Rebuilding the employment security system for the Rust Belt that created it

(THIS ARTICLE IS COURTESY OF THE BROOKINGS INSTITUTE)

 

Rebuilding the employment security system for the Rust Belt that created it

John C. Austin and Richard Kazis

Industrial transformation, brought on by global trade, new digital technologies, and changes in the structure of work, have hit Rust Belt communities hard. Some places, such as Pittsburgh and Kalamazoo, have gone through painful transitions and come out the other side. However, the majority of the Rust Belt’s older industrial cities continue to struggle with job loss and weak economic growth.

Authors

The collapse of the region’s labor-intensive manufacturing-based economy took its toll on the employment-based safety net protections that Midwestern employers and unions forged after World War II. Today, employer-based systems of health insurance, pensions, and unemployment insurance serve fewer and fewer Midwestern workers.

For Rust Belt workers and communities today and in the future, economic security policies must become more flexible and suited to a fast-changing economy. This will require balancing support for technological innovation with concerted efforts to reduce the costs of dislocation for people and places bearing the brunt of change.

THE MIDWEST BUILT AMERICA’S EMPLOYMENT-BASED SECURITY SYSTEM

In the years following World War II, the manufacturing industries of the industrial Midwest, together with their unions, hammered out a set of economic rules and policies that became the foundation for America’s subsequent economic prosperity and security.

Wage controls imposed during World War II set the stage for this system. Unable to increase worker pay, employers began to offer pensions and health insurance to attract and retain workers. The federal government assisted by exempting health insurance benefits from taxation for companies and individuals.

The transformation accelerated in the wake of the 1950 General Motors-United Auto Workers contract. Dubbed the “Treaty of Detroit,” it traded labor peace for wage gains based on productivity and cost-of-living increases. Large employers shared prosperity with their workers by providing them with health insurance, pensions, and other benefits. State and federal unemployment insurance policies that took shape during the Great Depression worked well for an economy in which periodic layoffs were temporary and skills were fairly transferable from one labor-intensive manufacturing sector to another.

The resulting system spread across the nation, in both union and non-union settings. The percentage of Americans covered by private pensions jumped from 3.7 million in 1940 to 19 million in 1960—nearly 30 percent of the labor force. By 1975, 40 million Americans were covered by private pension plans. The pattern of employer-provided health insurance coverage forged in Midwest industries became almost universal, rising from 10 percent in 1940 to just under 30 percent in 1946, reaching 80 percent of all workers by 1964.

Public sector employment systems, too, began to copy the agreements negotiated in the region’s private industries. In 1951, Wisconsin created the nation’s first stable statewide pension system for public employees and became the first state to allow public workers to participate in Social Security. Other states soon followed suit.

THE MIDWEST’S ECONOMIC DECLINE ERODED EMPLOYMENT-BASED ECONOMIC SECURITY

By the 1970s, global competition facilitated by technology-based innovations in communications and transportation began to challenge U.S. manufacturing dominance—and the employment-based safety net that had matured with it. In successive waves of industrial restructuring, employers shuttered inefficient factories, moved production to cheaper locales, automated where possible, and pushed costs and risks onto employees and suppliers.

Across the Rust Belt, between 2000 and 2010, this trend turned into a tsunami. Across six Great Lakes states, manufacturing employment dropped by 35 percent in 10 years—a more dramatic decline than during the Great Depression—eliminating 1.6 million jobs.

By 2015, only 5 percent of Fortune 500 firms offered defined benefit pension plans, down from 50 percent in 1998.

The wider impact on employer-provided benefits and the safety net protecting workers was devastating. The number of working-age Americans without health insurance jumped from 24 million to 37 million between 2001 and 2010, before the Affordable Care Act. Employer-provided defined benefit pension plans largely disappeared in the private sector, replaced by defined contribution 401(k) plans that shifted the burden for funding retirement onto workers. By 2015, only 5 percent of Fortune 500 firms offered defined benefit pension plans, down from 50 percent in 1998. Public employee agreements were harder to dismantle, but the underfunding of these state and local plans hit $1.4 trillion in 2016. Access to unemployment insurance (UI) diminished: In 2016, only 27 percent of all unemployed workers qualified for and received UI benefits, the lowest proportion in 40 years.

THE DISRUPTION WILL CONTINUE

As employers adapted to survive, their strategies to cut costs, enhance productivity, and shift risk heightened the instability of many Americans’ employment arrangements. They also set the stage for more disruption in the years ahead—change that will continue to hit Midwestern workers and communities particularly hard.

First, improvements in process automation, robotics, and machine learning are destabilizing employment. The McKinsey Global Institute projectsthat as many as one-third of U.S. workers may need to change occupations and acquire new skills by 2030, as robotics and artificial intelligence eliminate routine and repetitive jobs and create new jobs that require more and different skills.

The Midwest is at the epicenter of these shifts. Auto manufacturing uses half of all industrial robots in this country. Robots on the shop floor are concentrated in about 10 Midwestern and Southern states, led by Michigan, Ohio, and Indiana.

Where the robots are

Second, low educational attainment among the region’s industrial workforce could exacerbate employment dislocation due to automation and digitalization. A comparatively high proportion of Rust Belt working-age adults have only a high school diploma. Such workers may face greater difficulty making the transition to new kinds of occupations that demand higher-order cognitive skills.

A third destabilizing shift is the movement away from long-term, stable, full-time jobs toward contingent, alternative work arrangements. According to one study, nearly all net employment growth between 2005 and 2015 came from contingent work. In 2015, the Government Accountability Office estimated that contingent workers, including independent contractors and freelancers, part-time workers, on-call workers, temp firm employees, and self-employed workers, accounted for 40 percent of the U.S. workforce, up from 30 percent 10 years earlier.

The growth of more flexible work arrangements is a welcome development for many, particularly those working at the higher end of the labor market who have more skills and greater control over their work. But for Midwest workers with relatively low levels of formal postsecondary education and training, part-time work, being subcontracted out and paid as a “1099 worker,” or working in the “gig economy” have increased insecurity and reduced access to benefits and protections.

TOWARD A MODERNIZED ECONOMIC SECURITY SYSTEM

As our colleagues Mark Muro and Robert Maxim have outlined, America needs a new economic security system that is de-coupled from the once-dominant model of full-time, long-term employment with a single employer. This is particularly the case for Rust Belt workers. Policymakers seeking to rebuild economic security in the Midwest and across the nation should follow these principles:

  • Design for an era of economic instability and disruption—of frequent job and career switches—by increasing benefit portability.
  • Promote innovation, technological change, and risk-taking, but also prioritize effective supports for those who bear the brunt of the resulting changes.
  • Extend benefits to serve part-time workers, contractors, and those employed in multiple jobs.
  • Provide support not only during temporary dislocations, but also help individuals adapt and advance in the new economy, with both a safety net and a trampoline that accelerates return to the workforce and expands access to higher-skill, higher-paid jobs.

Policymakers and advocates are advancing a number of proposals that could be scaled to build a modern economic security regime:

Portability: Health care and pension benefits should be portable, universal, tied to individual employees, and delinked from full-time work and single employers. Benefits should be pro-rated for part-time employees based on hours worked. To finance this, some have suggested a Social Security-like mechanism of payroll deductions. Others have proposed more modest multi-employer or sectoral plans like those in the construction industry. Senator Mark Warner (D-VA) has proposed legislation to fund a set of pilots testing different approaches with different mechanisms.

Pro-ration of benefits: Too many benefits are tied to full or almost full-time work with a single employer. Work-related benefits that can reduce family stress and keep people in the workforce—including paid sick leave, family leave, and vacation days—should be extended to part-time employees on a pro-rated basis based on hours worked for a given employer.

Unemployment insurance reform: Eligibility requirements should be made more flexible so that more individuals can access unemployment insurance, including intermittent workers, those with low and variable wages, part-time workers not working enough hours, and entrepreneurs starting their own businesses. Experiments should combine benefit receipt with training, work preparation, and support for pursuing postsecondary credentials.

More aggressive adjustment assistance: Current Trade Adjustment Assistance is too modest, short-term, and tied to specific industries affected by trade. It is not nearly as strategic and proactive as labor market adjustment policies in other advanced industrial countries. More generous relocation assistance can support worker mobility and help people go where the jobs are. Retraining opportunities and support for programs with proven labor market value can help those needing to make significant mid-career changes.

The growth of more flexible work arrangements is a welcome development for many, particularly those working at the higher end of the labor market.

Rust Belt communities, industries, and workers created and benefited greatly from the old system in its prime—and they have arguably suffered the most from its collapse. In turn, they have the most to gain from a needed remaking of employment security and safety net policies that recognize and respond to today’s economic realities. To the degree that these new policies put solid ground beneath more people in Rust Belt communities, they can help shift the political conversation in these places from one based on nostalgia, anxiety, and resentment to one lifted up by greater hope and optimism.

Turkey: Can The People Force The Tyrant/Murderer Erdogan Out Of Office?

(THIS ARTICLE IS COURTESY OF THE BROOKINGS INSTITUTE)

 

After 15 years in government—particularly since a failed coup attempt in July 2016 crowned him with extraordinary executive authority—Turkey’s President Recep Tayyip Erdoğan has never been more powerful.

Authors

Yet as the June 24 snap elections called by his ruling Justice and Development Party (AKP) approach, there are growing signs that the political dexterity that has long allowed Erdoğan to determine the course of Turkish politics could be waning. While Turkish polls need to be read cautiously, many of them now suggest a high likelihood that the upcoming presidential election will be decided in a run-off, and that Erdoğan’s AKP will fail to retain its majority in parliament. This would create a completely novel and challenging political picture in which the opposition could have a greater say in policymaking than it has had for at least a decade.

CHALLENGES MOUNTING

Many thought that the decision to move the elections forward by over 16 months was a pre-emptive move by Erdoğan to avoid the damage an increasingly volatile Turkish economy is likely to inflict on his popular support. Both inflation and unemployment are over 10 percent and on the rise, the budget deficit saw a 58 percent increase in the past year, and the lira has lost more than 20 percent of its value against the U.S. dollar this year alone. (The dollar-to-lira rate is now 4.6 to 1; it was 3.75 to 1 in January, and around 2 to 1 as recently as mid-2013.) Nor is the Turkish government able to stem the tide: To the contrary, Erdoğan’s frequent and ideologically charged declarations against high interest rates as well as his recent promise to intervene more directly in the policymaking of Turkey’s Central Bank after the elections are increasingly perceived as contributing to the lira’s plunge.

Amid these economic worries, Erdoğan also faces the most diverse and rigorous pool of opposition candidates since he came to power in 2003. A new electoral alliance hoping to unseat Erdoğan includes not only the center-left Republican People’s Party (CHP) and the new center-right İyi (Good) Party, but also an Islamist faction, represented by the small yet influential Felicity Party—ironically, Erdoğan’s own political home during his rise to political stardom in the 1990s.

The allied opposition parties have each fielded their own candidates, but promise to unite behind whichever candidate makes it to a run-off against Erdoğan. The CHP’s presidential candidate is Muharrem İnce, a fiery orator who was once known for his staunch secularism and perceived as insensitive to the needs of Turkey’s pious Muslims and large Kurdish minority. Recently, however, he has struck a remarkably conciliatory tone on the campaign trail, adopting a narrative embracing Turkey’s ethnic and social diversity, promoting teaching Kurdish in government schools, and declaring that he has no intention to resurrect Turkey’s once-infamous headscarf ban. İyi Party leader Meral Akşener, the only woman in the race, is the first serious right-wing challenger to Erdoğan in over a decade. Finally, the conservative Felicity Party candidate, the British-educated party head Temel Karamollaoğlu, is easing into his role as an elder statesman and is dishing out intense moral criticism of the ruling AKP. The pro-Kurdish People’s Democracy Party (HDP)—which the government has heavily stigmatized—was left outside of the opposition alliance, but its party head and candidate Selahattin Demirtaş remains a charismatic leader for much of Turkey’s Kurds and secular youth. This diversity of options available to Turks of all political and ideological persuasions means that Erdoğan is now challenged from multiple sides and that there is likely to be increased opposition turnout at the polls.

ERDOĞAN’S VULNERABILITY

Indeed, such a widened political battleground was exactly what Erdoğan hoped to avoid in calling for the snap vote. Turkey’s opposition parties were outraged at what they took as an attempt to prevent Akşener’s newly-founded İyi Party from participating on a legal technicality. This was circumvented when CHP—shrewdly and unexpectedly—allowed 15 of its members of parliament to be transferred to İyi Party, allowing it to attain the minimum number of sitting MPs to qualify to participate in the snap elections.

Erdoğan himself, in what many perceived as a slip that only proved foul play by the government, criticized Turkey’s High Electoral Commission for not pre-empting what he called an “immoral” opposition strategy. Perhaps even more strikingly, HDP’s Selahattin Demirtaş, who has been jailed since late 2016 with multiple charges but still no indictment (let alone a verdict), is forced to run from behind bars while opposition candidates from Turkey’s right and left continue to call for his immediate release.

The AKP’s apparent heavy-handedness is paired with considerable hubris in the lead-up to the elections. The government casually postponed Turkey’s massively important university entrance exams—the culmination of a multi-year process, exhausting for students and financially draining for parents—once it became apparent that they coincided with the planned election date. In a similarly self-assured move, Finance Minister Mehmet Şimşek has noted that Turkey’s troubled markets will see normalization and reform “after the elections,” rejecting out of hand the possibility that the elections may disturb his own policymaking mandate.

But even as the ruling AKP is dismissive of the possibility that Turkey’s next president could be decided in a run-off, Erdoğan himself has been providing much of the fodder for Turkey’s reinvigorated opposition. Phrases lifted cheekily from awkward moments in Erdoğan’s own recent speeches have become humorous opposition slogans. Erdoğan once said he and his party would leave power if and when the electorate said “Tamam” (roughly meaning “okay,” or “that’s enough” in Turkish)—on Twitter, opposition activists have said “T A M A M” in over two million tweets, and the phrase has seeped into daily conversations. Similarly, “Sıkıldık mı?” (“Are we bored yet?” as employed somewhat sheepishly by the president mid-way through a lengthy address to an AKP youth congress) is a phrase that has caught on. İnce, Akşener, and Koramollaoğlu joined in, using the catchphrases both on and off social media often. Indeed, “T A M A M” and “Sıkıldık mı?” represent more than Turkey’s latest social media fad: Their easy and cheerful spread suggests an opposition that is increasingly able to unite around common themes and is rediscovering the tone of youthful irreverence that last befuddled and outraged the AKP government during the Gezi Park protests in 2013. Indeed, a growing number of Turkish commentators opine that it is increasingly the opposition that determines the tone and course of political debate in the country, with AKP officials adopting a clumsily defensive tenor.

Related Books

And ironically, it may have been the AKP government itself that has exposed Erdoğan’s Achilles heel. In pushing for the constitutional change that concentrated most executive powers in the person of the president but retained certain lawmaking and veto rights in the parliament, AKP lawmakers do not seem to have considered the possibility that the president’s party may not always hold a majority in parliament. Before the constitutional amendment, the fact that the AKP polled significantly higher than its individual competitors meant that it easily dominated the National Assembly; but the multi-party alliances officiated under the new system, as well as a widened political arena, change electoral math in such a way as to make an AKP parliamentary majority harder to achieve.

Precisely because the creators of last year’s constitutional amendment thought that the AKP was invincible at the polls and that Turkey’s diverse opposition was fundamentally incapable of achieving any internal harmony, then, an opposition parliament under an Erdoğan presidency is a real likelihood. The new system makes little provision for such a cohabitation, and an aggressive opposition could effectively cripple much of Erdoğan’s policymaking. Indeed, if the AKP were to lose its parliamentary majority in the first round of elections, Erdoğan would be entering the presidential run-off election with his aura of invincibility and traditional mastery over Turkish politics severely weakened.

WINNING VOTES, FAIRLY

To gain the upper hand, both sides will have to come up with more concrete policy proposals to remedy an ailing economy, prove their willingness to diffuse the country’s suffocating political polarization, and stir the hearts and minds of an increasingly young and well-educated electorate, 1.5 million of whom will vote for the first time in June.

Opposition parties are just starting to roll out their election programs. These programs, in particular, must convince the electorate that their vision is one that goes beyond unseating Erdoğan: It remains unclear, for example, how a politically and legally cumbersome return to the parliamentary system, which all opposition candidates promise, would be achieved. On the question of the economy, İnce in particular is making waves with talk of moving emphasis from an increasingly unwieldy construction sector to boosting high-tech industrial production, and Akşener with a thoughtful critique of youth unemployment. But a thorough and convincing roadmap for much-needed macroeconomic reform has not been forthcoming from either Erdoğan or his opponents. On foreign policy, İnce is unequivocally advocating improved relations with trans-Atlantic allies and the EU. Akşener, while stressing the need for a strong European-Turkish partnership, is critical of the EU for driving Turkey’s membership talks into a dead end, and not surprisingly emphasizes the importance of relations with the Turkic and Muslim world.

But perhaps most critically, all parties—government and opposition alike—should ensure that controversial new election laws should be applied conscientiously, and that the June 24 elections are free and fair without the slightest shadow of a doubt. Any domestic and international perception that the elections have been tampered with would only aggravate Turkey’s mounting social and economic woes. If the worst fears of some commentators are confirmed and incidents of coercion and violence sully the elections or their aftermath, Turkey’s already heated political scene could be brought to the brink.

To go back to the question we pose in the title: Yes, both Erdoğan and his challengers do have a real chance at victory in what may become Turkey’s most contested electoral race in recent history, and the AKP’s own mistakes should show that there is little to be gained by looking at Turkish politics dismissively.

Brooking’s Institute looks at the human side of medical cannabis policy

(THIS ARTICLE IS COURTESY OF THE BROOKINGS INSTITUTE)

 

FIXGOV

In a new documentary short, Brooking’s looks at the human side of medical cannabis policy

John Hudak and George Burroughs

Medical cannabis is an increasingly available, alternative medicine that tens of thousands of Americans are turning to in an effort to get relief from their symptoms. Jennifer Collins is one such patient. On Wednesday, Brookings released “The Life She Deserves,” a documentary short profiling Jennifer’s struggle with an epilepsy disorder and with the public policies that have stood between her and the medical intervention her doctors recommended. In Brookings’s first use of this medium, the film tells both a personal and a policy story, highlighting the human side of a public policy failure.

Jennifer’s Story

At a young age, Jennifer was diagnosed with Jeavons Syndrome, an epilepsy disorder characterized by frequent seizures that often present as a fluttering of the eyes. During these seizures, Jennifer loses awareness of her surroundings. Those smaller seizures—which can number in the hundreds per day—can also cluster into a more serious and dangerous grand mal seizure, of which Jennifer has suffered many.

With the diagnosis, Jennifer’s doctors began a standard pharmaceutical regimen that ultimately culminated in more than a dozen pills daily and maximum adult doses of powerful anti-seizure medications. Those medicines came with side effects that included mania and suicidal ideation. Ultimately, pharmaceuticals were unable to help with Jennifer’s seizures and the side effects became overwhelming. Desperate for a solution, Jennifer’s parents read online about children moving to Colorado to access non-intoxicating, cannabis-based medicines to treat conditions like hers.

“The Life She Deserves” profiles the difficult choices the Collins family faced and explores what many patients and families sacrifice in order to get medical relief. Whether it is for a child with epilepsy, a young woman battling breast cancer, an Iraq War veteran with PTSD, or an elderly woman with chronic arthritis, accessing medical cannabis often requires weighing steep costs against the benefits.

Jennifer is a unique individual who has bravely fought both a chronic condition and a dysfunctional public policy system from a young age. Her story tells us as much about a strong young woman from Virginia facing a significant, ongoing health challenge as it does about a system of laws in which federal policy contradicts both itself and numerous state laws. Her story is one that is relatable to patients and the family members, friends, and colleagues of patients who see what Jennifer and her family have seen: cannabis-based medicines can provide relief in some patients. However, Jennifer’s story is not a unique one.

“The Life She Deserves” shows the overwhelming challenges that government can pose when it comes between doctors and patients, researchers and science. The film also highlights what has become a new normal in this country: the medical cannabis industry. Cannabis growers and sellers are not a group of sinister drug peddlers, operating in the shadows. The film highlights how a husband-wife duo responsibly cultivate cannabis in a heavily regulated system. And the seller is a rabbi who, inspired by his father-in-law’s decades-long battle with MS, opened a family business where he dispenses cannabis to a wide variety of patients—just a stone’s throw from the same institutions of government that label him a narco-trafficker.

Remarkably, in 2018, the idea of medical cannabis has become normal and mainstream. But as we explore in “The Life She Deserves,” the health challenges that draw people to it are devastating and the failure to implement effective policies forces them to make major sacrifices in order to access treatment they need.

A new format for Brookings analysis

It was clear that Brookings needed to explore a new medium beyond the white paper in order to peel back the stigma that continually cloaks medical cannabis. By producing a documentary, we were able to sit across the kitchen table from Beth and Pat Collins, at their home as they shared their difficult journey. We learned what the viewers of this film quickly learn: they’re just two parents who want to give their daughter a normal life. Because of this medium’s ability to create intimacy, the viewer gets see how government policy and the human experience collide to tell a compelling story. And Brookings is in a unique position for storytelling. The institution delivers in-depth analysis that can be presented with the human experience, positive or negative. What Brookings needed was a vehicle for such work. The documentary is precisely that vehicle.

In addition to home videos of Jen’s childhood and footage of Beth Collins testifying at the state legislature, maybe the most poignant moments in the film are of silence. In “The Life She Deserves” Jen reflects on the long road she’s traveled and where she is headed. When she pauses to collect her thoughts, in that silence we can see the severity of what she has been through—an emotion that words could not capture. At that moment we get a rigorously honest look at the pain she has experienced and the strength and courage it took to survive and talk about it. This is the power of storytelling and this is the power of the documentary. We live in a time when many in our country—on both sides of the aisle—see many areas of public policy as broken. Like Jen, millions of Americans feel the effects of those policy failures every day. The opportunity for effective policy storytelling has never been greater, and at Brookings we’re looking forward to telling many more.

Medical Cannabis: A Broken Policy

Authors

To those familiar with the world of medical cannabis, it is no secret that public policy in this area is broken. We have written extensively at Brookings about the numerous policy problems including banking, taxes, interstate access, and others. “The Life She Deserves” focuses on some of the most glaring issues facing patients themselves—an often-overlooked area. And the main issue that impacts patients, even more than access, is how little is known about how to maximize the benefits of cannabis to treat different conditions effectively. The U.S. government has made expanding that knowledge extraordinarily difficult.

Beyond the U.S. government declaring that the cannabis is illegal, federal policy also adds layers of bureaucracy that make research into the medical value of cannabis much harder. In fact, researching cannabis is more bureaucratically challenging than researching any other substance designated Schedule I—the nation’s highest level of drug control.

There is no excuse for a government that makes research more difficult to conduct. Those efforts are anti-science and ensure that politics influences the pursuit of scientific answers. Compounding the problem is that as more states pass reforms that label cannabis as medicine, there is increased demand for answers about the substance’s medical value. There is an ever-present and growing need to ask more questions about cannabis, not fewer. As more patients use this substance in an effort to relieve symptoms, the federal government should be committed to helping understand this area of science.

After all, what could the federal government fear from more research? In fact, no one in the nation—regardless of views on cannabis—should oppose expanded research. As we have written before, if you are an avowed opponent of cannabis and believe it is dangerous, it has no medical value, is highly addicting, and is a gateway drug, you should encourage more research that will demonstrate those findings. Those findings would be a wakeup call to many patients and, more importantly, to policy makers at the state level. For those who support medical cannabis and believe it is a miracle drug that can cure everything from a cough to cancer, you, too, should demand more research to demonstrate not simply medical value, but the precise ways in which cannabis interacts with bodily systems to provide relief and cures. Finally, if you don’t really care about cannabis, the current policy should bother you. Federal government intervention in science should terrify you.

When government impedes researchers from asking the questions they believe are important and conducting research in ways that their expertise and medical literature suggest are critical, the substance should not matter. The principle matters. In a time of an unpopular president, an embarrassingly unpopular Congress, and trust in government at near-historic lows, who should you trust to steer the ship of science: a physician and medical researcher from Michigan or a guy who happens to represent Kalamazoo in Congress?

As Patrick and Beth Collins note in “The Life She Deserves,” one of the biggest challenges facing medical cannabis patients is a lack of understanding about exactly which cannabis-based products assist with which conditions. There is also a deficit of information about dosing, interactions, side effects, and a host of other characteristics that patients are used to knowing about medicines that they take. Part of the blame rests with states moving forward to bring to market cannabis-based medicines without their enduring the normal regulatory processes we expect in the United States. However, much of the blame rests with a federal government that has allowed a racially-motivated, institutionally perpetuated policy overwhelm a commonsense approach that would remove unnecessary bureaucracy from blocking research.

Many patients will tell you that there is no question that cannabis helps them (although there are a number of patients who will also say that it does little for them). The biggest question that remains, however, is whether the federal government will stop politicizing research and help facilitate answers to the questions that patients are demanding.

The human cost of leaving patients and families to fend for themselves is clear, in Jen’s case as we see in “The Life She Deserves,” and in countless other households.

Iran Is Going To Strike Israel The Only Question Is How And When

(THIS ARTICLE IS COURTESY OF THE BROOKINGS INSTITUTE)

 

ORDER FROM CHAOS

Will Iran attack Israel over the Syrian conflict? It’s only a matter of time

Dror Michman and Yael Mizrahi-Arnaud

As the dust settles following last weekend’s U.S.-French-British attack on Syrian chemical weapons facilities, the countdown to the next round of military conflict between Israel and Iran has begun. Last week, Israel once again targeted the T-4 (Tiyas) base in Syria, which houses Iranian drone forces, killing 7 Iranians and apparently destroying a drone infrastructure project. This is the same base from which an Iranian drone was launched in February, which the Israeli air force intercepted. Israel then hit the T-4 base and an Israeli aircraft downed by Syrian anti-aircraft fire.

Authors

An Iranian retaliatory strike against Israel is likely in the works. Where and how Tehran chooses to carry out its attack is still unclear, but for reasons that we describe below, it is most likely to be a rocket or missile attack launched from Syria. The choice will define what to expect for the future of Iranian and Israeli confrontations.

THE “WHY” QUESTION

There are very clear signals that this time Iran would indeed retaliate. Iranian media gave extensive coverage to the Israeli attack on T-4 last week. Iranian leaders, most noticeably Ali Akbar Velayati, the top advisor to Iran’s supreme leader, issued direct threats of retaliation. Hezbollah’s leader, Hassan Nasrallah, also warned Israel that this time there would be a steep price to pay; the highly publicized funerals of Quds forces personnel was the latest such indication. Iran is now both deeply and publicly committed to retaliate. The stage is set.

Iran is determined to cash in on its huge investment in Syria, by improving its military presence and the means with which to pressure Israel. Ultimately, its aim is to firmly establish itself as a regional power. Meanwhile, Israel is determined not to repeat the mistake it made in Lebanon—watching from the sidelines as the Iranian threat from Hezbollah intensified. Israel has made clear its intention to combat the threat from the start, while it remains manageable.

In Israel’s view, the time to act is ripe due to both geopolitical and strategic factors. First, Russia’s desire to keep the situation in Syria relatively stable puts Israel in the unique position of acting as a potential disrupter. Israel thus has leverage over the larger, and more powerful Russian state. Second, Israel’s freedom to operate in Syria’s skies may be limited in the future by improved Iranian or Syrian anti-aircraft capabilities, or by an international accord.

THE “HOW” QUESTION

While the intentions are clear, there remains considerable debate over what form the retaliation would take. In the Middle East, these nuances matter. There are several possibilities and each carries a different prospect for an Israeli counter-response.

A missile salvo appears to be the most appropriate Iranian response, both in terms of capabilities and risk calculation (and mirroring the Israeli missiles launched at T-4). However, the more crucial question is what target they will choose.

A military target appears to be the more appropriate response. A quid-pro-quo attack, aiming to deal a lethal blow to the Israel Defense Force’s reputation—or even better, the Israeli air force, since an F-16 fighter-jet (an emblem of Israel’s prowess), was downed in February. But a more effective deterrent may lie in targeting a big city—thereby eliciting a panic effect, even if it is intercepted by Israeli defense systems. The goal from the Iranian perspective may be to create public pressure that in turn would work to alter Israel’s risk calculation in Syria. On the down side, civilian centers are a less legitimate target, and might put Iran in an uncomfortable position internationally, when such a spotlight is the last thing Iran needs as worldwide concern over Iran’s intervention in the region crescendos.

The second dilemma facing the Iranians is from where to launch the missiles, the options being Iran, Syria, or Lebanon.

Launching from Iran will naturally send a strong message to Israel, both in terms of capabilities and determination. The clear disadvantage of this choice would be the legitimization of an Israeli counter-response in Iran, and yet another unnecessary escalation, for the time being, from the Iranian perspective.

Lebanon is well equipped with a variety of missiles, in both range and size, and therefore a convenient location for the Iranians. However, an escalation in Lebanon is far more damaging for all parties involved. It has the possibility to ignite a war between Israel and Hezbollah, and to harm crucial Hezbollah arsenals and infrastructure, serving neither Iranian nor Hezbollah’s interests.

Hezbollah is not interested in war at the moment, as its leaders are preoccupied with solidifying its image as the “protector” ahead of Lebanon’s parliamentary elections in May. The numerous casualties in Syria, and the fact the group still has close to 7,000 troops on the ground there, complicate this picture.

The most sensible option remains Syria, the arena with the least risk for the Iranians, and the relevant stage of the recent skirmishes. Yet, there are two main challenges that remain to be mitigated: the delicate relationship with the Russians and the risk of further damaging Iranians assets and capabilities in Syria, in case Israel will be forced to respond.

In order to avoid putting stress on the Russians, the Iranians would retaliate in a fashion the Russians would find tolerable and containable. Russia expressed its anger after the last Israeli attack, and therefore will most likely tolerate some sort of measured Iranian response. The question is: What does Russia consider measured? Possibly anything that doesn’t pose a substantial threat to stability in Syria and wouldn’t provoke an Israeli escalated response.

This appears to be an impossible equation to solve. Iran wants to buttress its deterrence capability after Israel proved willing to pay a steep price in order to prevent Iran from establishing another front in Syria (from where they could threaten Israeli security, as they have done in Lebanon with Hezbollah in the past).

After outlining the possible scenarios, an Iranian strike will most likely be a missile strike from Syria, aimed at a significant Israeli military target. In order to hit the target, it will have to be substantial in size. It is hard to imagine a scenario in which the target is hit and Israel’s response will be contained, unless the damage—both in lives and in capabilities—is negligible.

Israel understands that it can’t afford to blink.

Predicting the long-term prospects and evolution of this conflict is more difficult, since both parties are willing to pay a high price for their strategic interests.

An Israeli response to an Iranian retaliation depends on the extent of the damage; nonetheless, Israel understands that it can’t afford to blink. The determination and willingness to take risks has been clearly demonstrated—both by statements by senior officials and by attacks in recent months. For the time being, Israel will push back against Iran, at any cost, until either significant international pressure or diplomatic efforts work to inhibit Iranian strength in Syria. The Russians serve as a partial restrainer, but have limited motivation, and even more limited capabilities to actually enforce a solution on either party. Even if there were a simple solution, in light of Israeli and Iranian determination to inflict damage on each other, even at a high cost, Russian efforts would most likely prove unsuccessful.