Time for a Plan C

Originally published in The Washington Monthly on November 26, 2013.
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After years of fighting to make Plan B available without a prescription to girls of any age, the discouraging announcement that Norlevo, a European drug identical to Plan B, loses effectiveness in women who weigh more than 165 pounds and is completely ineffective for women who weigh more than 176 pounds, casts a dark shadow on what was previously celebrated as a victory for women’s health and empowerment. The racial and economic disparities of those who can benefit from Plan B turn out to be much starker than previously understood.

Manufacturers of the European drug announced that they will be updating their packaging information to reflect the weight limits, but it’s unclear yet whether the U.S. will make similar changes to the American version.

When the Obama Administration decided this past June to allow a federal district judge’s ruling to stand—which said that girls younger than 17 should be allowed to purchase plan B over the counter—it seemed like hard-won triumph for the scientific community and women’s rights organizations.

Planned Parenthood Federation of America president Cecile Richards, called the government’s decision to drop the appeal “a huge breakthrough for access to birth control and a historic moment for women’s health and equity.”

Yet this turns out to be a far greater “breakthrough” for some women than for others.

People knew Plan B was hard for poor people to access before this announcement. It’s expensive! One package typically costs between $30 to $65, which can be hard to raise on very short notice. In an economy where nearly 2/3 of the 3.6 million minimum wage workers are women, the affordability of Plan B is already a difficult if not impossible expense.

And, as one might expect, American women often come in over this new weight range. According to the Centers for Disease Control and Prevention, the average weight of American women during the years of 2007-2010 was 166.2 pounds. The average weight of non-Hispanic black women aged 20-39 was 186 pounds, and among Mexican-American women, 78 percent were overweight or obese.

To sum up: Plan B is an ineffective and often unaffordable emergency contraceptive for many American women, particularly minorities.

According to the Guttmacher Institute, in 2006, black women had the highest unintended pregnancy rate of any racial or ethnic groups. At 91 per 1,000 women aged 15-44, it was more than double that of non-Hispanic white women.

Plan B is not an abortion pill, like RU-486, which must be administered in a doctor’s office. Instead, it prevents the fertilization of an egg—which is why it must be used within about 120 hours of intercourse. The drug has been available by prescription since 1999, and contains levonorgestrel, a synthetic version of the hormone progestin. Levonorgestrel has been used in birth control pills for more than 35 years; Plan B contains a higher dose and is taken as two separate doses 12 hours apart.

But drug makers say they’re unsure if increasing levonorgestrel levels further would boost its effectiveness for women over 165 pounds. A spokeswoman for the European drug said, “A dose increase of levonorgestrel is not proven to be a solution for this problem.”

The spokeswoman recommended women with higher weight consider intrauterine devices (IUDs) as an alternative. Yet IUDs are even more expensive, costing anywhere from $500-$1000.

As the abortion fight wages on around the country, with more and more states and cities looking for ways to limit access to abortions or ban them entirely, the fact that a safe and legal abortion alternative is ineffective for many women is rotten news.

At least under the Affordable Care Act, women do have more options than they did several years ago. Birth control and preventive services like mammograms are now covered (barring more legal challenges); insurance premiums are now equal across genders.

But unplanned pregnancy is still a problem—even birth control isn’t 100% effective.

The U.S. Department of Health and Human Services’ Healthy People 2020 campaign aims to reduce unintended pregnancy by 10%, from 49% of pregnancies to 44% of pregnancies, over the next 10 years. According to the Guttmacher Institute, about half of the 6.7 million pregnancies in the United States each year (3.2 million) are unintended.

An emergency contraceptive that disproportionately benefits wealthier and skinnier Americans cannot be the only (relatively) affordable option. If we truly want to help reduce unplanned pregnancy and improve all women’s health and equality, then we need a plan C.

Lance Armstrong’s Ignoble Last Stand

Originally published in The Washington Monthly on November 21, 2013.
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Yesterday, in a last ditch effort to avoid testifying in court to his doping history, Lance Armstrong agreed to pay a $3 million settlement to a Nebraska-based insurance company which had previously given him performance bonuses. In exchange for the money, Armstrong’s sworn written statements will likely be barred from release.

Seems like a lot of money to avoid another testimony, considering he’s already publicly admitted to Oprah Winfrey that he used performance-enhancing drugs. That is, until you realize that if he admits in a court of law that he lied to his sponsors about doping, it will make it much easier to get him to pay monstrous financial penalties. The $3 million is a paltry price to pay in comparison to what Armstrong is really up against.

After Armstrong admitted to doping in January, he’s been busy with a litany of pending lawsuits in state and federal court. And the federal suit, brought on behalf of the U.S. Postal Service, his primary sponsor, is seeking hefty retribution. Under the Federal False Claims Act, a U.S. citizen can pursue major lawsuits against entities accused of defrauding the federal government. A guilty verdict means that the defendant must pay triple the amount of damages—in this case the trial could cost Armstrong up to $120 million, or three times what the U.S. Postal Service spent to sponsor Armstrong’s team over the course of six years.

It’s sure been a crap year for Lance Armstrong. He had to return his Olympic medal,give up his seven Tour de France awards, and lose all his major sponsors. Yet still, it could stand to get much worse.

In 2005, Armstrong testified under oath that he did not use performance-enhancing drugs. And now the trial attorney representing the U.S. government is accusing Armstrong of falsifying documents, evading drug tests, and committing perjury.

It might seem strange to see Armstrong twisting arms to get out of testifying in court something he already admitted so forthrightly on TV. But TV is just TV; it’s not legally binding. One can claim entertainment value, or First Amendment liberties, or any sorts of clever/dubious rationales. (A judge already dismissed a case this past September saying that Armstrong’s lies are protected in his memoirs because they were not advertising other products.)

Besides, Armstrong’s defense centers less on whether or not he used drugs and more on what others perceived as the contractual agreement between them at the time. Insurance companies and the Postal Service paid him millions of dollars to sponsor him and his team, and they argue that their name is defrauded as a result.

Armstrong argues that the Postal Service knew of his doping allegations and thus got exactly what they bargained for. He defends himself by saying that the government took no steps to investigate him despite the evidence, because they were contently reaping the fruits of his fame.

Given that Lance Armstrong realizes he’s going to have to pay some sum of money for all these suits—suddenly $3 million doesn’t seem so bad. One can understand why he’d try and avoid more concerted, direct legal questioning that could be used against him in future lawsuits. And the legal issues differ in these cases than in the content of his Oprah interview. Had he testified today in Austin he’d likely be faced with a barrage of questions about what he represents, what he told his sponsors specifically, did they rely on his representations, why exactly did they give him money, etc.

Some people are watching these events play out with a substantial level ofschadenfreude—the slow, painful and expensive downfall of the duplicitous cyclist represents cold hard justice. Yet this is heartbreaking for many others. I even had a family member quite close to me repeatedly defend Armstrong’s record, and wore his Livestrong bracelet every day for more than a decade until last year, when he finally couldn’t manage to defend him anymore. Lance Armstrong raised near $500 millionfor cancer research, and provided serious inspiration for people all around the world. There’s something ultimately depressing about all this, that snark, scorn and mockery can’t quite assuage.

Teacher Transfer

Originally published in The Washington Monthly on November 18, 2013.

A new study released this month by the U.S. Department of Education’s Institute of Education Sciences (IES) and Mathematica showed that transferring top elementary school teachers to low-income schools can help improve students’ performance. The problem is, even with monetary incentives, few seem eager to actually move.

The comprehensive study, which looked at large and economically diverse school districts, was designed to test the effectiveness of a strategy known in the ed reform world as “Talent Transfer Initiative” (TTI). Among other factors, it measured whether high performing teachers would move to low-income schools for two years if they were offered an additional $20,000 bonus.

Education reformers have looked to TTI as a way to remedy the growing resource and performance inequities between our nation’s best and worst schools, and to “professionalize” the teaching industry. Finding ways to reward top teachers is an integral part of many reformers’ vision of transforming the education field.

For this study, researchers presented 1,514 high performing teachers with the opportunity to consider transferring to a low-performing school for two years, in exchange for a $20,000 bonus. Participation rates were disappointing: 68 percent did not attend an information session and 78 percent did not fill out an online application. Ultimately, 88 percent of their target vacancies were filled, but clearly this points to some serious scaling challenges to this strategy.

In the past, TTI has been implemented in cities like Mobile, Alabama, Chattannooga, Tennessee and Palm Beach, Florida. These experiments compelled researchers to attempt to assemble a list of best practices, with regards to both timing and the scale of implementation. Researchers studied what kind of teacher was most likely to transfer and from where, as well as the intermediate impacts on students’ performances and test scores and teacher retention rates. They found that, in elementary schools, TTI teachers had positive impacts on reading and math test scores, although the evidence was sparser in middle schools. But if one combines the elementary school and middle school data, the impact was overall positive and statistically significant.

The study also drew some economic conclusions. They compared TTI to another popular proposed reform—classroom size reduction—and found that TTI was a cheaper alternative for comparable results. This was true at least in elementary schools, where they found it could save $13,154 per team, and in the long run even up to $40,000. Yet the evidence was mixed when exploring specific districts and middle schools, raising questions about whether it’s always more cost effective across the board.

Some suggest that the monetary incentive should be higher, or other incentives should be in place, to encourage more teachers to transfer to lower-performing schools. Teach For America for example, incentivizes college graduates not so much through money but by offering participants inclusion in an elite organization. Right now there is little prestige attached to TTI, just the $20,000 monetary bonus. Reformers might want to see if there’s a more distinct way to incorporate prestige; one can imagine this type of federal incentive packaged in the form of a special fellowship that includes elite conferences and training opportunities, meetings with and high recognition from state legislators, or even just seen as a nationally venerated program like AmeriCorps or Peace Corps.

Thoughts on the Closing of Open Zion

Originally published in The Daily Beast on November 11th, 2013.
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If the latest research on the American Jewish community has shown us anything, it’s that very often the people in positions of power, the leaders with the soapboxes and editorial positions, do not profess views that represent an overwhelming number of the individuals they claim to represent. And so, it was with great disappointment that I learned Open Zion would be closing shop and Peter Beinart would be moving on to new journalistic opportunities.

It seems strange to feel attached to a site that has existed for only a year and a half, and yet I know that I’m not alone in feeling a nervous sense of loss.

Part of what leaves people feeling unnerved is that there just is no other institutionalized forum for this kind of daily online discussion and debate. And especially at this time, right smack in the middle of fragile peace negotiations, losing that type of space provides a stark reminder of what kind of void it was originally created to fill. And how not even the finest Jewish publications out there, like The Forward and JTA really make it their mission to provide that kind of frankly uncomfortable discourse about the Israeli-Palestinian conflict. We can click between Mondoweiss, Al Jazeera, Commentary Magazine, +972 Magazine, The Jerusalem Post  and all the others to try to piece together what perhaps is the spectrum of the debate, but there’s no real space where they all converge. And unfortunately, it’s these media bubbles that so often replicate, reinforce and reproduce our fractious politics. Open Zion was not just an interesting news source, but an experiment to break down the dichotomy between the progressive and conservative media.

I remember attending a J Street U winter conference in January of 2012; Peter Beinart came to talk to me and dozens of other students about his upcoming book The Crisis of Zionism that would be released later that year. He informed us then that he was in the midst of launching a new website, Zion Square, which later became known as Open Zion, to “start a new kind of conversation.”

Everyone working on these issues began reading Open Zion. Where else could you read Yousef Munayyer and Gil Troy side-by-side? What other platform in the Jewish press gave the freedom for writers like Maysoon Zayid to weigh in next to Alan Dershowitz and Danny Dayan? But what seemed so “revolutionary” at the time just turned out to be patently obvious to us now. Of course we need that kind of space. We need to be reading Ali Gharib’s reporting next to Brent Sasley’s analysis, while also making space for Palestinians, politicians, feminists, journalists, students, educators, rabbis and policymakers.

We’ll soon need an alternative to fill the void. I hope some of the institutions we already have will make a greater effort to model that kind of discourse. I’d love to read more Palestinian voices in The Forward, or see liberal Zionists engage more directly with Mondoweiss writers. I wrote for Open Zion for my first time last February, when I weighed in on the BDS debate playing out at Brooklyn College. I later reapplied for an internship, spent the past summer in New York City and had the opportunity to write on all sorts of topics, from intermarriage, to Hebron, to the future of Hamas’s political leadership. Having the chance to research, write and publish on such things strengthened my relationship to the region, deepened my understanding of the issues, and connected me with all sorts of challenging individuals.I wish that Peter Beinart had exerted greater efforts to make Open Zion the type of institution that could survive his departure. Our community needed and still needs that kind of outlet. Maybe the ultimate judgment of the site’s success will be if other platforms in the community do indeed open themselves to diverse, ideologically opposed voices. Peter established the structure, but we don’t yet know if it’s sustainable.

It’s also true that Open Zion was certainly not perfect. The opinions were often unbalanced and many voices were under-represented or absent entirely, such as Haredi Jews and Palestinians living in Gaza. I know much of that stemmed from it having a tiny staff with ambitious goals. If the site had more resources, I think the breadth and depth of content could have been significantly expanded and engaged a greater number of readers and writers.

Our community is a vibrant one with diverse opinions, and our media outlets should settle for nothing less than representing that. Our bare minimum standard should be an acceptance that we can’t have a meaningful discussion about Israel’s future without engaging religious settlers, anti-Zionists, Palestinians and Jews together, in one hard, difficult conversation.

Part of me feels that Open Zion is ending too soon. But then again, it’s also possible that the site contributed to fostering a sense of communal complacency–perhaps we became too dependent on OZ “filling the niche” of open discourse.

Maybe in the end its departure can serve to wake us up.

Devaluation of Civic Education Serves to Perpetuate Political Dysfunction

In the 2012 election, only 50% of the youth voting bloc, Americans aged 18-29, turned out to cast their vote. That means 23 million young people did not participate, either because they were unable to make it to the polls, or by choice.

Low voter participation is a manifestation of political dysfunction. From an increasingly toxic influence of money in politics, to the sluggish speed at which our government legislates, to the apparent erosion, even within the highest levels of government, of respect for the Constitution—it is clear that the U.S. political system is not working for many of the millions of individuals it stands to represent.

But from where do these problems arise?

A root cause, and I define “root” as a problem that begets many other more serious problems, lies in our country’s de-emphasis and devaluation of civic education within our public schools.

Once prioritized by our leaders and legislators, civic education is now perceived as expendable. We’ve come to view standardized test preparation and international math rankings as more critically concerning than allocating time to teach democratic engagement.

The sad irony lies in that the original founders of public education saw public schools as precisely the place to cultivate conscientious, critical citizens. Thomas Jefferson, Horace Mann and John Dewey all believed that an educated citizenry was indispensible to a healthy and functional democracy. They recognized that to have a nation of ignorant citizens would render individuals incapable of electing good leaders or voting out of office those who abused their power. Horace Mann wrote in 1873, “Education is our only political safety. Outside of this ark all is deluge.” Jefferson in 1824 wrote, “The qualifications for self-government in society are not innate. They are the result of habit and long training.”

Until the 1960s, three types of courses in civics and government were common in American schools. Two of these courses, commonly known as “Civics” and “Problems of Democracy”, explored the role of citizens and encouraged students to discuss current issues. Those types of courses are rare today. The only course still typically offered in American public schools is “American Government,” which describes the institutions of government with scant reference to the role of citizens in making those institutions work.

The resulting deficit in civic engagement extends beyond low voting turnout. For example, as reported by the Campaign for the Civic Mission of Schools, between 1973 and 1994, the number of people who served as an officer of a club or organization, worked for a political party, served on a committee, or attended a public meeting on town or school affairs declined by over 35%.

African Americans and Hispanic students are twice as likely as their white counterparts to score below proficient on national civics assessments. A similar civic knowledge gap exists between America’s poorest and wealthiest students.

Lack of knowledge translates into lack of participation. Families that earn more than $75,000 per year, when compared to families that make less than $15,000 per year, are twice as likely to vote and six times as likely to be active in the political process.

These disparities in knowledge and involvement do not result from inherent differences in aptitude or interest. They are the result of a public education system which affords far fewer and lower quality civic learning opportunities to minority and low-income students.

Let me be clear: there has never been a “golden age” of political participation in the U.S. political system. Throughout most of our country’s history, over half of all U.S. citizens were denied the right to vote. Nonetheless, I reject the notion that our democratic system is flawed in its essential design.

Increased emphasis on civic education, while not the sole solution to our political malaise, is surely a consequential one. If we want more U.S citizens to participate in democratic life– to run for elected office, to write op-eds, to join civic organizations, to work on campaigns, to lobby their elected officials—in sum, to do all the messy, hard, tiring work that is self-government, then we must teach our kids that political participation is fundamentally important.

We need to prioritize civic learning with the same urgency and conviction that our leaders speak about STEM education. It is only then will we see people vote in higher numbers, people join advocacy organizations, and people hold their government leaders accountable.

If we want to see a more equitable and effective political system, then we should start by revisiting our civic education policies.

What are Institutional Review Boards and Why Should We Care? An Interview with Zach Schrag

Interview originally published in The Washington Monthly on November 1, 2013.
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In 2010, George Mason University Professor Zach Schrag published a book, “Ethical Imperialism: Institutional Review Boards and the Social Sciences,” exploring the history of federally regulated academic research in the United States.

Institutional Review Boards, or IRBs, as they’re known, were first created in the 1960s to approve, monitor and review biomedical and behavioral research involving humans. The idea was to protect human subjects from harm—a premise everyone could agree with—but in the intervening decades, Schrag argues, they’ve become obsolete, ineffective and overbearing, scaring social scientists out of doing hard-hitting research in their fields.

In a recent conversation with the Washington Monthly, Schrag explains where IRBs came from, how they’re harmful to social science, and what possibilities exist for reform.

What kinds of social science research are most negatively affected by the current IRB?

The one that really leaps out is research on sexuality. Time and again IRBs have been extremely squeamish when researchers come to them and say, “I want to study some kind of group, particularly a sexual minority.” Whether it’s about being gay or about adolescents and their sexuality…it tends to shoot up red flags all over the place.

We have a problem in this country where kids grow up gay, or transgender, or in some other marginalized category, and they feel alienated, misunderstood. One thing that good social science can do for them is to tell them that in fact it gets better, that you’re not alone. When the IRB is trying to protect, say, gay youth, by not letting the researchers talk to them, it may actually in the long run be doing harm by denying them the results that the research would create.

What happens to researchers who don’t comply with the IRB at their university?

There are risks to researchers who complain about this system—those who either deliberately refuse to comply or who choose to read the rules very carefully and comply no more than they have to, which has been my approach. Graduate students and untenured faculty are extremely vulnerable to threats. I have the luxury of tenure but if someone were to decide that I have violated a regulation then tenure won’t protect me. People feel scared. People shy away from research topics. The ethics regime has dissuaded people from doing the kinds of immersive research that for a long time was very important to sociology.

So should IRBs be abolished or should they be reformed?

This is a system that was primarily designed to regulate the kinds of research that people were thinking about it in the 1960s. I frankly question its modern utility in relation to biomedical research, but it’s particularly inept at regulating more exploratory, open-ended qualitative research of the kind that a lot of researchers in the social sciences and humanities pursue.

There are a lot of alternatives, particularly in terms of better communication and training. For example, someone judging the ethics on ethnographic field work in Peru should be expected to learn, let’s say, not about biomedical research but about ethnographic field work in Peru. I value expertise and I hope to see the energy focused on putting researchers in touch with other researchers. They need that kind of ethical questioning.

Some have argued that this process is an insidious form of censorship. Is this a First Amendment issue?

The problem is that even those who believe that the current regulations are not consistent with the First Amendment may not believe that the courts, and particularly the Supreme Court will agree with them. For example, Philip Hamburger at Columbia University argues for the unconstitutionality of IRBs, but at the same time he says that given recent Supreme Court opinions, we can’t trust the court to recognize this. Most people who are affected by IRBs are affected in their role as employees, and employees may have many fewer rights than do general citizens. I don’t think there is a great likelihood that we would find relief in the courts based on the way that precedents have gone.

How else could the rules change?

The federal government has recognized that this is a problem. In 2011, a group of agencies put out an Advanced Notice of Proposed Rule Making that recognized very explicitly that the system is not working well for many researchers. More recently, the National Research Council held a conference in which a lot of possible reforms were floated. Academics are still waiting to see what the next steps are with those options.

There are also a lot of people in Congress, in both parties, who are concerned with government overreach, and are worried about civil liberties. Indeed back in 1980 there was something of a bipartisan coalition thinking that these research regulations had gone too far. The House passed a bill that would have restricted the regulations somewhat. It died in the Senate.

Alternatively, you could find some relief at the university level because the regulations are brief, vague, poorly written, and somewhat contradictory. That gives universities a fair amount of wiggle room on how they actually implement the regulations. Ultimately though, we hope for more substantial reform.

A New Municipal-Level Challenge to Roe v. Wade in New Mexico

Originally published in The Washington Monthly on October 25, 2013.
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This November, Albuquerque, New Mexico could become the first city in the nation to enact a municipal abortion ban. The proposed law, “Pain Capable Unborn Child Protection Ordinance”, which seeks to ban abortions after 20 weeks of pregnancy, is designed to model a potent new national tactic for the anti-abortion community and to ignite a host of new lawsuits, all with the goal of eventually overturning Roe v Wade.

“It is a new strategy. There is more than one way to close an abortion clinic,” Troy Newman, president of Operation Rescue, a leading U.S. anti-abortion group that helped get the measure on the November 19 ballot in Albuquerque, told Reuters.

The bill provides no exceptions for victims of rape, incest, or for women suffering from “psychological or emotional conditions” related to their pregnancy. Exceptions could only be granted if it was determined that the mother could die or if the pregnancy would cause “irreversible” physical harm to a “major bodily function.”

Operation Rescue, headquartered in Wichita, originally sent two “pro-life missionaries” to Albuquerque—Tara and Bud Shaver—in order to rally support for the measure. Ms. Shaver is the spokeswoman for a coalition of Roman Catholic, evangelical and other groups advocating for the ballot initiative. They organized a petition with over 12,000 signatures—or roughly twenty percent of Albuquerque voter turnout in recent elections—requiring the city council to put the proposed ordinance on the November ballot.

The proponents of the bill are not only framing their public arguments around fetal pain, which has mixed evidence, but also around their intent to create a lawsuit strong enough to overturn Roe v. Wade.

Over the past three years, a dozen states have passed late-term abortion legislation. Nebraska was the first state to pass such a law in 2010, and its sponsor, Mike Flood was forthright about his intent to create more opportunities to challenge Roe in court.

“Clearly my bill walks away from viability as a standard and instead substitutes a scientific standard that I think the state of Nebraska has a legitimate and substantial interest in preserving and promoting fetal life at that point,” he told The Washington Post.

And just this past year, even though a federal court struck down Idaho’s fetal-pain lawon constitutional grounds, the National Right to Life Committee enthusiastically applauded the decision, signaling that any lawsuit was a good lawsuit for their purposes.

Polls show that the Albuquerque measure will likely pass with local support. Traditionally, Albuquerque courts have broadly interpreted cities’ powers, so the municipal ban will likely stand or fall on constitutional grounds when it reaches federal court.

Yet the prospect of the ordinance ultimately being struck down is clearly no deterrent for the anti-abortion activists. “The courts are crazy today, but we’re going to keep working to close these clinics,” Newman told Next City.

Litigation is expensive, and pro-choice activists will face major challenges to produce the resources to fight every constitutionally concerning reproductive ordinance that gets passed. And, since citywide laws can often provide statewide effects, the bang for the buck on this type of approach could be tremendous.

One thing is for sure. Anti-abortion folks are playing a long game.

President Obama Can Ease Sanctions on Iran By Himself–But That’s Not The End of the Story

Originally published in The Washington Monthly on October 23, 2013.

Diplomatic talks between world leaders and Iran earlier this month ended on the highest note in decades. While Iran stopped short of pledging to freeze its uranium enrichment program and offered no public plan to dismantle its nuclear facilities—both deal-breakers for hardliners—a diverse coalition of countries has already begun urging the U.S. to begin lifting sanctions on Tehran.

The next round of talks, scheduled for November 7, is expected to further advance those initial diplomatic baby-steps, raising the question of whether President Obama, should he promise to lift certain sanctions, will be able to do so, or whether he’ll have to get Congressional approval. Who controls U.S. sanctions anyway?

The short answer is that, as of now, the president has substantial power to enforce, strengthen, and waive sanctions with a stroke of a pen. But, of course, as in all things D.C., it’s more complicated than that. The long answer is that it’s possible that the politics and power struggles surrounding this particular issue could tie Obama’s hands as the process moves forward. Here’s a crash course in how it all works.

The backstory

The U.S. has had various sanctions on Iran since 1979, but economic sanctions on firms and countries conducting business with Iran really kicked off in 1996, with a law known today as the Iran Sanctions Act (ISA). We’ve upped the ante over the last few years with the passage of several more laws—the Comprehensive Iran Sanctions, Accountability, and Divestment Act (CISADA), the Iran Threat Reduction Act (ITRA), the Iran Freedom and Counter-Proliferation Act (IFCA) and the National Defense Authorization Act (NDAA)—which together significantly expand the scope of ISA and give the president the authority to increase penalties on firms and countries making deals with Iran. The result? A beleaguered Iranian population and an economy with inflation rates of almost 40 percent and unemployment reaching almost 20 percent.

Built into all that legislation is also quite a bit of presidential flexibility. Using what’s known as “waivers,” as well as special rules and exemptions that are written into the laws, Obama can decide whether to lift or implement certain sanctions, when, and to what degree. These tools fall into two main buckets: fact-based exemptions and discretionary waivers.

Fact-based exemptions give the president some wiggle-room, should certain, Congressionally-defined situations arise. For example, if a country is caught importing Iranian oil, but can demonstrate that it’s taking steps to reduce its imports, the president has the power to exempt those countries from sanctions if he wants. (Obama has used this type of exemption to avoid sanctioning countries in the European Union, as well as countries like India and China.)

Discretionary waivers are more powerful and act as a kind of executive safety valve. They give the president unilateral authority to waive sanctions, typically for six months at a time, should he decide that doing so is “vital to the national security interests of the United States.” The language is intentionally vague.

There’s also other language in the sanctions legislation that gives the president power to act unilaterally. For example, in the NDAA, Congress included a series of “presidential determinations” giving the president the power to decide whether the oil markets can bear the implementation of the sanctions prescribed.

So that’s the short of it. “Can the administration act by itself to take advantage of its discretion? The answer is yes,” said Elizabeth Rosenberg, a Senior Fellow at the Center for a New American Security and former Senior Advisor at the U.S. Department of the Treasury, who played a major role in implementing and enforcing financial sanctions on Iran. But, Rosenberg warns, political missteps could complicate Obama’s ability to use that discretion. She says that unless Obama manages his relationship carefully with lawmakers in the next few months, as diplomatic talks with Tehran begin to progress, certain hawkish members of Congress could take steps to make his life difficult.

Sabotage

One big factor is that there is no rule requiring Congress to include presidential discretionary measures in sanctions legislation; it’s just been custom. So Congress could, for instance, pass more financial penalties on Iran and limit the scope of, or eliminate entirely, the waivers, exemptions and presidential determinations.

It’s a trick they’ve tried before. In July, just days before Iranian President Hassan Rouhani was sworn in, the House overwhelmingly passed the Nuclear Iran Prevention Act of 2013 (H.R.850), which called for increased sanctions on Iran and—perhaps more importantly—limited Obama’s ability to use the fact-based exemption. (While the language gets technical very quickly, a lobbyist who monitors Iran legislation and who would speak to me only off the record summarized it like this: If H.R. 850 were to become law, it “doesn’t get rid of the waiver, but it makes it essentially useless.”)

It’s unlikely that H.R. 850 will become law in its current form, but the specter of limiting the scope of the exemptions in current or future sanctions legislation remains important. According to Ken Katzman, an expert on Iran at the Congressional Research Service, Congress has made efforts to demonstrate that it is well aware it has this authority.

For example, in the original version of ISA, passed in 1996, the language of the law indicates that the president has the power to waive sanctions if he decides that doing so would be “important” to the U.S. national interest. With the passage of CISADA in 2010, Congress changed that language to say that the president has the power to waive sanctions if he decides that doing so would be “necessary” to the national interest. With the passage of ITRA in 2012, Congress further tweaked that language, replacing “necessary” with “essential,” and, in some sanctions, with “vital.”

So what’s the point of all that thesaurus-wielding? Essentially it boils down to muscle-flexing. The lobbyist who works on Iran legislation put it like this: “The difference between ‘vital’ and ‘essential,’ or whatever it is, is legally meaningless. The change in wording is done by the proponents and the pressure groups of the bill just as a warning to the President—a show of political power—that they can tinker with this waiver too, if they want to.”

Tinkering with the language of the waivers and exemptions aside, Congress also has a few other disruptive tools up its sleeve. It could, for example, pass a joint resolution of disapproval of Obama’s use (or disuse) of the sanctions legislation. With a veto-proof majority in both chambers, joint resolutions carry the same legal weight as a law. Jamal Abdi, the Policy Director at the National Iranian American Council, also points out that it’s within Congress’ power to sue the U.S. government for not enforcing its laws. Both courses of action would require majority support in the House and Senate, That is, of course, unlikely at this point, given the fact that Obama’s cautious strategy enjoys the support of most Democrats and a war-weary public.

That support, however, does not preclude Congressional Republicans, and their allies on the right, from doing their best to throw a political tantrum should Obama agree to begin raising sanctions before Iran has suspended its nuclear program entirely. It’s possible, for example, that the House could continue to pass new sanctions legislation, as it did this past summer.

“You’re going to see more leaders like Mark Kirk (R-IL), publishing pieces wherever they can calling Obama an appeaser and bringing up the usual Nazi and Munich analogies,” said Matthew Duss, a National Security Policy Analyst for the Center for American Progress. In fact, Marco Rubio (R-FL) introduced a resolution for more sanctions just last week.

The American Israel Public Affairs Committee (AIPAC), the hardline lobbying group that enjoys an extraordinary amount of power in Congress, has argued repeatedly that the U.S. should not allow any loosening of sanctions until Iran has verifiably suspended its nuclear program. And Cliff May, the president of the Foundation for the Defense of Democracies (FDD) has called for an increase of sanctions on Tehran as soon as possible. He told the Washington Post that an increase “may push Iran dangerously close to the edge,” but that’s what’s necessary to make Iran realize that “smiles and empty rhetoric about ‘trust-building’” isn’t enough.

Anne Applebaum, a foreign policy columnist for the Post and Slate also expressed deep skepticism about lifting sanctions, citing the fact that hardcore Islamists still dominate much of the politics in Iran. “Talking is fine. But the negotiators in Geneva should leave any optimism at the door,” she wrote in Slate.

While Democrats in the Senate aren’t likely to allow new sanctions legislation to pass anytime soon, the discussion in the news—or a constant onslaught of new legislation passed by the House—might be enough to shake Iranian resolve. Abdi worries that if the US appears un-serious about dismantling sanctions, then Iran may be unwilling to make serious concessions in return.

Ultimately though while it’s not “beyond the scope and interest of this Congress” to make things difficult for Obama, it’s probably not “strategically wise” for them to choose that battle, either, Rosenberg says.

Obama’s strategy—cautiously considering winding-down sanctions against Iran in exchange for diplomatic cooperation—enjoys fairly robust popular support right now. In terms of those who back the renewed negotiations, “it’s a lot wider of a coalition than many people understand,” said Dylan Williams, the Director of Government Affairs for J Street. Anti-war coalitions, the U.S. business community, and the U.S. security establishment have all voiced support for negotiations. And according to the latest CNN/ORC poll, 78 percent of Americans are in favor of direct diplomatic negotiations between the U.S. and Iran—anything, it seems, to avoid another military engagement in the Middle East.

Duss, of the Center for American Progress, added that this could be an important victory for Obama. “I would just that note ever since Obama came into office, he’s been called naive, a dupe, an appeaser,” he said. “But here we are, five years later, and with regards to the position of Iran, there’s no way to say that this policy hasn’t succeeded in many ways.”

Johns Hopkins and the Primary Care Crisis

Originally published in The JHU Politik on October 20, 2013

By 2020, the Association of American Medical Colleges projects that there will be a shortage of at least 45,000 primary care doctors in the United States. That number is expected to reach 65,000 by 2025, as the Baby Boomer generation continues to retire en masse. And the battle will start feeling even more acute as an additional 32 million Americans begin seeking health care under the Affordable Care Act.

Johns Hopkins, one of the most elite medical institutions in the world, has been dragging its feet to address this problem. Between 2006 and 2008, of the 1,148 residents who graduated from Hopkins’ residency programs, only 8.97 percent went into primary care. Only two graduates went on to practice in a Federally Qualified Health Center (an organization that provides primary and preventive care to persons of all ages, regardless of their ability to pay or health insurance status), and not one participated the National Health Service Corps, a program designed to encourage doctors to practice in underserved areas.

In 2009, Hopkins’s residency programs, which receive subsidies from the US government, cost taxpayers $80.7 million. While that number is minute compared to the $2.8 trillion America spends on healthcare, it can certainly be argued that we’re not producing enough of the most needed kinds of doctors, which impacts the efficiency and strength of our healthcare system.

Of course, this problem is bigger than Johns Hopkins. According to a study by Academic Medicine, of the 759 residency sponsoring institutions, 158 produced no primary care graduates at all. Overall, only a quarter of all graduates enter primary care, and yet just a much smaller fraction of those will move to work where care is most scarcely found.

Medical education is expensive; according to the American Medical Association, the average graduate owes $140,000 in student loans. It’s understandable why students would be incentivized to specialize, where the profits are much greater, and where the time-consuming bureaucratic aspects of patient care are much less. Compare the average earnings for a pediatrician, $171,000, to the average earnings for a urologist, $401,000.

Some argue that this is not an either/or fight. That it’s okay for institutions like Johns Hopkins and Massachusetts General Hospital to train more specialists than primary care doctors, because specialists also face projected shortages. But this logic has some holes.

A prestigious institution like Johns Hopkins should be producing the type of doctor we need the most in this economy, and studies shows that primary health care saves money in the long term both for the individual and for the US taxpayer. For example, a study released by the Department of Health Care Policy and Financing looked at individuals who qualify for Medicaid, and found that those who sought primary care were one-third less likely to need emergency visits, inpatient hospitalizations or preventable hospital admissions than those who didn’t. But nearly sixty million Americans live in regions designated by the federal government as primary care shortage areas, even though many of them have health insurance.

Dr. Steve Kravet, the President of Johns Hopkins Community Physicians (JHCP) told me, “We recognize that a commitment to primary care is a key component of our ability to continue to lead the advancement of medicine locally, regionally, nationally, and internationally.” He pointed to JHCP’s 35 primary care locations throughout Baltimore and Washington, and said JHU doctors care for over 200,000 patients in urban, suburban and rural areas of need.

He also cited The Johns Hopkins Consortium for the Advancement of Primary Care, formed just two years ago, as a place to improve societal primary care and health outcomes. He told me that at their first annual retreat this past February, the deans of the Schools of Medicine, Nursing, and Public Health, as well as President Daniels all “spoke passionately” about our institutional commitment to primary care.

I’m glad to see Johns Hopkins stepping up to really prioritize primary care. It’s a crucial responsibility for such an influential medical institution. But I can’t help but wonder, given that people have been predicting this problem since as early as the 1960s, why it’s taken us so long.

The Government Shutdown Is Killing Antarctic Science

Originally published in The Washington Monthly on October 9th, 2013.
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There’s been a lot of news lately about the unexpected side-effects of the government shutdown, but here’s one that hasn’t garnered the attention it deserves.

On Tuesday the National Science Foundation announced that given the lack of appropriated funds, the U.S. Antarctic research program would be cancelled for the rest of the year. While that may not seem so important at first glance, Antarctic research diver Henry Kaiser calls it —with dramatic rhetoric very much intended— “the 9/11 for the science community.”

“There’s never been a disaster like this in science before,” he said, explaining that people who are not scientists—including journalists and politicians—seem not to understand the catastrophic ramifications of the closure on scientific studies. “It’s truly unprecedented,” he said.

That’s largely because of the nature of scientific research in Antarctica, a unique and fragile natural laboratory. If scientists, including geologists, glaciologists, oceanographers, volcanologists and biologists, fail to gather their annual data, it has the effect of either negating or seriously compromising decades of work—and wasting hundreds of millions of research dollars along the way.

“Most climate studies work on trends, and having gaps in the data is detrimental to being able to interpret them properly,” said Ross Powell, a geologist at Northern Illinois University and chief scientist for the WISSARD project, the first drilling expedition to discover life in a buried Antarctic lake. This year, with a $10-million investment by the NSF, Powell and his colleagues planned to search for a hidden estuary beneath the Ross Ice Shelf. Powell says that losing this field season would mean already wasting half the money, not to mention the myriad hours of operational and planning time.

Marine Biologist Gretchen Hofmann, who studies the effects of changing seawater acidity and temperature on marine life, says that long term records are necessary “to understand what’s been happening in the recent past.”

“These conclusions rely on continuity, and some of these studies have been going on for well over twenty years,” she said.

Richard Jeong, a researcher currently based at McMurdo, the United States’ Antarctic science facility and the largest research community on the continent, has begun to circulate a Change.org petition, calling for a shutdown exemption for Antarctic Program. More than 2,000 individuals have signed it, but it may be too late. Unlike national parks, which could reopen on Monday if the government reopened tomorrow—the amount of time and logistical preparation required to prepare for the Antarctic research program makes the likelihood of rescuing this research season extremely unlikely.

Although the Antarctic summer research season began last week on October 3rd, staff from Lockheed Martin, the NSF’s Antarctic operations contractor, have been working since late August to prepare for the season’s studies. “It takes them weeks to set everything up. There’s a whole slew of safety concerns, holes to be drilled, research preparation,” said Hubert Staudigel, a senior research geophysicist at the Scripps Institution of Oceanography who has been traveling to Antarctica for research every other year for the past ten years. “The problem with the Antarctic program is it’s like a machine with 100 cogs and you have to have every cog in place to make it work. It’s incredibly complex and it can’t just be stopped and started.”

And there’s safety considerations, too. “Would you want to deploy a group of mountaineers to the Antarctic knowing that you won’t have enough search and rescue people back at the station?” said Hofmann.

The National Science Foundation, which furloughed 99 percent of its workforce, has been unavailable to answer calls or provide real clarity on the situation.

The personal cost of the shutdown is also enormous for the staff, contractors and researchers. For example, two PhD students under Powell’s supervision who were set to go to Antarctica this month for thesis research may have to extend their study for an extra year, putting universities in precarious funding situations.

Lydia Kapsenberg, a PhD candidate at UCSB who was preparing to leave for Antarctica to continue an ongoing study on ocean acidification, says she and her team could expect to lose up to two years of data. “We’re looking at how changes in pH will affect animals and in order to do that we need to know what their current exposure is,” she said.

For now, it’s a waiting game, and people try and predict which types of studies can be saved, and which are simply ruined.

“Really awful things are happening as Congress recklessly and carelessly has their macho stare down,” said Hofmann.