Coming soon: ‘Repeal of the Job-Killing Health Care Act’ – Part II?


Professor Victor Rodwin writes:

The House vote to repeal what critics call “Obamacare” (the Patient Protection and Affordable Care Act – ACA — signed by President Obama on March 23, 2010) was a key part of the GOP campaign to win back the House of Representatives in the November elections. It worked as an effective mobilizing call to arms.

HR2  (Repeal of the Job-Killing Health Care Act) passed the House by a vote of 245 to 189 on January 19, 2011. The Senate, however, killed the bill February 2, and the issue receded to a background murmur. Republicans and Democrats have drawn their swords over the President’s budget, instead.

Still, repealing the health care act is likely to return to the political agenda. House Speaker John Boehner (R-Ohio) states that “The Congress can do better in terms of replacing Obamacare with common sense reforms that will bring down the cost of health insurance and expand access for Americans.”

To assess such a proposition, one would have to know more details about his party’s solutions. But proposals so far are conspicuously absent.

After Congress passed the ACA, Boehner called it a “dangerous experiment.” Texas Gov. Rick Perry called it “socialism on American soil.” Many of their Republican colleagues have reread the script used by the American Medical Association (AMA) in opposing extensions of health insurance coverage propounded by President Franklin Roosevelt, Harry Truman, Lyndon Johnson and Bill Clinton. They suggest that the ACA will result in a “government take-over” of American medicine, at worst, and “government-run” health care, at best.
But such attacks are dangerously misleading because they distort present realities and generate ill-founded fears.

We already have a massive government role in American health care; and for good reasons. We have socialized expenditures for our highest-risk populations – the elderly and severely handicapped (Medicare) and for the very poor (Medicaid) –  and we have a system of socialized medicine for our military veterans, which delivers health care of higher quality than what is received by the average American.

At the same time, most health care in the U.S. is provided by private non-profit hospitals and private doctors reimbursed on a fee-for-service basis. Clinical decisions remain largely in the hands of our physicians and to the extent that there has been increasing intervention and regulation of these decisions, it has come most forcefully from private insurance companies. Meanwhile, we have more government expenditure of biomedical research (NIH) and public health (CDC) than any nation in the world. And the system produces staggering rates of innovation in pharmaceutical research, medical devices and medicine.

The ACA is largely a bipartisan, half-way reform strategy inspired more by former Republican Governor Mitt Romney of Massachusetts than by left-leaning advocates of single-payer health insurance reform. It does not nationalize the health insurance industry. It does not increase the share of public hospitals. It does not set uniform prices for hospital and physician payment across all payers. And it does not assure universal coverage.

At best, the ACA, if implemented in 2014, will begin to increase coverage to 32 million of the more than 50 million Americans who are currently uninsured. It will achieve this objective through Medicaid expansion and the creation of health insurance exchanges that will strengthen federal regulation of the private health insurance industry through the prohibition of risk selection by insurance companies (the ban on refusals to cover pre-existing conditions and to set annual and life-time limits on coverage).

Finally, the ACA, passed before the extension of the Bush tax cuts for the wealthiest Americans, begins to reverse the post-Reagan policies of increasing income inequalities. It does so by increasing the existing Medicare payroll tax on all those earning over $200,000 ($250,000 for couples).

These are significant, but modest, steps toward what political scientist Jo White calls the “international standard” among health systems in wealthy capitalist democracies – Japan, Germany, France, United Kingdom, Canada, Switzerland, Australia, Netherlands, and many more.

This standard, met by all governments in such nations, either imposes taxes on its citizens or enforces a health insurance mandate to provide access to a minimum level of health care services. Without taxes or a mandate, there can be no universal health insurance coverage. Without universal health insurance coverage, we cannot meet the international standard.
 

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Thoughts for the New NYC Schools Chancellor, Cathie Black


Amy Ellen Schwartz writes:

Cathie Black’s appointment as New York City Schools Chancellor came at a difficult period. While her predecessor, Joel Klein, enjoyed swelling public coffers and large increases in per pupil spending, Chancellor Black takes office at a time when the budget is shrinking, certainly significantly and maybe substantially.

At the same time, while Chancellor Klein claimed standardized test results “proved” his reforms were working, the recent adjustments in those metrics have fueled doubt about whether – and to what extent – his hallmark strategies such as replacing large comprehensive high schools with new, small schools and increasing school autonomy “worked”. Even more, the turmoil created by opening and closing schools – and the attendant expense — raises questions about the sustainability of these reforms.

Bottom line: Cathie Black faces considerable challenges in the months ahead and it behooves us to help her succeed. In that spirit, I offer the following suggestions.

Beyond “What Works”: While education officials and policy makers tout the importance of finding out “what works”, we need more than that. We need to figure out “what’s worth the money” or what gives the biggest bang for the public buck. Is the high cost of new small schools worth the money, or would we do better to invest in\mid-size schools or schools-within-schools? Unfortunately, relatively little attention has been paid to the costs of interventions and reforms and so the evidence base is thinner than it should be – this is a gap that needs to be filled.

Special Education is Critical:
Between 2002 and 2008, full-time special education students increased by 20 percent, from just over 82,000 to over 98,000. (That’s an increase from 7.5 to 9.5 percent of total enrollment.) At the same time, direct per pupil expenditures for special education increased 31 percent. Together, this means that Special Education eats up a larger and larger share of the budget, threatening to crowd out spending and services for general education students. (My forthcoming paper with Leanna Stiefel provides more detail.) While federal and state rules and regulations place significant restrictions on classification, services, and so on, the school district can and must find ways to deliver required services in the most cost effective way possible.

Don’t overestimate the value of value-added: Although evaluating the efficacy of teachers and schools using test score based value-added measures has undeniable intuitive appeal, the usefulness of these measures in improving schools now is much more limited than the publicity might suggest. For one thing, value-added measures can only be calculated for a fraction of teachers in NYC public schools. (Currently, only about one in five.). More importantly, however, it seems unlikely that value-added scores will identify significant numbers of previously unidentified “bad teachers” that can then be dismissed to make way for (or save the jobs of) otherwise-hidden ‘great teachers”. I am certain that value-added analyses have an important role to play in education policy and practice in the long run – and equally confident that the short-run returns will be fairly small.

Moving Matters:
Chancellor Klein was fond of saying that much of his reform efforts were guided by a desire to create a system of good schools and not a good school system. In practice this meant that accountability fell to individual schools for the students currently enrolled. Who, then, is responsible for making sure that students enroll in schools that can provide the services they need? That they choose “well”? In a different vein, a growing body of research shows that student mobility between schools- prompted, say, by family dissolution, foreclosure, or behavioral or academic problems – harms their performance and, potentially, affects their peers. Helping students navigate between schools, adjust to new environments, and succeed will mean attention and accountability for the school system and not just a collection of good schools.

One of my colleagues once claimed that every home in New York City was within walking distance of one of the best public schools in the country…. and one of the worst. As a parent and alum of the New York City public schools, I wish Cathie Black the best of luck in her effort to make all of our schools better.

References

Stiefel, L., Schwartz, A. E. (2011). “Financing K-12 Education in the Bloomberg Years, 2002-2008″ in Jennifer A. O’Day, Catherine S. Bitter and Louis M. Gomez (Eds.), Education Reform in New York City: Ambitious Change in the Nation’s Most Complex School System (pp. 55-84). Cambridge MA: Harvard Education Press.
Stiefel, L., Schwartz, A. E., Conger, D. (2010). “Age of Entry and the High School Performance of Immigrant Youth.” Journal of Urban Economics, 67:303-314


The WikiLeaks Document Flood – What Do You Think?


Professor John Gershman writes:

The recent WikiLeaks document dump and the associated reporting by several prominent newspapers has made many researchers enthusiastic and has fanned the flames of hyperbole both on the part of WikiLeaks and its detractors. Both sides exaggerate the significance of the leaks, and the hyperbole obscures more significant issues.

The documents cover a period from 1966 to February 2010 from a range of embassies and personnel. The ones involving Iran and the Middle East garner the greatest attention, although most are unsurprising to anyone who follows the region. One less widely reported view is that of former National Security Council staffer Gary Sick, who argues that the documents indicate that the Obama administration has yet to seriously try an engagement strategy with Iran and that Washington has largely resisted the drumbeat for attacking Iran from its allies in the region.

Long-Term Effects

The broader question is whether these kind of leaks lead to longer-term difficulties for the pursuit of U.S. foreign policy. To the extent those policies include the routine use of diplomats as spies, it will be a good thing if the leaks reduce those efforts.

But some ask: Will foreign leaders will be less willing to be forthright in their views and opinions if they think they will appear soon on the internet?

Short answer: probably not. CNN tweets that while calling another government to talk about the leaks, Secretary Clinton was told, “Don’t worry about it, you should see what we say about you.”

Others have asked: Will U.S. diplomatic personnel be less forthright about their own opinions or expressing the views of others in diplomatic cables.

Again: probably not. Perhaps the language will be less colorful.

Will the now ramped-up security measures for these and presumably other types of documents inhibit the kind of information sharing that was pointed to as missing prior to the 9/11 attacks. Short Answer: Possibly — but getting the balance right takes time.

Finally, will the leaks will make some countries whose cooperation with the U.S. is unpopular at home retreat from their collaboration. Short Answer: Possibly in the short-term.

Don’t Buy the Hype

But those may not be the most important dimensions of WikiLeaks’ impact.
“Cablegate” – as the document dump has been dubbed — is in some ways a form of celebrity shock journalism, the equivalent of a s speech by Bono on African poverty monopolizing press attention while the people who have been working in the trenches on these issues for decades get overlooked. Outfits like the National Security Archive, Open the Government, and freedominfo – among many others — slog away on a daily basis, working to hold officials accountable and do the nitty-gritty work required to make the Freedom of Information Act meaningful and governments around the world more open and accountable.

Cablegate has, in fact, sparked a valuable debate on the benefits and limits that transparency can and should play in foreign policy. This kind of debate will only strengthen our democratic institutions as we publicly debate and identify the benefits and risks associated with secrecy. For example, even Daniel Ellsberg of Pentagon Papers fame suggested that some things should remain secret, at least for a period of time. Recent experiences suggest that such a debate is an important and valuable one — and that this is potentially a benefit that far outweighs the short-term risks to the conduct of foreign policy.

What’s your opinion? Comment below.


A Call for Public Service Scholarships, NYU Wagner Dean Ellen Schall’s Op-Ed Appears in the New York Daily News


WHEN HE LAUNCHED his candidacy for governor of New York, Attorney General Andrew Cuomo bemoaned the lack of a “meaningful back bench” for the 42% of state government workers eligible to retire in the next five years. At a time when New York government is widely viewed as dysfunctional, we have the responsibility and the opportunity to enlist a new generation of talented, highly skilled public servants.

That has been the hopeful ideal ever since President John F. Kennedy expressed it half a century ago. Despite the present difficulties, there are promising signs that we can now make it real. In fact, the Cuomo campaign has offered a promising start by articulating a plan to create scholarships for outstanding undergraduate and graduate students who commit to three years of service in “mission-critical positions” in state government after they graduate.

The plan would help make public service not only an honorable profession, but an affordable one as well.

If we don’t act, we will face an increasing service gap. More than 37,000 state employees have finished their public careers within the past six years. Tens of thousands more are expected to do so by 2015. Who will take their place and, in a time of increasing complexity and fiscal scarcity, take up challenges decisive for our future – from improving educational outcomes in low-income and middle-class communities, to updating transportation networks, opening new pathways to affordable housing and equipping workers with the new skills of the global age?

As dean of NYU’s Robert F. Wagner Graduate School of Public Service, I see graduates of programs like ours as creators of that future. Our students explore and analyze issues as wide-ranging as the benefits and unintended consequences of offering pedestrians and bicyclists more space on major city thoroughfares like Broadway, the impact of New York State’s STAR exemption on school district property taxation, and the importance of providing access to anti-malaria nets in Cameroon, West Africa. Our graduates are ready to become innovators and leaders, not just working in state government, but making it work to resolve seemingly intractable problems and rise to the challenges of a transformed and transformative era.

But here’s the often-insurmountable barrier: While these talented young people have a deep commitment to public issues and a passion for public service, too many have to make too much of a financial sacrifice if they follow their idealism into the public sector. Some feel they have to enter the more lucrative private sector to pay off loans. And countless other graduates of law schools, business schools and medical schools never even consider asking what they could do in public endeavors. Scholarships in return for service can be essential to enabling the brightest and most committed students to choose service – not just from schools of government, but from other disciplines as well.

“I know a number of people who wanted to work in public service but went in a more profit-oriented direction because of the cost,” is how Dominique West – a 28-year-old Harlem resident who received a master of public administration degree from NYU Wagner last year – put it to me.

West, an outstanding former high school teacher who pioneered a program that helped University of California, Berkeley – her alma mater – recruit and retain students from underrepresented groups, is currently pursuing her dream, at the city Education Department, of working at a policy level to improve urban schools. But her $60,000 graduate school debt casts a shadow across her commitment. The Cuomo scholarship proposal or something like it could free thousands of promising young people from facing a similar dilemma.

We all know that New York State has a multibillion-dollar budget deficit. People will wonder how we can afford to pay for such a program. A more foresighted question, however, would be how can we afford not to? The costs of incubating excellence in the next generation of public service would be repaid countless times, in manifold ways, with the development of the more responsive, creative and effective public sphere we so sorely need.

If legislators are serious about strengthening the pipeline to public careers, they must meet this challenge. Regardless of who occupies the governor’s mansion in 2011, let’s make sure that in years to come, we bring the best to work for us all across state government.

(This op-ed article by Ellen Schall, dean of NYU Wagner, originally appeared in the July 12, 2010, edition of the New York Daily News.)


RCLA and Institute of International Education Launch Leadership Program Evaluation


RECENT NEWS reports have highlighted the first significant decline in decades in the number of women dying from pregnancy and childbirth each year – a remarkable sign of progress in family planning and reproductive health services. Yet much remains to be done, and the health and well-being of women and families continues to be a global leadership challenge.

Since 2001, the Institute of International Education West Coast Center’s Leadership Development for Mobilizing Reproductive Health Program (LDM) has helped develop and sustain leaders working on the front lines of family planning, HIV/AIDS, adolescent reproductive health, gender-based violence, and improved maternal health care.

With support from the David and Lucile Packard Foundation, the LDM program has supported over 1,200 emerging and established leaders in developing the vision, commitment, knowledge and skills to make systemic improvements to reproductive health options and the overall quality of life, especially for vulnerable people. Currently, LDM focuses on institutionalizing strong in-country leadership programs, building and sustaining networks that are platforms for learning and action, and offering leadership development programs, especially for women and youth.

LDM leaders work in the poorest regions of countries in greatest need: Ethiopia, India, Nigeria, Pakistan, and the Philippines.  According to the new study on reproductive health in the medical journal The Lancet, India, Nigeria, Pakistan, and Ethiopia are among the six countries that accounted for more than half of all the maternal deaths in 2008.  That makes the LDM’s work with leaders in these countries and the Philippines all the more urgent.

In order to evaluate and document the impact of the program, RCLA is collaborating with the IIE West Coast Center and the Packard Foundation to conduct an evaluation utilizing action research and participatory methodologies. Amparo Hofmann-Pinilla, deputy director of the Research Center for Leadership in Action, and RCLA consultant Judith Kallick Russell will be the principal evaluators. The participatory process will draw on the insights of LDM fellows, staff from IIE and other key stakeholders to examine key components of the programs, assess gains over time and lessons learned, and determine together how to develop future initiatives.

“The LDM program has provided many opportunities for fellows and key stakeholders to connect, collaborate and learn from each other. The evaluation will support this effort by integrating findings from different countries, validating the experience of the fellows and LDM program staff and enabling us to envision possibilities for the future,” said LDM Program Director Cheryl Francisconi.

The nine-month evaluation process begins June 13-15 with an international gathering of IIE staff, national evaluators and country program managers in Manila, Philippines. The meeting will provide an opportunity for participants to get to know each other, learn more about the LDM program and context in each country; introduce and discuss the inception report and the diverse methodologies, and finalize initial research questions.

“We believe that this evaluation will support LDM program goals by infusing the collective work with a deeper understanding of the role leadership development can play as well as new lessons from program results. The participatory approach will also further strengthen leaders’ ability to continue advancing reproductive health and social change in their organizations and communities,” said Amparo Hofmann-Pinilla. 


The Time is Ripe for Leadership Diversity


By Bethany Godsoe

THE RECENT DEATHS OF ACCLAIMED CIVIL rights leaders Dorothy Height and Benjamin L. Hooks call for a moment of reflection on our nation’s history, the persistent and dismaying disparities confronting us, and the role we can each play in realizing a vision of a more just world. 

The National Urban Fellows Call to Action Summit on Diversity in Washington, D.C. on April 21 was just such a moment. An extraordinary group of people came together to discuss efforts to ensure that the highest levels of public service reflect and include the diverse people and voices that give our country its vitality, ambition, commitment to human rights, and creative spirit.

It was also a chance to share a key lesson from the work of NYU Wagner’s Research Center for Leadership in Action:  The bravado of heroic leadership has gotten us into trouble as a society. It has been our downfall in multiple arenas, from foreign affairs to financial services. The time has come to find a new model that will advance our nation toward greater opportunity and prosperity. Leadership diversity is that new model.

Leadership diversity is not about getting new faces into old roles. It is about radically shifting our understanding and practice of leadership. It is about opening ourselves to the possibility that effective leadership can take many forms and look very different from one context to the next. It is about taking up the work of leadership as a collective endeavor that taps the talents of people at all levels of organizations and across all sectors of society. Creating this openness to new forms of leadership both demands and supports the advancement and contributions of previously underrepresented groups from people of color to women to young people.

As we seek to promote the dominance of leadership diversity in our national discourse and practice of leadership, we must get past our pursuit of getting past our differences. Finding common ground is not the way forward. It is the way to limit our possibilities. Let’s use this call to action to lift up our differences and make them known. Let’s start living in the tensions those differences create. Let’s work with our differences to produce breakthroughs in how we take up the work of public service leadership.

This is not something that can wait for the next generation to resolve – the moment for change is now.  As Dorothy Height was known for saying, “If the time is not ripe, we have to ripen the time.”

(Bethany Godsoe is the Executive Director of NYU Wagner’s Research Center for Leadership in Action,)

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The post-racial conversation, one year later


ONE YEAR after the inauguration of America’s first African-American president, MSNBC presented “Hope and Fear in Obama’s America: 2010″ on Monday, January 18, at 10 p.m. (Eastern),an extended discussion on race, with Irshad Manji, Visiting Scholar at the Robert F. Wagner Graduate School of Public Service (NYU Wagner) and the Director of the Moral Courage Project at New York University.

Manji, author of the bestselling book “The Trouble with Islam Today,” joined a lively panel of thought leaders in discussing some of the most pressing and provocative issues related to the changing landscape of racial relations in the United States. This Martin Luther King Day special broadcast will be conducted live from Texas Southern University in Houston, and moderated by Chris Matthews of “Hardball” and radio host Tom Joyner.

 Tune in to hear Irshad Mani’s comments at http://www.msnbc.msn.com/id/21134540/vp/34929528#34929528  and offer your own by clicking the “Comments” link above.


The UN’s Human Development Report


Jeni Klugman, director of the United Nations Development Programme’s Human Development Report Office, visited NYU Wagner on November 19, 2009, and spoke to an audience about this year’s Human Development Report, of which the theme is migration.

In her talk, Klugman presented the key message of the report: overall, migration creates aggregate benefits for receiving countries and migrants.

Broader dimensions of how people fair beyond income, including health and education, were also examined in the report, she noted. Though, on average, migrants experience a three to four-fold increase in income, they also usually gain in health and education indicators as well. Some surprising facts were that the number of migrants as a percentage of the world’s population is the same as it has been since 1960–roughly three percent. Furthermore, most migration actually occurs within borders rather than between countries. Contrary to popular though, migration from developing to developed countries actually accounts for only 30% of all world migration.

The report shows that the effects of migration at the destination tend to be positive. There are no aggregate job losses and destination countries capture about one-fifth of aggregate gains–approximately $190 Million (US$). The World Values Survey shows that attitudes toward migration are much more nuanced than news headlines read. People prefer permanent over temporary migrants. Despite this information and a positive reception of the report overall, both physical and paper entry barriers are still high and being tightened further. This is because the recent recession has cut the demand for migrant workers. However, ageing and shrinking populations in developed countries foreshadow an eventual return in demand for migrant workers.

The diagnostic of the report recommends simplification and expansion of regular migration channels–particularly for low-skilled workers–conditional on labor demand; the ensuring of basic rights for migrants; reduction of transaction costs; improvement of the conditions in destination countries–particularly in developing countries; enabling of benefits to be gained from internal migration; and the making of mobility integral to national development strategies. Wagner’s Professor Natasha Iskander, a researcher of migration herself, emphasized the report’s statements and conclusions as being very bold, particularly in the U.S. political context. She also expressed her happiness with the positive global reception of and response to the report. Klugman responded that this positive reception may be in part due to the consultation process used in writing the report, which included regional nuances and priorities, as well as the particular attention paid to political economy. Whatever the reason, many are hopeful that this positive sentiment will be translated into more migrant-friendly policies, particularly at the national level.


As glaciers melt, adapting means more than cold, hard science


SCIENCE IS SO ELEGANTLY straightforward. Greenhouse gas emissions go up, the earth warms, glaciers melt, and some places get wetter while other places get drier.

Mark Carey, environmental historian at Washington & Lee University, certainly didn’t question climate feedbacks, and showed iconic photographic evidence of slowly retreating glaciers in the Peruvian Andes. What Carey did question during his lecture November 17 at NYU Wagner — the latest in the “Climate Change and Water” series sponsored by the school — was how climate science is used, and whether the equations really take all of the relevant variables needed for effective adaptation efforts into account.

Using the Cordillera Blanca range in the Peruvian Andes, Carey made a case for climate adaptation work in glacial areas to go beyond hard science into the muddy realm of historical trends, culture, and governance in the region. Why? Because glacial regions are naturally hazardous and unpredictable – glaciers are lax in staying put, and when they move around, the resulting earthquakes, avalanches and flash floods can wipe out villages and kill untold thousands in the valleys below. A warmer world exacerbates these incubating risks, and governments and international donors stand ready to prepare hazard mitigation projects designed by teams of engineers and other technicians.

Questions of adequate funding aside, things can get a little prickly. The science of engineers, glaciologists and climatologists isn’t so great at predicting human behavior – and its biases can result in conflicting situations and thus hamper efforts to reduce risks for vulnerable populations. Carey offered he hydro power sector as an example, showing first the historical influence of macroeconomic policy in promoting hydro development, and how the now-privatized sector continues to develop and compete with other users (e.g. farmers) for dwindling water supplies. 

Competition for water use resulted in the forcible takeover of a Duke Energy dam by local farmers, following accusations that the company was taking an unfair share of the supply and leaving them with too little for their crops. In a question of who has the ultimate right to a common-pool resource; the lack of legal and institutional clarity has resulted in an impasse that has lasted well over a year. Similarly, Carey reported on situations where glacier scientists, company representatives and government workers have become entangled in conflicts and occasional stone throwing, largely due to inattention to local attitudes and governance structures in studies and project work.

The main take-away of the presentation was that adaptation measures need not neglect history or fail to integrate the technical and social sciences — and can effectively mitigate conflicts in helping regions adapt to disappearing glaciers. Carey proposes a framework that gives some weight to sociocultural and governance issues, along with the technical questions Perhaps a next challenge is figuring out how to operationally integrate hard and soft sciences –  before the glaciers melt.


What the Internet tells us about Jihadi strategic thought


     WILLIAM McCANTS, program manager for Department of Defense’s Minerva Initiative, delivered a talk entitled “U.S. Power in Jihadi Strategic Thought” on Nov. 4 at  NYU Wagner, explaining how the Internet provides a window on the beliefs and suppositions of major jihadi thinkers.

       McCants said that terrorists think deeply about the uses for violence in the pursuit of their objectives.  Analysts such as McCants seek insights into the thoughts, beliefs and motivations of jihadis by examining information that jihadis post online to inspire their fellows and exchange ideas.

    Among three jihadi thinkers cited by McCants, he finds commonalities. Each believes that the United States has a finite amount of money it can spend on the wars in Iraq and Afghanistan, especially given the recent U.S. economic downturn. This limitation, they believe, constrains America’s ability to address other countries where terror threats exist. They believe that the U.S. military is spread too thin and that public opinion will not abide years-long wars.

      These jihadists also identify the media as a primary avenue by which the U.S. projects its power internationally.

       While McCants stressed that footsoldiers in the jihadi movement rarely think strategically, the information gleaned from the postings of jihadi thinkers is invaluable, in that it helps the U.S. gain a better understanding of jihadi motivations and it can assist in the development of counter-terrorism programs.

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