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Death of an era Once a fast-growing occupation in the country, sales jobs are vanishing, along with the potential they represent. G2
Business 5
sunday, september 26, 2010 OUTLOOK
Obama’s dilemma What to do when the working class is losing faith (bridge that divide) and Wall Street hates you (don’t sweat it). B5
CARPAGES
Facebook B2
myths about
R-Class revived It’s basically a minivan, but Mercedes makes it worth the ride. l Plus, thousands of ads for vehicles.
MARKETS
Fourth week of gains Demand for capital goods, technology products and consumer items gives markets a lift. G5
YTD: Dow NASDAQ S&P 500 +4.14% +4.94% +3.01%
The mega payoff of increased immigration is lost on the pols
I
have a plan that will raise wages, lower prices, increase the nation’s stock of scientists
and engineers, and maybe even create the nextGoogle. Better yet, this plan won’t cost the government a dime. In fact, it’ll save money. A lot of money. But fewpoliticians are going to want to touch it. Here’s the plan:More
immigration. A pathway to legal status for undocumented immigrants. And a recognition that immigration policy is economic policy and needs to be thought of as such. See what I meant about politicians not liking it? Economists will tell you that
immigrants raise wages for native-born Americans. They’ll tell you that they make things cheaper for us to buy here, and that if we didn’t have immigrants for some of these jobs, the jobs would move to other countries. They’ll tell you that we should allow for much more immigration of highly skilled people, because that’s about as close to a free lunch as you’re likely to find. They’ll tell you that the people who should most
Percentage change in wages of U.S. workers because of immigration
One study shows a positive effect on the wages of U.S. workers in all education groups:
+0.6%
All U.S. workers
+0.3% Less +0.4% H.S. than H.S. graduates +0.9%
Some College
+0.5% College Graduates
Another study also found an overall positive effect, but a negative effect on those with less than a high school degree and college graduates:
+2.2% +0.1% +0.9% -1.7% -4.7% EZRAKLEIN
Economic and Domestic Policy
want a path to legal status for undocumented immigrants are the low-income workers who are most opposed to such plans. And about all this, the economists are right. They’ll also admit there are
other considerations. Integrating cultures and nationalities is difficult.Undocumented immigrants raise issues of law and fairness. Border security is tough. Those questions are important. They’re just not the subject of this column. The mistake we make when thinking about the effect immigrants have on our wages, says Giovanni Peri, an economist at theUniversity of California at
ezra continued onG4
New visas approved for highly skilled workers
In thousands, by year
50 100 150 200 250
0 ’00 ’02 ’04 ’06 ’08
SOURCE: Te Hamilton Project THE WASHINGTON POST
G EZ
86,300
ILLUSTRATION BY DAVID PLUNKERT FOR THE WASHINGTON POST HOSPITALS The united state of The industry says more consolidations are on the way.
BY JULIE APPLEBY Kaiser Health News
F
rom their base in Baltimore, lead- ers of JohnsHopkinsMedicine can see the future — and it’s at the hospital down the road. The world-class academicmedi-
cal center is reaching deep into new territory, acquiring a hospital last year in suburban Maryland and awaiting approval to add SibleyMemorial in the District to its roster of hospitals and clinics. The acquisitions are part of a wave —
particularly in themid-Atlantic region—of consolidations leading to fewer indepen- dent hospitals and doctors, a trend that many industry executives say will grow because of the health-care overhaul. The action in the mid-Atlantic is being
watched closely,with experts saying consol- idation in other parts of the country has led to higher health-care prices—size is power, and commanding market share can give hospitals an edge in negotiations with insurers. That kind of leverage mirrors the advantage many big insurers have, which has prompted complaints fromdoctors and hospitals. Tensions between hospitals and insurers are running high as both face pressure to contain costs. “All the evidence very clearly shows
consolidation leads to higher prices,” said Martin Gaynor, an economist at Carnegie Mellon. “Guess who pays for those higher prices? Onemight think insurers would eat them. No, they don’t. It goes into higher
premiums.When premiums go up, employ- ers just pass themright on to their workers, either in the formof lowerwages or reduced benefits.” The Federal Trade Commission found
rapidly rising prices inmarkets after hospi- tals joined. For example, such steep increas- es followed the 2000 merger of two Chica- go-area hospitals that in 2008 the FTC forced the two to negotiate with insurers separately. That same year, the FTC filed a complaint
over Fairfax County-based Inova Health System’s plan tomerge with PrinceWilliam Health System, including a hospital in Manassas. The commission said the deal would give Inova control of nearly three- quarters of the Northern Virginia market and probably drive up costs for employers, consumers and insurers. The two dropped their plans to merge shortly after, and the Prince William system eventually joined with North Carolina’s Novant Health. Hospital leaders from Baltimore to Seat-
tle say the health law approved by Congress in March gives them even more reason to merge with or buy rivals, because of its emphasis on integrated systems where hospitals and doctors better coordinate care. Also fueling the trend: More doctors
want to be employed directly by hospitals, allowing them more job security without the hassles of running a business.But hiring groups of doctors can be an “expensive and daunting proposition” for a stand-alone
hospitals continued onG4 Merging hospitals
In the mid-Atlantic region, more hospitals are becoming part of a system while fewer remain independent.
200 150 100 Independent 50
Data shown for Maryland, Virginia, North Carolina and D.C.
0 2000 2005 2010
But nationally, the number of mergers has decreased.
100 200 300 400
0 U.S. total ’04 ’05 ’06 SOURCE: KPMG ’07 ’08 ’09 THE WASHINGTON POST
Hospitals involved in mergers
Hospitals in a system
Analysts say mergers push up prices.
At town hall, she was just looking for a little reassurance
B
y the time I called her, VelmaHartwas surprised at howherwords had been
dissected and analyzed.Hart is themiddle-aged,middle-class Marylandwomanwho asked PresidentObama to reassure her that he remained the crusader for change she had voted for. “The financial recession has
taken an enormous toll onmy family,” she told the president last week during a town hallmeeting inWashington. “My husband and I joked for years thatwe thought wewerewell beyond the hot- dogs-and-beans era of our lives. But quite frankly, it’s starting to knock on our door and ring true that thatmight bewherewe’re headed again.And quite frankly, Mr. President, I need you to answer this honestly: Is thismy newreality?” Hart,whowas aU.S.Army
Reservist for almost a decade, gave voice to the frustrations of everydayAmericans. But some sawmore than
MICHELLESINGLETARY The Color of Money
frustration. Whenwe talked,Hart said she
was amazed at the attention she’s getting for her remarks,which have overshadowed anything Obama said during the forum. She said her comments and question,whichweremeant to elicit comfortingwords from Obama, have become political fodder and have been misconstrued as proof that Obama’s die-hard supporters were prepared to abandon him— and dowhat?Become tea partiers? “I think he hasmade progress,”
color continued onG4
MICHAEL S. WILLIAMSON/THE WASHINGTON POST
VelmaHart created a buzz during aCNBC economic town hall event inMaryland when she spoke to President Obama about her dissatisfaction with the pace of economic recovery.
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