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Boris Johnson says UK 'past peak' of coronavirus outbreak as he promises 'comprehensive plan' on relaxing lockdown

PM makes declaration but UK sees second highest rise in cases in 24 hours, with 6,032 more




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New tell-all Harry and Meghan biography Finding Freedom promises 'unknown details' of couple's time together

A new biography of Harry and Meghan will "go beyond the headlines" and "reveal unknown details" of the couple's life together.




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Prime minister promises more pandemic aid to come from Ottawa

TORONTO - Justin Trudeau says there will be more support from the federal government to help certain sectors of the economy reeling from the impact of the COVID-19 pandemic. The prime minister made the promise yesterday, without getting into specifics, as he announced an extension to Ottawa's




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Coronavirus: Trudeau promises more COVID-19 aid to come from Ottawa

Justin Trudeau says there will be more support from the federal government to help certain sectors of the economy reeling from the impact of the COVID-19 pandemic.




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Prime minister promises more pandemic aid to come from Ottawa

Justin Trudeau says there will be more support from the federal government to help certain sectors of the economy reeling from the impact of the COVID-19 pandemic.




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The promise — and pitfalls — of antibody testing for COVID-19

In New York, the number of patients coming to the ER with COVID-19 symptoms has dropped and there is hope that the worst is behind us. As we look to the future, many of my colleagues on the frontline are eager to know if they have antibodies.





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Trump's pick for intel chief promises to keep politics out of coronavirus origins

Despite his reputation as a Trump loyalist, Rep. John Ratcliffe repeatedly pledged that he would, if confirmed as the next leader of the U.S. intelligence community, seek out and deliver the unvarnished truth on a range of national security issues.





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Brews Brothers review: What promised to be a quirky microbrew has come out as a flat lager

The tone of this half-hour comedy is part odd-couple, part hipster satire and part gross-out – but it stops short of taking any risks




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Fifa promises to fulfil £800m investment in women's football despite coronavirus pandemic

Fifa has promised to fulfil its planned investment in women's football despite the financial impact of the coronavirus pandemic.




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Manchester United duo Bruno Fernandes and Paul Pogba could be 'amazing together' with compromise, says Neville

Manchester United legend Gary Neville believes Paul Pogba and Bruno Fernandes have the potential to form an "amazing" midfield partnership if they are both willing to compromise.




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'No way food safety not compromised': US regulation rollbacks during Covid-19 criticised

Major pork plant closed after hundreds of workers contract coronavirus, while speeding up of poultry production lines raises concerns over standards

The US government is accelerating controversial regulatory rollbacks to speed up production at meat plants, as companies express growing alarm at the impact of Covid-19 on their operations.

Last week Smithfield shut down one of the largest pork plants in the country after hundreds of employees contracted the coronavirus. The plant in South Dakota – whose output represents 4–5% of US pork production – is reported to be the largest single-source coronavirus hotspot in the US, with more than 600 cases. In response, the company said it was “critical” for the meat industry to “continue to operate unabated”.

Now it has emerged that as a wave of plants announce closures, US meat plants are being granted permission to increase the speed of their production lines. This comes despite warnings that the waivers for higher speeds on slaughter and processing lines will compromise food safety.

Continue reading...




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The long, winding road to UFC 249 leads to a night that promises to be special

UFC 249, to take place Saturday in Jacksonville, Fla., without fans, will be perhaps the most unique pay-per-view event the promotion company has staged.




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The Lancet: New triple antiviral drug combination shows early promise for treating COVID-19 in phase 2 randomized trial

A two-week course of antiviral therapy with interferon beta-1b plus lopinavir-ritonavir and ribavirin, started within 7 days of showing COVID-19 symptoms, is safe and more effective at reducing the duration of viral shedding than lopinavir-ritonavir alone in patients with mild to moderate illness, according to the first randomized trial of this triple combination therapy involving 127 adults (aged 18 and older) from six public hospitals in Hong Kong.




omise

Ruby Princess preparing to leave as passengers promised full refund

The plans for the ship's departure come as Carnival Australia confirmed on Monday it would offer a full refund to guests on the cruise that returned to Sydney on March 19.




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Ruby Princess preparing to leave as passengers promised full refund

The plans for the ship's departure come as Carnival Australia confirmed on Monday it would offer a full refund to guests on the cruise that returned to Sydney on March 19.




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Markets surge on Fed's promise to act 'aggressively' to save a stalled economy

The ASX joins a global rally after the Federal Reserve says it will "aggressively" use its "full range of tools" to aid the recovery, as the US economy records its worst slump since the global financial crisis.




omise

Ruby Princess preparing to leave as passengers promised full refund

The plans for the ship's departure come as Carnival Australia confirmed on Monday it would offer a full refund to guests on the cruise that returned to Sydney on March 19.




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PM promises more pandemic aid to come from Ottawa

Prime Minister Justin Trudeau is addressing Canadians from outside his Rideau Cottage home, a day after announcing more support from the federal government is on its way to assist certain sectors of the economy hit by the COVID-19 pandemic.




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Gary Neville details Man Utd compromise Paul Pogba and Bruno Fernandes must make

Fernandes and Pogba are yet to feature in the same Man Utd side due to the Frenchman's rotten luck with injuries this season, but a partnership is on the horizon now he is back to full fitness




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Promise of T1D Vaccines; Can Bariatric Surgery Be Essential?

(MedPage Today) -- Researchers developed a potential vaccine for a certain type of virus infection that leads to an autoimmune attack, which may result in turn in part to the development of type 1 diabetes. "Our hope is that these trials will show...




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Too many 'shiny objects': Why it's risky to promise a coronavirus vaccine and cure

Coronavirus: There is a price to pay for pledging too much as the world anxiously awaits even a marginally effective therapeutic for the disease known as COVID-19.




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Rebiotix, Ferring's microbiome-based therapy RBX2660 shows promise

RBX2660 may bring an innovative therapeutic option to patients suffering from C. diff




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The promise of an Oxford vaccine reveals how a new Britain could thrive | Will Hutton

The partnership between AstraZeneca and the Jenner Institute should jolt our industry and banks


There was some good news last week. Oxford University’s Jenner Institute announced it was teaming up with AstraZeneca to take a promising prototype of coronavirus vaccine into volume production by the autumn. Of course there are caveats – the institute’s confidence in its vaccine may not be validated by the trials that began last week.

Still it was heartening, after so much tragic incompetence, that a British university and a British company could forge a relationship of such potential national importance.

The piping through which emergency credit must flow is atrophied and weak

Continue reading...




omise

Leading COVID-19 hope remdesivir fails to provide clinical benefit in first randomised trial

Gilead’s remdesivir, which has been hailed as one of the few truly promising treatments for COVID-19 at this early stage of the ongoing pandemic, has failed in its first randomised clinical trial, leaked data has revealed.




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Attorney General Eric Holder Speaks at the Robert F. Kennedy Children’s Action Corps / “Children of Promise” Premiere

"Throughout my life and career, I have seen the devastating effects that violence can have on young people. As Attorney General – and, above all, as the father of three teenage children – I am determined to help find the solutions – and to forge the partnerships – that we need to prevent and combat children’s exposure to violence."




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The Promise Of Precision Neuroscience And Launch Of Arkuda Therapeutics

Neuroscience has had a tough run of news lately. With Amgen deprioritizing neuro this year, Pfizer doing the same last year, and others like BMS, GSK, and AZ cutting back on CNS a few years earlier, it would seem dark

The post The Promise Of Precision Neuroscience And Launch Of Arkuda Therapeutics appeared first on LifeSciVC.




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New Study with Wellmune Shows Promise for Intestinal Barrier Function Improvements

A study demonstrated Wellmune® may protect intestinal barrier function in adults when faced with stress.




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Mice study: Faecal virus transplant shows promise in combating obesity and diabetes

Obese mice with unhealthy lifestyles gain significantly less weight and avoid type 2 diabetes when they receive bacteriophages from the faeces of a lean mouse, according to a new University of Copenhagen study.




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A single-centre investigator-blinded randomised parallel-group study protocol to investigate the influence of an acclimatisation appointment on children’s behaviour during N<sub>2</sub>O/O<sub>2</sub> sedation as measured by psycho




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Anti-obesity therapy with peripheral CB1 blockers: from promise to safe(?) practice




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Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

The Potential Promises and Pitfalls of Solar Geoengineering: An Interview with David Keith

Professor Robert Stavins interviews David Keith, Gordon McKay Professor of Applied Physics at the Harvard John A. Paulson School of Engineering and Applied Sciences, and Professor of Public Policy at Harvard Kennedy School, considered one of the world's leading scholars on solar geoengineering.




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Harvard Professor David Keith Discusses Potential Promises and Pitfalls of Solar Geoengineering in New Episode of "Environmental Insights"

David Keith, Gordon McKay Professor of Applied Physics at the Harvard John A. Paulson School of Engineering and Applied Sciences, and Professor of Public Policy at Harvard Kennedy School, discussed his groundbreaking research and policy work in the field of solar geoengineering in the newest episode of “Environmental Insights: Discussions on Policy and Practice from the Harvard Environmental Economics Program.” Listen to the interview here.




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




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Who says progressives and conservatives can’t compromise?


Americans often think of our country as being one of great opportunity – where anyone can rise from very modest circumstances, if they work hard and make good choices. We believe that often remains true.

But, for children and youth growing up in poverty, such upward mobility in America is too rare. Indeed, just 30 percent of those growing up in poverty make it to middle class or higher as adults. Though we’ve made progress in reducing poverty over the past several decades, our poverty rates are still too high and our rate of economic advancement for poor children has been stuck for decades. That is an embarrassment for a nation that prides itself on everyone having a shot at the American Dream.

What can we do to reduce poverty and increase economic mobility? In our polarized and poisoned political atmosphere, it is hard to reach consensus on policy efforts. Both progressives and conservatives want lower poverty; but progressives want more public spending programs to improve opportunity and security for the poor, while conservatives generally argue for more responsibility from them before providing more help.

Even so, progressives and conservatives might not be as far apart as these stereotypes suggest. The two of us—one a conservative Republican and the other a progressive Democrat—were recently part of an ideologically balanced group of 15 scholars brought together by the American Enterprise Institute and the Brookings Institution. Our charge was to generate a report with policy proposals to reduce poverty and increase upward mobility. An additional goal was simply to see whether we could arrive at consensus among ourselves, and bridge the ideological divide that has so paralyzed our political leaders.

Together we decided that the most important issues facing poor Americans and their children are family, education and work. We had to listen to each other’s perspectives on these issues, and be open to others’ truths. We also agreed to be mindful of the research evidence on these topics. In the end, we managed to generate a set of policy proposals we all find compelling.

To begin with, the progressives among us had to acknowledge that marriage is a positive family outcome that reduces poverty and raises upward mobility in America. The evidence is clear: stable two-parent families have positive impacts on children’s success, and in America marriage is the strongest predictor of such stability. Therefore marriage should be promoted as the norm in America, along with responsible and delayed child-bearing.

At the same time, the conservatives among us had to acknowledge that investing more resources in the skills and employability of poor adults and children is crucial if we want them to have higher incomes over time. Indeed, stable families are hard to maintain when the parents – including both the custodial mothers and the (often) non-custodial fathers – struggle to maintain employment and earn enough to support their families. Investing in proven, cost-effective, education and training programs such as high-quality preschool and training for jobs in high-growth economic sectors can improve the skills and employability of kids from poor families and lift them out of poverty through work.

Another important compromise was that progressives acknowledged that expecting and even requiring adults on public assistance to work can reduce poverty, as we learned in the 1990s from welfare reform; programs today like Disability Insurance, among others, need reforms to encourage more work. And reforms that encourage innovation and accountability would make our public education programs for the poor more effective at all levels. We need more choice in public K-12 education (through charter schools) and a stronger emphasis on developing and retaining effective teachers, while basing our state subsidies to higher education institutions more heavily on graduation rates, employment, and earnings of their graduates.

Conservatives also had to acknowledge that requiring the poor to work only makes sense when work is available to them. In periods or places with weak labor markets, we might need to create jobs for some by subsidizing their employment in either the private or public sector (as we did during the Great Recession). We agreed that no one should be dropped from the benefit rolls unless they have been offered a suitable work activity and rejected it. And we also need to “make work pay” for those who remain unskilled or can find only low-wage jobs – by expanding the Earned Income Tax Credit (especially for adults without custody of children) and modestly raising the minimum wage.

We also all agreed on other topics. For instance, work-based learning—in the form of paid apprenticeships and other models of high-quality career and technical education—can play an important role in raising both skills and work experience among poor youth and adults.  And, if we raise public spending for the poor, we need to pay for it—and not increase federal deficits. We all agree that reducing certain tax deductions for high-income families and making our retirement programs more progressive are good ways to finance our proposals.

As our report demonstrates, it is possible for progressives and conservatives to bridge their differences and reach compromises to generate a set of policies that will reduce poverty and improve upward mobility. Can Congress and the President do the same?

Editor's Note: this piece first appeared in Inside Sources.

Downloads

Publication: Inside Sources
      
 
 




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

Lebanon has formed a controversial new government in a polarised, charged atmosphere, and protesters are not going to be easily pacified by its promises, explains Rami Khoury.

The fourth consecutive month of Lebanon's unprecedented political and economic crisis kicked off this week with three dramatic developments that will interplay in the coming months to define the country's direction for years to come: Escalating protests on the streets, heightened security measures by an increasingly militarising state, and now, a new cabinet of controversial so-called "independent technocrats" led by Prime Minister-designate Hassan Diab.

Seeking to increase pressure on the political elite to act responsibly amid inaction vis-a-vis the slow collapse of the economy, the protesters had launched the fourth month of their protest movement, which had begun on 17 October last year, with a 'Week of Anger', stepping up their tactics and targeting banks and government institutions.




omise

What growing life expectancy gaps mean for the promise of Social Security


     
 
 




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CMMI's new Comprehensive Primary Care Plus: Its promise and missed opportunities


The Center for Medicare and Medicaid Innovation (CMMI, or “the Innovation Center”) recently announced an initiative called Comprehensive Primary Care Plus (CPC+). It evolved from the Comprehensive Primary Care (CPC) initiative, which began in 2012 and runs through the end of this year. Both initiatives are designed to promote and support primary care physicians in organizing their practices to deliver comprehensive primary care services. Comprehensive Primary Care Plus has some very promising components, but also misses some compelling opportunities to further advance payment for primary care services.

The earlier initiative, CPC, paid qualified primary care practices a monthly fee per Medicare beneficiary to support practices in making changes in the way they deliver care, centered on five comprehensive primary care functions: (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and, (5) planned care and population health. For all other care, regular fee-for-service (FFS) payment continued. The initiative was limited to seven regions where CMMI could reach agreements with key private insurers and the Medicaid program to pursue a parallel approach. The evaluation funded by CMMI found quality improvements and expenditure reductions, but savings did not cover the extra payments to practices.

Comprehensive Primary Care Plus uses the same strategy of conducting the experiment in regions where key payers are pursuing parallel efforts. In these regions, qualifying primary care practices can choose one of two tracks. Track 1 is very similar to CPC. The monthly care management fee per beneficiary remains the same, but an extra $2.50 is paid in advance, subject to refund to the government if a practice does not meet quality and utilization performance thresholds.

The Promise Of CPC+

Track 2, the more interesting part of the initiative, is for practices that are already capable of carrying out the primary care functions and are ready to increase their comprehensiveness. In addition to a higher monthly care management fee ($28), practices receive Comprehensive Primary Care Payments. These include a portion of the expected reimbursements for Evaluation and Management services, paid in advance, and reduced regular fee-for-service payments. Track 2 also includes larger rewards than does Track 1 for meeting performance thresholds.

The combination of larger per beneficiary monthly payments and lower payments for services is the most important part of the initiative. By blending capitation (monthly payments not tied to service volume) and FFS, this approach might achieve the best of both worlds.

Even when FFS payment rates are calibrated correctly (discussed below), the rates are pegged to the average costs across practices. But since a large part of practice cost is fixed, it means that the marginal cost of providing additional services is lower than the average cost, leading to incentives to increase volume under FFS. The lower payments reduce or eliminate these incentives. Fixed costs, which must also be covered, are addressed through the Comprehensive Primary Care Payments. By involving multiple payers, practices are put in a better position to pursue these changes.

An advantage of any program that increases payments to primary care practices is that it can partially compensate for a flaw in the relative value scale behind the Medicare physician fee schedule. This flaw leads to underpayment for primary care services. Although the initial relative value scale implemented in 1992 led to substantial redistribution in favor of evaluation and management services and to physicians who provide the bulk of them, a flawed update process has eroded these gains over the years to a substantial degree.

In response to legislation, the Centers for Medicare and Medicaid Services are working correct these problems, but progress is likely to come slowly. Higher payments for primary care practices through the CPC+ can help slow the degree to which physicians are leaving primary care until more fundamental fixes are made to the fee schedule. Indeed, years of interviews with private insurance executives have convinced us that concern about loss of the primary care physician workforce has been a key motivation for offering higher payment to primary care physicians in practices certified as patient centered medical homes.

Two Downsides

But there are two downsides to the CPC+.

One concerns the lack of incentives for primary care physicians to take steps to reduce costs for services beyond those delivered by their practices. These include referring their patients to efficient specialists and hospitals, as well as limiting hospital admissions. There are rewards in CPC+ for lower overall utilization by attributed beneficiaries and higher quality, but they are very small.

We had hoped that CMMI might have been inspired by the promising initiatives of CareFirst Blue Cross Blue Shield and the Arkansas Health Care Improvement initiative, which includes the Arkansas Medicaid program and Arkansas Blue Cross Blue Shield. Under those programs, primary care physicians are offered substantial bonuses for keeping spending for all services under trend for their panel of patients; there is no downside risk, which is understandable given the small percentage of spending accounted for by primary care. The private and public payers also support the primary care practices with care managers and with data on all of the services used by their patients and on the efficiency of providers they might refer to. These programs appear to be popular with physicians and have had promising early results.

The second downside concerns the inability of physicians participating in CPC+ to participate in accountable care organizations (ACOs). One of CMMI’s challenges in pursuing a wide variety of payment innovations is apportioning responsibility across the programs for beneficiaries who are attributed to multiple payment reforms. As an example, if a beneficiary attributed to an ACO has a knee replacement under one of Medicare’s a bundled payment initiatives, to avoid overpayment of shared savings, gains or losses are credited to the providers involved in the bundled payment and not to the ACO. As a result, ACOs are no longer rewarded for using certain tools to address overall spending, such as steering attributed beneficiaries to efficient providers for an episode of care or encouraging primary care physicians to increase the comprehensiveness of the care they deliver.

Keeping the physician participants in CPC+ out of ACOs altogether seems to be another step to undermine the potential of ACOs in favor of other payment approaches. This is not wise. The Innovation Center has appropriately not established a priority ranking for its various initiatives, but some of its actions have implicitly put ACOs at the bottom of the rankings. Recently, Mostashari, Kocher, and McClellan proposed addressing this issue by adding a CPC+ACO option to this initiative.

In an update to its FAQ published May 27, 2016 (after out blog was put into final form), CMMI eased its restriction somewhat by allowing up to 1,500 of the 5000 practices expected to participate in CPC+ to also participate in Medicare Shared Savings Program (MSSP) ACOs. But the prohibition continues to apply to Next Gen ACOs, the model that has created the most enthusiasm in the field. If demand for these positions in MSSP ACOs exceeds 1,500, a lottery will be held. This change is welcome but does not really address the issue of disadvantaging ACOs in situations where a beneficiary is attributed to two or more payment reform models. CMMI is sending a signal that CPC+, notwithstanding its lack of incentives concerning spending outside of primary care, is a powerful enough reform that diverting practices away from ACOs is not a problem. ACOs are completely dependent on primary care physician membership to function, meaning that any physician practices beyond 1,500 that enroll in CPC+ will reduce the size and the impact of the ACO program. CMMI has never published a priority ranking of reform models, but its actions keep indicating that ACOs are at the bottom.

The Innovation Center should be lauded for continuing to support improved payment models for primary care. Its blending of substantial monthly payments with lower payments per service is promising. But the highest potential rewards come from broadening primary care physicians’ incentives to include the cost and quality of services by other providers. CMMI should pursue this approach.


Editor's note: This piece originally appeared in Health Affairs Blog.

Authors

Publication: Health Affairs Blog
Image Source: Angelica Aboulhosn
       




omise

A Fair Compromise to Break the Climate Impasse


Key messages and Policy Pointers

• Given the stalemate in U.N. climate negotiations, the best arena to strike a workable deal is among the members the Major Economies Forum on Energy and Climate (MEF).

• The 13 MEF members—including the EU-27 (but not double-counting the four EU countries that are also individual members of the MEF)—account for 81.3 percent of all global emissions.

• This proposal devises a fair compromise to break the impasse to develop a science-based approach for fairly sharing the carbon budget in order to have a 75 percent chance of avoiding dangerous climate change.

• To increase the likelihood of a future climate agreement, carbon accounting must shift from pro­duction-based inventories to consumption-based ones.

• The shares of a carbon budget to stay below 2 °C through 2050 are calculated by cumulative emis­sions since 1990, i.e. according to a short-horizon polluter pays principle, and national capability (income), and allocated to MEF members through emission rights. This proposed fair compromise addresses key concerns of major emitters.

• According to this accounting, no countries have negative carbon budgets, there is substantial time for greening major developing economies, and some developed countries need to institute very rapid reductions in emissions.

• To provide a ‘green ladder’ to developing countries and to ensure a fair global deal, it will be crucial to agree how to extend sufficient and predictable financial support and the rapid transfer of technology.

The most urgent and complicated ethical issue in addressing climate change is how human society will share the work of reducing greenhouse gases (GHG) emissions. Looking ahead to 2015 when a new international treaty on climate change should be agreed upon, we fear we are headed towards a train wreck.

Key developed countries have made it clear they will not accept any regime excluding emerging economies such as China and Brazil, and the U.S. and other ‘umbrella’ countries are calling for only voluntary, bottom-up com­mitments. Yet the major developing countries have made equity the sine qua non for any kind of agreement: they will not take on mandatory emission reduction targets with perceived implications for their economic growth and social development, unless the wealthier countries commit to deep emissions cuts and act first.

These entrenched positions between the different blocs have led to the current impasse, but as Nobel laureate economist and philosopher, Amaryta Sen pointed out, the perfect agreement that never happens is more unjust than an imperfect one that is obtainable.

What is a fair and feasible way to break the impasse, given that all efforts are faltering? The most difficult task is determining a country’s fair share of the required emissions reductions in a way that is politically feasible. After 20 years of negotiations and gridlock, it is clear that many conflicting principles of equity are brought to the table, so a solution will have to be based on some kind of ‘negotiated justice,’ or a ‘fair compromise,’ which will not be one preferred by just one group of countries.

A few basic requirements must be met. A feasible, fair and effective climate agreement must involve the largest emitters from both the developed and developing countries. Such an agreement must find a way to engage the latter without penalizing them or the former countries too much. In order to secure progress, above all it must be acceptable to the two world superpowers and top carbon emitters, China and the U.S.; with this leadership, in fact, other emitters will likely follow. This agreement could be forged in a ‘plurilateral’ setting where a limited number of countries come together first, and then be brought into the formal U.N. negotiations as the basis for a future deal, perhaps by 2015.

How can future negotiations on emissions reductions overcome such political inertia? We suggest that taking three manageable steps to a fair compromise will unlock progress.

First, negotiate a core agreement between the 13 members in the MEF (including the EU-27), which accounts for 81.3 percent of all global emissions. This makes the negotiations feasible, where deals can be struck that would be impossible in the vast U.N. forum.

Second, use consumption-based emissions accounting, which is much fairer than the cur­rent production/territorial-based accounting that all past agreements and negotiations have been based upon. These are relatively new numbers developed by the Norwegian research center CICERO, and have been vetted by the top scientific journals and increasingly utilized by policymakers.

Third, forge a fair compromise to allocate emissions rights. We propose a compromise based on a short-horizon ‘polluter pays principle’ and an indicator of national capability (income).

This third step in particular is a genuine compromise for both developed and developing countries, but it is re­quired to break the current gridlock. Each MEF member gives and takes something from this simple, workable framework and all gain a liveable planet in the future.

Throughout the paper we first explain why counting carbon emissions by consumption is far better and the im­plications of doing so, and we then introduce the MEF and why it is a promising arena for forging a bold compro­mise like the one so badly needed before 2015. We then calculate what the numbers actually mean for that group of countries and develop a proposal for a fair compromise that embodies a feasible but fair operationalization of the central equity principles of the U.N. climate treaty, i.e. action by countries according to their responsibility and capability. We conclude with a discussion of how a start in the MEF could lead to a new framework being brought into those broader negotiations.

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The false promise of ‘pro-American’ autocrats

U.S. efforts to promote democracy in the Middle East have long been paralyzed by a unique “Islamist dilemma”: We want democracy in theory but fear its outcomes in practice. In this case, the outcomes that we fear are Islamist parties either doing well in elections or winning them outright. If we would like to (finally)…

       




omise

Who says progressives and conservatives can’t compromise?


Americans often think of our country as being one of great opportunity – where anyone can rise from very modest circumstances, if they work hard and make good choices. We believe that often remains true.

But, for children and youth growing up in poverty, such upward mobility in America is too rare. Indeed, just 30 percent of those growing up in poverty make it to middle class or higher as adults. Though we’ve made progress in reducing poverty over the past several decades, our poverty rates are still too high and our rate of economic advancement for poor children has been stuck for decades. That is an embarrassment for a nation that prides itself on everyone having a shot at the American Dream.

What can we do to reduce poverty and increase economic mobility? In our polarized and poisoned political atmosphere, it is hard to reach consensus on policy efforts. Both progressives and conservatives want lower poverty; but progressives want more public spending programs to improve opportunity and security for the poor, while conservatives generally argue for more responsibility from them before providing more help.

Even so, progressives and conservatives might not be as far apart as these stereotypes suggest. The two of us—one a conservative Republican and the other a progressive Democrat—were recently part of an ideologically balanced group of 15 scholars brought together by the American Enterprise Institute and the Brookings Institution. Our charge was to generate a report with policy proposals to reduce poverty and increase upward mobility. An additional goal was simply to see whether we could arrive at consensus among ourselves, and bridge the ideological divide that has so paralyzed our political leaders.

Together we decided that the most important issues facing poor Americans and their children are family, education and work. We had to listen to each other’s perspectives on these issues, and be open to others’ truths. We also agreed to be mindful of the research evidence on these topics. In the end, we managed to generate a set of policy proposals we all find compelling.

To begin with, the progressives among us had to acknowledge that marriage is a positive family outcome that reduces poverty and raises upward mobility in America. The evidence is clear: stable two-parent families have positive impacts on children’s success, and in America marriage is the strongest predictor of such stability. Therefore marriage should be promoted as the norm in America, along with responsible and delayed child-bearing.

At the same time, the conservatives among us had to acknowledge that investing more resources in the skills and employability of poor adults and children is crucial if we want them to have higher incomes over time. Indeed, stable families are hard to maintain when the parents – including both the custodial mothers and the (often) non-custodial fathers – struggle to maintain employment and earn enough to support their families. Investing in proven, cost-effective, education and training programs such as high-quality preschool and training for jobs in high-growth economic sectors can improve the skills and employability of kids from poor families and lift them out of poverty through work.

Another important compromise was that progressives acknowledged that expecting and even requiring adults on public assistance to work can reduce poverty, as we learned in the 1990s from welfare reform; programs today like Disability Insurance, among others, need reforms to encourage more work. And reforms that encourage innovation and accountability would make our public education programs for the poor more effective at all levels. We need more choice in public K-12 education (through charter schools) and a stronger emphasis on developing and retaining effective teachers, while basing our state subsidies to higher education institutions more heavily on graduation rates, employment, and earnings of their graduates.

Conservatives also had to acknowledge that requiring the poor to work only makes sense when work is available to them. In periods or places with weak labor markets, we might need to create jobs for some by subsidizing their employment in either the private or public sector (as we did during the Great Recession). We agreed that no one should be dropped from the benefit rolls unless they have been offered a suitable work activity and rejected it. And we also need to “make work pay” for those who remain unskilled or can find only low-wage jobs – by expanding the Earned Income Tax Credit (especially for adults without custody of children) and modestly raising the minimum wage.

We also all agreed on other topics. For instance, work-based learning—in the form of paid apprenticeships and other models of high-quality career and technical education—can play an important role in raising both skills and work experience among poor youth and adults.  And, if we raise public spending for the poor, we need to pay for it—and not increase federal deficits. We all agree that reducing certain tax deductions for high-income families and making our retirement programs more progressive are good ways to finance our proposals.

As our report demonstrates, it is possible for progressives and conservatives to bridge their differences and reach compromises to generate a set of policies that will reduce poverty and improve upward mobility. Can Congress and the President do the same?

Editor's Note: this piece first appeared in Inside Sources.

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Syrian refugees and the promise of work permits


Issuing work permits to refugees in return for donor support for jobs is seen as a “win-win-win” for refugees, host countries, and the international community. It would stem the flow of refugees to Europe, decrease the dangers of radicalization, and prevent the exploitation of refugees as a source of cheap labor. At last February’s “Supporting Syria and the Region” conference co-hosted by the U.K., Germany, Kuwait, Norway, and the United Nations, former British Foreign Secretary David Miliband called for a million work permits to be made available to Syrians, 200,000 each in Jordan and Lebanon and 600,000 in Turkey.

Turkey issued a decree in January 2016 allowing work permits for Syrians. Jordan also agreed to provide work permits for up to 200,000 Syrians over a number of years in exchange for aid and the opening of European markets to goods produced or special economic zones—all this to lead to jobs for one million Jordanians as well when other aid and spending is added in. Lebanon, whose fragile confessional politics makes the one million plus Sunni refugees a more palpable threat, has chosen not to issue work permits. Yet, according to the International Labor Organization (ILO), “around half of (working age) Syrian refugees are economically active and just one-third have access to overwhelmingly informal and low-skilled employment.” That’s around 165, 000 employed informally. The number is around 160,000 in Jordan  with 1.3 million Syrians and over 400,000 in Turkey with 2.7 million Syrian refugees.  

In Turkey and Jordan, as elsewhere, work permits are tied to employers who apply on behalf of employees once residency, registration, and health requirements are met. In both countries, employers must pay the legal minimum wage and social security payments. The permits are renewed annually. But, for the majority of Syrians working in labor markets with an abundance of local and foreign low-skill, low-wage workers, the pay is nowhere near the minimum wage. As to the promised jobs in the special zones, those will take time to materialize, and we already know that, at least in the garment sector, up to 80 percent of the workers are young women from South Asia, largely residing in dorms but at least receiving the minimum wage. Whether Syrians can adapt to this model remains to be seen. In both Jordan and Turkey, there are certain limits on the percentage of Syrians versus locals in many manufacturing and services jobs; in Jordan there is some evidence that “ghost” Jordanian workers are used to get around this requirement.

Jordan already has over 240,000 foreign workers, mainly Egyptians and Asians, who have work permits, with the total number including those working illegally may be as high as a million. There is a move to get Syrians to replace the foreign workers with permits but that seems a bit uncertain. It seems unlikely that employers will be eager to replace employees, often of long standing and for whom they have gone to the expense of getting work permits.  In Turkey, with fewer foreign workers, many locals work informally, though they tend to get paid significantly more than Syrians. The chances of employers hiking up wages to legalize Syrian employees, whether in Jordan or Turkey, are slim and the record to date appears to confirm this.   

In Jordan, the government provided a three-month grace period for workers to receive permits free of charge. Less than 2,000 permits had been granted by April. An ILO survey in Jordan, which looked at workers in the construction and agriculture sectors, noted that while 90 percent of workers had heard about the grace period, none in the agriculture sector and only 85 percent in construction had work permits, though almost all knew that getting caught might mean detention at the Azraq refugee camp. And an inability to pay social security constituted a major barrier. Often a concern is to go through employers to get the permit.  

In Turkey, the numbers are not encouraging either: By May, only 10,000 had actually registered for work permits. Refugees International reports that Turkey’s work permit program may end up benefitting 40,000 Syrians or roughly 10 percent of those actually working. The government, though, thinks that the program will eventually help all those currently working informally.

The ILO, United Nations High Commissioner for Refugees, and Refugees’ International have praised the Jordanian and Turkish governments for granting work permits. The decision was not easy and was politically charged in both countries. But the political and psychological significance of providing an opening for Syrians to slowly integrate themselves and move towards a stable future is certainly worth pursuing, even if it doesn’t bring immediate rewards. Already, Turkey allows Syrian doctors and medical personnel to work in health centers serving refugees. Over 4000 Syrian teachers have received stipends from a Ministry of Education program funded by UNICEF and western donors. And agricultural workers no longer need work permits so long as provincial governors give their approval.

Eventually delinking work permits from employers will help, and the ILO urges Jordan to do so for agricultural and construction workers. In both Jordan and Turkey, lowering social security payments would also smooth the transition. More support to vocational training, health care, education for children are other ideas being pursued. While making work permits available is not the same as a blanket “right-to-work” law for refugees, a right protected under the U.N. 1951 Refugee Convention but accepted in full neither by Jordan nor Turkey (however, the key international treaty that protects the right to work in binding form is the International Covenant on Economic, Social and Cultural Rights to which Jordan and Turkey are signatories), this is an opening and one that the international community should monitor and support. Aside from the February conference, other agreements—such as the one between the EU and Turkey and the upcoming EU deal with Lebanon and Jordan—provide suitable platforms towards improving on this initial phase.   

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  • Omer Karasapan
     
 
 




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Walk this Way:The Economic Promise of Walkable Places in Metropolitan Washington, D.C.


An economic analysis of a sample of neighborhoods in the Washington, D.C. metropolitan area using walkability measures finds that:

  • More walkable places perform better economically. For neighborhoods within metropolitan Washington, as the number of environmental features that facilitate walkability and attract pedestrians increase, so do office, residential, and retail rents, retail revenues, and for-sale residential values.

  • Walkable places benefit from being near other walkable places. On average, walkable neighborhoods in metropolitan Washington that cluster and form walkable districts exhibit higher rents and home values than stand-alone walkable places.

  • Residents of more walkable places have lower transportation costs and higher transit access, but also higher housing costs. Residents of more walkable neighborhoods in metropolitan Washington generally spend around 12 percent of their income on transportation and 30 percent on housing. In comparison, residents of places with fewer environmental features that encourage walkability spend around 15 percent on transportation and 18 percent on housing.

  • Residents of places with poor walkability are generally less affluent and have lower educational attainment than places with good walkability. Places with more walkability features have also become more gentrified over the past decade. However, there is no significant difference in terms of transit access to jobs between poor and good walkable places.

The findings of this study offer useful insights for a diverse set of interests. Lenders, for example, should find cause to integrate walkability into their underwriting standards. Developers and investors should consider walkability when assessing prospects for the region and acquiring property. Local and regional planning agencies should incorporate assessments of walkability into their strategic economic development plans and eliminate barriers to walkable development. Finally, private foundations and government agencies that provide funding to further sustainability practices should consider walkability (especially as it relates to social equity) when allocating funds and incorporate such measures into their accountability standards.

The Great Recession highlighted the need to change the prevailing real estate development paradigm, particularly in housing. High-risk financial products and practices, “teaser” underwriting terms, steadily low-interest rates, and speculation in housing were some of the most significant contributors to the housing bubble and burst that catalyzed the recession. But an oversupply of residential housing also fueled the economic crisis.

However, a closer look at the post-recession housing numbers paints a more nuanced picture. While U.S. home values dropped steadily between 2008 and 2011, distant suburbs experienced the starkest price decreases while more close-in neighborhoods either held steady or in some cases saw price increases. This distinction in housing proximity is particularly important since it appears that the United States may be at the beginning of a structural real estate market shift. Emerging evidence points to a preference for mixed-use, compact, amenity-rich, transit-accessible neighborhoods or walkable places.

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A Historic Compromise in Tunisia? What Rome Can Teach Carthage


Next Sunday’s first round of the Tunisian presidential election is unlikely to produce an outright winner but the country can already lay claim to the most democratic success story in the uncertain post-Arab Spring period.

Earlier this year, the Islamist-led National Constituent Assembly in Tunis produced a pluralist constitution that set the stage for a parliamentary contest on October 26 in which the incumbents lost. That simple fact of political alternation is a historic milestone: Ennahda is not the only Islamist party to lose the confidence of its initial protest-vote electorate, but it is the first to live to tell the tale.

Islamist participation in the democratic process

The birthplace of the Arab Spring offers a tantalizing third way toward Islamist participation in the democratic process: a Goldilocks outcome between Turkish majoritarianism and Egyptian militarism. Tunisia is different: it is smaller, lacks a hegemonic army, and Ennahda doesn’t have anywhere near a majority of votes.

The alluring tableau, however, conceals a fragmented elite and a scattered electorate. Twenty-seven parties declared candidates for president, although a handful have dropped out. Last month, more than 15,000 candidates running on over 1,300 party lists vied for 217 parliamentary seats. Only two-fifths of eligible adults registered to vote and less than two-thirds of them actually voted.

The main pattern to emerge from parliamentary elections is the same that has defined the country for decades: an existential battle between Islamists and anti-Islamists with a majority for neither. The Islamists lost six percentage points (32 percent) but the secularists were not exactly embraced. Taking into account non-registration and abstention, the victorious party Nidaa Tounes’s share of the legislative vote (38 percent) corresponds to roughly one out of five eligible voters.

These results accurately reflect a highly polarized society. Nidaa Tounes is led by presidential frontrunner Beji Caïd Essebsi, an 87-year-old who served under every regime since 1956 independence and who stoked voters’ fear of Ennahda’s “seventh century project” during the campaign. Ennahda’s leadership framed the election as a contest “between supporters of the revolution and supporters of the counter-revolution.” It is the only Muslim-majority country where nearly half of the population claims to never step foot in a mosque.

Do Tunisians favor “authoritarian government”?

For the first time since the 2011 revolution, polling this summer showed a majority of Tunisians favoring “authoritarian government” over an “unstable” democratic government. Also for the first time, Ennahda declined to field a presidential candidate to contain apprehensions about them. While Essebsi mostly enjoys an untainted reputation his party, Nidaa Tounes is a loose coalition including many holdovers from the previous regime.

The last time electoral democracies experienced a comparable juncture was not in 2013 Cairo or Gezi Park, but rather Rome during the tense 1970s. In 1976, the Italian Communist Party received one-third of the votes, making it the largest Communist electoral bloc west of the Iron Curtain. Frequent small-scale terrorist attacks took place against the backdrop of global tensions between NATO and Warsaw Pact members.

It is hard to remember a time when the term “socialism” provoked as much angst as “Sharia” does today, but Tunisia stands at a crossroads analogous to the old Cold War alternatives of Washington and Moscow, with Qatar and other Gulf states filling the shoes of the old “evil empire.”

Recognizing that Italy was too divided to govern alone, party leader Enrico Berlinguer proposed a historic compromise (compromesso storico) with the archenemy Christian Democrats to bridge a seemingly impassible cultural-political gap.

Ennahda party faces doubts

Today’s Ennahda party faces the same doubts as Communist leaders in postwar Europe: are they truly pluralist democrats? Do they accept power sharing? The executive director of Nidaa Tounes, Mondher Belhadj Ali, said in an interview in Tunis earlier this year that Ennahda must undergo the equivalent process of the various leftist parties in Europe during the Cold War. The party needs to renounce its “jihadist logic,” Belhadj said, in the same way that the German left distanced itself from international Marxist-Leninist creed at Bad Godesberg in 1959.[1]

To be considered trustworthy despite its association with a revolutionary ideology, the Italian Communist Party (Partito Comunista Italiano, or PCI) underwent key shifts. Its leadership broke with the international Comintern by supporting Italy’s NATO membership. They also refused Moscow’s order of “intransigence” through silent partnership with a Christian Democrat-led government, giving way to the “via Italiana” – an Italian path – to socialism.

Why did the PCI pursue this path at a moment of rising strength, when their share of the vote was peaking at 32 percent? Italian Communists had no doubt noticed that NATO countries were willing to forego democratic outcomes in Chile three years earlier in the name of political stability and anti-communism.

“Alternative to the Islamic State”

It is also apparent that Ennahda’s leadership has correctly interpreted the West’s silence after the arrest of Egypt’s first democratically elected president last year. The party’s agreement to omit the word “Sharia” from the constitution, its decision to ban the extremist group Ansar Echaria and its voluntary departure from political posts in 2013 have been taken as early signs of a willingness to compromise. There is no exact Islamist equivalent to Moscow and the Comintern, but Ennahda has offered itself up as “the alternative to the Islamic State.” Ennahda has also adopted an official party line not to govern alone but only in alliance with other parties. Party leader Rached Ghannouchi said he hopes to avoid “the repetition of the Egyptian bilateral polarizing model.”

Political pressure already forced Ennahda and its partners to wage not merely ideological but also actual military war on violent Islamist extremism. The martyrs of the Tunisian Revolution now include not only the two secular politicians who were assassinated in the first half of 2013 but also the 39 Tunisian soldiers who have been killed since then – including five in an attack earlier this month.

The interim government has not hesitated to combat religious enemies of the state. President Moncef Marzouki, a human rights activist, looked ashen in an interview in his office this summer: “I deeply regret it: it means killing and arresting people but I have to defend this state” – at times leading to the deaths of a dozen combatants per month, including six on election weekend.[2]

In the years since the revolution, through a mixture of coercion and conviction, the religious affairs ministry whittled down the number of prayer spaces under the control of Salafi extremists from over 1000 in 2011 to under 100 today. This summer, the government fired an imam who refused to say prayers for a soldier who died in a raid on an Islamist cell.”[3]

Like Berlinguer before him, Ghannouchi has made timely visits to meet with American officials and offer democratic reassurances – but to far greater effect than the Italian Communists ever managed. Washington’s reception of the PCI is captured by the chiaroscuro headshot of Berlinguer on a June 1976 cover of Time declaiming “The Red Threat.” In 2012, the magazine named Ghannouchi one of the “World’s Most Influential People,” someone who offers “a vision of a moderate, modern and inclusive political movement.”

Critics will point out that shortly after the compromesso storico, the Communist Party’s electoral base bottomed out. Left-wing terrorism did taper off but not before the Red Brigades kidnapped and executed the Communists’ main Christian Democratic interlocutor, former Prime Minister Aldo Moro, in 1978.

Compromise may lead to national unity

With counterterrorism support to resist such extremist violence on the fringes and more enthusiastic backing from Western capitals, however, a Tunisian historic compromise may yet deliver the national unity that the country needs to advance to self-confident partisan rule – and mutual faith in political alternation. The recent announcement of joint U.S.-Tunisian counter-terrorism exercises and a gift of $14 million worth of equipment and supplies are small in scale but their timing conveys a broader reassurance.

The lack of a clear political mandate may turn out to be the hidden advantage of this inaugural election season in Tunisia. The country’s political parties can now use the first full presidency and parliamentary session of a democratic Tunisia to blaze a third way between military rule and majoritarian Islamist democracy.

Just as Italian communism was a different animal than the Soviet Communist Party, Tunisian exceptionalism is a real thing. The accelerated modernization period under Independence leader Habib Bourguiba after decolonization left behind the lowest illiteracy rate and lowest birthrate in the neighborhood. Its relatively peaceful democratic revolution has now passed several institutional milestones. As President Moncef Marzouki put it, “if the experiment in Islamic democracy doesn’t work here then it’s unlikely to work anywhere.”[4]

The Italian Communist Party voted to dissolve itself almost 24 years ago, not long after the Berlin Wall fell and sealed its obsolescence. An equivalent geopolitical shift in Sunni Islam – away from the hegemony of ideologically rigid Gulf States – is as unimaginable now as was the thaw of November 1989. But a great compromise between the region’s modern nemeses – secularist and Islamist – could well dislodge the first brick.


[1] Jonathan Laurence interview with Mondher Belhadj Ali, May 2014, Tunis, Tunisia.
[2] Jonathan Laurence interview with Tunisian President Moncef Marzouki, May 2014, Carthage, Tunisia.
[3] Jonathan Laurence Interview with Tunisian Minister of Religious Affairs Mounir Tlili, May 2014, Tunis, Tunisia.
[4] Ibid.
Image Source: © Anis Mili / Reuters