Excerpts from recent editorials in the United States and abroad:
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Sept. 30
The Wall Street Journal on Biden, Medicare prescription drug premiums
’Tis the season for election handouts. On Friday the Biden Administration announced lower Medicare prescription drug premiums, which will naturally be paid for by taxpayers. The political irony is that Biden officials are increasing subsidies to insurers they otherwise vilify to mitigate pre-election harm from the Inflation Reduction Act.
The Centers for Medicare and Medicaid Services (CMS) touted in a press release that average Part D premiums will decline by about $90 next year while benefits will improve “thanks to the Inflation Reduction Act and other new enhancements.” P.S.: Seniors can show their gratitude by voting for Democrats.
Recall how Democrats sought to reduce Medicare drug spending by capping patient out-of-pocket costs at $2,000 annually and shifting more of the entitlement’s cost to insurers. CMS also sweetened benefits with regulatory tweaks. But Democrats failed to appreciate that there’s no such thing as a free entitlement expansion.
Insurers projected that Part D premiums would balloon next year, when the $2,000 cap and other freebies kick in. Providing basic Part D benefits next year is estimated to cost $179.45 a month on average, up from $64.28 this year and $34.71 in 2023, according to CMS.
CMS uses a complicated formula to subsidize premiums, but healthcare analysts projected that premiums would rise by hundreds of dollars. Some insurers warned they might exit the market to avoid losing money. Seniors are notified of the premium spikes before open enrollment begins in mid-October. Talk about a surprise bill.
To head off this self-induced political mess, CMS launched this summer a “demonstration project” to “stabilize” the market that involved boosting payments to insurers. Congress in 1967 allowed Medicare to test new payment models to improve the efficiency of healthcare delivery, but such projects are supposed to be implemented on a small scale.
This Biden project 2025 instead rewrites the IRA to spend money that Congress didn’t appropriate to fix Democrats’ handiwork. CMS says that nearly all insurers signed up for its program, which is expected to cost about $5 billion. Voila, CMS says Part D monthly premiums will decline next year by $7.45 to $46.50. It’s good to be President.
Biden officials may have drawn inspiration from their Obama predecessors, which in 2010 stood up a demonstration project that boosted payments to insurers to prevent Medicare Advantage premiums from spiking owing to cuts Democrats made to the program in ObamaCare. Those subsidies were projected to cost $8 billion over three years.
The Government Accountability Office wrote in 2012 that the project “dwarfs all other Medicare demonstrations—both mandatory and discretionary—conducted since 1995 in its estimated budgetary impact and is larger in size and scope than many of them.” The Biden IRA patch dwarfs that 2012 fix in size, scope and budgetary impact.
Democrats in Congress and the press rightly slammed the Trump Administration in autumn 2020 for floating a demonstration project to send seniors $200 drug discount cards before the election. But no one cares when a Democrat is abusing executive power and taxpayers to win the senior vote.
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Sept. 27
The Washington Post on lowering birth rate in the United States
To have children or not to have them? That is the question more and more Americans are asking themselves. Only 26 percent say having children is extremely or very important for a fulfilling life, according to a Pew Research Center survey, whereas 71 percent say the same about “having a job or career they enjoy.” The U.S. fertility rate has plummeted to 1.6 lifetime births per woman, well below the “replacement rate” of around 2.1, at which point a population remains stable between generations.
Lower birthrates mean fewer young people, which means a shrinking workforce and more difficult economic growth. But there are other reasons to hope for more children, no less real for being more intangible. Mass reluctance to bring a new generation into the (admittedly troubled) world could signify growing pessimism in a society that has historically thrived on optimism. A disproportionately elderly society could be a wiser but less dynamic one, with fewer young people to take risks, contribute new ideas and — yes — provide youthful joie de vivre.
The declining birthrate is puzzling, given that being married with children correlates with self-reported happiness — among both men and women. Nearly 40 percent of women who are married with children say they are “very happy,” according to the 2022 General Social Survey. It’s just 25 percent for those married without children, and even lower for those who are unmarried either with or without children. Meanwhile, 35 percent of married men with children report being very happy, compared with 14 percent of unmarried, childless men.
Of course, correlation is not causation. These data could indicate that having children tends to make people happy, or that happy people tend to have children. Either way, for most people, getting married is the first step to having children — and marriage is becoming less frequent. Twenty-five percent of 40-year-olds have never married, according to a Pew survey. In 1980, the figure was 6 percent. Unmarried rates are higher among men, who are also significantly more likely than women to want children in the first place.
In their book, “ What Are Children For?,” authors Anastasia Berg and Rachel Wiseman show that a growing number of women say they don’t want children because of the economic costs. But the data complicate this picture. After being behind for a while, millennials have largely caught up and are even eclipsing previous generations on various income and wealth metrics. And in countries where economic supports for women are very generous, as in Norway and Finland, the fertility rate has dropped below the United States’ in recent years.
Today, having children is a choice rather than an expectation, and more women are deciding that the trade-offs are too great in light of competing life goals. If you can’t have it all, which many women feel they can’t, then a choice must be made, and having children comes to be seen increasingly as a zero-sum consideration.
This is progress. Expanding the range of choices available to individuals is what makes a free society free. Americans should not idealize a past when women were pressured into marrying unimpressive men or shamed for pursuing their careers.
But, just as people shouldn’t be pressured by circumstance into having children, they shouldn’t be dissuaded from it, either. Social expectations to engage in helicopter parenting might make having kids seem like a task only available to those with unlimited time and resources. Zoning regulations that limit housing density — including “in-law suites” — create impediments that restrict multigenerational housing, making child care harder. Major cities have become increasingly childless places: If more of your neighbors and peers are single or childless (and seem to be enjoying their lives), then this will likely temper your own enthusiasm about having kids.
As philosopher Jennifer A. Frey writes: “Marriage and parenthood are leaps of faith that require individuals to go from thinking and choosing for ‘me’ to thinking and choosing for ‘we.’” A leap of faith isn’t easy. Countries that have tried to boost birthrates through economic incentives have largely failed. But government could still seek to make the decision to have children easier for prospective parents: through ensuring access to decent child care, investing in high-quality education, boosting monetary assistance such as the child tax credit, permitting the construction of more and more densely built homes. Policies such as these would ease burdens on stretched families and promote healthy child-rearing — making them worthwhile regardless of whether they also supercharged American fertility.
ONLINE: https://www.washingtonpost.com/opinions/2024/09/27/children-happiness-marriage-families-birthrate/
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Sept. 27
The Boston Globe on a nursing shortage in the US
The federal government is predicting a nursing shortage in 2025, and we’re already seeing signs of one locally. Around one-fifth of registered nursing positions in Massachusetts home health care and nursing homes are unfilled. Massachusetts hospitals spent $1.1 billion last year hiring temporary registered nurses to fill vacancies. Nationally, according to a 2022 survey of nurses, the median age of a registered nurse was 46 years old, and more than one-quarter of all nurses reported that they planned to leave nursing over the next 5 years.
Yet in July, the US State Department announced that it was effectively freezing visa availability for foreign nurses until the next fiscal year starts in October, cutting off a potential supply of internationally trained nurses who want to work in the United States.
Importing new foreign-trained medical professionals won’t fully solve the nursing shortage. It won’t address challenging job conditions, including understaffing and stress, that lead to turnover. As this board previously argued, Massachusetts also needs to reform its state licensing systems if it wants to welcome more foreign-trained doctors and nurses.
But a bipartisan bill, the Healthcare Workforce Resilience Act, that would allow 25,000 foreign-trained nurses into the United States is a common-sense step that should be an easy political lift. The bill doesn’t increase the number of visas that would be authorized; it lets immigrants use visas that were previously authorized by Congress but went unused for administrative reasons (for example, paperwork wasn’t processed by the end of the fiscal year). The bill also includes 15,000 green cards for doctors, which would likely be used to give permanent residency to foreign-trained doctors already practicing in the US.
Similar bills to “recapture” unused immigration visas were signed by former president Bill Clinton in 2000 and former president George W. Bush in 2005, with the 2005 bill focused specifically on visas for nurses, according to the Niskanen Center, a pro-immigration think tank.
The current bill is sponsored by Senator Dick Durbin, a Democrat who chairs the Senate Judiciary Committee; Republican Senator Kevin Cramer; and Democratic Representative Brad Schneider. It includes Democratic and Republican cosponsors because having an adequate health care workforce affects red and blue states.
One would think much-needed health care professionals should be at the front of the line in the US immigration system. But due to the system’s complexities and caps, even nurses who are fully qualified to work in the United States and have a job offer here get stuck in a green card backlog of around three years, according to the American Association of International Healthcare Recruitment, which supports the bill. (The backlog for Indian and Chinese workers is longer because of country-based visa limits.) The United States caps total employment-based visas at 140,000 a year, and nurses fit into a particular subcategory for workers who have a bachelor’s degree but no master’s degree.
Under this bill, any nurse who obtains a visa would need to have taken the US nurse licensing exam, passed an English exam, and had their education and credentials verified while in their home country. They also must be sponsored by a US employer. Christopher Musillo, general counsel for AAIHR, said a nurse who gets a visa could start working within 30 to 60 days of arriving in the United States.
The situation for physicians is different because they, unlike nurses, can obtain temporary work visas. Musillo said the new visas would likely go to doctors already practicing in the United States on temporary visas who face a years-long backlog to obtain permanent residency.
The Massachusetts Medical Society and Massachusetts chapter of the American College of Physicians came out in support of an earlier version of the bill in 2020. The Massachusetts Health and Hospital Association also supports it. A letter from 52 national organizations representing health care professionals, provider organizations, and patient advocacy groups sent to congressional leaders in February said a shortage of doctors and nurses is already leading to decreased health care access and foreign professionals will “strengthen and provide stability to the US health care system.”
As baby boomers age, the demand for health care will grow. A proposal to allow more foreign-trained doctors and nurses to live and practice in the United States should not be blocked by a broader federal debate over immigration. The United States needs these qualified professionals.
ONLINE: https://www.bostonglobe.com/2024/09/27/opinion/nurse-shortage-congress/
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Oct. 1
The St. Louis Post-Dispatch on the GOP and reproductive rights
Little ladies of America, put down your sewing kits and listen up: Donald Trump and the Republican Party have your cute little backs. They’re going to protect you — from making your own choices about reproduction, from deciding whether to own a cat, maybe even from traveling between states.
Heck, girls, today’s GOP will even protect you from the burden of thinking!
“WOMEN WILL BE HAPPY, HEALTHY, CONFIDENT AND FREE! YOU WILL NO LONGER BE THINKING ABOUT ABORTION!” the former president recently posted — helpfully putting it in all-caps so even female readers can understand it. “… I WILL PROTECT WOMEN AT A LEVEL NEVER SEEN BEFORE.”
Of course, you’ve already sampled Trump’s idea of “protection,” in the form of abortion bans in half the country that have now been officially confirmed to have cost women’s lives. Trump — who is more singularly responsible for those bans than any other individual in America, thanks to his three Supreme Court appointments — knows how grateful you are to him.
But it’s not just Trump for whom you should be knitting scarves of gratitude, ladies. Other Republican luminaries these days are also offering invaluable advice on how the fairer sex can be happy, healthy and compliant.
There’s JD Vance, Trump’s running mate. When recently confronted with a 2021 interview in which he derided “childless cat ladies” who “want to make the rest of the country miserable too,” he … doubled down, snarking: “I’ve got nothing against cats.”
It’s hard to believe this duo is trailing among women by double digits in polls. Don’t you chicks know what’s good for you?
Vance has also suggested that parents should have more votes in elections than non-parents, and that women who don’t have their own kids aren’t qualified to teach in schools.
Setting aside what generations of nuns might think of that suggestion, it’s a useful reminder, ladies, that to today’s Republican leaders, you are, first and foremost, incubators — reproductive systems that also happen to be capable of speech. Aren’t you honored?
Speaking of reproductive systems: All girls should watch that educational 2022 video that recently surfaced of Mark Robinson, the North Carolina Republican gubernatorial nominee, waving his hand around his groin area and declaring that one of the biggest problems in society today is that women need to just “get this under control.”
(How to do that? In the immortal words of Trump himself, “Grab them by the … ” Y’know.)
Then there’s Bernie Moreno, the GOP’s Senate nominee in Ohio, who recently derided those “single-issue voters” — meaning, women who have the gall to vote in the interest of their own bodily autonomy. He declared it “crazy” that women over 50 would care about reproductive rights. “I’m thinking to myself: I don’t think that’s an issue for you.”
Hmm. Not to overload your female brains here, but is Mr. Moreno suggesting that anyone who can’t get pregnant should keep their damned noses out of other people’s reproductive decisions? What an unintentionally intriguing concept! Discuss among yourselves, girls.
But don’t discuss too much. Today’s Republican Party — which, remember, is protecting you — wants to ensure that you don’t have access to information that isn’t good for you.
For example, Missouri’s Republican lawmakers have considered outlawing billboards and websites that might provide you with dangerous information about out-of-state abortion options. (Sorry, honey, the First Amendment is only for men.)
In Texas, they’ve even tried to prevent women from driving to other states for abortion services.
Women behind the wheel is generally a bad idea anyway, are we right?
So come Nov. 5, ladies, you should walk to the polling places — and vote to protect yourselves.
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Sept. 29
The Guardian on the killing of Hassan Nasrallah and rising tensions in the Middle East
When the US and France launched a call for a temporary ceasefire in Lebanon on Thursday, they were confident that Benjamin Netanyahu backed it. A day later, still in New York for the UN general assembly meeting, the Israeli prime minister approved the airstrike on Beirut that killed the leader of Hezbollah, Hassan Nasrallah.
Many in Lebanon – as well as in Israel, Syria and elsewhere – will not mourn a man with so much blood on his hands. But they are terrified. More than 1,000 people in Lebanon have reportedly been killed in the past week. Almost a fifth of the population is said to be displaced; families are sleeping in the streets. With bombs still falling, and the threat of a ground invasion looming, Mr Netanyahu said that Israel’s work was not completed.
Hezbollah believed that contained escalation was possible when it launched rocket attacks on Israel after the Hamas atrocities on 7 October. Israel has proved it wrong, taking leaps up the escalation ladder that include what appear to be clear breaches of international law. In doing so, it has humiliated not only Hezbollah and its patron, Iran, but the US and Joe Biden personally.
US and French officials briefed that Mr Netanyahu had privately approved the Lebanon ceasefire that he then publicly rejected. Over months, the Israeli prime minister has periodically told Washington what it wants to hear, and then done whatever he wanted. As Israel feigned some interest in US diplomatic initiatives, it was planning the comprehensive assault on Hezbollah that has poured fuel on the flames. Mr Netanyahu has repeatedly treated his country’s staunchest and most essential ally with contempt, using the weapons it supplied. Tens of thousands lie dead in Gaza, and the Middle East is sliding towards the abyss weeks from the US election.
Hezbollah is now reeling. Senior political and military leaders have been killed; those who survive are beset by mutual suspicion. It faces pressure within Lebanon, from those furious at the state of the country and frightened the group is driving it to outright catastrophe. Iran does not want to be baited into a war on Israel’s terms; it has always relied on proxies. But Hezbollah was supposed to be protection against a direct Israeli attack. Now it wants to re-establish deterrence and reassure proxies without triggering the very fate it fears.
Israel wants its citizens to be able to return to their homes in the north. Many more Lebanese citizens are displaced, and Israel has launched four times as many attacks on Hezbollah as vice versa in recent months. But Hezbollah still has tens of thousands of fighters and a large arsenal. When Iran launched its first direct attack on Israel this spring, Arab states helped Israel to see off the drones and missiles. It can’t expect that again. And Tehran may see accelerating its nuclear programme as the key to future security – though that would itself increase the risk of a big Israeli attack.
The failure of Mr Biden’s embrace of Mr Netanyahu is starker than ever. The president should tell him that the US will not continue to supply weaponry so that Israel can recklessly ignore it. As world leaders have insisted, a ceasefire in Lebanon is the immediate priority. But only a ceasefire and hostage release deal for Gaza too – and beyond that, the creation of a Palestinian state – can bring the region peace.
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