentists of all time: Jock Sutherland.

Pitt’s Hall of Fame football coach, who led the school to four Rose Bowl appearances in the 1920s and ’30s, was himself a member of the faculty at the Pitt Dental School, teaching crown and bridge work in the mornings and blocking and tackling in the afternoons. His reputation as both a dentist and a football coach created a connection between dentistry and football at the university that lingered for many years.

Historically, many Pitt football teams have been filled with players who would go on to become dentists. At one time, the Panthers even had an unofficial nickname of “The Fightin’ Dentists.” Often, that was a fairly accurate description of the team’s players. For example, Pitt’s famed 1963 team, (which finished 9-1 and was ranked fourth in the nation) actually had on its roster 15 players who would go on to become dentists.

As you might suspect, most dentists become interested in sports dentistry through an interest in sports. “When I was a kid, I wanted to be the catcher for the Pirates,” says Dr. Ranalli. For Dr. Gottlieb, it was being involved in his children’s sports teams that first got him involved.

“My kids were involved with soccer,” says Gottlieb. “And my assistant coach was also a dentist. We started making mouth guards for the team, and one thing led to another. It just took off from there.”

Gottlieb says sports dentistry is an occupation through which your reputation grows by “word of mouth,” and, no, he’s not making a pun. If you are listed in the directory of the Academy of Sports Dentistry, you never know who might want your services.

For example, Green remembers once getting a call from a member of the San Diego Chargers on the day before a game against the Steelers at Three Rivers Stadium. The player needed a new mouth guard because he had lost his. So Green was summoned to the Chargers hotel, set up an impromptu dental office in the bathroom of the player’s hotel room, took an impression and completed the job.

Ranalli attends all of the home games for the Pitt football team’s events, as well as men’s and women’s basketball, but it’s extremely rare that he is ever called to action while a game is in progress. The biggest emergency he can recall is attending to a Pitt women’s basketball player who was elbowed in the face near the end of the first half of the last game of her senior year. The blow dislodged the tooth from its socket, and Ranalli had to re-position it. Unfortunately, he couldn’t do it in time to get her back in the game. Fortunately, his presence helped save the tooth.

But mostly, sports dentists have to be content with knowing their best work isn’t likely to involve dramatic emergencies or unusual surgery. No, their best work is more likely to come on the preventive side. Changing people’s attitudes about the need for mouth guards doesn’t make headlines, but in the end it could be the most important work a sports dentist can do.

Dr. Gottlieb’s favorite sports dentistry story involves his son, whom he was driving home following a soccer tournament in Erie. They were almost back in Pittsburgh before Gottlieb looked in the rearview mirror and noticed his son had failed to remove his mouth guard. “He said it was so darned comfortable, it was like it was part of him,” says Dr. Gottlieb. For a sports dentist, no story could have a better ending.

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