Small rural town in oregon and i just ponder how in your professional career, youre traveling the world and living in a different environment completely but you have reported on World Affairs from all kinds of different reactions and some of the worst tragedies in the planet but you chose to focus on a small town in oregon, why . We were running around and covering mandatory crises and we would go back to my beloved hometown where my mom is still on the family farm and we saw humanitarian crisis unfolding there. A quarter of the kids who were on my old Number Six School bus were on drugs and alcohol and suicide and carol and i tried to process that in the kids who got on the bus right after me where the kids and their sisters and smart talented kids, farland died of drug and alcohol abuse, zealand died in a house fire when he was drunk and farland blew himself up cooking meth and regina died from hepatitis from drug use. For a while we wondered is this something about yamhill, we realized this is a National Problem that we have deaths of despair, the Life Expectancy is falling for three years in a row in america and union hill in my old bus to which to see the pain across america. Use all this through the lens of returning home and i think it almost could have been entitled School Bus Number six, so many stories are drawn from the friends that you had growing up there and expanding from there. And surely you grow up in an hunt, upper west side, thats a whole different world and i am early in your relationship, you got to see yamhill insult unfolding, how did the lens for which you saw differ from what nick was saying. I dont think you can get further from yamhill in manhattan, a up on the upper west side, it was smack in the middle of the urban world so when i first approached yamhill i was like what are these people like i was basically like we think of whats going on right now as a tale of two americas, on the top deck of a vote there is a party in the bottom deck is where the hole in the hole is happening in all these people are struggling to try to figure out what to do and how to stay afloat. So i think manhattan in many ways, the people of manhattan, many of them are in the party and they just dont know what is going on in the lower deck so for me it took a while, when they started learning in meeting these people and learning about the background and talking to them i realized they are very complicated human beings and the stories that we learned about their household and their background and the journeys that they took were so alarming and so heartbreaking that we could not help until the rest of the world. So used an analogy of the ship in the upper deck in the lower deck and whats going down below, your book uses another analogy in the title type wrote in some of my speeches and in congress they talk about a wide solid path for families to thrive in here its not just a narrow path but a tightrope. What are you conveying by that. Absolutely, the whole point, for those of us who are in the uppermiddleclass and above who are very well educated and at least graduated from high school and college, we have a pack, fairly wide path ahead of us, if we fall we can pick ourselves up. But many of these people, especially people in the m hill and the towns around america, people are walking on a tightrope in one miss and they fall, there is no safety net. The falling into a childs him that you describe in this book as involving drugs, alcohol, Domestic Violence, suicide, its a pretty oblique picture and theres a dynamic that you wrestle with and is his personal responsibility and do they need to walk the tightrope better or is it their fault they got into a tightrope instead of a nice path. Personal responsibility versus collective responsibility. What have you concluded. Personal responsibility is absolutely real, i think we can make the case that progressives like myself dont fully appreciate the personal responsibility israel, one has to give agency to people. But i think over the last 50 years, we have vastly overdone it and it would be obsessed with the personal responsibility narrative, blaming the people who fall off the tightrope for the catastrophes that follow. At this point you can predict this inaccuracy, the outcomes of a newborn infant and when you can do that, its not because the infant is making bad choices or showing your responsibility, my only to have a personal responsibility conversation, lets also have the conversation about our collective responsibility to help the people who are on my bus number six, theres so many ways we can help them and benefit them and society. Paul ryan who you quote, in our country they do not determine the outcome of your life and in the book you introduce the term or you share this term of Adverse Childhood Experiences and what youre basically saying if you have collected childhood experiences, your odds of succeeding drop dramatically which you prochain as the odds of being in poverty increased substantially. So explain this childhood adversity really impact your life. A pretty well documented by scientists who have into lazy situations. Many of us have an adverse childhood experience. P and skip divorce, theres a big move from one state to the next that is somatic but when you start piling up six, seven, eight or even three or four, that can have a really traumatic experience, partly depending upon the age of the child and specifically if the child is between 0 5, that is when the brain is developing at the most rapid pace for the rest of the persons life. That is when the brain develops quickly, we think of children being really resilient. But theyre not as resilient as we think. In fact when they were stressed in the house, violence, yelling, abuse, that creates stress and the baby and that means that the hormone is coursing through the brain and as the brain is growing, its what impacts the development of the brain architecture for the little baby. If this is not corrected, the babys brain will not develop really properly. So if we can address these issues early on and there are treatments, ways of using therapy, counseling, we can put that baby, the young child onto a better course so we do not see them two decades later in poverty or drugs or dropping out of college or high school event. His thought to that, its also not just a psychological trauma and troubles. Its also health in fact people who have stacked up aces are much more likely later on in life to have heart disease, to chronic disease like diabetes, that is a huge cost on society as well. To add something, thinking about the personal responsibly narrative as a mention, we call the success sequence that conservatives mention, it is true if somebody does three things, they largely avoid property and graduate from high school and if they get a fulltime job then they have kids that only 2 live in poverty and if they get into the 79 live in poverty. Clearly those involve an element of bad choices and personal responsibly. But they also reflect what we as a society do. One reason so americans kids have sex as American Kids but we as a society do not make education available and dont make Birth Control available. Our High School Graduation rates are substantially lower than those in many other oecd countries because we dont place the same premium, there certainly ways that we can shift it and not that American Kids are dumber than others or less diligent. So i think this obsession has neglected the public side of the equation and the policy side of the equation. The odds are stacked against folks who are raised with these various stressors and childhood, i wanted to go back for a moment to your conversation of how the brain is actually rewired and in what ways is the rewiring compromise one success in adulthood. A lot of it has to do with the development of the brain architecture. The cortisol is a stressor hormone, most of us as adults, happens for a little bit and goes away and slows right through us. Because of the babys brain is developing so rapidly and also so young, its much more fragile than we think that it really does impair the development. So does it make the kids more successful to addiction and less able to have if you will a committed relationship or just multiple effects. Multiple effects, they do show later on that all of these things that you talk about also more likely to not graduate from high school, more likely to have suffer from adhd, a number of elements that make it harder for the child growing up to actually succeed, that is why pediatricians are so focused on trying to address in california and the new Surgeon General there. They say from the university of oregon that the cortisol, one thing it does it prepares children for a violent turbulent dangerous environment and it puts them there on a hairtrigger response in one consequence is that it makes it harder to concentrate on the blackboard because they are being trained to look for potential threats behind them so that seems to be one pathway in which the cortisol impairs education and concentration. I believe in the book that you note Warren Buffett with the ovarian lottery and i heard him speak about how he was born under different circumstances he would not be a multibillionaire both because of the infrastructure to others establishment but the circumstances of the path to do well. So it is disturbing that in so many ways the United States as a developed country seems to be doing a poor job than other democracies, other republics that could have similar problems and you note for 39th and cleaning Drinking Water and 40th and traumatology and 61st on High School Enrollment and we suffer more stress than the average person in venezuela in her Life Expectancy is dropping. So heres the United States with our Congress Working on these issues, the state legislatures working on these issues, the county, how is it that were having horrific outcomes. It doesnt tell it to america, on the one hand we have Economic Statistics showing us gdp doing well, stock market is rocky hi and so we look at these measures and inflation is low and we look at these and they were doing well. But then if you peel behind the statistics, they look at other broader statistics and you can see that is not the full picture. A lot of men for instance dropped out of the workforce and they will not even be counted and these men may be selfmedicating and been out of jobs for a while and dont have the confidence to jump back in and we interviewed a number of them in yamhill and we know that is what is happening, they are not even looking so they would not be counted as looking. If you look at the Life Expectancy statistics as nick mentioned, that is another broader measure and its because of the deaths of despair which are three types of deaths of despair which are characterized by two economists at princeton and they looked at the census data and saw the death of despair was deaths related to alcoholism, death related to Drug Overdose and death from suicide brought record height to assay rate since world war ii. And they dropped a little bit with the Drug Overdose in 2018 so that is a good sign but its still 67000 68000 who died from Drug Overdose, not a small figure. That ways on the entire nation, the average Life Expectancy. Its pretty dramatic. Were seen a very dramatic to pave a good road and the outcomes. But why is the United States not doing a better job in getting people off onto a solid paved road. I think that this is a 50 year course that the u. S. Took in the strategy in 1968 and the tendency to stigmatize in Human Capital and benefit programs on the basis that were africanamerican to benefit and under and investment in Human Capital and benefits across the u. S. I think it also relates to president reagans narrowed were government can do no good and is part of the problem. And its a glorification of business taking of power from labor unions through corporations, coupled with the war on drugs, mass incarceration, i think i a few f these came together until the 1970s the u. S. Was in line whether the median. Since 1970s the other countries surpass us and i think the root causes and underinvestment in american and capital citizens. Developed countries similar to our own. Let me throughout a thought, i see this through the lens of trying to change policy and the government. What i am seeing is that our institution have been changing in a way that create power for the powerful, we do touch on this in the book, we know at one point when you have high wealth divisions, the wealthy then have disproportionate political power which leads to rules that benefit the wealthy and if we think about America Today and the inequality that we are seeing between the rich and the poor, were at a very high ratio compared to these other countries. So is it possible that the inequality and wealth is influencing the political system in ways that is preventing us from investing the resources on the fundamentals that paid the path for success to ordinary families. I think thats exactly right that you create an inequality that self perpetuates through the mechanism of economic power turning into political power, its a little bit similar what happened in the gilded age in American History and i hope so because of course then progressive followed. It took a Great Depression, it took a world war and so thats a little scary that it took that intervention to put us on a path where for the three decades after world war ii we had an investment in programs that really did lift up the middle class, not everyone, discriminations are still rampant but we made some progress in that realm as well, in order to implement the very similar policy proposals that we will get to in a moment, do we need to change the structure of political power. I do think that we need more enlightenment when it comes to the segment of society in a thinker being totally ignored, partly because everybody can point to the high gdp and nobody needs to change anything, on average its going well but if jeff bezos walks into a room of 100 people on average everybody will have a higher level of wealth it does not make any difference who are not jeff bezos. Thats a problem, recognizing that there is a need to lift up all americans and i think also its important maybe it helps policymakers to recognize if the u. S. Wants to compete against the rest of the world, other countries like china and india with a billion plus people power, we dont have the people power especially failed must enter much less if we dont lift up americans and have as Many Americans as possible and have full potential to be productive and innovative and bring america back to number one. I know my parents really talked about the sense of unity coming out of world war ii and they relayed how in their lifetime they experienced this, my mother came from an extraordinary level of poverty, her mother with her first three children, lost the three children to the county in the middle the Great Depression and lived in a boxcar, who can imagine my grandmother realizing that her grandson might serve in the u. S. Senate. Extraordinarily change for the both sides of the family. But you describe in the book how the community of yamhill saw much of the impact of moving forward during the years and how in roughly the mid70s started to stall out and decline. What happened in the mid70s and started to drive the reversal. First of all i think many people in the ml and probably in your hometown would attribute their past success to rugged individualism and theres certainly a lot of that. But frankly, historically it was also a certain amount of brilliant government plans, the reason people came to places like yamhill was the homestead programs. They transform places like yamhill, the g. I. Bill of rights likewise. Those programs to invest in and people in community certainly helped and when things potentially the root cause of things going downhill was good jobs going away. Because local employer was a glove factory, and close down and there were new jobs that came in but the people who had worked at the glove factory were not able to get those new jobs, men in particular felt the loss of jobs, not only a monetary sense but psychologically as well, local institutions like churches were not able to handle the trauma, people self medicated, they got criminal records which made them less employable and less marriageab marriageable, the Family Structure collapsed quickly and had been very tightknit, unraveled quickly. So you have the right manufacturing, you had gloves and you have the consequences you mentioned the bill of rights and the Mortgage Program for veterans returning and being able to buy houston have equity in savings and i think youre absolutely right about jobs being critical to the strain of a family. It does give structure, it gives dignity and gives resources. When youre unemployed, bad things start to happen, weve seen this in towns across oregon and for example lumber town loses the sawmill and you see some people move out right away, you see others who dwell in Domestic Violence of alcoholism and drug use increase. Jobs are critical. I think in yamhill and a lot of White Communities around the u. S. And back in the 1990s there are lot of comments made about African American communities that were struggling at the time and here is a sin to money is talk about how the problem with black culture was a byword for deadbeat dads or people making bad choices, meanwhile the harvard at sociologist said its about jobs leaving. He was exactly right, when jobs left they left appalachia, maine, when they left parts of ohio, the same pathologies unfolded, this was about culture, this is about jobs. In the u. S. We are not as resilient of a country will make comes to job losses. You can see easily with a person to what happens in canada, after the financial crisis happened when automakers laid off a lot of autoworkers and they laid them off in detroit and windsor Ontario Canada by the same company and you can see the difference. In the u. S. Because it was a financial crisis, the extended Unemployment Benefits of people got more money but they actually lost their job and they also lost their healthcare which is a huge stressor on a family. Over in canada they lost their jobs but they did not lose their healthcare because canada has universal healthcare in the government intervened and looked around for where the demand was in other types of jobs, they found out nursing how to demand so they arranged for Training Programs for autoworkers to retrain to go into the nursing field and yes, it is not their main job but they were able to get osha back into the world and years later theyre not selfmedicating, depressed or isolated the way people in the u. S. Were. I want to talk about the loss of jobs and this is an area where we might have different opinions and im just going to throw it out there. When i sold the mid70s with the start of the opioid over market to basically chinese production and chinese benefited from competing with lower wages, lower environmental standards, they can make things more cheaply so you had a glove factory and the club factory said we cannot compete with the chinese making gloves or maybe we can right now lets move our factory to china because we will benefit and the cost of production will be less and will make more money. And we have seen a lot of factories go overseas and some of us still think we made a mistake about being so quick to open our market in a way that we did to help drive the job loss. I think on the one hand globalization couldve been a force that we cannot actually compete, we cannot prevent from happening because individual factories are going to make their decisions based on what will yield the death return, they were going to costa rica, other places, latin america or in asia, they will make that decision on their own unless theres a lot overseas. I think there wouldve been competition from other countries going overseas, i think this is a force that, they had been slower but nonetheless, we did not adjust very well. Overall, it is kept inflation because costs were lower for goods that americans used so that goodness was the benefit spread among 320 americans rather just those workers losing their jobs and it felt much more intensely by a Smaller Group of people. I think that the country, other countries also have globalization and automation, they have not suffered the same degree that the u. S. Has partly because of the policies that the u. S. Has taken, we do not adapt quickly to job losses, we dont actually as a society try to help with nudges and the people who have been laid off, you have to find your own job now. But other countries also have universal healthcare and they do much better at job retraining and helping laidoff workers retrain for other types of jobs. You want to touch on that. [laughter] im afraid trader and i think a lot of us did not appreciat appreciate we talked about creative destruction, that is great in a textbook but i think we hadnt appreciated those peoples lost her job in the old industry and they might selfmedicating and might cook meth and their families might break down and it became the trade might benefit the size of the u. S. As a whole, it came all the more important to make sure supported those as of the destruction might lose their jobs and invest in their education so they could adapt to new jobs and we blew it, the winners did not compensate the losers at all. I remember very well as i was studying economics, the argument was if you have a trade deficit the Exchange Rates will adjust over time and so the trade deficit will adjust and therefore you will not have a net loss of jobs, that turned out to be wrong for a different conversation, a lengthier conversation, one that we need to respond to. So in the situation that you are describing with universal healthcare, you mentioned in the book is one of the remedies, i talk about the four foundations for family to thrive, i got a picture of four sides of the foundation and you have healthcare and housing and education and the good paying job. So in your final chapter of the book, you start to address various issues and it pretty much follows into the four categories and maybe starting with health, universal healthcare and eliminating unwanted pregnancies. Which goes back to having access to healthcare and familyplanning and why is the United States doing so poorly on pregnancies versus other countries and of course you have noted already that that is one of the three factors that has a huge impact on the success of the next generation of having children outside of the structure of a family. I want to stress that we have made progress for instance on teen pregnancy, the peak was in 1990s when there was so much teen pregnancy and then we sort of recognize the problem and we have addressed it in its came down by a lot, still higher than a lot of other countries but its came down a lot which shows when we put our mind differently,. It does make a difference. It absolutely does. And we have made progress on things including homelessness, we actually reduced better homelessness by nearly half in six years and is continuing to go down under the administration as well. When we want to make a change we really can do it very well, its a matter of having the political will and i agree with all those foundations, the really critical and i think healthcare is very important and i just hope policymakers will remember that it should be available to everybody if they want to lift americans so they can help americans compete against the rest of the world, healthcare is pretty important. How does that travel around rural oregon, i heard a lot of people note that the expansion of medicaid has greatly helped in rural areas, the one thing it does not have as a deductible meaning you have to pay thousands from the beginning so therefore you avoid going to the doctor and because people can pay bills through medicaid its a local clinic has expanded in size and taken on things like drug addiction or Mental Health and i wondered if any of this strengthening of rural healthcare mightve been something that affected or improved healthcare in yamhill. We actually have talked to a lot of people in yamhill who say theyre so grateful that their healthcare is paid for and including one of our friends ended up buying but he died in the hospital and was in the hospital several times before he passed away. The family was very grateful that he could be in the hospital and have some more time. Some of those families that are struggling have been able to get help with Mental Health and so forth. Absolutely. Im not sure they made the connection the organ was not expended medicaid and therefore they got it, i dont think they make those connections but were very grateful for the results. Im starting to see a little bit of keep your hands off my Healthcare Plan reaction and certainly the premises of the exchange which means you can get a policy at the same price even if you have a preexisting condition have become highly valued factors. Can we turn the tables and ask you a question. We make the case in the tight group that the politics on some of the issues may be changing but youre on the front lines and you have to get votes to some of the folks. But we argue that as some of the social problems have become associated in the public mind, not with africanamericans but the framing has made it easier politically to address in a way that is hypocritical but perhaps more compassionate as well. On issues like medicaid for example, the politics may now be in lifting the minimum wage, the White Working Class is socially conservative but actually economically more liberal. Do you buy that. Certainly on healthcare, absolutely. People used to come to my town hall and say used to get to 65 and say life i get on medicare. I do not hear that anymore. In the most rural parts of oregon, those are the places where expansion of medicaid has had the biggest impact and i think you would have a hard time praying that out of their hands because it really has been a positive and for jobs, healthcare jobs is a significant contribution to a community as well. The things i hear about now are why am i getting gouged on the high cost of drugs. And why is it a situation where healthcare, if youre not on health plan is so stressful, change jobs in healthcare, how to get healthcare in the middle of the year. My spouse has healthcare but im on other plans, where was the plan dropped, what about my kids, how to get on Children Healthcare insurance program. The complexity of her system and i hear people say the other challenge and why do i have to fight with the insurance comfort. At the very time and some other major disease, your studying the bills trying to figure out can you pay the deductible and shouldnt this be covered in you having to be in a fight with your insurance company, this is much higher in our system. Healthcare is one piece and by the way to gouging of americans on drugs, 80 of americans are ready to say we should get the same fair price than any other developed country gets, if congress cannot get a dumb thats another sign toward the damage of her institution. That lobbies can exercise political power and the wealthy to the simple majority in the senate and to the level of lobbying that mean a very fundamental problem affecting people across the spectrum not addressing this. That is troubling. Number 30 very far from number one. What can we do, right now only one in seven or one in graduate from high school. Thats kind of appalling. Some states require kids to stay in school until 18 hopefully they will graduate. Im where we could tell them if we want a drivers license you havdrivers license youhave to h school. Its kind of the way that we improved the car driving safety. We first implemented seatbelts we didnt use seat belts at all and that was dangerous and to improve safety we added airbags and have padded dashboards that this personal narrative is basically lets put needles in the dashboard so when you hit yourself is going tyour salt isu a lesson. Host we learned a lot about him. The return of the investment. The biggest prison cost and more taxes are paid. Its the highest return of investment available in the u. U. S. For the programs the bi that thy presented it as the benefits to the children. It took me back to when i was in high school and are high school was expelling students of smoke and so i went to the administration and i said is this really the right thing to do, these kids are not going to get a high school education, should it be something different, there are some in the area i told the administrators decided to go the other way. I went around to the punjab high schools but that is the point that we are making is to find a way to help keep kids engaged in school and something you didnt mention that i will toss out in that regard i didnt have to pay any fees or. Tennis, speech team, chess team. Now my kids have graduated from the same school and everything has tests that reduce Student Engagement and if i could wave a magic wand that is a real issue. It is distracting the teacher entirely so she cant teach 20 other kids. It is the tightrope they have to navigate if we do not charge then how are we going to pay for these others to come in and do something. Lets touch on twhat steps ontos eliminating homelessness for children. We know the cost especially for children are enormous because of the aces that we talked about earlier. We are able to reduce veteran homelessness by half between 2010 to 2016. They are out in the streets. If they found it unconscionable that America Today we have on any given night more than 100,000 kids homeless, then we could reduce that by half and we could dramatically reduce it with a combination of vouchers, shelters, priority etc. And so again it comes down to the low end of the budget proposes cutting the programs. What do you say to those that say you say raise my taxes which isnt going to help me help somebody else. Why cant they figure it out for themselves . They are homeless because of the lottery that you mentioned earlier and we also know that if we dont pa pay up front and we will end up paying at the back and many times over the. The Hedge Fund Mogul that paid 238 million for a condo and property taxes based only as itt for 9. 8 billion they are getting a subsidy there so theres a lot of an evenness in the tax code and loopholes to drive a truck through. Guest it gets all kinds of subsidies to the very welloff and back when i was with habitat for humanity and i saw the impact of the home for a child and i knew without what you are saying about the need for children to have all is absolutely right, the stable home changes life of a child. Because i never had a place they are living in a tent or basement with their parents and those children are going to have to contribute more in taxes. So lets make that happen there is one last set of ideas that doesnt fall neatly into these ideas of housing and jobs. That is a monthly child allowance. How should we look at that . Beginning in 19991 of the key elements they provided this child allowance basically a monthly payment. Michael bennett cosponsored a bill that would do something along those lines. About 100 million a year we can afford a 2 trilliondollar tax cut of two reduce Child Poverty by half sacks. To allow the child to participate in sports. Guest we know the outcomes are better and actually congress they were often called individual Development Accounts and they involved the payment that would be in a savings account often matched as of the savings were put in and could only be used for housing, starting business, things like this. Host thank you for highlighting this in your book and it came about because my habitat for humanity where i saw ownership made a difference independent of affordable housing. I had an intern researched the idea of grants to buy homes and she discovers the idea of the program. It became regional and i became a state legislator and we have the biggest subsidy for the programs in the country. We need bipartisan help now to publicize that a lot with a bipartisan hand up to the three pathways poverty in the middle class and education, Small Business and home ownership. I appreciate you all engaging in this conversation and exploring the challenges we have in america through the line of the struggling world community. What happens next i hear there might be a film coming out associated with this. Thats right. Thats right. There is a film version of tightrope that we hope will be on tv in the fall. So, stay tuned. Host and what should we make sure the viewers know about the experience youve gone through and examining the challenge . Is penetrating your focus on jobs is important because they are at the heart of so much pain and suffering that beholds a household and certainly ones we interviewed around at the rest of the country to be a common theme. The everybody has to contribute to that and policymakers to should be very influential when it comes to this. Host i think that your examination of these issues through the broad challenges facing america reminded me very much in a way of Robert Kennedy going to appalachia and saying heres what is in america, such poverty and distress, and realizing that these situations were on par with countries that we think of as so much poorer than the United States of america, and cant we do better and that examination helped launch a lot of thinking for words making the country work better for all americans. So thank you for exploring this. Its been a pleasure to converse with you and it is timely in the middle of a policy discussion that always offers a president ial campaign year. Well done. Thank you very much. Good evening. Thank you everybody for coming. Im a visiting fellow at the American Enterprise in state and also commentary editor of the Washington Examiner and we had a great discussion tonight. We have brought here the author of dignity which came out earlier this year and its an excellent book. I read it and i love it and we are going to be something afterwards. You should buy it. Its beautiful and i say that because it is also a photo book as well as