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  • Early Education Pays Economic Dividends: Vote Accordingly

    North Carolina’s early childhood education system is hurting. The advocacy group NC Child reports 44 percent of the state’s families living in a “child care desert,” with more than three times as many children as openings in centers.  A third of the state’s providers may close within three months because they lack funds to pay wages competitive enough to attract workers. By June 2024—next week—the pandemic funding that has temporarily stabilized childcare runs out. Child care advocates are asking state legislators for $300 million to keep centers afloat and affordable. They asked last year, too, for the same amount. To no avail. A report from the Century Foundation also predicts child care center closures —1,178 in North Carolina, affecting 155,539 children. Wait. What’s the return on investments in early education? Turns out, it’s high. Quality child care means lower crime rates, fewer poor people going to prison, fewer unemployed, and more, higher-paying jobs. Benefits reverberate for generations to come. During the Trump administration, cuts in outreach and enrollment reduced the number of children covered by health insurance. Food and housing insecurity for children also rose, due to cuts in SNAP benefits and housing assistance. And, an article in Education Week recently detailed a Heritage Foundation conservative policy agenda that includes how a second Trump administration might use the federal government to promote private school choice and parents’ rights, which will make it harder for public schools to serve poor children. Lack of quality childcare hurts families and the economy. This pickle is ironic when we remember that North Carolina practically pioneered early childhood education nationwide in 1993, under former Gov. Jim Hunt’s Smart Start. Though Smart Start’s still a player, its current network of 65 local partnerships in 2024 is not enough. Nobel-prize-winning economist James Heckman studies investments in early education. He and his colleagues report a 13 percent return on investment for comprehensive, high-quality, birth-to-five early education. Researchers analyzed life outcomes in health, crime, income, IQ, schooling, and the increase in mothers’ incomes when childcare enables their re-entry into the workforce. Bottom line: Early years matter. From birth to age 5, brains develop fast. A baby's ability to learn is “unparalleled,” in Heckman’s words. “Safe, nurturing, enriching environments strengthen early brain development, while stressful or unstable environments can harm it. When children attend high-quality ECE (early childhood education) during these important years, they benefit from enhanced cognitive and social-emotional development. Even though evidence for long-term effects of ECE on child development is mixed, some studies show that participating in high-quality ECE yields long-term advantages for individuals and for society, including higher educational attainment, better adult health, and less involvement in crime. High-quality centers with stimulating and developmentally-appropriate environments provide more than health and safety, they nurture “responsive” relationships with teachers. All young children can benefit from high-quality ECE, but it especially helps children from low income families, children with disabilities served in inclusive classrooms, and dual language learners. This November, vote for candidates who care enough about children to keep early childhood education in North Carolina fully funded. This will strengthen not only North Carolina’s families, but also its economy. Wouldn’t it be great to say we take care of all of our kids because they are the future? Betty Joyce Nash reported for the Greensboro News & Record and the Hendersonville Times-News before moving to Virginia where she worked as an economics writer for the Federal Reserve Bank of Richmond. She co-edited Lock & Load: Armed Fiction, an anthology of literary short stories that probe Americans' complicated relationship to firearms. (University of New Mexico Press, 2017.)

  • President Biden missed chance to relate to campus protestors

    As famine plagues Gaza and university students in North Carolina and throughout the United States express outrage at the slaughter of Palestinians, Israeli tanks and troops have entered Rafah and seized control of the border crossing with Egypt. Protestors have been arrested at the University of North Carolina at Chapel Hill and at N.C. State and are present on the Quad at UNC-Asheville. On university campuses throughout the nation, administrators have called in police to remove encampments and students from occupied buildings. Thirty-six students at UNC-Chapel Hill have been among more than 2,200 people arrested at U.S. campuses as of May 5, according to CNN. President Biden responded to the student protests May 2nd, saying they “put to the test two fundamental American principles. First, the right to free speech and the right for people to peacefully assemble and make their voices heard. The second is the rule of law. Both must be upheld.” Vandalism, trespassing, breaking windows, shutting down campuses and forcing the cancelation of classes or graduation, none of this is peaceful protest, he said. When a reporter asked if the protests had caused him to reconsider his policies toward Israel, he said “no, “ as he walked away from the podium. Biden delivered the clarity he insisted was needed. But in answering that question, he expressed an abysmal lack of empathy and understanding for the angst students and others feel about the war in Gaza and the U.S. role in supporting Israel’s prosecution of it. The comment disrespected the anguish students and others feel about the Israeli assault that began after Hamas terrorists killed more than 1,200 Israelis and took more than 200 hostages. More than 34,000 Gazans, many of them defenseless women and children, have been killed by the Israeli response. Biden could have said, “Look, I understand their distress over the immense suffering and I’m doing all I can to try to end it in a way that will bring stability to the region. I applaud their courage and commitment, but please, for all our sakes, they need to stay within the bounds of the law.” Biden rightfully denounced the anti-Semitism that has tainted many protests. But not all protestors who want to see the U.S. exert more pressure to end the assault on Gaza are anti-Semitic. This is the greatest challenge of Biden’s presidency. The long-term implications of the war between Israel and Hamas for the world and for the U.S. are profound. Few people understand that better than veteran New York Times foreign affairs columnist Thomas Friedman. Friedman spent 10 years from 1979 to 1989 reporting from Beirut, Lebanon, and Jerusalem. His book, “From Beirut to Jerusalem,” gives readers a comprehensive account of the complex history, motivations amd interests that drive this ongoing conflict. His many sources in the Middle East and the U.S. make his current columns for The New York Times perhaps the most insightful analysis regarding the war. In an April 16 column, Friedman wrote that he gives “the Biden team generally high marks for the job that it has done responding to the hugely fraught and complex Gaza war….” Friedman supports what he calls the “Biden Doctrine,” a convergence of strategic thinking and planning he’s learned about through his reporting. It would involve a defense alliance among the U.S., friendly Arab states and Israel against Russian-allied Iran and the terrorist groups it backs including Hamas, Hezbollah, and the Houthis. It would require Israel to agree to a ceasefire, to agree to withdraw from Gaza and to allow an Arab peacekeeping force to take control there, and to agree to work toward a Palestinian state with a reformed Palestinian Authority. The barriers to such a stabilization of the Middle East are manifold, and include the intractable Israeli Prime Minister Benjamin Netanyahu. Friedman has written that there is probably zero hope for a resolution to the Israeli-Palestinian and the Israeli-Iranian conflict without regime change in Iran, Israel and the Palestinian Authority. Early this week, Netanyahu sent troops into Rafah, the area to which more than a million Palestinians have retreated as their homes and cities have been destroyed, in a likely futile effort to wipe out Hamas. On Monday, the Israeli military began targeted strikes against the city hours after Hamas agreed to a cease-fire proposal negotiated by Egypt and Qatar to pause the fighting. Israel said the proposal didn’t meet its requirements, but that it would send a delegation to the mediators. On April 24, Biden signed a $95 billion military aid package for Ukraine, Israel and Taiwan. Despite that, Friedman wrote a couple of days later, the Biden administration has been telling Netanyahu that if he mounts a major military operation into Rafah, the U.S. will restrict some arms sales to Israel. As Friedman repeatedly points out, by continuing to pummel Gaza, Israel is becoming an international pariah. More critically for Americans, Israel is undermining the legitimacy of its staunchest supporter, the United States and the Biden administration. “The Democrats who just gave Israel $26 billion are coming telling us that we’re going to lose the White House if we don’t vote for Biden,” Hatem Bazian, a UC Berkeley lecturer who co-founded Students for Justice in Palestine, told Stanford University protestors, the San Francisco Chronicle reported. “You’re gonna lose the White House because you lost our vote. You lost the White House because you opted to protect Netanyahu rather than protect the American public.” Protestors are leveraging the only influence they have. Unless the Biden team does a better job of leveraging its influence over Netanyahu, and communicating its Middle East policy with voters, the only regime change may be in the United States. Joy Franklin is a journalist and writer who served as editorial page editor of the Asheville Citizen-Times for 10 years. Prior to that she served as executive editor of the Times-News in Hendersonville, N.C. Franklin writes for Carolina Commentary.

  • Big Pharmacy Benefit Managers Evade Oversight

    As a pharmacist, I have seen firsthand the impact today’s big pharmacy benefit managers (PBMs) have on patients they claim to serve.  Most patients don’t realize that PBMs control the price you pay at the pharmacy counter. While PBMs promote health plan cost savings to businesses for their employees, their records often tell a different story. Thankfully, in Raleigh and in Washington, law makers are finally waking up to the role PBMs play in drug pricing. For years, PBMs have operated in the shadows, signing up employers to trust them and utilize their services, while effectively evading any oversight attempts by state regulators. In 2021, the NC General Assembly passed a ban on the practice of rebate accumulating, which PBMs used to deny patients their due savings from drug discount programs. How did PBMs escape oversight? The answer is that just a handful of large PBMs control 80% of the U.S. market. The PBMs then lobby Congress and oversight agencies to prevent any questioning of their business practices. This market domination is problematic because with no legal mechanisms in place to ensure accountability, PBMs can hide behind harmful, profit-motivated pricing practices while employers and patients pay the price. Traditional PBMs tout their size and scale as factors that secure better deals for clients. It is true that big PBMs can procure drugs in larger quantities at wholesale prices, but they often fail to pass these savings benefits on to their clients. Recently in Washington, lawmakers asked the CEO of UnitedHealth Group (UHG), a large PBM, to testify before the Senate Finance Committee. UnitedHealth Group’s Optum Rx unit, along with CVS/Aetna’s Caremark and Cigna’s Express Scripts, now control 80% of the PBM market. With $370 billion in revenues last year, UnitedHealth has grown so big that it now employs more than 10% of all physicians in America and even owns an FDIC-insured bank that can advance payments to providers on pending claims! With this large of a share of the market, the American people deserve some oversight and questions to be answered. I am urging the Senate Finance Committee to keep asking companies like UnitedHealth Group to explain its rapid consolidation of the market, as well as its vertical integration that is limiting consumer choice and hurting patients at the pharmacy counter. It is past time PBMs are held accountable for their impact on healthcare costs, and leaders in Washington need to pass PBM oversight measures. This legislation and oversight will finally bring accountability and reform to this broken system and put the focus back on patients, where it belongs. NC Rep. Wayne Sasser (R) is a pharmacist by trade and represents Montgomery and Stanly counties in the NC General Assembly.

  • Hydroxychloroquine.

    Remember that word? Unless you’re studying for a spelling bee, it probably doesn’t ring a bell. But when you hear the much-bandied about question in the current political arena, “are you better off than you were four years ago?”, that bell ought to ring. Because that’s where we were four years ago. There’s a human tendency to put a pleasant gauze over the past, emphasizing the positive and minimizing the negative. So, when considering the lay of the land four years ago, one might vaguely recall a couple of contact points with the economy, the price of gas and price of food, were better. One might not recall that four years ago employment fell by a combined 22.4 million in March and April. That decline of 15 percent was unprecedented in modern times. (The decline in the Great Recession of 2007 was 6 percent). That’s because four years ago we found ourselves in the grip of the COVID pandemic. That’s where hydroxychloroquine comes in. The Trump administration's chaotic response to the pandemic included promoting unproven treatments like hydroxychloroquine and even suggesting the use of bleach as a potential cure. Misinformation spread like wildfire, leading to confusion and fear among the populace. There was plenty of magical thinking – that it would go away with the coming of warmer weather, etc. There was plenty of pin-the-blame game, with Trump and media allies insisting that COVID be called the Wuhan Virus or Chinese Virus. Above all there was a push to reopen the economy, despite the fact that ramped up testing and other safety measures weren’t in place. There was also a push to split a frightened populace even further, with Trump delivering tweets railing against lockdown measures in the states with Democratic governors – Virginia, Michigan and Minnesota all got the “LIBERATE!” treatment. Misinformation was running rampant and conspiracy theorists were having a field day. Over in Britain, they were burning cell towers, as somehow someone came up with the idea 5G technology was spreading COVID. Similarly, messages coming from the White House briefings were all over the board. When masking was recommended Trump watered down the message by saying the recommendation wasn’t really a mandate and he couldn’t see himself wearing one. As to hydroxychloroquine, well, it’s been around as a malaria treatment for decades. Somehow it got touted as a COVID treatment, and Trump picked up on it. On several other treatments that weren’t really treatments as well. A paper called the “Impact of Trump's Promotion of Unproven COVID-19 Treatments and Subsequent Internet Trends: Observational Study’’ at the National Library of Medicine reported “From March 1 to April 30, 2020, Donald J. Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump’s average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%.” During White House briefings Trump mentioned hydroxychloroquine 37 times in total; chloroquine 12 times; azithromycin 8 times; and remdesivir 8 times in total. April of 2000 also gave us the tale of Trump and bleach. Contrary to popular belief, Trump didn’t actually say folks should drink bleach, but he did muse about whether disinfectants could be used to treat coronavirus infections inside human bodies. It was close enough to saying “drink this stuff’’ that Lysol issued a statement essentially saying “don’t do that.’’ Trump’s comments came after Department of Homeland undersecretary for science and technology William Bryan presented a study finding sun exposure and cleaning agents like bleach could kill the covid virus on surfaces. "So, supposedly we hit the body with a tremendous, whether it’s ultraviolet or just very powerful light,” Trump said, “and I think you said that hasn’t been checked, but you’re going to test it. And then I said supposing you brought the light inside the body, which you can do either through the skin or in some other way. (To Bryan) And I think you said you’re going to test that, too. Sounds interesting, right?" Four years ago, we were frightened of losing our jobs and our lives. Against this backdrop people were looking to their government for leadership. That’s what we were getting. Despite the challenges we faced four years ago, it's hard to deny that things have improved since then. The current situation may not be perfect, but we are in a much better place today than we were back then. Jim Buchanan is a longtime mountain journalist and author.

  • Who are we as Americans?

    On October 7, 2023, the world changed.  Hamas attacked innocent Israeli citizens enjoying a concert.  Women were raped and senior citizens were kidnapped along with children, women and men.  A terrible, horrible, cowardly act against the Israeli people.  The world was outraged with this act of terrorism.  President Joe Biden was quick to offer unequivocal support for Israel.  Most Americans supported the comments and position of the American President. The world was outraged and supported Israel’s counter attack against Hamas, formally known as Harakat al-Muqawama al-Islamiya.  More than 1,200 Israeli citizens were killed on October 7, 2023. No one would argue with Israel’s right to defend itself and target Hamas for this horrendous act of terrorism.  More than 270 hostages were taken, with over 134 still being held by Hamas. As the war enters its fifth month; there is no end in sight.  What we do know is that more than 30,000 Palestinians have been killed and over 70,000 wounded; with reports that more than half of those killed or wounded are women and children.  Not to mention the recent shooting of starving Palestinians surrounding food trucks. Does President Biden make a mistake by continuing to offer unequivocal support to Israel? I believe he does, considering Israel’s brutal military response, which most Americans, likely including the President, could not have anticipated. Daily photos, video, and commentary from Al Jazeera show the devastation of Gaza.  The displacement of over 2 million Palestinians, who are without food, water, electricity, and the basics of human life.  When you see complete residential areas demolished, along with hospitals, schools, churches, warehouses and any place where civilians gather, it turns your stomach.  Gaza is considered the worst place for children now in the world.  Keep in mind the population of Palestinian children is close to half of the population in Gaza.  It stands to reason when you drop 2,000-pound bombs that you are going to kill children. The United States is being called complicit in this indiscriminate attack on Palestinians in Gaza. The United States has vetoed three (3) UN security council resolutions calling for humanitarian aid to Gaza.  Moreover, when the US rightfully points the finger at Russia’s aggression into Ukraine, we as the world leader for peace and democracy need to be careful with our international policies; or risked being accused of hypocrisy. This commentary began with the atrocious attack on October 7th and Israel’s rightful duty to respond militarily and to gain the release of their blameless hostages.  Moreover, Prime Minister Benjamin Netanyahu has stated his goal of eliminating Hamas and freeing the hostages.  The families of hostages want the primary objective to be bringing their family members’ home. It seems to me, Netanyahu has another agenda: the genocide of all Palestinians in Gaza.  You tell people to leave the northern sector of Gaza and go south, and then you bomb them.  You bomb hospitals, you shoot at ambulances, you bomb schools; and then you blame Hamas. This does not add up; and begs the question, who are we as Americans? I stand with the Arab Americans who voted “uncommitted” during the Michigan primary in February.  I cannot support the policy of Israel killing civilians and blaming it on Hamas. What happens to the Palestinians after the Israel-Hamas war?  Who will rebuild their schools, hospitals, homes and infrastructure?  It cannot be built on the revenge seeking of Netanyahu. Some military experts believe it is not possible to eliminate Hamas.  Retired Lt. Gen. Ben Hodges, former Commanding General of U.S. Army Europe says: “To ‘eliminate’ or destroy Hamas, Israel will have to destroy the root cause of Hamas, its reason for existence. That means Israel will have to accept progress towards a two-state solution and Palestinian statehood for Gaza and the West Bank. Prime Minister Netanyahu is on record in January 2024, stating, he is opposed to a Palestinian state because it would constitute “an existential danger to Israel.” To resolve this terrible situation, it is time for American leadership to do what is best for Palestinians and Israelites to prevent the ongoing genocide. Many say we are hesitant to do the right thing, because we are politically supportive of Israel. Who are we as Americans?  As Americans, we are a diverse group of individuals who come from different backgrounds, beliefs, and experiences. We have a long history of standing up for what is right and fighting for justice. It is our nature to lead and take action when faced with challenges. By taking a leadership role in resolving these conflicts, we can work towards creating a more peaceful world.  By supporting our allies, such as Israel, and holding them accountable when it is necessary. Let us remember the values that define us as Americans—compassion, unity, and freedom. It is up to us to lead positive change and create peaceful solutions. Virgil L. Smith formerly served as president and publisher of the Asheville Citizen-Times and Vice President for Human Resources for the Gannett Company. He is the principal for the Smith Edwards Group and the author of "The Keys to Effective Leadership.” He is the founder and a writer for Carolina Commentary. Photos from US News and Al Jazeera

  • No peace for HCA until Mission once again becomes world class

    The grievous decline in the quality of care provided by Asheville’s Mission Hospital during the past five years incites outrage and frustration on multiple levels. Failed leadership and corporate shortsightedness and greed have turned one of the nation’s premier health systems into one where substandard care may have resulted in patient deaths. There was a time, not so long ago, when Mission and its integrated region-wide network ranked as one of the nation’s Top 15 Health Systems. The rating meant Mission performed better on six measures - fewer deaths, fewer complications and infections, shorter length of stay, shorter emergency department wait times, lower costs and higher patient satisfaction - than hundreds of other health systems evaluated. That was before, in a surprise announcement in March 2018, the not-for-profit Mission’s Board of Directors revealed its intent to sell Mission to HCA Healthcare, the nation’s largest hospital chain, for approximately $1.5 billion. The sale was completed in February 2019. The announcement shocked virtually everyone – local leaders, Mission employees, associated medical professionals, patients and the larger community. Five years later, Mission is in “immediate jeopardy” of losing Medicare and Medicaid reimbursements as a result of nine deficiencies related to incidents that happened between April 2022 and November 2023. The U.S. Centers for Medicare & Medicaid Services (CMS) defines “Immediate jeopardy” as noncompliance that “has placed the health and safety of recipients … at risk for serious injury, serious harm, serious impairment or death….” In early February, CMS informed Mission that it has 23 days to fix the problems or risk losing Medicare and Medicaid funding, thereby threatening the financial viability of the hospital. CMS cited Mission’s failure to meet standards in six areas: governing body, emergency services, nursing services, patients’ rights, quality assurance and laboratory services. Accountability for this precipitous decline in quality of care rests with multiple entities. First, there’s North Carolina’s Republican-dominated legislature which, for a decade, refused to approve expansion of Medicaid to hundreds of thousands of uninsured North Carolinians under the Affordable Care Act. The fact that 90 percent of the expansion would be paid for by the Federal government failed to overcome their stubborn partisan opposition. Lawmakers finally approved the expansion in 2023, too late for a number of struggling rural hospitals, and too late to provide a critical income stream for Mission before it was sold. After selling Mission Hospital to HCA, according to reporting by Asheville Watchdog, Mission board members acknowledged that Mission was profitable and financially strong, but they were concerned about falling reimbursements from Medicare and Medicaid. Given lawmakers' refusal to expand Medicaid, there was no reason for them to expect that to change. They worried that Mission would face a future of cost-cutting that would ultimately degrade the quality, access and affordability of care, a concern that turned out to be ironic. Second, there’s the failure of Mission’s not-for-profit board and then-CEO Ronald Paulus to involve the community in the decision to sell one of its most valuable and essential assets, one critical not only to the health of Western North Carolinians but to the region’s economic strength. By failing to do so, they denied the community an opportunity to engage in a dialogue that might have changed the outcome. Third, there’s a serious question about whether the board performed adequate due diligence before selling Mission. Because everyone involved had to sign non-disclosure agreements, much of the circumstances surrounding the sale remain a mystery. But public record documents obtained by Asheville Watchdog suggest that HCA courted Mission directors and executives months before Mission’s board authorized CEO Paulus to start looking for potential partners. It appears HCA had an inside track from the beginning. Mission’s directors invited only a few companies to make proposals and quickly dismissed other suitors besides HCA. They invited only one other bidder to make a formal presentation and speedily rejected that bid, which came from a nonprofit, it was later disclosed. The board chose HCA, despite the fact that in 2017, HCA paid more than $200 million to settle lawsuits related to its purchase of a nonprofit hospital in Kansas City and that in 2003 HCA paid the government more than $1.7 billion in restitution, fines and penalties to settle fraud cases. By contrast, New Hanover County Commissioners recently sold their publicly owned regional hospital to Novant, a non-profit associated with the UNC Health and UNC School of Medicine, after ample opportunity for public comment, for approximately $2 billion. Fourth, and most outrageous, is the way HCA has systematically dismantled one of the nation’s premier regional health care systems. Western North Carolinians have long relied on Mission for advanced, high-quality health care. But for decades, Mission has also been an economic engine, making the area attractive to retirees and digital nomads and providing a hub for peripheral health related businesses. “This is a four-level problem, “Dr. Clay Ballantine told an audience of about 350 people who attended an Asheville Watchdog sponsored event titled “HCA-Mission at Five Years: What Can We Do to Restore Better Healthcare in WNC?” “You’ve got Mission Hospital,” Ballantine said. “You got satellite hospitals, but you’ve also got all these primary care and subspecialty practices that are under Mission’s purview and they are throughout the region. And then at the fourth level is patient services like rehab, low-cost pharmacies, and medical equipment that people need. HCA has impacted every single level of this system.” As of 2022, Ballantine said, 3,500 Mission employees had left, including at least 200 doctors. HCA has gutted staff, failed to provide adequate supplies and shutdown laboratory facilities, Ballantine said.  World class cancer and cardiology departments have been devastated. The situation is so bad, N.C. Attorney General Josh Stein is suing HCA and Mission for violating its asset purchase agreement regarding cancer care and emergency services. In its response, HCA insists the agreement is “silent as to the quantity or quality of services required.” And even though HCA pledged to maintain the same level of charity care that had been in place before it purchased Mission, Asheville Watchdog reported that a draft report of a study by a Wake Forest professor of law and public health found that “genuine charity care has diminished in systematic and extensive ways … with unfortunate effects on access to health care in western North Carolina.” It was multiple complaints from Mission nurses to the NC Department of Health and Human Services about policies, staffing levels, and quality of care that finally resulted in the inspection that brought about the CMS order to fix problems or lose Medicare and Medicaid funding. Those nurses’ persistent advocacy on behalf of their patients brings hope for improvement. State Sen. Julie Mayfield, D-Buncombe, organized a Feb. 6 news conference to allow Mission nurses, local elected leaders and other advocates to respond to the CMS finding. Mayfield and others voiced their outrage over the decline in care. In her opening remarks, Mayfield said, “If HCA is unable or unwilling to put the health and safety of our people first, then it’s time to find a company that will. Let me be clear, this community will not stop our advocacy and we will not quiet our voices until Mission Hospital once again provides world class care and the public’s trust and confidence in our hospital has been restored.” While it may be possible for HCA to accomplish such a reversal, it should be remembered that HCA’s first obligation is to its stockholders, who are likely pretty satisfied. Net income attributable to HCA Healthcare in the fourth quarter of 2023 totaled $1.607 billion, or $5.93 per share. Improvement adequate to meet an acceptable level of care shouldn’t be tolerable when we know a much higher standard has been and can be provided by Mission Hospital. Whatever it takes, our voices should not go quiet until that standard has been achieved again. Joy Franklin is a journalist and writer who served as editorial page editor of the Asheville Citizen-Times for 10 years. Prior to that she served as executive editor of the Times-News in Hendersonville, N.C. Franklin writes for Carolina Commentary.

  • We Are the Economy

    Inflation has cooled since the 9% Covid-related spike in 2022, to around 3.4 %, as consumer spending and supply chains have “normalized.” The Federal Reserve’s anti-inflation interest-rate hikes helped, too. Though this rise in the ‘real interest rate’—calculated as interest rates minus the rate of inflation—could temporarily slow growth, North Carolina is one of the top five states where people are moving. A flood of federal spending on infrastructure, microchips, and electrification boosted North Carolina’s construction sector, and the nationwide housing shortage hasn’t hurt either. Low inventory is keeping home values high and rising. This gives homeowners confidence to spend, which helps prevent recession. Weirdly, though this economic news these days seems “good,” national consumer polls show disagreement with the healthy assessment. Fewer than one-quarter of registered voters in a Wall Street Journal poll, for instance, agreed the economy was “headed in the right direction.” Ben Harris and Aaron Sojourner of the Brookings Institution designed a model to study this perception gap. Their findings suggest biased sources of information play a role— that it’s not the economy, it’s the economic news that’s to blame. That news has become systematically more negative, starting in back in 2018. The negative bias has grown over the past three years. But maybe the respondents’  circumstances haven’t changed. We the people are the economy. Our spending behavior drives economic health, but we need confidence in the elected officials who answer to voters. Those officials can’t set interest rates, of course, but they do make policy. Rules governing electoral systems—think about North Carolina’s recently gerrymandered election maps, drawn unfairly and in secret—can be manipulated to create an electorate that tilts policy to richer, whiter districts. Those rules can also create barriers to voting that disenfranchise low-wage workers, young people, and others who rely on absentee or voting by mail. Senate Bill 749 is another insult. The bill would change the composition of elections boards and lead to gridlock, even election chaos, and threaten early voting. Both are being challenged in court. Recent research shows that the Voting Rights Act of 1965 reduced the Black-White wage divide; conversely, the recent judicial decision rescinding parts of the act has aggravated economic inequality. Studies link smaller differences in the turnout rate between low and high income voters with more generous state income support programs, higher minimum wages, and lower income inequality. As economic inequality worsens, frustrated citizens see the economy as “rigged” and turnout lags, especially in poor communities. This may explain the way citizens are interpreting today’s news about the economy’s health. Maybe survey respondents are distracted by global events in Israel or Ukraine, or maybe they only watch biased news channels. Or maybe, nothing has changed for them. Their wages haven’t gone up, but inflation has eroded purchasing power. They still can’t find child care. They don’t own a house. The strong construction sector hasn’t put them into affordable housing. Maybe they’re not buying these reports of a strong economy because they’re not feeling that strength or seeing evidence that their elected officials are working for them, no matter what the numbers say. Or maybe they don’t believe the good economy is sustainable, given today’s political climate. Since we are the economy, citizens’ beliefs will influence what we buy, literally, and figuratively, in our minds, and with our pocketbooks. That surely influences economic outcomes.

  • Most parents are happy with their public schools

    Public policy is, in many regards, akin to steering a supertanker. It takes a long time to change direction. Here in North Carolina, we've embarked on a major public policy change that likely has flown under the radar of many, if not most of our citizens. A decade ago, the state legislature included something called the Opportunity Scholarship program as part of the state budget. It was pitched as a way to help poor children escape public schools that were below par. North Carolina isn't the only state with a voucher program. Once a bit of fringe theory, the voucher movement has over the last couple of decades gained steam in many parts of the country. It's not merely gaining steam in North Carolina; it's downright turbocharged. This year's budget calls for about a billion dollars in new spending over the next decade, going from $176.5 million this year to more than half a billion each year by the 2032-33 budget. The argument remains that parents deserve a choice if their children are in failing public schools. That's hard to argue with. On the other hand, if public schools are failing and we don't have the money to fix them, it's sort of hard to argue that we have the money to fund scores of new schools through such a boom in voucher spending. Despite the fact that most parents are happy with their public schools, there's a cottage industry out there saying they aren't . Public schools have long been under attack but not with the level of fury that has been seen in recent years. From Commom Core to Critical Race Theory to a variety of LGBTQ controversies to the catch-all of "wokeism,'" public schools have been a punching bag. The uncertainity of the COVID era, a new pandemic few of us knew anything about sparked a whole new round of criticism when schools were, at the bottom line, trying to figure out how to keep kids alive. Were some mistakes made? Certainly. We were on an entirely new playing field when it came to a new disease. More than 1 million dead Americans later, it's safe to say public schools probably made fewer mistakes than other public sectors. Regardless, COVID helped spur a new push toward vouchers and provatization. And that push certainly has some hallmarks. In North Carolina, the top 71 recipients of the state's $134 million vouchers were religious schools, mainly Christian schools with a scattering of Islamic schools. Church and state separation arguments aside, there are some problems here. Private schools, unlike public schools, don't have to take everyone. Public schools have to provide services to students who need special services or accomodations under the Americans with Disabilities Act. Experiments with vouchers elsewhere have been...instuctional. Billed as a way to get kids out of failing public schools, in Arizona three-quarters of initial applicants for vouchers had never been in a public school in the first place. In Wisconsin, more than 40 percent of voucher schools have closed since that state's program begain in 1990. A person with a cynical eye might think some schools were started just to collect voucher money. A person with a synical eye might also note that education budgets are the largeest outlays for state govenrments. Ome of the biggest concerns of all about our fracturing educatiron system boils down to E. Pluribus Unum: Out of many, one. "An education system is the reproductrive organ of every culture,' worte Kenneth R. Conklin, Ph.D., back 2004,'...a society's culture is a living entity which transcends all the society's individual members. A society's culture can survive far longer than the lifespan of any of its members, because its educational system passes down the folkways and knowledge of one generation to subsequent generations. A culture changes over time, but has a recognizable continuity of basic values and behavioral patterns that distinguishes it from other cultures. That continuity is provided by the educational system." But the educaiton systemn itself needs continuity. A public education system mixes kids from differrent backgorunds and social statuses and, ideally, lets them learn how to deal with those who are different. "If a school system provides a basic curriculum which is the same for all students, the adults who emerge will hold the same basic knowledge and atitutdes as one another," Conklin continued. "Certainly, there will be great differendes of individual ability and outcome; but there will be an underlying cohesiveness. However, if some schools admit only certain kinds of students and give them an educational program significantly different from other schools, it can be expected that the emerging adults will hold fundamentally different attitudes and beliefs." "The easiest way to break apart a society long-term without using violence is to establish separate educational systems for the groups to be broken apart." Is that the path we're on in North Carolina - indeed, in much of Americaa? That remains to be seen. But one thing's for sure: This shoip has left the dock. And if we're on the wrong course, it will take us a very long time to turn it around. Jim Buchanan is a longtime mountain journalist and author.

  • The impact of investigative news coverage

    The news gathering business is not what it used to be. That is especially true in local communities where there is a lack of investigative reporting to hold the powerful accountable, to record history, to celebrate and to inform. Bill Kovach and Tom Rosenstiel in The Elements of Journalism, tells us that journalism “is not defined by technology, nor by journalists or the techniques they employ.” Rather, “the principles and purpose of journalism are defined by something more basic: the function news plays in the lives of people.” Unfortunately, newspapers in particular have been on a downward spiral for more than 40 years. Meanwhile, digital news sources are on the upswing, as people are using their mobile devices to stay informed of breaking news alerts. The breaking news alerts have value, but they don’t replace the in-depth investigative reporting that provides the type of coverage needed to keep the general population informed. Fortunately in North Carolina a handful of online investigative news sources, such as The Assembly, Carolina Public Press and Asheville Watchdog, are working to fill the void. It’s no secret that technology and lifestyle changes contributed to the consistent decline of traditional newspapers, a decline that impacts democracy in the United States and North Carolina. News organizations such as the New York Times, Washington Post, the Wall Street Journal and national cable news networks such as CNN, Fox News, and MSNBC continue to provide in-depth national and international coverage. However, they are not providing the in-depth coverage needed at state houses, including the North Carolina Legislature. An initiative called Press Forward, coordinated by the MacArthur Foundation in cooperation with 20 nonprofit organizations plans to invest $500 million over the next five years in local media organizations. That is a significant infusion of dollars to address the predicament of local news. The initiative will invest in nonpartisan efforts to provide access to news that is important to residents and voters. It is crucial that news organizations hold elected officials accountable for their policymaking. A case in point is House Bill 259, the appropriations bill that funds state agencies, departments and institutions, that became law in October 2023. The Republican-controlled legislature inserted language into the bill that gives them the authority to appoint special Superior Court Judges to eight-year terms without oversight and exempts them from the state public records law, allowing them withhold their documents from public view. They also inserted language that empowers the Joint Legislative Commission on Governmental Operations, or GovOps, to investigate state and local government agencies, as well as private companies and charities that received taxpayer funding. Public employees contacted by investigators would be required to keep those communications and requests for information confidential. One Democratic lawmaker compared the new powers to setting up a new government “Gestapo,” a comparison to Nazi Germany. There will be severe penalties for not cooperating with an investigation, which could cost jobs and result in criminal charges. The role of newspapers and other media is to shed light on this type of legislation by keeping the public informed. While some state news organizations covered these add-ons to the budget bill, local news outlets don’t have the staff or resources to provide their readers with adequate coverage of the legislature and how the laws they pass affect them. The decline of newspaper readership gives legislators and government officials the freedom to enact legislation that is often not in the best interest of the public. Rather it is in the best interest of the politicians and their desire to remain in power and control the state for their political party. This has been clear with gerrymandering, a strategy that disenfranchises voters, and with the attack on public education, with the push for more charter and private schools. Voters have to do their own due diligence to find out the potential impact of laws passed by state lawmakers . Unfortunately, they cannot count on newspapers, as times have changed forever. The investment by the MacArthur Foundation and other foundations is an important step in reshaping the news and information landscape. Here are other strategies voters can utilize: 1. Follow reliable online news sources: While traditional newspapers may be declining, there are still many reliable online news sources available. Readers can follow reputable news websites. 2. Check the legislature's website: The North Carolina General Assembly's website provides access to bills, committee meetings, and other information related to the legislative process. Readers can check the website to find out what is happening in the legislature. 3. Follow legislators' social media: Legislators often post updates and information on their social media accounts. By following their accounts, readers can stay informed about their actions and positions. 4. Attend public hearings: The legislature holds public hearings on bills, and attending these hearings provides an opportunity to learn more about proposed legislation and provide input. Readers can find information on hearings by checking the legislature's website or contacting their representatives. 5. Engage with advocacy groups: There are many advocacy groups working to hold legislators accountable and promote transparency in government. Readers can engage with these groups to stay informed and get involved in advocacy efforts. Stay informed to make sure legislators serve their constituents’ interest, not their own. If not, use the power of the ballot box to replace them. Virgil L. Smith formerly served as president and publisher of the Asheville Citizen-Times and Vice President for Human Resources for the Gannett Company. He is the principal for the Smith Edwards Group and the author of "The Keys to Effective Leadership.” He is the founder and a writer for Carolina Commentary.

  • Why make voting hard? To reduce voting as a credible way to make democratic decisions

    North Carolina’s hit parade of voter suppression marches on, now that the GOP has overridden Gov. Roy Cooper’s veto of Senate Bill 749, with tight ballot-receipt deadlines and extra signature scrutiny for mail-in voting, plus extra identification for same-day registrants. Both rules especially affect people of color and young voters who register on voting day and vote by mail at higher rates. Maybe politicians who become legislators don’t want deliberate debate and democratically-determined decisions. Or maybe even actual democracy. Rather than an election-day postmark, ballots must be received by poll-closing, which could invalidate many votes, due to delivery variation. New rules about same-day registration—extra identification and throwing away ballots of registrants whose mail comes back as undeliverable—make it harder to register during an early voting period. These rules especially affect the young and people of color. Tight turnarounds for mail-in voting make no sense, when there’s little to no evidence of electoral fraud. The practice dates from the Civil War, but Republicans seem to think it’s a scam, a partisan ploy designed to steal their votes. But even before the 2020 election, during Covid, absentee voting was on the rise. The only scam afoot is the GOP’s systematic efforts to undermine democracy. Mail-in voting includes signature verification, drop boxes in safe locations, and address confirmation. A Washington Post analysis found few (0.0025 percent) possibly fraudulent votes in the 2016 and 2018 elections. And, according to The Hill, in 20 years and 250 million mail-in votes, there were 143 criminal convictions. Significantly, the law also shifts county and state election board appointments from the governor to legislators; House speaker, Senate leader, and minority party leaders in each chamber would each appoint two members, replacing the current five-to-three, governor-selected appointees. Such deadlocked,bi-partisan boards are a gridlock guarantee. Deadlocked boards are figuring as prominently in partisan politics as in corporations. Corporate deadlocked boards are designed to keep a CEO entrenched. What should we infer from the GOP’s political move? Maybe gridlock is the goal. Suppose members deadlock on election certification; if legislators are called to decide, the Republican majority rules. District maps, currently being re-drawn, may also be GOP-gerrymandered. Theoretically the new configuration could avoid partisan advantage, through healthy debate and compromise. In reality, the deadlock ensures tied votes on decisions, with legislators stepping in to make the call. Is that what we want? One-party rule? Republicans have veto-proof majorities as well as a N.C. Supreme Court majority of 5-2 after last year’s election. Compromise and democratic deliberation seem forgotten and forsaken; certainly they seem like pre-Trump notions. Maybe some legislators have forgotten such skills and why they matter to voters. Or, maybe politicians who become legislators don’t want deliberate debate and democratically-determined decisions. Or maybe even actual democracy. Betty Joyce Nash reported for the Greensboro News & Record and the Hendersonville Times-News before moving to Virginia where she worked as an economics writer for the Federal Reserve Bank of Richmond. She co-edited Lock & Load: Armed Fiction, an anthology of literary short stories that probe Americans' complicated relationship to firearms. (University of New Mexico Press, 2017.)

  • An unaffiliated voter calls for radical coalition

    On Aug. 28, Muhsin Mahmud, an exchange student from the UK, was making a video as he walked through the idyllic campus of my alma mater, the University of North Carolina. “You can have a little picnic here,” he said, panning around to show the tall trees and crisscrossed sidewalks with students leisurely walking to class. That was the ironic moment when air raid style sirens abruptly began blaring throughout Chapel Hill, shattering the peace. “I have no idea what the hell that is,” Mahmud said right before loud speakers announced an "armed, dangerous person." That was also the moment my daughter, a current student, called me. We were on a video call for two hours as we both sifted through online rumors about what was going on. The lockdown continued for an hour more as police methodically ruled out the possibility of a mass shooting like the one that occurred at our sister school, UNC-Charlotte. Thankfully, the terrifying incident turned out to be “only” a single murder. Outside North Carolina, it didn’t even get a lot of news coverage since it didn’t qualify as a mass shooting event. That changed, however, on Aug. 30 when The Daily Tar Heel — the student run newspaper published every Wednesday — appeared in newsstands. Instead of the football edition the editorial staff had already completed, the front page of the paper was covered with bold black and red text messages that students had exchanged during lockdown: HEY — COME ON SWEETHEART — I NEED TO HEAR FROM YOU. CAN YOU HEAR ANY GUNSHOTS? I’M IN CLASS EVERYONE IS LOSING IT PEOPLE ARE LITERALLY SHAKING. GUYS I’M SO FUCKING SCARED. The front page was such an authentic encapsulation of the moment that it immediately went viral. That evening President Biden posted an image of his hand holding his cell phone as he read the page. In the coming days, the young editors were being interviewed by NPR, NBC and other national press. As my own social media filled up with posts and reposts of the page, most parents and other adults were supportive, proud, and frankly in awe of what these student journalists had accomplished; however, a small but vocal minority had perplexing reactions like these: “Please remove this post…it contains foul language and just needs to be deleted.” “This language is inappropriate. Take it down or blur the words." “This post needs to come down because of the language.” That group of adults was more outraged by F-bombs being used in college students’ texts than they were by a gun being used to commit murder and spread terror throughout the UNC campus. I think it’s important to note that these people weren’t online trolls whose purpose is to bait people into reacting emotionally. They were real people who probably believed they were being virtuous. I imagine many of them were earnest conservative Christians speaking out for their values. I am an unaffiliated voter, part of the largest voting group in the state. While I tend to vote Democratic, I have voted for multiple Republicans and have been satisfied with several Republican officials I’ve known over the years. However, I doubt I will vote for a Republican in a partisan race for at least ten years, and the reason is related to the “outrage” reactions I witnessed on social media after the shooting. I’ve been watching closely and from what I see, the Republican Party is no longer interested in governing or solving problems or doing anything constructive. They don’t think it’s the government’s role to provide a safety net for the vulnerable or to ensure communities have safe water or to provide public education for all children. The only thing they seem to care about is the outrage of the week, which often makes no sense to anybody else. So instead of talking about ways to prevent terrorist-style events from happening on our college campuses, they were talking about how offended they were by strong language. Other things they are outraged about? Books with same-sex parents. (Not my family’s values!) The separation of church and state. (There should be prayer in school!) And anything they label as woke. (Removing Confederate statues! The anti-patriarchy of the Barbie movie! The footwear on the Green M&M!) It is ridiculous. It’s ridiculous but it’s also terrifying. The flash-in-the-pan outrage parade serves to manipulate a large voting bloc of evangelical Christians who strive to put their faith first. I believe these people are sincere and well-intentioned, but from my perspective, in recent years the vast majority tend to support any politician who makes a lot of noise about Christian values, even as that person is advocating legislation that harms Americans, the Earth we share, and global stability and often behaving in most un-Christian ways. From what I was taught growing up in a Southern Baptist church, many of the actual policies pushed by these extremely religious-sounding politicians directly oppose the foundational teachings of Christ. Also, from what I see, these leaders are exclusively Republicans. My parents were Republicans and I have been an engaged voter for more than 40 years. I feel confident in saying the Republican Party of the past does not exist today. I find this upsetting because I believe a healthy two-party system in which ideas can be debated is important, but I know we can’t pretend that today’s Republicans are working to create anything other than chaos to achieve an authoritarian right-wing state in which they control everything and everybody. It is not hyperbole to say they are following a fascist playbook. The outrage of the week is fundamental to their effort. The outrage of the week is the Pied Piper of the radical right-wing movement, causing a huge voting bloc of people to elect legislators who will make drag shows illegal but not child marriage, who argue that a microscopic embryo has more rights than a ten-year-old rape victim, who will deliberately make it more difficult for people of color to vote, who will criticize college students’ text messages rather than challenge the gun lobby. To have a choice in future elections we have to defeat authoritarians who have co-opted the Republican label. I’m asking other unaffiliated voters to re-examine the idea that we currently have two legitimate parties to choose from. I’m asking them to think about joining a coalition of people — including many former leaders in the Republican party (Stuart Stevens, Jennifer Rubin, Steve Schmidt, Justice Michael Luttig, Tom Nichols, Nicolle Wallace, Christine Todd Whitman, and many others) — in voting Blue. From my perspective, the faster we elect Democrats in a landslide, the faster we can put guardrails back in place (such as passing the Voting Rights Act) and the faster we can rebuild a two-party system that reflects the will of the people. I am cautiously optimistic. I have to believe that most Americans are in favor of limiting the proliferation of AK-15s in our communities. I have to believe that most people support our public education system. I have to believe that most people want voting to be accessible for all eligible Americans. I have to believe that most people will come to see beyond the outrage of the week and realize we have to address issues that affect people’s lives rather than made-up offenses. Elizabeth Gibson is a freelance writer who learned to meet deadline using black manual typewriters at the University of North Carolina at Chapel Hill. She has lived in the mountains of Western North Carolina for more than 30 years.

  • GOP lawmakers' priorities on display as session drags on

    In early September, N.C. Superintendent of Schools Catherine Pruitt told the State Board of Education that school systems need more time to comply with the controversial Parents Bill of Rights that became law in August when the Republican-led legislature overrode Gov. Roy Cooper’s veto. The law requires educators to alert parents if their child changes his or her name or uses a different pronoun at school, restricts instruction about gender identity and sexuality in K-4 classrooms, requires parental consent for providing health care to children, requires parental permission to opt into surveys that ask questions about sexual behavior, illegal activity or mental health issues and requires school systems to more fully inform parents about how to object to materials or curriculum topics. Except for the provision about providing health care, which doesn’t kick in until Dec. 1, the law went into effect Aug. 15, days before school started on Aug. 28. Developing policies and procedures to comply will take hours of meetings and significant resources at a time when many school systems are still trying to find teachers to fill vacancies. If this were a law that promised to better prepare North Carolina students to navigate a world where those with nimble discernment and critical thinking skills will be best positioned to thrive, implementing it would be a good investment of time and resources. But, to the contrary, it’s a law that’s unnecessary, intrusive, likely disruptive and potentially harmful. It’s hard to see how this law furthers the primary function of public schools, which is to educate students and provide them with the skills they need to be contributing members of society. It’s even harder to think of a praise-worthy reason GOP lawmakers would spend the 2023 session, which began in January, hashing out divisive bills like this one and another one that denies treatment to young people with gender dysphoria, when they couldn’t be bothered to pass a 2023-2024 budget, the most fundamental thing their constituents send them to Raleigh to do. There can be little doubt, both these laws are an attempt to marginalize a very small number of vulnerable young people. Tamika Walker-Kelly, president of the NC Association of Educators, the state’s largest teachers’ group, told WRAL news in Raleigh that teachers are most concerned with the effect the new Parents Bill of Rights law will have on LGBTQ+ students and families, especially the provision that requires schools to inform parents if a student is questioning their own gender. “We know that not every student who comes to us at school has a caring adult, and sometimes the educator or the school personnel is that caring adult for that student,” she said. “It is our responsibility, part of our professional standards and code of ethics, to think about first the priority of the student, their health and safety. We will continue to navigate that as educators, but this provision in the law does make that a lot more difficult.” In the fall of 2022, the news agency Reuters worked with the health technology company Komodo Health Inc. to identify the number of young people, ages 6 to 17, in the United States who sought and received gender-affirming care between 2017 and 2021. Komodo’s analysis draws on full or partial health insurance claims for about 330 million U.S. patients, including those covered by private health plans and public insurance like Medicaid. The data included roughly 40 million patients annually between ages 6 and 17. In 2021, the total number of young people diagnosed and/or treated for gender dysphoria, which is defined as distress caused by a discrepancy between a person’s gender identity and the one assigned to them at birth, was about 42,000. The total U.S. number over the five-year period was 121,882. Putting that into context, during the 2020-2021 school year, approximately 1.6 million students attended North Carolina public and charter schools. North Carolina makes up about 3.2 percent of the total U.S. population of about 340 million. That means there are likely less than 1,500 students in the entire state of North Carolina, where there are 2,500-plus public schools, who experience gender dysphoria. Why would state lawmakers spend time targeting such a small and vulnerable number of students instead of passing a budget that will hopefully give the state’s poorly paid teachers a raise? It is especially concerning given the evidence that youth who suffer from gender dysphoria are at high risk of severe depression and suicide. A study published by the Journal of the American Medical Association found that receipt of gender-affirming care in one small cohort of transgender and nonbinary youth was associated with 60 percent lower odds of moderate or severe depression and 73 percent lower odds of suicidality over a 12-month follow-up. There can be little doubt that decreased social support and increased stigma likely to result from legislators meddling in very private matters will almost certainly lead to increased mental health problems for this small group of young people. Meanwhile the calendar rolled toward mid-September with the state’s citizens still waiting for a budget that should’ve been passed with the start of the fiscal year July 1. Will teachers get a hefty raise? Will per pupil funding for schools increase significantly to give them the resources they need to prepare North Carolina students to navigate a world of evolving technology? A report published by the Education Law Center found that per-pupil funding in North Carolina ranked lower than any other state, when compared to the state’s wealth. In terms of total funding per pupil, the state fell from 46th in 2008 to 48th in 2020, according to the report. Will these metrics change as a result of the 2023-2024 budget? If not, it’s pretty clear that GOP lawmakers think fighting a manufactured culture war against a small vulnerable group of young people is more important than providing an adequate education for the state’s entire student population. Joy Franklin is a journalist and writer who served as editorial page editor of the Asheville Citizen-Times for 10 years. Prior to that she served as executive editor of the Times-News in Hendersonville, N.C. Franklin writes for Carolina Commentary

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