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.

INTRODUCTION

Over the past decade, the focused attention of African nations, the United States, U.N. agencies and other multilateral partners has brought significant progress toward achievement of the Millennium Development Goals (MDGs) in health and malaria control and elimination. The potential contribution of these strategies to long-term peace-building objectives and overall regional prosperity is of paramount significance in sub-regions such as the Horn of Africa and Western Africa that are facing the challenges of malaria and other health crises compounded by identity-based conflicts.

National campaigns to address health Millennium Development Goals through cross-ethnic campaigns tackling basic hygiene and malaria have proven effective in reducing child infant mortality while also contributing to comprehensive efforts to overcome health disparities and achieve higher levels of societal well-being.

There is also growing if nascent research to suggest that health and other humanitarian interventions can result in additional benefits to both recipients and donors alike.

The social, economic and political fault lines of conflicts, according to a new study, are most pronounced in Africa within nations (as opposed to international conflicts). Addressing issues of disparate resource allocations in areas such as health could be a primary factor in mitigating such intra-national conflicts. However, to date there has been insufficient research on and policy attention to the potential for wedding proven life-saving health solutions such as malaria intervention to conflict mitigation or other non-health benefits.

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I’m late to the conversation about whether or not Republican efforts to insist on sixty votes for cloture on Chuck Hagel’s nomination as Secretary of Defense constitutes a filibuster. Bernstein’s earlier piece ("This is what a filibuster looks like") and Fallows’ recent contribution provide good, nuanced accounts of why Republican tactics amount to a filibuster, even if some GOP senators insist otherwise. In short, the duck test applies: If it looks like a duck, swims like a duck and quacks like a duck, then …. it’s a filibuster!

Still, I think there’s more to be said about the politics and implications of the Hagel nomination. A few brief thoughts:

First, let’s put to rest the debate about whether insisting on sixty votes to cut off debate on a nomination is a filibuster or, at a minimum, a threatened filibuster. It is. Even if both parties have moved over the past decade(s) to more regularly insist on sixty votes to secure passage of major (and often minor) legislative measures and confirmation of Courts of Appeals nominees, we shouldn’t be fooled by the institutionalization—and the apparent normalization—of the 60-vote Senate. Refusing to consent to a majority’s effort to take a vote means (by definition) that a minority of the Senate has flexed its parliamentary muscles to block Senate action. I think it’s fair to characterize such behavior as evidence of at least a threatened filibuster—even if senators insist that they are holding up a nomination only until their informational demands are met.

Second, there’s been a bit of confusion in the reporting about whether filibusters of Cabinet appointees are unprecedented. There appears to have been no successful filibusters of Cabinet appointees, even if there have been at least two unsuccessful filibusters against such nominees. (On two occasions, Cabinet appointees faced cloture votes when minority party senators placed holds on their nominations—William Verity in 1987 and Kempthorne in 2006. An EPA appointee has also faced cloture, but EPA is not technically cabinet-level, even if it is now Cabinet-status). Of course, there have been other Cabinet nominees who have withdrawn; presumably they withdrew, though, because they lacked even majority support for confirmation. Hagel’s situation will be unprecedented only if the filibuster succeeds in keeping him from securing a confirmation vote.

Third, using cloture votes as an indicator of a filibuster underestimates the Senate’s seeping super-majoritarianism. (Seeping super-majoritarianism?! Egads.) At least two other recent Cabinet nominations have been subjected to 60-vote requirements: Kathleen Sebelius in 2009 (HHS) and John Bryson (Commerce) in 2011. Both nominees faced threatened filibusters by Republican senators, preventing majority leader Reid from securing the chamber’s consent to schedule a confirmation vote—until Reid agreed to require sixty votes for confirmation. The Bryson unanimous consent agreement (UCA) appears on the right, an agreement that circumvented the need for cloture. Embedding a 60-vote requirement in a UCA counts as evidence of an attempted filibuster, albeit an unsuccessful one. After all, other Obama nominees (such as Tim Geithner) were confirmed after Reid negotiated UCAs that required only 51 votes for confirmation, an agreement secured because no Republicans were threatening to filibuster.

Finally, what are the implications for the Hagel nomination? If Republicans were insisting on sixty votes on Senator Cornyn’s grounds that “There is a 60-vote threshold for every nomination,” then I bet Reid would have been able to negotiate a UCA similar to Sebelius’s and Bryson’s. But Hagel’s opponents see the time delay imposed by cloture as instrumental to their efforts to sow colleagues’ doubts about whether Hagel can be confirmed (or at a minimum to turn this afternoon’s cloture vote into a party stand to make their point about Benghazi). Of course, it’s possible that the time delay will work to Democrats’ benefit if they can make headlines that GOP obstruction puts national security at risk. (Maybe Leon Panetta should have jetted to his walnut farm to make the point before the cloture vote.) Whatever the outcome, the Hagel case reminds us that little of the Senate’s business is protected from the intense ideological and partisan polarization that permeates the chamber and is amplified by the chamber’s lax rules of debate and senators’ lack of restraint. Filibustering of controversial Cabinet nominees seems to be on the road to normalization—even if Hagel is ultimately confirmed.

In a new essay, “The New Challenge to Market Democracies,” Senior Fellow William Galston argues that “the centrality of economic well-being in our politics reflects long-held assumptions about the purposes of our politics. If economic growth and well-being are in jeopardy, so are our political arrangements.”

Galston, the Ezra K. Zilkha Chair in Governance Studies, makes the case that economic growth and well-being are indeed in jeopardy for a variety of reasons, including: wage growth that has just kept up with inflation; family and household incomes that remain below their pre-Great Recession peak; the share of national income going to wages and salaries is as low as it’s been in nearly 50 years; and a difficult jobs situation in which workers are getting paid less, the number of people working part-time who want full-time work remains high, and few new jobs offer middle range incomes. “These trends,” Galston writes, “bode ill for the future of the middle class; many parents now doubt that their children will enjoy the same opportunities that they did.”

Galston offers three broad policy prescriptions related to employment and tax reform:

1. “We should adopt full employment as a high-priority goal of economic policy and welcome the wage increases that it would generate.”
2. “We should use the tax code to restore the relationship between wage increases and productivity gains.”
3. “We should adopt a strong presumption against provisions of the tax code that treat some sources of income more favorably than wages and salaries,” which includes scrapping tax expenditures that “disproportionately benefit upper-income investors.”

Calling economic growth a “moral enterprise” as well as a material goal, Galston—acknowledging economist Benjamin Friedman—concludes that:

the central question the United States now faces is whether the next generation will again achieve broadly shared prosperity or rather experience the stagnation of living standards. Broad prosperity is both the oil that lubricates the machinery of government and the glue that binds our society together. Economic stagnation means a continuation of gridlocked, zero-sum politics and a turn away from the spirit of generosity that only a people confident of its future can sustain.

Read “The New Challenge to Market Democracies.”

Even in comfortable times, the service cutbacks and fare increases being proposed by the Metropolitan Transportation Authority would have sparked outrage from New Yorkers. Coming in the depths of the most serious economic crisis since the Great Depression, things seem that much worse.

Not that it's any consolation to frustrated New York transit riders and taxpayers, but you are not alone. Transit agencies like the MTA are reeling nationwide; all are suffering from factors at least some of which they really can't control without some legislative help.

This is not to deny the pain that could occur unless the state comes up with a rescue plan. In its 2009 budget, the agency proposes painful service cutbacks and fare increases to help cover a projected deficit of around $1.5 billion.

No fewer than 51 transit agencies around the country are in the same financial situation. For example, the Massachusetts Bay Transportation Authority that runs Boston's smaller transit system is chewing over major service cuts and fare increases if the state doesn't help cover its $160 million deficit.

The fact that so many transit agencies are struggling may come as a surprise. After all, didn't Washington just pump a lot of money into infrastructure as part of the $787-billion American Recovery and Reinvestment Act? Wasn't public transit a big part of that law?

Yes. The stimulus package provides $8.4 billion to be spent on transit this year. That's a helpful shot in the arm to metropolitan transit agencies that Washington ordinarily relegates to second-class status. And the MTA will receive the largest portion of this money: more than $1 billion. Even by today's standards, that's nothing to sneeze at.

But how much will it really help? Federal rules in effect since 1998 stipulate that this money can be spent only on capital improvement projects and not to finance gaps in day-to-day operating expenses.

Surely there is no transit service without capital - the buses, trains, tracks and other facilities that make the system run. However, operating costs - which are generally about twice as high as capital expenses for the largest transit agencies - cover the salaries of the workers who keep the system running, as well as the debt contracted to pay for capital projects.

So as the federal government aims to put Americans back to work on shovel-ready, temporary construction jobs, transit agencies are looking at the likelihood of laying people off from stable, permanent positions.

Why the disconnect?

The response in Washington is predictably stubborn: Recovery money cannot be used for operating expenses because operating is not a federal role.

You would think that the pressure of this policy would lead to transit agencies that are self-sufficient - where passenger fares pay the full costs of operating the system.

But large metropolitan transit agencies generally "recover" only about one-third of their costs from subway riders and about one-quarter from bus passengers. The MTA has the highest cost-recovery ratio among all subway operators - its fares pay for two-thirds of operating costs.

For large bus systems, the MTA's New York City Transit ranks second only to New Jersey's in terms of the share of operating costs paid for by riders. The Long Island Rail Road is the seventh among the 21 commuter rail systems in the country, recovering from fares close to half of its operating costs.

So what should be done to close the MTA's budget gap?

For one thing, lawmakers in Albany need to recognize that the state contributes a lower proportion of the MTA's budget from its general revenue than other states provide to their transit agencies from general revenue. In New York, about 4 percent of all the MTA operating costs are covered by the state budget; in other states, transit agencies are getting closer to 6 percent.

Raising state general fund support to national levels would be a good place to start helping the MTA.

Another idea is to get Washington to help. Not in doling out more money, but in stepping aside and empowering metropolitan agencies to spend their federal money in ways that best meet their own needs.

Specifically, the federal rules could be changed to allow transit agencies to spend their transit capital stimulus dollars on operating expenses. Certainly, agencies have capital needs as well, but particularly in these stressful economic times they should have the short-term flexibility to use those federal dollars to meet their immediate problems.

Over the long term, some form of federal competitive funding for operating assistance also might provide the right incentive - or reward - to states and localities to commit to funding transit.

Based on their level of commitment, metropolitan agencies, localities and states that legislatively dedicate a stable stream of funds could potentially receive federal operating assistance, perhaps as a matching grant. The federal government would be helping those who help themselves.

The New York metropolitan area cannot afford to have a transit system that is hampered from operating at its fullest and most efficient potential.

An extensive transit network like the MTA provides important transportation alternatives to those who have options and basic mobility for those who don't. It can help mitigate regional air-quality problems by lowering overall automobile emissions and slowing the growth in traffic congestion.

It also can provide economic benefits by creating development opportunities around transit stations and help enhance regional economic competitiveness as an important and attractive metropolitan amenity.

Such a functioning network plays a fundamental role in attracting highly skilled labor and talent, which we know is so important in 21st century metropolitan America.

Over 30 years ago, the World Bank began to develop policies to safeguard the rights of those displaced by Bank-financed development projects. The safeguard policy on involuntary resettlement initiated in turn a series of follow up policies designed to safeguard other groups and sectors affected by Bank investments, including the environment and indigenous people. Since its adoption in 1980, the Bank’s operational policy on involuntary resettlement has been revised and strengthened in several stages, most recently in 2001. The regional development banks – African Development Bank, Asian Development Bank, InterAmerican Development Bank, the European Bank for Reconstruction and Development, and the International Finance Corporation (IFC) – have all followed the World Bank’s lead and developed policies for involuntary resettlement cause by development projects financed by these multilateral banks.

While the policies are complex, the basic thrust of these safeguard policies on involuntary resettlement has been to affirm:

• Involuntary resettlement should be avoided where feasible.
• Where it is not feasible to avoid resettlement, the scale of displacement should be minimized and resettlement activities should be conceived and executed as full-fledged sustainable development programs on their own relying on commensurate financing l and informed participation with the populations to be displaced.
• Displaced persons should be assisted to improve, or at least restore their livelihoods and living standards to levels they enjoyed before the displacement.^[1]

Even with these safeguards policies, people displaced by development projects risk – and very large numbers have actually experienced – a sharp decline in their standards of living.^[2] Michael Cernea’s Impoverishment Risks and Reconstruction model identifies the most common and fundamental risks of such displacement and resettlement processes: landlessness, joblessness, homelessness, marginalization, food insecurity, increased morbidity and mortality, loss of access to common property, and social disintegration.^[3] If insufficiently addressed, these embedded risks convert into actual processes of massive impoverishment. And particular groups may be especially affected, as noted in the World Bank’s Operational Policy: “Bank experience has shown that resettlement of indigenous people with traditional land-based modes of production is particularly complex and may have significant adverse impacts on their identity and cultural survival.” (OP 4.12, para.9)

These safeguards policies are an important instrument to minimize and overcome the harm suffered by those displaced by development projects. It should be noted, however, that there have always been problems in the implementation of these policies due to the evasive implementation by borrowers or the incomplete application by World Bank staff. The Bank’s interest in researching the impacts of compulsory resettlement triggered by its projects has been sporadic. In particular, World Bank has not carried out and published a comprehensive evaluation of the displacements caused by its massive project portfolio for the last 20 years. The last full resettlement portfolio review was conducted two decades ago, in 1993-1994. In2010, with the approval of the Bank’s Board, the Bank’s Independent Evaluation Group (IEG) undertook a broad review on how not only the policy on involuntary resettlement, but all social safeguards policies have or have not been implemented. Reporting on its findings, the Independent Evaluation Group (IEG) publicly faulted World Bank management for not even keeping basic statistics of the number of people displaced and not making such statistics available for evaluation.^[4] Similar analytical syntheses are missing from other multilateral development agencies, such as, IADB and EBRD. There is a strong sense within the community of resettlement specialists that successful cases are the exception, not the norm. In sum, projects that are predicated on land expropriation and involuntary resettlement are not only forcibly uprooted large numbers of people, but leaving them impoverished, disenfranchised, disempowered, and in many other aspects worse off than before the Bank-financed project.

While the Bank’s safeguard policies were in need of review and many argued for a more explicit incorporation of human rights language into the policies, the Bank took a different approach. The Bank’s team tasked with “reviewing and updating” eliminated many robust and indispensable parts of the revised existing safeguards, watered down other parts, and failed to incorporate important lessons from the Bank’s own experiences as well as relevant and important new knowledge from social, economic, and environmental sciences.

At the end of July 2014, the Bank published a “draft” of the revised safeguards’ policies which were not based on consultation with civil society organizations (CSOs) as had been promised. Rather the newly proposed policies were held close and stamped “strictly confidential.” The numerous CSOs and NGOs involved for two years in what they thought was a consultative process learned only from a leak about plans by Bank management for proposals to the Bank’s Board and its Committee for Development Effectiveness (CODE). Because of this secrecy, the Bank’s Board and the CODE itself were not made aware of the civil society’s views about the Environmental and Social Safeguards draft policy, before CODE had to decide about endorsing and releasing it for a new round of “consultation.”

As is well known, the process shapes the product. These bizarre distortions in the way the World Bank conducted what should have been a transparent process of genuine consultation resulted in some deep flaws of the product as manifest in the current draft ESS.

The backlash was inevitable, strong, and broad, coming from an extensive array of constituencies:’ from CSOs, NGOs, and various other groups representing populations adversely affected by Bank financed projects, professional communities , all the way to various organisms of the United Nations. More than 300 civil society organizations issued a statement opposing the Bank’s plans and at World Bank meetings in mid-October 2014, civil society organizations walked out of a World Bank ‘consultative meeting’ on the revised policies. The statement argued that the consultative process had been inadequate and that the safeguards were being undercut even at a time when the Bank is seeking to expand its lending to riskier infrastructure and mega-project schemes. While the Review and Update exercise was expected to strengthen the provisions of existing policies, instead the policies themselves were redrafted in a way that weakened them. The civil society statement notes that the revised draft “eliminates the fundamental development objective of the resettlement policy and the key measures essential to preventing impoverishment and protecting the rights of people uprooted from their homes, lands, productive activities and jobs to make way for Bank projects.”^[5] Not only did the revised policy not strengthen protections for displaced people, but each of its “standards” represents a backwards step in comparison to existing policies. According to the draft revised policies the Bank could now finance projects which would displace people without requiring a sound reconstruction plan and budget to “ensure adequate compensation, sound physical resettlement, economic recovery and improvement.” Moreover, the application of some safeguards policies would now become optional. Although the regional development banks have not – so far – begun to take actions to weaken their own safeguard policies, there is fear that they will follow the Bank’s lead.

Just as humanitarian response to internally displaced persons seems to be sliding backward, so too the actions of development agencies – or at least the World Bank – seem to be reversing gains made over the past three decades.

The city of Chicago is increasing retrofits by using stimulus dollars to expand the opportunity for energy efficient living to low-income residents of large multi-family rental buildings. To aid this target demographic, often left underserved by existing programs, the city’s new Multi-Family Energy Retrofit Program introduces an innovative model for retrofit delivery that relies on private sector financing and energy service companies.

Chicago’s new Multi-Family Energy Retrofit Program draws on multi-sector collaboration, with an emphasis on private sector involvement supported by public and nonprofit resources. Essentially, the program applies the model of private energy service companies (ESCOs), long-used in the public sector, to the affordable, multi-family housing market. In this framework, ESCOs conduct assessments of building energy performance, identify and oversee implementation of cost-effective retrofit measures, and guarantee energy savings to use as a source of loan repayment.

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The U.S. military will carry out a major modernization of its strategic nuclear forces in the 2020s.

It will cover all three legs of the strategic triad.

Much of the planned program makes sense. The long-range standoff (LRSO) — a new nuclear-armed cruise missile to outfit strategic bombers — does not.

The primary reason for the modernization program is that many US strategic weapons systems are aging out, and American policy is that, as long as there are nuclear weapons, the United States will maintain a safe, secure and robust nuclear deterrent.

The Ohio-class ballistic missile submarines will begin to hit the end of their service life in the late 2020s, and the Navy will need new submarines. Submarines and submarine-launched ballistic missiles (SLBMs) make up the most survivable leg of the triad, and they carry the bulk of deployed US strategic warheads.

The service life of the Minuteman III intercontinental ballistic missile (ICBM) runs out in 2030. The Air Force seeks a replacement ICBM. At a minimum, keeping an ICBM leg of the triad would require another life extension program for existing Minuteman III missiles.

As for the air-breathing leg of the triad, the Air Force wants to procure 80 to 100 B-21 bombers. Plans are shrouded in secrecy but reportedly will incorporate stealth features and advanced electronic warfare capabilities to allow the aircraft to penetrate contested air space. The Air Force is also modernizing the B61 nuclear gravity bomb for use on strategic bombers.

It is not clear why the United States will need to replace 400 deployed ICBMs on a one-for-one basis, particularly as the Air Force several years ago was prepared to go down to 300. A force of 200-300 ICBMs would suffice and result in significant cost savings. Likewise, one can challenge the requirement for 12 new ballistic missile submarines, as opposed to nine or 10.

The biggest question, however, arises over the LRSO, with a projected cost of $20 billion to $30 billion. The Air Force originally developed nuclear-armed air-launched cruise missiles (ALCMs) in the 1970s because the B-52 — then the mainstay of the strategic bomber fleet — presented a big target for adversary radars. That would make it hard for the aircraft to penetrate air defenses. A B-52 armed with ALCMs could remain outside of radar range and release its cruise missiles.

The B-2, with its stealth features, was designed to restore a penetrating capability. The Air Force plans to use stealth and electronic warfare capabilities to give the B-21 a penetrating capability as well. If these bombers can defeat and penetrate air defenses, that makes the LRSO redundant. (Moreover, unlike in the 1970s, the Air Force today has very capable long-range conventionally armed cruise missiles that provide a standoff capability for bombers.)

If, on the other hand, the stealth of the B-21 will be compromised in the not-too-distant future, then one has to question the wisdom of spending $60 billion to $80 billion — and perhaps more — to procure the B-21. If we believe the B-21 would soon encounter problems penetrating air defenses, scrap that program. Buy instead modified Boeing 767s, a variant of which will serve as the Air Force’s new aerial tanker, and arm them with the LRSO.

The Air Force’s evident attachment to the B-21 suggests, however, that it believes that the aircraft will be able to defeat adversary air defenses for some time to come. That means that the LRSO would add little capability to the US strategic force mix.

If one were to argue for the redundant capability provided by the LRSO, the number of new ALCMs that the Pentagon proposes to purchase — 1,000 to 1,100 — is difficult to understand. Even allowing for extra cruise missiles for test purposes, the number seems excessively high.

In its 2010 annual report to Congress on implementation of the Strategic Offensive Arms Reduction Treaty (SORT), the State Department advised that, as of Dec. 31, 2009, the United States had 1,968 operationally deployed strategic nuclear warheads. That figure captured the actual number of nuclear warheads atop SLBMs and ICBMs plus the number of nuclear bombs and ALCMs at air bases for use by bombers.

On June 1, 2011, a State Department fact sheet showed the number of deployed US strategic warheads as 1,800 as of Feb. 5, 2011, when the New Strategic Arms Reduction Treaty (New START) went into force. A Dec. 1, 2011, fact sheet provided a more detailed breakdown of US strategic forces. It stated that, as of Sept. 1, 2011, the United States had 1,790 deployed strategic warheads and 125 deployed strategic bombers. Like SORT, New START counts each warhead on a deployed ballistic missile as a deployed warhead. But New START counts bomber weapons differently from SORT. New START attributes each deployed bomber as one warhead, regardless of the number that it can carry or the number of weapons that may be at bomber bases.

The 125 deployed bombers on Sept. 1, 2011, would have counted as 125 under New START’s deployed strategic warhead total. Reducing 1,790 by 125 yields 1,665 — the number of deployed warheads then on US SLBMs and ICBMs.

Comparing the SORT and New START numbers is a bit of an apples-and-oranges comparison, but it gives some idea of the number of bomber weapons at US strategic bomber bases. Unless there was a dramatic increase in the number of warheads on ICBMs and SLBMs between the end of 2009 and September 2011 — and there is no reason to think that there was — comparing SORT’s 1,968 figure (end of 2009) to the 1,665 deployed warheads on ICBMs and SLBMs (under New START counting rules in September 2011) suggests some 300 nuclear bombs and ALCMs were at bomber bases. The B-2s would have been armed with bombs, which indicates a maximum of 200-250 ALCMs. The Federation of American Scientists (FAS) also estimates that there are about 300 nuclear weapons at strategic bomber bases, of which 200 are nuclear-armed ALCMs. FAS believes an additional 375 ALCM airframes are held in reserve.

This comparison raises the question: Why would 1,000-1,100 ALCM airframes be needed to support a couple of hundred deployed ALCMs?

The United States should sensibly modernize its strategic deterrent, particularly in a time of tight defense budgets. The case for the LRSO is demonstrably weak, especially for the planned size of the program. The LRSO should be shelved.

This piece was originally published in Defense News.

Event Information

Increasingly, there are concerns about the direction of Turkey’s politics, economy, security, and foreign policy. Debate is growing about the Turkish economy’s vibrancy, and its commitment to democratic norms is being questioned. Moreover, against the backdrop of the chaos in the region, its ability to maintain peace and order is hindered. These difficulties coincide with a larger trend in which the global economy remains fragile, European integration is fracturing, and international governance seems under duress. The spill-over from the conflicts in Syria and Iraq has precipitated a refugee crisis of historic scale, testing the resolve, unity, and values of the West. Will these challenges prove pivotal in reshaping the international system? Will these trials ultimately compel the West to formulate an effective collective response? Will Turkey prove to be an asset or a liability for regional security and order?

On April 14, the Turkey Project of the Center on the United States and Europe at Brookings hosted a discussion to assess Turkey’s strategic orientation amid the ever-changing international order. Panelists included Vice President and Director of Foreign Policy Bruce Jones, Şebnem Kalemli-Özcan of the University of Maryland, and Francis Riccardone of the Atlantic Council. Cansen Başaran-Symes, president of the Turkish Industry and Business Association (TÜSİAD) made introductory remarks. Turkey Project Director and TÜSİAD Senior Fellow Kemal Kirişci moderated the discussion.

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• Uncorrected Transcript (.pdf)

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• 20160414_turkey_neighborhood_transcript

This keynote presentation by Bruce Katz at City Hall in Seattle describes how a vibrant center city stimulates a region's economy. The presentation also assesses how Seattle is faring on this front and what steps the city should take as it looks to the future.

The metro program hosts and participates in a variety of public forums. To view a complete list of these events, please visit the metro program's Speeches and Events page which provides copies of major speeches, powerpoint presentations, event transcripts, and event summaries.

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Seattle Mayor Ed Murray recently announced a plan to raise the minimum wage in his city to $15/hour over the next few years. The plan emerged from a special business/labor advisory committee, approved by 21 out of 24 its members, after four months of hearings, academic studies, and debate . The measure awaits approval by the City Council, but the move to $15/hour in Seattle seems well underway.

Seattle may be the first, but it won’t be the last, city to take this bold step. Granted, there were some peculiarities in Seattle’s case, including a $15/hour minimum wage ballot initiative that succeeded in the nearby city of SeaTac in November, and the election of a new Socialist Party Seattle City Council member who campaigned on the issue. But with inequality taking center stage as a political issue in big cities around the country, mayors, businesses, and labor advocates are watching Seattle closely.

However, the focus on big cities shouldn’t obscure the fact that wages are a function of regional economics. Seattle is indeed a big city, with 635,000 residents and (by our count) nearly 500,000 jobs. But it’s only part of King County, Washington, which has roughly 2 million residents and more than 1 million jobs. And King County is just one of three counties that make up the wider Seattle metropolitan area, with a population of 3.5 million and 1.8 million jobs.

While low-wage jobs are prevalent in Seattle, they’re even more prevalent in its nearby suburbs. Using data from the American Community Survey, my colleague Sid Kulkarni and I calculated that between 2009 and 2011, there were on average 149,000 jobs (full-time and part-time) in the city of Seattle that paid less than $15/hour. Over the same period, the remainder of King County had an average of 216,000 jobs that paid hourly wages below that threshold. These low-wage jobs represented 30 percent of all jobs in Seattle, and 34 percent of all jobs in the rest of King County.

It stands to reason that low-wage jobs are more suburban than high-wage jobs. Typically, the highest-value jobs in a region are located in central cities. High-paying sectors like finance, advanced health care, information technology (Redmond notwithstanding), and higher education tend to be more urban than suburban. Yes, cities also have lots of low-paying jobs in hospitality and retail, but so do suburbs. Those jobs tend to follow people, and most people in major metro areas live in suburbs. As my colleague Elizabeth Kneebone has found, as population sprawls, so does low-wage work.

To be sure, many people who live in the King County suburbs of Seattle will benefit from a $15/hour Seattle minimum wage, because they work in the city. According to a University of Washington study conducted for Mayor Murray’s Income Inequality Advisory Committee, fully four in 10 people who earn less than $15/hour working in Seattle jobs—and who would thus presumably benefit from the minimum wage increase—live outside of the city. That’s particularly important in a region like Greater Seattle, where suburbs are home to most of the poor. At the same time, the UW study finds that nearly as many Seattle residents in sub-$15/hour jobs work outside the city limits.

None of this amounts to an argument against Seattle taking the first step toward increasing its minimum wage. Residential and commercial demand is so strong in the city these days that Seattle may have more latitude than its suburbs to boost its minimum wage significantly without encountering negative employment effects. And maybe the city needs to move first in order to convince its neighbors (and itself) that a $15/hour minimum wage won’t make the sky fall.

But these statistics offer an important reminder that the problems of low wages, inequality, and social mobility do not stop at city borders. Ultimately, more cities might try acting in coordination with their surrounding jurisdictions, as the District of Columbia did with two Maryland counties, to boost their minimum wages and ameliorate any “border effects.” And as Seattle contemplates other key policy initiatives, like universal preschool and backfilling state cuts to transit funding (a King County ballot initiative failed last month), it should keep open the lines of communication with its neighbors, and act as one county—or region—where it can.

Seattle Mayor Ed Murray recently announced a plan to raise the minimum wage in his city to $15/hour over the next few years. The plan emerged from a special business/labor advisory committee, approved by 21 out of 24 its members, after four months of hearings, academic studies, and debate . The measure awaits approval by the City Council, but the move to $15/hour in Seattle seems well underway.

Seattle may be the first, but it won’t be the last, city to take this bold step. Granted, there were some peculiarities in Seattle’s case, including a $15/hour minimum wage ballot initiative that succeeded in the nearby city of SeaTac in November, and the election of a new Socialist Party Seattle City Council member who campaigned on the issue. But with inequality taking center stage as a political issue in big cities around the country, mayors, businesses, and labor advocates are watching Seattle closely.

However, the focus on big cities shouldn’t obscure the fact that wages are a function of regional economics. Seattle is indeed a big city, with 635,000 residents and (by our count) nearly 500,000 jobs. But it’s only part of King County, Washington, which has roughly 2 million residents and more than 1 million jobs. And King County is just one of three counties that make up the wider Seattle metropolitan area, with a population of 3.5 million and 1.8 million jobs.

While low-wage jobs are prevalent in Seattle, they’re even more prevalent in its nearby suburbs. Using data from the American Community Survey, my colleague Sid Kulkarni and I calculated that between 2009 and 2011, there were on average 149,000 jobs (full-time and part-time) in the city of Seattle that paid less than $15/hour. Over the same period, the remainder of King County had an average of 216,000 jobs that paid hourly wages below that threshold. These low-wage jobs represented 30 percent of all jobs in Seattle, and 34 percent of all jobs in the rest of King County.

It stands to reason that low-wage jobs are more suburban than high-wage jobs. Typically, the highest-value jobs in a region are located in central cities. High-paying sectors like finance, advanced health care, information technology (Redmond notwithstanding), and higher education tend to be more urban than suburban. Yes, cities also have lots of low-paying jobs in hospitality and retail, but so do suburbs. Those jobs tend to follow people, and most people in major metro areas live in suburbs. As my colleague Elizabeth Kneebone has found, as population sprawls, so does low-wage work.

To be sure, many people who live in the King County suburbs of Seattle will benefit from a $15/hour Seattle minimum wage, because they work in the city. According to a University of Washington study conducted for Mayor Murray’s Income Inequality Advisory Committee, fully four in 10 people who earn less than $15/hour working in Seattle jobs—and who would thus presumably benefit from the minimum wage increase—live outside of the city. That’s particularly important in a region like Greater Seattle, where suburbs are home to most of the poor. At the same time, the UW study finds that nearly as many Seattle residents in sub-$15/hour jobs work outside the city limits.

None of this amounts to an argument against Seattle taking the first step toward increasing its minimum wage. Residential and commercial demand is so strong in the city these days that Seattle may have more latitude than its suburbs to boost its minimum wage significantly without encountering negative employment effects. And maybe the city needs to move first in order to convince its neighbors (and itself) that a $15/hour minimum wage won’t make the sky fall.

But these statistics offer an important reminder that the problems of low wages, inequality, and social mobility do not stop at city borders. Ultimately, more cities might try acting in coordination with their surrounding jurisdictions, as the District of Columbia did with two Maryland counties, to boost their minimum wages and ameliorate any “border effects.” And as Seattle contemplates other key policy initiatives, like universal preschool and backfilling state cuts to transit funding (a King County ballot initiative failed last month), it should keep open the lines of communication with its neighbors, and act as one county—or region—where it can.

In the long run-up to the Pennsylvania primary, there's been a good deal of candidate discussion of the state's economy and how to fix it.

But missing from the prescriptions of what the federal government would do and how it would do it has been a discussion of where it will happen.

That needs to change because place matters. For all the ink spilled on the declining fortunes of the commonwealth, there are many bright spots around the state that could be catalysts to growth and prosperity.

Recent Brookings research shows strength in varied fields across the state:

Advanced health care, pharmaceuticals, and information technology in Greater Philadelphia.

Health care, architecture and engineering, and banking in Pittsburgh.

Heavy construction, machinery and food processing in Lancaster.

Industrial gases, health care and higher education in the Lehigh Valley.

The state's economy is an amalgam of its 16 metropolitan areas that generate 92 percent of its economic output.

The top six metropolitan areas alone - Philadelphia, Pittsburgh, Harrisburg-Carlisle, Allentown-Bethlehem-Easton, Scranton/Wilkes-Barre, and Lancaster - constitute 68.4 percent of the state's population and produce 80.5 percent of the state's economic output.

The research underscores that four key assets overwhelmingly located in metropolitan areas - innovation, modern infrastructure, strong human capital, and quality places - are needed today to drive productivity of firms and workers, improve the wealth and opportunities of families, and ensure sustainable growth. America's metropolitan assets - the universities, the health-care concentrations, and the skilled-labor pools - are the drivers of our national economy and the key to future American competitiveness and success.

So what does this mean for Greater Philadelphia? And what would a more thoughtful federal role look like?

Two realms with extensive current federal involvement are transportation infrastructure and innovation. Cogent efforts from Washington in both these areas could significantly leverage state and local efforts.

Rather than thinly spreading transportation-infrastructure dollars across the country, the federal government should spend strategically.

For Greater Philadelphia, supporting its competitive advantage as the linchpin of Amtrak's Northeast Corridor with federal dollars for more frequent and reliable service would strengthen the region as a rail hub, as has been championed by the Greater Philadelphia Chamber of Commerce.

Additionally, federal transportation policy should empower metropolitan areas with the discretion to spend funds flexibly, whether that's improving the aging SEPTA system, beginning the work of reinventing and burying Interstate 95 to increase access to the Delaware waterfront, or increasing transit access of city residents to suburban jobs.

Regarding innovation, unfortunately, the federal government currently has no unified national strategy to maximize high-quality jobs and spread their benefits throughout the Philadelphia region. Instead, it has a series of highly fragmented investments and programs.

Current programs put strong emphasis on research, but are insufficiently attentive to the commercialization of that research and blind to how innovation and jobs arise from the intense interaction of firms, industry associations, workers, universities and investors - a nexus ready to be capitalized on in Greater Philadelphia as documented by the Economy League of Philadelphia in a report for the CEO Council for Growth.

To this end, the federal government should reorganize its efforts and create a National Innovation Foundation, a nimble, lean organization whose sole purpose would be to work with industries, universities, business chambers, and local and state governments to spur innovation. Similar, successful national agencies are already up and running in competing nations, such as Britain, France, Sweden and Japan.

This effort should include R&D and support for technology-intensive industries such as information technology and pharmaceuticals, but it also must make small and medium-size manufacturers more competitive and train workers in manufacturing and low-tech services to work smarter.

Looking forward, our federal government must realize this is a "Metro Nation" and value and strengthen economic juggernauts such as Philadelphia.

Only by organizing our currently fragmented investments in transportation and innovation - and targeting them where they will provide the greatest return, metropolitan America - will the United States continue not only to compete, but also to lead.

INTRODUCTION

Over the past decade, the focused attention of African nations, the United States, U.N. agencies and other multilateral partners has brought significant progress toward achievement of the Millennium Development Goals (MDGs) in health and malaria control and elimination. The potential contribution of these strategies to long-term peace-building objectives and overall regional prosperity is of paramount significance in sub-regions such as the Horn of Africa and Western Africa that are facing the challenges of malaria and other health crises compounded by identity-based conflicts.

National campaigns to address health Millennium Development Goals through cross-ethnic campaigns tackling basic hygiene and malaria have proven effective in reducing child infant mortality while also contributing to comprehensive efforts to overcome health disparities and achieve higher levels of societal well-being.

There is also growing if nascent research to suggest that health and other humanitarian interventions can result in additional benefits to both recipients and donors alike.

The social, economic and political fault lines of conflicts, according to a new study, are most pronounced in Africa within nations (as opposed to international conflicts). Addressing issues of disparate resource allocations in areas such as health could be a primary factor in mitigating such intra-national conflicts. However, to date there has been insufficient research on and policy attention to the potential for wedding proven life-saving health solutions such as malaria intervention to conflict mitigation or other non-health benefits.

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This presentation by Alan Berube to the Cleveland EITC Forum explains how boosting low-income families' participation in tax credits can help put the city's workers, neighborhoods, and the local economy itself on more solid financial ground.

The metro program hosts and participates in a variety of public forums. To view a complete list of these events, please visit the metro program's Speeches and Events page which provides copies of major speeches, powerpoint presentations, event transcripts, and event summaries.

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About 12,000 troops will parade through Tiananmen Square in Beijing tomorrow to celebrate the 70th anniversary of Japan’s surrender to the allies in World War II. China’s leadership is ostensibly using the anniversary as an opportunity, to use the Chinese phrasing, to celebrate “victory in the World Anti-fascist War and the Chinese people’s War of Resistance against Japanese Aggression.”

But really, the purpose is to display its modernized weaponry ahead of several key international visits by President Xi Jinping. For Western leaders, the parade has proven a diplomatic nightmare: The Chinese have pressured them to attend, but they realize that the event is aimed at celebrating the country’s new international assertiveness (and perhaps to sideline a rather bloody summer on the Chinese stock markets). 

Students pose with Chinese national flags and red stars in preparation for the parade on August 31, 2015. Photo credit: Reuters/China Daily.

It’s the present, stupid

Sixty-six years after the end of the war, the world has been learning how to deal with a new China—now a powerful country with a strong economy and an increasingly well-equipped military. China’s defense budget has seen a double-digit increase for the past 25 years, and the country now has J-15 fighter jets, Z-19 attack helicopters, and a truck-mounted version of the DF-41 intercontinental missile. There is little doubt the parade will be impressive both in precision and display. 

In spite of how the Chinese leadership spins it, the parade is not just about history—it’s also about the present and the future. China is using it as a moment to show off its strengths and assert a stronger role in the Asia-Pacific region (as tensions in the South China Sea remain high), if not the world.

The red carpet

One interesting sight will be the VIP box: Which heads of state will actually attend? Confirmed leaders include Russian President Vladimir Putin (who himself hosted Xi Jinping last May for a huge victory parade in Moscow); South African President Jacob Zuma; Venezuelan President Nicolas Maduro; Sudanese President Omar Hassan al-Bashir (who has an international arrest warrant against him); and—somewhat unexpectedly considering World War II sensitivities in the region—South Korean President Park Geun-hye. Park will attend ceremonies, but not the parade. North Korean leader Kim Jong Un will not be present, nor will Japanese Prime Minister Shinzo Abe. 

Fellow leading industrial nations countries don’t want to put Japan in a bind, but no one is willing to offend China. Hence, state leaders have responded to the standing Chinese invitation with an array of contortions. In the end, no Western leader will attend: President Barack Obama—who will be hosting Xi Jinping in the United States in a few weeks—will be represented by U.S. Ambassador to China Max Baucus. Unlike for the launch of the Asian Infrastructure Investment Bank (AIIB) earlier this year, Washington didn’t pressure other Western leaders to avoid Beijing. This wasn’t necessary, as those governments all had their own reasons for staying away. Even the German president—a largely ceremonial figure—has declined. So has his French counterpart François Hollande, who will travel to China in October to discuss climate issues; French Foreign Minister Laurent Fabius will attend instead. Italy will also be represented by its foreign minister. As for the United Kingdom, Prime Minister David Cameron chose to wait for the Chinese state visit to London in October to meet Xi in person. Britain is represented by a former Conservative cabinet minister, Kenneth Clarke. Even more surprising is the list of retired statesmen: former German Chancellor Gerhard Schroeder, who is known to have engaged with Russia’s Putin after leaving office in 2005, will be in there, like his friend and former U.K. counterpart Tony Blair. 

Aircraft perform during a rehearsal on August 23, 2015 for the September 3 military parade in Beijing. Photo credit: Reuters.

Enough troubles

The U.S.-China relationship is already complicated enough and needs no further upsets. While China flexes its muscles with a parade, America is in the middle of a presidential campaign during which candidates—such as Republican Wisconsin Governor Scott Walker, who recently called on President Obama to cancel Xi's visit—are openly criticizing China. For his part, Donald Trump claimed that “China would be in trouble” should he become president, adding: “The poor Chinese.” Although these kinds of comments cannot be taken too seriously, they will require even more diplomatic skills on the part of the current administration, and its successor, to fully restore fully the U.S.-China dialogue.

In these circumstances, it is no surprise that Washington has shown little interest in attending the Beijing events. Nor does the Obama administration want to be part of a demonstration of assertiveness weeks before a state visit to Washington by President Xi. History tells us that U.S.-China relations are going to get even more interesting than a parade.

I was honored today to speak at the kick off meeting of the new ReFormers Caucus. This group of over 100 former members of the U.S. Senate, the House, and governors of both parties, has come together to fight for meaningful campaign finance reform. In the bipartisan spirit of the caucus, I shared speaking duties with Professor Richard Painter, who was the Bush administration ethics czar and my predecessor before I had a similar role in the Obama White House. 

As I told the distinguished audience of ReFormers (get the pun?) gathered over lunch on Capitol Hill, I wish they had existed when in my Obama administration role I was working for the passage of the Disclose Act. That bill would have brought true transparency to the post-Citizens United campaign finance system, yet it failed by just one vote in Congress.  But it is not too late for Americans, working together, to secure enhanced transparency and other campaign finance changes that are desperately needed.  Momentum is building, with increasing levels of public outrage, as reflected in state and local referenda passing in Maine, Seattle and San Francisco just this week, and much more to come at the federal, state and local level.

One in five tax filers in the United States claims the Earned Income Tax Credit—a refundable federal tax credit targeted to low-income working Americans that has proven to be one of the nation’s most effective anti-poverty policies. Last year, at tax time the average EITC filer claimed just over $2,400 through the credit.

However, the share of filers claiming the EITC and the level of benefits they receive vary widely within and across communities, as shown by the local-level IRS data we post each year on our EITC Interactive data tool. For instance, almost one in three filers in the Memphis metro area claimed the credit (32 percent) in tax year 2013 compared to just 12 percent of filers in metro Boston. Local labor market conditions can affect these numbers, like the incidence and concentration of low-wage jobs or regional differences in cost of living and average wage levels. But the credit itself is also designed to vary across different kinds of filers and families. Maximum credit levels for workers without children are quite small, but they increase considerably for workers with one, two, or three children—boosting the credit’s work incentive and anti-poverty impacts.

For the first time, our EITC Interactive tool now includes data on how EITC receipt varies by the number of children claimed.

According to that data, last tax year workers without qualifying children received an average credit of $281 (Figure 1). Although they made up almost one in four EITC filers, childless workers accounted for just 3 percent of EITC dollars claimed, due to the small size of their credit (Figure 2). In contrast, workers with one child—the largest share of EITC filers (37 percent)—claimed an average credit of $2,316. Workers with two kids accounted for 27 percent of EITC filers, but with an average credit of $3,682 they took home 40 percent of all EITC dollars. Working families with three or more children made up the smallest share of EITC filers last tax year, but claimed the largest credit on average at $4,036.

These data, which are available down to the ZIP code level, offer insights into the ways in which the makeup of the EITC population (and the low-wage workforce more generally) varies across places. Returning to the Memphis and Boston regions, each metro area received more than half a billion dollars through the EITC last year ($517 and $512 million, respectively). However, the number of filers claiming the EITC was much larger in metro Boston (256,456) than in the Memphis metro area (178,241). In part, these numbers reflect the fact that 30 percent of metro Boston’s EITC filers were childless workers. In the Memphis metro area, just 15 percent of EITC filers did not have qualifying children, while 41 percent had one child, 31 percent had two children, and 12 percent had three or more children—higher than Boston’s share of EITC filers with children across the board (37 percent had one child, 24 percent had two children, and 9 percent had three or more children).

For EITC outreach campaigns working to ensure eligible filers claim the EITC at tax time, and for practitioners looking to use tax time to connect low-income workers to financial services and benefits, these numbers give a sense of who lives in their community and how to target their services. For advocates and policymakers, these numbers help shed light on how potential changes to the credit might affect different places.

For instance, the Obama administration, several legislators, and at least one presidential candidate have proposed expanding the EITC for workers without qualifying children to make it a more effective poverty alleviation and work support tool. Every congressional district in the country has childless workers or noncustodial parents who would stand to benefit from that expansion. But that expansion would be particularly important for the more than 240 districts—largely clustered on the coasts and roughly split between Republican and Democratic representatives—with above average shares of childless EITC filers (Map 1).

In contrast, if Congress does not act to make recent expansions to the credit permanent, every district will see a cut in EITC benefits in 2017, when the credit for workers with three or more children is set to disappear. In particular, more than 200 districts with above average shares of EITC filers with three or more kids—this time predominantly Republican districts clustered in the Intermountain West, parts of the Great Plains, and along the Texas border—would be most affected (Map 2). 

In the coming weeks, we will be delving deeper into the impact of proposed and potential changes to the EITC and releasing new resources on the EITC-eligible population and the credit’s anti-poverty impact. In the meantime, these new EITC Interactive data offer an important resource that can help practitioners, policymakers, advocates, and researchers better understand how the EITC affects low-income workers and families and their communities across the country.

Editors’ Note: According to a new Pew poll, half of Israeli Jews have come to seek not only a Jewish majority but even Jewish exclusivity in Israel. That doesn’t bode well for Arab-Jewish coexistence in Israel, writes Shibley Telhami—even aside from what happens in the West Bank and Gaza. This post originally appeared on the Monkey Cage blog.

When U.S. leaders and commentators warn that the absence of a two-state solution to the Israeli-Palestinian conflict will make it impossible for Israel to be both a Jewish and democratic state, they generally mean that a Jewish democracy requires a Jewish majority; if Israel encompasses the West Bank and Gaza, Arabs will become a majority. What they may not have realized is that, in the meantime, half of Israeli Jews have come to seek not only a Jewish majority but even Jewish exclusivity.

That is one of the most troubling findings of a new Pew poll in Israel. And it doesn’t bode well for Arab-Jewish coexistence in Israel—even aside from what happens in the West Bank and Gaza.

This major study was conducted from October 14, 2014, to May 21, 2015, among 5,601 Israeli adults ages 18 and older. (Disclosure: I served as an adviser to the project). It found that 48 percent of all Israeli Jews agree with the statement “Arabs should be expelled or transferred from Israel,” while 46 percent disagreed. Even more troubling, the majority of every non-secular Jewish group, including 71 percent of Datim (modern orthodox Jews) agreed with the statement.

While age is not much of a factor when it comes to attitudes toward expelling Arabs from Israel, younger Israelis are slightly more likely to agree with the statement that Arabs should be expelled than older Israelis.

These attitudes are anchored in a broader view of identity and of the nature of the Israeli state. Overall, only about a third of Israeli Jews say their Israeli identity takes precedence over their Jewish identity, with the overwhelming majority of every group, except for secular Jews, saying their Jewishness comes first.

This view has consequences for citizen rights. Not surprisingly, the overwhelming majority of all Jewish Israelis (98 percent) feel that Jews around the world have a birthright to make aliya (immigration to Israel with automatic Israeli citizenship). But what is striking is that 79 percent of all Jews, including 69 percent of Hilonim (secular Jews) say that Jews deserve “preferential treatment” in Israel—so much for the notion of democracy with full equal rights for all citizens.

These attitudes spell trouble for Arab citizens of Israel who constitute 20 percent of Israel’s citizens. It’s true that attitudes are dynamic; they are partly a function of Jewish-Arab relations within Israel itself, but also outside, especially within the broader Palestinian-Israeli conflict. Like their Jewish counterparts, Arab citizens of Israel (mostly Muslim, but also including Christians and Druze), identify themselves with their ethnicity (Palestinian or Arab) or religion above their Israeli citizenship. And these ethnic/religious identities intensify when conflict between Israel and the Palestinians in the West Bank and Gaza intensifies. There is no way to fully divorce the broader Palestinian-Israeli conflict from Arab-Jewish relations within Israel.

In recent years, this latter linkage has become central for two reasons: loss of hope for a two-state solution, and the rise of social media that has displayed extremist attitudes that used to be limited to private space. In the era of Facebook and Twitter, Arab and Jewish citizens post attitudes that deeply offend the other: An Arab expresses joy at the death of Israeli soldiers killed by Palestinians, while a Jew posts a sign reading “death to Arabs.” Hardly the stuff of co-existence. Leave it to opportunist politicians, extremists and incitement to do the rest.

But there is also an American responsibility—not so much with regard to failure of diplomatic efforts, but with the very positing of the nature of the conflict itself, and the nature of the state of Israel. As President Obama considers steps he could undertake on the Israeli-Palestinian conflict before leaving office, he may contemplate addressing what has become a distorting and detrimental discourse that serves to give a pass to non-democratic attitudes, and diversion of attention from core problems.

First, there is something wrong with positing the possibility of Arabs as constituting a demographic problem for Israel. It legitimizes the privileging of Jewishness over democracy. It also distorts the reason why Israel is obligated to end occupation of the West Bank and Gaza; it has nothing to do with the character of Israel as such, but with international law and United Nations resolutions.

Second, while states can define themselves as they wish (and are accepted by the international community accordingly), the American embrace of the “Jewishness” of Israel, cannot be decoupled from the Palestinian-Israeli context, or from the overarching American demand that all states must be for all their citizens equally.

In part, this is based on the notion that the UN General Assembly (Resolution 181) recommended in 1947 dividing mandatory Palestine into an “Arab” and a “Jewish” State. In part, it’s based on the notion that the Palestinian-Israeli conflict is a political conflict that can be resolved through two states, one manifesting the self-determination of Jews as a people, and one manifesting the right of self-determination of Palestinians as a people. The two were bound together. An embrace of a Jewish state that excludes a Palestinian state defeats the principle.

If two states become impossible, America chooses democracy over Jewishness. In fact, this has been consistently reflected in American public attitudes across the political spectrum, most recently in this November 2015poll; in the absence of a two-state solution, 72 percent of Americans would want a democratic Israel, even if it meant that Israel ceases to be a Jewish state with a Jewish majority.

More centrally, even with two states—one manifesting Jewish self determination and one Palestinian self-determination—an overarching, principled American position takes precedence: If Israel is a state of the Jewish people, it must also be above all a state of all its citizens equally; (and if Palestine is to be a state of the Palestinian people, it must also be a state of all its citizens equally). This democratic principle, highlighted front and center in a reformulated American position, can help avoid legitimizing undemocratic attitudes in the name of Jewish identity.

Event Information

Under the Food and Drug Administration Amendments Act (FDAAA) of 2007, the FDA has the authority to require pharmaceutical manufacturers to develop Risk Evaluation and Mitigation Strategies (REMS) for drugs or biologics that carry serious potential or known risks. Since that time, the REMS program has become an important tool in ensuring that riskier drugs are used safely, and it has allowed FDA to facilitate access to a host of drugs that may not otherwise have been approved. However, concerns have arisen regarding the effects of REMS programs on patient access to products, as well as the undue burden that the requirements place on the health care system. In response to these concerns, FDA has initiated reform efforts aimed at improving the standardization, assessment, and integration of REMS within the health care system. As part of this broader initiative, the agency is pursuing four priority projects, one of which focuses on improving provider-patient benefit-risk counseling for drugs that have a REMS attached.

Under a cooperative agreement with FDA, the Center for Health Policy at Brookings held an expert workshop on July 24 titled, “Risk Evaluation and Mitigation Strategies (REMS): Building a Framework for Effective Patient Counseling on Medication Risks and Benefits”. This workshop was the first in a series of convening activities that will seek input from stakeholders across academia, industry, health systems, and patient advocacy groups, among others. Through these activities, Brookings and FDA will further develop and refine an evidence-based framework of best practices and principles that can be used to inform the development and effective use of REMS tools and processes.

Event Materials

• REMS_PBRC_Meeting_Agenda
• REMS BR Speaker Bios
• REMS BenefitRisk Meeting Summary
• REMS BenefitRisk communication white paper

Summary

Global education plays an important role in contributing to U.S. foreign policy objectives. In a recent speech, Secretary of State Hillary Clinton highlighted education, along with health, agriculture, security, and local governance as the core areas for U.S. international development investment. She emphasized the importance of education, particularly of girls and youth, in improving global stability, speeding economic growth, and helping global health, all of which advance U.S. interests in the world.

But how effective has the U.S. government been in supporting global education? Unfortunately, its many good education activities and programs are not leveraged for maximum impact on the ground, especially in situations of armed conflict and state fragility. Challenges of U.S. foreign assistance—for example, fragmentation across multiple agencies, lack of policy coherence, diminished multilateral engagement—generally affects its work in education. Luckily some of the core strengths of U.S. assistance have an impact as well, specifically the large amount of resources (in total terms, if not relative terms) devoted to education and the vast breadth and depth of American academic, philanthropic and NGO partners engaged in pioneering work on education in the developing world.

This report analyzes the effectiveness of U.S. government education work specifically in relation to conflict-affected and fragile states. Findings across five domains—global reach, resources, technical expertise, policy and multilateral partnerships—show that U.S. education aid falls critically short of what it is capable of achieving. The U.S. government has substantial strengths in this area, especially in global reach, resources, and technical expertise, demonstrating a real comparative advantage in the field of education in situations of conflict and fragility. However, its fragmented policy across agencies and its limited multilateral engagement prevent it from maximizing its strengths, leaving it punching below its weight on this important issue. In this sense, the U.S. government is a classic underachiever, failing to efficiently deploy its many capabilities and potential for maximum impact.

There has never been a better time for looking at the aid-effectiveness of U.S. government education work. The Obama administration is bringing increased focus on the Paris Principles for Aid Effectiveness to its development initiatives. The U.S. Congress is actively engaged with pending legislative action to modernize foreign assistance and improve U.S. support for universal education. Two major reviews of foreign assistance are underway: the Quadrennial Diplomacy and Development Review led by the Department of State and USAID, and the Presidential Study Directive on U.S. Global Development Policy led by the White House.

Questions about foreign assistance reform asked in these two reviews can be applied to the education sector. For example, how can the U.S. government improve its education assistance by using a “whole-of-government” approach, by focusing on comparative advantages and strengths, and by improving coordination and by increasing multilateral engagement?

Careful analysis and answers to these questions can help propel the U.S. from its current position as an underachiever to being a leader in global education, specifically in contexts of conflict and state fragility.

This report makes nine specific recommendations, many of which could be achieved without any substantial increase in funding, that would enable the U.S. government to greatly increase the effectiveness of its education aid to populations living in contexts of conflict and state fragility.

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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.   

Unlike prime-age Americans, who have experienced declines in employment and labor force participation since the onset of the Great Recession, Americans past 60 have seen their employment and labor force participation rates increase.

In order to understand the contrasting labor force developments among the old, on the one hand, and the prime-aged, on the other, this paper develops and analyzes a new data file containing information on monthly labor force changes of adults interviewed in the Current Population Survey (CPS).

The paper documents notable differences among age groups with respect to the changes in labor force transition rates that have occurred over the past two decades. What is crucial for understanding the surprising strength of old-age labor force participation and employment are changes in labor force transition probabilities within and across age groups. The paper identifies several shifts that help account for the increase in old-age employment and labor force participation:

• Like workers in all age groups, workers in older groups saw a surge in monthly transitions from employment to unemployment in the Great Recession.
• Unlike workers in prime-age and younger groups, however, older workers also saw a sizeable decline in exits to nonparticipation during and after the recession. While the surge in exits from employment to unemployment tended to reduce the employment rates of all age groups, the drop in employment exits to nonparticipation among the aged tended to hold up labor force participation rates and employment rates among the elderly compared with the nonelderly. Among the elderly, but not the nonelderly, the exit rate from employment into nonparticipation fell more than the exit rate from employment into unemployment increased.
• The Great Recession and slow recovery from that recession made it harder for the unemployed to transition into employment. Exit rates from unemployment into employment fell sharply in all age groups, old and young.
• In contrast to unemployed workers in younger age groups, the unemployed in the oldest age groups also saw a drop in their exits to nonparticipation. Compared with the nonaged, this tended to help maintain the labor force participation rates of the old.
• Flows from out-of-the-labor-force status into employment have declined for most age groups, but they have declined the least or have actually increased modestly among older nonparticipants.

Some of the favorable trends seen in older age groups are likely to be explained, in part, by the substantial improvement in older Americans’ educational attainment. Better educated older people tend to have lower monthly flows from employment into unemployment and nonparticipation, and they have higher monthly flows from nonparticipant status into employment compared with less educated workers.

The policy implications of the paper are:

• A serious recession inflicts severe and immediate harm on workers and potential workers in all age groups, in the form of layoffs and depressed prospects for finding work.
• Unlike younger age groups, however, workers in older groups have high rates of voluntary exit from employment and the workforce, even when labor markets are strong. Consequently, reduced rates of voluntary exit from employment and the labor force can have an outsize impact on their employment and participation rates.
• The aged, as a whole, can therefore experience rising employment and participation rates even as a minority of aged workers suffer severe harm as a result of permanent job loss at an unexpectedly early age and exceptional difficulty finding a new job.
• Between 2001 and 2015, the old-age employment and participation rates rose, apparently signaling that older workers did not suffer severe harm in the Great Recession.
• Analysis of the gross flow data suggests, however, that the apparent improvements were the combined result of continued declines in age-specific voluntary exit rates, mostly from the ranks of the employed, and worsening reemployment rates among the unemployed. The older workers who suffered involuntary layoffs were more numerous than before the Great Recession, and they found it much harder to get reemployed than laid off workers in years before 2008. The turnover data show that it has proved much harder for these workers to recover from the loss of their late-career job loss.

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I was honored today to speak at the kick off meeting of the new ReFormers Caucus. This group of over 100 former members of the U.S. Senate, the House, and governors of both parties, has come together to fight for meaningful campaign finance reform. In the bipartisan spirit of the caucus, I shared speaking duties with Professor Richard Painter, who was the Bush administration ethics czar and my predecessor before I had a similar role in the Obama White House. 

As I told the distinguished audience of ReFormers (get the pun?) gathered over lunch on Capitol Hill, I wish they had existed when in my Obama administration role I was working for the passage of the Disclose Act. That bill would have brought true transparency to the post-Citizens United campaign finance system, yet it failed by just one vote in Congress.  But it is not too late for Americans, working together, to secure enhanced transparency and other campaign finance changes that are desperately needed.  Momentum is building, with increasing levels of public outrage, as reflected in state and local referenda passing in Maine, Seattle and San Francisco just this week, and much more to come at the federal, state and local level.

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Despite being a developed and prosperous country, Japan faces a host of basic challenges today and going forward—some of its own creation and others beyond the country’s control. For example, Japan lacks essential natural resources, while also facing overcrowding in cities and depopulation in rural areas. As a result, food and energy self-sufficiency is low. Also, while the dual phenomena of a low birthrate and an ageing population have long been deemed problematic, these issues are rapidly growing more serious. The problems Japan faces today are potentially the same problems the rest of the world will face in the near future. Japan, therefore, may serve as a bellwether for the global community as many nations anticipate similar challenges in the future.  

On October 26, the Center for East Asia Policy Studies at Brookings and the U.S.-Japan Research Institute co-hosted Hiroshi Komiyama, chairman of the Mitsubishi Research Institute and president emeritus of the University of Tokyo, for a discussion of his recent book, “Beyond the Limits to Growth: New Ideas for Sustainability from Japan.” In this book, Komiyama examines the issues facing Japan—and the world—presenting a number of potential viable solutions and offering insights into Japan’s experiences and the lessons it can provide for a more sustainable future.

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• Overcoming the limits to growth: Sustainability lessons from Japan

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• Uncorrected Transcript (.pdf)

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INTRODUCTION

Over the past decade, the focused attention of African nations, the United States, U.N. agencies and other multilateral partners has brought significant progress toward achievement of the Millennium Development Goals (MDGs) in health and malaria control and elimination. The potential contribution of these strategies to long-term peace-building objectives and overall regional prosperity is of paramount significance in sub-regions such as the Horn of Africa and Western Africa that are facing the challenges of malaria and other health crises compounded by identity-based conflicts.

National campaigns to address health Millennium Development Goals through cross-ethnic campaigns tackling basic hygiene and malaria have proven effective in reducing child infant mortality while also contributing to comprehensive efforts to overcome health disparities and achieve higher levels of societal well-being.

There is also growing if nascent research to suggest that health and other humanitarian interventions can result in additional benefits to both recipients and donors alike.

The social, economic and political fault lines of conflicts, according to a new study, are most pronounced in Africa within nations (as opposed to international conflicts). Addressing issues of disparate resource allocations in areas such as health could be a primary factor in mitigating such intra-national conflicts. However, to date there has been insufficient research on and policy attention to the potential for wedding proven life-saving health solutions such as malaria intervention to conflict mitigation or other non-health benefits.

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Editors’ Note: On March 23, the Working Group on Egypt sent a letter to President Obama urging him to publicly and privately object to Egyptian President Abdel Fattah el-Sissi’s accelerating crackdown on human rights and civil society organizations. Brookings senior fellow and director of the Center for Middle East Policy Tamara Wittes was among the letter’s signers, and she explains her decision to do so. The letter was originally published by the Project on Middle East Democracy (POMED).

Tamara Wittes: In a disordered Middle East, America needs anchors of stability and reliable partners to help it achieve its goals. Both are in sadly short supply. 

For more than thirty years, Egypt was an anchor of stability and a reliable American partner in regional security. From the time Sadat expelled Soviet advisers and broached peace with Israel, ties with Egypt have been a core pillar of American Middle East policy. But, as my colleague Steven Cook presciently noted way back in February 2012, Egypt’s revolution accelerated the launch of what he calls a “long goodbye” between these two formerly indispensable partners. He argued back then that shifting from a “special relationship” to something more transaction would have four concrete benefits for Washington:

First, Washington will no longer be in the unseemly position of providing taxpayer largesse—however small in the grand scheme of things—to a government that resents the United States and clearly does not share its values. Second, it will provide an opportunity for a much-needed change in military-to-military relations in which the United States merely pays for the services it needs like expedited transit through the Suez Canal. Third, it is consistent with this moment of empowerment and dignity for Egyptians many of whom do not want U.S. assistance either because they believe it actually stands in the way of a democratic transition or accept Aboul Naga’s argument along with those who couldn’t care less about U.S. assistance because it doesn’t touch their lives. Finally, it will free up funds for the United States to help others who actually might want Washington’s help, perhaps the Tunisians, Moroccans, or some sub-Saharan African countries would be grateful for development assistance.

Since that blog post went up, Egypt has had three different governments and lost its place as a diplomatic and security leader in the region; while the United States has withdrawn from Iraq and begun to do the same in Afghanistan, while emphasizing burden-sharing in its new fight against ISIS. All of these shifts strengthen the argument for a more distant and transactional U.S.-Egyptian relationship. 

Moreover, since his accession to power (first in a military coup in July 2013 and then in a highly constrained election in 2014), President Abdel Fattah el-Sisi has made decisions that are undermining both Egypt’s domestic stability and key American policy goals in the region. 

• Sisi’s failure to move forward on economic reforms (recommended by leading Egyptian voices, regional supporters, and international donors) has left his country in a spiral of shrinking cash reserves, capital flight and currency devaluation that together threaten the government’s ability to import needed food and medicine and to carry out core government functions. 
• Sisi’s counterterrorism campaign in the Sinai has succeeded in “making the sand jump,” as one regional security official told me, but it seems to have stoked more than tamped down the fire of violent extremism threatening both Egypt and Israel; meanwhile, its alleged military abuses have sparked a Senate request for investigation.
• The intense political polarization and relentless repression of post-coup Egypt are producing other destabilizing effects, which are detailed in the Egypt Working Group’s newest letter to President Obama posted below (I am a member of the Working Group). 

To top it all off, the Egyptian government continues to throw obstacles in the road of U.S.-Egyptian cooperation. Its military resists learning from the hard-won American experience in effective counterinsurgency. Its leadership has resolutely refused to allow core bilateral aid programs, like those supporting higher education, to move forward. And at the same time, the Egyptian government continues to promote conspiracy theories about the United States to its public through media smears and show trials, and now, apparently, to its newly elected parliamentarians. 

It’s long past time for the United States to undertake a strategic review of its approach to the Middle East, one focused on building anchors of stability and sustaining reliable partners in pursuit of American priorities. Egypt, as I told The New York Times, no longer qualifies as either one. That doesn’t mean the two countries can’t continue to work together in those narrow areas where they agree on interests, priorities, and approaches. 

But Secretary of State Kerry’s public embrace last week of Egyptian Foreign Minister Shoukry cannot hide the facts—there is no “back to business” option for the U.S.-Egyptian relationship, and it seems increasingly clear that even direct White House engagement would not shift Egypt’s leadership off of its self-destructive trajectory. Egypt's looming instability demands that the United States take steps now to safeguard itself from reliance on a country we cannot rescue, not least from its own leaders' worst impulses. 

March 23, 2016

Dear Mr. President,

We are writing to urge you to speak directly with Egyptian President Abdel Fattah el-Sissi and to express both publicly and privately your objection to his accelerating crackdown on human rights, including recent moves to prosecute civil society organizations. You were correct to declare in September 2014 that “America’s support for civil society is a matter of national security,” and nowhere is that more true than in Egypt today.

President el-Sissi’s campaign against civil society takes place against the backdrop of unprecedented abuses by Egyptian security forces, including extrajudicial killings, the detention of tens of thousands of political prisoners, the widespread documented use of torture, and the forced disappearances of hundreds of Egyptians. The killing of Italian student Giulio Regeni, whose tortured body appeared on a roadside near Cairo a week after his abduction in late January, has come to international attention, but many Egyptians have shared his fate since President el-Sissi came to power.

On March 24, an Egyptian court will hear a request to freeze the bank accounts and other assets of two internationally-respected human rights defenders, Hossam Bahgat and Gamal Eid, along with members of Eid’s family. Mr. Bahgat and Mr. Eid and other activists may soon be indicted and face trial for illegally accepting foreign funding—a criminal charge that violates their right to free association and could carry a sentence of up to 25 years in prison.

The imminent proceedings are a major step in Egyptian authorities’ campaign to crush the last remnants of Egypt’s independent civil society and human rights community. Egypt’s media has recently reported that dozens of organizations are under criminal investigation, essentially for their peaceful work to monitor abuses and to hold Egypt’s government accountable to its own constitution and international human rights commitments. In recent weeks, Egyptian authorities have ordered the closure of a prominent anti-torture organization, the Nadeem Center; summoned staff from several human rights organizations for interrogation; banned prominent rights activists and advocates from traveling outside Egypt in violation of the Egyptian constitution; and harassed and threatened human rights activists with arrest and violence. The media regularly propagate vitriol against human rights defenders, portraying them as traitors and security threats.

If this crackdown is allowed to reach its conclusion, it will silence an indigenous human rights community that has survived more than 30 years of authoritarian rule, leaving few if any Egyptians free to investigate mounting abuses by the state.

The current attacks on Egypt’s rights advocates are a continuation of the same criminal prosecution of American and German NGO workers in Egypt that began in 2011. That prosecution, driven by senior members of the Egyptian government still in high office today, resulted in the June 2013 criminal convictions, in a deeply flawed trial, of 43 Egyptian and international NGO staff, including 17 American citizens. President el-Sissi, who was the head of military intelligence in 2011 when Egypt’s military government launched the investigation, has refused repeated requests to overturn the convictions.

While the current crackdown is primarily targeting domestic organizations, there are indications that international NGOs may also face increased pressure, including some that currently do not even have offices or staff working in Egypt. On March 20, the newspaper Al Masry Al Youm published the names of more than 150 individuals and civil society organizations reportedly under investigation for receiving foreign funding, including prominent American and European organizations such as the Center for International Private Enterprise, the Solidarity Center, Transparency International, Save the Children, Catholic Relief Services, CARE, AMIDEAST, the National Democratic Institute, and the International Republican Institute.

Mr. President, in your September 2014 Presidential Memorandum on Civil Society, you pledged that the United States government—including you personally—would stand firmly with those in civil society facing pressure or harassment from their governments. While the past five years have been tumultuous and challenging for U.S. policy toward Egypt, this is another defining moment for the United States, a moment that tests your pledge to “stand with civil society.” Secretary Kerry’s March 18 statement of concern was welcome, but further action is urgently needed. Past practice demonstrates that when the United States government speaks clearly, in one voice, and consistently on NGO freedom and human rights in Egypt, the government in Cairo listens.

It is essential that you act to stand up for human rights, freedom of association, and the rights of both Egyptian and international civil society organizations to work together on behalf of common goals. You must make crystal clear to President el-Sissi that continued assaults on civil society, including harassment of U.S. organizations, will make it difficult for the administration to cooperate across a range of issues, including your administration’s efforts to promote American investment in Egypt and to provide financial assistance to the Egyptian government and military. If Egypt’s government continues down a path to destroy its own civil society, American support and assistance will become, in both principled and practical terms, impossible.

Sincerely,

The Working Group on Egypt