The Strange Tale of Pregnancy and Heredity: Chimerism

The term chimera is derived from classical Greek mythology in which there was a beast containing a body made up of parts of three different animals.  The term chimera has come to be used to refer to any animal that consists of parts from more than one animal.  This seemingly bizarre occurrence turns out to be rather common in nature with we humans being no exception.  This recently discovered fact is only one of the many revelations provided by Carl Zimmer in his fascinating book She Has Her Mother's Laugh: The Powers, Perversions, and Potential of Heredity.

Zimmer tells the story of a woman from Washington state, Lydia Fairchild, who in 2003 filed for welfare benefits.  She had three children and was pregnant with a fourth.  She was required to have a DNA test to verify that she was the mother of her children.  The test results indicated that her husband was the father of her children, but she was not the mother.  The state officials suspected that she was guilty of at least welfare fraud if not of having kidnapped the children.  She was being threatened with the loss of her children and jail time.  None of her records or personal references helped because the DNA test was deemed infallible.  When she delivered her fourth child the state sent a witness to observe the event and to get a DNA sample from the child.  Again, the DNA results indicated that Lydia could not be the child’s mother.  Even though a state witness observed the birth, the DNA tests were still treated as being incontrovertible.

Fortunately for Lydia, her legal representation heard about a similar case in Boston where a woman named Karen Keegan needed a kidney transplant and had her three sons and husband tested for acceptability as donors.  The DNA studies indicated that her husband was the father of the sons, but she couldn’t possibly be the mother of two of them.  Again, she was suspected of foul play, but this time the doctors involved decided to look further for an explanation.  They acquired as many tissue examples from Karen as they could and discovered that her organs contained two separate pedigrees, as if she had been the product of two separate fertilized eggs instead of one.  Both Karen and Lydia are what would come to be known as a tetragametic chimera. 

In pregnancy, more than one egg can be fertilized at a time.  If two are fertilized they would normally develop into fraternal twins.  In some cases, the two fertilized eggs can merge very early in development.  If the embryos are of the same sex, the merger is difficult to recognize, if of different genders, the sexual development can be abnormal.

“Tetragametic twins start out as two embryos with separate genomes, and then merge entirely.  Only one child is born, and there is no other human being to point to.  All we can do is trace their intimately mingled cell lineages to their separate sources.”

Consider Karen Keegan’s development.

“The cells of one twin gave rise to all her blood.  They also helped to give rise to other tissues, as well as some of her eggs.  One of her sons developed from an egg that belonged to the same cell lineage as her blood.  Her other two children developed from eggs belonging to the lineage that arose from the other twin.”

This form of chimerism is rare, but common enough that physicians now know to consider it when genetic anomalies appear.  It is rather astonishing that a single person can essentially be constructed from two different people and continue to function normally.  Isn’t our immune system designed to attack cells that are not our own?  How does it deal with two classes of cells?

We now know that there is much more common form of chimerism that can occur during pregnancy that does not require the merging of embryos.  Embryos develop in the placenta.  There is a barrier that can transmit nutrients and other molecules from the mother’s blood to support the embryo’s development.  But there is supposed to be no transmission of cells.  Over a century ago it was discovered that transmission of cells could occur, but it was not until the 1960s that it became clear that this transmission was a common occurrence during pregnancy.  It would take another thirty years before it was realized that these cells, transmitted in both directions, mother to embryo and embryo to mother, could live for a very long time and could become an active participant in bodily functions.  This form of chimerism came to be called microchimerism. 

“Their research has revealed that all pregnant women have fetal cells in their bloodstream at thirty-six weeks.  After birth, the fraction drops, but up to half of mothers still carry fetal cells in their blood decades after carrying their children.”

“Very often, a mother’s cells will infiltrate their children’s bodies, where they can endure and grow long after her death.  According to one estimate, 42 percent of children end up with cells from their mothers.”

It gets even more complicated when a mother has multiple pregnancies.  Cells from a son who was born can then be transferred from the mother to a subsequent daughter.  One study detected this occurrence, and it was not particularly rare.  Males have an X chromosome and a Y chromosome.  Females have two X chromosomes instead.  Women should not have any Y chromosomes in their bodies.  If they do, it is evidence of a transfer that occurred from another human entity.

“At the University of Copenhagen, scientists got blood samples from 154 girls ranging in age from ten to fifteen.  They cracked open the cells in the blood and searched them for Y chromosomes.  In 2016 they reported that twenty-one girls—more than thirteen percent—had them.”

Searching for Y chromosomes in women is a simple way to determine how long these cells persist.

“Lee Nelson, a rheumatologist at the Fred Hutchinson Cancer Research Center, and her colleagues examined the cadavers of fifty-nine women who died, on average, in their seventies.  In 63 percent of the women, the scientists found Y chromosomes in their brains.”

Zimmer also notes that given this propensity for microchimerism, the practice of utilizing a surrogate mother to carry a couple’s child is no longer as simple as it once seemed.  The surrogate can inherit cells from the fetus and the fetus may no longer become the genetically simple child that the parents assume.

Given that this form of chimerism is so common and that it can persist indefinitely, what might its effects be?  It is known that women are more susceptible to autoimmune diseases.  Could this be because females, as mothers, will generally be subjected to higher concentrations of foreign cells than a male who will only encounter them once?  Once again, scientists looked for evidence of Y chromosomes in females suffering from the autoimmune skin disease scleroderma.

“Nelson and Bianchi found that women with scleroderma had far more fetal cells from their sons than did the healthy women.  Other scientists who carried out similar studies got the same results for a number of other diseases.  These findings aren’t definitive proof that microchimerism made these women sick, however.  It was also possible that the diseases came first, and the fetal cells only later flocked to the diseased tissues where they could multiply.”

And then there are these observations which suggest that having these fetal cells acquired in pregnancy can be beneficial.

“In another woman, Bianchi discovered that an entire lob of her liver was made up of Y-chromosome bearing cells.  Bianchi was even able to trace the paternity of the cells to the woman’s boyfriend.  She had had an abortion years before, but some of the cells from the fetus still remained inside her.  When her liver was damaged later by hepatitis C, Bianchi’s research suggested, her son’s cells rebuilt it.”

“It is also possible that fetal cells help mothers fight cancer.  In 2013, Peter Geck of Tufts University and his colleagues looked for cells with Y chromosomes in the breast tissue from 114 women who died of breast cancer and 68 women who died of other causes.  Fifty-six percent of the healthy samples had male fetal cells in them.  Only twenty percent of the cancerous tissue had them.  Geck speculated that fetal cells swooped into the niches of breast tissue that are good for proliferating cells.  Those may be the same niches cancer cells need to find in order to grow into tumors.”

What is startling about this topic is that this notion of humans as chimera is so new, and the knowledge about the consequences of this phenomenon is so inadequate.  Who knows what else we might yet learn about ourselves?  Occasionally, we hear of “miracles” occurring where no medical explanation is possible.  Perhaps they are not so much miracles as indications that the human body is still too complicated for us to understand.

The interested reader may find informative the following articles based on information found in Zimmer’s book:

Internal Heredity and Mary Lyon’s Contribution: A Female Advantage?

Intelligence and Heredity: Nurturing Our Children Is Critical

Wealth, Intelligence, and Longevity: Is Intelligence the Key Factor?

Genetic Inheritance of Height: Can We Understand It?

Average Height as an Indicator of National Social Success

Bad Science Has Consequences: Eugenics and Emma Wolverton’s Story

Democrats Push Legislation to Improve Social Security: The Social Security 2100 Act

The recovery of the control of the House after years out of power, and the disgust with the Republicans under Trump, seem to have invigorated the Democrats and encouraged them to pursue some of their fondest social goals.  At the top of their list has to be shoring up the healthcare system which Trump has been trying to weaken over the past two years.  Regenerating a healthier version of Obamacare is a priority, but if Medicare is ever going to be put on a sound financial basis it must capture revenue and the associated savings from providing a Medicare-for-all type program.  Next on the list is to recognize that the current Social Security System plus private retirement savings is just not cutting it when it comes to providing financial security in retirement.  As private retirement pensions disappear, and reliance on personnel savings plans has been demonstrated to be inadequate, some sort of enhanced federal system is required.  The Democrats seem to be taking a baby step in that direction with what is being called the Social Security 2100 Act.

The purpose of this legislation is both to upgrade the coverage of the current Social Security system and to place it on a sound financial footing.  Young people today should no longer have to listen to the lies coming from the right claiming that Social Security will not be there for them when they come to retirement age.  Robert Pear produced an article for the New York Times, Democrats Push Plan to Increase Social Security Benefits and Solvency, that describes the legislation.  The Democrats have actually come up with a bold plan that dismisses the notion that benefits must be decreased to save money and replaces that with an expansion of benefits paid for with a modest increase in taxes for all wage earners, and a significant increase for those with wage incomes over $400,000 per year. 

“The bill would provide an across-the-board benefit increase equivalent to about 2 percent of the average Social Security benefit. It would raise the annual cost-of-living adjustment to reflect the fact that older Americans tend to use more of some services like health care. And it would increase the minimum benefit to ensure that workers with many years of low earnings do not retire into poverty.”

Those with the lowest pre-retirement earnings, who depend the most on Social Security for their retirement income, receive the biggest benefit gains.  A provision would raise the income level above which Social Security benefits are taxable providing tax relief to lower income retirees.  All earners and employers will experience a gradually increasing payroll tax.  The most significant feature is imposing payroll taxes on those earning $400,000 or more annually.  They would face the tax on earnings up to a current value of $132,900, then no payroll tax until reaching the $400,000 number at which point one-half the payroll tax, currently valued at 6.2% but increasing to 7.4% in 2043, would be applied.  Employers would also pay that amount.  This is a significant tax on the wealthy, but rather than a straight income tax, the wealthy would regain much of their contributions in retirement income just like everyone else.

 “’Our bill, supported by more than 200 members of the House, would enhance and expand the nation’s most successful insurance program, which touches the lives of every American,’ said Representative John B. Larson, Democrat of Connecticut and the principal author of the legislation.”

“Mr. Larson, the chairman of the Ways and Means Subcommittee on Social Security, said he would hold hearings and forums around the country on the legislation.”

Action, as proposed in this bill, is clearly needed.

“Nonpartisan actuaries at the Social Security Administration say that the program will soon be spending more than it takes in and that the trust funds for retirement and disability benefits will be depleted by 2034 if Congress makes no changes.”

“By contrast, under Mr. Larson’s bill, Social Security would be solvent — ‘able to pay all scheduled benefits in full on a timely basis’ — for 75 years, and after that its financial condition would be improving, according to projections by Stephen C. Goss, the chief actuary of Social Security.”

“Of all the money raised by the bill, about one-fourth would be used to increase benefits, and the rest would cover projected deficits in the Social Security trust over the next 75 years.”

Of all the possible tax-raising proposals, this one should be the least noxious to the general public.  With Democrats in the majority in the House, it would stand a good chance of passing there.  With Republicans in charge of the Senate, its prospect there would be less sanguine, but if the public gets behind it, opposition could become difficult with another election in the offing, one where many Republican seats are on the ballot.

“The Congressional Budget Office injected a note of fiscal reality into the debates this past week. Assuming no change in existing law, it estimated that the budget deficit, $779 billion last year, would exceed $1 trillion every year from 2022 to 2029.”

“It forecast remarkable growth in federal spending dedicated to people 65 or older. By 2029, it said, such spending, which includes Social Security, Medicare and Medicaid, will account for 50 percent of all federal spending aside from interest payments on federal debt. That represent a substantial increase from 35 percent in 2005 and 40 percent last year.”

Fixing Social Security is only one part of the problem, the easier part.  Still to be done would be reining in medical expenditures, about one half of which are paid by the government.  The best way to do this is by incorporating Medicare and Medicaid into a single payer plan that couples their cost savings with a majority of younger, healthier people who will pay into it but require less medical care.  Medicare-for-all plans fit that prescription.  Let’s start the conversation on both initiatives and find a way to make them work.

The interested reader might find the following articles informative:

What Medicare for All Could Mean for the United States

Moving to a National Retirement Plan

Airbnb Economics: The Good and the Bad

Airbnb is one of the most successful of the tech platforms that allow participants to earn money providing a service to others.  Like many tech companies, it grabbed a place in the economy by the strategy of breaking rules and ignoring laws, claiming it was something new and beneficial to society, so it deserved special treatment. The service in Airbnb’s case is the provision of one’s residence for short-term use.  Typically, a visitor to a location will bypass commercial lodging for a better bargain by renting a person’s dwelling for a few days.  Airbnb facilitates these types of transactions.  It has become a world-wide player, raising many questions about its social consequences in the areas in which it operates.  A study produced by Josh Bivens for the Economic Policy Institute addresses these concerns.  It was titled The economic costs and benefits of Airbnb.

Bevin concedes that both sides in the financial transaction can benefit economically.  The provider of the lodging earns extra money, while the traveler can save money on lodging costs by getting a lower price than available commercially.  His major issues are with the external costs imposed on society as a whole by these transactions. 

One tends to think of a financially stressed person earning a few extra dollars to help with the bills, but the popularity of the model has led many to create a perversion of this concept.  If an individual can earn money this way, then those who have the wealth to control a number of dwellings can earn even more money.  Airbnb is becoming less a tool for the financially needy and more a vehicle for the wealthy to generate income and often avoid the fees and taxes associated with what, for them, is a commercial business.

“…many Airbnb listings are actually owned by households with multiple units to rent… any economic occurrence that provides benefits proportional to owning property is one that will grant these benefits disproportionately to the wealthy…”

People who possess multiple dwelling units are best able to utilize the Airbnb platform, but in so doing, they are removing units from the general housing market and helping drive up housing costs for everyone.  Studies have documented this effect in major cities.  Saving money on travel costs, which are a small share of people’s expenses, is not a wise investment if at the same time housing costs, which are a major fraction of household expenditure, are being driven upward.

Studies indicate that Airbnb does not generate additional visitors to the communities in which it operates.  There is no net new business generated, but the diversion from commercial lodgings to Airbnb weakens those entities as payers of taxes and fees, and providers of employment.  Any loss of tax revenue will usually be felt by the neediest within society first.  If not properly regulated and taxed, Airbnb becomes yet another vehicle by which funds are taken from the poor and passed on to the wealthy.

Airbnb also provides a mechanism for negating zoning laws that prohibit commercial enterprises in residential areas.  Those regulations were generated to protect the property values and lifestyle of the residents.  Any degradation in neighborhood conditions from short-term rentals to people who have no commitment to preservation of the ambient lifestyle could cause diminished property values.

“When owners do not reside in their residential property, this can lead to externalities imposed on the property’s neighbors. If absentee owners, for example, do not face the cost of noise or stress on the neighborhood’s infrastructure (capacity for garbage pickup, for example), then they will have less incentive to make sure that their renters are respectful of neighbors or to prevent an excessive number of people from occupying their property.”

“In cities where the spread of Airbnb has become a political issue, hundreds (if not thousands) of complaints have been made in this regard.”

Bevins provides these summary comments.

“The current policy debates sparked by the rise of Airbnb have largely concerned tax collections and the emergence of ‘mini hotels’ in residential neighborhoods. At its inception, Airbnb advertised itself as a way for homeowners (or long-term renters) to rent out a room in their primary residence, or as a way for people to rent out their dwellings for short periods while they themselves are traveling. However, in recent years Airbnb listings and revenues have become dominated by ‘multi-unit’ renters—absentee property owners with multiple dwellings who are essentially running small-scale lodging companies on an ongoing basis.”

“This evolution of Airbnb into a parallel hotel industry raises questions about the preferential treatment afforded to this rental company. These questions include, ‘Why isn’t Airbnb required to ensure that lodging taxes are collected, as traditional hotels are?’ And, ‘Why is Airbnb allowed to offer short-term rentals in residential neighborhoods that are not zoned for these uses, while traditional hotels are not allowed in these same neighborhoods?’”

His conclusion is that there is nothing “special” about Airbnb.

“No reason for local policymakers to let Airbnb bypass tax or regulatory obligations.”

Uber and the Gig Economy: How Many Are Earning How Much?

Uber is the most prominent member of a group of companies that offer opportunities for people to earn money by contracting (often quite informally) to perform tasks for a given price.  In Uber’s case, drivers use their own vehicle to drive passengers from one location to the other.  Uber provides the platform that connects the driver and passenger, collects a fee for this service, and manages the payment process.  The drivers are considered independent contractors (thus far) and are responsible for meeting their expenses of doing business including tax requirements and providing any benefits, such as healthcare, that may be required.  This is a common situation for those in the gig economy.

Many, particularly those involved in providing such platforms, think of this as a job creating environment in which workers benefit from controlling their schedules and work habits.  Critics denounce such arrangements as converting full-time work into day-labor jobs in which workers collaborate with businesses in order to perform tasks for as little pay as possible.  Uber, as a provider of employment, has been studied by many academics, but the results have been confused by differing assumptions about compensation and expenses for its drivers.  Lawrence Mishel has attempted to put all the various studies on the same basis in order to eliminate the disparities.  His work was published by the Economic Policy Institute as Uber and the labor market: Uber drivers’compensation, wages, and the scale of Uber and the gig economy.

Mishel provides a detailed analysis of the compensation issues for Uber drivers.  Here, only his conclusions are presented.  Uber begins by taking about a third of the charges paid by the customer to cover the service it has provided the driver.  The actual cost of the service is determined by Uber.

“Uber driver compensation—the income drivers get after deducting Uber fees and driver vehicle expenses from passenger fares—averages $11.77 an hour. This average Uber driver hourly compensation is substantially less than the $32.06 average hourly compensation of private-sector workers and less than the $14.99 average hourly compensation of workers in the lowest-paid major occupation (service occupation workers).”

The figure of $11.77 per hour does not include payroll taxes (Social Security and Medicare) that the driver is required to pay, nor does it include the expense of any benefits such as healthcare.  After payroll taxes are deducted the figure falls to $10.87.

“Uber driver “discretionary compensation”—the income drivers get after deducting Uber fees and vehicle expenses and the mandatory extra Social Security/Medicare taxes that self-employed drivers must pay—averages $10.87 an hour.”

Mishel further estimates a wage that is comparable to those of traditional workers who usually receive at least some benefits from their employer.

“The Uber driver “wage”—comparable to the wages (reported for employees on federal tax Form W-2) earned by regular W-2 employees—averages $9.21 an hour. (We calculate this W-2 equivalent wage by deducting the following in order, from passenger payments: all Uber fees, such as booking fees and commissions; vehicle expenses; and the cost of a modest benefits package, including mandatory employer-side payroll taxes. Our estimate also takes into account expense and benefit interactions with the federal tax code).”

The net wage to compare with other types of employment then drops to $9.21 per hour.

“The Uber driver W-2 equivalent hourly wage is roughly at the 10th percentile of all wage and salary workers’ wages, meaning Uber drivers earn less than what 90 percent of workers earn. The Uber driver W-2 equivalent hourly wage falls below the mandated minimum wage in the majority of major Uber urban markets…”

Given these results, Uber, as a representative of the gig economy, is not promising as a creator of jobs.  Who needs a technology that produces minimum wage or below jobs?  But is Uber actually creating jobs, or is it merely a platform by which those with an income can add to it by working additional hours for Uber?

“Uber drivers have high turnover and, on average, work only part of the year (an average of three months) and part time (an average of 17 hours per week).”

Converting Uber drivers’ participation in the economy to a full-time equivalent (an FTE, 40 hours per week for a full year), Mishel finds that Uber activity is a tiny part of the overall employment figure.  He also takes Uber’s estimated two-thirds share of the gig economy and concludes that the entire gig economy is also tiny both in terms of employment and economic activity.

“There are about 833,000 Uber driver participants in a year. If one weights participants by their weeks worked and their weekly hours, then Uber drivers amount to 90,521 full-time, full-year equivalent (FTE) workers and account for just 0.07 percent of national FTE employment. We scale this proportion by Uber’s two-thirds share of the gig economy (according to research by Seth Harris of Cornell University and Alan Krueger of Princeton University) and find that the entire gig economy—online platform employment—accounts for just 0.1 percent of national FTE employment. Uber and the entire gig economy are not a significant portion of the national economy despite several years of rapid growth.”

“Uber drivers’ aggregate compensation, based on total hours worked and hourly compensation, is roughly $5.0 billion, or 0.022 percent of aggregate national compensation (one-fifth of 0.1 percent). Adjusting for Uber’s two-thirds share of the gig economy, we find that the total compensation for the entire gig economy—online platform employment—accounts for just 0.034 percent of total national compensation.”

While Uber is big enough to generate disruption in the traditional taxi market, it and its siblings don’t seem to be heralding a revolution in the economics of employment.

Modern Labor Activism

Much has been written about the decline of the labor movement in the United States.  The notion of a “labor movement” is usually associated with the existence of labor unions.  The number of union workers operating in the public domain is still significant, but union representation in the private sector has been falling for decades and is increasingly rare.  The public/private diversion is partly due to the hostility towards unions by private corporations, and partly to changes in employment conditions as the economy has evolved.  Most pundits would predict that this decline will continue into the indefinite future.

Unions once had the power to create work standards that would become national in scope.  The fact that they could negotiate higher wages, better working conditions, and job security forced nonunion companies to elevate their compensation for employees when unions were common.  Now, the fact that the few workers covered by unions enjoy better employment conditions is a cause for dismay by others who view them as coddled workers who earn more without having to work very hard.  Does this mean that unions are a dying concept and that labor activism is dying also?  Janet Paskin provided an article for Bloomberg Businessweek, The Resurrection of American Labor in the online version, that suggests that there might still be some life left in the domain of worker activism.

She points out that the number of strikes by workers in 2017 was a mere eight.  Against all odds, that number increased to 20 in 2018.  Unhappy employees had found new ways to apply leverage to their employers and get what they wanted.

“Aggrieved workers, however, took matters into their own hands, using social media and other tech tools to enhance their campaigns. From industry walkouts to wildcat teachers’ strikes, they made very public demands of their employers. The official number of major work stoppages recorded by the BLS [Bureau of Labor Statistics] in 2018 nearly tripled, to 20. Off the picket line, workers also won a wide range of concessions. Facing employee pressure, Google and McKinsey &Co. dropped contracts for government work employees found objectionable; thousands of dismissed Toys “R” Us workers got a severance fund; and Starbucks Corp.  expanded parental and sick leave policies.”

Traditional forms of worker empowerment may be fading away, but unhappy employees will be with us forever.

“’Workers aren’t waiting for the traditional forms of organizing, as provided under labor law,’ says Tom Kochan, co-director of the MIT Sloan Institute for Work and Employment Research. ‘They’re looking for new options, whether that’s Google employees on a one-day walkout or workers filing online petitions with their management about everything from scheduling to fringe benefits’.”

Kochan has been studying workers and their feelings about their terms of employment since the 1970s.

“At the beginning of his career, about one-quarter of workers were represented by a union and another third, according to a national Quality of Employment Survey, said they’d join one if they had an opportunity. The next time the question was fielded, in the mid-’90s, workers’ interest in joining a union had barely budged.”

“Kochan and his colleagues put the question to almost 4,000 workers in 2017. The results: Almost 2 out of 3 said they had less of a voice than they felt they deserved, and nearly half said they’d like the opportunity to join a union. ‘That doesn’t mean they want an actual union in the traditional sense,’ Kochan says. ‘It’s more of an expression that they’re looking for some form of voice, a desire for real influence’.”

Employees have discovered that social media tools can be very efficient at gathering supporters for initiatives and for propagating concerns and demands.

“Historically, only unions could provide the cohesiveness and leverage workers needed to speak as a group. Now workers have Facebook and Twitter, both to talk among themselves and to make their case to their employers in a potentially embarrassing way. Technology has given rise to a new set of tools—targeted ads to reach disillusioned workers, text blasts to engage them, online petitions to make demands clear.”

Specialized tools have also been developed to assist workers who feel they need to organize in order to correct some wrong.

“Around the same time, a pair of tech-savvy activists with labor roots, Michelle Miller and Jess Kutch, launched Coworker.org, which creates networks of employees and provides them with tools so they can push for pretty much anything they feel would improve their working lives.”

“Some 230 new worker groups have sprung up in the past decade, forming the backbone of what’s come to be called alt.labor. Among them, Organization United for Respect, known as OUR, has become expert at uniting workers through technology. Spun out of a movement by Walmart workers to petition the country’s biggest employer for change after several traditional union drives failed, the group has broadened its mandate to include all low-wage workers, particularly in retail.”

Paskin provides several examples where this kind of specific issue campaigning has paid off.  Consider former employees of Toys “R” Us and their accomplishment.

“When Toys “R” Us, preparing for liquidation, said it wouldn’t pay severance to more than 30,000 employees, OUR organizers stepped in. They ran online ads to reach workers, connecting them first with a peer-to-peer texting tool, then one-on-one phone calls, then committee calls. The workers gathered in Facebook groups to commiserate, share strategies, and organize demonstrations online and in real life. Eventually, KKR and Bain Capital, the company’s private equity owners, agreed to put up $20 million for ex-employees—short of the $75 million workers say they’re owed but a concession the firms weren’t legally obliged to make. OUR is now putting Sears Holdings Corp. employees in touch with Toys “R” Us workers who can preach the power of collective action.”

Paskin suggests that events of recent years have generated a surge in activism related to political and social issues that will encourage a continued focus on work issues as well.

“Beyond the growing number of union alternatives, demonstrations by employees are part of a rise in political activity overall. The years since the 2016 election have witnessed the largest protests in U.S. history, inspiring a lot of people—particularly college-educated twentysomethings—to demonstrate for the first time. And while a Black Lives Matter protest or a Women’s March on Washington may seem unrelated to work, they can inspire people to speak out for other causes.”

Unions are encouraging these new forms of worker activism as a means of achieving their traditional goals and as a way of demonstrating the effectiveness of collective action.

“Unions continue to make the case for their relevance—and have been reinvigorated by all the nontraditional labor activism. At least 18 states raised the minimum wage, a victory for the union-backed ‘Fight for $15.’ Similarly, after popular upswells, at least three more states and three more cities added paid sick time laws—reforms usually advocated by unions.”

Developing a notion that collective action can be an effective means of righting a wrong, especially if the younger people become activated, has to be a good thing for our society.  Stagnation and political standoff seem to be the order of the day.  We need activism to generate progress in dealing with the problems we face.  The young should be the ones to provide the numbers and the energy to generate motion because they will be the ones who will suffer the most from the lack of progress.

On the Chaos of Brexit: What the US Should Note

The dysfunction of the UK government as it struggles to come to some decision as to how to proceed given the upcoming deadline for European Union exit is readily apparent.  Hari Kunzru provides an article in the New York Review of Books that discusses the reasons why the nation placed itself in such dire straits.  It is titled Fool Britannia and was generated as a review of a book by Fintan O’Toole: Heroic Failure: Brexit and the Politics of Pain.  What emerges from Kunzru’s piece for the reader in the United States is that we are only slightly less dysfunctional than the UK, and the reasons for our problems are quite similar.

The US has its blue states and red states, and all 50 have differing views on social and political issues.  The United Kingdom is not nearly as united as it might appear to the casual observer.  It is dominated by England in terms of size and population, but it includes Wales, Scotland, and Northern Ireland, all of which have historical and cultural differences with England.  It is the border shared by Northern Ireland and the nation of Ireland that produces the major sticking point between the UK and EU.  How can one maintain a free and open land border between the two entities and at the same time accommodate two different sets of regulations on trade with other nations?  That issue could, and probably should, torpedo Brexit entirely.  The US has similar problems with, for example, red states and blue states moving in different directions on the regulations of firearms and environmental issues. Will open borders between states be maintained, or will we need border checkpoints for detecting the transport of illegal weapons?

The US, with its centuries of slavery and Jim Crow regulations, continues to struggle with racial issues.  African Americans still must deal with forms of discrimination that complicate their lives.  The Hispanic population has grown considerably in recent generations with that growth being augmented by undocumented immigrants who penetrated the border or have overstayed a visa.  More recently, refugees from both Central America and the Middle East have been added to the flow and caused considerable political strife.  The analogous situation in the UK involves its history as a colonial power.  The British Empire became the British Commonwealth and allowed many natives of former colonies to obtain residency in the UK.  Joining the EU required the UK to welcome residents of other EU countries, a growth of foreigners analogous to workers leaking through the US border.  Finally, the UK was faced with accommodating the more generous EU treatment of the many refugees pouring out of the Middle East.  It was issues related to the growing multicultural nature of society that contributed to Brexit and the election of Donald Trump.

Kunzru provides this perspective on race in the UK.

“In Tinker Tailor Soldier Spy, one of a body of thrillers that are also among the most acute literary portrayals of the British establishment’s experience of postwar decline, John Le Carré’s hero, George Smiley, goes to see Connie Sachs, a motherly drunk who was once a secret service librarian and is now a repository of institutional secrets. ‘Poor Loves,’ she says of George and his colleagues, her ‘boys.’ ‘Trained to Empire, trained to rule the waves. All gone. All taken away. Bye-bye, world.’ Many of those who took it away were, of course, foreigners, particularly those former colonial subjects who unaccountably agitated for decolonization. Their arrival ‘over here’ was one of the most visible changes to postwar Britain, and as O’Toole points out, the rhetoric—'swamping,’ being a stranger in one’s own country, strain on public services, and so on—that was once used to demonize new arrivals from the Commonwealth has been repurposed for use on EU migrants. O’Toole argues provocatively that the decline of what might be called traditional British racism made room for a new anti-Europeanism, as if there’s a fixed national quantum of xenophobia that must find an object if the United Kingdom is to maintain its integrity.”

An important aspect of support for Brexit comes from conservatives who resent the decline in influence and power of what was once the mighty British Empire.  Brexit is an attempt by many to “Make England Great Again” (MEGA?).  Note the use of England rather than Britain or the United Kingdom.  Kunzru makes it clear that it is England that is driving Brexit.  Analogous to the situation in the US, there is also a rural/urban divide in England.  London dominates England and its economy, and it is tightly coupled to the EU.  It was the non-urban rural voters who carried the day for both Brexit and Trump.

Both the US and the English think of themselves as “exceptional” nations with a history and culture that sets them apart and makes them superior to other nations.  Kunzru tells the reader that England is beset by a “deep sense of grievance and a high sense of superiority,” a description that fits well the diehard supporters Trump has generated.  When the decision to join the EU was made, many thought the English would rise to their natural role as rulers of the union.

“For many commentators writing at the time of Britain’s entry into the Common Market in 1973, dominance in Europe was to be compensation for the loss of empire. ‘What about Prince Charles as Emperor?’ asked Nancy Mitford, facetiously expressing the secret belief of many British people that Europe could be a new vehicle for old global ambitions. The discovery that the role of ‘first among equals’ wasn’t on offer led to a loss of enthusiasm for Europeanism, which suddenly appeared in a different and sinister light, as a form of subordination to old enemies.”

Surprisingly, many Brits see themselves as having defeated the Germans in WWII only to lose the nation to them in peacetime.

“Though the Suez Crisis and imperial decline loom large in the imagination of Brexit, O’Toole writes that it’s ‘the war’ that is ‘crucial in structuring English feeling about the European Union.’ For half a century, English soccer fans have lamely taunted their more successful German counterparts by chanting that their country has won ‘two World Wars and one World Cup.’ Since the 1960s, comic books with names like Commando, Warlord, and Battle Picture Weekly have kept World War II alive in the minds of British boys with violent stories of ‘daring bomber raids over Germany, through close-combat jungle fighting against hard-as-nails Japanese, and depth-charge blasted submarine warfare, to hard-hitting battles across North Africa, Italy and northern Europe’.”

“Crucially, the equation of a ‘European superstate’ with a project of German domination is part of what O’Toole calls the ‘mental cartography’ of English conservatism. In 1989 Margaret Thatcher showed François Mitterand a map (taken out of her famous handbag) outlining German expansion under the Nazis, in order to demonstrate her misgivings about German reunification. On January 7 of this year, the pro-Remain Conservative MP Anna Soubry was forced to pause a live TV interview outside Parliament as protesters sang, ‘Soubry is a Nazi, Soubry is a Nazi la-la-la-la.’ The European Union is, to these people, just a stealthy way for the Germans to complete Hitler’s unfinished business.”

This sense of exceptionalism and superiority has even driven some to welcome a disastrous No Deal Brexit, which would generate shortages of many materials and significant economic disruption, as a means of regenerating the presumed more heroic British character of times past.

“On December 16, the former Brexit secretary Dominic Raab tweeted, ‘Remainers believe UK prosperity depends on its location, Brexiters believe UK prosperity depends on its character.’ Faith in Brexit does indeed seem to correlate with belief in the existence of national character, an innate and invariant set of shared qualities that apparently includes an aptitude for governance. On December 30 an editorial in London’s Sunday Times spluttered: ‘After more than four decades in the EU we are in danger of persuading ourselves that we have forgotten how to run the country by ourselves. A people who within living memory governed a quarter of the world’s land area and a fifth of its population is surely capable of governing itself without Brussels’.”

“The underside of nostalgia for an imperial past is a horror of finding the tables turned. For the more unhinged Brexiteers, leaving the EU takes on the character of a victorious army coming home with its spoils.”

The decline in importance of the UK as a nation produced a “deep sense of grievance and a high sense of superiority,” leading to the Brexit dilemma.  The US shares many of the characteristics, both historical and cultural, of the British.  As our influence and ability to dominate the world inevitably diminishes, we are also seeing arise a “deep sense of grievance and a high sense of superiority.”  Donald Trump feeds those emotions.  One can only hope that we will learn from the UK lesson to tame our ambitions and make them consistent with the changing world in which we live.  The US does not need an equivalent to the foolishness of Brexit in its future.

What Medicare for All Could Mean for the United States

The notion of a government medical plan option to compete with private plans arose during the discussion around formulating the Affordable Care Act (Obamacare).  At the time it seemed a stretch too far and was discarded.  Bernie Sanders pushed the issue again in the 2016 campaign, generated some backing for a government single payer plan, and in September 2017 formally proposed the Medicare for All Act of 2017 (S.1804).  Now that liberal Democratic candidates are gearing up their campaigns for president in 2020, the idea of Medicare for All is receiving serious attention, at least from some candidates.  Kamala Harris, for one, came out publicly in favor and immediately received blowback from conservatives who derisively claimed that it still is, and always will be, a step too far.  But is it?

Polling is said to indicate that liberal-leaning voters have moved more to the left then they were two years ago and much more than they were when Obamacare was constructed.  It seems Medicare for All will at least receive the consideration it deserves.  It is a way to provide adequate medical care to everyone, and it has the potential to deliver that care at a net lower cost.

A group at the University of Massachusetts at Amherst, the Political Economy Research Institute (PERI), analyzed the characteristics of the plan proposed by Sanders and produced Economic Analysis of Medicare for All.  If one follows the link to the article one gains access to 200 pages of analysis.  The study provided this summary.

“This study by PERI researchers Robert Pollin, James Heintz, Peter Arno, Jeannette Wicks-Lim and Michael Ash presents a comprehensive analysis of the prospects for a Medicare for All health care system in the United States. The most fundamental goals of Medicare for All are to significantly improve health care outcomes for everyone living in the United States while also establishing effective cost controls throughout the health care system. These two purposes are both achievable. As of 2017, the U.S. was spending about $3.24 trillion on personal health care—about 17 percent of total U.S. GDP.  Meanwhile, 9 percent of U.S. residents have no insurance and 26 percent are underinsured—they are unable to access needed care because of prohibitively high costs. Other high-income countries spend an average of about 40 percent less per person and produce better health outcomes. Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents.”

The report concludes that this is not a costly new federal program; rather, it is a means of expanding coverage while saving money. 

“Working from the relevant research literature, we estimate that, through implementation of Medicare for All, overall costs of providing full health care coverage to all U.S. residents could fall by about 19 percent in the first year of full operations relative to spending levels under the existing system. The most significant source of cost saving under Medicare for All will be a series of structural changes. These will be in the areas of: 1) administration (9.0 per­cent savings in total system costs); 2) pharmaceutical pricing (5.9 percent savings in system costs); and 3) establishing uniform Medicare rates for hospitals, physicians, and clinics (2.8 percent savings in system costs). We therefore estimate that these three areas of structural change under Medicare for All can achieve, overall, about 17.7 percent in total system cost savings relative to the existing U.S. health care system.”

The addition of service for uninsured and underinsured people is an added cost that brings the net savings down to about 10%.  As the study summary indicates, most advanced countries provide coverage-for-all that produces superior health outcomes than our system at about 40% less cost.  Given that, one should assume that even greater savings can eventually be sought.

Applying the Medicare throughout the healthcare system imposes standardized compensations for procedures covered under Medicare.  This should lower revenue per patient as part of the cost savings of the program.  The study suggests that the elimination of the administration burden of dealing with insurance companies will allow physicians to treat more patients in the same amount of time (and there will be more patients).  The study also assumes that lower pharmaceutical prices will be negotiated to bring costs more in line with those in other advanced countries.  Such savings are already being realized in Medicaid and the Veterans Administration.  Insurance companies should be the biggest losers because much of their current functionality will disappear, but they might also continue to play a role as providers of supplementary services not covered by the basic Medicare for All plan, much as they do now for Medicare Advantage Plans.  There will be many who will oppose changes of such magnitude.

The time might not yet have come for such a momentous transformation of our healthcare system, but the time has come to discuss the positives and negatives of such a move.  If we don’t begin serious discussion of the issues, change will never happen, and we will be forever burdened with overly expensive and dismally inefficient healthcare.