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Saturday, March 31, 2018

Easter week ~ philosophy of miracles

Do you believe in miracles?  echo from "The Conversation"

Why they make perfect sense for many

This year, on Easter, the most essential of Christian holy days in the liturgical calendar, Easter, coincides with perhaps the silliest of annual secular celebrations, April Fools’ Day. 

Easter commemorates a miraculous event, the resurrection of Jesus Christ from the dead. April Fools’ Day is marked by practical jokes and hoaxes.

The conjunction of these two days raises a question: Is the belief in miracles the mark of a fool? One major thinker, the Scottish philosopher David Hume, said yes.


Hume’s definition

Hume published perhaps his most widely read work 270 years ago, the “Enquiry Concerning Human Understanding.” A milestone in philosophy, its 10th section, which he entitled “Of Miracles,” was intentionally omitted.


Hume later explained that he excised the section to avoid offending his readers’ religious sensibilities – and perhaps also to spare himself the censure to which doing so would give rise. 

Yet the 10th section is included in all modern editions.

In “Of Miracles,” Hume claims to have discovered an argument that will check what he calls “all superstitious delusion.” It is based on this definition of a miracle: “A transgression of a law of nature by a deity or invisible agent.”

Though not original to Hume, this definition quickly gained wide assent. Just 60 years later, Thomas Jefferson had produced his own version of the Bible, “The Life and Morals of Jesus,” from which all of the miracles had been expunged as offenses against reason.

A bit about Hume

Born in 1711 in Edinburgh, Hume entered university there at the remarkably young age of 12, but he never graduated. He read voraciously. As a young man, he suffered something close to a mental breakdown. His initial attempts to write philosophy fell “dead-born from the press,” but he landed a post as a librarian at the university. He subsequently wrote a best-selling history of England. In a number of important philosophical works, he exemplified skepticism, the view that certain kinds of knowledge are impossible, and naturalism, the belief that only natural forces can be evoked as explanations.

Hume’s skepticism led him to reject many speculations about the nature of reality, such as belief in the existence of God. Though he produced a number of important philosophical works, his views on religion encumbered his career. He died, likely from some form of abdominal cancer, in 1776.

Concerning the role of miracles in Christianity, Hume wrote in “Of Miracles”:

“The Christian religion not only was at first attended with miracles, but even at this day cannot be believed by any reasonable person without one. Mere reason is insufficient to convince us of its veracity: and whoever is moved by Faith to assent to it, is conscious of a continued miracle in his own person, which subverts all the principles of his understanding, and gives him a determination to believe what is most contrary to custom and experience.”

By defining miracles as either highly improbable or perhaps even impossible events, Hume essentially guarantees that reason will always weigh strongly against them. He points out that different religions have their own tales about miracles, but because they contradict one another on multiple points, all of them cannot be true. He also argues that those who claim to have witnessed miracles are gullible and hopelessly biased by their own religious beliefs.

Hume’s enduring influence

Hume’s views on miracles have many defenders in the present day. For example, the biologist Richard Dawkins defines miracles as “coincidences which have a very low probability, but which are, nonetheless, in the realm of probability,” implying that they can be accounted for by science. The late polemicist Christopher Hitchens rejected claims of miracles by saying, “That which can be asserted without evidence can be dismissed without evidence.”

So pervasive is Hume’s account of miracles that it can even be found in the dictionary. Oxford Dictionary’s definition of a miracle is “an extraordinary and welcome event that is not explicable by natural or scientific laws and is therefore attributed to a divine agency.” If miracles do not contradict science outright, the definition suggests, they at least resist explanation by scientific principles, and thus stand out as supernatural, a category of events that many people reject out of hand.

Augustine’s alternative view of miracles


Of course, other accounts of miracles are possible. Augustine of Hippo, writing in the fifth century, explicitly rejected the idea that miracles are contrary to nature, holding instead that they are contrary only to our knowledge of nature. He went on to argue that miracles are made possible by hidden capacities in nature placed there by God. In other words, our knowledge of what is naturally possible is limited, and new potentialities may over time reveal themselves.

At prior points in history, many capabilities we take for granted today would have seemed miraculous. Human flight, the wireless transmission of the human voice, and the transplantation of human organs would have struck men like Hume and Jefferson as impossibilities. It is likely that as history continues to unfold, new capacities in nature will be identified, and human beings will command new powers that we cannot imagine today.

Miracles versus science
It would be a mistake, however, to assume that the course of history inexorably moves unusual events from the domain of the miraculous to the scientific. Augustine also famously wrote:

“Is not the universe itself a miracle, yet visible and of God’s making? Nay, all the miracles done in this world are less than the world itself, the heaven and earth and all therein; yet God made them all, and after a manner that man cannot conceive or comprehend.”

Augustine does not argue that human understanding cannot advance, or that science is impossible. Nor does he regard science and miracles as opposed to one another. To the contrary, Augustine is highlighting an account of science and the human desire to know that treats the world as we experience it every day as no less miraculous than any event that science cannot explain. From this point of view, daily life is full of wonder, if only we see it rightly.

Miracles today

As a physician, I regularly experience this sense of wonder in the practice of medicine.

We know a lot about how babies are made, how human beings grow and develop, how infections and cancer arise, and what happens when we die.

Yet there is also a great deal we don’t understand. In my experience, deepening our scientific understanding of such events and processes does not diminish our sense of wonder at their beauty. To the contrary, it deepens and enriches it.

Inspecting cells through a microscope, using CT and MRI to peer into the inner recesses of the human body, or simply listening carefully as patients offer up insights on their lives – these experiences open up the realm of wonder to which Augustine is pointing. Of course, many people outside of medicine enjoy similar experiences, as when sunlight filters down through the leaves or forms a rainbow as it passes through drops of rain.

Some, Hume among them, might say that it would be a blessing to drive out all trace of the miraculous from our view of the world, perhaps even dismissing the possibility of miracles outright. 

Others – myself included – think otherwise. Far from seeking to expunge the miraculous from life, we strive instead to reawaken our awareness of its presence. To those who see the world in such terms, April 1 this year is less about hoaxes than the blossoming of a renewed sense of wonder at the fullness and beauty of life.

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Studying history can mentor leadership ~ an Atlantic echo

The Iraq War and the Inevitability of Ignorance 

The focus is on the 1 percent who serve

By James Fallows in The Atlantic : an essay about leadership, and responsibility and the consequences of decision making, with a presidential focus. 

There’s a specific reason it is so hard to be president—in normal circumstances—and why most incumbents look decades older when they leave the job than when they began. The reason is that the only choices normal presidents get to make are the impossible ones—decisions that are not simply very close calls on the merits, but that are guaranteed to lead to tragedy and bitterness whichever way they go.

Take Barack Obama’s famed choice not to back up his “red line” promise in Syria, which was a focus of Jeffrey Goldberg’s “The Obama Doctrine” Atlantic cover story two years ago. The option Obama chose—not intervening in Syria—meant death and suffering for countless thousands of people. 

(Unfortunately, IMO) ...the option President Obama rejected—ie, intervening—would have meant death and suffering for countless thousands of the same people or others. 

Agree or disagree on the Syria outcome, any such decision is intellectually demanding and morally draining. Normal presidents have to make them, one after another, all day long. (

Why don’t presidents get any easier choices? 

Because someone else has made all of those before they get to the president. Obama’s decision to approve the raid on Osama bin Laden’s compound turned out to be a tactical and political success. When he made it, he had to weigh the possibility that it could end in world-publicized failure—like Jimmy Carter’s decision to attempt a rescue of American hostages in Iran, which ended in chaos, and which Carter later contended was what sealed his fate in his re-election run.

A special category of impossible decision, which I was introduced to in the two years I worked for Jimmy Carter in the White House and have borne in mind ever since, turns on the inevitability of ignorance. To be clear, I don’t mean “stupidity.” 

People in the government and military are overall smarter than press portrayals might suggest. Instead I mean really registering the uncomfortable fact that you cannot know enough about the big choices you are going to make, before you have to make them.

Sometimes that is because of deadline rush: The clock is ticking, and you have to act now. (To give a famous example: In 1980 U.S. radar erroneously indicated that the Soviets had launched a nuclear-missile attack, and Zbigniew Brzezinski, as Jimmy Carter’s national-security adviser, had to decide at 3 a.m. whether to wake the president to consider retaliation. Before the world was rushed toward possible nuclear obliteration, the warning was revealed as a false alarm before Brzezinski could place the call.) 

Most of the time it is because the important variables are simply unknowable, and a president or other decision-maker has to go on judgment, experience, hunch.
This point sounds obvious, because we deal with its analogues in daily-life decisions big and small. No one who decides to get married can know what his or her spouse will be like 20 years in the future, or whether the partners will grow closer together or further apart. Taking a job—or offering one—is based at least as much on hope as on firm knowledge. You make an investment, you buy a house, you plan a vacation knowing that you can’t possibly foresee all the pitfalls or opportunities.

But this routine truism takes on life-or-death consequences in the choices that presidents must make, as commander in chief and as head of U.S. diplomatic and strategic efforts. The question of deciding about the unknowable looms large in my mind, as I think back 15 years to the run-up to the Iraq war, and think ahead to future such choices future presidents will weigh.

There’s a long list of books I wish presidents would have read before coming to office—before, because normal presidents barely have time to think once they get there. 

To give one example from my imagined list: the late David Fromkin’s A Peace to End All Peace is for me a useful starting point for thinking about strains within the modern Middle East. 

Fromkin'sbook argues, in essence, that the way the Ottoman Empire was carved up at the end of World War I essentially set the stage for conflicts in the region ever since. In that way it is a strategic counterpart to John Maynard Keynes’s famous The Economic Consequences of the Peace, written just after the conclusion of the Versailles agreements, which argues that the brutal economic terms dealt out to the defeated Germans practically guaranteed future trouble there.

Also high up on my “wish they’d read” list is Thinking in Time: The Uses of History for Decision Makers, by two Harvard professors (and one-time mentors of mine), Ernest May and Richard Neustadt. In this book, May and Neustadt reverse the chestnut attributed to an earlier Harvard professor, George Santayana, that “those who do not remember the past are condemned to repeat it.” Instead they caution against over-remembering, or imagining that a choice faced now can ever be exactly like one faced before.

The most famous and frightening example is Lyndon Johnson’s, involving Vietnam. Johnson “learned” so thoroughly the error of Neville Chamberlain, and others who tried to appease (rather than confront) the Nazis, that he thought the only risk in Vietnam was in delaying before confronting communists there. A complication in Johnson’s case, as this book and all other accounts of Vietnam make clear, is that he was worried both about the reality of waiting too long to draw a line against Communist expansion, and perhaps even more about appearing to be weak and Chamberlain-like.

Because of the disaster Johnson’s decisions caused—the disaster for Vietnam, for its neighbors, for tens of thousands of Americans, all as vividly depicted in last year’s Ken Burns / Lynn Novick documentary—most American politicians, regardless of party, “learned” to avoid entanglement in Asian-jungle guerrilla wars. 

Thus in the late 1970s, as the post-Vietnam war Khmer Rouge genocide slaughtered millions of people in Cambodia, the U.S. kept its distance. It had given up the international moral standing, and had nothing like the internal political stomach, to go right back into another war in the neighborhood where it had so recently met defeat.

From its Vietnam trauma, the United States also codified a crass political lesson that Richard Nixon had applied during the war. Just before Nixon took office, American troop levels in Vietnam were steadily on the way up, as were weekly death tolls, and monthly draft calls. The death-and-draft combination was the trigger for domestic protests. Callously but accurately, Nixon believed that he could drain the will to the protest if he ended the draft calls. 

Thus began the shift to the volunteer army—and what I called, in an Atlantic cover story three years ago, the “Chickenhawk Nation” phenomenon, in which the country is always at war but the vast majority of Americans are spared direct cost or exposure. (From the invasion of Iraq 15 years ago until now, the total number of Americans who served at any point in Iraq or Afghanistan comes to just 1 percent of the U.S. population.) ...

May and Neustadt had a modest, practical ambition for their advice to study history, but to study it cautiously. “Marginal improvement in performance is worth seeking,” they wrote. “Indeed, we doubt that there is any other kind. Decisions come one at a time, and we would be satisfied to see a slight upturn in the average. This might produce much more improvement [than big dramatic changes] measured by results.

My expectation is more modest still: I fear but expect that the U.S. is fated to lurch from one over-“learning” to its opposite, and continue making a steadily shifting range of errors.

The decision to invade Iraq was itself clearly one of those. The elder George Bush fought a quick and victorious war to drive Saddam Hussein out of Kuwait in 1991. But he stopped short of continuing the war into Iraq to remove Saddam Hussein from power—and so his son learned from that “failure” that he had to finish the job of eliminating Saddam. (As did a group of the younger George Bush’s most influential advisors: Dick Cheney, who had been secretary of defense during the original Gulf war, and returned as George W. Bush’s vice president. Colin Powell was chairman of the Joint Chiefs of Staff the first time around, and secretary of state the second. Paul Wolfowitz was undersecretary of defense during the first war, and deputy secretary of defense during the second. And so on.)

Two of the writers who were most eloquent in making their case for the war—Christopher Hitchens, who then wrote for the Atlantic among other places, and Michael Kelly, who was then our editor-in-chief—based much of their case on the evils Saddam Hussein had gotten away with after the original Gulf War. (Hitchens died of cancer in 2011; Kelly was killed in Iraq, as an embedded reporter in the war’s early stage.) Then Barack Obama, who had become president in large part because he opposed the Iraq war — which gave him his opening against the vastly better known and more experienced Hillary Clinton— learned from Iraq about the dangers of intervention in Syria. 

And on through whatever cycles the future holds.

Is there escape from the cycles? In a fundamental sense, of course not, no. But I’ll offer the “lesson” I learned—50 years ago, in a classroom with Professor May; 40 years ago, when I watched Jimmy Carter weigh his choices; 15 years ago, in warning about the risks of invading Iraq. 

It involves a cast of mind, and a type of imagination.

As the Bush administration moved onto a war footing soon after the 9/11 attacks, no one could know the future risks and opportunities. But, at the suggestion of my friend and then-editor Cullen Murphy, I began reporting on what the range of possibilities might be. Starting in the spring of 2002, when the Bush team was supposedly still months away from a decision about the war, it was clear to us that the choice had been made. I interviewed dozens of historians, military planners, specialists in post-war occupations, and people from the region to try to foresee the likely pitfalls.

The result, which was in our November, 2002 issue (and which we put online three months earlier, in hopes of affecting the debate) was called “The Fifty-First State?” Its central argument was: The “war” part of the undertaking would be the easy part, and deceptively so. The hard part would begin when U.S. troops had reached Baghdad and the statues of Saddam Hussein were pulled down—and would last for months, and years, and decades, all of which should be taken into consideration in weighing the choice for war.

It conceivably might have gone better in Iraq, and very well could have, if not for a series of disastrously arrogant and incompetent mistakes by members of the Bush team. 

Fallows wrote, "I won’t go into details here: I laid them out in several articles, including this, this, and this, and eventually a book. But the premise of most people I interviewed before the war, who mostly had either a military background or extensive experience in the Middle East, was that this would be very hard, and would hold a myriad of bad surprises, and was almost certain to go worse than its proponents were saying. Therefore, they said, the United States should do everything possible to avoid invading unless it had absolutely no choice. Wars should be only of necessity. This would be folly, they said, and a war of choice."

The way I thought of the difference between those confidently urging on the war, and those carefully cautioning against it, was: cast of mind. The majority of people I spoke with expressed a bias against military actions that could never be undone, and whose consequences could last for generations. I also thought of it as a capacity for tragic imagination, of envisioning what could go wrong as vividly as one might dream of what could go right. (“Mission Accomplished!”) ~ MaineWriter: Certainly, a wrong minded bravado, the mission has yet to "be accomplished.

Any cast of mind has its biases and blind spots. 

But Fallows writes about being impressed, in thinking about the history he has lived through and the histories read, by how frequently people with personal experience of war have been cautious about launching future wars. 

This does not make them pacifists: Harry Truman, artillery veteran of World War I, decided to drop the atomic bomb. But Ulysses Grant, Dwight Eisenhower, Colin Powell (in most of his career other than the Iraq-war salesmanship at the United Nations)—these were former commanding generals, cautious about committing troops to war. They had a tragic imagination of where that could lead and what it might mean.

What lesson do we end with? Inevitably any of them from the past will mismatch our future choices. The reasons not to invade Iraq 15 years ago are different from the risks to consider in launching a strike on North Korea or on Iran, or provoking China in some dispute in the East China Sea. The value of tragic imagination remains: for leaders considering war or peace, for the media in stoking or questioning pro-war fever, for the 99 percent of the public in considering the causes for which the military 1 percent will be asked to kill, and die.

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Friday, March 30, 2018

Maine Governor LePage call to action ~ Medicaid Expansion


Maine Providers Standing Up for Healthcare



For Immediate Release
March 30, 2018
Contact: Julie Schirmer, LCSW and Juliana L’Heureux, RN
                     

***Media Advisory***

Next Tuesday, Healthcare Providers to Hold State House Press Conference Calling on Governor LePage to Comply with Medicaid Expansion Law
Tuesday, April 3rd is the date prescribed by law for Maine DHHS to submit MaineCare expansion plan to the federal government

AUGUSTA, ME – Next Tuesday, April 3rd at 12:00 p.m., Maine Providers Standing Up for Healthcare will hold a press conference at the Maine State House to call on Governor Paul LePage to comply with the voter-approved law to expand Medicaid and to inform the people of Maine that the law will not go into effect unless Governor LePage and the Trump Administration take action.

Maine healthcare providers, state legislators – including Speaker of the House Sara Gideon, advocates, and beneficiaries will speak at the press conference to help highlight the stakes for the 70,000 Maine children, families, and patients with chronic illness, including opioid addiction, who are waiting to hear about MaineCare medical and behavioral health coverage.

“Mainers want more access to healthcare, not less, and are no longer willing to wait,” Speaker Sara Gideon said in a statement. “Medicaid expansion will provide affordable care to nearly 70,000 hardworking Mainers who have been struggling to make ends meet. Additionally, this referendum will also bring $500 million dollars into our economy, creating new jobs and increased opportunity, along with the benefits of a healthier workforce. Maine people have waited five years for Medicaid expansion and today marks an important deadline. It’s been a long road, but I’m committed to ensuring that people finally have access to affordable, life-saving healthcare.”

“I wish I could introduce one of my patients to Gov. Paul LePage. This patient is a young man whose situation illustrates how Medicaid can pay huge dividends for individuals, families, communities and the state. He became my primary-care patient last fall, soon after his visit to an emergency department for physical trauma,” Dr. Sam Zager wrote in a recent Portland Press Herald op-ed. “This young man is not simply a Medicaid recipient; he is the anchor of his family. He knows the dignity of both an honest day’s work and having health care. Why won’t Maine’s governor expand Medicaid and guide over 70,000 more Mainers and their families in the direction of health?”

“As a clinical social worker, I am deeply concerned about the delays in the progress toward MaineCare expansion and the implications for the health of our communities. I work with people daily whose lives would dramatically improve if they had health care. Without insurance, medications, and care, a chronic disease can easily become a terminal illness. As a last resort they seek free care and frequent the emergency rooms of critical-care hospitals, many of which are in economic jeopardy,” wrote LCSW Julie Schimer in a recent Forecaster letter to editor. “The people of Maine passed MaineCare expansion by an 18 percent margin. The governor repeatedly states that he will not pursue MaineCare expansion due to lack of funds. The law is clear. The money is there. The health of our communities is in peril the longer we delay.”

WHO:             Maine Providers Standing Up for Healthcare
                        Speakers include:
Ø  Speaker of the House Sara Gideon
Ø  Sam Zager, MD, M.Phil  Family Practice Physician
Ø  Representative Anne Perry, FNP
Ø  Robyn Merrill, MSW, Esq, Maine Equal Justice Partners
Ø  Nicole Clegg, Planned Parenthood of Northern New England

WHAT:          Press Conference calling on Governor LePage to comply with the Mainecare expansion law

WHEN:          Tuesday, April 3, 2018 at 12:00 p.m.

WHERE:       State House Welcome Center
210 State Street, Augusta ME
            
In November 2017, Maine voters approved the expansion of Medicaid, as provided under the Affordable Care Act, by a margin of 59 to 41 percent. Although Governor LePage vetoed five expansion bills the legislature previously sent him, he is unable to veto this law passed at the ballot. The Maine Department of Health and Human Services (DHHS) must submit a plan by April 3rd to the federal Center for Medicare and Medicaid Services (CMS), to begin enrolling Mainers in July. Based on public statements and letters from the governor and DHHS Commissioner to legislators, we have every reason to believe that this plan will not be submitted. We demand the governor comply with the law.

###


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Enough is Enough ~ Parkland and the Vietnam protests

An Echo from The Washington Post and Newspaperdirect 
By James Hohomann (Echo articles and opinions are selected by my MaineWriter via random searches of the nation's newspapers.)

The great achievement . . . was to bring a large swath of Americans together in dissent, establishing their (unified) cause.."

US Navy officer John Kerry and Ted Kennedy during the Vietnam War era
In the Vietnam War years (1955-1975), millions of young people lived in fear that they — or someone they loved — would have their number called, and they’d be shipped off against their will to the rice paddies and jungles of a faraway land, for a cause they felt was unjust and futile. 

From 1964 to 1973, the U.S. military conscripted 2.2 million men — boys, really — out of an eligible pool of 27 million. This helped fuel the mass movement against the war.

A key reason the protests against the war in Vietnam were so much more potent than against the war in Iraq is that there was a draft back then.

Young people today aren’t worried about being drafted to fight Kim Jong Un in North Korea. But many are palpably concerned that they or someone they know could get shot at school. 

High-profile incidents, culminating with the February 14, 2018, mass shooting in Parkland, Fla., have shaken many middle-class kids, who would not otherwise be inclined to activism, out of their suburban comfort zones.

Saturday’s (March 24), March for Our Lives was so big because the fears are so personal. A whole generation has come of age since the 1999 massacre at Columbine High School in Colorado that left 13 dead. More than 100 people have died from gunfire at school since then, and more than 187,000 students attending at least 193 primary or secondary schools have experienced a shooting on campus during school hours, according to a Washington Post analysis.
These numbers are relatively small when compared with the 58,000 Americans who died during Vietnam, but they are nonetheless staggering. Schools, of course, are not supposed to be war zones. Like other forms of terrorism, these shootings instill panic in the rest of the population.

From coast to coast, hundreds of thousands of people protested Saturday for stricter gun laws. Many attendees said during interviews or speeches that they were motivated by dread and anxiety that they could be next.
Former secretary of state John F. Kerry sees parallels between the Parkland survivors and “many of the Vietnam veterans who returned home and felt compelled to speak out about their experience.”

“Every historic moment has its own power, and these young people deserve their own moment,” Kerry said in an email.

“Many of the students have earned the right to be heard through a shared loss that innocents should never experience. Their moral clarity defies politics or partisanship. . . . These young people have touched the conscience of the country about common sense on guns, and they have the power to make it a voting issue again.”

Kerry became an antiwar activist after volunteering as a naval officer in Vietnam, an experience that profoundly shaped his worldview and service in the Senate. 

“Marjory Stoneman Douglas High students were compelled because they’d seen friends suffer and die for a policy that they thought was a mistake,” he said, referring to the veterans who became protesters. “Because they’d served, they couldn’t be dismissed by Spiro Agnew and the Nixon White House. The same way, these young people from Parkland and all over the country can’t be written off by mere politicians. Their moral authority is unimpeachable.”

The 74-year-old also sees analogues between the March for Our Lives and the movement to protect the environment, another issue that many view in existential terms. “The environment was written off for a long time as a minor issue,” he said. “Earth Day 1970 changed all of that when millions filled the streets of America and turned the environment into a voting issue and forced [Richard] Nixon to create the EPA.”

The march in Washington on Saturday, March 24, mixed political activism with the raw emotion of teenagers who are dealing with the murder of their friends under the glare of the national spotlight, which in this era means nasty criticism from trolls on the Internet.

“Sam Fuentes, a senior shot in the leg at Stoneman Douglas, up on stage while delivering her speech to a national television audience. She recovered and led the crowd in a rendition of ‘Happy Birthday’ for her slain classmate Nicholas Dworet, who would have turned 18 on Saturday,” according to The Post’s account.

“Emma González, 18, took the stage in a drab olive coat and torn jeans, speaking of the ‘ long, tearful, chaotic hours in scorching afternoon sun’ as students waited outside . . . on the day of the shooting. With a flinty stare, tears streaming down her face, González stood silent on the rally’s main stage for nearly four minutes — evoking the time it took Parkland shooter Nikolas Cruz to carry out his attack. The crowd began chanting, ‘Never again.’ ”

History tells us that change won’t happen overnight. Zachary Jonathan Jacobson, a historian of the Cold War, saw echoes in the Saturday protests of the nationwide demonstrations against the Vietnam War on Oct. 15, 1969. Students skipped class in 10,000 high schools, and experts estimate that about 2 million Americans protested that day.

“A withdrawal from Vietnam was not negotiated for three more years; a full withdrawal not for another six,” Jacobson said. “But while [Nixon] refused to comment publicly on the demonstrations, letting ‘it be known that he was watching sports on TV in the White House’ that day, we now know that the president was privately spooked. The protests forced Nixon to cancel plans to expand the war with an offensive of aerial bombing, harbor mining [and] even an invasion of North Vietnam.

“The unity of action firmly established that the antiwar movement had a constituency that could be mobilized,” he added. “The great achievement . . . was to bring a large swath of Americans together in dissent, establishing that their antiwar cause was not fueled by a dangerous fringe that Nixon could, with a few dirty tricks, stamp out or discredit.”

Cathy Richardson, lead singer of the rock band Jefferson Starship, said the energy emanating from the *Enough is Enough* Washington DC crowd is reminiscent of the anti-Vietnam War protests. 

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Thursday, March 29, 2018

Jacksonville Florida ~ echo to put checks on Donald Trump

Our institutions must keep Donald Trump in check ~ checks and balances in the Constitution

The Florida Times-Union
jacksonville.com: Protect Robert Mueller

The framers of the Constitution designed a system that uses separation of powers, and checks and balances to protect us from abuses of power by our leaders. 

Are we a society based on the rule of men or a society based on the rule of law?

If President Donald Trump fires special counsel Robert Mueller, it will be up to the Congress to check him. If past indications hold true, Congress will do nothing.

The country will then have to wait until November to have a chance to vote in a Congress willing to check the power of this would-be dictator.

But between now and November, how much more chaos and damage can Trump and Russian President Vladimir Putin inflict on our country?

I fear the worst.
Scott Brackett, Fleming Island

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Op-Ed echo from Military Times: The Illusion of Russian Power

An echo opinion written by Joseph V. Micallef is a best-selling military history and world affairs author, and keynote speaker. Published in Military Times. 
Russian President Vladimir Putin gave a speech on March 1st, test and graphics in this article's link.
(Vladimir Putin's speech link is included in this article.)

"In trying to play what, in the long term, is an inherently weak hand, Putin and his Kremlin cronies have traded a short-term advantage for a long-term disadvantage and, in doing so, may well have relegated Russia to what Leon Trotsky called the dustbin of history."

On March 1, just weeks before a presidential election that would run him for an unprecedented fourth term as president of Russia, Vladimir Putin, in a speech at the Manezh Central Exhibition Hall, outlined what he described as six, new Russian super weapons that would alter the strategic balance of power in the world.

The premise of the speech was underscored by Putin's finish when he declared, "No one has listened to us ... so you listen to us now."

The speech came just a few weeks after the Trump Administration unveiled its National Defense Strategy in which Russia and China were singled out as near-peer rivals, indirectly lending credence to Putin's boast that Russia had returned to the ranks of the great powers. Predictably, Putin's March 1 speech precipitated an avalanche of articles in the Western media declaring a Russian military resurgence.

Is it possible that three decades after the collapse of the Soviet Union, Russia has in fact once again become a near-peer rival to the United States? What are these new super weapons that Putin unveiled? Are they real or are they a Potemkin illusion? What impact could they have on the strategic balance between Russia and the U.S.?
Moscow military parade
RUSSIA'S NEW SUPER WEAPONS

In his speech, Putin described six new weapons systems that he said Russia had started to deploy or would soon do so. These consisted of a cruise missile with a nuclear engine, since named Burevestnik -- Russian for the storm petrel, a seabird whose presence mariners believe foretells bad weather; the RS-28 Sarmat Intercontinental Ballistic Missile; a nuclear-tipped hypersonic boost-glide vehicle named Avangard; a nuclear-armed unmanned undersea drone since named Poseidon; a dual-purpose nuclear and conventional air-launched hypersonic cruise missile called Kinzhal, Russian for dagger; and a short-range directed-energy weapon since called Peresvet -- named for a 14th century warrior monk, Alexander Peresvet, venerated in the Russian Orthodox Church for his role in a battle against the Mongols.

These weapons systems are both strategic and tactical. They are a wish list of the kind of offensive capabilities that Russia would like to possess. As such, they speak volumes about the weapons Russia fears from the West and where it sees its own military vulnerabilities.

Ever since the Reagan "Star Wars" initiative, the U.S. has put considerable effort into developing an anti-missile defense system. To date, such systems have had limited success. They have been able to shoot down only about half the missiles they were tested against, and their reliability against an attack of ICBMs is in doubt.

Russia currently has approximately 1,700 nuclear warheads spread across about 500 ICBMs. The entire Russian arsenal of nuclear weapons, however, both deployed and non-deployed, is about 7,000 warheads. Some of those are in the process of being dismantled. At the peak of the Cold War, the Soviet Union had amassed a stockpile of about 45,000 nuclear weapons.

What Moscow fears is that continuing upgrades to the Aegis BMD system could give the U.S. a relatively low cost, rapidly deployable anti-missile shield. Technically, with the deployment of the SM3 Block IIA missile and future technical upgrades, Aegis could have the potential to protect the entire continental United States.

Russia does not yet have a reliable anti-missile defense system, nor is it likely to be able to afford the development and deployment of one. Should the U.S. succeed in developing an effective anti-missile shield, the mutually assured destruction that has underpinned the strategic balance between the two nations would be obsolete.

Moscow is well aware of that vulnerability, hence Putin's emphasis on showcasing hypersonic weapons systems like the boost-glide delivery vehicle, the hypersonic cruise missile, or the flight programmable nuclear-powered cruise missiles.

All these weapons are designed to overcome an anti-missile defense shield by deploying weapons with unpredictable, programmable flight paths or weapons capable of outrunning any anti-missile defenses by operating at speeds from Mach 5 to Mach 20.

In short, the message that Putin wanted to deliver was that even if the U.S. succeeds in deploying an anti-missile defense system, the next generation of Soviet missiles has already made that defensive shield obsolete.

The second set of weapons systems unveiled by Putin were tactical in nature, although some of the strategic weapons, like the nuclear-armed cruise missiles, could serve in a tactical role as well. Weapons systems like the Poseidon, nuclear-armed underwater drones or the Kinzhal hypersonic cruise missiles would be particularly useful against ships deployed at sea.

That's no coincidence, since a ship-based, anti-missile defense shield would have significant advantages for anti-missile defense. Such a system could be deployed where it was needed most and would have greater evasive capabilities than a land-based system. U.S. Navy ships don't, at the moment, have an effective defense against missiles traveling at such hypersonic speeds.

An additional advantage of hypersonic missile is that they dramatically shrink the window between actionable intelligence and an actual attack.

HOW REAL ARE THEY?

So how real are these weapons? Putin's speech was accompanied by dramatic computer-generated graphics that depicted simulated attacks. All of which were aimed at clearly American targets.

One segment showed nuclear-armed, hypersonic glide vehicles raining down on Florida. Another showed a nuclear-armed cruise missile crossing the Atlantic, going around Cape Horn at the tip of South America, and then proceeding across the South Pacific to attack Hawaii. For the complete speech, in Russian, including all of the computer-generated graphics, go here.

The Pentagon was quick to dismiss Putin's speech as old news, saying that most of the weapon systems he announced were not new and that the defense community was already aware of them. Likewise, it's unclear whether some of the video footage depicting the new weapons systems were actual functioning prototypes or simply mockups.

What is clear is that, barring a dramatic change in Moscow's finances, it is unlikely that Russia can afford the development and deployment of all these new weapons systems. At the very least, such deployment will likely come at the cost of slowing down the modernization of Russia's conventional military forces -- although a significant portion of that modernization has already been completed.

RUSSIA'S 21ST CENTURY FINANCES
Modern Russia may have inherited the military arsenal of the former Soviet Union, complete with a formidable force of nuclear-armed missiles, but it also inherited all the structural economic problems that plagued the USSR. Moreover, the breakup of the Soviet Union, and the loss of Soviet control over the eastern bloc, left Russia with a much smaller population and industrial base.

In 1989, when the Soviet Union collapsed, its population was roughly 286 million. The U.S., by comparison, had a population of about 249 million. Since then, the U.S. population has grown to about 325 million, while that of Russia has fallen to about 143 million.

Comparisons of industrial production are difficult since they involve a large number of state-controlled enterprises that operated inefficiently. Between 50 percent and 60 percent of the industrial base of the USSR was retained by Russia. This does not include industry in the Communist bloc that the USSR could avail itself of.

A comparison of automobile production between the two countries can serve as a rough index of industrial capacity. In 2016, Russia produced about 1.3 million vehicles. The U.S. in comparison produced around 12.2 million vehicles.

In terms of GDP, in 1989 the Gross Domestic Product of the U.S. was $4.862 trillion, while that of the Soviet Union was $2.5 trillion. Per capita GDP was $19,800 versus $8,700.

By comparison, in 2016 Russia's GDP was $1.283 trillion, while that of the U.S. had grown to $18.62 trillion. Russian per capita GDP was roughly the same at $8,946, while that of the United States had increased to $57,608. Adjustments for purchasing power parity, however, would reduce the gap between the two countries.

At $1.283 trillion, Russia's GDP is smaller than Turkey's and just barely larger than the Philippines. Alternatively, it is slightly larger than the state of New York and slightly smaller than that of Texas. Russia may have inherited the military arsenal of a super power, but it is an economic dwarf on the world stage.

Moreover, its economy is heavily dependent on the extraction of raw materials, principally hydrocarbons. Roughly 70 percent of the Russian government's budget comes from the proceeds of its oil exports. Moscow needs oil prices to be between $65 and $75 a barrel in order to balance its budget, and it needs oil prices in excess of $100 per barrel in order to generate sufficient government revenues to fully fund its military expansion and modernization. Neither price threshold is likely in the short term.

The Kremlin's dilemma is that Russia's military aspirations are simply too big for its wallet (Maine Writer one Russian Ruble = 0.017 US- in other words, that's seventeen cents!). 

It may have a formidable military force, but that force requires maintenance to keep it effective and its technology has a life span. Most of it will be obsolete within one generation, all of it in less than two.

Legacy weapons systems can prove formidable against a tenacious but technologically unsophisticated adversary as Russia found out in Syria or the U.S. did in Afghanistan. But against a near-power rival, generation-old technology will quickly become obsolete.

NON-MILITARY OFFENSIVE CAPABILITIES

Russia cannot afford an arms race with the United States, any more than the Soviet Union could afford an arms race against the United States during the Reagan and Bush administrations. It certainly cannot afford to engage with the U.S. in building an anti-missile defense system.

Putin's new super weapons are designed to convince American policymakers that, with Russia's new capabilities, an anti-missile defense shield will be obsolete before it ever gets built.

That doesn't mean that those new weapons systems aren't real. They may be, even if they may still be some ways from being fully perfected, much less deployed. Nor does it mean that Moscow is not a formidable opponent. It is, and it will continue to be for the foreseeable future.

The Kremlin has done a brilliant job of developing a host of non-military offensive capabilities. It has formidable cyberwarfare capabilities. It has weaponized social media and turned it into a tool for creating social havoc. Who would have thought that, in the hands of the Kremlin, Facebook and Instagram could be turned into weapons of social mass destruction?

Likewise, notwithstanding the fact that the Russian military is a fraction of that of its Soviet predecessor, it has shown, in Syria for example, that against a militarily unsophisticated opponent, Russian military power can be a decisive game changer -- especially if that force is applied with little regard for collateral damage.

A WASTING ASSET

What it does mean, however, is that the elements that constitute Russian military power are a wasting asset. Its rate of obsolescence will vary depending on the opponent that it is pitted against -- faster for a near-power rival, slower against a less militarily sophisticated opponent. But it is a wasting asset nonetheless; only the speed of its obsolescence is in question. The Russian economy simply does not have the wherewithal to maintain a 21st century military force.

A Russia fated for eventual decline will be a far more dangerous opponent than one that can maintain its status as a near-power rival. Realizing that its hand may be more constrained in the future may make Moscow more willing to take risks in the short term.

The choice that Russia had in the 1990s was to decide whether it wanted to join the Western international system headed by the U.S. and its allies or whether it wanted to maintain its post-world war II status as an alternative pole to that international system. Ultimately, Russia chose to maintain the veneer of a great power status, even though it lacked the economic wherewithal to sustain it over the long term.

The price of that decision was to deprive itself of the Western investment and trade that could have modernized the Russian economy and brought it fully into the 21st century and, in the process, given the Russian people a rising standard of living.

The comparison with the former Soviet satellites in Eastern Europe is telling. In 1989, Poland's GDP was around $70 billion and per capita GDP was around $6,000, about 75 percent of the Soviet equivalent. Three decades later, Polish GDP has grown to $470 billion and per capita GDP has increased to $15,049, almost double that of Russia.

Is a doubling of per capita GDP the price Russians paid for the road not taken? Is that the ultimate price of Putinism and Kremlin cronyism?

Students of Russian history are quick to point out that given Russia's large size, the inhospitable terrain, the lack of transportation infrastructure, indefensible borders and a legacy of repeated invasions, only an authoritarian strong man can maintain order and ensure that Russia does not fly apart.

The average Russian, they argue, prefers the order of a Putin-like strong man to the more democratic free-wheeling chaos of late Russian President Boris Yeltsin.

That may well be true. Regardless of whether Moscow's authoritarianism is an inevitable consequence of Russian geography, however, that authoritarianism need not contrapose itself as an alternative to the Western system of world order.

In trying to play what, in the long term, is an inherently weak hand, Putin and his Kremlin cronies have traded a short-term advantage for a long-term disadvantage and, in doing so, may well have relegated Russia to what Leon Trotsky called the dustbin of history.

-- The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of Military.com. 

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Wednesday, March 28, 2018

Miami echo ~ calling for protection of DACA children

Congress should protect undocumented DACA immigrants and their families ~ echo opinion published in The Miami Herald


After Donald Trump ended the DACA ~
Deferred Action for Childhood Arrivals

From not protecting DREAMers, to rescinding Temporary Protected Status, to aggressively threatening sanctuary cities, instituting travel bans for people from Muslim-majority countries and unleashing Immigration Customs and Enforcement (ICE) officers to terrorize local communities, the Trump administration is on a nativist mission to harm all undocumented families.

Rather than providing funding for the Department of Homeland Security, Congress should focus on what really matters — developing a solution for DACA and a fair pathway to citizenship for undocumented communities. 

If people of faith don’t step up now, our children and grandchildren will suffer grave repercussions of inaction.

We must resist Trump’s campaign of violence against immigrant communities by refusing to provide information about the people they serve. Lawmakers should pass policies that affirm immigrants’ sense of belonging in a nation built by immigrants.

We need action that protects entire communities, keeps families together and recognizes both the sacrifices and contributions of immigrants in this country. Rather than targeting undocumented communities in our churches, schools, workplaces and neighborhoods, Congress should act to keep families together. After all, all people, regardless of legal status, deserve protection and a sense of belonging. There are no exceptions.

From Nanci J. Palacios Godinez, Organizer, Faith in Florida, in Orlando

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Tuesday, March 27, 2018

Michigan echos ~ all gun violence is prevenable

Three letters to the editor in published in Michigan's "Lansing State Journal"


Letter number 1.

Congress, stand up to the NRA

Lansing, Michigan ~ Another shooting equals thoughts and prayers. But, our greedy Congress accepts blood money from the National Rifle Association (NRA) to do nothing about stricter gun legislation. Since 1968 more than 1.5 million people have died on U.S. soil, as a result of guns; yet, Congress keeps offering their "thoughts and prayers". One shoe bomber's failed attempt to blow up an airplane resulted in Congress enacting stricter safety regulations at airports. We now take off our shoes in the screening process prior to boarding a plane. Congress, it is time to man up on gun legislation and prove you can't be bought.

Ann Lawrence, Lansing

Letter number 2

Vote out blood money

Grand Ledge, Michigan ~ Yet another mass murder of school children causing untold grief and pain. Assault rifles have no place in civilian hands. They are military weapons. Politicians who accept blood money from the National Rifle Association (NRA) must be voted out of office at the next opportunity.

Deanna Hanieski, Grand Ledge

Letter number 3

Take military weapons out of civilian hands

Okemos, Michigan ! I am an 84-year-old retiree. I served in the United States Marine Corps during the Korean War. I am familiar with military weapons. These weapons should not be available to civilians. Some politicians and the NRA suggest that school teachers could have a weapon to protect their students. This is insane! Can you imagine a teacher pulling out her 38 revolver to battle with a deranged maniac who has many rounds of ammo in a semi-automatic or automatic military rifle? The solution is to take military weapons away from civilians. We should also take steps to deal with our mentally ill populations.

Louis Bacon, Okemos (
Meridian Charter Township, Michigan)

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Maine Medicaid Expansion - echo opinion

Maine Voices: Medicaid can do so much for Mainers, why does the governor resist expansion?


It would support families, save lives, improve health, create jobs – and to cap it all off, it's a huge bargain.

Dr. Sam Zager, ~ PORTLAND, Me ~ I wish I could introduce one of my patients to Gov. Paul LePage.


This patient is a young man whose situation illustrates how Medicaid can pay huge dividends for individuals, families, communities and the state. He became my primary-care patient last fall, soon after his visit to an emergency department for physical trauma.

Besides dealing with this immediate concern, he and I also talked about his substance abuse problem. Somewhere between his prison time and seeing the havoc of the opioid crisis all around him, he understood he needed help. His low-wage job doesn’t include health insurance, but fortunately, he has it through Medicaid.

The expansion of Medicaid – also known as MaineCare – would extend such benefits to over 70,000 other Mainers like this young man, at a net cost to the state of $62 million. In other words, the state annually would effectively pay a mere $867 per person for health insurance – an incredible bargain.

Nearly two-thirds of states have capitalized on this deal. Expansion states cover people with income up to 138 percent of the federal poverty level ($16,753 annually for an individual; $34,638 for a family of four). Every other state in New England has expanded Medicaid, which has yielded them better than 9-to-1 matching funds from the federal government. The Maine Legislature has approved expansion of Medicaid five times in recent years. Each time, Gov. LePage vetoed it. Then last November, Maine voters took the veto-proof step of passing a Medicaid expansion referendum by a wide margin: 59 percent to 41 percent.

By law, Gov. LePage’s administration now has until April 3 to submit an expansion plan to the federal government. Unfortunately, he has given every indication that he will not do so.

Frugality has its place, but Maine already has the necessary money to invest. Earlier this month, the state’s Revenue Forecasting Committee affirmed that for each of the next four years there would be $180 million to $190 million of unappropriated revenue. There also are hundreds of millions of dollars in Maine’s Medicaid fund, even though Maine already forfeited tens of millions of dollars by not expanding Medicaid earlier, when the federal government was paying the entire expansion cost.

Despite that low state cost, the benefits would be profound.

• For starters, health insurance saves lives. The best estimates from the medical literature – presented by Harvard health economists in studies published in 2014 and 2017 – suggest that expanding coverage would save around 140 lives each year in Maine.

• Second, quality-of-life, chronic illness and other non-mortality outcomes significantly improve when people have health insurance, the Harvard researchers concluded last year in a separate article.

• Third, healthier people contribute to healthier families and more vibrant, prosperous communities.

• Finally, expansion would infuse Maine’s economy with hundreds of millions of dollars annually. In a report released last September, Maine-based health economist Elizabeth Kilbreth estimated that expansion would generate about 6,000 permanent jobs in the state, spread across the health and non-health sectors. Some of those jobs would help keep critical-access hospitals, departments and clinics open, which is a major concern in the vast rural Maine landscape.

The comprehensive, Medicaid-funded primary care to which my patient has access gives him much more than a fighting chance to have a fulfilling and productive life. Now, his injury has healed; he remains sober from opioids, with the help of Suboxone (the brand name for buprenorphine); he is quitting smoking; he has been exercising more; and he is working full-time.

I asked him recently to reflect on his personal journey. He told me that things have gotten much better since getting care. “(I’m) workin’ a full-time job, payin’ taxes, payin’ my fines off, helpin’ my parents pay for their house, savin’ up for a basic car,” he told me.

And then his thoughts turned to his school-aged daughter: “Since I’ve been here, I’ve gotten a lot closer with her, thinking about her. I used to just want to get high, and spend all my money on that, but that’s not ruling me now. (Instead, my daughter) wants to hang out with me all the time, so I think I’m doing all right by her.”

This young man is not simply a Medicaid recipient; he is the anchor of his family. He knows the dignity of both an honest day’s work and having health care. Why won’t Maine’s governor expand Medicaid and guide over 70,000 more Mainers and their families in the direction of health?

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Monday, March 26, 2018

Immigrant care for the elder;y ~ Trump is harming the elderly

Trump Targets Immigrants, Elderly Brace To Lose Caregivers

BOSTON — After back-to-back, eight-hour shifts at a chiropractor’s office and a rehab center, Nirva arrived outside an elderly woman’s house just in time to help her up the front steps.

Nirva took the woman’s arm as she hoisted herself up, one step at a time, taking breaks to ease the pain in her hip. At the top, they stopped for a hug.

“Hello, bella,” Nirva said, using the word for “beautiful” in Italian.

“Hi, baby,” replied Isolina Dicenso, the 96-year-old woman she has helped care for for seven years.

The women each bear accents from their homelands: Nirva, who asked that her full name be withheld, fled here from Haiti after the 2010 earthquake. Dicenso moved here from Italy in 1949. Over the years, Nirva, 46, has helped her live independently, giving her showers, changing her clothes, washing her windows, taking her to her favorite parks and discount grocery stores.

Now Dicenso and other people living with disabilities, serious illness and the frailty of old age are bracing to lose caregivers like Nirva due to changes in federal immigration policy.

Nirva is one of about 59,000 Haitians living in the U.S. under Temporary Protected Status (TPS), a humanitarian program that gave them permission to work and live here after the January 2010 earthquake devastated their country. Many work in health care, often in grueling, low-wage jobs as nursing assistants or home health aides.

Now these workers’ days are numbered: The Trump administration decided to end TPS for Haitians, giving them until July 22, 2019, to leave the country or face deportation.


In Boston, the city with the nation’s third-highest Haitian population, the decision has prompted panic from TPS holders and pleas from health care agencies that rely on their labor. 


Moreover, the fallout offers a glimpse into how changes in immigration policy are affecting older Americans in communities around the country, especially in large cities.

Ending TPS for Haitians “will have a devastating impact on the ability of skilled nursing facilities to provide quality care to frail and disabled residents,” warned Tara Gregorio, president of the Massachusetts Senior Care Association, which represents 400 elder care facilities, in a letter published in The Boston Globe. Nursing facilities employ about 4,300 Haitians across the state, she said.

“We are very concerned about the threat of losing these dedicated, hardworking individuals, particularly at a time when we cannot afford to lose workers,” Gregorio said in a recent interview. In Massachusetts, 1 in 7 certified nursing assistant (CNA) positions are vacant, a shortage of 3,000 workers, she said.

Nationwide, 1 million immigrants work in direct care — as CNAs, personal care attendants or home health aides — according to the Paraprofessional Healthcare Institute, a New York-based organization that studies the workforce. Immigrants make up 1 in 4 workers, said Robert Espinoza, PHI’s vice president of policy. Turnover is high, he said, because the work is difficult and wages are low. The median wage for personal care attendants and home health aides is $10.66 per hour, and $12.78 per hour for CNAs. Workers often receive little training and leave when they find higher-paying jobs at retail counters or fast-food restaurants, he said.

Americans face a severe shortage in home health aides. 


With 10,000 baby boomers turning 65 each day, an even more serious shortfall lies ahead, according to Paul Osterman, a professor at Massachusetts Institute of Technology’s Sloan School of Management. He predicts a national shortfall of 151,000 direct care workers by 2030, a gap that will grow to 355,000 by 2040. That shortage will escalate if immigrant workers lose work permits, or if other industries raise wages and lure away direct care workers, he said.

Nursing homes in Massachusetts are already losing immigrant workers who have left the country in fear, in response to the White House’s public remarksand immigration proposals, Gregorio said. Nationally, thousands of Haitians have fled the U.S. for Canada, some risking their lives trekking across the border through desolate prairies, after learning that TPS would likely end.

Employers are fighting to hold on to their staff: Late last year, 32 Massachusetts health care providers and advocacy groups wrote to the Department of Homeland Security urging the acting secretary to extend TPS, protecting the state’s 4,724 Haitians with that special status.

“What people don’t seem to understand is that people from other countries really are the backbone of long-term care,” said Sister Jacquelyn McCarthy, CEO of Bethany Health Care Center in Framingham, Mass., which runs a nursing home with 170 patients. She has eight Haitian and Salvadoran workers with TPS, mostly certified nursing assistants. They show up reliably for 4:30 a.m. shifts and never call out sick, she said. Many of them have worked there for over five years. She said she already has six CNA vacancies and can’t afford to lose more.

“There aren’t people to replace them if they should all be deported,” McCarthy said.

Nirva works 70 hours a week taking care of elderly, sick and disabled patients. She started working as a CNA shortly after she arrived in Boston in March 2010 with her two sons.

She chose this work because of her harrowing experience in the earthquake, which destroyed her home and killed hundreds of thousands, including her cousin and nephew. After the disaster, she walked 15 miles with her sister, a nurse, to a Red Cross medical station to try to help survivors. When she got there, she recounted, the guards wouldn’t let her in because she wasn’t a nurse. Nirva spent an entire day waiting for her sister in the hot sun, without food or water, unable to help. It was “very frustrating,” she said.

“So, when I came here — I feel, people’s life is very important,” she said. “I have to be in the me


The work of a CNA or home health aide — which includes dressing and changing patients and lifting them out of bed — was difficult, she found.

“At the beginning, it was very tough for me,” Nirva said, especially “when I have to clean their incontinence. … Some of them, they have dementia, they are fighting. They insult you. You have to be very compassionate to do this job.”

A few months ago, Nirva was injured while tending to a 285-pound patient who was lying on her side. Nirva said she was holding the patient up with one hand while she washed her with the other hand. The patient fell back on her, twisting Nirva’s wrist.

Injury rates for nursing assistants were more than triple the national average in 2016, federal labor statistics show. Common causes were falling, overexertion while lifting or lowering, and enduring violent attacks.

Nirva works with a soft voice, a bubbling laugh and disarming modesty, covering her face with both hands when receiving a compliment. She said her faith in God — and a need to pay the bills to support her two sons, now in high school and college — help her get through each week.

She started caring for Dicenso in her Boston home as the older woman was recovering from surgery in 2011. Like many older Americans, Dicenso doesn’t want to move out of her home, where she has lived for 63 years. She is able to keep living there, alone, with help from her daughter, Nirva and another in-home aide. She now sees Nirva once a week for walks, lunch outings and shopping runs. The two have grown close, bonding in part over their Catholic faith. Dicenso gushed as she described spending her 96th birthday with Nirva on a daylong adventure that included a Mass at a Haitian church. At home, Dicenso proudly displays a bedspread that Nirva gave her, emblazoned with the word LOVE.

On a recent sunny winter morning, Nirva drove Dicenso across town to a hilltop clearing called Millennium Park.

“What a beautiful day!” Dicenso declared five times, beholding the open sky and views of the Charles River. As she walked with a cane in one hand and Nirva’s hand firmly clasped in the other, Dicenso stopped several times due to pain in her hips.

“Thank God I have her on my arm,” Dicenso said. “Nirva, if I no have you on my arm, I go face-down. Thank God I met this woman.”

In addition to seeing Dicenso, Nirva works three shifts a week at a chiropractor’s office as a medical assistant. Five nights a week, she works the overnight shift, from 11 p.m. to 7 a.m., at a rehabilitation center in Boston run by Hebrew SeniorLife. CEO Louis Woolf said Hebrew SeniorLife has 40 workers with TPS, out of a total of 2,600.

It’s not clear how many direct care workers rely on TPS, but PHI calculates there are 34,600 who are non-U.S. citizens from Haiti, El Salvador, Nicaragua (for which TPS is ending next year) and Honduras, whose TPS designation expires in July. In addition, another 11,000 come from countries affected by Trump’s travel ban, primarily from Somalia and Iran, and about 69,800 are non-U.S. citizens from Mexico, PHI’s Espinoza said. Even immigrants with secure legal status may be affected when family members are deported, he noted. Under Trump, non-criminal immigration arrests have doubled.

The “totality of the anti-immigrant climate” threatens the stability of the workforce — and “the ability of older people and people with disabilities to access home health care,” Espinoza said.

Asked about the impact on the U.S. labor force, a DHS official said that “economic considerations are not legally permissible in TPS decisions.” By law, TPS designation hinges instead on whether the foreign country faces adverse conditions, such as war or environmental disaster, that make it unsafe for nationals to return to, the official said.

The biggest hit to the immigrant workforce that cares for older patients may come from another program — family reunification, said Robyn Stone, senior vice president of research at LeadingAge, an association of nonprofit groups that care for the elderly. Trump is seeking to scrap the program, which he calls “chain” migration, in favor of a “merit-based” policy.

Osterman, the MIT professor, said the sum of all of these immigration policy changes may have a serious impact. If demand for workers exceeds supply, he said, insurers may have to restrict the number of hours of care that people receive, and wages may rise, driving up costs.

“People aren’t going to be able to have quality care,” he said. “They’re not going to be able to stay at home.”

But since three-quarters of the nation’s direct care workers are U.S. citizens, then “these are clearly not ‘jobs that Americans won’t do,’” argued David Ray, spokesman for the Federation for American Immigration Reform, which supports more restrictive immigration policies. The U.S. has 6.7 million unemployed people, he noted. If the health care industry can’t find anyone to replace workers who lose TPS and DACA, he said, “then it needs to take a hard look at its recruiting practices and compensation packages. There are clearly plenty of workers here in the U.S. already who are ready and willing to do the work.”

Angelina Di Pietro, Dicenso’s daughter and primary caretaker, disagreed. “There’s not a lot of people in this country who would take care of the elderly,” she said. “Taking care of the elderly is a hard job.”

“Nirva, pray to God they let you stay,” said Dicenso, sitting back in her living-room armchair after a long walk and ravioli lunch. “What would I do without you?”

KHN’s coverage of end-of-life and serious illness issues is supported in part by theGordon and Betty Moore Foundation.

Melissa Bailey: mbailey@kff.org@mmbaily

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