Category: Health Policy

Funding The Revolution

The Daily Escape:

Lake Louise, Alberta, Canada in snow – photo by Yan Gao

When the President and the incoming Speaker of the House get into a televised shouting match over whether we have enough money to fund Trump’s wall, you know that things have to change in America. They’re fighting over use of a limited resource, the US government’s funding.

We now have within our means the ability to feed, clothe, shelter, and educate everyone. But, as a country, we are unwilling to do so, because we buy into neoliberal economic theory. Never in history have we had the ability to make our species as secure as we do now, but we choose instead to make as many as insecure as possible.

Until about 1980, economic growth created a level of prosperity that earlier generations of Americans could only dream about. But, economic growth no longer makes people more economically secure. We’ve become prisoners in a system that promotes permanent growth, where wages stagnate, schools decay, and Goldman Sachs sits inside our government.

The question we should be asking is: How can our politics provide an answer to our people’s need for economic security? We know that neoliberalism has reduced many of our people to states of economic insecurity. We know that our economic and social order must change, and profoundly, or face an eventual revolution. This isn’t an option, it’s a certainty.

That means that only state funding will create the (peaceful) change we need.

Here’s a big idea from Richard Murphy, a UK tax accountant:

…To put this another way, what may be the biggest programme of change ever known in human history is required in very short order. We need new energy systems; transformation of our housing stock; new transport infrastructure; radically different approaches to food that might even require rationing if we cannot create change any other way; different ways of working and new ways of using leisure time.

Murphy goes on to say:

But this must be done in a way that increases certainty. Jobs must be created on the ground…And I mean, in every constituency….but the transport and other infrastructure must be provided in that case and that does not simply mean more roads. The social safety net must be recreated. That means a job guarantee. It also means a universal basic income. And business must be transformed. Since that process will be incredibly expensive this requires capital and if that means state investment and co-ownership, so be it.

Murphy says that if this was wartime, our government would find the money to fund radical change. He says that we can no longer just extract higher taxes from the rich to solve our funding requirements, we need to create a vision, a plan and funding to achieve the change required.

One way to fund a portion of these requirements may be to restrict funding for the military, to eliminate tax breaks and subsidies for corporations. More from Murphy:

The time for pussy-footing is over. We know what we need to do. We know the scale of the issue. We know the reasons for acting….and we know we can pay for it. This is not left or right as we know it. And any party not addressing it is part of the problem and not the solution.

He’s suggesting deficit financing for societal gain. What are the chances that revolutionary change can happen? Almost zero today. Left to our political class, we’re just going to keep on doing what we’re currently doing, that is, until we can’t.

As we said yesterday, people say, “It’s the system, we can’t change it”.

But, in the Middle Ages, the exact same thing could have been said about feudalism. That institution was deeply entrenched, it was “how things are, and were meant to be.” It was inconceivable that something like democratic government could ever succeed feudalism, yet it did.

Today, our revolutionary task is to allow democracy to express its full potential to reshape and revitalize our social and economic life.

We must begin by setting priorities, taking resources from areas that drain the economy. Then we need to devote those resources to things that will make for a healthier, more secure economy.

One example is to adjust the priority that military defense spending has in our economy. Let’s stop being the world’s policeman, nobody wants us to do it. Then, use the excess resources to build infrastructure, and renewable energy systems.

Everything else we need then will become easier to build.

It’s a matter of deciding what our priorities are, and voting for those who agree with that vision.

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Monday Wake Up Call – December 3, 2018

The Daily Escape:

Boston Public Library – photo by joethommas

The NYT’s David Brooks:

We’re enjoying one of the best economies of our lifetime. The GDP is growing at about 3.5% a year, which is about a point faster than many experts thought possible. We’re in the middle of the second-longest recovery in American history, and if it lasts for another eight months it will be the longest ever.

So everything’s good, no? Not really. More from Brooks: (emphasis by Wrongo)

Researchers with the Gallup-Sharecare Well-Being Index interviewed 160,000 adults in 2017 to ask about their financial security, social relationships, sense of purpose and connectedness to community. Last year turned out to be the worst year for well-being of any since the study began 10 years ago.

And people’s faith in capitalism has declined, especially among the young. Only 45% of those between 18 and 29 see capitalism positively, a lower rate than in 2010.

Brooks’ conclusion? It’s not the economy, we all just need more community connections.

His is another attempt to dress up the now-failing neoliberal economics. Things look good today from some perspectives, but our economy is crushingly cruel from others. Brooks seems to think that millions of Americans are struggling to pay their rent or mortgage, education loans, health care insurance or buy groceries because they have failed to master the art of networking in their neighborhoods.

Alienation is behind the rise of Trumpism, and the rise of populism across the world. In that sense, Brooks is correct, but the leading cause of people’s alienation is economic inequality.

And the leading cause of economic inequality is corporate America’s free rein, supported by their helpmates in Washington. Last week, Wrongo wrote about the exceptional market concentration that has taken place in the US in the past few years. He suggested America needs a revitalized anti-trust initiative. In The Myth of Capitalism, authors Jonathan Tepper and Denise Hearns write:

Capitalism without competition is not capitalism.

For decades, most economists dismissed antitrust actions as superfluous, so long as consumers were not the victims of price-gouging. Monopoly capitalism is back, and it’s harmful, even if a company’s core product (like Google’s and Facebook’s) is free to consumers. As we wrote last week, there’s excessive corporate concentration in most industries, including air travel, banking, beer, health insurance, cell service, and even in the funeral industry.

All of this has led to a huge and growing inequality gap. That means there is little or no economic security for a large and growing section of the American population. People see their communities stagnating, or dying. They feel hopeless, angry, and yes, alienated.

One consequence is that we’ve seen three years of declining life expectancy, linked to growing drug use and suicides. We seem to be on the edge of a social catastrophe.

But our real worry has to be political. People could become so desperate for change that they are willing to do anything to get it. The worry then, is that few vote and a minority elects a strong man populist leader, simply because he/she tells them what they want to hear. That leader can then go out and wreak havoc on our Constitutional Republic.

After that, anything could happen.

Despite what Brooks thinks, we don’t have a crisis of connections. It’s a crisis of poorly paying jobs, job insecurity, and poverty. When people look at their economic prospects, they despair for their children. Doesn’t it matter that in America, health care, education, and transportation all lag behind other developed countries?

The unbridled ideology of free markets is the enemy. Our problem isn’t that individual entrepreneurs went out and took all the gains for themselves, leaving the rest of us holding the bag. It’s more about how neoliberal economics is used both by government and corporations to justify an anti-tax and anti-trust approach that has led to extreme wealth and income concentration in the top 1% of Americans.

The reality is that the nation’s wealth has become the exclusive property of the already prosperous.

We need to wake up America! We have to stop for a second, and think about how we can dig out of this mess. When America bought in to FDR’s New Deal programs 75 years ago, we entered an era we now think back on nostalgically as “great”.

And it isn’t enough to talk about how we can look to Sweden or Norway as economic models. Both have populations of under 10 million, and our society is far less homogeneous than theirs.

We need a uniquely American solution to this problem. It will involve reforming capitalism, starting with tax reform, and enforcing anti-trust legislation.

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Saturday Soother – December 1, 2018

The Daily Escape:

Yukon Grizzly before hibernation – 2014 photo by Paul Nicklen

Quite the week. We had barely digested Thanksgiving dinner when we heard about Russia seizing three Ukrainian Navy vessels in the Azov Sea. We learned that Paul Manafort lied to Robert Mueller, and that his lawyer reported everything that occurred between Manafort and Mueller to the White House. Then, we heard that Trump’s former in-house lawyer, Michael Cohen has admitted to lying to Congress, and is now cooperating with Mueller. Who knows what it all means?

But, the big story this week was that we learned that life expectancy in the US fell to 78.6 years, a 0.3 year decline from our peak. From CNN:

Overdose deaths reached a new high in 2017, topping 70,000, while the suicide rate increased by 3.7%, the CDC’s National Center for Health Statistics reports.

We are witnessing social decay in America. This is consistent with what Angus Deaton and Ann Case called “deaths of despair” in 2017. The WSJ has a detailed breakdown, and also points out how other countries are continuing to show progress:

Data the Centers for Disease Control and Prevention released on Thursday show life expectancy fell by one-tenth of a percent, to 78.6 years, pushed down by the sharpest annual increase in suicides in nearly a decade and a continued rise in deaths from powerful opioid drugs like fentanyl. Influenza, pneumonia and diabetes also factored into last year’s increase.

From Yves Smith:

Americans take antidepressants at a higher rate than any country in the world. The average job tenure is a mere 4.4 years. In my youth, if you changed jobs in less than seven or eight years, you were seen as an opportunist or probably poor performer. The near impossibility of getting a new job if you are over 40 and the fact that outside hot fields, young people can also find it hard to get work commensurate with their education and experience, means that those who do have jobs can be and are exploited by their employers.

The 2017 data paint a dark picture of health and well-being in the US, reflecting the effects of addiction and despair, particularly among young and middle-aged adults. In addition, diseases are plaguing people with limited access to health care.

In the late part of the last century, and the early years of this century, there was a steady decline in heart-disease deaths. That offset a rising number of deaths from drugs and suicide. Now, we’re not seeing those heart-related declines, while drug and suicide deaths occur earlier in life, accounting for more years of life lost.

The worst aspect is that it never had to be this way. These drug and suicide deaths are “collateral damage” caused by the social and economic changes in America since the 1970s.

And we made most of those changes by choice.

Wrongo is reminded that last month, he learned that something similar had happened in Russia under Gorbachev. Under Perestroika, millions of Russians lost jobs. The government’s budget deficits grew. The death rate exceeded the birth rate. Nearly 700,000 children were abandoned by parents who couldn’t afford to take care of them. The average lifespan of men dropped to 59 years.

Are we in a slow motion disaster that could be similar to what Russia went through back in the 1990s?

We’ve become hardened. These American deaths are largely anonymous. When AIDS was ravishing the gay community in the 1980s, people were able to appreciate the huge number of deaths by seeing, or adding to, the AIDS Memorial Quilt, which eventually weighed more than 50 tons.

There is no equivalent recognition for these deaths of despair.

A traitorous American ruling class has sold out its middle and lower classes. If you doubt that, think about Wal-Mart. The Walton’s fortune was made by acting as an agent of Chinese manufacturers, in direct competition with US manufacturers. Doesn’t that seem like treason?

Relax, there’s nothing you can do about all of this today, the first day of December. Time to get what solace you can from a few minutes having a coffee, and a listen to a piece of soothing music.

Start by brewing a cup of Kona Mele Extra Fancy coffee from Hula Daddy Kona Coffee ($64.94/lb.). It has an aroma of dark chocolate, fruit and flowers. And shipping is free.

Now settle back and listen to a few minutes of George Winston’s “December”. Here are Part 1: Snow, Part 2: Midnight, and Part 3: Minstrels:

Those who read the Wrongologist in email can view the video here.

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Sunday Cartoon Blogging – November 11, 2018

Possibly the best news about the mid-terms was that the long-promised youth vote was finally real.  A study by Tufts University found that: (brackets by Wrongo)

Approximately 31% of youth (ages 18-29) turned out to vote in the 2018 midterms, an extraordinary increase over the CIRCLE estimate in 2014 [when 21% voted] and the highest rate of turnout in at least 25 years.

Harvard’s Institute of Politics found that, in 2014, approximately 10.8 million young Americans voted, with Democrats preferred 54%-43%, compared to 14.7 million in 2018 (Democrats preferred 67%-32%). So the Dem’s share of the youth vote increased by 13 percentage points in four years.

The actual number of Republican votes cast by those under 30 remained stable from 2014 to 2018. So, nearly all of the 4 million increase in turnout came from those supporting Democrats.

Wrongo tried to stay away from Jim Acosta and Jeff Sessions for today’s cartoons. It wasn’t easy.

Another place where thoughts and prayers are really needed:

After the CA shooting, there was a fire, followed by a shower for the GOP:

2020 is right around the corner:

From the cartoonist, Clay Jones: After the 2014 midterms, the first major candidate to announce a presidential bid, not an exploratory committee, was Ted Cruz in March 2015. Now, that doesn’t mean we’ll have an announcement in four months…but we don’t have long.

Media madness starts on Monday:

We wouldn’t need to throw the TV out the window if the media actually covered ISSUES. You didn’t hear that last Tuesday, HHS published Final Regulations that will allow employers and universities to deny health insurance coverage of contraception to any woman based on the company’s “moral” or “religious” belief. Did anyone see coverage of this issue before it happened? Which news organizations are covering it now?

Florida, same as it ever was:

Back to the usual totally repellent ads next week:

 

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Nothing Is More Important Than Voter Turnout

The Daily Escape:

Cau Vang (Golden Bridge) Da Nang, Vietnam. This footbridge opened to the public in 2017 – photo via themindcircle

The next few elections will determine if the US remains a minority-ruled country for the foreseeable future. And is there a significant number of non-voters who are predisposed to vote for Democrats.

Check out Adam Bonica’s article in Sunday’s NYT. Bonica, who is a political scientist at Stanford, says that generational shifts are under way that are more powerful politically than people realize. By 2020, half of eligible voters will be Millennials, or Post-Millennials (Gen Z). They will be two-thirds of voters by 2032, and they skew toward the Democrats:

The bottom chart shows that, while the nation is on the cusp of a generational revolution, Millennials and Gen Z’ers haven’t turned out to vote in the way that their elders do. This negates a 31 point Democrat edge in Millennials.

Bonica says that as they age, Millennials will become more likely to vote. He cites a general rule of thumb that turnout increases by about one percentage point with each year of age. This makes it possible to forecast how the generational advantage will grow over the next decade: By 2026, Millennials are expected to account for 19% of votes cast, up from 12% in 2014, with Democratic-leaning Gen Xers and Gen Zers accounting for an additional 34%.

As this happens, the Republican-leaning Silent Generation is projected to account for only 8% percent of votes cast in 2026, down from 23% in 2014. Their participation is bound to go down, the oldest members of the Silents will be 101 in 2026.

But, getting younger voters to turn out is a problem. Bonica says that among advanced democracies, turnout in national elections is a strong predictor of income inequality. The US has both the lowest turnout and highest share of income going to the top 1 percent. He has a very interesting chart showing turnout graphed against income inequality:

Virtually all other western democracies have higher voter turnout than the US. This is unlikely to be a coincidence. Bonica says:

This makes democracy an issue to campaign on. The Democratic base understands that it is waging a battle for the future of the country….They are also painfully aware that our electoral system is biased against them. A rallying cry to put democracy back on the offensive will get the base to sit up and pay attention. Delivering on the promise will get them to the polls.

This year, the Democrats need to focus with laser-like attention on winning the House. They are unlikely to get the Senate. Possibly, they can limit their losses to few, or maybe zero, net.

The Democratic message, assuming they can get their messaging act together, needs to be about these four points:

  • Better jobs
  • Ensuring democratic elections
  • Healthcare for all
  • Higher taxes on corporations

The Democrats can point at the GOP, saying they are the party of corruption, and of doing the bidding of the rich elites. From the Democrats’ point of view, ensuring democratic elections means: Less hacking, easier registration, more days of early voting, and vote-by-mail. All encourage civic engagement and participation.

The fact that Republicans generally do worse when more people turn out to vote is their own fault. We need to point out that their plan is to use vote suppression to weaken democracy, replacing it with a Trump-branded authoritarianism.

And there’s the issue of the Republican-controlled Supreme Court. It will have a strong conservative majority for the next few decades, and that’s going to mean Citizens United isn’t going away, and the Voting Rights Act won’t be strengthened.

Our only weapon is turnout.

We can’t just sit back and let demographics deliver us to power. Democrats will have to fight for these policies. We shouldn’t care that the odds seem stacked against the people who back these values.

Generational change is coming, and with it an opportunity to fundamentally transform the American government and who it serves.

To help with that, Democrats must insist on making voting easier, and more universal.

Then, hone their message.

Then, do everything in our power to make it happen.

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Send Establishment Democrats to the Bench

The Daily Escape:

City Hall Subway Station, NYC – via @themindcircle

We live in disorienting times. Disorienting in that our society, and our values, are in motion. We are no longer anchored by social mores, beliefs, or any shared vision of the future. Our politics are evolving as well. We can’t simply blame Trump, or those who elected him for taking us to this scary place. The bipartisan consensus that’s ruled this country since the 1940s — neoliberal domestic policy, and neoconservative foreign policy ─ no longer produces the same results for our citizens that it has produced since the Eisenhower era.

Establishment Democrats bear some of the blame. And looking forward to the mid-terms and beyond, they have failed to do the simplest work — forming a worldview, then persuading others about their vision, and the steps to achieve it.

We can also blame establishment Republicans, but they have collapsed. The new right is much farther right, more authoritarian, and whiter. And who would have thought they would be the pro-Russia, anti-FBI, anti-DOJ, and (maybe not a complete surprise), the pro-police state party?

History shows that when society turns like this, the establishment parties can disappear, as did the Federalists and the Whig parties. And when one party changes, the other must as well. After Lincoln, neither the Republicans, nor the Democrats, were the same parties.

Perhaps it’s time to take these words in the Constitution to heart:

…to secure these rights, Governments are instituted among Men, deriving their just Powers from the Consent of the Governed…

Therefore, if the Dems are to win back the hearts and minds of the people, regardless of what the banks and corporations want to do, Government must be the advocate for the People.

That requires that our political parties confront the banks, corporations, military contractors, and the other oversized creatures that feed at the government trough.

Is that something that the establishment Democrats (Wrongo likes calling them the “Caviar Dems”) are willing to do? They used to champion social and economic justice, but not so much today. Today, they follow the same neo-liberal economic policies that Republicans champion.

And with few exceptions, they are as neo-conservative on foreign policy as any Republican.

Republicans have undergone a different mutation. They celebrate the globalized economy, and support the domestic gig economy as a means of growing corporate profits. They still celebrate Christian values, so controlling Supreme Court appointments is their great achievement, along with ruinous tax cuts.

America’s corporate tax revenues are going down, while social and infrastructure costs keep rising. So far, under both parties, government has continued to spend money it doesn’t have. It borrows, and pretends that everything is under control.

Now, after 10 years of economic expansion, we continue to pile up deficits. What’s going to happen in the next recession? The truth is, we are poorer, and weaker, as a country than we think. But few politicians are willing to help us face reality.

We see both Bernie Sanders and Alexandria Ocasio-Cortez, the Democratic nominee for Congress in NY, describe themselves as socialists. But, in fact, that’s not what they are. Merriam-Webster defines socialism as:

Any of various economic and political theories advocating collective, or governmental ownership and administration of the means of production and distribution of goods.

Obviously, they hope to take over the corporate-friendly establishment Democratic Party, but if you call yourself a socialist, then, at a minimum, you need to advocate for government ownership of the means of production, i.e., industry. You’re only a socialist to the extent that you advocate that.

Will Bernie or Alexandria nationalize General Motors, Apple, or ExxonMobil? No.

Even advocating for “Medicare for all,” isn’t socialism. Neither Medicare, nor other single-payer programs like Medicaid, are really socialized medicine. No one is advocating for an actual government takeover of hospitals, or turning doctors into government employees. If they really wanted socialized medicine, their cry would be “VA for all,” not “Medicare for all.”

Sanders and Ocasio-Cortez are social democrats. In a social democracy, individuals and corporations continue to own the capital and the means of production. Wealth remains produced privately.

But taxation, government spending, and regulation of the private sector are much more muscular under social democracy than is the case under today’s neo-liberal economic system.

Joel Pett has a great illustration of the difference between Sanders/Ocasio-Cortez and Republicans:

It’s time for the Dems to change direction. Carry the “Medicare for all” banner proudly. Work to end income inequality. Work to add jobs for the middle class.

Send the establishment Democrats to the bench.

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Monday Wake Up Call – June 11, 2018

The Daily Escape:

Interior, Cuba’s Capitol Building, Havana – 2018 photo by Conor Morrissey

Two things to address on Monday. Take a look inside the program that separates the families of asylum seekers. The WaPo reports that:

A Honduran father separated from his wife and child suffered a breakdown at a Texas jail and killed himself in a padded cell last month, according to Border Patrol agents and an incident report filed by sheriff’s deputies.

The death of 39 year-old Marco Antonio Muñoz, had not been publicly disclosed by the DHS, and did not appear in any local news accounts. Muñoz was found on the floor of his cell May 13 in a pool of blood with an item of clothing twisted around his neck:

According to Border Patrol agents…Muñoz crossed the Rio Grande with his wife and three-year-old son on May 12 near the tiny town of Granjeno, Texas. The area is a popular crossing point for Central American families and teenagers who turn themselves in to apply for asylum in the United States.

Soon after Muñoz and his family were taken into custody, they arrived at a processing station in nearby McAllen and said they wanted to apply for asylum. Border Patrol agents told the family they would be separated. That’s when Muñoz “lost it,” according to one agent…

Unruly detainees are taken to local jails where they can be placed in more secure settings or isolation cells. Border Patrol agents found a vacant cell for Muñoz 40 miles away at the Starr County Jail in Rio Grande City. Muñoz was booked into the jail at 9:40 pm. He remained combative, and was placed in a padded isolation cell. Guards said they checked on Muñoz every 30 minutes, and observed him praying in a corner of his cell the following morning.

A guard who walked by the cell at 9:50 am said he noticed Muñoz laying in the center of the floor, unresponsive and without a pulse. Local sheriff’s deputies recorded the incident as a “suicide in custody.” But the capper is this remark by an ICE agent: (emphasis by Wrongo)

Another agent familiar with what happened said he couldn’t understand why Muñoz “would choose to separate himself from his family forever” by taking his own life.

This asshole’s salary is paid by you and me! It’s time we see these agents for who they really are.

Second, last week the DOJ filed a brief urging a Texas court to invalidate the Affordable Care Act’s crucial insurance reforms, including the prohibition on refusing to cover people with preexisting conditions. In their complaint, states (including Texas and other red states) point out that since Congress has repealed the penalty for going without insurance, the freestanding requirement to get insurance, which is still on the books, is therefore unconstitutional. And because it’s unconstitutional, the courts must invalidate the entire ACA. From the Incidental Economist:

There’s a strong argument to be made in the ACA’s defense. And the Justice Department has had a durable, longstanding, bipartisan commitment to defending the law when non-frivolous arguments can be made in its defense.

If the Justice Department can just throw in the towel whenever a law is challenged in court, it can effectively pick and choose which laws should remain on the books. That’s a flagrant violation of the President’s constitutional duty to take care that the laws are faithfully executed. More:

The President has a duty to take care that all the laws are executed, not just the ones he likes. And while there are cases in which the Justice Department has deviated from that principle, they are extremely rare.

The Trump administration has just announced that it doesn’t care that a law was passed by Congress and signed into law by the President. All that matters is that it hates the law and has a (weak) argument for casting it aside.

Time to wake up America! There is a revolution underway, and we’re being fed the elephant of authoritarianism one little slice at a time. This time, the revolution is televised every day, but we’re not connecting the dots quickly enough.

To help America wake up, here is Iris DeMent with “Living in the Wasteland of the Free”, from her 1996 album, “The Way I Should”:

This song is 22 years old, but still rings true. Iris says: “The poor have now become the enemy” and “Let’s blame our troubles on the weak ones“.

Today, both are true, and are simply sickening.

Those who read the Wrongologist in email can view the video here.

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Travels With Wrongo – Poland Edition

The Daily Escape:

Chopin’s Piano at his birthplace, Zelazowa Wola, Poland. Chopin is far and away the most famous Polish national – 2018 photo by Wrongo

Sometimes there can be unintended consequences, even when the intended consequence is a good idea.

The focus of Wrongo and Ms. Right’s visit to Poland is to learn more about the current state of Polish nursing (Ms. Right is a PhD nurse). Over the past few years, Poland has worked very hard to create national qualification standards for nurses in practice, and to dramatically improve the quality of their education. Prior to 2004, most nurses attended vocational schools, they entered practice after two years, and most of their education was on-the-job training.

Today, most nurses entering practice have Bachelor’s degrees. Both Master and PhD degrees are offered as well. There is a detailed, nation-wide standard for nursing education that is required in all 420 schools of nursing.

This all happened in a period of about 14 years, and is a direct result of Poland joining the European Union in 2004. The EU’s interest was that Polish nursing education and practice standards would be raised to meet the overall standards for EU member countries. To that end, the EU provided Poland with funding that was used for “bridge studies”, designed to bring the vocational school graduates up to the new standards, and university programs for new nurses.

The results are impressive. Today, Polish nurses meet the standards of the EU. They are in demand for jobs all across the other EU countries.

This has led to an unintended consequence: a nursing shortage in Poland. In Poland, the average nurse’s salary is about $10,000/year. But as you can see below, Polish nurses can earn substantially more elsewhere in Europe. These are pre-tax monthly averages in Euros:

Source: Nursingcee

Nurses earn less than the average worker in Poland. The average salary in Poland in Q1 2017 was 4,449 zt, or about $1215/mo. Compare that to a nurse’s average salary of $833/month, and the reason for the shortage is clear. About 20,000 nurses migrate annually from Poland to elsewhere in the EU.

The result is a current 60,000 nurse shortage in Poland, where there are 5.4 nurses per thousand of population. That ratio is 9.1/thousand in the OECD countries. And it is the younger, educated nurses that are leaving: The average age of a Polish nurse is 51.

Over the past two days, we met with the chief nurse executives at two hospitals, the vice-minister for nursing in the Ministry of Health and the president of the Polish equivalent of the American Nurses Association. None could articulate a clear strategy for ending the nursing shortage, or for increasing the average nursing salary sufficiently to slow outward migration for economic reasons.

Most Americans were unaware of how the EU imposes standards on member countries for many aspects of economic life until the Brexit issue arose in the UK. Those in the UK who voted to leave the EU felt that the requirements to stay were not worth the costs. That may have been a shortsighted decision.

There will always be costs when a degree of sovereignty is surrendered when joining an organization like the EU.  Consider Jan and Thera Kuiper, dairy farmers at Kuiper’s dairy in the Netherlands, who Wrongo and Ms. Right met in 2017. The Kuiper’s went from being simple dairy farmers supplying a local market, to now selling 4000 pounds of cheese a week throughout the EU. It wasn’t easy to comply with the EU’s requirements to sell cheese, but now their business is thriving.

It looks like Mr. Market will continue to determine where Polish nurses work, at least until Poland comes up with a solution that leads to better pay at home.

Until then, those who are most confident in their skills will continue to move elsewhere in the EU for better pay.

And Poland will continue to have a first-world system of nurses’ education, without a first-world career path for their graduates.

Since Wrongo is returning to the US on Saturday, there can’t be our customary musical interlude to start the weekend. But, Wrongo and Ms. Right had the pleasure of hearing a private performance of three pieces by Chopin on Friday by the remarkable 23 year-old Polish pianist, Wojciech Kruczek. Among the pieces Kruczek played for us was Chopin’s Ballade No. 1, in G minor. Chopin’s four Ballades are one-movement pieces for solo piano. Ballade No. 1 was completed in 1835 when Chopin was 25. The Ballades are considered to be some of the most challenging pieces in the standard piano repertoire. Here is the Ballade #1 by Mr. Kruczek

While the video says the artist is Kayo Nishimizu, Wrongo assures you that it is Wojciech Kruczek.

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Last Day In Budapest Teaches a Valuable Lesson

The Daily Escape:

Liberty (or Liberation) Statue, Budapest, Hungary. The statue was erected in 1947 in remembrance of the liberation of Hungary by Soviet troops. Many recalled the period of  Soviet control as a time when they were “under liberation” – 2018 photo by Wrongo

Sometimes a person-to-person experience can jolt you from your comfort zone, and provide insight into a wholly different life experience. On Monday, we visited Tabitha House, a pediatric hospice and palliative care facility in Hungary. As its name implies, it provides end of life care for terminally ill children or for those kids with chronic and life-shortening conditions.

We spent time talking with Judit Hegedus, head nurse of Tabitha House. She told us that Tabitha House is the largest pediatric hospice in Hungary. It has five beds.

Just five beds.

There are 9.8 million people in Hungary, of which 2.1 million are children. The first Hungarian hospice started in 1991, and insurance coverage for adults in hospice began in 2004. But it took until 2017 before there was any government financing for pediatric hospice and palliative care.

As of 2015, the most recent year with data, there were only 215 hospice/palliative care beds in Hungary. If this seems low, the World Health Organization’s recommendations for a country with a population of 10 million like Hungary is that a minimum of 500 beds are needed.

Tabitha House has a mostly part-time staff of 15, including pediatric and hospice nurses, a psychologist, a physiotherapist and a physician. There is a problem recruiting sufficient professionals because some misunderstand the value of palliative care, and they share society’s fear of childhood death.

Obviously, there is a large unfilled pediatric hospice need in Hungary. The most cost-effective way to expand assistance to terminally ill kids would be by offering home care services. Judit says that in-patient costs average about $72/day, low by US standards. In-home care costs about $16.50/visit.

While funding expansion is an issue, she hopes to initiate offering home care services later in 2018.

When we arrived at Tabitha House, we expected to be moved by the struggle of kids fighting for their lives. Of course that happened, but the biggest emotional wallop came from listening to Judit, and watching her staff deal with the impossible situation they face. In their country, there is an overwhelming need for pediatric hospice services, and totally insufficient resources to meet that need.

You leave feeling that these people are saints. They are a happy team, persevering despite having to make do with less-than-the-best equipment, and fighting the long odds facing their patients.

It was touching to stand with Judit in front of their “family tree”, a wall mural of a tree with many branches. At the end of each branch was a photo of a child. Judit would pause with her finger over each, say the child’s name, and offer a short memory of him or her.

There are wonderful people in the world. People who are not playing the angles, who are not reaching for wealth. People who exclude no one from their care and concern.

People who do good simply because it is necessary.

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Saturday Soother – April 7, 2018

The Daily Escape:

Cherry Blossoms, Tokyo Japan – March 29 photo by Eugene Hoshiko

Maybe Wrongo has Spring Fever, but how could he, when it snowed again yesterday? He promises to put the snow shovel in the garage for its three-season nap on Monday, no matter what.

The delay of spring’s arrival got Wrongo thinking about change. We like to think that little changes in our environments, either natural, or socio-cultural, but change they do, every day. And except for a few details, Wrongo is certain that this blog’s readers are all on the same page: Change is in the air, and nothing stays the same. And we’re not just talking about the weather.

Yesterday is gone
Tomorrow is already here.

Wrongo has been writing this blog since March, 2010. Over the past eight years, he has explained how our political/social/economic systems operate, and why/how they can easily fail. And how we do not seem to have a rational, coherent plan to avoid that failure. Yet, each year we seem to inch closer to failure.

Are we doing anything more than Don Quixote was doing? Wrongo, by writing and you, by reading this blog? But Wrongo persists. He’s here, you are here, and once again, as in 1968, change is in the air.

Millions of people are on the move, leaving their ancestral homes, fleeing conflict and poverty. They are trying to find a place to survive, while others who were left behind are dying in the millions. With the increased efforts by migrants to survive, both Europe and the US are closing the gates, hoping to keep the immigrant mob on the outside. But at home, we already have achieved conflict, poverty and death that isn’t caused by immigrants. It is, to paraphrase Jimmy Buffet, “Our own damn fault”.

On Monday in our little corner of Connecticut, we will have a very New England form of direct democracy, a special town meeting. Those citizens who show up will get to vote on whether the Town issues bonds to finance the repair of our roads, which have suffered 20+ years of deferred maintenance. Maybe 100 people will show up, (out of 8,000 voters) maybe less. Those who do show up will decide if we fix our roads, or not. They will decide if lower taxes are better than safe roads.

So Wrongo and Ms. Right spent today stuffing envelopes into mailboxes. This vote is the culmination of a two-year effort to get our town to address how poor our roads have become. We will see if our efforts today help to break voters from their Golden Slumbers, and participate.

If they fail to show up, it will be their own damn fault if the vote goes against whatever their viewpoint is on the bonds.

Wrongo believes that political change is in the air, but that change locally and nationally depends primarily on voter turnout. Turnout depends on people being motivated enough to waddle on down to their polling place and vote, even if the weather is bad, the candidate isn’t perfect, and their one vote doesn’t seem to matter.

But today’s Saturday, and it’s time to settle back, relax, and get soothed. Or work on your taxes, if you have procrastinated. To help you relax, brew up a cup of Gedeb Lot 83 Ethiopia Natural coffee ($18.95/12oz) from JBC Coffee Roasters in Madison, WI. It has a sweetly tart structure with a rich umami undercurrent and satiny mouthfeel.

Now settle back in your favorite chair and listen to “Spring Waltz” supposedly by FrĂ©dĂ©ric Chopin.

However, it isn’t really called that, it isn’t a waltz, and it isn’t by Chopin. It is actually “Mariage d’Amour” composed by Paul de Senneville in 1987. It was wrongly titled and became wildly popular, so the various YouTube channels that feature it won’t correct its name. Still it is very beautiful, and of the season:

Those who read the Wrongologist in email can view the video here.

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