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660 lines
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<title>Daily-Dose</title><meta content="width=device-width, initial-scale=1.0" name="viewport"/><link href="styles/simple.css" rel="stylesheet"/><link href="../styles/simple.css" rel="stylesheet"/><style>*{overflow-x:hidden;}</style><link href="https://unpkg.com/aos@2.3.1/dist/aos.css" rel="stylesheet"/><script src="https://unpkg.com/aos@2.3.1/dist/aos.js"></script></head>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
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<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
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<ul>
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<li><a href="#from-new-yorker">From New Yorker</a></li>
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<li><a href="#from-vox">From Vox</a></li>
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<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
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<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
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<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
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<li><a href="#from-ars-technica">From Ars Technica</a></li>
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<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
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</ul>
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<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
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<ul>
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<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Is the Nancy Pelosi Era Really Ending?</strong> - The Speaker of the House is stepping aside, but her school of politics isn’t going anywhere. - <a href="https://www.newyorker.com/magazine/2022/12/05/is-the-nancy-pelosi-era-really-ending">link</a></p></li>
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<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Are We Doomed to See a Biden-Trump Rematch in 2024?</strong> - One thing’s sure: the early betting is often wrong—ask President Rand Paul. - <a href="https://www.newyorker.com/news/letter-from-bidens-washington/are-we-doomed-to-see-a-biden-trump-rematch-in-2024">link</a></p></li>
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<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Sam Bankman-Fried and the Long Road to Taking Crypto Mainstream</strong> - The disgraced founder of FTX played on the vanities of the establishment, reassuring V.C. firms and the media that smart-guy insiders like him could save the world. - <a href="https://www.newyorker.com/news/our-columnists/sam-bankman-fried-and-the-long-road-to-taking-crypto-mainstream">link</a></p></li>
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<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Why I Quit Elon Musk’s Twitter</strong> - A platform that once represented the new frontier of digital democracy is being used by the world’s richest man to troll us all. - <a href="https://www.newyorker.com/news/daily-comment/why-i-quit-elon-musks-twitter">link</a></p></li>
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<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Meaning of the Colorado Springs Attack</strong> - The essential precondition for mass violence is not guns or hate but a culture of terror, a common imaginary that includes the possibility of a mass shooting. - <a href="https://www.newyorker.com/news/our-columnists/the-meaning-of-the-colorado-springs-attack">link</a></p></li>
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</ul>
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<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
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<ul>
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<li><strong>The 2024 Senate map is terrifying for Democrats. That’s one reason Georgia’s runoff matters.</strong> -
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<figure>
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<img alt="Sen. Raphael Warnock, in navy suit, and woman in grey sweatshirt pose for selfie together in front of many yellow and blue campaign posters that read “One More Time Georgia” and “Warnock, US Senate”" src="https://cdn.vox-cdn.com/thumbor/oIKGh60aCUr3OmIK97A4135bHoI=/0x0:3467x2600/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71681516/GettyImages_1442634879b.0.jpg"/>
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<figcaption>
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Sen. Raphael Warnock takes a selfie with a supporter during a campaign rally at Georgia Tech in Atlanta on November 18, 2022. | Brandon Bell/Getty Images
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</figcaption>
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</figure>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
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Democrats will have the majority next year. After that, things get much tougher.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="36DlCL">
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OKgc0X">
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Democrats prevailed <a href="https://www.vox.com/policy-and-politics/23425051/midterm-elections-2022-senate-majority-congress-democrats-cortez-masto">in this year’s Senate elections</a> — but that was the easy part.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kypD6J">
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The hard part is coming in 2024, when the party faces a starkly unfavorable map that could put them in a deep Senate hole for some time if things go even somewhat poorly.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TjJ5xz">
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So even though next week’s runoff pitting Sen. Raphael Warnock (D-GA) against Herschel Walker (R) won’t determine next year’s Senate majority, because Democrats have already won it, its outcome will have significant implications for how well-positioned the party is in its next very challenging Senate cycle.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="z4sOZn">
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Currently, just three Democratic senators represent states Donald Trump won in 2020, and they’re all up for reelection in 2024. These are Joe Manchin (D-WV), Jon Tester (D-MT), and Sherrod Brown (D-OH), though only Brown has confirmed he’s running again. These are all very red states, and winning them in a presidential year will be quite difficult for Democrats.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lAPotU">
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But the vulnerabilities go deeper. The only remotely close states in the presidential contest where Republicans are defending seats are Florida and Texas — two states where Democrats keep coming up short of late. Democrats are also defending seats in five states Joe Biden very narrowly won in 2020. These seats are held by Kyrsten Sinema (D-AZ), Tammy Baldwin (D-WI), Bob Casey Jr. (D-PA), Jacky Rosen (D-NV), and Debbie Stabenow (D-MI).
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GgLbGM">
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Democrats might think they have nothing to worry about regarding this group of seats, because, look, the party just defied the naysayers in the tough year of 2022, winning at least one statewide contest in each of these — so clearly these states lean in their favor.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="j5692E">
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But it’s always a mistake to overread the results of the last election, and to underestimate how much things could change before the next one. Particularly if Trump is not the nominee again, the party coalitions could be scrambled in unpredictable ways. And even Trump came quite close to winning these states in 2020.
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</p>
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<h3 id="1lWU8v">
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The Class of 2024
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</h3>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1LgPgg">
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Senators serve six-year terms, so only one-third of the body is up for election each cycle. And the particular grouping of Senate seats (referred to as a “<a href="https://www.senate.gov/senators/Class_I.htm">class</a>”) up for election in 2024 has enjoyed a particularly charmed run for Democrats. You have to go all the way back to the 1994 GOP wave for a strong Republican performance. Since then, they’ve been on the ballot in the following years:
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</p>
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<ul>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3BGdDa">
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2000: A closely fought presidential year in which Al Gore won the popular vote but George W. Bush won the Electoral College, and Democrats picked up four Senate seats on net
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</li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QEBZsa">
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2006: A Democratic wave year, in which the party retook both the House and the Senate, picking up six seats in the latter chamber
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</li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vcmw0Q">
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2012: A strong Democratic year for Barack Obama’s reelection, in which the party unexpectedly expanded its Senate majority by two seats
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</li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CYCxjd">
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2018: Another Democratic wave year — but the party had won so many seats in deep red states in previous cycles that they had several incumbents in strongly Republican territory, so they ended up with a net loss of two seats
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</li>
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</ul>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fWxUMm">
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So this Senate class is risky for Democrats in part because they’ve had such good luck with it in the past. Nearly half of Democrats’ Senate majority — 23 sitting senators — come from this grouping of seats, so they’ll all be on the ballot in 2024. Meanwhile, only 10 Republicans will be up, though special elections could increase this number. That’s already a numerical disadvantage. But the disadvantage extends to which specific seats are up.
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</p>
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<h3 id="wiIyvH">
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Which specific seats are up
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</h3>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QOJOC9">
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To understand the extent of the Democrats’ challenge, it’s important to realize that the Senate has changed. In the past, it was common for a state’s voters to back Senate and presidential candidates from different parties. For instance, after the bitterly fought 2000 election, 30 of 100 sitting senators represented states that their party’s presidential nominee did not win in the most recent election. That’s a lot of ticket-splitting.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8pkI1s">
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Since then, that number has gradually dwindled, as red-state Democrats and blue-state Republicans have retired or gone down to defeat. When Trump took office, there were 14 such senators remaining. Next year, there will be either five or six (depending on whether Walker can unseat Warnock in Georgia’s runoff election). The Senate has sorted by partisanship.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tjAlN3">
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Of course, very close states at the presidential contest can still go either way. But it’s gotten much tougher to defy partisan gravity in deeply Republican or Democratic states — especially in a presidential year. In 2016, zero states elected presidential and Senate candidates from different parties. In 2020, just one state did, as Republican Sen. Susan Collins and Joe Biden both won in Maine.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nuugks">
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In 2024, all three Democratic senators representing states Trump won in 2020 — Manchin in West Virginia, Tester in Montana, and Brown in Ohio — are up.
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</p>
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<figure class="e-image">
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<img alt="A chart showing Democrats have 23 Senate seats up for election in 2024. Three are in states Trump won by large margins in 2020, and five more are in closely fought swing states." src="https://cdn.vox-cdn.com/thumbor/OocNf4c-Q5bJfParHm7fERWMZR8=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24220842/Screen_Shot_2022_11_22_at_4.04.02_PM.png"/> <cite>Andrew Prokop/Vox</cite>
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</figure>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Et2UCZ">
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<a href="https://www.foxnews.com/politics/manchin-reacts-republican-challenger-i-always-wish-everyone-best">Manchin</a> and <a href="https://www.mtpr.org/montana-news/2022-11-17/sen-tester-says-he-hasnt-decided-on-2024-run">Tester</a> haven’t announced whether they’re running again. Both have repeatedly won in their respective states, though their victories in 2018 were narrow (they each won by about 3.5 percentage points). If either or both retire, Democrats would have immense difficulty finding nominees with comparable cross-partisan appeal. Brown <a href="https://spectrumnews1.com/oh/columbus/news/2022/11/15/senator-sherrod-brown-will-seek-fourth-term-2024">has said</a> he is running again, and Ohio isn’t quite as red as the other two states, but if Republicans can find a competent challenger, he’ll face a tough contest too.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GQt362">
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So that’s three seats where, per underlying partisanship alone, Democrats will have a hard go of it.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TA0miq">
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Then there are five swing states which, if recent history is any guide, are likely to have closely matched Senate and presidential outcomes.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CWVivc">
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In Arizona, Kyrsten Sinema has infuriated progressives and <a href="https://www.vox.com/the-highlight/23323231/ruben-gallego-arizona-latino-voters">may face a primary challenge</a> from Rep. Ruben Gallego. In Nevada, Jacky Rosen just saw her colleague Catherine Cortez Masto narrowly survive <a href="https://www.vox.com/policy-and-politics/23425137/midterm-elections-2022-nevada-senate-cortez-masto-adam-laxalt">a very close contest</a> in 2022. Then there are the well-liked Rust Belt incumbents Debbie Stabenow, Tammy Baldwin, and Bob Casey Jr.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VMedRn">
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None of them will start off as underdogs, and all could well survive. But again, much will likely depend on the presidential contest, and if that contest trends toward the GOP, several of these Senate seats could follow.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="STwjMo">
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Next is a set of likely Democratic states — Maine, where independent Sen. Angus King caucuses with the Democrats; he is 78 and hasn’t announced whether he’s running again, Minnesota (Amy Klobuchar), Virginia (Tim Kaine), and New Mexico (Martin Heinrich). All start as the favorites, but these states aren’t so overwhelmingly Democratic that they’re absolutely certain to win.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XSmW3r">
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Beyond that, Democrats will also have to defend the seat of Sen. Bob Menendez (D-NJ), who is <a href="https://www.nytimes.com/2022/10/26/nyregion/bob-menendez-federal-investigation.html">under federal investigation again</a>. Menendez was previously indicted on public corruption charges in 2015, but his <a href="https://www.vox.com/2017/11/16/16655750/bob-menendez-mistrial">trial ended with a hung jury</a> and the Justice Department gave up on the case. New Jersey is a solidly Democratic state but the party would probably feel better if their nominee wasn’t perennially a DOJ target.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="khcZ4D">
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Meanwhile, of the GOP-held seats up for election, only those held by Sens. Rick Scott (R-FL) and Ted Cruz (R-TX) are in remotely close presidential states.
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</p>
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<figure class="e-image">
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<img alt="A chart showing that Republicans are only defending 10 Senate seats in 2024, and they’re all in states Trump won in 2020." src="https://cdn.vox-cdn.com/thumbor/1XfQYH4aKqWa3jgvODXKDSd1GLo=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24220565/Screen_Shot_2022_11_22_at_2.37.28_PM.png"/> <cite>Andrew Prokop/Vox</cite>
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</figure>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nEctYM">
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Florida has been trending away from Democrats, as recently seen in Gov. Ron DeSantis and Sen. Marco Rubio’s landslide reelection victories this month. Texas has been trending toward Democrats (Trump only won it by <a href="https://www.nytimes.com/interactive/2020/11/03/us/elections/results-texas-president.html">5.6 percentage points</a> in 2020, and Cruz won reelection by <a href="https://www.nytimes.com/elections/results/texas-senate">2.6 percentage points</a> in 2018), but still, Democrats haven’t won a statewide race there <a href="https://www.kxan.com/news/texas-politics/why-cant-texas-democrats-win-state-stays-solidly-red/">since 1994</a>.
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</p>
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<h3 id="5ANhAs">
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The takeaway
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</h3>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mN1StY">
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Democrats’ forbidding 2024 Senate math raises the stakes of the Warnock/Walker runoff in Georgia — if the party starts off with a 51-49 majority rather than a 50-50 one, they can at least afford to lose one seat next cycle without losing control.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AxGI2C">
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That’s especially important because, in a presidential year, the party’s biggest challenge will be holding on to their three seats in deep red states — West Virginia, Montana, and Ohio. The first big question is whether Manchin and Tester will run again, and if they do, the next question is whether they can keep defying partisan gravity, as Collins did in 2020.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DQdp0F">
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But an analysis based purely on statewide partisanship would suggest Democrats are likely to lose all three seats even in a great year for their presidential candidate and their party nationally. That’s the main reason holding the Senate will be so tough for them. The 2022 Senate map was, <a href="https://www.vox.com/2021/10/18/22724808/democrats-senate-disadvantage-shor-klein">as I wrote last year</a>, “relatively balanced,” but the 2024 map just isn’t. (And again, that’s mainly because Democrats have been so successful in these races previously, so they simply have more to lose.)
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uiX65m">
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And if 2024 is not a good year for Democrats nationally? Well, then they could lose some or all of those five swing state seats, putting them at a serious deficit in the Senate that it could take many years to climb out of.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZltNdm">
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gwEDYg">
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</p></li>
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<li><strong>Why it’s so hard for rural hospitals to survive in America</strong> -
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<figure>
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<img alt="Protesters carry signs that read “Save rural hospitals” and “Rural hospitals save lives.”" src="https://cdn.vox-cdn.com/thumbor/IBMfu71RHpl3yKfff5ORyC_qwZ4=/84x0:1468x1038/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71681426/GettyImages_477235056a.0.jpg"/>
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<figcaption>
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Activists attend a rally for rural hospitals on Capitol Hill in Washington, DC, on June 15, 2015. Over the last 10 years, more than 130 rural hospitals have closed, and hundreds more are projected to be in danger of closing soon. | Brendan Smialowski/AFP via Getty Images
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</figcaption>
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</figure>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
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Patients are losing access to health care because community hospitals can’t afford to stay open.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IYuotQ">
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Locally owned and operated community <a href="https://www.vox.com/22923432/maternity-wards-hospitals-covid-19-pandemic">hospitals</a> these days often face an impossible dilemma: Should they allow <a href="https://www.vox.com/policy-and-politics/2021/2/1/22250286/joe-biden-health-care-plan-hospital-monopolies">a larger hospital system to take over their operations</a>, which can mean cuts to staff and services — or close entirely?
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BqS4BY">
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These hospitals are an essential lifeline for health care, often the only place where patients can receive hospital-level care without having to travel hours away from their homes. They are part of the fabric of the community, providing not only medical services but also good-paying jobs and other secondary benefits.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Vc1Leu">
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But <a href="https://www.vox.com/health-care/2020/1/29/21075388/medicare-for-all-what-countries-have-universal-health-care">the US health care system</a> puts small, locally controlled hospitals at a disadvantage. Revenue is based almost entirely on the volume of medical services a hospital provides and, by their very nature, hospitals serving rural or otherwise remote communities do not see as many patients. That has put many of them in poor financial condition. Over the last 10 years, more than 130 rural hospitals have closed; hundreds more are projected to be in danger of closing soon. The pandemic took <a href="https://www.vox.com/22934992/covid-19-pandemic-doctors-nurses-public-health-shortages">a toll on hospital finances</a>, too, simultaneously making more small hospitals vulnerable to closure while also leading larger systems to look at potential acquisitions more skeptically.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Hh0ivf">
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Facilities seeking to avert the devastating effects of a full closure are left with limited options for keeping the doors open. A takeover is sometimes the only viable avenue. But that comes at a cost, as two recent episodes illustrate.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Q0mvM2">
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First, the deal can fall through. The Greenwood Leflore Hospital had for months been exploring a potential merger with the University of Mississippi Medical Center once local leaders decided the hospital, owned jointly by the city and county government, could no longer stay open on its own. As Mississippi Today <a href="https://mississippitoday.org/2022/11/04/ummc-wont-save-greenwood-leflore/">reported earlier this month</a>, the current owners agreed to put up $9 million to cover outstanding debts and deferred maintenance in order to make the deal more appetizing, but it still wasn’t enough to convince UMMC to take over the facility. Their options now are to find another buyer or close.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BF9Ecx">
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But even if a deal goes through, the pain can still come later. The community hospital in Sharon, Connecticut, was first acquired by a larger system in 2017 and then its ownership changed again in 2019 after the merger of two corporate entities. One of the conditions for state regulators approving the sale was that the new owners, Nuvance Health, agreed to maintain maternity care services. But within two years, the company seemed prepared to break that deal. Labor and delivery services could soon end. A community coalition is now fighting to prevent the loss of critical health care in their area.
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</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RIEKIn">
|
||
The same stories have played out across the country. The Sharon hospital has been living through the same story as <a href="https://www.vox.com/22923432/maternity-wards-hospitals-covid-19-pandemic">nearby Windham Community Hospital</a>, almost beat for beat, just with a different owner. As larger systems continue to look for opportunities to scale up their operations, and as private equity has invested more in health care, local hospital services are increasingly subject to the whims of corporate owners who have no or little connection to the community.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5OvPYo">
|
||
Be eaten or face extinction — that is the predicament in which the US health system has placed many community hospitals. And whatever they choose, patients can lose.
|
||
</p>
|
||
<h3 id="NQEbrf">
|
||
Why community hospitals are under constant financial pressure
|
||
</h3>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="s57BEU">
|
||
The American health system makes it really hard for small hospitals serving small communities to subsist. According to <a href="https://www.shepscenter.unc.edu/product/health-system-challenges-for-critical-access-hospitals-findings-from-a-national-survey-of-cah-executives/">a report from the University of North Carolina’s rural health research program</a>, 30 percent of all US hospitals were operating in the red as of 2018 and a majority of unprofitable facilities are located in rural communities.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="a3eCnI">
|
||
The US does not provide hospitals with a steady level of revenue, the kind of <a href="https://www.vox.com/policy-and-politics/2020/1/22/21055118/maryland-health-care-global-hospital-budget">“global budget”</a> where hospitals are given a set amount of money for their expected expenditures based on the patients they serve and the medical care they are likely to need. American hospitals have to try to bring in as much money as they can by performing as many services as they can, but without allowing their overhead to balloon.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2B9hsW">
|
||
There are federal lines of funding, such as the Critical Access Hospitals program, meant to ameliorate those challenges. But that funding has long been deemed insufficient to keep the most distressed facilities open. Additional funding for these hospitals authorized under the Affordable Care Act, through Medicaid’s disproportionate share hospital program, is set to expire soon.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cjEgQF">
|
||
These hospitals are also the most likely to see patients who are on Medicaid or uninsured, which means they end up recouping less money for the services they provide. Some of those people are uninsured because they live in a state that refuses to expand Medicaid through the ACA, another drag on hospitals’ finances.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZItPSk">
|
||
Even those patients with employer-sponsored insurance in rural areas are more likely to have a high-deductible health plan that requires them to spend more of their own money on their health care. And the patients that these communities serve have higher rates of obesity, diabetes, and other chronic conditions.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mjcEmh">
|
||
Stir it all together and you have hospitals serving patients with a lot of medical needs but an inability to pay. That can lead to the egregious <a href="https://www.nytimes.com/2022/09/24/business/nonprofit-hospitals-poor-patients.html">debt collection practices</a> that have been the source of (deserved) scrutiny, as hospitals try to squeeze every penny out of patients, even those ill-equipped to cover the costs.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mC4dbs">
|
||
For the hospitals, it can be a difficult balancing act. Maintaining a labor-and-delivery department in a rural community with fewer births, one of the services commonly targeted for cuts when times get tough, can be expensive. A hospital needs nurses available to staff the unit and OB-GYNs either on staff or under contract who can be available at a moment’s notice. But you can end up spending a month’s worth of staff salary for a handful of births — and those births are often covered by Medicaid, with the lowest reimbursement rates of any US health insurer.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3kOcgD">
|
||
The pressure to find more money is real. But siphoning it from already-impoverished patients isn’t a sustainable solution. That leaves these hospitals with few options except to explore mergers in order to continue operating. But that comes with its risks, too, either if the new owner is not responsive to the community’s needs (as in Sharon) or if the deal falls through and there is no financially viable way to keep the hospital open (as in Greenwood).
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lGTdU3">
|
||
Countries with more organized health care systems, where funding for hospitals is not entirely dependent on the volume of services they provide, are less likely to be faced with these problems. As public officials confront the possibility of rural hospitals shuttering for good and leaving their communities with nowhere nearby to receive medical care, they seem to recognize that a more comprehensive solution is necessary
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tPVa70">
|
||
“The financial issues facing health care are becoming universal in our state. We need a universal plan to address them,” Mississippi Lt. Gov. Delbert Hosemann said in <a href="https://mississippitoday.org/2022/11/04/ummc-wont-save-greenwood-leflore/">a statement to Mississippi Today</a> about the Greenwood facility.
|
||
</p>
|
||
<h3 id="PS1GOy">
|
||
The difficult choice for small community hospitals facing closure
|
||
</h3>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KhIx85">
|
||
When I read the reports of what was happening at the Sharon hospital, I was struck by the parallels with the situation in Windham, Connecticut, <a href="https://www.vox.com/22923432/maternity-wards-hospitals-covid-19-pandemic">which I covered earlier this year</a>. A small hospital had been acquired by a larger hospital system. In Windham, it was Hartford HealthCare; in Sharon, it was Health Quest, and later, after that company was merged with another to create a new nonprofit hospital network, Nuvance Health.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AtSsbL">
|
||
As part of those transactions, the larger health system pledged to maintain the current menu of services on which the community had come to rely. But that promise was quickly broken.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5ek0qg">
|
||
In Windham, the hospital first downgraded its ICU unit to a more limited “critical care” department. Then, without first seeking the necessary state approval, the Windham facility made the decision to close its labor-and-delivery department in 2020. That decision would have left expectant mothers to travel 30 minutes or more to give birth; as I reported earlier this year, at least one mom gave birth on the side of the road because her ambulance could not reach the new designated hospital for childbirth in time.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wHfl2p">
|
||
In Sharon, the hospital staff was told in 2020 that labor-and-delivery services would soon cease, in spite of a five-year prohibition on ending lines of service, according to a timeline compiled by the Save Sharon Hospital coalition. Nuvance then announced publicly in 2021 that it would close the maternity ward before it even sought approval from state regulators, just as Hartford HealthCare had in Windham. Around the same time, they revealed plans to downgrade the ICU unit in Sharon, another cost-saving measure that had previously been undertaken in Windham.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wtRYd1">
|
||
As in the first case, the Sharon hospital said that these maneuvers had been necessary because of a declining birth rate and the hospital’s strapped finances. The community coalition in Sharon has appealed to state lawmakers and regulators to try to block the closure. They are following the example of their counterparts in Windham, which had protested that maternity ward closure to state regulators and prevailed in an initial ruling that is now under appeal.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KyCcuf">
|
||
The stakes are high: Much as in Windham, the nearest hospital that provides labor and delivery services is a 38-minute drive, according to Save Sharon Hospital.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5wvh5y">
|
||
“The well-being of the hospital’s patient population is highly dependent upon its services,” Save Sharon Hospital said in a statement. “Patients in labor or experiencing obstetrical emergencies may be unable to reach an alternative hospital in time to avert a crisis.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5sdcXI">
|
||
The Sharon hospital is living through the challenges that come with being absorbed into a bigger system. Individual sites can become increasingly specialized, and low-profit services that require scale to be profitable — such as delivering babies — end up being consolidated into specific facilities, even if that means patients will have to travel farther to receive them.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="47lODR">
|
||
The research on how hospital acquisitions affect care is limited and the results are mixed. Some studies have found <a href="https://pubmed.ncbi.nlm.nih.gov/34542619/">improved mortality for heart attacks</a>, higher profitability, and <a href="https://journals.lww.com/jhmonline/Abstract/2020/10000/Capital_Expenditures_Increased_at_Rural_Hospitals.8.aspx">more capital investments</a> after an outside buyer takes over a community hospital. But other studies have concluded that <a href="https://pubmed.ncbi.nlm.nih.gov/31893515/">patients report a worse experience</a> at recently acquired hospitals, and <a href="https://onlinelibrary.wiley.com/doi/10.1111/jrh.12461">an associated drop in inpatient charges</a> may indicate that hospitals reduce or eliminate certain lines of service after they merged with another system.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fAVGmB">
|
||
What’s clear is that a merger is often the tool of last resort for a hospital that doesn’t make enough money and is accumulating debt. Because the alternative can be even worse.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6NQxS4">
|
||
In Greenwood, Mississippi, a city of 15,000 people, 90 miles from Jackson and 130 from Memphis, the locally owned community hospital is under duress. The hospital had been in talks with the larger University of Mississippi system since the summer, as its leaders sought to stave off closure.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nhFnFe">
|
||
It is a common problem in that part of the country; more than half of Mississippi’s rural hospitals are at risk of closure, according to the state health department. Greenwood has already <a href="https://www.djournal.com/news/around-mississippi/negotiations-collapse-between-mississippi-medical-facilities/article_ff52424a-34df-5b32-9f91-23965f1e6be8.html">stopped</a> labor-and-delivery services in order to save money; another hospital in the Delta area where Greenwood is located also recently <a href="https://www.mpbonline.org/blogs/news/hospitals-in-mississippi-risk-closure-and-state-officials-debate-medicaid-expansion/">closed</a> the only neonatal ICU unit in the area in another desperate attempt to cut costs.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Gs1kQ4">
|
||
The Greenwood hospital had slashed dozens of staff positions, and the local governments that currently own the facility had even <a href="https://mississippitoday.org/2022/10/28/county-city-commit-9-million-for-greenwood-hospital/">authorized</a> $9 million to cover outstanding debts that the facility owes to Medicare and for deferred maintenance in order to make the deal more appealing to UMMC.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3VN0rI">
|
||
But it wasn’t enough. UMMC said in a statement it could not make the finances work. The hospital could close by the end of the year unless a solution can be found.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dJVDjz">
|
||
“We did not have a Plan B,” Greenwood City Council President Ronnie Stevenson <a href="https://mississippitoday.org/2022/11/04/ummc-wont-save-greenwood-leflore/">told Mississippi Today</a>. “This community needs a hospital. We don’t want to have to rush to Jackson … We want to save lives here, and having a community hospital will save lives.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3xjlbY">
|
||
The Greenwood facility is facing the final dilemma for community hospitals: merge or perish. Mergers had been rising before the Covid-19 pandemic, with a substantial uptick in activity between 2011 and 2016, the most recent period covered in <a href="https://journals.sagepub.com/doi/10.1177/0046958020935666">a 2020 study</a>. The pace <a href="https://revcycleintelligence.com/news/healthcare-merger-and-acquisition-activity-hit-record-low-in-q1-2022">appears to have slowed</a> as a result of the pandemic, but the structural forces that have led more and more small hospitals to seek a buyer aren’t going away.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FOSl0w">
|
||
So long as the US health system makes it difficult for community hospitals to survive on their own, the stories that are playing out in Greenwood and in Sharon seem destined to be repeated.
|
||
</p></li>
|
||
<li><strong>Poor countries are developing a new paradigm of mental health care. America is taking note.</strong> -
|
||
<figure>
|
||
<img alt="" src="https://cdn.vox-cdn.com/thumbor/CFQQO7m7ZXauqV-rCV6VouJOzBw=/445x0:3112x2000/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71626044/Vox_November_Highlight_Story_7__Dark_Version__Final_16_9.0.jpeg"/>
|
||
<figcaption>
|
||
Violeta Encarnacion for Vox
|
||
</figcaption>
|
||
</figure>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
|
||
This is what the future of mental health could look like.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dKbbiH">
|
||
When you look at the numbers, it’s easy to gape in horror.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="q3mALc">
|
||
In Ghana, a nation of 32 million people, there are only 62 psychiatrists.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TSjTS7">
|
||
Zimbabwe, with a population of 15 million, has only 19 psychiatrists.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AY5iSH">
|
||
And in Uganda, there are 47 psychiatrists serving a country of 48 million — less than one single psychiatrist for every million people.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cnoaJK">
|
||
These are staggering ratios. To get your head around them, take the US as a comparison. There are around <a href="https://psychiatry.org/patients-families/what-is-psychiatry">45,000 psychiatrists</a> for all 333 million Americans, which translates to about 135<strong> </strong>psychiatrists for every million people. That’s still not enough — experts are actually warning of an escalating <a href="https://www.aamc.org/news-insights/growing-psychiatrist-shortage-enormous-demand-mental-health-services">shortage</a> — and yet it’s a whopping 135 times more coverage than exists in Uganda.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="apmP88">
|
||
These numbers have very real, and sometimes very brutal, implications for people’s lives. When psychiatry and other forms of professional mental health care are not accessible, people suffer in silence or turn to whatever options they can find. In Ghana, for instance, thousands of desperate families bring their ailing loved ones to <a href="https://harpers.org/archive/2017/05/a-prayers-chance/">“prayer camps”</a> in hopes of healing, only to find that the self-styled prophets there chain their loved ones to trees. Instead of receiving medical treatment for, say, schizophrenia, the patients receive prayers.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JvKRYF">
|
||
The scandal of mental health care in developing countries has been <a href="https://www.theguardian.com/global-development/2020/feb/03/all-we-can-offer-is-the-chain-the-scandal-of-ghanas-shackled-sick">well documented</a>, and surveying it, you could be forgiven for thinking the solution is straightforward: These countries just need to train more psychiatrists and mental health professionals of the type you’d find in the US.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dDbF3w">
|
||
But that’s too simplistic. Yes, training more mental health specialists will be part of the answer for these nations. But what’s most interesting is that developing countries have also figured out a new way to tackle the deficit in mental health care — and it could hold lessons for the developed world as well.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="00sdoV">
|
||
Specifically, these nations have been serving as a proving ground for a model called community-based care, where non-specialist providers or lightly trained laypeople — picture someone like your grandmother, not a doctor — deliver brief mental health interventions in informal settings like homes or parks.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="C1AEs8">
|
||
Whereas importing Western norms can alienate local populations, who may not view mental health problems as medical, brain-based problems, community-based care has found acceptance because it pays attention to cultural context. Lay counsellors meet patients where they are — both literally, in terms of physical space, and conceptually, in terms of their beliefs about mental health.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="en6gcJ">
|
||
This model has turned out to be not only cheap to operate and easy to scale, but also incredibly effective for treating issues like depression. So effective, in fact, that the model is now being exported to the US, which stands to learn a lot from these poorer countries.
|
||
</p>
|
||
<div class="c-wide-block">
|
||
<figure class="e-image">
|
||
<img alt="A young man sits on a bed beside an older woman beside a glowing curtain." src="https://cdn.vox-cdn.com/thumbor/2FePFhS7IMg-ogVArzBKqWPfPyM=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24221139/GettyImages_1297778820.jpg"/> <cite>Brent Stirton/Getty Images</cite>
|
||
<figcaption>
|
||
Dixon Chipanda, psychiatrist and founder of the NGO Friendship Bench, visits with his grandmother. He says she was part of his inspiration for the benches project.
|
||
</figcaption>
|
||
</figure>
|
||
</div>
|
||
<p class="p--has-dropcap" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xCwRlH">
|
||
<strong>In 19th-century Europe, </strong>the reigning paradigm of mental health care was <a href="https://ehne.fr/en/encyclopedia/themes/political-europe/control-and-discipline/psychiatric-institutions-in-europe-nineteenth-and-twentieth-century">the asylum</a>. The belief was that people suffering from psychiatric conditions should be institutionalized and treated on an inpatient basis. As Europeans exported this belief to the territories they colonized, asylums sprang up everywhere, from Ghana to India.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Nixazy">
|
||
By the middle of the 20th century, asylums were becoming discredited: They were too often sites of coercion and violence, not to mention notoriously overcrowded and unhygienic. At the same time, the discovery of new psychiatric medications fostered hope that patients could be treated on an outpatient basis. In Europe, many asylums shut down.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bWtS9B">
|
||
But in the colonies, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998654/">they didn’t</a>.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="96ujQm">
|
||
In Accra, the capital city of Ghana, a psychiatric hospital built on this model in 1904 still houses hundreds of patients, some voluntary and some involuntary. Their issues range from depression to psychosis. It’s a resource-strapped, overcrowded institution. When I <a href="https://www.vox.com/future-perfect/2019/5/30/18644865/ghana-data-poverty-development-census">visited the hospital in 2019</a>, I found that some patients sleep outdoors in a courtyard, where a motley collection of beds draped in mosquito nets was scattered around.
|
||
</p>
|
||
<div class="c-float-right">
|
||
<aside id="HpR25O">
|
||
<q>The few who train in psychiatry tend to move to richer nations</q>
|
||
</aside>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0fiW1R">
|
||
Thinking about the legacy of colonialism helps explain why this warehousing of the mentally ill persists, explained Vikram Patel, a psychiatrist and a professor of global health at Harvard Medical School.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="S23iJB">
|
||
“When the Europeans left Africa, Asia, and Latin America, they left virtually no higher education infrastructure for the native people. Basically, the colonizers left nothing,” he said. Upon gaining independence, some postcolonial countries had <a href="https://qz.com/525601/twenty-sub-saharan-countries-have-only-one-medical-school-and-six-have-none">just one medical school</a> for the whole nation. “And if psychiatrists can only be trained in medical schools, well, then, you know. There’s nothing.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="95uSz2">
|
||
The very limited training capacity — and very limited funding to increase that capacity — has led to a supply-side problem. Today, that problem is aggravated by a major <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618877/">brain drain</a>: The few who do train in psychiatry tend to move to richer nations offering them a more comfortable life.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GiHete">
|
||
And most would-be doctors in Africa<strong> </strong>don’t want to specialize in psychiatry. For some, that’s because it’s associated with institutionalization or incarceration. Others, aware that their cultures stigmatize mental illness as the work of evil spirits, may fear being viewed as <a href="https://assets.publishing.service.gov.uk/media/57a08b0d40f0b64974000932/Kapungwe_etal_AfrJPsy_13.pdf">“tainted”</a> by contact with mentally ill people. And this stigma creeps all the way up to the policymakers debating how to allocate scarce resources.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HKTuGj">
|
||
“We bring these stigmas into the boardrooms and into decisions we make around fiscal planning,” Tina Ntulo, who leads the mental health nonprofit StrongMinds in Uganda, told me. “You do not budget for a person who you think is cursed or bewitched.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QPWTdJ">
|
||
Many would-be patients are also hesitant to see psychiatrists, who represent a foreign idea.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ydnp8G">
|
||
“People just don’t conceive of their mental health problem as a biomedical problem,” Patel said. “They do not say ‘I feel the way I do because I have an illness in the brain.’ That is exquisitely uncommon.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dnvtqk">
|
||
And in cultures that don’t view mental health problems through a medical lens, stigma is a major barrier to seeking out professional care. In one large-scale <a href="https://pubmed.ncbi.nlm.nih.gov/15863750/">survey</a> in Nigeria, for example, 83 percent of respondents said they would be afraid to even have a conversation with someone with a mental health problem. The social costs of being branded as mentally unwell are just too high.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5Dn6K8">
|
||
This is part of why some developing countries are moving toward community-based care. When you receive care from someone who’s familiar and helps you without necessarily applying a diagnostic label, it can mean there’s less stigma.
|
||
</p>
|
||
<p class="p--has-dropcap" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YOScDL">
|
||
<strong>Despite being a psychiatrist himself,</strong> Patel does not believe the answer to the mental health care deficit is to just train more doctors like him. Instead, he’s become one of the most influential advocates for community-based care, where people with just a bit of training — weeks or months, not years<strong> — </strong>offer focused therapy. Empowering non-specialist providers or laypeople to take on tasks formerly done by specialists is what the World Health Organization refers to as “task-shifting” or “task-sharing.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9U3T6S">
|
||
You might think that therapy delivered by a layperson is fine for countries that can’t afford more mental health professionals, but certainly not the ideal. Yet Patel and others who embrace the community-based model are making a much more radical claim.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="x5iqih">
|
||
“A lot of people think this is just a stopgap arrangement. It’s not,” Patel told me. “In the US itself, you need community health workers. What we need in <em>all </em>countries is the same model. We need to have an army of community-based health workers, nurses, social workers, delivering evidence-based interventions.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LNS2IL">
|
||
And they are, in fact, evidence-based. Over the past two decades, dozens of randomized controlled trials (RCTs) and other studies have come out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009149.pub3/full">in favor of</a> the community-based model.
|
||
</p>
|
||
<div class="c-float-right">
|
||
<aside id="9W8GIH">
|
||
<q>Friendship Bench has already served more than 158,000 people</q>
|
||
</aside>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pEeivg">
|
||
<a href="https://www.friendshipbenchzimbabwe.org/">Friendship Bench</a> offers a prime example of what community-based care can look like. Rather than expecting people who are mentally unwell to seek out a psychiatrist’s office, this Zimbabwean nonprofit recruits “grandmothers” — middle-aged or older women who help out in their communities — to learn enough about depression and anxiety to recognize them, and then to treat those disorders using problem-solving therapy. That’s exactly what it sounds like: a therapy that teaches people the skills to devise their own solutions to the problems they face.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yLq3C1">
|
||
Each grandmother, recognizable in her uniform, will then go sit on a bench in a yard. People come along, wanting to talk. In fact, since Friendship Bench was created in 2006, <a href="https://www.friendshipbenchzimbabwe.org/">more than 1,600 grandmothers</a> have been trained, and they’ve already served more than 158,000 people — to great effect.
|
||
</p>
|
||
<div class="c-wide-block">
|
||
<figure class="e-image">
|
||
<img alt="People sitting on benches looking at books in their laps or listening to the speaker, who is not in the picture." src="https://cdn.vox-cdn.com/thumbor/J1awoAkiIoirc6v43YCUcbGvolU=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24221120/GettyImages_1297778551.jpg"/> <cite>Brent Stirton/Getty Images</cite>
|
||
<figcaption>
|
||
Friendship Bench counsellors attend a Sunday service at the Catholic church in Msvingo, Zimbabwe. The NGO offers free mental health counselling through trained grandmothers who work as lay health workers in clinics.
|
||
</figcaption>
|
||
</figure>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HKoYC2">
|
||
In a 2016 <a href="https://jamanetwork.com/journals/jama/fullarticle/2594719">study</a>, 573 patients were assigned to either a Friendship Bench or to a bolstered version of standard psychiatric care available in Zimbabwe, which includes antidepressants. Six months later, only 14 percent of those who’d sat with a grandmother were still depressed, compared to 50 percent of those in the standard care group.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="caNLrg">
|
||
Another great example can be found in Uganda and Zambia: <a href="https://strongminds.org/">StrongMinds</a>, a nonprofit founded in 2013, trains laypeople to lead group talk therapy sessions as a way to treat women with depression. Over a 12-week period, the women learn to identify the triggers of their depression and devise strategies to overcome them, using a form of therapy called group interpersonal therapy.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qI2lMu">
|
||
“This therapy is culturally appropriate. It sees interpersonal relationships as the treatment for depression,” said Tina Ntulo, the country director for Uganda. “And on this continent we are still highly relational and dependent on each other.”
|
||
</p>
|
||
<div class="c-float-right">
|
||
<aside id="NlFgwv">
|
||
<q>Six months later, only 14 percent of those who’d sat with a grandmother were still depressed</q>
|
||
</aside>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OnqJwp">
|
||
Working with laypeople has enabled StrongMinds to scale up quickly, reaching more than 160,000 women to date.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nPNMoQ">
|
||
“One of the amazing things our staff found is that the village volunteers [who’ve been trained to deliver the therapy] are so much better at mobilizing the women to come for therapy,” Ntulo told me. “Our staff said they never saw such high attendance for therapy when they were running it.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BHBKCi">
|
||
Two RCTs have demonstrated that this intervention is both powerful and cost-effective. Independent researchers <a href="https://founderspledge.com/stories/mental-health-report-summary">estimate</a> that StrongMinds prevents the equivalent of one year of severe major depressive disorder for a woman at a cost of $248 — a pretty good deal, especially when you consider this helps the woman as well as her dependents.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="x6l6tw">
|
||
Such interventions have spillover effects. The researchers note that mental health care can lead to material benefits: A non-depressed woman is more likely to be able to work, earn income, and get her kids to school so they can one day work and earn income, too.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1tNWGA">
|
||
A third example of community-based care can be found in India, where Patel co-founded an organization called <a href="https://sangath.in/">Sangath</a>. It developed a six-session program in which lay counselors treat patients with severe depression. The program showed strong <a href="https://sangath.in/wp-content/uploads/2015/07/HAP-PDF.pdf">results</a>, leading to significantly lower symptom severity and higher remission than in a control group after three months.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lDRC52">
|
||
But what’s really amazing about it is that, a full five years after researchers conducted the initial trial in India, a <a href="https://gautam-rao.com/pdf/Rao_psychotherapy_paper.pdf">followup</a> still showed significant differences between those who had received the treatment and a control group. The benefits, it turned out, could really last.
|
||
</p>
|
||
<p class="p--has-dropcap" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QHjDS6">
|
||
<strong>Right about now,</strong> you may be thinking: This laypeople stuff sounds all well and good for people dealing with common mental disorders like depression or anxiety, especially if they’ve got mild cases, but some people need an actual psychiatrist.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Oov9nl">
|
||
Even ardent proponents of community-based care agree with that.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OzqHId">
|
||
“You need some psychiatrists. There’s no question that they play a role,” Patel said. That can be true even when it comes to the common mental disorders: After all, though Sangath’s community-based program for treating depression in India showed strong results, about <a href="https://sangath.in/wp-content/uploads/2015/07/HAP-PDF.pdf">a third</a> of participants remained depressed after the program.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JAejEd">
|
||
So the claim is not that community-based care should replace psychiatry. It’s that making mental health care primarily the business of psychiatrists, with little room for alternative approaches depending on context, is a mistake.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hGtv4L">
|
||
Of course, achieving the right balance between the two models is tricky.
|
||
</p>
|
||
<div class="c-float-right">
|
||
<aside id="Ggmy8Y">
|
||
<q>Laypeople handle the easier cases, while nurses handle somewhat more complex cases</q>
|
||
</aside>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iaHFed">
|
||
At StrongMinds, Ntulo is very clear with the laypeople being trained about what is and isn’t within their remit. “When a person’s symptoms fall outside depression, this is not your client,” she said. “So you refer the person to the health center, and a clinician there will assess.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SGf2Zn">
|
||
At a health center, some of the tasks reserved in the West for a psychiatrist have been shifted to nurses. They can prescribe certain medications, for instance. They consult a flow chart that makes it easier to assess a patient — is he hearing voices or not? — and when symptoms indicate the patient’s problem is beyond their capacity, the nurses refer him to the next level of care above them. Essentially, laypeople handle the easier cases, nurses handle somewhat more complex cases, and the really complex cases may be referred to a psychiatrist for treatment.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UHT77c">
|
||
StrongMinds is not anti-medication on principle, but doesn’t dispense it — partly because current-generation psychiatric medications are less available in developing countries like Uganda, and partly because much of the population would balk at the idea that a mental health condition is something they should treat with medication. Instead, StrongMinds uses the methods it thinks are most effective for the context.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TG9Gy9">
|
||
It’s a system that makes sense to Ntulo, who says only a minority of people need a psychiatrist. “Everybody else could actually receive services through talk therapy and they’d probably be able to stay well for a long time,” she told me.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RwIQO0">
|
||
Patel agrees. He estimates that community-based care could probably address 80 percent of mental health morbidity. “The irony is that 80 percent of the money that’s being spent — this is my back-of-the-envelope calculation — is for that 20 percent that need hospitalization,” he said. “I think the real problem is that we do not spend enough at the base of the pyramid.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NHTN4m">
|
||
Kwabena Kusi-Mensah, a Ghanaian psychiatrist, is a little skeptical about how far community-based care can go. “On paper, it’s a brilliant idea, really fantastic,” he said. “But having watched it be implemented for over 10 years now, there have been serious problems and challenges.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="i1C6Vd">
|
||
Ghana, he explained, has trained a lot of mid-level staff called community psychiatric officers. These CPOs are like physicians’ assistants who’ve been given some additional training in psychiatry. The idea was that they would work in small villages or towns, to help bridge the treatment gap there.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GkYNVZ">
|
||
In reality, the CPOs have drifted into major urban centers; now that they’ve got specialized training, they want to use it to secure a better life for themselves. But what’s even more worrying to Kusi-Mensah is that some of them are going over and above what they’ve been trained to do. He worries that this overreach could put patients at risk — if, for instance, they try to treat problems they’re not qualified to treat.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ilq5m7">
|
||
For that reason, he actually prefers task-sharing of the sort that Friendship Bench does with its grandmothers. “These are not medical people,” he said, “so they are less likely to overreach and do things they’re not supposed to do.”
|
||
</p>
|
||
<div class="c-wide-block">
|
||
<figure class="e-image">
|
||
<img alt="A man beside a tall brick wall applies stain to a slatted wooden bench." src="https://cdn.vox-cdn.com/thumbor/eoD4XagR0yJms9fej9uG5rqykVk=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24221129/GettyImages_1297778727.jpg"/> <cite>Brent Stirton/ Getty Images</cite>
|
||
<figcaption>
|
||
A carpenter works on a bench near a Friendship Bench site.
|
||
</figcaption>
|
||
</figure>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mb9Mcd">
|
||
When it comes to tasks that require medical know-how, he’d prefer to see psychiatrists in place to handle those, not mid-level staff. And he told me he’s “hyped up psychiatry” to many young medical students, enticing them to enter the field. But he’s careful not to entrench himself too much in either a pro-psychiatry camp or a pro-community-care camp because he doesn’t want to become too ideologically attached to one or the other.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XmbaIO">
|
||
“With extremes of ideology, if you lean too much to one way or another, you end up in a ditch,” he said. “So stay in the middle of the road, is the way I think about it.”
|
||
</p>
|
||
<p class="p--has-dropcap" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7iSQ1M">
|
||
<strong>What all these community-based programs,</strong> <a href="https://www.vox.com/future-perfect/23141405/violence-crime-cbt-therapy-cash-shootings">and others in a similar vein</a>, have discovered is the power of getting local laypeople to meet folks where they are.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GQmqQ4">
|
||
Kusi-Mensah emphasized that importing Western norms just doesn’t work: If you want to help people in a place like West Africa, you can’t discount the importance of traditional beliefs, including religion.
|
||
</p>
|
||
<div class="c-float-right">
|
||
<aside id="kSYqwc">
|
||
<q>They might encourage prayers to be said alongside medical treatment</q>
|
||
</aside>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7xdAFF">
|
||
“In our cultural background, where things are overspiritualized, our biggest competitors in mental health provision are the prophets,” he told me, referring to those who profess to heal patients with prayers, like in Ghana’s notorious prayer camps.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="oGSuhT">
|
||
Efforts are now underway to work with, not against, faith-based healers to improve care. Some mental health professionals have gone to the prayer camps and introduced medications as a complementary treatment. Instead of saying “prayer doesn’t work, take this pill instead,” they might encourage prayers to be said alongside medical treatment. This type of collaboration has resulted in <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial/AEB544BD47DA5095088B08CE1516AFAE">improved clinical outcomes</a> for the patients.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ujD8jY">
|
||
But working within the camps is controversial because it could give the appearance of condoning them. Less controversial are efforts to partner with religious leaders in various towns and villages. Pastors and imams often double as informal mental health counselors anyway — that’s true in the US, too — so, the thinking goes, why not view them as another cadre of laypeople who can be trained? And for mental health problems that are beyond their ken, why not establish a referral pathway between them and the mental health care professionals?
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LFstBL">
|
||
“I’m a bit of a pragmatist,” Kusi-Mensah told me. “So I think the best we’re going to get is this sort of rapprochement, where it’s like, ‘Okay, there’s a spiritual component, so let the pastor handle that, but also there’s a medical component, so the doctor will handle that.’”
|
||
</p>
|
||
<aside id="SCk44O">
|
||
<div>
|
||
|
||
</div>
|
||
</aside>
|
||
<p class="p--has-dropcap" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Dba1ja">
|
||
<strong>Western nations like the US </strong>favor a biomedical and highly individualistic view of mental health. Compared to, say, a Ghanaian, an American is more likely to conceive of her mental health problem as a brain problem and seek out medication from a psychiatrist. And she’s got a far better chance of accessing one.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RIZLGG">
|
||
Yet Americans’ mental health is <a href="https://www.npr.org/2022/09/21/1124365508/whats-really-causing-americas-mental-health-crisis">in such bad shape</a> that the US Preventive Services Task Force recently recommended that doctors screen every patient under 65 for anxiety. And 90 percent of American adults say the US is experiencing a mental health crisis, according to a <a href="https://www.kff.org/other/report/kff-cnn-mental-health-in-america-survey/#:~:text=90%25%20of%20US%20adults%20say,published%20Oct.%206%2C%202022.">new poll</a> from CNN and the Kaiser Family Foundation.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4enYQw">
|
||
To Patel, this indicates that the biomedical system can’t be the whole solution. “Mental health care is inadequate not because there’s not enough psychiatrists in most countries,” he said. “If that was the case, the US should have a perfect system. But it has a huge number of problems. It is living proof that the problem isn’t only about the lack of psychiatrists.”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OWmlyK">
|
||
America once flirted with the idea of community-based care. As Vice <a href="https://www.vice.com/en/article/qj4mmb/the-movement-against-psychiatry">explained</a>:
|
||
</p>
|
||
<blockquote>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zke7ym">
|
||
When state facilities and asylums began to be shut down <a href="https://www.motherjones.com/politics/2013/04/timeline-mental-health-america/">in the 1960s</a>, in an initiative known as <a href="https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html">deinstitutionalization</a>, there was a vision expressed, first <a href="https://www.kqed.org/news/11209729/did-the-emptying-of-mental-hospitals-contribute-to-homelessness-here">by</a> President John F. Kennedy and then <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690151/">by</a> the Carter administration, of a <a href="https://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/">community-centered mental health model</a> that would step in to replace it. But funding cuts from the Reagan administration in the 1980s <a href="https://www.psychiatrictimes.com/view/dungeons-and-back-alleys-fate-mentally-ill-america">halted the funding and legislation dedicated to</a> community health centers.
|
||
</p>
|
||
</blockquote>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="l9LcQR">
|
||
It’s taken a few decades, but America now seems ready to experiment with community-based care again as a supplement to psychiatry. What’s exciting is that, this time, it’s taking inspiration from poorer countries.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iYbQc0">
|
||
Zimbabwe’s Friendship Benches have <a href="https://www.youtube.com/watch?v=ofcSRsRtriw">made their way to New York City</a>. Walk around Manhattan and you might see a trained layperson sitting on a big orange bench, waiting to listen or talk about issues ranging from depression to addiction. These are issues some of the laypeople have experienced themselves, so they’re nonjudgmental. They literally meet people where they are, lugging their bench around from spot to spot, as part of the Thrive NYC program aiming to create a mental health system that works for everyone.
|
||
</p>
|
||
<div id="Ov8egX">
|
||
<div style="width: 100%; height: 0; padding-bottom: 56.25%;">
|
||
|
||
</div>
|
||
</div>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hNzSOq">
|
||
India’s Sangath program for depression, meanwhile, is now being rolled out in Texas, where Patel is collaborating with the Meadows Mental Health Policy Institute and Baylor Scott and White, the largest not-for-profit health care system in the state.
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xgoswC">
|
||
And this year, Uganda’s StrongMinds is <a href="https://www.strongmindsamerica.org/">setting up a pilot in New Jersey</a>. The idea is to address the US mental health gap by reaching people who can’t afford to pay for a licensed professional, with a focus on serving Black people, Indigenous people, and people of color.
|
||
</p>
|
||
<p class="c-end-para" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MGXPVq">
|
||
“We just finished training the team in New Jersey!” Ntulo told me. “They’re going to use the same model we use. It’s an amazing solution for a health system that is so commoditized, like yours.”
|
||
</p>
|
||
<aside id="a0tR2P">
|
||
<div>
|
||
|
||
</div>
|
||
</aside>
|
||
<div class="c-float-right">
|
||
<div id="R8qahI">
|
||
<div>
|
||
|
||
</div>
|
||
</div>
|
||
</div></li>
|
||
</ul>
|
||
<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
|
||
<ul>
|
||
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Winning Streak wins Osman Sagar Cup</strong> -</p></li>
|
||
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>FIFA World Cup 2022, South Korea vs. Ghana | Starting line-ups released</strong> - Here are the starting line-ups for the FIFA World Cup 2022 Group H match between South Korea and Ghana</p></li>
|
||
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Illustrious Ruler, Bohemian Grandeur, Dear Lady and The Intimidator please</strong> -</p></li>
|
||
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Magileto and Karyna show out</strong> -</p></li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Philosophy, Fortunatus, Victoria Punch, Artemis Igacia and Mystic Eye please</strong> -</p></li>
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</ul>
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<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
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<ul>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Home guard caught for distilling illicit liquor in Kozhikode</strong> - Excise squad seizes distillation accessories from his house</p></li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Mysuru farmers demand milk procurement at ₹40 a litre</strong> - They submit memorandum to Chief Minister Basavaraj Bommai in Mysuru</p></li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Sharmila arrested by police in Warangal district</strong> - Attack on Sharmila’s personal caravan; vehicle set on fire by reported TRS activists</p></li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Govt. allows Enforcement Directorate to share info with 15 more agencies</strong> - Through the notification, the Enforcement Directorate would be able to share data with a total of 25 agencies, including the 10 specified earlier</p></li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Bishops’ council calls for resolution of issues in Vizhinjam</strong> - An impartial and equitable inquiry should be made into the incidents on Sunday and government must take steps immediately to prevent the situation from growing worse, they demanded</p></li>
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</ul>
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<h1 data-aos="fade-right" id="from-bbc-europe">From BBC: Europe</h1>
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<ul>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Russian attacks on energy grid amount to genocide, says Ukraine</strong> - The prosecutor-general tells the BBC Russian attacks are aimed at “the full Ukrainian nation”.</p></li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Italy landslide: Five bodies found as rescue work continues</strong> - Heartbreaking accounts emerge of the last moments of victims of a landslide on the Italian island of Ischia.</p></li>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>World Cup 2022: Belgium 0-2 Morocco - Abdelhamid Sabiri and Zakaria Aboukhlal seal late win</strong> - Morocco cause the latest shock at a World Cup that has been full of surprises by beating Belgium with two late goals.</p></li>
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||
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>World Cup 2022: Portugal ‘don’t understand how’ Danilo Pereira broke ribs</strong> - Portugal manager Fernando Santos says the team “do not understand how” midfielder Danilo Pereira fractured his ribs in training this week.</p></li>
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||
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>World Cup 2022: Croatia 4-1 Canada - Andrej Kramaric scores twice to send Canada out</strong> - Alphonso Davies scores Canada’s first-ever World Cup goal, but it is not enough to stop them being knocked out following a defeat by Croatia.</p></li>
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||
</ul>
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<h1 data-aos="fade-right" id="from-ars-technica">From Ars Technica</h1>
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||
<ul>
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<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>USB-C desktop power chargers tested—the best GaN-based boxes</strong> - We tested the best multi-port, high-wattage chargers for the plug-deprived. - <a href="https://arstechnica.com/?p=1893887">link</a></p></li>
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||
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>[Updated] Here are all the best Cyber Monday we could find</strong> - Cyber Monday is here bringing new deals to mix with many still-available Black Friday deals. - <a href="https://arstechnica.com/?p=1898433">link</a></p></li>
|
||
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The evolution of whales from land to sea</strong> - Genomes of cetaceans help tell story of mammals who returned to life aquatic. - <a href="https://arstechnica.com/?p=1899963">link</a></p></li>
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||
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The best Cyber Monday deals for Apple devices</strong> - Apple is offering gift cards, and retailers are serving up discounts. - <a href="https://arstechnica.com/?p=1899376">link</a></p></li>
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<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Scientists debate the role of a virus in multiple sclerosis</strong> - Recent study offers evidence of link between Epstein-Barr and multiple sclerosis. - <a href="https://arstechnica.com/?p=1899794">link</a></p></li>
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||
</ul>
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<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
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<ul>
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<li><strong>What is the difference between Politicians and Flying Pigs ?</strong> - <!-- SC_OFF -->
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||
<div class="md">
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||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
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||
The letter f
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||
</p>
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||
</div>
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||
<!-- SC_ON -->
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||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/swazer_t21"> /u/swazer_t21 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/z6po8a/what_is_the_difference_between_politicians_and/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/z6po8a/what_is_the_difference_between_politicians_and/">[comments]</a></span></p></li>
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||
<li><strong>An old couple was sitting in Church…</strong> - <!-- SC_OFF -->
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||
<div class="md">
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||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
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||
…and the wife noticed that people were staring at her.
|
||
</p>
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||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
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||
She leaned across to her husband and whispered, “I’ve just let go a silent fart. What do you think I should do?”
|
||
</p>
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
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||
He said, “I think you should get fresh batteries for your hearing aid.”
|
||
</p>
|
||
</div>
|
||
<!-- SC_ON -->
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Goatmanthealien"> /u/Goatmanthealien </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/z6lojl/an_old_couple_was_sitting_in_church/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/z6lojl/an_old_couple_was_sitting_in_church/">[comments]</a></span></p></li>
|
||
<li><strong>How does an American cop like their coffee</strong> - <!-- SC_OFF -->
|
||
<div class="md">
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
|
||
Black with a couple of shots in it
|
||
</p>
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||
</div>
|
||
<!-- SC_ON -->
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/shadow_king13"> /u/shadow_king13 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/z6izmk/how_does_an_american_cop_like_their_coffee/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/z6izmk/how_does_an_american_cop_like_their_coffee/">[comments]</a></span></p></li>
|
||
<li><strong>I was voted “Least likely to Succeed” by my high school class.</strong> - <!-- SC_OFF -->
|
||
<div class="md">
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
|
||
I hate being a teacher.
|
||
</p>
|
||
</div>
|
||
<!-- SC_ON -->
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/porichoygupto"> /u/porichoygupto </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/z6dhvl/i_was_voted_least_likely_to_succeed_by_my_high/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/z6dhvl/i_was_voted_least_likely_to_succeed_by_my_high/">[comments]</a></span></p></li>
|
||
<li><strong>What’s a three letter word that starts with gas?</strong> - <!-- SC_OFF -->
|
||
<div class="md">
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
|
||
Car.
|
||
</p>
|
||
</div>
|
||
<!-- SC_ON -->
|
||
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/beforethesunwillrise"> /u/beforethesunwillrise </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/z6ad73/whats_a_three_letter_word_that_starts_with_gas/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/z6ad73/whats_a_three_letter_word_that_starts_with_gas/">[comments]</a></span></p></li>
|
||
</ul>
|
||
|
||
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