The Washington Post National Weekly - March 19, 2017

SUNDAY, MARCH 19, 2017

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They’re poor and sick and they voted for Trump.

Now what? PAGE 12

Politics Reshaping the EPA 4

Nation Stopping terrorists in the U.S. 9

5 Myths The ‘deep state’ 23

SUNDAY, MARCH 19, 2017

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CARE HAIR WITH E 3 PAG A Cut Above See

E PAGE TURNING THpe See PAGE 5 Ye Olde Bookshop

MARCH 2017

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Alternative treatments nd their place See Page 16

NATURAL PATHS TO HEALTH

Alternative methods of health and healing are big business in the North Central Washington region.

HAIR AND MORE WITH HEART

We profile A Cut Above hair salon in Cashmere, where the hairstyles can change, but the customers are lifelong converts to this friendly and supportive salon.

YES, WENATCHEE HAS A BOOK STORE

Ye Olde Bookshoppe in downtown Wenatchee is alive and well, and the owner’s passion for reading is contagious.

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KLMNO WEEKLY

THE FIX

19 targets for extinction BY

A ARON B LAKE

12. The Denali Commission is a regional development agency focused on Alaska. It’s got a $20 million budget.

T

here are 19 federal agencies that have the distinction of facing a 100 percent cut — i.e. extinction — in the budget President Trump released Thursday.

Cuts to these agencies total about $3 billion.

They offset about 6 percent of the $54 billion Trump wants to add for the military.

What do these agencies do? Let’s explore.

1. The Corporation for Public Broadcasting

helps fund public broadcasters nationwide, including NPR and PBS. But the CPB is actually a small portion of the funding for those national outlets. The proposed cuts would be felt much more by local public broadcasters, which account for about 90 percent of the agency’s $440 million in grants.

2. The National Endowment for the Arts de-

13. The African Development Foundation

focuses on directing aid to countries in subSaharan Africa. It has a $30 million budget.

14. The Inter-American Foundation funds ANDREW HARRER/BLOOMBERG NEWS

6. The Legal Services Corporation, with a

budget of $300 million, helps provide legal advice to poor people.

7. The Institute of Peace was formed in 1984 to analyze and try to prevent conflicts around the world and has a $35 million budget.

livers grants to fund and promote various fine arts across the country. It was launched by President Lyndon B. Johnson as part of the Great Society. Its budget is $148 million.

8. The Interagency Council on Homelessness

3. The National Endowment for the Humanities is similar to the NEA — and has the same

was founded about a half-century ago to help promote economic growth in oft-struggling Appalachian counties stretching from New York to Mississippi. Its budget is $146 million.

$148 million budget. NEH deals with grants for education programs related to culture.

4. The Institute of Museum and Library Services is the main federal funder of local

branches. Its budget was $230 million last year.

5. The Corporation for National and Community Service is the biggest of these programs, at

more than $1 billion. It houses national service initiatives such as AmeriCorps.

KLMNO WEEKLY

is tasked with implementing a federal strategy to fight the issue. Its budget is $4 million.

9. The Appalachian Regional Commission

10. The Delta Regional Authority has a budget of $25 million and serves counties in eight states in the Mississippi Delta region: Alabama, Arkansas, Tennessee, Louisiana, Mississippi, Kentucky, Missouri and Illinois.

11. The Northern Border Regional Commission has an $8 million budget and serves Maine,

New Hampshire, New York and Vermont.

This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2017 The Washington Post / Year 3, No. 23

grass-roots groups and nongovernmental organizations in Latin America and the Caribbean, at a budget of $22 million.

15. The U.S. Trade and Development Agency

promotes U.S. exports by working to do things such as improve transportation infrastructure and otherwise facilitate trade in dozens of countries. Its current budget is $60 million.

16. The Overseas Private Investment Corporation has a budget of $83 million and pro-

motes U.S. economic investment in the developing world by working with private partners.

17. The Woodrow Wilson International Center for Scholars is essentially a govern-

ment-funded foreign policy think tank with a budget of $11 million.

18. The Chemical Safety Board was part of the Clean Air Act of 1990, and it helps investigate industrial chemical accidents. It has a budget of $11 million.

19. The Neighborhood Reinvestment Corporation is otherwise known as NeighborWorks

America, and it spends its $175 million budget issuing grants to and otherwise assisting community development organizations. n

©The Washington Post

CONTENTS POLITICS THE NATION THE WORLD COVER STORY PARENTING BOOKS OPINION FIVE MYTHS

4 8 10 12 17 18 20 23

ON THE COVER Andrea Easley, 50, of Keystone, W.Va., is on disability and on an average day takes up to 10 medications. She depends on Medicaid for her health care.

(Photo by BONNIE JO MOUNT/The Washington Post)

SUNDAY, MARCH 19, 2017

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POLITICS

Shaping the EPA he often opposes

BY J ULIET E ILPERIN AND B RADY D ENNIS

F

or more than a decade, Sen. James M. Inhofe has raged against the scientific consensus that humans are fueling climate change, calling it “the greatest hoax” ever perpetrated on Americans. The Oklahoma Republican has blasted the Environmental Protection Agency as an “activist organization” that has unfairly burdened everyone from farmers to fossil-fuel companies.

Now the man critics once dismissed as a political outlier has an unprecedented opportunity to shape the nation’s energy and environmental policies. And he has helped populate the upper ranks of the agency he has derided with several of his closest confidants.

At least half a dozen former aides to Inhofe — and counting — have been hired into top positions at the EPA and the White House.

The chief of staff and deputy chief of staff to EPA Administrator Scott Pruitt, a fellow Oklahoman and longtime friend of Inhofe, spent years working for the senator.

Pruitt’s senior advisers on air, climate and legal issues are Inhofe alumni. In addition, two former Inhofe aides have become top domestic and international energy and environmental advisers to President Trump.

“It gives me a level of comfort to know that we have a bureaucracy that’s actually going to be serving instead of ruling,” Inhofe said in an interview this past week, describing his former staffers as qualified professionals who will protect the environment. “They are going to be very realistic.

They’re going to do it in a way that will not be punitive. The previous administration was almost looking for ways to punish people.”

Comforting is not how many of Inhofe’s longtime opponents would describe the changes.

“Inhofe was like the original climate-denier in chief. He was one of the first people spouting this gibberish — fact-free but dangerous gibberish,” said Gene Karpinski, president of the League of Conservation Voters.

“Now he and his cronies have far

J. SCOTT APPLEWHITE/ASSOCIATED PRESS

Allies of Inhofe, a climate-change skeptic, are joining agency’s ranks more reach and are far more dangerous than they’ve ever been. . . .

That’s good news for the polluters but horrible news for public health.”

Inhofe, 82, has been in the Senate since 1994 and has served as the top Republican on the Senate Environment and Public Works Committee for 12 out of the past 14 years. For much of that time, he has been one of the nation’s most powerful climate-change skeptics, even writing a book in 2012 attacking the science around global warming, which most of the world has accepted as a serious and urgent threat.

His most high-profile assault on climate science — one President Barack Obama mocked mul-

tiple times — came on a cold day in February 2015, when he stood on the Senate floor, fresh snowball in hand, to suggest that Earth could not be warming in any dangerous way, given the winter weather outside.

Ryan Jackson, Inhofe’s former chief of staff, helps account for part of why so many of the senator’s aides are now helping guide the administration’s policymaking.

Jackson, who helped shepherd Pruitt’s nomination, then became the administrator’s chief of staff and started tapping his former colleagues for top agency posts.

While nearly every federal department has been undergoing major changes since Trump took office in January, few have seen as

Sen. James M. Inhofe (R-Okla.) has said that humanperpetuated global warming is a “hoax.”

rapid and dramatic a shift as the EPA. It has already scrapped a request for data about methane emissions that could have paved the way for tighter restrictions on more than 15,000 U.S. oil and gas firms, and Trump has directed the agency to roll back a rule designed to protect 60 percent of the nation’s water bodies.

On Wednesday, Pruitt announced plans to revisit fuel standards the Obama administration set for cars and light trucks that will be built five years from now. And his staff is preparing to unwind the centerpiece of Obama’s effort to combat climate change — the “Clean Power Plan,” which limits carbon dioxide emissions from

SUNDAY, MARCH 19, 2017

5

POLITICS power plants.

To carry out the changes Trump has promised, namely setting the EPA on a more minimalist course that will constrain federal authority over the environment, the new administration has recruited a group of conservative stalwarts who have spent years working to advance Inhofe’s objectives.

At times, some of them have worked directly for the mining, oil and utility companies that they are now charged with regulating.

“The Inhofe brigade has landed, secured the beach and is moving inland with precision as well as speed,” said Stephen Brown, vice president for government affairs at Tesoro, a major oil refiner.

What exactly will that invasion look like?

Those behind it are, for the most part, not nearly as colorful or outspoken as their former boss, even as they share many of his views and objectives.

Congressional aides of both parties described Jackson as one of the most soft-spoken managers on Capitol Hill. Amanda Gunasekara, who will advise the EPA administrator on air and climate issues, had been working for Inhofe less than a month when he asked her to hand him a snowball on the Senate floor two years ago to prove that global warming had not snuffed out winter altogether.

Andrew Wheeler, a front-runner to serve as Pruitt’s No. 2, served the senator for 14 years before going on to lobby for the coal giant Murray Energy, Xcel Energy and the Nuclear Energy Institute. A few former Inhofe aides — Wheeler, as well as George Sugiyama and Michael Catanzaro, who is now in the White House — have worked at the EPA before.

Inhofe and his aides have shown legislative savvy. Even as the senator decried the Obama administration’s work on carbon dioxide emissions from power plants, mercury pollution and smog as burdensome for business and possibly illegal, Inhofe and his staff struck major deals on bipartisan issues including chemical safety, transportation and water infrastructure.

Joseph Stanko, who heads government relations at the law firm Hunton & Williams, said the combination of Republicans’ electoral success last year and the Obama administration’s aggressive use of executive authority has given con-

CSPAN2

servatives a rare opening.

“It’s a real confluence of there being a philosophical alignment between Senator Inhofe and the administration, the Republicans holding both branches of government and there being, for lack of a better word, opportunity created by the prior overreach,” said Stanko, whose clients include Koch Industries, Southern Co. and the Electric Reliability Coordinating Council.

Joining the outsiders Opponents see the Trump administration and the influx of Inhofe staffers to the EPA as the early steps in the dismantling of crucial regulations Obama put in place to combat climate change.

“The EPA was a staunch defender of the environment and supporter of climate action under the Obama administration,” said Michael Mann, a climate scientist at Pennsylvania State University.

“It is now instead being wielded by the fossil-fuel interests who are running the Trump administration as just another weapon in their war on environmental protection and climate action.”

Trump wasn’t Inhofe’s first, or even second, choice for president last year. Initially, Inhofe endorsed his Senate colleague Marco Rubio (Fla.) in the GOP primaries, then, after he dropped out, Ohio Gov. John Kasich. But Inhofe then pivoted to Trump and began forging ties with the campaign through his friend and fellow senator Jeff Sessions (R-Ala.), advis-

ing Trump on defense and regulatory issues.

The dominance of Inhofe’s staffers reflects not just an ideological shift but the fact that even an administration of outsiders needs some insiders to help run the place. Inhofe remains extremely close with his former aides, whom he teasingly calls “has-beens.”

Pruitt, like Inhofe, is determined to transfer some of the power his agency has amassed to the states. Earlier this month, a Wall Street Journal columnist described Pruitt, in a nod to the constitutional bent of the late Justice Antonin Scalia, as “an EPA originalist.” Privately, according to aides, the administrator relished the moniker. As Oklahoma attorney general, Pruitt sued the agency he now heads numerous times, often making the argument that the Obama administration had overstepped its legal authority.

Pruitt, who caused an uproar recently in a CNBC interview when he questioned whether carbon dioxide emissions are the primary driver of climate change, has made it clear he plans to focus the agency on more-traditional pollutants. His goals include minimizing lead exposure from drinking water — an issue on which Inhofe joined forces last year with then-Sen. Barbara Boxer (D-Calif.), despite opposition from House Republicans — and cleaning up contamination in Superfund and contaminated industrial sites.

“Finally, we have someone in

Inhofe holds a snowball on the Senate floor in February 2015 to suggest that Earth could not be warming in any dangerous way, given the winter weather outside.

KLMNO WEEKLY

there that’s not going to be harassing the public with punitive regulations,” Inhofe said of Pruitt and his former staffers. “What I want them to do is to do what they are supposed to be doing — be concerned about the environment, the water, the air. . . . I’d like to see an EPA there to actually serve people and make life better for them.”

While it will take months to finalize the EPA’s budget for the coming fiscal year, the White House has proposed significant reductions that could complicate Pruitt’s task and gut the agency. In the budget proposal released Thursday, the EPA’s funding was $5.7 billion, down from the most recently enacted budget of $8.2 billion, a 31 percent cut. Deep cuts could prompt unrest among employees, many of whom remain skeptical of the new administration and its motives, and eliminate staffers Pruitt and his senior advisers would need to accomplish their priorities.

Those include not just redoing Obama-era rules but possibly reexamining the way the EPA conducts its scientific assessment of health risks and other factors that underpin the regulations it issues.

“When I talk to people on the left, they are both happy that all these Inhofe people are there but also simultaneously scared,” said Dimitri Karakitsos, who left his post as Inhofe’s senior committee counsel in October to join the firm Holland & Knight as a partner.

They are relieved, he said, because the new appointees have shown a willingness to broker compromises on thorny issues.

But, Karakitsos added, “the reason why I think they are scared is because it’s a really smart, thoughtful group that’s over there,” one that is not going to put out rules “on a whim that are easily undone.”

A Senate Democratic aide who has worked with many of the former Inhofe staffers agreed.

“These are folks who are very capable. They know the agency and its programs,” said the staffer, who spoke on the condition of anonymity in order to talk frankly. “They’re smart and hardworking, and they certainly could dismantle the programs if they were asked to do that. But the question is how they will react if they’re asked to do that.” n ©The Washington Post

SUNDAY, MARCH 19, 2017

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KLMNO WEEKLY

POLITICS

Trump has a lot riding on health care

BY J OHN W AGNER AND A BBY P HILLIP

I

n the roiling debate over the plan to replace the Affordable Care Act, there’s a lot more at stake for President Trump than whether the bill can be saved: Its fate could also determine how much else he can get done on Capitol Hill in the early stages of his presidency.

With the bill facing strong resistance on multiple fronts, Trump’s effort to shepherd it through Congress is shaping up as a pivotal test of a president’s ability to wield influence in Washington, a growing number of Republicans say.

A win on an issue as fractious as health care could serve as a rallying point for even tougher fights ahead, including some Trump agenda items that wouldn’t otherwise be GOP priorities and others that would probably require Democratic support.

But falling short on a marquee campaign promise — when both chambers are controlled by the president’s party — would almost certainly sap momentum for Trump’s agenda. Moreover, Republicans are counting on cuts from former president Barack Obama’s health-care law to make the budget math work on other Trump priorities, particularly major tax reductions.

“It’s difficult to see the kind of aggressive agenda that they’ve outlined for the rest of this year without some sort of repeal-andreplace success,” said Michael Steel, a former senior aide to former House speaker John A. Boehner (R-Ohio), referring to the House bill that seeks to scale back Obamacare.

The coming weeks, Steel said, “will show whether the Trump administration can use the tools of the White House to move legislation forward.”

As a candidate, Trump promised he would work with Congress to pass legislation that would dramatically cut taxes, spur $1 trillion in infrastructure investments, significantly expand school choice and make it easier to afford child care. And he promised he would

KEVIN LAMARQUE/REUTERS

A win or loss on the issue could shift president’s odds on taxes, infrastructure and other priorities get started on all that — and six other pieces of legislation — in his first 100 days, according to a “Contract with the American Voter” he released before Election Day. Now past the 50-day mark, only one of those bills — the House GOP health-care plan — has been introduced. And its path has grown more treacherous by the day, with mounting concerns about the millions of Americans projected to lose coverage.

A senior White House official disputed the notion that a defeat on health care would slow Trump’s momentum on other fronts.

“Our plan is if you don’t succeed, try, try again — and improve,” the official said.

Trump has promised to cut taxes on the middle class and to lower the corporate tax rate from 35 percent to 15 percent.

Another key to paying for those efforts is a House proposal for a “border adjustment tax” that would treat companies’ exports far more favorably than imports.

Senate Republican leaders have been cool to the idea, however, and some GOP lawmakers are looking to Trump to bridge that divide.

Trump also has a major sales job ahead with members of his own party if he is to make good on a pledge to spur $1 trillion in infrastructure investments. The administration has yet to lay out a plan but has said it will rely heavily on public-private partnerships and tax incentives to keep the cost to the U.S. Treasury in check. Still, many Republicans remain wary of what could be cast as a big-government spending proposal.

On those and other fronts, Trump could use leverage that would come with salvaging a health-care bill.

“What the president is able to do here is pretty critically important for the rest of his agenda,” said Josh Holmes, a former chief of staff to Senate Majority Leader Mitch McConnell (R-Ky.). “If they can pilot that in for a landing, I think it bodes well for future activity.”

On the flip side, a defeat on health care will only embolden Democrats, whose cooperation Trump will need on several fronts.

“For Trump to fail would probably send a dagger through the heart of the rest of his legislative agenda,” said Jim Manley, who was

President Trump has vowed to dramatically cut taxes, but if the Republican-led Congress fails to pass changes to the Affordable Care Act, those proposed tax cuts would become much harder to implement.

a senior aide to former Senate minority leader Harry M. Reid (DNev.).

Sen. Charles E. Grassley (RIowa) agreed that “you won’t be doing any tax revision” if the health-care law fails, but he argued other goals were attainable.

Sen. Orin Hatch (R-Utah) said “it might embolden the Democrats if they can win on this issue. And we’ve got to make sure they don’t win on it.”

Republicans are trying to pass the bill using a process known as “budget reconciliation,” a bill that does not require 60 votes in the Senate, which has 52 Republicans.

The effort to gut Obamacare threatens to tear loose the stitches that have held the Republican establishment and the conservative base together.

The president has said he is fully supportive of the bill crafted

by Republican leaders, but he has also signaled being open to responding to conservatives’ concerns on some counts, including the timing of a phaseout of expanded Medicaid coverage.

That posture has led conservative activists to pin more blame on Congress than Trump for the bill’s rocky rollout — and provided some hope that the new president can still enact other priorities.

“I think it’s possible to get a ton achieved this year,” said Michael A. Needham, chief executive of Heritage Action. “It’s going to require a sense of openness and collaboration that we’re seeing from the White House and President Trump.”

Beyond Trump’s desire to make a show of action in the first months of his presidency, the intensive schedule is born of political necessity. Members of Congress facing reelection in 2018 are staring down the real prospect of backlash if none or only some of their agenda comes to fruition.

“Anytime you’re starting to legislate, your window of opportunity starts to close, especially in the House once you get closer to election year,” said the House leadership aide. “You need to move quickly to get things done.” n ©The Washington Post

SUNDAY, MARCH 19, 2017

7

POLITICAL ANALYSIS

KLMNO WEEKLY

Trump’s deep cuts echo Reagan’s BY

D AN B ALZ

P

resident Trump’s governing blueprint represents the most ambitious effort to cut domestic spending and pare back the federal government since former president Ronald Reagan came to Washington in 1981. Whether it will come close to accomplishing the president’s ambitions is a far different question.

Trump’s budget proposes to raise discretionary defense spending by $54 billion in the next fiscal year and cut domestic discretionary spending by an equivalent amount, a sizable shift in priorities. To pay for his defense buildup, he would take huge chunks out of the budgets at the State Department, the Environmental Protection Agency and other agencies.

The list of programs identified for elimination is lengthy, with targets both familiar and obscure.

The president’s ambitions go beyond the numbers in his new budget, however. Earlier this past week, Trump signed an executive order designed to reorganize the executive branch. Unlike President Bill Clinton’s initiative to reinvent government, Trump’s order appears to be far more expansive, with a stated goal of finding programs and perhaps whole agencies that could be eliminated.

“Presidents create their own eras,” said John Samples of the Cato Institute. “If he did this — whatever he said in the campaign — you might see a different cycle going forward with more restraint and a reduction in the size of government. This could be the beginning of a new cycle, but he’s got to get from here to there.”

That caveat — “whatever he said in the campaign” — is not insignificant. Trump has emerged as a president with an agenda to tear down parts of the federal government that he sees as superfluous or hostile to his views. Stephen K. Bannon, White House senior counselor and chief strategist, has talked about the “deconstruction of the administrative state.”

As a candidate, Trump espoused some of the goals he is following now — cutting regula-

-30%

-20%

-10%

Trump’s budget proposal

0%

DECREASE

INCREASE

This budget addresses only discretionary spending, which is set by congressional budget resolutions and makes up more than a quarter of the budget.

Defense +9%

-$0.2 billion

Treasury -4%

-$1.1

Justice -4%

-$1.7

Transportation -13%

-$6.2

Housing and Urban Development -13%

-$9.2

Commerce -15.7% Army Corps of Engineers -16% The budget also proposes to eliminate funding for other independent agencies, including:

Health and Human Services -18%

-$2.5

-$2.6

The increases, which include a boost in defense spending, a down payment on the border wall and funds for school choice programs, would come out of non-defense discretionary programs.

These cuts would affect most of the operating budgets for executive departments and agencies.

Education -14%

-$1.5

-$10.9

$4.4

Interior -12%

-$2.4

-$4.7

$2.8

Veteran Affairs +6 %

Energy -6%

-$1.5

-$15.1

$52 billion

Homeland Security +7%

NASA -1%

-$0.5

-$1

10%

Labor -21% Agriculture -21% State Department -29% Environmental Protection Agency -31% Other agencies -10%

-$2.9 -30%

-20%

-10%

0%

Source: Office of Management and Budget

tions, for example — but also promised to hold harmless programs such as Social Security and Medicare and pledged a healthcare program that would provide coverage to everyone while also promising major tax cuts. If he sticks to those pledges, the impact on the deficit could be significant.

All this leaves open the question of what Trump’s true priorities are.

Are they mainly to raise defense spending, thereby being forced to find offsetting savings from domestic spending? Are they to reduce the deficit significantly, in which case what he is proposing will not go very far? Are they to take an ax to the executive branch, through regulatory changes and the elimination of programs, in an

The National Endowment for the Arts, the Chemical Safety Board, the Corporation for Public Broadcasting, the United States Institute of Peace, the United States Interagency Council on Homelessness and the Woodrow Wilson International Center for Scholars.

THE WASHINGTON POST

effort to fight a bureaucracy that he appears to see as hostile?

“In terms of the overall change in direction, this is basically following the Reagan blueprint to reorder priorities in discretionary spending,” said former senator Phil Gramm (R-Tex.), a Democrat who played a key role in Reagan’s first budget battle. “It would be modest in any private entity, but in government, it’s significant.”

The domestic cuts proposed in Trump’s budget will produce pain and are likely to spark the same kind of backlash that has greeted past efforts. Trump enjoys the advantage of having a Congress in Republican hands, and one that includes many members who came to Washington determined

What are Trump’s true priorities?

For the most part, that remains to be seen.

to cut government’s size and scope. But built-in resistance to cuts in specific programs will test Trump’s ability to shift priorities.

But his overall fiscal plan remains a work in progress. What was released does not include his proposals to overhaul the tax code.

But his campaign promises included cutting the corporation tax and reducing tax rates, including on wealthy individuals. The only way to increase defense spending, therefore, is to go hard after domestic spending.

Trump’s order on reorganizing the executive branch could prove significant, if Mick Mulvaney, the new Office of Management and Budget director, fully picks up on the mandate in the directive. “It is a wide-open invitation for the OMB director to think big and to go after programs and to propose eliminations,” said Chris Edwards of the Cato Institute. “I expect it to be a very bold study.”

One priority of the new administration appears to be to change the relationship between Washington and the states and cities by devolving power away from the federal government. That was one of Reagan’s goals.

Many governors are anxiously watching the early moves of Trump’s administration, wondering whether changes in programs, whether big-ticket ones like Medicaid or smaller programs targeted for elimination, will put greater burdens on the states unless there is more flexibility built in.

“It’s very much a zero-sum game at the state level,” said Scott Pattison of the National Governors Association. “It’s not like there are pots of money sitting around that can move in. If grants are cut to state and local governments, something has to give.”

Finally, the priorities of many GOP congressional leaders and Trump’s more populist supporters may not always intersect. That, too, will be one of the balancing acts Trump must manage. Gramm said successful administrations are the ones that follow the process diligently through to the end.

Trump is only at the beginning. n ©The Washington Post

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KLMNO WEEKLY

NATION

Opioid crisis changes role of police BY

K ATIE Z EZIMA

T

he nation’s opioid epidemic is changing the way law enforcement does its job, with police officers acting as drug counselors and medical workers and shifting from lawand-order tactics to approaches more akin to social work.

Departments accustomed to arresting drug abusers are spearheading programs to get them into treatment, convinced that their old strategies weren’t working. They’re administering medication that reverses overdoses, allowing users to turn in drugs in exchange for treatment, and partnering with hospitals to intervene before abuse turns fatal.

“A lot of the officers are resistant to what we call social work.

They want to go out and fight crime, put people in jail,” said Capt. Ron Meyers of the police department in Chillicothe, Ohio, a 21-year veteran who is convinced that punitive tactics no longer work against drugs. “We need to make sure the officers understand this is what is going to stop the epidemic.”

Officers are finding children who were barricaded in rooms while their parents got high, and they are responding to the same homes for the same problems.

Feelings of exasperation course through some departments in which officers are interacting with the same drug users over and over again, sometimes saving their lives repeatedly with naloxone, a drug that reverses an opiate overdose.

“You’re tired of dealing with this person because it saps your resources and it’s frustrating, and sometimes that manifests itself in a poor attitude or police officer becoming cynical or sarcastic,” said Officer Jamie Williamson of the police department in Ithaca, N.Y., where he said heroin is on every corner of the city. “But you want to get them the help so you don’t have to deal with them and so that person gets to a better place.”

According to the Centers for Disease Control and Prevention,

MADDIE MCGARVEY FOR THE WASHINGTON POST

Officers act as counselors, doctors, social workers more than 33,000 people died of opiate overdoses in 2015, a record.

Opioids now kill more people than car accidents, and in 2015 the number of heroin deaths nationwide surpassed the number of deaths from gun homicides. The expansion of the problem has forced officers to fundamentally rethink their work.

“When I came out of the police academy, it was law enforcement enforcing the law,” said Kevin Coppinger, the sheriff in Essex County, Mass., and a former police chief in Lynn, Mass. “Now police officers have to be generalists. You have to enforce the law, you have to be social-service workers and almost mental-health workers.”

One morning this month in Chillicothe, Meyers, Ross County Deputy Sheriff J. David Weber and three others sat in a conference room, reviewing police reports about six white men between the ages of 26 and 34 who overdosed the week before. One needed four doses of naloxone to survive.

The officers are part of the Ross County Post Overdose Response Team, known as PORT, which vis-

its the home of each person in the county who overdosed during the prior week. Sometimes family members don’t know that their loved one overdosed, but most people are receptive to the intervention, said Teri Minney, the partnership’s coordinator.

The group provides information that includes a list of support group meetings, a brochure on how to contact treatment providers and detox centers and a primer on naloxone.

Weber said he and the team are blunt, telling victims that they are playing “Russian roulette.”

Though the team hopes the person won’t use drugs again, it knows they probably will. So it implores them to do so in the presence of others, so someone can call for help.

“This is just one piece of the puzzle,” Minney said.

Police must also work as frontline social-service providers in homes where children are present during an overdose.

“We’re struggling to get them somewhere safe,” Meyers said.

“You could send them to grand-

Deputy J. David Weber, center, and Capt. Ron Meyers talk with a woman who gave CPR to an overdose victim in Chillicothe, Ohio. The men are members of the Ross County Post Overdose Response Team, which visits the home of each victim.

ma’s house, but she’s also a heroin addict. You have to vet everyone who you send those kids to.”

Officials said drugs are taking a particular toll on children. In Martinsburg, W.Va., police have partnered with the Berkeley County Schools and Shepherd University to form the Martinsburg Initiative. It links schools, law enforcement, families and the community to help children who are living in traumatic situations, such as having an incarcerated parent or a history of domestic violence, and connects the families with available resources. Police Chief Maury Richards said it is based on data showing that children who grow up in dysfunctional households are more likely to use drugs.

“Unless we get a handle on this, it could really unravel our entire community and society as a whole,” Richards said.

Even run-of-the-mill calls such as shoplifting and car break-ins now have a drug connection, as do more serious ones like robberies.

In large cities such as Cincinnati and small towns including Mount Sterling, Ky., calls for overdoses sometimes overwhelm local emergency response systems.

Louisville’s emergency medical services are making “overdose run after overdose run,” said spokesman Mitchell Burmeister. In February, the system received 52 overdose calls in 32 hours, most of which were believed to be related to heroin or fentanyl.

Tom Synan, chief of the Newtown, Ohio, police department and a leader of the Hamilton County Heroin Coalition, said the staggering numbers are difficult because “we are in this job to help people” and often the resources are not there to do it correctly.

“Law enforcement has been forced to take the lead on this, and we probably are not the best profession to be doing this because our job really is to enforce laws,” he said, noting that he has seen family after family torn apart by addiction. He keeps in touch with the children of some who have died. “I never got into police work thinking I’d watch an entire generation die of drugs.” n

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NATION

KLMNO WEEKLY

Defusing homegrown extremists BY

J OBY W ARRICK

O

n his way to planting an explosive in a Manhattan alley last September, suspected bombmaker Ahmad Rahimi stumbled into a deep hole in the U.S. system of safeguards against domestic terrorist attacks.

The Elizabeth, N.J., resident had twice come under scrutiny by the FBI because of reported extremist views and suspicious travel overseas. But investigators found no grounds for arresting him, and they lacked alternative measures for maintaining surveillance or influencing the Afghan immigrant’s behavior.

That gap is the subject of a new bipartisan report that warns of a serious flaw in U.S. defenses against homegrown terrorism: the lack of an effective, comprehensive system for finding, redirecting and rehabilitating Americans who may be on a path to violent extremism. Unless such a system is put is put into place, the report says, law-enforcement officials will be left to try to prevent attacks only after the would-be terrorist becomes operational.

“Fighting terrorism requires both tactical efforts to thwart attacks and strategic efforts to counter the extremist radicalization that fuels its hatred and violence and undergirds its strategy and global appeal,” says the report, based on a year-long study commissioned by the Washington Institute for Near East Policy think tank.

The report, released Wednesday, urges federal backing for an array of programs that would seek to prevent radicalization from taking root in local communities, as well as measures to identify and help individuals who are already on a path toward radicalism. The proposed remedies would mostly take place outside the criminal justice system, while maintaining a strong “connective tissue” with law enforcement so that police can be forewarned if someone appears on the brink of committing violence, it says.

JESSICA REMO/NJ ADVANCE MEDIA FOR NJ.COM VIA ASSOCIATED PRESS

Community engagement and earlier intervention could help stop lone-wolf attacks, report says The study’s release comes as the Trump administration is conducting a formal review of federal programs that focus on countering violent extremism — or CVE, as the field is known. Current efforts have drawn criticism from lawmakers as well as some senior Trump aides.

Matthew Levitt, a former FBI counterterrorism analyst and a co-author of the study, said past U.S. administrations have been slow to embrace communitybased approaches that some politicians see as “soft.” The resulting absence of a comprehensive strategy has allowed dangerous individuals to slip under the radar, he said.

Such was the case with the suspects in two of last year’s most sensational acts of domestic terrorism: Rahimi, the man suspected of planting homemade bombs in New York’s Chelsea neighborhood and two New Jersey towns; and Omar Mateen, the gunman who killed 49 people in a nightclub in Orlando last June. Both men had been subjects of FBI probes in previous months, but investigators dropped the cases

after failing to find evidence of criminal intent.

“Empowering and incentivizing communities to be active in these cases is in the local and national interest, and the FBI would be the first to say this,” said Levitt, who now directs the Washington Institute’s Stein Program on Counterterrorism and Intelligence. At a time when the bureau is conducting more than 900 terrorism-related investigations around the country, he said, it is vital that community organizations be involved in “reducing the pool of future violent extremists and handling cases in which the person has not yet crossed the legal threshold.”

The study, which included high-ranking counterterrorism officials from previous Republican and Democratic administrations, recommends that government agencies adopt approaches similar to those used by publichealth officials to prevent and contain epidemics. It calls for a three-tiered system that would seek to limit exposure to extremist ideology in the first place, then spot potential problems and re-

Bomb squad personnel stand around the scene of an explosion near the train station Sept. 19, 2016, in Elizabeth, N.J. Ahmad Rahimi is suspected of planting homemade bombs in New York’s Chelsea neighborhood and two New Jersey towns.

spond to them before they turn into serious threats. The approach would draw in a wide array of community organizations — from mosques, churches and civic organizations to social workers and mental health counselors.

The system’s latter tier would include “off-ramp” programs to help rehabilitate formerly radicalized individuals — including former prison inmates as well as defectors or returnees who traveled overseas to join jihadist groups. The U.S. penal system now offers scant assistance to ensure that people convicted of terrorism-related offenses do not return to their old patterns, Levitt said.

“In the next few years, you’re going to see people released from prison after being convicted on terrorism charges,” he said.

“There are no reentry programs within the U.S. prison system other than the typical parole officer, who doesn’t do CVE stuff.”

The report recommends that the proposed initiatives address not just Islamist radicalization, but also other extremist groups, including far-right white supremacist groups behind a rash of attacks on ethnic and religious minorities in recent months. It also suggests that U.S. officials exercise caution in choosing terms used to label or describe radical groups.

The bipartisan panel noted the distinction between “Islamic” extremism — the administration’s preferred term — and “Islamist” radicals, which refers to followers of a “radical political ideology separate from Islam as a religion.”

“Any serious and effective effort to counter the extremist ideology driving groups like the Islamic State and al-Qaeda must be part of a larger strategy to prevent and counter the full range of Islamist and other extremist ideologies posing security threats to the United States,” the report says. “And the reason is not ideological; it is practical and programmatic and has to do with how good-governance and public safety programs actually work on the ground in local communities across the country.” n

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KLMNO WEEKLY

WORLD

Anger surges ahead of Turkish vote

BY K AREEM F AHIM AND A NTHONY F AIOLA

Istanbul

S

o far in a rancorous campaign season, the Turkish government or its opponents have invoked Nazi Germany, terrorist groups, fifth columns and a Latin American dictator.

And that was in the campaign’s first two weeks.

There is just under a month to go before a referendum in April that will allow Turks to vote on a series of constitutional amendments that could give Turkey’s dominating leader, President Recep Tayyip Erdogan, vast new powers and allow him to remain in office for more than a decade.

But already, the poisonous rhetoric surrounding the campaign has aggravated tensions in this divided nation, raising fears about the aftermath of the vote. And the anger has surged beyond Turkey’s borders, upending its foreign alliances, including in Europe. Last Sunday, as part of an escalating feud with the Dutch government, Erdogan warned that the Dutch would “pay a price” after Turkish ministers were prevented from visiting the Netherlands.

The tensions have been building for months. Fistfights broke out in the Turkish parliament when lawmakers debated the proposed changes. Now, at campaign rallies, the referendum is portrayed as an existential struggle over the nation’s future, propelling Turkey either toward tyranny or stagnation. Abroad, the government’s nationalist rhetoric is beginning to have an impact on the war against the Islamic State in Syria, according to U.S. officials, who cite Turkey’s increasingly vociferous opposition to any battle plan that would include Syrian Kurds that Ankara regards as part of a terrorist group.

Incendiary arguments between Turkey and several European allies, including the Netherlands and Germany, erupted after Turkish ministers were prevented from addressing potential voters at rallies in both countries. Last week-

CHRIS MCGRATH/GETTY IMAGES

Looming referendum to give Erdogan sweeping powers fuels nasty rhetoric at home and abroad end, after the Dutch government blocked Turkey’s foreign minister from visiting the Netherlands, citing security concerns, protests broke out in both countries, provoking angry recriminations amid an unexpected diplomatic crisis.

“Shame on the Dutch government for succumbing to antiIslam racist and fascists, and damaging long-standing Turkey-NL relations,” Ibrahim Kalin, Erdogan’s spokesman and senior adviser, wrote on Twitter last Sunday. It was a reference to a view that European governments were lashing out at Turkey in response to their own domestic pressures, and trying to siphon off popularity from right-wing, anti-immigrant parties in Europe, such as that of Geert Wilders, whose party was expected to make major gains in the Dutch legislature but came in second to the prime minister’s party in last week’s election.

Erdogan has associated the German and Dutch governments with the Nazis.

The heated rhetoric is a reflec-

tion, in part, of how difficult it is to predict the outcome of the referendum. Polls have shown the country evenly split or a slight edge for the “no” vote that would represent an embarrassing defeat for Erdogan, who served as prime minister for 11 years before becoming president in 2014.

“There is a lot at stake for the government, the party and the president,” said Soli Ozel, a professor of international relations at Kadir Has University in Istanbul.

The vitriolic comments by some Turkish officials — which have included casting opponents of the constitutional changes as sympathetic to terrorist groups — underscored the government’s worry at polls showing the “no” vote gaining momentum, he said.

“They are concerned they will not be able to pull it off this time.”

The amendments would transform Turkey’s government, by abolishing the post of prime minister in favor of what has been called the “executive presidency,” while enlarging the parliament

People gather on a promenade in Istanbul. Next month, Turks are scheduled to vote in a referendum on constitutional amendments that could give the Turkish president vast new powers.

and empowering the president to unilaterally issue decrees. Erdogan’s supporters argue the changes would leave the president free to govern what has become an unruly state, hobbled by political instability and coalition governments, and as the country faces threats to its stability from foreign and domestic militant groups.

“This change will make Turkey stronger in the region, and it will act faster against threats from inside and outside,” the prime minister, Binali Yildirim, said at a rally for the “yes” vote last month in Ankara as he passionately advocated for measures that included the elimination of his job.

The government’s most ardent supporters, at least, enthusiastically embraced his arguments.

“We’re concerned about terror,” said Nimet Buyukaras, a homemaker who had traveled from the far east of Turkey to attend the rally. “If he wins the referendum,” she said, referring to Erdogan, “it will all be better.”

Erdogan’s opponents have accused the government of playing on public fears after a string of deadly militant attacks over the past few months. The more worrying backdrop to the referendum, they say, is the authorities’ crackdown on enemies and opponents after a failed coup attempt in July, resulting in the dismissals or arrests of tens of thousands.

Passage of the amendments would formalize the sweeping powers Erdogan claimed after the attempted coup, effectively transforming Turkey into a dictatorship, his opponents say. Or, as an informational campaign brochure distributed by the pro-Kurdish People’s Democratic Party, or HDP, whose leaders have been jailed in the past few months, puts it: “Can the deed of a country be given to one person?”

In a tight contest, the Turkish government is eager to turn out the expatriate vote, especially in Germany, which hosts a vast Turkish diaspora, including 1.4 million eligible voters, a majority of whom have tended to support Erdogan.

Campaigning in Germany by Turkish politicians in the past has

SUNDAY, MARCH 19, 2017

11

WORLD sparked diplomatic riffs between Berlin and Ankara, but this time has been far more acrimonious.

Across Germany, politicians have portrayed the Turkish vote as a power grab by Erdogan. The recent detention in Turkey of the German Turkish journalist Deniz Yucel, a correspondent of the daily Die Welt, has added to the outrage.

In the aftermath of the arrest, venues in at least five German towns canceled appearances by Erdogan surrogates, mostly because of what officials have called security concerns. Then came Erdogan’s reference to the Nazis — a burst of anger that many in Turkey, including some of the government’s opponents, considered justified and may serve to bolster Erdogan’s support at home.

In a series of increasingly stinging rebukes, German Chancellor Angela Merkel has accused Erdogan of trivializing the victims of the Nazis and demanded that he stop making the comparison.

At the same time, Merkel has stressed that Turkey and Germany were bound together in many ways, highlighting her delicate position as she navigates her relationship with the Turkish leader.

After more than 1 million asylum seekers arrived in Germany over the past two years — the majority of them Syrians, Iraqis and Afghans fleeing war, and traveling via Turkey — a European Union deal with Ankara to stem the flow of migrants has helped close down the route most of them used. Erdogan has threatened to open the floodgates again — something that could be politically devastating for Merkel, now locked in her own unexpectedly tight race for reelection.

“Merkel has a problem,” said Josef Janning, head of the Berlin office of the European Council on Foreign Relations. “She has been accused of licking Erdogan’s feet and being blackmailed by him and being afraid to speak her mind. . . .

The problem is that Erdogan can pretend not to need Germany, not to need the E.U. But Merkel cannot pretend to not need Turkey.”

The Turkish vote is scheduled for April 16.

“If it’s a yes vote, by and large the current situation will have been legalized and legitimized,” said Ozel, the professor at Kadir Has University. “If there is a no vote, the unhappiness of the presidency will be known by all.” n

KLMNO WEEKLY

To many people in India, zero means a great deal R AMA L AKSHMI New Delhi BY

I

ndian students are taught very early in school that India’s contribution to the world of mathematics is zero.

Way back in the 5th century, an Indian mathematician used zero in the decimal-based place-value system, an achievement that citizens here have always celebrated with pride.

Now, a small but ambitious team of Indian and international scholars called Project Zero wants to go deeper. In the past year, they have been asking the question: What made the invention of zero possible in India?

The initiative is a heady cocktail of academic research and cultural pride, and it coincides with a new wave of hyper-patriotism among Indians that has risen since Hindu nationalist Prime Minister Narendra Modi came to power in 2014.

Indians are reclaiming their heritage, embracing yoga, promoting the ancient Sanskrit language, buying traditional herbal products and celebrating — at times exaggerating — achievements in history.

At a three-day brainstorming event in New Delhi next month called Camp Zero, several scholars will take stock of what is known about the origin of zero and will commission research to find out what philosophical traditions may have led Indians to come up with the concept.

The mission, the group’s website says, is an “attempt to settle once and for all the continuing controversy in the world as to when, where and why the zero digit was invented.”

The project will also boost “the imagination and the image of India,” said Robinder Sachdev, president of Imagindia Institute, a lobbying firm that promotes India’s image and is supporting the project here.

The origin of zero has been an enduring subject of debate because other cultures, including the Mayans, also claim to have used the zero.

NEW DELHI; DOMINIQUE FAGET/AFP/GETTY IMAGES

Indian students are taught that India contributed the idea of zero to the world of mathematics.

“Finding the source of zero is a bit like finding the source of the Nile,” said Dinesh Singh, a mathematics professor at Delhi University and a member of the Indian Society for History of Mathematics. He is not associated with Project Zero. “Nobody has a clue about exactly when and how the zero came into play.

Scholars at Project Zero say the key may lie in early Hindu and Buddhist philosophical discourses about the concept of “emptiness” and “void,” which began many centuries before the mathematical zero came about.

“Even though zero popped up in different places in different forms, Indians are credited to have given zero to the world. But zero did not appear all of a sudden,” said Annette van der Hoek, a Dutch scholar on Indian studies and coordinator of the Zero Project. “We find the cultural notion of zero-ness or emptiness in philosophy, arts and the architecture much earlier. We want to trace its steps as far back as we can and look for the bridges between philosophy and mathematics. What was the philosophical mind-set that provided a fertile ground for such an invention?”

At Camp Zero, mathematicians, philosophers, astrophysicists, archaeologists and numismatists will frame research questions for PhD scholars and examine manuscripts, coins, stone tablets and seals. The research, they hope, will produce books, inform school textbooks and offer opportunities for doctoral re-

search.

The doctrine of “sunyata,” or “void,” is one of the most profound contributions of philosophy from India, said Sundar Sarukkai, professor of philosophy at the National Institute of Advanced Studies in Bangalore.

“Its possible connection to the mathematical zero is also of great interest, and hopefully this kind of work will draw more students into studying and researching these philosophical and mathematical traditions, which ironically has been neglected within India itself,” Sarukkai said.

Buddhist philosophical texts in the 3rd century have elaborate verses about emptiness — “sunyata,” in Sanskrit.

The ancient Mayans used an empty tortoise-like “shell shape” to depict zero, but Indian historians say that it did not seem to have influenced global numeral systems. Arab merchants encountered the zero in India and carried it to the West.

What is widely found in textbooks in India is that a mathematician and astronomer, Aryabhata, in the 5th century used zero as a placeholder and in algorithms for finding square roots and cube roots in his Sanskrit treatises.

Last year, his bronze bust was installed at the UNESCO office in Paris during a conference on zero.

The Indian origin of zero and the decimal system have always been a matter of immense national pride, immortalized in a Bollywood song in 1970 that Indians still sing at public events.

But experts say that much of the ancient Indian traditional knowledge was primarily oral, making it difficult to date zero’s origin.

Not everyone is holding their breath for a great new discovery.

“It is going to be a painstaking task that will require a lot of money.

Our ancient manuscripts are scattered all over; some may even be abroad,” Singh said. “They will have to make a concerted effort to decipher, date and sequence the manuscripts. But I doubt they will come out with anything definitive.” n

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COVER STORY

An unhealthy contradiction

They are poor and sick, and they voted for Trump.

What will happen to them without Obamacare?

BY J ESSICA C ONTRERA PHOTOS BY B ONNIE J O M OUNT

A

NOTHER MORNING, ANOTHER LIST of patients and problems in the hands of 35year-old Keisha Saunders. Diabetes, depression, heart disease.

Robert needs lower blood pressure. Buffy needs prescriptions filled. Mary needs to lose 50 pounds, so she can get what she really needs, a new hip.

Again, the list extends to the bottom of Keisha’s notepad, as it has so many days since the Affordable Care Act mandated that everyone have health insurance. Unlike in Washington, where health care is a contentious policy debate, health care where Keisha is a nurse practitioner is a daily need to be filled. The high rates of chronic diseases in McDowell County

have made it the county with the shortest life expectancy in the nation.

It’s also a place that voted overwhelmingly for President Trump, whose promise to repeal the ACA will soon affect nearly every patient Keisha treats at the Tug River health clinic in Northfork, W.Va., including the one waiting for her in exam room No. 2.

“How are you doing?” she asks Clyde Graham, who is 54 and has been out of work for four years.

“I ate a sandwich from Arby’s,” he says. “And it jumped me out for like, three days. I mean it just burned.”

Heartburn is just the latest problem for Clyde, a patient Keisha sees every three months.

Like so many in this corner of Appalachia, he used to have a highly paid job at a coal mine.

Company insurance covered all of his medical needs. Then he lost the job and ended up here,

holding a cane and suffering not only from heartburn but diabetes, arthritis, diverticulitis, high blood pressure and high cholesterol.

Because of the ACA, Clyde’s visit is covered by Medicaid. Before the law, most West Virginians without children or disabilities could not qualify for Medicaid, no matter how poor they were. The ACA — better known here as Obamacare — expanded the program to cover more people, such as Clyde, who can depend on Keisha to fix his heartburn without having to worry about the cost.

As for the other problems in his life, he has put his hopes in Trump, who came to West Virginia saying he would bring back coal and put miners back to work. When Trump mentioned repealing Obamacare, Clyde wasn’t sure what that might mean for his Medicaid. But if he had a job that provided health insurance, he reasoned, he wouldn’t need Medicaid anyway, so he voted for Trump, along with 74 percent of

SUNDAY, MARCH 19, 2017

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Right, nurse practitioner Keisha Saunders, who grew up in Northfork, W.Va., keeps a photo of her brother, Derrick, who was uninsured when he was diagnosed with kidney cancer. He died at 25. Opposite page: Medicaid patient Clyde Graham is 54, unemployed and has a host of health issues.

McDowell County.

Tug River Health Association treats about 8,700 patients, resulting in some 20,000 visits a year to its five clinics. In 2016, 12,284 of those visits were from patients on Medicaid, up from 5,674 in 2013, before the ACA took effect here.

Without the ACA, many of those patients wouldn’t be able to afford care. Will they soon lose their coverage? Will they stop coming to the clinic? Lately, Tug River’s chief executive has been telling his staff, “The key word going forward is uncertainty.”

To Keisha, all is uncertain beyond this moment, in which she prescribes Nexium for Clyde’s heartburn, examines him from head to toe and sends him to the lab across the hall for blood work.

“I’ll see you in three months,” she says, hoping that will be true, and heads to exam room No. 1, where another patient is waiting.

“What’s going on today?” she asks, and walks in the room to find out.

M

EANWHILE IN THE FRONT OF THE CLINIC, more patients are coming in through the heavy doors and up to a glass window where a receptionist is waiting.

“Hi, honey, how are you?” Tammy McNew says to each one. Over the past four decades, McDowell County has lost 60 percent of its population, so she rarely needs to ask their names. Instead, she asks what seems like the most important question in health care these days: “Got your insurance card with you?”

If the answer is no, she will send them back to

Keisha anyway, and the clinic will depend on federal grants to make up the cost. But more often in recent years, the answer is what a middle-aged woman with springy curls says as she passes her Medicaid insurance card through the window: “Yes, ma’am,” she tells Tammy, who slides it into a scanning machine.

In other parts of the country, the primary impact of the ACA has been requiring people to have private health insurance, but in poor and sick communities like McDowell County, the law’s dominant effect has been the Medicaid expansion, which has given more people access to the kind of health care that wasn’t widely available or affordable to them before. With an insurance card in her pocket, the patient at Tammy’s window can venture into the realms of medical care that are typically out of reach to those without one: blood work, immunizations, specialized doctors, surgery, physical therapy.

If she needs mental health counseling, the clinic no longer sends her to the next county over; last July, Tug River was able to hire a psychologist, who is now treating 180 people, many of whom are trying to overcome opioid addictions.

If she needs medication, the nurses won’t go digging in a closet of samples left by drug reps as they used to do for the uninsured. The medication will come from a pharmacy and cost no more than a few dollars.

This clinic is in Northfork, a community of a few hundred people along the railroad that carries coal through the mountains. Keisha, who is black, was raised in this predominantly

white county, in a home overlooking the cinderblock church where her father, a coal miner, serves as pastor. She attended the middle school beside the clinic parking lot, which now has busted windows and gaping holes in its brick facade. There weren’t enough children to fill it, as every year the closing of more mines drove job-seekers out of the county.

Eventually, Keisha was one of them. After graduating high school and becoming a mother at 18, she realized that if she wanted to become something more for her daughter, she would have to leave.

She moved 45 minutes away, to Princeton, W.Va., where she got a nursing assistant certification and a job in a nursing home. But every Sunday, she strapped her daughter Kiana in her car and drove back to McDowell County, checking in on her always-fading town. Bulldozed, shuttered or abandoned: the grocery store, beauty salon, florist and furniture store. Still open: the dollar store, medical equipment store, funeral home and her father’s church, where Keisha would usually sit with her brother Derrick.

It was 2003 when Derrick started to feel pains in his back and groin, and Keisha, then a 22-year-old licensed practical nurse, started to understand what insurance could mean. Derrick was 24 — too old to be covered by his father’s insurance but unable to afford his own.

He thought his only option was to go to an emergency room. His parents remember him returning home, having been told there was continues on next page

SUNDAY, MARCH 19, 2017

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COVER STORY from previous page

nothing wrong with him. When the pain didn’t go away, Derrick tried a different ER. Keisha would later learn that doctors thought her brother was seeking pain pills. Months passed.

All the while, a tumor inside his kidney was growing. A few months after the cancer was finally discovered, Derrick died at 25.

Keisha didn’t allow herself to wonder what might have happened if he’d had insurance.

She focused on remembering their last days together, when the doctors said the cancer was too advanced to be stopped by treatment, so she treated him with chocolate instead. M&Ms by his bedside.

She kept working at the nursing home and then in hospice care, raising Kiana and taking classes at night. When she was 30, she completed a graduate degree and became a nurse practitioner. She made the drive back to McDowell County again, this time to ask for a job.

At first, some patients at Tug River were wary of her loud laugh and big hoop earrings.

Others had known her since she was a little girl.

She cared for them all, and her schedule grew busier as the ACA came to McDowell County and made more people eligible for insurance.

In 2016, Trump yard signs and bumper stickers started appearing along her drive to work.

In the clinic, one doctor and the janitor could regularly be heard rehashing the latest controversy and what they liked about Trump. Keisha had decided she would vote for Hillary Clinton, because of health care and because she wanted to see a woman become The high rates president. But it wasn’t in Keisha’s job description — or personality — to talk of chronic politics. She avoided the subject.

Come election night, she was too diseases in exhausted after another packed day at the clinic to stay awake. She didn’t McDowell learn who won until the morning.

In all of those Sundays at church, County have Keisha was taught that God has a plan.

If God planned for Trump to win the made it the election, she told herself that morning, it must be for a reason.

county with the

N

OW TRUMP IS IN the White House and Keisha is pressing her fingers into the stomach of expectancy in 24-year-old Ruby Thompson. Nearly every patient Keisha sees has been the nation. affected in some way by the ACA, and in Ruby’s case, the ACA’s Medicaid expansion is the reason she has insurance.

According to the list on Keisha’s notepad, Ruby is just here to refill a prescription, but Keisha checks her as if they are meeting for the first time. She tries to feel for anything abnormal around Ruby’s stomach, which is a little too thin, but Keisha knows cigarettes can cut into a person’s appetite. “Are you still smoking?”

“Yeah,” Ruby answers, tugging at a gold necklace that spells MOM. “Do you want to stop?” “I will eventually, I guess.” Ruby is another patient who voted for Trump because of his promise to bring back jobs. She hasn’t yet lost hope that she can become a secretary, but for the past two years

shortest life

Used clothing and household items still remain behind the broken glass of a shuttered business in Northfork.

The town has been in economic decline for decades and now has only a handful of operating businesses.

she’s been working at KFC. She has health insurance only because she was fined on her taxes for not having it, at which point she found out that because of the ACA, she qualified for Medicaid. It is insurance at its most tenuous, though, because if Medicaid reverts back to a program only for the neediest people, the working poor will be most at risk of losing their coverage.

“Go ahead and sit up,” Keisha says after checking Ruby’s ankles for swelling, a potential sign of diabetes. She writes a prescription and sends Ruby to the front desk to make an appointment for November, when she is due for a breast exam and cervical cancer screening.

Another patient comes in: Carolyn Hodges, 68, who tells Keisha that she’s been feeling dizzy. Carolyn has Medicare, the public health insurance for the elderly. Medicare doesn’t cover all health-care costs, which is why Carolyn is as worried about the price of her medications as the fact that she’s been bumping into walls.

The last time she went to pick up her husband Roger’s insulin, Carolyn tells Keisha, the pharmacist said it would be more than $600, instead of the $100 or so they usually pay. That was when she learned Roger was in the Medicare prescription “donut hole,” which means that the cost of his medications had exceeded his limit for the year, and he would be forced to pay far more for prescriptions until the year ended and the tab started over. One initiative of the ACA has been to close that hole incrementally, but Carolyn, unaware of that, sees the bills piling up and thinks she knows who must be to blame.

“Thank you, Obama!” Carolyn says, throwing her arms in the air.

Keisha nods and keeps typing into her chart.

Another patient: Andrea Easley, 50, who has struggled for so long that there wasn’t much more the ACA could do to help her. She already had Medicaid, which she depends on for her health care, and disability payments, which she uses to pay her rent, support her 70-year-old mother and send checks to her son who is in prison in Charleston, W.Va. “What’s going on, Miss Andrea?”

“My nose,” Andrea says, nearly shouting. “I had just come in. Sit down. Sneeze. My nose went to burning. I mean, it burned like someone gone and set fire to my nose.”

Despite taking more than a dozen medications a day, Andrea’s problems never seem to go away. Her life isn’t one where she thinks much about politics — she didn’t vote in the election — but of stomach issues, coughing, lack of sleep, fights with her mother, stress over her son.

“Have you tried a humidifier?” Keisha asks.

“What is that?” Andrea says. “It keeps the moisture in the air,” Keisha explains. “Do you sleep with your mouth open?”

“I don’t know how I sleep. I’m not half sleeping. Now last night, it made me mad,” she says. “Them cats out there meowing, and I’m trying to go to sleep, and they’re out there doing all such things they have no business doing . . .”

Looking up at Andrea from her low swivel stool, Keisha listens. She knows other patients are waiting. But she also knows that sometimes her patients need to talk, so she gives no sign that she has anyplace else to be. Only when Andrea pauses does she say, “I do think you need a humidifier. I think that will help some.”

“Where can I get that from?” “Well,” Keisha says, knowing her answer will upset Andrea,

SUNDAY, MARCH 19, 2017

15

penalizes anyone who doesn’t pay for Medicaid coverage, even if all they can afford is a dollar a month. There’s even a plan that proposes keeping the Medicaid expansion just as it is.

With so much to be resolved, Keisha hands Amanda a form to sign up for Medicaid. They walk together to the front desk, where Keisha asks Tammy to schedule Amanda’s first prenatal appointment.

“Thank you,” Amanda tells her.

“You’re welcome,” Keisha says. “I hope everything goes well.”

S

Keisha Saunders examines Clarence Workman at the Tug River health clinic. Workman said he struggled with Obamacare in the beginning but that “things are excellent right now.”

“you have to buy it.”

Another patient: Charles Collins, 39, who believes that the impact of the ACA was to make his own health-care costs rise. He is privately insured through his job at a coal mine one county over. The mine used to cover 100 percent of his medical expenses, but starting this year, only 90 percent is covered, and his dental insurance, he tells Keisha, “ain’t worth a nickel.”

“That’s a mess,” she says. Charles unclips his miner’s overalls so she can place the stethoscope on his chest, and tells her about getting his tooth pulled.

“I got a bill for $324 and they paid a dollar of it,” he says about his insurance. He is glad Trump is repealing the ACA, because in his opinion working people are being forced to pay for those who sit around and do nothing. But no matter what Trump does, Charles knows the bill for this visit is coming.

Another patient, here for the first time: a 33-year-old woman who voted for Hillary Clinton. She has no insurance, by choice. She didn’t feel she needed it. Now, because of a test result in Keisha’s hands, she will.

“Hi Miss Amanda, I’m Keisha, the nurse practitioner here.”

“Nice to meet you,” Amanda says, pushing back a lock of cherry-colored hair.

Keisha asks Amanda about her symptoms, then gets to the point. She turns to face her and says, “It looks like — you’re pregnant.” “I’m pregnant?” “Yes. Were you expecting . . .” “That’s such good news!” Amanda says.

“I’m glad you’re happy,” Keisha says. “Good!

Yay!” Amanda lifts her palms in the air, and they double high-five. Then come the questions

Keisha needs to ask for her chart.

Is the baby’s father involved? “I think he’s going to be a little apprehensive,” Amanda says.

Is she working? “Not currently,” Amanda says, explaining to Keisha that she just moved back to West Virginia after living in Ohio. So far she has put in applications at gas stations and restaurants.

Is she at all familiar with the area? With the doctors she’ll need to see? With what she needs to do now? Amanda wrings her hands between her knees. “I have no idea where to go next,” she says.

And here is another version of uncertainty in the clinic, this time a patient’s. If she signs up for Medicaid, which covers low-income, pregnant women, she’ll be covered through her pregnancy. But after that? Her access to insurance will depend on what happens over the next months in Washington, where so many plans for the ACA’s replacement are floating around. One, just unveiled in the House, would roll back the Medicaid expansion slowly, meaning Amanda could keep her public insurance after the baby is born. In a few years, however, someone like her might not be able to do the same, and instead might receive tax credits to help offset the cost of private insurance.

But that’s just one plan. There have been plans based on “block grants” and plans based on “per capita caps.” Some plans give people tax credits based on their income. Some base the tax credits on their age; some on where a person lives.

There’s the plan once proposed by Trump’s secretary of health and human services, which would get rid of the Medicaid expansion entirely.

There’s the plan Vice President Pence implemented when he was governor of Indiana, which

OMETIMES, BETWEEN PATIENTS, KEISHA retreats into her office, sits at the folding table she uses as a desk and takes a few steadying breaths. If she has enough time she also prays, and since January some of those prayers have been for President Trump.

“I just pray that he makes the right decisions,” she says. “I’m not sure what’s going to happen. All we can do is pray about it.”

She prays for others, too. Her daughter. Her parents. Her brother. She prays for her patients, that they stay healthy, that they lose weight, that they take their insulin shots the correct way, that the woman with the rotting tooth will follow up on her promise to go to the dentist, that the man whose wife died after saying to him, “Honey, do you think I’m getting better?” will find a way to ease his loneliness.

And what if, in a few months, those “I just pray that patients lose their insurance? She’ll pray about that, too, she says, but first [Trump] makes she will explain the sliding-fee program, the closet full of sample medicathe right tions from drug reps, the forms she can submit asking pharmaceutical compadecisions,” nies for discounts, the free clinic at the medical school four hours north — all says Keisha the things she will do to try to get them the care they need, even if they can’t Saunders. “I’m afford it.

One more deep breath and a last not sure what’s prayer for herself — “Okay, Lord, help me get myself together” — and then going to she picks up her stethoscope. It’s Friday afternoon, and seven patients happen. All we need to be seen before she can go home to her teenage daughter. can do is pray “Hey there, how are you?” she starts with one. about it.”

“Oh goodness, you have been having a rough time,” she tells a man with kidney stones.

“You are not broken,” she says to a woman who the psychologist recently diagnosed as bipolar, and so it goes until she finishes caring for her last patient, nearly an hour after the clinic has closed.

She powers down her laptop and carries her notepad to the blood-work lab, where there is a paper shredder. Ripping off the top page with today’s list of patients and problems, she drops it into the machine and watches it disappear.

Then she slides the notepad into her bag to take home. Another week of need is coming, and she wants to be prepared. n @ The Washington Post

SUNDAY, MARCH 19, 2017

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KLMNO WEEKLY

VETERANS

‘This shows you he cares’ BY

M ICHAEL S . R OSENWALD

F

our years after the Taliban blew off most of his left arm in Afghanistan, former Army Sgt. 1st Class Ramon Padilla traveled to Dallas for a wounded warrior golf tournament. For putting advice, he relied on the man who sent him to war.

“Sir,” Padilla asked former president George W. Bush, “where is this hole breaking?”

Bush, looking at Padilla’s ball 20 feet from the hole, gave his exsoldier an order: “Ramon, just make the freakin’ putt.”

A few months later, Bush took up painting and was given a similar order from his instructor while brooding over colors — “Just paint the cube, George.”

For both men, the answer to their struggles was the same: Don’t dwell. Move on. Padilla made the putt, a story he tells to inspire wounded vets to take up the sport.

Bush painted the cube, then moved on to fruit, his dogs, self portraits and pictures of world leaders.

Now, with the wars behind him but still ever present in his mind, Bush has published “Portraits of Courage,” an immediate bestselling book of 98 portraits of warriors he befriended after they came home not quite the same as they left. Padilla, 42, is on the cover with six other veterans staring off into the distance — pensive, wounded.

Only one is smiling.

Besides losing his arm, Padilla, suffered a traumatic brain injury and cracked part of his skull.

“It looks like me because of the scar on my head,” Padilla said, staring at himself on the cover. “I guess he got my pointy nose right, too.”

To Padilla, who lives with his wife and three kids in Waldorf, Md., and works at the Pentagon helping other wounded warriors find internships, the portrait is more than just a 14-by-16-inch reminder of the permanent wounds he suffered during the longest war in the country’s history. It is proof that Bush continues to make good on a promise to spend the rest of his life helping and celebrating the more than 2.6 million men and women sent into battle after the

LINDA DAVIDSON/THE WASHINGTON POST

Man wounded in Afghanistan is among the veterans painted in George W. Bush’s new book Sept. 11, 2001, terrorist attacks.

“He’ll never forget what all the warriors did for this country,” Padilla said. “This shows you he cares. He’s not forgetting.”

Padilla and Bush met at a tournament the former president hosted for veterans organizations, including the Salute Military Golf Association. The association was founded by Jim Estes, a pro golfer from Olney, Md. Padilla, a baseball and football star in high school near Los Angeles, was referred to the group by his rehabilitation therapist at Walter Reed medical center.

At his first lesson, Padilla hit the ball farther and more accurately than many two-handed weekend duffers. Eventually, he helped develop a prosthesis that allowed him to swing with two arms. The sport centered him.

“It gave Ramon the confidence he needed to move on as a father, a husband, really as a man,” Estes said. “And besides that, he really became an excellent golfer.”

But on the course that day in

Ramon Padilla, top, lost his arm and suffered other injuries while serving in Afghanistan in 2007.

He met former president George W. Bush at a golf tournament for wounded warriors, and Bush later asked to paint a portrait of him, left, seen in Bush’s book “Portraits of Courage.”

2011 with the former president, Padilla was less concerned with his score than he was with making sure Bush did not feel awkward around him or the other wounded warriors. Padilla doesn’t blame him for his wounds.

“I’m pretty sure people have a lot of questions for him,” Padilla said. “There’s a lot of controversy.

He did his best as president. We were proud and honored he sent us to war to fight for our country.

We wanted to do that for him. I would never want to disrespect him or question him in anything he did.”

So Padilla didn’t bring up what happened on July 8, 2007.

He and his squad had just finished their patrol in the mountains in Afghanistan and were preparing for dinner — Philly cheesesteaks made by a soldier from Philly. Padilla went to round up his men, yelling, “Hurry up before I get . . . shot.”

A few seconds later, a rocketpropelled grenade blew up just steps from Padilla, leaving his arm dangling from his body by skin and ligaments. After surgeons completely removed his arm, they left it on his chest as a way to temporarily comfort him.

“Even though I had lost it,” Padilla said, “I hadn’t lost it.”

Padilla spent more than two years recovering at Walter Reed, wondering how he would play catch with his kids and provide for his family. But he kept all that to himself with the former commander in chief, though Bush could clearly see Padilla had returned with only one arm.

“We talked about family,” Padilla said. “I said, ‘Hey sir, how is your putting going? How are your daughters?’ Stuff like that. I didn’t want him to be uncomfortable.”

Padilla and his wife, Judith, were invited to Bush’s home. Laura Bush showed them around, telling the stories behind family mementos and photos. Bush had not started painting yet.

“I had been an art-agnostic all my life,” Bush wrote in the introduction to “Portraits of Courage.”

In the spring of 2012, a Yale history professor visited Bush at his office. The professor mentioned Winston Churchill’s essay “Painting as a Pastime.” Bush reveres Churchill. He said to himself, “If that old boy can paint, I can paint.”

Bush took an online art history course from the Museum of Modern Art. He hired an instructor.

“There’s a Rembrandt in this

SUNDAY, MARCH 19, 2017

17

PARENTING body,” he told her. “Your job is to liberate him.” And he turned his “man cave” into an art studio.

“For the first time in my sixty-six years,” he wrote in the book’s introduction, “I picked up a paintbrush that wasn’t meant for drywall.”

The cube. Landscapes. Those much-talked-about self portraits in the bathtub and shower. Bush painted whenever he had time.

Eventually, he painted portraits of world leaders he knew — Vladimir Putin, Tony Blair, the Dalai Lama.

In 2015, painter Sedrick Huckaby suggested that Bush paint people he knew but others did not.

“Instantly, I thought of painting wounded warriors I had gotten to know,” Bush wrote, directing his staff to collect photos and stories of veterans he remembered, including Padilla, who also served in Iraq.

Padilla got an email that Bush wanted to paint him, and the former president used a photo taken of him during his trip to Dallas.

This was not some sort of apology, a way to make amends for decisions that many Americans still vehemently condemn and that have killed almost 6,900 U.S. service members. In promoting the book last week, Bush told the “Today” show that he still thought he had made the right decisions in sending American troops to war in Iraq and Afghanistan.

“I regret they got hurt,” he said.

The portraits of the wounded warriors are meant “to show their determination to recover, lack of self-pity, and desire to continue to serve in new ways as civilians,” Bush wrote in the introduction. “I painted these men and women as a way to honor their service to the country and to show my respect for their sacrifice and courage.”

Proceeds from the $35 book will go to veterans charities. The portraits are also being displayed at Bush’s presidential library in Dallas. Padilla hopes to travel there to see his face, and that scar, hanging on the wall. He would certainly love to see Bush again. After he made that long putt, Bush grabbed him and rubbed his hair in celebration.

“It was like he was my uncle,” Padilla said. “I had that kind of bond with him.”

In the meantime, he’s showing off the book to friends and family.

Bush autographed the page with his portrait.

“To Ramon,” he wrote. “With respect and admiration.” n

KLMNO WEEKLY

Despite maternity leave buzz, little has changed BY

J ENA M C G REGOR

M

any companies have been noisily publicizing their cushy parentalleave policies in recent years, telling the world they’re bestowing workers with an increasingly generous length of time to take off and bond with their newborns. Deloitte now gives new moms and dads 16 weeks of paid leave. Etsy hands out a full six months. Netflix said in 2015 that its workers could take off a child’s entire first year.

But while the headlines may be making a splash, the more generous policies aren’t making much of a dent in the overall numbers.

The average number of weeks employers are giving workers actually fell slightly over the past decade, even as a greater percentage of companies offered 12 weeks or more in annual leave, according to new data from a nationally representative sample of more than 900 companies.

“Even though those have been the focus of media stories, they don’t show the whole picture,” said Ellen Galinsky, senior research adviser for the Society for Human Resource Management, which publishes the survey.

In 2005, Galinsky said, employers with at least 50 workers allowed an average maximum of 15.2 weeks in maternity leave, compared with 14.5 weeks in 2016. That average is slightly higher than the length of time found in 2014 and 2012 but lower than the one in 2008 and 2005. The data was first reported

by Bloomberg News.

The report also shows that more companies are paying women who go on parental leave — 58 percent of companies now offer some pay during leave. The number has been roughly flat since 2012 but is up from 46 percent in 2005. However, the percentage of employers offering workers 100 percent of their regular pay during leave has dropped, according to Galinsky’s data, declining from 17 percent in 2005 to just 10 percent

VITALINKA/BIGSTOCK

last year.

What explains the trend? While it’s possible some companies have cut back their benefits over time, Galinsky said that’s unlikely, as maternity leave isn’t usually the kind of perk companies trim.

Some slight changes to survey logistics — in 2016, HR managers could complete the survey online, rather than only by telephone, and were pushed with more follow-up questions — could have had some effect on how companies respond or describe their policies.

But Galinsky and senior researcher James T. Bond noted that the drop in weeks is probably best explained by some differences in the sample. The study is not longitudinal — in other words, the same 900 companies weren’t examined over the 11-year period — but is a nationally representative sample of the U.S. economy each year the study is done, weighted by employer size.

A larger percentage of all employers offered new moms 12 weeks off in 2016. But at the high end, surprisingly, the group of companies surveyed in 2005 were even more generous than those surveyed last year. Netflix may have gotten much attention for offering a full year off for new parents, but there were companies in the 2005 survey that offered new mothers at least the same. And among employers that offered the most leave in 2005 — more than three months off — the average number of weeks offered was 28 weeks, much higher than the 21 weeks among that group in 2016.

The shift in employers covering

women’s entire paycheck while out on leave is probably due to a slight rise in companies that offer short-term disability leave, shifting the mix toward partial pay, Galinsky said.

Still, what is clear to Galinsky is that the ample perks giving companies in certain industries good PR haven’t yet translated into better benefits for everyone. It still could, however.

“The companies that are oneupping each other by offering more and more wonderful leaves are doing so for the same reason all companies do so — for the retention of their talent,” she said. Now, “if you’ve got 78 percent of employers saying they’re having difficulty attracting the right employees,” she said, that could change. “We just haven’t seen it yet.”

Other recent studies have also shown that efforts to increase parental leave — whether via state legislation or individual corporate benefits — have done little to improve how many women actually use the leave they’re offered. A recent study by Jay Zagorsky, a research scientist at the Center for Human Resource Research, used census data to find that the number of U.S. women taking maternity leave has been about the same over the past two decades, despite an improving economy and changes to some state laws that now mandate paid leave. (Use of paternity leave, meanwhile, tripled over the same period.)

Zagorsky’s data showed that only about 47.5 percent of women were compensated in 2015 for taking maternity leave, a percentage that is increasing, though only by 0.26 percentage points per year. At that rate, it could take another decade before even half of women will get paid time off during maternity leave.

“We are a much richer country since the 1990s,” Zagorsky said in an interview in January. “Looking at the maternity data, it does not suggest that any of the increased wealth has flown toward new working mothers.” n

SUNDAY, MARCH 19, 2017

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KLMNO WEEKLY

BOOKS N ONFICTION l REVIEWED

BY

D ANA M ILBANK

T

he nation is hopelessly split between left and right, Democrats and Republicans, facts and alternative facts, reality and Sean Spicer. But there is one notion that could, and should, unify us, or at least all of us under the age of 53 or over the age of 76: Pretty much everything that has gone wrong is the baby boomers’ fault.

Boomers took over the government in the early 1990s, when Bill Clinton’s 1992 victory installed them in the White House and Newt Gingrich’s Republican Revolution of 1994 gave the generation a majority in the House that persists to this day.

And how has that worked out for them? Well, the Greatest Generation survived the Great Depression, won the Second World War, brought about the enormous postwar economic boom, outlasted the Soviet Union in the Cold War and established the United States as the sole superpower. Since then, the boomers — the Worst Generation, if you will — have squandered most of that.

The United States, challenged all over the world, is receding and turning inward. The economy still hasn’t recovered fully from the financial collapse of 2008, the worst since the Great Depression.

The federal debt is out of control, and inequality is worse. Boomers expanded entitlement programs that are wrecking the nation’s finances; they failed to act on global warming; they presided over declining faith in virtually all institutions, from religion to the Supreme Court; and their children may be the first generation with dim prospects of doing better than their parents did.

And now they’ve given us a president who is the epitome of boomer excess: narcissistic, impulsive and uncompromising.

This deterioration on the boomers’ watch was no accident. They grew up selfish and unyielding and have governed that way, creating the polarization that has paralyzed our politics and left us unable to solve the nation’s problems.

Given my own Gen X grievances against the boomers, I was delighted to learn that another Xer, venture capitalist Bruce Cannon Gibney, shares my generational hostili-

The boomer generation blew it all up

GETTY IMAGES/ISTOCKPHOTO

ty. In “A Generation of Sociopaths: How the Baby Boomers Betrayed America,” Gibney delivers an unrelenting critique of the Worst Generation. Perhaps too unrelenting. He blames boomers for a lot of bad things that they did — and a lot more bad things that they didn’t do.

The core of Gibney’s argument, that the boomers are guilty of “generational plunder,” is spot-on. He accuses them of “the mass, democratically-sanctioned transfer of wealth away from the young and toward the Boomers,” and he’s right. In addition to making a mess of Social Security and Medicare, Gibney notes, they dragged the national savings rate down to 5 percent between 1996 and 2016, from 10 percent between 1950 and 1985.

But Gibney blames the boomers for everything: abortion, divorce, overeating, high inflation, taking deferments during Vietnam, failing to launch a mass movement calling for the rebuilding of Vietnam after the war, crime, poor educational standards, corporate tax rates, adjunct professors. At one point, he rails about “Pat Robertson fulminating about homo-

A GENERATION OF SOCIOPATHS How the Baby Boomers Betrayed America

By Bruce Cannon Gibney Hachette.

430 pp. $27.

sexuals, feminists, and praying for the deflection of hurricanes while his website minions opined on the afterlife of pets.” Robertson was born in 1930, a decade before the oldest boomer. Gibney also has words for “feckless non-entities like Marco Rubio.” Rubio, born in 1971, is nearly a decade younger than the youngest boomers.

Gibney complains that “many young boomers leapt at the neoMalthusian nonsense peddled in the 1960s and 1970s by a slightly older generation of writers.” So is this the fault of the young boomers or of the Silent Generation’s Paul Ehrlich (born 1932), who wrote “The Population Bomb”?

Even Earth-in-the-balance Al Gore is criticized as anti-environment, in “his original form as pork-barreling scenery wrecker.”

Gibney is just a wee bit sweeping when he pronounces that “the story of the past forty years has been the substitution of sentiment for science” and that “the Boomers were the first modern generation to harbor really negative feelings about reality and science.”

Surely we can give the boomers

the blame they deserve for trashing the country while acknowledging that they have also been responsible for major advances in medicine and science, in arts and culture, in civil rights and the rights of women, disabled people and gay people. Can we at least give them some credit for rock-androll?

I’m no more qualified than Gibney to give the generation a psychiatric diagnosis, though I think the boomers are more properly labeled a generation of narcissists than a generation of sociopaths. (My own cynical generation has trended more toward the sociopathic.) Generational theory tells us that the boomers are “idealists.” They believe passionately in their view of the world, and they are unbending. The problem is there are two halves of the baby boom: the Woodstock counterculture types and their ideological opposites, those who created the modern religious right. These have been at war since the 1960s, and that war, continued in politics, is what has paralyzed the country for a generation.

“As a group, the Boomers managed to be simultaneously for the war and against serving in it. Their responses to Vietnam were confused,” Gibney writes. But they weren’t confused. Gibney is conflating two entirely different groups of boomers.

It isn’t ill intent, or sociopathic instincts, that caused boomers to make such a mess of America. It is the collision of two strongly idealistic cohorts within the same generation. Their shared selfishness led boomers on both sides of the divide to believe that only they had the right answers and that there was nothing to be gained by compromise. Liberals increased spending on government programs. Conservatives cut taxes.

And both allowed the culture wars to rage — on abortion, religious liberties, gay rights, gun ownership, civil liberties and more. Neither side yielded. Now they’ve left the rest of us, Gen Xers and millennials alike, to clean up their mess. n Milbank is a syndicated columnist with The Washington Post, author of three books and a Gen Xer.

SUNDAY, MARCH 19, 2017

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BOOKS

KLMNO WEEKLY

A dark thriller’s moving moments

Getting high in Hitler’s Germany

F ICTION

N ONFICTION

‘S

l

REVIEWED BY

P ATRICK A NDERSON

ay Nothing,” Brad Parks’s big, ambitious, sometimes troubling, always suspenseful new novel, portrays an American family besieged by evil. They’re the Sampsons, Scott and Alison, and their 6-year-old twins, Sam and Emma, who live in Norfolk, Va., where he’s a federal judge and she works with disabled children. As the story begins, they’re about as happy a family as you’ll ever meet. Then everything changes.

Scott has “the largest patent lawsuit in U.S. history” coming before his court. The case will decide the ownership of a new drug that will prevent many heart attacks and thereby earn billions of dollars for one side or the other.

Then, after school one day, Sam and Emma are kidnapped, and Scott receives an anonymous message: Deliver the verdict we want or you will never see your children again. Chopping off fingers is part of the threat. “Say nothing,” the caller warns.

It’s a strong plot, and Parks makes the most of it. The horrified parents agree that they must not summon the police or FBI, because of the risk that the kidnappers will find out. Scott must go against his every instinct and serve not justice but whatever is needed to save his children. Most readers, particularly if they are parents, will cheer his decision.

We see the two foreign-born thugs, brothers, who are holding and sometimes abusing the twins.

One of Alison’s worst fears is realized when these criminals feed the children peanut butter sandwiches — to which Emma is allergic. The captors find her on the floor, face red and blotchy, eyes swollen shut.

The ordeal extends for three weeks as various stages of the lawsuit unfold. Despite the parents’ vow of silence, Alison insists on telling her family — her mother, three sisters and brothers-inlaw — what has happened. As Scott feared, problems result. The pressures the parents face test

their love, as each makes angry, unfair accusations against the other.

In court, the judge’s questionable rulings lead a publicity-seeking congressman to demand his impeachment. The judge comes to suspect that a member of his staff may be cooperating with the kidnappers. A man the judge secretly enlists for help vanishes. Although cruel and dangerous, the thugs holding the children are clearly not the brains of this billion-dollar crime — but who is?

Parks, a husband and father, writes well about the legal issues and political pressures that arise, but the novel’s great strength is his sensitive portrait of the parents’ love and pain. In one passage, the judge recalls, “I thought of how, when we first brought the twins home from the hospital, Alison and I used to creep into the nursery and watch them breathe. . . . We wanted to make sure they were still doing it. But I think part of it was also to enjoy the unfathomable miracle we had conspired to create.”

Another time, Scott struggles to explain the emotions that overwhelm him: “The despair was followed by feelings of supreme impotence, soon to be replaced by rage, then heartaches, then hatred, then anxiety, then rage again.” Either parent would die to save the children, but the challenge is not that simple.

We wait anxiously to learn who is behind the kidnapping and what fate will befall this family.

That cannot be revealed here, but it can be said that the novel’s final pages are exciting, surprising and deeply moving. How moving? Its ending brought me to tears, and, where books are concerned, such moments are rare. Parks’s six novels about investigative reporter Carter Ross won crime-fiction prizes, but this stand-alone carries his work to a new level. n Anderson regularly reviews mysteries and thrillers for The Washington Post.

I SAY NOTHING

By Brad Parks Dutton.

448 pp. $26.

BLITZED Drugs in the Third Reich

By Norman Ohler Houghton Mifflin Harcourt.

292 pp. $28.

l

REVIEWED BY

T IMOTHY R . S MITH

n the 1930s, a smitten German could buy his fräulein boxed chocolates spiked with methamphetamine. When Germany invaded France in 1940, its soldiers marched on Pervitin, an early form of crystal meth, which kept them perked for the lightning speed of Blitzkrieg warfare.

On the verge of destroying the British forces at Dunkirk, Hermann Göring, the head of the air force, was zonked on morphine when he had a eureka moment. “The world lay at his feet, and in his blissfully opium-soaked brain he decided that the glorious victory over the Allies should under no circumstances be left to the arrogant leaders of the army,” writes Norman Ohler in “Blitzed,” his fascinating, engrossing, often dark history of drug use in the Third Reich.

Weather interfered, the planes stayed put, and the army watched as the British slipped away.

Reading “Blitzed,” one gets the impression that the Germans were consuming Pervitin like Goldfish crackers or Skittles, “to help with childbirth, to fight seasickness, vertigo, hay fever, schizophrenia, anxiety neuroses, depressions, low drive, disturbances of the brain — wherever the German hurt, the blue, white, and red tube was at the ready.”

During the waning days of the war, the Nazis developed cocaine chewing gum for young sailors to use while piloting single-man submarines on suicide missions.

“Trust the Germans to concoct some truly awful sh--,” the writer William Burroughs commented.

Addiction went to the top. Adolf Hitler began taking glucose injections in the 1930s so he could hold his arm in the Nazi salute for impossibly long times, ever the Übermensch. But as the war advanced,

he became dependent on harder stuff. Hitler’s doctor gave the Führer daily injections of oxycodone, hormone preparations, a collection of pills and serums, and quack remedies made from pigs’ liver.

“In fact it was the immediate high of the injections that allowed Hitler to feel like a world ruler and gave him a sense of strength and unshakable confidence that he needed to make everyone else keep the faith in spite of all the desperate reports coming from every front,” Ohler writes.

Hours after a near-fatal bombing in his bunker, Hitler took an injection of oxycodone to meet with Benito Mussolini, Italy’s strongman. His appearance at the train depot seemed miraculous.

But Hitler’s injuries, including two burst eardrums, were worse than expected. The only local anesthetic available was cocaine, and it started a new addiction.

By the end of the war, Hitler had the telltale signs of an addict: Track marks mottled his forearms, his hands trembled. He stooped.

He drooled. His blood was the consistency of strawberry jelly. By the winter of 1945, with Soviet forces closing on Berlin, Hitler ran out of drugs.

“Now the Fuhrer had irrevocably entered the reality of his lost war,” Ohler writes. “Everything weighed on him all of a sudden, and as an infinitely heavier burden than before — naked as he was without the hormones of happiness.”

He shot himself on April 30. Out of drugs, he knew full well the reality of his demise. As for his mistress, Eva Braun, his final gift to her wasn’t a box of chocolates but a cyanide pill. n Smith is on the staff of Book World, The Washington Post’s book review section.

The Nazis developed cocaine chewing gum for young sailors to use while piloting single-man submarines on suicide missions.

SUNDAY, MARCH 19, 2017

20

KLMNO WEEKLY

OPINIONS

NFL needs to prescribe better medical procedures SALLY JENKINS is a sports columnist for The Washington Post.

T

he NFL can’t treat players for pain just by aligning their chakras, everyone understands that. But there is simply no legitimate rationale for some of the league’s crude, expedient and abusive drug practices revealed in court filings obtained by The Washington Post. Medicine in the league is a matter of competing pressures and opposing priorities, and until those conflicts are resolved, the league will continue to be at risk of looking like drug lords.

The NFL likes to pretend that its drug problems are all in the past, a relic of the wild 1960s, and that we’re in the “health and safety era” now. But material from the NFL’s own doctors and trainers, submitted by lawyers for 1,800 players suing the league, reveal that the problem is in fact persistent. Everyone from Commissioner Roger Goodell to owners to assistant trainers knows this, just as they know that the chronic painkiller abuse is driven by a compromised medical system in which concern for profits competes with concern for players.

Obviously, the players have to be part of the solution, too. But here’s the thing: They have the least power in this equation, because of the unguaranteed structure of so many of their contracts and the pressure to play to get paid. They trust their doctors to take good care of them.

Just as you trust yours. You might think you need 20 Vicodin to do your work. That doesn’t mean your doctor should give it to you.

It’s understandable that NFL doctors and trainers might have difficulty sorting out what’s best for an injured player worried about losing his roster spot. But some of the worst material in the lawsuit turns on evidence of deception, whether NFL teams willfully hid the risks, side effects and toll of their painkiller practices from players intentionally, not just negligently, to hurry them back on the field for the sake of business. Federal court Judge William Alsup remarked on this in a ruling he made in July, when he rejected

the NFL’s request to dismiss the case: “When asked about side effects of medications, club doctors and trainers responded, ‘none,’ ‘don’t worry about them,’ ‘not much,’ ‘they are good for you,’ or, in the case of injections, ‘maybe some bruising,’ ” Alsup wrote. “These answers misrepresented the actual health dangers posed by these drugs.”

There is no provision in any collective bargaining nor employment contract that covers such conduct. Players did not sign up for this. Ex-players still in their 30s are complaining of kidney and liver damage. Young men in their early 20s are consuming the same number of painkillers as elderly people with chronic arthritis. In 2011, according to a team memo cited in the suit, the New York Jets went through 1,564 doses of Vicodin and 1,178 doses of Toradol. Do the rough math. It’s a 20-week season, and there are 53 men on a roster.

And none of this is counting the pills that were never written down.

Sensational as some of the drug logs and memos contained in the lawsuit are, it’s what’s not in the record that’s most disturbing. For years, I’ve heard from workers’ compensation lawyers who say NFL teams systematically undercut claims by withholding drug and injury notations from players’ medical records. But I’d never seen firm evidence to back up that contention, until now.

The suit reveals a survey of medical records from 745 players

SUE OGROCKI/ASSOCIATED PRESS

Abuse of painkillers such as Vicodin is driven by a system in which concern for profits competes with concern for players, the writer says.

used by clubs in workers’ compensation claims. Of those, 164 had no records at all. To repeat: no records at all. Another 196 contained no mention of any drugs. None. A total of 64 mentioned drugs — but not dosages. And 321 mentioned only some dosages.

Now, either the NFL’s doctors and trainers are so incompetent they can’t write, or this is a scheme.

The NFL’s shoddy recordkeeping doesn’t just potentially deprive players of fair injury compensation. It potentially injures them further. Put yourself in the position of a former player who is in renal failure even though he’s not yet 40, with no history of kidney disease in his family. He’s being treated by a specialist and has complications such as high blood pressure and violent headaches. It would seem important — even critical — to have reliable records of his treatment in the NFL. The NFL long has been urged to make some fundamental changes that would relieve medical conflicts of interest and improve players’ long-term health. Congress has held hearings on the subject. A 2008 congressional Research Report observed that it was unclear whether “it’s the patient-doctor relationship or the doctor-owner relationship” that matters.

Just last month, a Harvard study recommended that players’ physicians should not be in direct pay of teams, nor report directly to team execs. Rather they should forward a “Player Health Report.”

This is nothing but good moralmedical sense.

Everyone knows what other changes should be made, too.

Expanding roster sizes and providing more guarantees in contracts would reduce pressure on physicians to heavily medicate and rush players back to the field — and on players to compete hurt and drugged. All of these things would allow players time to heal and doctors room to explore safer alternatives to painkiller overuse.

But, of course, they require owners to give up some of their $14 billion in annual revenue, and control.

The league did itself no favors with its denial of the concussion crisis and has struggled ever since to redefine itself as proactive and responsible to its audience. The painkiller lawsuit similarly exposes it.

Once again, the league lingers behind the times, hypocritically shaming players with penalties for smoking pot, while allegedly fostering an opioid problem on par with heroin. The league wants us to believe that this is the era of “health and safety.” It won’t be until it makes the changes that put player health before profits. n

SUNDAY, MARCH 19, 2017

21

OPINIONS

KLMNO WEEKLY

TOM TOLES

The Fed’s high-stakes decision ROBERT J. SAMUELSON writes a weekly column on economics.

T

oward the end of 1942, Winston Churchill, in announcing a rare victory over the German army, uttered one of his more memorable phrases: “This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” The same might be said today of the American economic recovery. Progress, though real, is incomplete.

Nine years after Bear Stearns’s collapse — the first sign that the economy was in serious trouble — the recovery seems to have healed the Great Recession’s worst wounds. Job creation has been steady. Payroll jobs total 145.8 million, up about 16.1 million from the slump’s low point and 7.5 million from the pre-recession peak.

There’s also upbeat news on wages. In a new report, economist Elise Gould of the left-leaning Economic Policy Institute (EPI) reports that median wages, adjusted for inflation, grew 3.1 percent between 2015 and 2016 — a feat that, if repeated for a decade, would mean an increase of a third. (The median wage is the one exactly in the middle of all wages.)

“What stands out in this last year of data is that the economic recovery appears to finally be reaching a broad swath of American workers,” Gould writes.

“In fact, wage growth in 2016 was more rapid for middle- and lowwage workers than for those at the top.” The unemployment rate, 4.7 percent in February, is close to

what many economists think is “full employment.”

And yet, stubborn problems linger. Corporate managers, small-business owners and consumers all remember the traumatizing effects of the financial crisis and Great Recession. To protect against a repetition, they’ve become more risk-averse. Similarly, some of the recovery’s “good news” needs to be qualified.

Consider wages. Recent increases for middle-income workers mostly represent catchup from losses suffered in the recession. The table seen here reflects data in Gould’s report. It shows the median hourly wage for men and women in four recent years, corrected for inflation.

MEDIAN HOURLY WAGES 2000 2007 2015 2016

Men

Women

$19.44 $19.45 $19.18 $19.33

$15.22 $15.90 $15.87 $16.08

Source: Economic Policy Institute/The Washington Post

As can be seen, men’s median hourly wage — not counting fringe benefits — is slightly below its levels in 2000 and 2007, the peak year before the recession. Women’s median wage is up about 6 percent since 2000 and slightly more than 1 percent since 2007.

The recovery, though encouraging, is certainly no economic panacea. Mounting inequality remains a big issue.

From 2000 to 2016, the best-paid 5 percent of men achieved a 30 percent wage increase, according to Bureau of Labor Statistics data analyzed by Gould. For women, the comparable gain was 24 percent.

Another glaring problem has been the dismal performance of productivity. Productivity is economic jargon for efficiency; without improved productivity, broad gains in living standards are impossible. From 1948 to 2016, productivity gains averaged 2 percent annually; but since 2012, gains have been less than 0.4 percent a year. If continued, and combined with rising inequality, this suggests stagnant

living standards or worse for millions.

With unemployment low and price pressure rising, the Federal Reserve usually increases interest rates to slow the economy and preempt higher inflation. This is happening. On Wednesday, the Fed raised the Fed funds rate to 1 percent. Many economists expect two more comparable increases in 2017, bringing the rate to 1.5 percent.

But might the Fed be oversensitive to inflation? Other economists think so. Writing recently in the Wall Street Journal, Jason Furman — recently President Barack Obama’s chief economist — urged the Fed to run the economy “a little hotter, driving up wage growth and bringing more people back into the workforce.”

In other words: The Fed should give the economy “room to run” — meaning fewer interest-rate increases. Perhaps. But what seems sensible also could be wishful thinking. The lesson of the double-digit inflation of the late 1970s and early 1980s is that, once higher inflation captures popular psychology, it takes a crushing recession to purge it.

That’s probably still true.

The stakes here are enormous.

If the Fed gets it wrong, we will all pay. n

SUNDAY, MARCH 19, 2017

22

KLMNO WEEKLY

OPINIONS

BY BAGLEY FOR THE SALT LAKE TRIBUNE

Let’s end judicial nomination war JAMES ROBERTSON is a retired U.S. district judge for the District of Columbia.

In the summer of 1987, I led a team of young lawyers to oppose President Ronald Reagan’s nomination of Robert Bork to the Supreme Court. Our work, which today would be called opposition research, found its way into the devastating confirmation hearing testimony of Erwin Griswold, the former Harvard Law School dean who had been Bork’s predecessor as solicitor general.

I do not claim that the work of my little team had any real impact on the Senate’s 58-to-42 vote rejecting Bork’s nomination. Griswold was only one in a parade of powerful anti-Bork witnesses, and Bork’s arrogance and tin ear for politics were his own worst enemies. As distasteful as the battle was, the end — the successful nomination of Anthony M. Kennedy after Bork’s defeat — seemed to justify the means.

Nevertheless, I regret my part in what I now regard as a terrible political mistake. While the nation did wind up with a much more acceptable choice, the treatment of Bork touched off a Thirty Years’ War on judicial appointments. We have politicized the judicial confirmation process far beyond historical norms and undermined public confidence in the judiciary. It’s time for a truce.

Judge Neil Gorsuch is superbly well-prepared and well-qualified to serve as an associate justice of the Supreme Court. There is no real dispute about that.

Nevertheless, it seems that antiGorsuch forces are girding their

loins for battle. “Poor Gorsuch,” they will say. “We’re going to do the best we can to defeat your nomination — but it’s not about you.”

Just what is it about, then?

The first answer is: “We don’t like the decisions we are afraid he will make.” Anyone with a basic understanding of how judges make decisions rejects that simplistic argument out of hand. Teams of young lawyers are certainly doing opposition research on Gorsuch today just as we did 30 years ago, but they have found nothing disqualifying yet and (I predict) will fail to do so.

Does his record support the label “extremist”? Certainly not.

BY DANZIGER FOR THE RUTLAND HERALD

“Ideologue”? No. “Conservative”?

Yes, of course — but elections do have consequences. Gorsuch has declined and will continue to decline to answer questions about how he would decide any issue that might come before him — not only because he is ethically bound to do so, but also because, until he reads the briefs and hears the arguments, he doesn’t know. Neither does anyone else.

Another common reason to oppose Gorsuch: “The Democratic base demands it.”

That answer gives new meaning to the term “leading from behind.” It assumes that this “base” is a rabid, unthinking multitude of sans-culottes who must be obeyed. But the real base that Democrats need to find and cultivate is voters who can distinguish outrageous actions from responsible ones.

Democrats should want leadership from the front, not mindless obedience to those whose only position is opposition. Responsible leaders should be explaining the function of the third branch in the U.S. constitutional system, the importance of judicial independence and the danger of a politicized judiciary. A base that understands those things will support the prompt and

uncomplicated confirmation of Gorsuch.

The final reason for opposition — and for many Democrats the most powerful one — is really schoolyard talk: “Because you did it to Merrick Garland.” Set aside for a moment the obvious retort from Republicans — that is, “We did it to Garland because we had the votes, and you don’t” — and consider instead where the argument goes from there. It goes on and on and on. We will struggle without end, each obstructionist act lacking any better reason than the most recent insult. This is the Hatfields and McCoys. The Jets and Sharks.

Are there no statesmen in politics today? No game theorists? It is true that Democrats would not receive many points for making a cooperative move that can be coerced anyway, but (as the Harry Reids and Mitch McConnells of this world love to remind one another) there will be another election, and what goes around comes around. A peace offering, plainly labeled as such, just might lead to something that is better for the country than mindless, vindictive tit for tat. What do the Democrats have to lose? n

SUNDAY, MARCH 19, 2017

23

KLMNO WEEKLY

FIVE MYTHS

The ‘deep state’ BY

M ARC A MBINDER

The White House seems to buy the “deep state” theory of governance — the notion that the will of a duly elected president can be thwarted by bureaucrats, especially in the national security realm. While civil servants and the 5.1 million people with security clearances do some­ times act in concert (when fighting a war, for instance), many miscon­ ceptions persist about them.

MYTH NO. 1 It’s the hidden source of national security policy.

The reality is that the deep state is a major, hidden amplifier of national security policy that is set by elected officials and carried out primarily through public communication, concentrated diplomacy and overt military action. After 9/11, for instance, the George W. Bush administration decided that preemptively killing terrorists before they could strike the homeland was a top priority. The military carried out that policy by war, as did the CIA’s drone fleet. Similarly, the CIA’s “enhanced interrogation” program was approved at the highest levels of our government by citizens we elected to serve us.

Congressional leaders knew the gist of what was happening, even if they didn’t get all the details.

If President Trump decides to reach out to Vladimir Putin, the deep state will help him, even if the product of its intelligence gathering suggests wariness and caution. These operations are merely meant to assist difficult political choices made by the executive branch.

MYTH NO. 2 The deep state evades oversight.

In the 1970s, the Vietnam War and Watergate emboldened Congress. After a series of investigations, known to history by the last names of the senators who chaired them — Pike and Church — a more modern oversight system was born for the

intelligence and defense worlds.

Military policy, defense spending, intelligence agencies and homeland security all have separate committees before which officials must regularly testify under oath and justify their actions. At least some members of Congress must be notified before the start of any CIA covert operation, and the most highly classified of all defense activities, known as waived Special Access Programs, must be orally briefed to bipartisan congressional leadership.

Increased public access to information has also made sleuths of everyone, and the ability of less-powerful actors in our democracy to instigate larger investigations of the deep state has become a significant check.

president. Budgets can be slashed.

Programs can be curtailed. And policy can be changed. The Obama administration made it harder for the government to assert its state secrets privilege, directed the Office of the Director of National Intelligence to declassify and disclose a significant amount of information about the NSA’s legal wrangling with federal courts, and asked the NSA to disclose to companies many of the “zero day” (or previously unknown) vulnerabilities found by its hackers.

MYTH NO. 3 The deep state is unchangeable.

The deep state is highly fragile — vulnerable, by its nature, to single-point failure, usually in the form of individuals who have something they’d like to tell the world. Think of Edward Snowden’s intellectual revolt against the National Security Agency, or the decision by a lonely Army private in Iraq to steal diplomatic cables, or whomever gifted WikiLeaks with the CIA’s phone and television hacking tools. In this way, a single person can completely alter the way an institution conducts tradecraft.

Further, bureaucrats cannot avoid the consequences of misbehavior directed at the

MYTH NO. 4 The deep state leaks gratuitously.

Nowadays, the deep state seems to be the source of fewer leaks of classified information than political officeholders and their staffs. The knowledge we have about the inner workings of Trump’s White House appears to be coming from his own top aides.

We have no way of knowing whether the officials who told reporters that Trump was keeping information about Flynn’s contacts with Russian Ambassador Sergey Kislyak from his vice president came largely from Trump’s own team. But given how tightly held that information was, at least some of them had to be close to the

CARLOS BARRIA/REUTERS

Some see the hand of the “deep state” in the forced resignation of former national security adviser Michael Flynn, right.

president.

MYTH NO. 5 The military-industrial complex is the deep state.

While Eisenhower’s “militaryindustrial complex” was white, male, Christian and ruled by a priesthood that sanctified nuclear doctrine above all else, the national security bureaucracy today is professionalized, rulebased and highly diverse. It is organized around counterterrorism.

Furthermore, the deep state contains multitudes, and they are often at odds with one another.

Defense contractors exulted at Trump’s election, as did a plurality of rank-and-file soldiers, sailors, airmen and Marines who voted for him. But top generals and career civilians, whose interests converge around the public good, civic norms and global stability, fretted. And the CIA’s senior officer cadre blanched.

The constituent parts of the deep state often do not align.

They do not form one conspiracy. n Ambinder, a fellow at the Annenberg School of Communication and Journalism at the University of Southern California, is a co-author of “Deep State.”

SUNDAY, MARCH 19, 2017

24

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