Opinion

L&T Publisher Earl Watt

As we all prepare to enter a new year with all the hope and promise it brings, we may visit some goals we want to accomplish in 2025.

There are the boiler plate goals like weight loss, workout commitments, healthier living and the like, and those are all good.

Being able to let go of bad habits is never easy for any of us, and we will continue to battle with our inner demons every step of the way.

There will be a tendency to believe the deck is stacked against us, that somehow we cannot improve because there is a concerted effort that we should fail.

THE POSTSCRIPT, Carrie Classon

This year had a lot of ups and downs for me.

This past spring, I felt about as low as I have felt about my writing since I started. My book was going nowhere. There seemed to be nothing I could do to better its chances of being sold. I was unsure if anything I was writing was any good.

Then something happened. And that something was nothing at all.

Guest column

Thomas Ryan American Association  for Homecare

The next Congress will inherit a healthcare disaster.

Across America, companies that provide vital medical equipment to Medicare patients in their homes are drastically cutting services -- or shutting their doors completely. Without action, millions of seniors could lose access to oxygen tanks, wheelchairs, and other essential equipment that keeps them healthy at home.

At the start of 2024, Medicare slashed payments for a major segment of home medical equipment providers by 20%. These rates -- already too low before this year's cuts -- now fall catastrophically short of market realities. A perfect storm of supply chain disruptions, rising fuel costs for equipment delivery and service calls, and a nationwide shortage of trained technicians has sent operating costs soaring. Other payers -- including private Medicare Advantage plans, commercial insurers, and Medicaid -- have followed Medicare and cut their rates as well.

For hundreds of small businesses that provide home care to seniors, the math no longer works. Congress must act to restore Medicare reimbursement for homecare to pre-2024 levels.

A July 2024 survey of providers reveals the scope of the emergency. More than nine in 10 companies have had to make operational changes to keep their doors open. Two-thirds are no longer able to provide certain essential medical equipment to Medicare patients. One in three providers reports dipping into personal savings just to keep serving their communities.

When these companies close, they leave behind healthcare deserts where patients have no alternative sources for oxygen tanks, hospital beds, or wheelchair repairs. One provider's stark warning echoes across the industry: "We are to the point if reimbursement doesn't increase soon, we will be shutting our doors and leaving 15,000 patients without a provider."

What makes these reimbursement cuts so baffling is their ignorance of basic health economics. Caring for patients at home reduces visits to the hospital, which cost more than $3,000 per day, on average.

Or consider the costs of long-term institutional care. The average cost of a stay in an assisted living facility is $5,300 a month. For patients who require nursing home care, the tab can run nearly $10,000 a month.

Home medical equipment that can allow people to receive care at home -- like home-oxygen systems and mobility aids -- can save patients and their families tens of thousands of dollars.

This crisis comes at precisely the wrong moment. McKinsey estimates that up to $265 billion worth of care services for Medicare beneficiaries could move from facilities to homes by 2025, representing a massive transformation in how we deliver health care. As America's senior population grows, we should be strengthening home-based care -- not undermining it.

Every day of inaction deprives more seniors of the option to stay in their homes, where they'd prefer to be -- and increases the risk that additional providers will have to close their doors permanently.

Congress must act to restore adequate reimbursement for home medical equipment. The independence and dignity of millions of Americans hang in the balance.

ABOUT THE AUTHOR — Thomas Ryan is president and CEO of the American Association for Homecare (aahomecare.org). A version of this piece originally appeared in Medical Economics.

Guest  column

Roy Beck Author

A century ago, overwhelming majorities of both parties in Congress voted for the Immigration Act of 1924, which dramatically cut immigration.

The editors of Black newspapers and magazines across the country enthusiastically backed these reductions. Some even advocated for deeper cuts.

These early 20th-century African American leaders wanted to reduce the number of foreign workers admitted each year to give descendants of American slavery a competitive advantage in the labor market. Over the next four decades, the Immigration Act made it more difficult for employers to import foreign workers instead of recruiting Black U.S. citizens -- just as African American leaders had anticipated.

The legislation immediately resulted in immigration dropping from 707,000 in 1924 to 294,000 in 1925 -- and to less than 200,000 a year, on average, over the next four decades.

Labor markets tightened, leading to historic improvements in incomes and working conditions for Americans of all races. But African Americans enjoyed the most rapid gains of any group. By 1929, W.E.B. DuBois exclaimed in the NAACP's journal that the "stopping of the importing of cheap White labor on any terms has been the economic salvation of American Black labor."

In recent decades, this positive consequence of the 1924 law has been overshadowed by criticism of the law's national origin quota system, with its near-bans on immigration from Africa and Asia.

Yet we shouldn't forget that the bill's most important advocates were unions, progressive civic and religious reformers, Black leaders, and civil rights publications. They got the results they sought from the law -- increased incomes for America's workers and a society with much less inequality.

Economists and historians have repeatedly noted that American incomes rose almost immediately for all classes after 1924.

Nobel laureate economist Sir Angus Deaton of Princeton recently explained that "inequality was high when America was open [to immigration before 1924], was much lower when the borders were closed, and rose again post Hart-Celler [the Immigration and Nationality Act of 1965] as the fraction of foreign-born people rose back to its levels in the Gilded Age. It has also been plausibly argued that the Great Migration of millions of African Americans from the rural South to the factories in the North would not have happened if factory owners had been able to hire the European migrants they preferred."

David Leonhardt of The New York Times wrote in his recent book "Ours Was the Shining Future" that reduced immigration following the 1924 Act "contributed to the surge in working-class incomes" in a period that saw Black workers rise even faster than white workers, "well before the passage of 1960s civil rights laws."

Simply put, America became a middle-class nation during the long period of lower immigration. Dramatically lower immigration was not the only cause. But it was one of the key ones.

In 1965, Congress scrapped the 1924 law. In the spirit of the Civil Rights Era, lawmakers' intention was to end the discriminatory national origin quotas.

Their Immigration and Nationality Act of 1965 restarted mass immigration. No Congress since has corrected the mistake. Today, the federal government hands out over 1 million green cards annually, welcomes hundreds of thousands of guest workers, and accepts millions of illegal immigrants and other uninvited entrants.

Naturally, that affects labor markets. The head of the International Monetary Fund recently remarked that, compared to other developed countries, U.S. "wages are not pushing up, because there is no strong pressure because of lack of labor."

As Americans mark the centennial of the Immigration Act of 1924, policymakers would be wise to consider the fact that the legislation unleashed the power of tight labor markets to improve the lives of ordinary Americans.

ABOUT THE AUTHOR — Roy Beck is author of "Back of the Hiring Line: A 200-year history of immigration surges, employer bias, and depression of Black wealth." This piece originally ran in the Houston Chronicle.