Vox clamantis in deserto
Don Pesci : Long after 'The Little Pink House' outrage, a rectification bill
“The Little Pink House’’ in New London was moved to another location after a long, unsuccessful protest by its owner, property-rights advocate Susette Kelo. The property upon which it rested was seized by eminent domain so that it could be made available to Pfizer Inc. It was a rare seizure. Usually, property seized under eminent domain is made available for some public purpose. In the Kelo case, the Fort Trumbull Property was transferred from one private owner to another private owner to further economic development. The property was seized by the state because New London wished to induce Pfizer to set up shop on the property. Pfizer moved on; nature soon reclaimed the vacant property.
Kelo lost her battle when the U.S. Supreme Court shamelessly decided in favor of the City of New London, in Kelo v. City of New London, 545 U.S. 469 (2005).
The case produced two notable dissents, one written by Justice O'Connor, joined by Chief Justice Rehnquist and Justices Scalia and Thomas, and a separate, originalist dissent written by Thomas.
Noting that the taking represented a reverse Robin Hood intent – taking from poor householders and given to a wealthy company – O’Conner argued that the majority decision eliminates "any distinction between private and public use of property — and thereby effectively delete[s] the words 'for public use' from the Takings Clause of the Fifth Amendment… Any property may now be taken for the benefit of another private party, but the fallout from this decision will not be random. The beneficiaries are likely to be those citizens with disproportionate influence and power in the political process, including large corporations and development firms.”
Thomas argued that the court had relied upon false precedents, and he accused the majority of replacing the Fifth Amendment's "public use" clause with a very different "public purpose" test. “This deferential shift in phraseology,” Thomas noted, “enables the Court to hold, against all common sense, that a costly urban-renewal project whose stated purpose is a vague promise of new jobs and increased tax revenue, but which is also suspiciously agreeable to the Pfizer Corporation, is for a 'public use’… Something has gone seriously awry with this Court's interpretation of the Constitution. Though citizens are safe from the government in their homes, the homes themselves are not.”
Pfizer is gone, “The Little Pink House’’ has been moved, the stinging dissents have lost their sting, but there are two Connecticut legislators who are not in the habit of forgetting grievous wrongs: State Rep. Tami Zawistowski, who has produced a rectification bill that has been co-sponsored by Rep. Gail Lavielle. Both women are work-horse legislators rather than tinsel-top show-horse representatives pushing the latest enticing snake oil legislation.
“I find it problematic,” Zawistowski said, "that opponents would like to have available other people's property for economic development or transit-oriented development unfettered by protections of private property rights. If they're building a highway or rail line for public use - fine, but a shopping mall or apartments near a rail line where someone is going to make money? No. I get it if properties are blighted or abandoned - but there are other statutes that will allow that.”
On the question of property rights, the right and left in the Supreme Court converged, if only in dissent; in so doing, the dissenters were reaffirming the views of Thomas Jefferson on the preeminence of the right to own and dispose of property:
“The right to procure property and to use it for one's own enjoyment is essential to the freedom of every person, and our other rights would mean little without these rights of property ownership. It is also for these reasons that the government's power to tax property is placed in those representatives most frequently and directly responsible to the people, since it is the people themselves who must pay those taxes out of their holdings of property… Charged with the care of the general interest of the nation, and among these with the preservation of their lands from intrusion, I exercised, on their behalf, a right given by nature to all men, individual or associated, that of rescuing their own property wrongfully taken."
Zawistowski's bill would right a wrong, reaffirm a masterful dissent that brought together both Justices O’Connor and Thomas in a stirring defense of the right of property holders, and ring loudly Jefferson’s liberty bell in defense of a right “admitted by all” – even “before the establishment of government.”
Committee Bill No. 5123 affirms that “No real property may be acquired by a redevelopment agency by eminent domain pursuant to section 8-128 under a redevelopment plan under this chapter for the purpose of producing income from such real property to a private entity or for the primary purpose of increasing local tax revenue.”
Any bill that brings together in agreement Supreme Court justices of the right and left, that is affirmed by the founders of the Republic, and that protects the natural free rights of all the citizens of Connecticut against predatory corporations allied with unconstitutional political interests, must be affirmed by legislators of good will acting in a non-partisan manner for the greater good of the people of Connecticut.
This one should proudly pass through the Connecticut General Assembly with its banners unfurled.
Don Pesci is a Vernon, Conn.-based columnist.
i
'What has to be there'
— Photo by Alice Abbott Kimball
To make do, making a living:
to throw away nothing,
practically nothing, nothing that may
come in handy:
within an inertia of caked paintcans,
frozen C-clamps, blown strips of tarp, and
pulling-boat molds,
to be able to find,
for whatever it's worth,
what has to be there:
From “Eaton’s Boatyard’’ (in Castine, Maine), by the late Philip Booth
David Warsh: Of Brexit and Czechoslovakia
“Chaos,’’ by George Frederic Watts.
SOMERVILLE, Mass..
Is anything more worth saying about the analytics underlying Britain’s options with Brexit? I think so – in this case, by an expert on the fate of the socialist economies of Eastern Europe when they moved from plan to market, leaving the old Comecon treaty tying them to trade within what had been the Soviet bloc .
Peter Murrell, an East Anglian, cast his last vote in England in 1975, in the referendum on whether Britain should remain in Europe. He voted to leave, for many of the same reasons that Brexiters cite today. He believed that Europe was too culturally diverse to expect integration to work well with Britain, especially open borders. Free trade agreements would have been enough to further a close relationship, he reasoned then.
But in 1975, 64 percent of the electorate voted; two-thirds of them preferred to remain. Murrell left for the United States. Today he is professor of economics at the University of Maryland, and the author, 30 years ago, of an unparalleled study of the difficulties facing the socialist economies’ transition.
In The Nature of Socialist Economies: Lessons from Eastern European Foreign Trade ( Princeton, 1990), Murrell offered a detailed empirical study of patterns of trade of nine socialist countries. He found that the determinants of the most important differences between capitalism and socialism lay outside the scope of the standard neoclassical model. He adopted a Schumpeterian or evolutionary view instead, emphasizing innovation and the information-sharing that takes place within multinational corporations. He predicted that transition policies based on the standard view might end badly. By then it was too late, of course, but in general he was right.
In 1975, Murrell says, the cost of Britain leaving what was then called the European Economic Community would have been trivial. The cost of leaving the European Union today will be enormous. Tennyson was wrong when he wrote “Tis better to have loved and lost than never to have loved at all,” Murrell says. In the case of institutional integration, it would have be better to have never entered a relationship than to have been in one and have to leave.
It could, however, be worse – much worse – if Britain crashes out of the European Union without an agreement. Murrell is, he says, “quite optimistic” about the long-term future of Britain. The problem now is to limit the damage to be wrought in the short-run. It is here, he says, that the official studies are badly wrong.
When I asked Murrell to expand on this, he jotted down his thoughts.
The formal analysis about the economic effect of a hard Brexit relies on the theory that exiting a set of institutional arrangements simply has an effect that is of the same size and opposite sign of entering the arrangements. The Bank of England’s analysis assumes the magnitude of the effects of integration and de-integration are symmetric. The Treasury’s analysis simply ducks the issue: “This analysis focuses on the long-term impacts of the UK’s exit from the E.U.…the impact on the U.K. economy after it has adjusted to the change in economic relationship. Therefore, the analysis cannot incorporate or attempt to forecast any potential short-term disruption or any associated long run impacts.”
This assumption that exit equals negative entry cannot hold. In a slow evolutionary process, businesses adapt to a specific set of institutional relationships. At the same time, they form relationships with other businesses on whom they can depend, in which trading relationships are supported by a history of trustworthy behavior and the personal trust that can only come from deep knowledge of one’s trading partner.
After a set of rules have been in place for many years, businesses have built up a large amount of productive organizational and relationship capital. Day-to-day operations are dependent on that capital. This capital is also a means by which businesses can be confident that their opportunities in the future will look similar to those in the past, allowing them to plan and invest for the future.
That organizational and relationship capital is destroyed when politicians radically change a set of rules, thereby foreclosing possibilities for trade that go with these rules. There is a resultant drop in productivity in the short-term, a fall that has no long-term relevance. There is “deer in the headlights” phenomenon as well: future-oriented actions are not being taken because of the huge uncertainty about what the future will look like.
(A nuance here is often overlooked: Why does opening up possibilities not do the same thing as the foreclosing of possibilities, since that opening up immediately changes the types of competitors a firm will have? The answer is that when possibilities are opened up, the effect on firms will happen only slowly, as other firms adapt. In the foreclosing of possibilities by government fiat, that change must happen overnight.)
So how might economists forecast the effects of such exiting? Well the standard procedure would be to look at similar instances in the past, and if there are sufficient instances use them in a statistical analysis. However, to quote the Bank of England “There is no precedent of an advanced economy withdrawing from a trade agreement as deep and complex as that which the UK has with the EU.”
But this is not quite right. The appropriate precedent is one where a society has chosen to change a large proportion of the rules under which its economy functioned, literally overnight. The EU is not only about trade but also about the very rules that set the framework for the economy.
What is the closest precedent of a society overthrowing the rules for its economy in very short order, including asking firms to reorient their trading relationships very quickly? The closest is the transition in Eastern Europe, beginning in 1989 after Soviet President Mikhail Gorbachev let those countries determine their own futures.
The general picture that emerged from those times was one of economic chaos in the first years, with production and sales deeply damaged by the loss of suppliers cut off by the new arrangements. In turn, with sales declining, firms could no longer pay their debts and this led to crisis for all their trading partners. Supply-side recessions resulted, leading to large falls in national income, and in many countries political reactions that even questioned the turn away from communism.
For a specific parallel to Brexit, consider Czechoslovakia.
Of all the countries in Eastern Europe, Czechoslovakia would be surely the one that was able to make an immediate success of the transition process. The country had been the best managed of all the Eastern European countries during the socialist era. It entered the transition as the richest, without any legacy of foreign debt to stymie its progress. After its Velvet Revolution in 1989, there was near unanimity on the general goal of creating a market-capitalist-democracy.
Bordering the richest part of Europe, the country could expect a huge array of trading opportunities to become easily available. A group of competent technocrats took charge of the economic transition process.
They decided to take their time, to plan for change, rather than to rush headlong into the process. A year was devoted to planning, with the dramatic change of system to occur on Jan. 1 1991. That year of planning was a period of economic stability.
Initially, the auspices were good. Strong in 1990, under the soon-to-be demolished old system, GDP grew by more than 5%, buoyed by very strong retail sales. Therein lies a first lesson for Brexit. The anticipation of problems ahead leads to behavior that might temporarily boost the economy, with the hoarding of supplies and the desire to buy objects that might no longer be available once the changes hit.
In Czechoslovakia, this indeed was the calm before the storm. During 1991, GDP dropped by 20 percent, retail sales by 14 percent, construction output by 35 percent, the number unemployed went from under 10,000 in the beginning of 1990 to over 500,000 by the end of 1991. And the list could go on…
What happened to all those marvelous new opportunities in Western Europe, not much more than 100 miles from Prague? Trade to the West expanded slowly during 1991, and foreign direct investment in Czechoslovakia remained at paltry levels. Of course, this situation dramatically changed in just a few years, but the fact is that new opportunities do not lead to immediate results. New knowledge has to be developed and new relationships forged.
There we have the most important lesson from transition. The route to the Promised Land begins with a steep downhill section. Despite its huge inefficiencies and woeful institutions, the old system could provide much more well-being in the short-term than the chaotic move to what would turn out to be a much better world in the long-run.
And remember that Czechoslovakia was changing to a system that all knew would be more productive in the long-term. This is a very dubious proposition in the case of Brexit. And the political support for the changes in Czechoslovakia was very strong. Any Brexit will begin with half the country deeply opposed.
A third lesson about the dangers may be learned from Czechoslovakia: The country no longer exists. As always in times of great change, there are those who lose more and those who lose less. In Czechoslovakia, reflecting differential links to the old and new, the eastern part was hit much harder than the western part.
These two parts are now the independent countries of Slovakia and the Czech Republic, separating from each other on Jan. 1 1993. For sure old enmities played a part, but so too did the tensions brought about by the widening disparities between the two regions, disparities that could not be addressed in the swift move to the new system.
In Britain 56 percent of voters in Northern Ireland and 62 percent of voters in Scotland voted against Brexit. If Brexit occurs and it brings new hardships, there is no doubt then Brexit will be regarded as yet another instance of “Perfidious Albion’’. A break with Scotland and the renewing of the ‘‘troubles’’ in Northern Ireland are distinct possibilities.
Mervyn King, former governor of the Bank of England, ventured a much more optimistic opinion last week, contradicting his successor, Mark Carney. Six months of planning would be enough to mitigate dislocation costs, King said. “The more wild, exaggerated view that somehow we’re going to have queues of lorries on the M20 for five years or more is pretty absurd.”
Murrell told me, “He’s quite right that it is absurd. After six months, the lorry drivers will give up and exports to the E.U. will be down by a half!”
In Richard II, Murrell notes, John of Gaunt laments over the decline of “this royal throne of kings, this scepter’d isle”, observing that “That England, that was wont to conquer others, Hath made a shameful conquest of itself”. That’s it in a nutshell, he says. Shakespeare had it right.
David Warsh, a veteran economics and political columnist, and an economic historian, is proprietor of economicprincipals.com, where this piece first ran. He is based in Somerville,
Vertigo in downtown Providence; stripes in Namibia
Above, painting by Jim Bush in his joint show with Paul Murray (below), “From Providence to Namibia, ‘‘ at the Providence Art Club through April 19.
By Paul Murray
The chaining of a student strip
On Thayer Street
Photo by Rhododendrites
From Robert Whitcomb's "Digital Diary,'' in GoLocal24.com
On March 18, GoLocal had a story about how national chains have taken over Providence’s Thayer Street, heavily populated by students from Brown and RISD. It reminded me of how much quieter the retail strip was in our first stretch in Providence, in the late ‘70s. Then, the restaurants, with the exception of the International House of Diabetes, ah I mean Pancakes, and all the shops were one-off local establishments. The street had a kind of quaintness, such as little gift shops run by genteel blue-haired ladies.
All long gone, and the street could now be almost anywhere, with a few exceptions, most notably The Avon, the old art deco-ish movie theater, Andrea’s restaurant and Spectrum India. To me the biggest disaster was the closing, in 2004, of the College Hill Bookstore, with its eclectic, even inspired collection of books and magazines. It was far more interesting than the still very bland Brown Bookstore. The College Hill Bookstore was the hub of the street, killed by the Internet, as with so many local shops. (Spectrum India was on Thayer Street before moving into the College Hill Bookstore’s site.)
That Brown has grown, and become more of a national and international school, is another reason that the quirky New England aspects of Thayer Street have mostly disappeared. The Thayer Street retail strip could now be almost anywhere, which may be quite all right with most of the college community that now uses it.
I sort of like the much more crowded, city-like (including bigger, taller buildings) and perhaps more dynamic Thayer Street of today, although I and many neighbors also miss the often sleepy charm of 40 years ago.
Then you have the city’s other big student neighborhood – the one that has developed in downtown Providence, with the expansion there of Johnson & Wales University, RISD, URI and Roger Williams University bringing remarkable change. Now there are many more people downtown day and night than three decades ago, and it’s become much more of a residential as well as commercial neighborhood. This has offset much or all of the effects of the exit of many big companies from downtown over the past few decades. It may be hard to believe now but Providence used to be a major corporate-headquarters town.
Anyway, the recent transformation of downtown has been very heartening considering how abandoned it looked, especially after office hours, not so many years ago.
To read the GoLocal story, please hit this link.
Sneaky month
The sun was warm but the wind was chill.
You know how it is with an April day
When the sun is out and the wind is still,
You're one month on in the middle of May.
But if you so much as dare to speak,
A cloud comes over the sunlit arch,
A wind comes off a frozen peak,
And you're two months back in the middle of March.
— From “Two Tramps in Mud Time,’’ by Robert Frost
The past isn't past
“George Nugent grave, Somme, France, ‘‘ by Bonnell Robinson, in her joint show with photographer Richard Zauft at Lesley University’s VanDernoot Gallery, Cambridge, Mass. through April 7.
Robinson shows photographs of World War I fronts, which she's been photographing for over a decade. "What amazed me was how much remains in evidence of that conflict," she told the gallery. "Unusual contours of wheat fields, undulating hillsides too regular to be natural, occasional debris or rubble, unexploded and rusting shells left by farmers by the roadside to be picked up by demolition teams. …The scars are still visible, haunting and deeply disturbing."
William Morgan: The door guy of Brooklyn, Conn.
Twenty years ago, we were restoring our newly acquired house, a 1915 vicarage in Providence, and needing a front door. My wife, Carolyn (who was our contractor), phoned Rudy Rzeznikiewicz in Brooklyn, Conn., and asked him if had a 42-inch wide, six-panel door. "I have one," replied the man who has over a thousand doors for sale.
Rudy Rzeznikiewicz and Carolyn Morgan
Rudy's operation, Brooklyn Restoration Supply, is centered in two former chicken houses. One holds the doors, mantles and balusters from three centuries, along with salvaged hardware, while the other is filled with old wood–boards and beams. Spread across a large yard in between is a serendipitous collection of all sorts of architectural bits and pieces spared the wrecking ball or the landfill, plus dozens of granite millstones.
Some of Rzeznikiewicz's 1,000 doors
There's nothing fancy about Rudy's place: there is no computerized inventory, no refreshments, no place to sit, and you cannot pay with a credit card. Yet people in the antiques and home-restoration business know about this treasure trove and come from all over to this most rural part of Connecticut
Just a fraction of the flooring and paneling available
Some of the many millstones
But the best thing about Rzeznikeiwicz's operation is Rudy himself. Even if we are not in search of a specific board or piece of hardware, we like to go to Brooklyn just to spend time with this knowledgeable, fascinating, and honest antiquarian. (Rudy was a valuable source when I was researching books about early American houses and churches.)
Rudy Rzeznikiewicz
Rudy looks much the same as when we first met him two decades ago, although he will be 90 his next birthday. Half of that span has been spent guiding those fixing up houses by rescuing and recycling the superior materials of pre-Home Depot days. He started dairy farming here as a teenager. And, typical of so many rural New Englanders, Rudy has patched together a life of all sorts of jobs – assessor, bus driver, postman, firefighter – that has let him stay on the family farm where he was born.
Providence-based writer William Morgan has a degree in restoration of historic architecture from Columbia University. He is the author of, among other books, The Cape Cod Cottage and American Country Churches.
A matter of priorities
After the Visitor Spoke
After the visitor spoke at my high school about climate change,
I could not stop crying.
“Do you want to talk about it?” a counselor asked.
I shook my head.
I did not want her in my life.
Besides, she would never believe
I was crying because Matt twirled Steffie’s hair during the lecture
And I heard him ask her to the prom.
— Felicia Nimue Ackerman
Judith Graham: More joint-replacement patients rehabbing at home
Hip- joint replacement.
Older adults and their families often wonder: Where’s the best place to recover after a hip or knee replacement — at home or in a rehabilitation facility? A Brown University-linked study addresses that issue.,
Increasingly, the answer appears to be home if the procedure is elective, friends and family are available to help and someone doesn’t have serious conditions that could lead to complications.
This trend is likely to accelerate as evidence mounts that recuperating at home is a safe alternative and as hospitals alter medical practices in response to changing Medicare policies.
The newest data comes from a March study in JAMA Internal Medicine of 17 million Medicare hospitalizations of people from 2010 to 2016. All the patients were older adults and went home or to a skilled nursing facility after a medical procedure or a serious illness. Knee and hip replacements were the most common reason for these hospitalizations.
People who were sent home with home health care services demonstrated the same level of functional improvement as those who went to a skilled nursing facility (assessments examined their ability to walk and get up and down stairs, among other activities), the study found. And they were no more likely to die 30 days after surgery (a very small percentage in each group). Overall, costs were significantly lower for patients who went home, while hospital readmissions were slightly higher — a possible signal that home health care services needed strengthening or that family caregivers needed better education and training.
“What this study tells us is it’s certainly safe to send people home under many circumstances,” said Dr. Vincent Mor, a professor of health services, policy and practice at Brown University’s School of Public Health who wrote an editorial accompanying the study.
The new report expands on previous research that came to a similar conclusion. In 2017, experts from New York City’s Hospital for Special Surgery published a study that examined 2,400 patients who underwent total knee replacements and were discharged home or to a skilled nursing facility for rehabilitation between May 2007 and February 2011. There were no differences in complication rates at six months or in functional recovery and patient-reported outcomes at two years.
“As a result of these findings, we are encouraging all of our patients to consider home discharge after TKA [total knee replacement],” the authors wrote.
The year before, researchers at New York University reported in JAMA Internal Medicine that from 2009 to 2012 and 2013-14, discharges to rehabilitation facilities fell from 68 to 34 percent for patients undergoing hip and knee replacements, from 71 to 22 percent for patients with cardiac valve replacement surgeries, and from 40 to 30 percent for patients who’d had spinal fusion surgery. Instead, more people were sent home to recover. During this period, NYU Langone Medical Center assumed financial responsibility for “episodes of care” for joint replacements that include the post-hospital recovery period — a policy that Medicare is now promoting.
Diane Rubin, 67, who lives on Long Island, had a hip replacement at the NYU medical center in January. Before the surgery, she got a list of things she’d need to do to prepare for her recovery; afterward, a nurse and physical therapist visited her at home regularly for about three weeks. “I was more comfortable recuperating at home and I’ve had absolutely no complications,” she said.
How do physicians decide where to send patients? “In general, we tend to send patients to skilled nursing facilities who are older, sicker, more deconditioned after surgery, and who have no spouse or caregiver, fewer resources and little social support,” said Dr. Leora Horwitz, a co-author of that study and associate professor of population health and medicine at New York University School of Medicine.
Though it’s widely believed that people who live alone might not do well going home, last year researchers at The Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia published research showing that isn’t necessarily the case. At their institution, patients are assigned a nurse navigator who provides assistance before and after hip or knee replacements. Patients who lived alone stayed in the hospital longer and received more home health care services than those who lived with others.
When they recuperated at home, the Rothman Orthopaedics patients didn’t have higher rates of medical complications, returns to the hospital or emergency room visits than those who went to rehabilitation facilities. Nearly 90 percent of people who lived alone said they’d again choose a home discharge.
Dr. William Hozack, a co-author of the study and professor of orthopedic surgery at Thomas Jefferson University Medical School, acknowledged that patients who go to rehabilitation are probably sicker and more debilitated than those who go home, potentially biasing research results. Still, practices have changed considerably. Today, he and his colleagues send 95 percent of patients who get hip and knee replacements home to recover, instead of directing them to institutions.
People shouldn’t underestimate how much help they may require at home, especially in the first few weeks after surgery, said Carol Levine, director of the United Hospital Fund’s families and health care project, who has had two hip replacements. The potential downsides to going home include a greater burden on caregivers and the possibility that complications won’t be identified as quickly, needs will go unmet if friends and family can’t pitch in, and people won’t follow through on recommended rehabilitation regimens. And outcomes may not be as favorable if services that support people at home aren’t readily available
Utah’s Intermountain Healthcare, a health system that operates 23 hospitals and nearly 170 medical clinics, is bringing an array of services — palliative care, dialysis, primary care and hospital care — into the home through its new Intermountain at Home program. Recovering at home after a hospital procedure is also a focus, and Intermountain has created standardized procedures for hip and knee replacements over the past few years, according to Rajesh Shrestha, the system’s chief operating officer of community-based care.
Every joint-replacement patient going home after surgery now gets a thorough assessment to determine the resources that are needed. A care plan is created and a case manager, usually a registered nurse, makes sure that physical therapy, durable medical equipment and home health care are supplied. The case manager also coordinates postoperative care with orthopedic surgeons and makes sure that patients reconnect post-surgery with their primary care physicians. And a team of providers is available 24/7.
During the past few years, discharges to rehabilitation facilities have declined by half at most of Intermountain’s Utah facilities, with no notable increase in complications or hospital readmissions, Shrestha said. During 2018, 85 percent of knee replacement patients and 88 percent of hip replacement patients went home after surgery, respectively.
At Kaiser Permanente, a health plan with more than 12 million members, a substantial number of patients who get elective hip and knee replacements are skipping a hospital stay altogether and going home the same day. In Kaiser’s Southern California region, same-day joint replacement home discharges now total about 50 percent, according to Dr. Nithin Reddy, who oversees joint replacements for the region. (Kaiser Health News is not affiliated with Kaiser Permanente.)
Kaiser Permanente has made this possible by changing how procedures are done (an anterior approach for hip replacements, for example), introducing new protocols for pain management (opioids are used less frequently), altering anesthesia protocols (less general anesthesia and more regional anesthesia), reducing blood transfusions and hiring “total joint coordinators” (typically nurses) to help with the transition from the hospital to home. All patients go home with home health care, receive two outreach calls the week after surgery and get comprehensive handbooks with checklists of what to do before and after surgery and common concerns to look out for.
“We have very robust discharge criteria: Patients have to have well-managed pain and be able to get in and out of bed by themselves and in and out of the restroom by themselves. And they need to be able to walk 50 to 75 feet unassisted, using a walker,” Reddy said. “If they can’t do those things, they aren’t safe for a home discharge and [rehabilitation at] a skilled nursing facility would come into play.”
Magdalena Ritayik, 66, one of the doctor’s patients, had a knee replacement last September after cortisone shots stopped working and pain became a constant companion. Six years before, her husband had both knees replaced, separately, and stayed in the hospital three days each time. By contrast, Ritayik went home the afternoon after her surgery, only to find a nurse and physical therapist waiting there for her.
“The nurse went over all the medications, when to take them and how much. The physical therapist showed me how to do bending and stretching with a chair in the living room and to raise [my leg] while I was lying on the bed,” Ritayik said. “The first week you have to stay home. After the second week, I was walking almost like regular. A month after the surgery, I was at full extension and full bending.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
Judith Graham is a Kaiser Health News reporter.
Judith Graham: @judith_graham
Layers of light and shadow
“Slow Autumn’’ (mixed media on paper), by Sabrina Garrasi, in her show at Lanoue Gallery, Boston, through April 27.
The gallery says:
“Through Garrasi's deft handling of watercolor, gouache, ink, acrylic, tempura and 22kt gold leaf, she creates translucent layers with ethereal qualities of light and shadow.’’
The fire this time
From the Rev. Bill Comeau’s show “Learning From the Masters,’’ opening March 31 at the Providence Art Club.
Llewellyn King: Don't let autonomous-transport developers rush to market
A WestJet Boeing 737 MAX 8 on final approach. The model is now grounded.
A shadow has fallen across the future of autonomous transportation, one of the key aspects of the city of the future and of the widespread use of artificial intelligence. It comes from Boeing in the form of the computer problem that has grounded the world’s fleet of 737 Max 8 aircraft.
No definitive cause of the crashes of Lion Air Flight 610, in the Java Sea, which killed 189 people, and Ethiopian Airlines Flight 302, en route from Nairobi to Addis Ababa, which killed 157 people, has been established yet. But the everything points to the computerized stall-avoidance system.
In terms of computing in aircraft, this is no more than an embarrassment. In terms of loss of life, it is ghastly. In terms of the public confidence in the growing role of computing in everything, it is grave.
These crashes have stimulated public fear, and public fear hangs around. So does institutional fear -- even when the problem has been identified and remediated.
Consider these events, which have left a long-lasting residue of fear:
Thalidomide was a drug developed in Germany and first marketed there to pregnant women as an anti-depressant.. Use spread around the globe and the results were devastating: More than 10,000 babies were born without one or two major limbs, like arms and legs.
I am told, although it is never mentioned, thalidomide haunts the drug industry. It has affected both the development of new drugs and the regulation of drugs to this day. The long delays and exhausting trials new drugs go through are partly due to something that happened in the late 1950s.
The Three Mile Island nuclear-power plant accident, in Pennsylvania in 1979, has affected nuclear design and regulation of nuclear plants ever since, although no life was lost. There was a partial meltdown of the core and the result fed the anti-nuclear movement which, ironically, pushed utilities back to coal -- now under attack because of its environmental impact.
The Max 8 problem, in terms of computing in aircraft, is no more than a glitch, possibly the result of a rush to market. But the loss of life is terrible and the loss of confidence immeasurable.
A whole array of high-tech companies is hoping to bring autonomous transportation to the streets within a decade or not much longer. These include Uber, Lyft and Google. Tesla would like to see autonomous electric trucks handling intercity deliveries.
This push to the driverless has huge energy and resources behind it. It is a part of what has come to be known as the smart city revolution. It also is part of what has been described as the Fourth Industrial Revolution.
Early autonomous cars have depended on sensors to guide them. The car in front slows and the car behind picks this up from its sensors. When autonomous vehicles are fully developed, these cars and all the others on the road will be in constant communication with each other. Car A will tell Car B, “I am breaking” and so on down through a line of traffic. It is coming.
The message from Boeing’s catastrophe is: Get it right or you will scare the public off, as happened with Three Mile Island. Some willing propagandists scared the public off nuclear — our best way of making a lot of electricity without carbon.
The technology in aircraft is very sophisticated. Almost all passenger airliners have been able to land themselves once they intercept a radio signal, called the glide slope, at an advanced airport. They are packed full of computers operating all sorts of wondrous systems.
If all the computers on the fatal Max 8s had been talking to each other, as traffic will have to in the coming era of autonomous vehicles, they might well have shut down the stall avoidance system that was mis-sensing an imminent stall.
The neo-Luddites will try to exploit the Boeing catastrophe into slowing smart city development. The challenge for autonomous technology is to get it right. Not rush to market.
Llewellyn King is executive producer and host of White House Chronicle, on PBS. His email is llewellynking1@gmail.com and he’s based in Rhode Island and Washington, D.C.
Didn't love that dirty water
From Robert Whitcomb's "Digital Diary,'' in GoLocal24.com
“Well, I love that dirty water (I love it, baby)
I love that dirty water (I love Baw-stun)’’
From “Dirty Water,’’ (1965) by the Standells, a tribute to the polluted waters of Boston Harbor and the Charles River, which of course flows into it.
As the Trump administration continues to weaken the understaffed Environmental Protection Agency, I think of Boston Harbor before the EPA and the great Boston Harbor cleanup, which the creation of the EPA (1970) and the Clean Water Act (1972) helped set in motion. I had summer jobs on the Boston waterfront in the ‘60s and well remember how rank the harbor was. My workmates and I would sometimes take the lunch boat, which offered many scenic attractions, but on a hot day, the smell was foul enough to make us put down our sandwiches.
The cleanup was a great social, aesthetic and economic boon for our region, as has been the gradual cleanup of Narragansett Bay.
Don Pesci: The real cost of Connecticut's tax increases
Arguing against a legislatively imposed minimum wage increase, Brian Jessurun, co-owner of four northeastern Connecticut restaurants, writes in an op-ed in The Hartford Courant that “By all accepted accounting metrics, this state is virtually bankrupt. Reputable estimates place Connecticut’s unfunded liability debt at $70,000 per taxpayer, more than many of them have set aside for their own retirements. The only chance we have of getting out from under that burden is a burst of prolonged prosperity, which would increase state revenues without significantly increasing the taxes that are already driving away job creating businesses and tax paying residents.”
At last, some readers of the paper in which the op-ed appeared might exclaim – light!
We all know that artificial – read, political -- increases in the cost of labor are attended by predictable but unwanted consequences. Whatever the state taxes tends to disappear, and the anti-free market boost in the minimum wage can only be regarded as a tax on the diminishing earnings of Jessurun’s businesses.
Very large businesses may be able to absorb such expensive mandates by passing the increase in the cost of labor to its customers – or not. There is more than one way, especially for large mobile businesses to slip the noose, sometimes by moving operations out of state, sometimes by reducing hours for its full-time staff. When a large company moves out of state, the business takes with it the taxes it might have surrendered to the state, and the tax-milking by thirsty, spend-thrift legislators comes to a stop.
Small businesses that cannot move operations will shut down, thus depriving the state of expected revenues it might have reaped had the state not imposed an artificial increase in the cost of labor that businesses could not absorb.
Connecticut has yet to recover the job losses that recessions always bring. While the rest of the nation pulled itself out of the Great Recession, which lasted from December 2007 to June 2009, almost 10 years ago, Connecticut has prolonged its recession by straining an overburdened economic engine with unsupportable tax increases and needless regulations.
So then, one might suppose that the new governor,
Ned Lamont, and its General Assembly, top-heavy with Democrats, nearly half of them progressives, would be loathed to heap taxes and regulations on a state that is still recovering from a recession that ended elsewhere in the nation nearly a decade ago.
Not a bit of it. Former Gov. Lowell Weicker saddled Connecticut with an income tax after he had cautioned during his fraudulent campaign for governor that imposing such a tax in the midst of a recession would be like “pouring gas on a fire.” The two Republican governors who followed Weicker, John Rowland and Jodi Rell, were imperfect firewalls unable to curb the appetite for spending of a Democratic-dominated General Assembly. Gov. Dannel Malloy boosted taxes twice and then, as Weicker had done before him, lit out of town rather than stand for re-election to a third term in office, after having achieved an approval rating of 25 percent.
The election of Lamont heralded a new day. He was a business man who possibly understood the importance of a flourishing economy, a man who might hasten an epoch of “prolonged prosperity that would, in Jessurun’s words, “increase state revenues without significantly increasing the taxes that are already driving away job creating businesses and tax paying residents.”
Here is a PARTIAL list supplied by the Yankee Institute of additional taxes proposed by Democrat legislators: $652 million in sales tax increases, which is projected to be up to $1.1 billion by 2022; $515 million increase in healthcare provider taxes, which are passed on to patients through higher insurance costs and payments for medical care; $480 million in toll revenue, 60 percent of $800 million in expected revenue by 2024; $340 million raised by a new 0.5 percent payroll tax to pay for paid FMLA; $163 million soda tax; $71.5 million property-tax increase by 2022, to pay for teacher pension payments; $70 million income tax increase, mostly from canceled exemptions; $50 million corporate tax increase (average of two years), includes offset for elimination of the Business Entity Tax; $41.6 million in license and fee increases; $30.2 million plastic bag tax; $17.8 million in other miscellaneous tax increases, including on vaping, a real estate conveyance tax increase on homes over $800,000, and an increase in the movie ticket tax; $9 million for the gift tax repeal…
"A fool,” the old adage has it, “learns only from his own mistakes. A wise man learns from the mistakes of others."
People inside and outside of Connecticut may be forgiven for being unable to distinguish whether the new administration is foolish or stupid.
Don Pesci is a Vernon, Conn.-based columnist.
John L. Lahey: Make curricula faster, cheaper and better
Quinnipiac University’s Arnold Bernhard Library and clock tower, the focus of main campus quadrangle, in Hamden, Conn. Sleeping Giant Mountain is in the background. The author of this essay is a former president of the university.
From The New England Journal of Higher Education, a service of The New England Board of Higher Education (nebhe.org)
During my 40-plus years working in higher education I have witnessed a remarkable transformation in a wide range of industries – telecommunications, computing, transportation, media, publishing, manufacturing and retailing, to name a few. In almost every case these transformations have resulted in an improved product and/or service that is more responsive to consumer needs, more efficient and effectively produced, and offered at lower and lower cost to the consumer. The most obvious exception to all of these industry transformations is higher education.
Every year for the past 10 years I’ve made it a point to attend a futuristic conference in Silicon Valley having nothing to do with higher education. I was more interested in learning how high-tech Silicon Valley entrepreneurs viewed the world and the culture that attracted and produced these innovators and their startup companies. I was truly amazed at the extent to which these Silicon Valley entrepreneurs believed they were just one algorithm away from radically changing a long-established industry, its product or services, or creating an entirely new one. The mantra for these entrepreneurs and Silicon Valley generally is: faster, cheaper, better.
Using these same standards of faster, cheaper, better, let’s apply them to higher education and the changes that it has witnessed over my 50-plus years dating back to 1964. For starters: The bachelor’s degree that I earned in 1968 took me 120 credit hours, eight semesters, and four years to achieve. The per-credit-hour charge back then was $21. That same degree today costs about $1,200 per credit (both based on private university tuition costs). With respect to “better,” I’m willing to accept that today’s undergraduate education is at least as good as it was when I was a student, although frankly I’m hard-pressed to say that it is significantly better. And with respect to “faster,” the same bachelor’s degree that I earned in 1968 still today takes 120 credit hours, eight semesters, and four years to complete.
In short, the degrees that higher education awards today versus 50 years ago are neither faster nor better and certainly not cheaper. Earning a degree today costs about 57 times more than what it did five decades ago. All of which leads me to an opportunity for efficiency which has largely been overlooked in higher education, namely the curriculum. And the beauty of this opportunity is that it offers the best if not the only hope for higher education to satisfy all three of the Silicon Valley goals of faster, cheaper and better.
Seven years ago, at my urging, Quinnipiac University developed a number of accelerated dual-degree bachelor’s/master’s programs (originally called 3-plus-1 programs). The first one we developed was a bachelor’s in business combined with an MBA. The second was a bachelor’s in communications combined with a master’s degree in communications/journalism. These two combined offerings already existed at Quinnipiac as separate degree programs that required five years or 10 semesters to complete at the cost of five years or 10 semesters of tuition.
Our newly developed accelerated dual-degree programs offered these same two degrees in four years or eight semesters at a cost of four years or eight semesters of tuition. This accelerated program reduced by one full year both the time of completion and the cost of tuition yielding a savings or cost reduction of 20% or approximately $40,000. In addition, shortening the time of completion by one year allowed the graduates of these programs to enter the workforce one year earlier, offsetting the cost even further depending on the salary earned that first year after graduation. For example, a net income from a first-year take-home salary of $60,000 combined with $40,000 in reduced tuition effectively reduces the cost of dual degrees by 50% from $200,000 for the traditional five years of tuition to $100,000 with four years of tuition payments of $160,000 reduced to $100,000 by earning $60,000 net income in the fifth year.
These accelerated dual-degree programs have been expanded to other schools and colleges at Quinnipiac and now include additional 3-plus-1 programs, as well as 3-plus-2 programs and 3-plus-3 programs for dual degrees that traditionally required six or seven years to complete at a cost of six or seven years of tuition.
The common thread for all of these dual-degree programs is that they shorten the traditional amount of time required by one year, reduce the cost of the dual degrees by one year’s tuition and allow the graduate to enter the workforce one year earlier, earning an extra year’s salary. The popularity of these programs has grown such that over 20% of the Quinnipiac freshmen entering in the fall of 2018 were enrolled in one of these dual-degree programs.
The key element in the success of these programs both academically and financially is the curriculum and specifically the elimination of duplication within the curriculum for a bachelor’s and a master’s in the same program, such as business or communication. Most people believe the cost of higher education has gone up dramatically in large part because we are a personnel intensive industry. But I submit that the reason we need so many faculty and other personnel is because the curriculum has expanded and expanded over the years with little effort to eliminate unnecessary duplication of content among many bachelor’s degrees and their corresponding graduate degrees.
To end on a positive note: If we do indeed expand our focus on the curricula and eliminate unnecessary duplication within degree programs, we will not only lower the cost of higher education, but unlike with traditional cost reduction efforts, we will not compromise quality. Reasonable class sizes and full-time faculty-to-student ratios can be maintained for optimal learning. At the same time, more efficient curricula will more effectively engage and challenge today’s students who are far ahead of educators in their desire for all things faster, cheaper, better.
John L. Lahey is president emeritus and professor of logic and philosophy at Quinnipiac University, in Hamden and North Haven, Conn.. He served as president from 1987 to 2018.
David Warsh: Labor economist Alan Krueger and the 'methods revolution'
The late labor economist Alan Krueger.
SOMERVILLE, Mass.
Stanley Karnow had it right when he said many years ago that a reporter’s toolkit consists of two main things: background knowledge and skepticism. He might have added that a good supply of shoe leather helps as well.
I was reminded of Karnow’s maxim by the death on March 14 of Alan Krueger, 58, of Princeton University. I was sad to think I hadn’t seen Krueger or spoken to him since 2011, when he became chairman of President Obama’s Council of Economic Advisers, succeeding Austan Goolsbee.
At first I thought the lapse must have been a function of my having left newspapering for the Web a decade earlier. Then I decided it had more to do with the life cycle. I was spending more time writing books and less time covering the beat.
My sense of loss was nothing compared to the grief expressed in the community of labor economists, which recognized that the irony that a man who had spent much of his career studying the ill-effects of reversal on others, mostly economic, had died by his own hand. Catherine Rampell, of The Washington Post, reviewed his career.
Krueger was born in 1960. That meant he was 21 in 1981, the year IBM began running those Charlie Chaplin ads for its new “microcomputers.” The age of highly adaptable personal computers was just getting underway.
He graduated from Cornell University’s School of Industrial and Labor Relations, in 1983, then did his graduate work at Harvard University, getting his Ph.D. in 1987. Princeton University hired him and put him in the office next to Prof. David Card, four years his senior.
By then, a broad movement in empirical economics was underway. Card thinks some part of it started with Robert LaLonde’s work on the evaluation of competing methodologies. I have often heard that Joshua Angrist’s study of the effects of the Vietnam draft lottery on the lifetime earnings of draftees was especially influential. Princeton’s Orley Ashenfelter was the dissertation adviser of each, and Card as well. Harvard Prof. Richard Freeman’s search for natural experiments is often mentioned.
Krueger brought with him to Princeton a subscription to the New England Journal of Medicine, each of its articles prefaced with a description of the particular”methods” and “research design” by which the result was obtained. Card , laughing, recalled in an interview, ”[It] would come in every week, so there was a lot of stuff to read…. And if you’d never seen that before, and you were educated as an economist in the 1970s or 1980s, that just didn’t make any sense. What is research design? And I remember one time I said, ‘I don’t think my papers have a research design.’ ”
Card and Krueger contributed a widely cited study and subsequent book about what happened in the fast food industry when New Jersey raised its minimum wage and Pennsylvania didn’t. They concluded that raising the minimum wage had relatively little impact on employment. (Their finding generated both controversy and further research.) Randomized controlled trials soon followed in development economics, and field experiments of various sorts, and, eventually, the application of machine learning to big data.
Financial Times columnist Tim Harford noted the other day that Krueger liked to call all this “the credibility revolution.” Nobel awards haven’t begun to be awarded to economists in the movement yet, but they will. Card was recognized with the John Bates Clark Medal in 1995 as an especially influential economist of his generation before the age of 40
I have long thought that there is a good book to be written about the methods revolution. That was the biggest thing going on in economics for many years after 1990. I’m not the man to do it; my shoe leather budget shrank dramatically after I left the Boston Globe. When that book is done, it will assign a prominent position to Alan Krueger.
David Warsh, a veteran political and economics columnist, is an economic historian and proprietor of economicprincipals.com, where this essay first ran. He is based in Somerville.
Cooperating trees
“Woolroot (driftwood, cooper, wool and oil pastel), by Leslie Wilcox, in her show “Enrootables,’’ at Boston Sculptors Gallery, April 3-May 5.
The gallery says:
“Inspired by evidence of trees’ underground social network known as the
‘wood wide web,’ Wilcox shrouds sea-distressed deadwood
with twisted metal screening to explore earthbound similarities and shared connections between
human forms and life-sustaining, mutually communicative arboreal forests.
Supplanting human bones with driftwood tree roots, Wilcox creates organic skeletal forms tightly
encased in copper and bronze screens, referencing bark or sapwood or skin. ‘Enrootables’ cultivates a
glimpse beneath the forest floor to reveal shared alliances through communication and care among
multiple species. And while mimicking our own modern behavior, themes of cooperation for mutual
benefit are discovered, including human dependence on trees’ filtration of carbon dioxide. Evidence of
trees living among their parents, siblings and offspring growing twice as tall and living twice as long
fosters this transfer of knowledge and expertise to future generations, thus safeguarding the existence
of thriving forest biospheres. Can what we learn from these strategies ensure the same for the future of
humankind? (Companion reading: The Hidden Life of Trees, by Peter Wohlleben).’’