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In the days following the June 27 CNN-produced presidential debate between President Joe Biden and former President Donald Trump, national news outlets have been dominated by stories of Biden’s poor performance and calls from various pundits, and even the New York Times Editorial Board, for him to step aside.   Yet, there have been no calls for Trump to step aside as the Republican nominee, despite the fact that his debate performance, while more robust than Biden’s, was almost wholly untethered from fact or truth. Why have lead stories not hammered him for his lies or questioned whether he is mentally sharp enough to remember what’s actually true? Does he really believe the “alternative facts” he proclaims?   Most news organizations have fact-checked the debate and called out his unfamiliarity with the truth, but those stories have not led the news cycle day after day and they have not resulted in pundits raising the question of whether such a deceptive, or perhaps delusional, person is fit to serve as president of the United States.   In the era of social media, news organizations no longer set the agenda for the nation in the way they once did, but the stories that dominate their coverage, and the focus or lack thereof they put on aspects of those stories, still affect the public’s perception of what’s important and what isn’t.   The debate format favored Trump, in part because moderators did not challenge his lies.   As Medhi Hasan in The Atlantic, Heather Cox Richardson on her Substack site “Letters from an American,” and others have pointed out, intentionally or otherwise, Trump used a debate tactic called the “gish gallop,” which would make it hard for even the most skilled debater to formulate an effective response.  As Richardson explained, "It's a rhetorical technique in which someone throws out a fast string of lies, non-sequiturs and specious arguments, so many that it is impossible to fact-check or rebut in the amount of time it took to say them. Trying to figure out how to respond makes the opponent look confused, because they don't know where to start grappling with the flood that has just hit them."   The network said before the debate that the moderators would not challenge the accuracy of the candidates’ statements. That left Biden with the hopeless task of trying to set the record straight while also laying out his own agenda for a second term.   Trump made false or mostly false statements regarding virtually every topic moderators asked about. He said Biden “allowed millions of people to come in here from prisons, jails and mental institutions,” which the fact-checking site Politifact labeled “Pants on Fire,”  the label it reserves for the most outrageous lies. He said “The problem (Democrats) have is they're radical, because they will take the life of a child in the eighth month, the ninth month, and even after birth,” labeled “false” by Politifact, which pointed out that willfully terminating a newborn’s life is infanticide and is illegal in every U.S. state. And the lies and outrageous exaggerations went on and on and on.   Trump repeatedly said Biden was the worst president ever and claimed that he was the best. Biden pointed out that presidential scholars had ranked Trump as the worst president ever which, according to Politifact, is true. The 2024 Presidential Greatness Project Expert Survey, released in February, collected responses from 154 presidential historians. The historians ranked Biden as the 14th best president in U.S. history, and put Trump last.   Whether Biden’s health and mental acuity will carry him through a second term as president cannot be known with any certainty. The same must be said of Donald Trump. At age 81, Biden is only three years older than Trump, who is 78.   One thing is certain, Biden’s halting debate performance justifiably raised concerns within the Democratic Party about whether he should be their standard bearer in November. And it justifiably riveted the attention of news organizations.   Yet Trump somehow escaped the same scrutiny. No one expects the Republican Party to hold him accountable. It has so far shown him sycophantic devotion, despite his deceitful, philandering, vengeful and self-aggrandizing language and behavior. But the news organizations that seem obsessed with Biden’s performance might do well to focus a brighter spotlight on Trump’s.

The failure to convict Trump in the months following the January 6th insurrection, coupled with the Republican Party's unwavering loyalty to him, has brought us to this critical juncture. This lack of foresight and partisan loyalty has put our nation's democracy in peril. On May 30th, 2024, Donald J. Trump was convicted of 34 felonies in the State of New York. This historic trial was a major blow to the former President of the United States, who had claimed that the trial was rigged by President Joe Biden. However, the evidence presented during the trial showed that Trump had indeed committed multiple crimes, including paying $135,000 in hush money to Stormy Daniels, a porn star, to keep her quiet about their alleged affair. The charges were brought by District Attorney Alvin Bragg, and many Republicans and media commentators have criticized the decision to bring the case to trial. However, 12 Manhattan jurors convicted Trump on 34 counts. Eleven charges for legal services; 11 charges for checks paid for legal services and 12 charges for legal expenses. The sentencing hearing on July 11th is crucial for Americans and the world in order to see what kind of justice will be administered to Donald J. Trump.  Will he receive probation?  Will he be relegated to community service?  Or will he be jailed for his actions?  Jail may include weekends or a period of time behind bars.  This is an important moment in American History.  Will Judge Merchan administer justice as he would for an ordinary American? Or will he signal that Trump is indeed above the law as he believes he is? Trump's behavior has worried many Americans. He is known for his dishonesty and lack of accountability, and his conviction on multiple counts of fraud and other crimes is a major blow to his reputation. Most disturbing are his comments about wanting to be a dictator on Day One if re-elected. The failure to convict Trump during his impeachment trial in 2021 has also contributed to the current crisis. Many Republicans have refused to hold Trump accountable for his actions, and instead have continued to support him despite his numerous scandals. This lack of accountability has allowed Trump to continue to act with impunity. In North Carolina, the upcoming election has brought the very essence of democracy into sharp focus. The state's gubernatorial race is currently locked in a virtual tie between Trump supporter Mark Robinson, a Republican, and Democrat Mark Stein. This closely contested contest mirrors the national political landscape: Republicans are bolstered by a majority on N.C. Supreme Court and by a majority on the U.S. Supreme Court. The United States has reached a precarious state, with roots dating back to the early 1990s and Newt Gingrich's Contract for America. Fast forward to 2021, when the Senate acquitted Trump of charges related to inciting an insurrection that resulted in the deaths of five people, including two law enforcement officers. The Republican-led Senate, under Majority Leader Mitch McConnell's leadership, had demonstrated its hypocrisy by blocking President Obama's Supreme Court nominee,  Merrick Garland, from a hearing. This stark contrast is evident in McConnell's swift approval of subsequent Supreme Court nominees, which gave the Court a conservative majority of 6-3. On July 11th when Trump is scheduled for sentencing, democracy will be on trial and the world will be watching.  Remember,  Judge Arthur Engoron has already found Trump is liable for fraud in the civil case, where Trump was fined close to a half billion dollars for sexual misconduct and for taunting the plaintiff. If Trump is re-elected in 2024 and is allowed to remain in office without facing any consequences for his actions, it could have disastrous consequences for American democracy. Trump has already shown that he is willing to use his power to undermine democratic institutions and silence his critics, and if he is allowed to continue in office without accountability, it could lead to a complete erosion of democratic values. In conclusion, Judge Juan Merchan has a critical role to play in ensuring that justice is served in this case. A jail sentence may be necessary to send a strong message that no one is above the law, regardless of position or power. The future of American democracy depends on it. 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.

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.)

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.

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.

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.

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

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.

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.

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 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.

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.)