Soriek
2yr ago
Yeah I think I underappreciated how much of the Chavez Era was just outlandish incompetence / having no plan at all rather than a concerted socialist effort failing on pure economic terms. I'm not sure why but I had an impression of Chavez as a pretty smart guy.
Soriek
2yr ago
Do you really? The left never seems to have any problem with leftist dictatorships (too long to list here). Sure, they may recognize Kim is taking it too far, and maybe Pol Pot made a goofie or two, but otherwise dictatorship of the proletariat doesn't seem to represent any serious problem.
OP described himself as a progressive democrat, not a marxist-leninist.
Soriek
2yr ago
Democrats impose some destructive rule
What rule are you talking about? State regs constraining supply are very much bipartisan. This is true for education requirements as well as for more obviously monopolistic rules like CON/COPA.
Soriek
2yr ago
I'm in favor. It would be a pretty massive move away from federalism and towards centralization, so I imagine it would be hard to pass though.
Soriek
2yr ago
It does, but the Republicans, including Sen Cassidy, aren't proposing addressing state level restrictions either, so it's the only solution on the table at the moment. I don't know exactly how the grants will be distributed, but if they can raise wages for nursing college teaching positions, it can also be a way of luring more talent there.
Soriek
2yr ago
Was the idea of raising wages discussed?
Yeah, this was the crux of the side debate, where Democrats pointed out in the past they've tried to pass greater funding to allow for raises, but Republicans have been opposed. The rule that 80% of federal funds must go to direct workforce is also an atetmpt to ensure that wages are prioritized, if not having raises literally mandated.
If there truly are not enough workers who meet the legal requirements, then maybe the law should be changed to stop limiting supply. The federal government could make a "shall issue" style law for getting qualified as a caregiver.
I think this would be ideal, but both Democrats and Republicans are less likely to pass laws that are seen as targeting state level regulations in absence of a very compelling reason. It happens of course, but getting a serious majority on board with removing a masters degree requirements for specific industries for twenty seven states or whatever is a harder legislative sell than just passing funding laws or regulations that aren't directly challenging state govs. Significantly, this wasn't even discussed by either party in the hearing, I've just happened to hear Senator Cassidy say it in another context.
Or leave it up to facilities and customers to negotiate the level of training they require.
Training and cert requirements are also mostly handled by state law so unfortunately there isn't a ton of room to directly negotiate for providers.
Soriek
2yr ago
Staffing Shortages in Nursing Homes
Recently the House Energy and Commerce Health Subcommittee held a hearing about two new Biden Administration rules impacting staffing in nursing homes.
The lay of the land is that everyone in both parties agrees that we have a critical lack of workers in nursing homes. There have been more than 500 long term facility closures in 2020, and we would need to fill 150,000 jobs just to reach pre-pandemic levels. One of the witnesses mentioned that most nursing homes do not have anywhere near the minimum number of staff that the Center for Medicare and Medicaid Services considers a requirement to be safe. Higher numbers of staffing are also associated with higher quality patient care and lower deaths. Some witnesses related horror stories of nurses not being able to wash patients who had soiled themselves because they were dealing with more urgent medical situations for other patients.
This is especially urgent because by 2030 all 75 million of the boomers will be over 65 and the demand for care will only continue to rise. So the Biden Administration has proposed two rules to address the situation.
1 - The Proposed Minimum Staffing Rule would require there to be a registered nurse on-site 24 hours a day (up from 8 hours currently), and a ratio of one nurse for every 44 residents and one nurse aid for every ten residents.
• Republicans objected that the Kaiser Family Foundation found as many as 80% of nursing homes would not be able to meet the minimum staffing requirements, and compliance costs alone would be tens of millions per state. This would be especially difficult for rural nursing homes where trained staff are rare.
• Democrats responded by pointing out that the rule phases in over three years, gives rural facilities five years, and makes full exceptions for nursing homes that are trying to find staff but can’t.
• Republicans also claimed there simply aren’t enough trained staff out there to be hired, which makes the requirement impossible. It’s unclear if this is true; the witnesses were pretty evenly divided.
• (Related tidbit from outside this particular hearing: Senator Bill Cassidy, Bernie Sanders’ Republican counterpart on the Senate HELP Committee, has complained that we have a shortage of trained nurses partially because many states require nursing colleges to be taught by nurses with masters degrees, who are few in number and already mostly working as practitioners. I can buy this because in my experience looking into other healthcare issues, state level regulations often do make federal laws go much less far. For example pricing transparency rules don’t really matter when states allow hospitals to be monopolies.)
• Democrats responded that the rule provides $75 million in grants to train nurse aids, and also pointed out that Democrats repeatedly have tried to boost federal spending to help with this kind of training and hiring but Republicans were opposed soooo.
2 - The proposed Medicaid Access Rule would require home health agencies to pass through a minimum of 80% of funds to direct health care work force.
• Republicans objected that this only leaves 20% of funds to handle everything else: administrative costs, facilities, training, supervision.
• Democrats countered by demonstrating that non-profit nursing homes were spending on average 43 more minutes per patient each day than for-profit nursing homes, and this held consistent across urban vs rural areas as well as rich vs poor areas. Meanwhile, for-profit orgs are also, obviously, walking away with more profit. Thus, the 80% rule is just a way of ensuring that the federal funds goes to our most critical problem: staffing and patient care, since clearly you can’t rely on businesses choosing to do this on their own.
It's a crappy situation. Basically everyone agrees that the current status quo is unacceptable, but also nursing homes genuinely don't seem to be the funds to hire the desperately needed more nurses, even though they were able to (at least moreso) only a few years ago? The only solution seems to be raising federal funding for nursing homes to hire more people, but this is unlikely to happen any time soon. It would probably be easier to get everyone to agree on stuff like lifting the supply restrictions on nursing colleges, but of course that happens on the state level and is much more complicated to address from the federal side.
Soriek
2yr ago
Yemen
Imagine declaring war on a sovereign nation and no one even notices. This is much the experience of the Houthis, who declared war on Israel Tuesday and started firing missiles to widespread same-day coverage from media behemoths such as amwaj.media, Indiatimes, and Greek City Times. This might seem like a bit of a joke (and probably largely is) given that the Houthis are a marginal fighting force and also over 1000 miles away from Israel, but they do actually have ballistic missiles capable of reaching that far. In fact, the Israeli Arrow air defense system claims to have already intercepted missiles they believe to have come from Yemen.
Regardless of Yemen’s own power level, this mostly feels a little unsettling as it's another domino leaning towards a larger regional war, though the Houthis should be understood as part of the same Iranian proxy network that includes Hamas and Hezbollah, which is different than a more traditional sovereign nation getting involved. Also interesting are the implications for Saudi Arabia, which has been normalizing relations with both Israel and the Houthis (and kind of sort of Iran) and is now in a crappy position for both:
Yemen has enjoyed more than a year of relative calm amid a U.N.-led peace push. Saudi Arabia has been holding talks with the Houthis in a bid to exit the war, as Riyadh focuses on economic priorities at home.
But Houthi missile and drone attacks on Israel have increased the risks of conflict for Saudi Arabia.
The most direct flight path for any drone or missile launched from Yemen passes over western Saudi Arabia near the Red Sea before flying over Jordan and into Israel.
The Saudi government communications office did not respond to a request for comment on the kingdom's concerns over Houthi attacks.
Soriek
2yr ago
Venezuela
I’ve covered in recent weeks that America has undergone a thaw in relations with Venezuela, lifting sanctions in exchange for the Maduro Administration allowing free and fair elections. This began with an opposition party primary, which was marked by intimidation and whose winner, Machado, is still not legally allowed to run for president. Still, it happened, and that’s gotta count for something...
“Top court in Venezuela suspends outcome of opposition primary”
Well, I guess that didn’t last long. The US has, reasonably, said that Venezuela needs to get it together or the sanctions come back. Technically Maduro has till the end of November to lift their prior ban on Machado and specify a date for the election, but as things are going now it doesn’t necessarily look like this thaw will even get that far.
Related: New Scott post on Hugo Chavez
Argentina
All eyes have been trained on Juntos por el Cambio, the center right party that came third place in the first round of Presidential elections and got bumped out of running. Where will their support go in the runoff between Kirchnerist Economy Minister Sergio Massa and giga-libertarian Javier Milei? This was less obvious than it seemed because the party was somewhat torn between its more moderate side vs more conservative, free market side, led by former President Mauricio Macri.
Ultimately Macri apparently persuaded Presidential candidate Patricia Bullrich to endorse Milei, despite him being a huge dick to her throughout the election (“Among other things, Milei called Bullrich an 'assassin' and falsely accused her of planting bombs in kindergartens during her militant leftist youth.”) Bullrich conducted a press conference side by side Milei, offering her endorsement, but this doesn’t necessarily mean he’ll get her 24% share of the vote. Already moderates from within the coalition have balked, including JxC senators and the leaders of two allied parties, the Civic Coalition and the Radical Party. It’s still unclear what the results of the election will be, and less clear still if JxC will survive in its current form at all.
Armenia
After Azerbaijan’s conquest of Nagorno-Karabakh and subsequent flight of the inhabitants, the previous few weeks have seen the US government warning about the threat of Azerbaijan continuing onwards to invade Armenia and Canada threatening to start sanctions. I covered last week one commentator who felt war was imminent, but recently Armenian Prime Minister Nikol Pashinyan has surprised everyone and actually said he wants to sign a peace agreement with Azerbaijan and restore diplomatic relations. Pashinyan was also PM during the 2020 war and narrowly survived being unseated by domestic protests.
I guess a man knows when he’s beat, and this probably is good insurance against an actual invasion, but likely the fallout will be devastating for him politically. Russia, historically Armenia’s protector though the two have fallen out of friendship, was apparently not consulted on the decision and requested more information from Armenia on their plans.
Soriek
2yr ago
Germany
Germany has been taking a little tour of Africa and boosting relationships. President Steinmeier recently visited Tanzania where he committed to openly discussing Germany’s colonial crimes against Tanzania in hopes of boosting diplomatic relations, including meeting with victims of the repression of the Maji Maji rebellion (estimated 200k-300k death toll).
Chancellor Scholz also made visits to Ghana and Nigeria, where he proposed Germany buying more natural gas from Nigeria. This is partially a continuation of several years of Germany deepening energy times with Africa, including importing more from Algeria and offering to help Senegal develop off shore gas fields. However, onlookers are wondering if the present push is also a result of the slow moving fallout of shuttering Germany’s nuclear power supply, which has made securing a steady electric supply a larger concern for “energy hungry Germany” than normal. If so, turning to Nigeria isn’t necessarily a great sign here as they’ve had recent difficulties keeping their own power grid running, but hey, they just cut off power to Niger so I guess they got extra for sale.
Chile
In the second round of constitution drafting, Chile’s right wing Republican party (who were initially against changing the dictator-era constitution at all) have now released their version of a new constitution, which will be voted on in a referendum come December 17th. Like Boric’s resoundingly defeated left wing constitution before it, the Republican proposal will include a grabbag of conservative gimmes many of which probably have no place in a constitution at all, including provisions to restrict abortion, “remove a tax on houses (which effectively pay only a fraction of high-income owners, and it’s considered vital to fund services in low-income municipalities), cut the number of seats in Congress, speed up the expulsion of irregular immigrants and grant preferred treatment to victims of terrorism.”
Currently 51% of voters are against the change and 34% in favor. That said, the polls have been trending of support for the changes increasing, even if they’re still long way off and the most likely outcome is failure.
While the country was reasonably united in wanting to cast away the last vestiges of the dictatorship (the recent rise of Pinochet-boos like Kast not withstanding), there doesn’t seem to be much else they can actually agree on.
The government of President Gabriel Boric has said it does not plan a third attempt, and 58% of polled voters said they are also against another rewrite attempt.
The pledge to revamp the South American country's constitution was the main political agreement reached following raucous and sometimes violent protests that played out in 2019.
While around 80% of Chileans voted to draft a new constitution in 2020, voters have grown wary following growing political polarization, economic stagnation and crime.
Sudan
Eyes have been trained on the human rights situation in Israel, but it’s worth noting things have never recovered in Sudan either, where the conflict still rages on (ironically with a similar death toll over a longer time span).
Fighting between the national army, led by Abdel Fattah al-Burhan, and Mohammed Hamdan Dagalo’s paramilitary Rapid Support Forces, has been raging for almost seven months, claiming the lives of more than 9,000 people and forcing almost 5.8 million from their homes.
The economy has taken a massive hit, with the International Monetary Fund expecting it to contract more than 18% this year.
Peace talks are resuming in Sudan, though not for the first time so it remains to be seen if they actually go anywhere. Notably, the actual factions at war…do not seem to be in attendance? What is everyone even going to talk about?
The latest round of peace talks in Jeddah this week are being attended by officials from Saudi Arabia, the US and the Intergovernmental Authority on Development, an East African bloc whose members include Kenya, Ethiopia and Uganda. Notably absent are representatives from Sudanese political parties and former rebel groups — although they had met in Addis Ababa to lay out plans for a return to democracy.
An added hitch is that Iran and Sudan have normalized relations after seven years apart, which has caused some onlookers to worry about Iran becoming a new source of weapons and influence in the conflict, at a time when Iranian proxies are already flashpoints in Gaza, Lebanon and Yemen.
Colombia
“Colombia regional elections: The political wave of change comes to a halt”
Gustavo Petro was the first ever leftist president elected in Colombia, and came to power buoyed on a wave of progressive political energy. Since then his agenda has floundered, whether you blame opposition obstruction (certainly true) or personal corruption (also possibly true), that’s the way it is. Colombia isn’t doing too badly, the economy has recovered steadily, the cartels are increasing in power but Petro has been successively establishing peace with the radical guerilla groups, and there’s still a significant demand for some of the poverty alleviation measures he’s championing, such as land reform. But in the regional elections this week voters signaled they may be done with the experiment:
In 2019, alternative candidates won in several major cities such as Bogotá, Medellín, Cartagena and Cúcuta, and in smaller ones such as Buenaventura, Manizales and Palmira. In 2022 the traditional parties — Liberal, Conservative, Democratic Center, Radical Change, Social Party of National Unity — did not even have candidates for the presidency. These results contrast with the outcome of Sunday’s vote.
The choice was clear: Sunday’s regional and local elections in Colombia could either strengthen or weaken the wave of political transformation that has been building in the country in recent years. And the result was also clear: the wave has lost steam. The main mayoralties and governorships were won by politicians from different sides of the political spectrum, but they had one thing in common: they came from traditional political parties or had the majority support of them. The elections marked the return of the status quo…
[Gustavo Petro’s] party, the Historical Pact, was defeated in the mayoral race of Bogotá, where Petro himself had been mayor. “The survival of the Historical Pact is at stake in the Bogotá mayor’s office,” the party’s candidate, Gustavo Bolívar, told EL PAÍS at the beginning of the campaign. On Sunday, Bolívar came in third place.
Soriek
2yr ago
Ethiopia
I've mentioned in the past that, not content to not wage bloody warfare against an ethnic sectarian movement, President Abiy has tried to forcibly integrate the Amhara militia Fano into the armed forces. Fano didn't like that and conflict broke out. Abiy, who received a PhD in Conflict Resolution, knew exactly how to handle such a situation and started killing the crap out of holdouts. It isn't covered much but this has been raging for a while:
Dozens of civilians have been killed this month by drone strikes and house-to-house searches in Ethiopia's Amhara region, where authorities have touted security gains since conflict erupted in July, a state-appointed human rights commission said on Monday [the 30th].
At least 183 people were killed in the first month of the conflict, the United Nations said in late August. But with internet connections down across the region, it has been difficult to get a clear picture of the situation.
On the other hand, Abiy has now walked back his earlier statements that the Red Sea was a strategically critical area that Ethiopia must control, and has now promised his very irate neighbors in Djibouti, Eritrea, and Somalia, that he's definitely not planning to invade their countries anytime soon. That's that conflict resolution PhD at work.
Soriek
2yr ago
Sorry I've been pretty slammed lately. Yes it has been scrapped; Tinubu was very in support of an interventoin but the rest of the government wasn't. Even though his party has a majority in the Senate, the Senate still voted against a military intervention (and ECOWAS intervening without Nigeria is implausible).
As far as I know though the ECOWAS sanctions are still in place, which includes Nigeria cutting off the 90% of Niger's electricity that they provide (if that's changed, I can't find up-to-date info on it). As an aside, Nigeria has been barely able to sustain their own power supply, which has led some to claim the electricity blockade against Niger is mostly covering their own lack of capacity.
Soriek
2yr ago
Yeah certainly a fair point, I guess I was imagining more like present-day dry towns and counties in the US which chose those laws as a reflection of their values rather than prohibition era US choosing those laws as a solution to an issue.
Soriek
2yr ago
I had literally no idea Finland had a prohibition era, or that it lasted so long into recent history, that’s fascinating. Is the stereotype of Finland as a hard drinking country a recent one, or just totally off base?
Soriek
2yr ago
More interesting is that Armenia expelled Azeris relatively recently, with other rounds of the same stuff.
Yeah it does give the events a very different flavor, not that it justifies what’s happening in the present day.
Good point, and I'm hoping to do a longer write up on the impact of private equity on the healthcare market in general. One of the interesting pieces of legislation being debated right now is site-neutral pricing, where one hospital system can't charge different prices for the same services at different facilties. Ideally it's supposed to combat the recent spread of PE backed hospital orgs buying up private practices and charging wildly inflated "off-campus/off-site" fees to visit those doctors.
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