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    Private payrolls increased by 103,000 in November, below expectations, ADP says

    Private payrolls grew by 103,000 workers in November, below the downwardly revised 106,000 in October and the 128,000 Dow Jones estimate.
    After leading job creation for most of the period since Covid hit in early 2020, leisure and hospitality recorded a loss of 7,000 jobs.
    Services-related industries provided all the job gains for the month, as goods-producers saw a net loss of 14,000.

    A postal worker wearing a Santa hat, sorts through mail and packages during a media tour hosted by the US Postal Service at the Los Angeles Processing and Distribution Center, the largest in the country, equivalent to 29 football fields, on November 30, 2023. 
    Frederic J. Brown | AFP | Getty Images

    Private sector job creation slowed further in November and wages showed their smallest growth in more than two years, payrolls processing firm ADP reported Wednesday.
    Companies added just 103,000 workers for the month, slightly below the downwardly revised 106,000 in October and missing the 128,000 Dow Jones estimate.

    Along with the modest job growth came a 5.6% increase in annual pay, which ADP said was the smallest gain since June 2021. Job-changers saw wage increases of 8.3%, making the premium for switching positions the lowest since ADP began tracking the data three years ago.
    After leading job creation for most of the period since Covid hit in early 2020, leisure and hospitality recorded a loss of 7,000 jobs for the month. Trade, transportation and utilities saw an increase of 55,000 positions, while education and health services added 44,000 and other services contributed 15,000.
    Services-related industries provided all the job gains for the month, as goods-producers saw a net loss of 14,000 due to declines of 15,000 in manufacturing, despite the settlement in the United Auto Workers strikes, and 4,000 in construction. Recent layoffs in Silicon Valley and on Wall Street also did not show up in the data, as both sectors posted gains on the month.
    “Restaurants and hotels were the biggest job creators during the post-pandemic recovery,” said ADP chief economist Nela Richardson. “But that boost is behind us, and the return to trend in leisure and hospitality suggests the economy as a whole will see more moderate hiring and wage growth in 2024.”
    Companies with between 50 and 499 employees led job creation, with an addition of 68,000. Small businesses contributed just 6,000.

    The ADP report comes two days before the more widely watched nonfarm payrolls count from the Labor Department. The two reports can differ widely, though the numbers for private payrolls were close in October as the Labor Department reported growth of 99,000, just 4,000 below the revised ADP tally.
    Including government jobs, nonfarm payrolls increased 150,000 in October and are expected to show growth of 190,000 in November, according to Dow Jones.
    Another sign that the labor market is loosening came Tuesday, when the Labor Department reported that job openings declined to 8.73 million in October, the lowest level since March 2021. More

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    U.S. consumers will soon wake up to ‘out of control’ interest on their credit cards, economist says

    Consumer spending is being financed by credit cards where interest is “over the top, out of control, off the hook right now,” economist Carl Weinberg told CNBC.
    Weinberg sees a retrenchment in spending in the new year, as debt burdens rise — though probably not enough to push the U.S. economy into a recession.
    Monica Defend, head of the Amundi Investment Institute, said she sees a coming pullback in consumer spending as sufficient to trigger a recession in the first half.

    The U.S. economy should be able to avoid a recession next year — but a sharp pullback in consumer spending is among the biggest risks of that occurrence, according to economist Carl Weinberg.
    “Consumers are just waking up to the fact that they’re financing their spending by running up their credit cards, and that the interest on those credit cards is over the top, out of control, off the hook right now,” the chief economist of High Frequency Economics told CNBC’s “Squawk Box Europe” on Wednesday.

    “That’s going to lead to, I think, a retrenchment in consumer spending, as we get into the new year.”
    Weinberg’s base case assumes a slowdown in growth, rather than a recession.
    “But the risk is, and I agree it’s a nontrivial risk, that consumers get into trouble,” Weinberg said, noting figures from the New York Federal Reserve showing a rise in delinquencies on credit cards.
    “Real incomes have just started coming back again, and not by nearly enough to cover some of the increases in the debt burdens that we’re seeing. So credit to the household sector, consumer credit cards, that’s where the downside risk is. That’s where the risk to this Goldilocks forecast is, and I’m watching it.”
    A “Goldilocks” scenario is one in which an economy is growing enough to avoid a recession and a negative hit to the labor market, but not so strongly that it fuels inflation.

    A U.S. recession in the first half of next year is the base case for Monica Defend, head of the Amundi Investment Institute.
    “Financing and financial conditions, eventually, will start to bite the U.S. consumer that is progressively depleting the excess savings that have been … protected during 2023,” Defend said Wednesday on “Squawk Box Europe.”
    “Consumption will slow down, we’re seeing the labor market progressively cooling, and this is going to continue. And therefore, we do expect a technical recession in the United States first and second quarter.”
    Many strategists see the U.S. as having achieved a “soft landing” for its economy through interest rate hikes. They nevertheless remain cautious on the outlook for 2024, as they warn of the delayed and unpredictable impacts of higher rates.
    U.S. growth has stayed strong this year, as other major economies — including the euro zone and U.K. — have stagnated.
    Investment stimulus delivered by initiatives such as the Inflation Reduction Act will not be enough to overcome the slowdown in consumption, Defend said Wednesday.
    “During the pandemic, there has been substantial transfers from the government into households and, therefore, consumers. If you look at saving rates, it has been really peaking, but now is pointing south quite remarkably,” she said.
    “Because of this and the excess savings actually depleting, we don’t think that the U.S. consumer will be able to stand and to maintain the same levels it had over the last two years.” More

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    Saudi Arabia offers 30-year tax relief plan to lure regional corporate HQs

    Saudi Arabia announced a 30-year tax exemption package for foreign companies establishing their regional headquarters in the kingdom.
    The move is the latest in its aggressive campaign to attract international investment and headcount.

    Cityscape of Saudi capital Riyadh.
    Harri Jarvelainen Photography | Moment | Getty Images

    DUBAI, United Arab Emirates — Saudi Arabia announced a 30-year tax exemption package for foreign companies establishing their regional headquarters in the kingdom, the latest move in its aggressive campaign to attract international investment and headcount.
    “The Ministry of Investment of Saudi Arabia, in coordination with the Ministry of Finance and the Zakat, Tax and Customs Authority today announced 30-year tax incentive package for The Regional Headquarters (RHQ) Program, to further streamline the process for multinational companies (MNCs) to establish their RHQ in Saudi Arabia,” the Saudi state press agency wrote in a statement Tuesday.

    The offer includes a 0% corporate tax rate for 30 years, which will be applied for companies “from the day they obtained their RHQ license,” the statement read.
    The program “aims to attract MNCs to set up their RHQ in Saudi Arabia and position the Kingdom as the leading commercial, industrial and investment hub for the MENA region, by offering a range of benefits and premium support services that complement the Kingdom’s globally competitive value proposition,” the statement added.

    A controversial ultimatum

    The kingdom grabbed investor attention and sparked controversy in February 2021 when it first announced its RHQ campaign, declaring that any foreign company that did not have its regional headquarters office in Saudi Arabia by the start of 2024 would be barred from doing business with state entities.
    The news stunned investors and expat workers, many of whom saw the move as a shot at Dubai, the United Arab Emirates commercial capital that is home to the highest concentration of Middle East regional headquarters.
    In October of this year, Saudi ministers made clear that the ultimatum still held firm: Foreign companies will need to base their regional headquarters in the kingdom by Jan. 1, 2024 or be barred from lucrative government contracts.

    Many foreign investors are still skeptical of the ability of Saudi Arabia — an infamously conservative Muslim theocracy known for its highly criticized human rights record — to sufficiently attract foreign talent.
    Expats in the regional HQ hub of Dubai question the kingdom’s ability to provide sufficient quality-of-life services like international schools, ample housing, and aspects of a more Western lifestyle, such as alcohol, which is currently illegal in Saudi Arabia.
    Saudi Arabia says the RHQ program has so far licensed more than 200 companies to operate their regional head offices in the kingdom. And in an apparent response to the concerns of many expat workers that families there would struggle to find international schools for their children, “seven international K-12 schools have announced their new campuses in the Kingdom,” the Saudi Press Agency statement wrote.

    “The tax incentive gives multinational companies operating in the region yet another reason to make Saudi Arabia home to their regional headquarters, on top of other benefits such as relaxed Saudization requirements and work permits for the spouses of RHQ executives,” Saudi Minister of Investment Khalid Al-Falih was cited by the SPA as saying.
    The kingdom’s regional HQ drive is a part of Vision 2030, an ambitious campaign launched by Crown Prince Mohammed bin Salman in 2016, which aims to create private sector jobs and diversify its economy away from oil as Saudi Arabia’s population — more than 60% of whom are under the age of 30 — grows. More

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    Job openings slide to 8.7 million in October, well below estimate, to lowest level since March 2021

    Job openings openings totaled 8.73 million for the month, a decline of 617,000, or 6.6%, the Labor Department reported Tuesday in its monthly JOLTS report.
    That was the lowest total since March 2021 and brought the ratio of openings to available workers down to 1.3 to 1.

    Job openings tumbled in October to their lowest in 2½ years, a sign the historically tight labor market could be loosening.
    Employment openings totaled a seasonally adjusted 8.73 million for the month, a decline of 617,000, or 6.6%, the Labor Department reported Tuesday. The number was well below the 9.4 million estimate from Dow Jones and the lowest since March 2021.

    The decline in vacancies brought the ratio of openings to available workers down to 1.3 to 1, a level that only a few months ago was around 2 to 1 and is nearly inline with the pre-pandemic level of 1.2 to 1.
    Federal Reserve policymakers watch the report, known as the Job Openings and Labor Turnover Survey, closely for signs of labor slack. The Fed has boosted interest rates dramatically since March 2022 in an effort to slow the labor market and cool inflation, and is contemplating its next policy move.
    While job openings fell dramatically, total hires only nudged lower while layoffs and separations were modestly higher.
    Quits, which are seen as a measure of worker confidence in the ability to change jobs and find another one easily, also were little changed. The quits rate had peaked around 3% of total employment in late 2021 into early 2022, during what briefly was known as the Great Resignation as workers left their old jobs in search of positions that paid more and offered better working conditions; it since has declined to 2.3%.
    “This data certainly solidifies the Fed’s decision to keep rates unchanged while looking for signs of a pivot in the upcoming meeting next week,” said Tuan Nguyen, U.S. economist at RSM. “Besides inflation, job opening data, serving as a proxy for labor demand and wage pressure, has been the Fed’s top priority in recent times.”

    Declines in job openings were widespread by industry.
    The biggest sector decline was education and health services (-238,000), followed by financial activities (-217,000), leisure and hospitality (-136,000), and retail (-102,000).
    The JOLTS data comes just a few days ahead of the Labor Department’s nonfarm payrolls count for November. Economists expect that report to show an increase of 190,000, an uptick from October’s 150,000, according to Dow Jones.
    Fed officials have been targeting the red-hot jobs market as a specific area of concern in their battle to take inflation down from what had been a four-decade high last year. Seeing a decline in job openings likely will be welcome news to policymakers as it could mean that less labor demand could help bring the jobs market back in line from what had been a huge mismatch with supply.
    The Fed holds its two-day policy meeting next week, with markets largely expecting the Federal Open Market Committee to leave interest rates unchanged. Traders in the fed funds futures market are pricing in rate cuts to begin in March on anticipation that inflation data will continue to show progress and as the central bank tries to fend off a potential slowdown or recession ahead.
    In other economic news Tuesday, the ISM services index for November registered a reading of 52.7%, representing the share of companies reporting expansion versus contraction. The reading was nearly a full percentage point higher than October and slightly above the Dow Jones forecast for 52.4%.
    Gains in the survey came from inventory sentiment, inventories and new export orders. Employment nudged higher to 50.7% while prices edged lower to 58.3%. A reading above 50% represents growth.
    Don’t miss these stories from CNBC PRO: More

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    U.S. Job Openings Dropped in October

    The News:Job openings fell considerably in October, hitting the lowest level since March 2021, the Labor Department announced on Tuesday.There were 8.7 million job openings in October, down significantly from 9.3 million in September, according to the Job Openings and Labor Turnover Survey. That was lower than economists’ expectations of 9.3 million openings.The rate of layoffs was little changed, as was the rate of quitting, which generally reflects workers’ confidence in their ability to find new employment.Job openings declined significantly in October, the Labor Department said.Tony Cenicola/The New York TimesWhy It Matters: The state of the labor market affects interest rate policy.The labor market is closely watched by the Federal Reserve as it mulls its interest rate policy. A cooling labor market tends to fuel predictions that the Fed will not further increase rates, which have risen to a range of 5.25 to 5.5 percent from nearly zero in March 2022.The labor market has been surprisingly resilient since the Fed started its rate increases in a campaign to tame inflation. But as the job market shows signs of cooling, so has consumer spending. Many companies told investors that in the most recent quarter customers were pulling back and spending less on products and more on services and experiences. The Fed’s preferred inflation measure confirmed that consumer spending slowed in October.At the same time, investors are increasingly hopeful that the Fed is done raising rates. Jerome H. Powell, the chair of the Federal Reserve, recently suggested in a speech that the central bank would leave rates steady if data continued to point to a cooling economy. The 10-year U.S. Treasury yield fell on Tuesday, reaching its lowest point since September, as investors expected interest rates to fall in the future.A reduction in job opportunities discourages the Fed from raising rates or keeping them high too long because such a trend often foreshadows a recession. “With this evidence coming in that the labor market is cooling substantially, I think it’s raising the chances that the Fed is done with the rate hikes,” said Julia Pollak, chief economist at ZipRecruiter.Background: Unemployment and openings have reverted to earlier levels.Though the labor market is slowing, it remains a healthy landscape for workers. The unemployment rate ticked up in October, to nearly 4 percent, which is in line with prepandemic levels.Job openings reached a record of more than 12 million in March 2022 and have trended down since. The last time job openings hovered around nine million — where it is now — was in the spring of 2021.There are still ample opportunities for workers. The rate of hiring remained steady in October despite the decline in openings.One difference is that layoffs are lower than they were before the pandemic. That probably reflects companies’ decisions to reduce staffing by natural attrition rather than cuts.“This is perhaps the biggest sign that we still have a strong economy and labor market,” said Sonu Varghese, a strategist at Carson Group, a financial advisory firm.Though inflation has slowed significantly since the Fed started raising rates in March 2022, it remains above the central bank’s 2 percent target.The Fed’s preferred inflation measure fell to 3 percent in October from a year earlier. But without including food and fuel prices, which are volatile and less sensitive to the Fed’s policy actions, the rate was 3.5 percent.What’s next: The November jobs report comes on Friday.The November jobs report will be released on Friday by the Labor Department. Economists forecast that the unemployment rate will stay around 4 percent, with a gain of about 180,000 jobs.That report will be one of the last insights into the state of the labor market before the Fed’s next policy meeting on Dec. 12 and 13. More

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    Why Doctors and Pharmacists Are in Revolt

    Dr. John Wust does not come off as a labor agitator. A longtime obstetrician-gynecologist from Louisiana with a penchant for bow ties, Dr. Wust spent the first 15 years of his career as a partner in a small business — that is, running his own practice with colleagues.Long after he took a position at Allina Health, a large nonprofit health care system based in Minnesota, in 2009, he did not see himself as the kind of employee who might benefit from collective bargaining.But that changed in the months leading up to March, when his group of more than 100 doctors at an Allina hospital near Minneapolis voted to unionize. Dr. Wust, who has spoken with colleagues about the potential benefits of a union, said doctors were at a loss on how to ease their unsustainable workload because they had less input at the hospital than ever before.“The way the system is going, I didn’t see any other solution legally available to us,” Dr. Wust said.At the time he and his colleagues voted to unionize, they were one of the largest groups of private-sector doctors ever to do so. But by October, that distinction went to a group that included about 400 primary-care physicians employed in clinics that are also owned by Allina. The union that represents them, the Doctors Council of the Service Employees International Union, says doctors from dozens of facilities around the country have inquired about organizing over the past few years.And doctors are not the only health professionals who are unionizing or protesting in greater numbers. Health care workers, many of them nurses, held eight major work stoppages last year — the most in a decade — and are on pace to match or exceed that number this year. This fall, dozens of nonunion pharmacists at CVS and Walgreens stores called in sick or walked off the job to protest understaffing, many for a full day or more.The reasons for the recent labor actions appear straightforward. Doctors, nurses and pharmacists said they were being asked to do more as staffing dwindles, leading to exhaustion and anxiety about putting patients at risk. Many said that they were stretched to the limit after the pandemic began, and that their work demands never fully subsided.“We’re seen as cogs in the wheel,” Dr. Alia Sharif said, “You can be a physician or a factory worker and you’re treated exactly the same way by these large corporations.”Jenn Ackerman for The New York TimesBut in each case, the explanation runs deeper: A longer-term consolidation of health care companies has left workers feeling powerless in big bureaucracies. They say the trend has left them with little room to exercise their professional judgment.“People do feel put upon — that’s real,” said John August, an expert on health care labor relations at the Scheinman Institute at Cornell University. “The corporate structures in health care are not evil, but they have not evolved to the point of understanding how to engage” with health workers.Allina said that it had made progress on reducing doctors’ workloads and that it was partnering with health care workers to address outstanding issues. CVS said it was making “targeted investments” in pharmacies to improve staffing in response to employees’ feedback, while Walgreens said it was committed to ensuring that workers had the support they needed. Walgreens added that it had invested more than $400 million over two years to recruit and retain staff members.Professionals in a variety of fields have protested similar developments in recent years. Schoolteachers, college instructors and journalists have gone on strike or unionized amid declining budgets and the rise of performance metrics that they feel are more suited to sales representatives than to guardians of certain norms and best practices.But the trend is particularly pronounced in health care, whose practitioners once enjoyed platinum-level social status at high school reunions and Thanksgiving dinners.For years, many doctors and pharmacists believed they stood largely outside the traditional management-labor hierarchy. Now, they feel smothered by it. The result is a growing worker consciousness among people who haven’t always exhibited one — a sense that they are subordinates constantly at odds with their overseers.“I realized at end of the day that all of us are workers, no matter how elite we’re perceived to be,” said Dr. Alia Sharif, a colleague of Dr. Wust’s at Allina who was heavily involved in the union campaign. “We’re seen as cogs in the wheel. You can be a physician or a factory worker, and you’re treated exactly the same way by these large corporations.”‘We were all partners.’ Then came the metrics.Pharmacists at Walgreens and CVS have complained of understaffing and overly aggressive performance targets. Spencer Platt/Getty ImagesThe details vary across health care fields, but the trend lines are similar: A before-times in which health care professionals say they had the leeway and resources to do their jobs properly, followed by what they see as a descent into the ranks of the micromanaged.As a pharmacy intern and pharmacist at CVS in Massachusetts beginning in the late 1990s, Dr. Ed Smith found the stores consistently well staffed. He said pharmacists had time to develop relationships with patients.Around 2004, he became a district manager in the Boston area, overseeing roughly 20 locations for the company. Dr. Smith said CVS executives were attentive to input from pharmacists — raising pay for technicians if there was a shortage, or upgrading clunky software. “Every decision was based on something that we said we needed,” he recalled.Dr. Wust looked back on his days in an independent practice of about 25 doctors with a similar wistfulness. “We were all partners,” he said. “It was relative workplace democracy. Everybody got a vote. Everybody’s concerns were heard.”Over time, however, consolidation and the rise of ever-larger health care corporations left workers with less influence.As so-called pharmacy benefit managers, which negotiate discounts with pharmacies on behalf of insurers and employers, bought up rivals, retail giants like Walgreens and CVS made acquisitions as well, to avoid losing market power.The chains closed many of their newly owned locations, driving more customers to existing stores. They sought to cut costs, especially labor costs, as the benefit managers reined in drug prices.Around 2015, Dr. Smith stepped down from his role as a district manager and became a frontline pharmacist again, reluctant to supervise co-workers under conditions he considered subpar. “I couldn’t ask my pharmacists to do what I couldn’t accomplish,” he said.Among his frustrations, he said, was the need to strictly limit the number of workers each pharmacy could schedule. “Every week that you’re over your labor budget, you get a call, regardless of prescription volume, from your district manager,” Dr. Smith said. “If your budget for tech hours is 100 and you used 110, you get a phone call. It’s not much money — maybe $180 — but you’re getting a call.”Asked how labor budgets were applied, CVS said managers were “provided guidance” based on expected volume and other factors, with adjustments made to ensure adequate staffing.Dr. Smith and other current and former CVS and Walgreens pharmacists said their stores’ allotment of hours for pharmacists and pharmacy technicians had dropped most years in the decade before the pandemic.The pharmacists also described being held to increasingly strict performance metrics, such as how quickly they answered the phone, the portion of prescriptions that are filled for 90 days rather than 30 or 60 days (longer prescriptions mean more money up front) and calls made urging people to fill or pick up prescriptions.For years, Walgreens and CVS pharmacists could largely ignore these narrower metrics so long as overall profits and customer satisfaction stayed high. But in the early to mid-2010s, both companies elevated the importance of these indicators, several pharmacists said.At Walgreens, many pharmacy managers began reporting to a districtwide retail supervisor rather than a supervisor trained as a pharmacist. “It coincided with more pushing of the metrics,” said Dr. Sarah Knolhoff, a Walgreens pharmacist from 2009 to 2022.“Never having been a pharmacist, they would push the pharmacy the same way they would push the front end,” Dr. Knolhoff added, alluding to the rest of the store.CVS said that performance metrics were needed to ensure safety and efficiency for patients but that in recent years it had reduced the number of metrics it tracked. Walgreens announced last year that it would no longer rely on “task-based metrics” in performance reviews for pharmacy staff members, though it still used them to track store-level performance.‘Corporate tells you how to manage your patient.’At health systems like Allina, doctors have incentives to talk to patients about conditions that may not be relevant to their immediate care. Health experts say it can help ensure that high-risk conditions are attended to.Jenn Ackerman for The New York TimesThe transition for doctors and nurses came around the same time. As independent medical practices found they had lost leverage in negotiating reimbursement rates with insurers, many doctors went in house at larger health systems, which could use their size to secure better deals.The passing of the Affordable Care Act in 2010, along with federal rule-making efforts, rewarded bigness by tying reimbursement to certain health outcomes, like the portion of patients who must be readmitted. Getting bigger helped a hospital system diversify its patient population, the way an insurer does, so that certain groups of high-risk patients weren’t financially ruinous.Administrators increasingly evaluated their medical staff according to similar metrics tied to patients’ health and put a variety of incentives and mandates in place.Doctors and nurses chafed at the changes. “Corporate tells you how to manage your patient,” said Dr. Frances Quee, president of the Doctors Council, which represents about 3,000 doctors, most of them at public hospitals. “You know that’s not how you’re supposed to manage your patient, but you can’t say anything because you’re scared you’re going to be fired.”At Allina, primary care doctors are given incentives to talk to patients about their high-risk or chronic medical conditions, even if those conditions are well managed and aren’t relevant to a visit.“Is that a valuable use of our 25 minutes together?” said Dr. Matt Hoffman, a primary care doctor at an Allina clinic that unionized in October. “No, but it means Allina gets more money from Medicare.”Dr. Wust said hospital administrators increasingly relied on management theories borrowed from other industries, like manufacturing, that sought to minimize excess capacity.For example, he said, obstetricians at Allina had one or two hold spots a day of 15 minutes each, in case of a patient emergency, when he began working at the system. Several years ago, Allina took away these buffers, instructing obstetricians to double book instead.Asked about the hold spots, Allina said, “We’re always looking at how we’re using our resources to deliver high-quality care.” It said the incentives tied to high-risk conditions could still be achieved if a doctor stated that the problem was no longer relevant. Dr. Josh Scheck, another Allina primary care doctor, said he found the nudge helpful and not very time consuming to address. He said the health system had allowed his clinic to experiment with ways to make its work flow more efficient.Other health workers complained that some of the metrics they’re evaluated on, like patient satisfaction, made them feel like retail clerks or dining employees rather than medical professionals.Adam Higman, an expert on hospital operations at the consulting firm Press Ganey, said consolidation and the increased use of metrics had arisen in response to a need to lower U.S. health care costs, long the world’s highest per capita, and ensure that the spending actually benefits patients.He pointed to data showing that more empathetic and communicative doctors and nurses — factors that affect patients’ experience — lead to healthier patients.But Mr. Higman acknowledged that many health systems had increased tensions with doctors and nurses by failing to involve them more in developing and putting in place the system of metrics on which they are judged. “The progressive, smart health systems and medical groups are listening to physicians, looking at their experience and turnover and creating venues to have discussions,” he said. “If not, that’s one of the contributing factors to organizing.”‘I would not have put unions and physicians in the same mind.’Nurses went on strike for three days in January at Mount Sinai Hospital in New York to protest understaffing.Gregg Vigliotti for The New York TimesThe pandemic magnified these strains.As retail chains rolled out Covid-19 vaccines, pharmacists complained of being overworked to the point of skipping bathroom breaks and said they worried constantly about making mistakes that could harm patients. (CVS said it began closing most pharmacies for 30 minutes each afternoon last year to give pharmacists a consistent break. Walgreens said “dedicated pharmacist meal breaks” began in all stores in 2020.)Doctors and nurses found that their already backed-up inboxes were suddenly bursting, as frightened patients clamored for medical advice. Administrators sought to squeeze more patients into overloaded hospitals and clinics.The breaking point came when the height of the pandemic passed, but conditions barely improved, according to many workers. Although health systems had promised to add staffing, many found themselves running deficits amid inflation and a shortage of doctors and nurses.Professionals who had never considered themselves candidates for union membership began to organize. When she started at Allina in 2009, Dr. Sharif said, “I would not have put unions and physicians in the same mind — it would have been a totally alien concept.” She reached out to the Doctors Council last year for help unionizing her colleagues.Dr. Quee, the union president, said that inquiries from doctors were up more than threefold since the second group of Allina doctors unionized last month — and that as a result, the Doctors Council was hiring more organizers. (Allina is appealing the outcome of the union vote at the hospital but not at its clinics.) Even pharmacists are reaching out. “Two days ago, pharmacists called me from Florida,” she said. “We’ve never done pharmacists before.”In September, Dr. Smith, who long ago shifted from CVS district manager to frontline pharmacist, took on an additional role: labor organizer. After CVS fired a district manager who had refused to close some stores on weekends to address understaffing, Dr. Smith helped organize a series of coordinated sick days and walkouts in the Kansas City, Mo., area, where he has worked for the company in recent years.The walkouts affected roughly 20 locations and drew the company’s chief pharmacy officer and a top human resources official to town for a meeting with the renegades. A few weeks later, CVS said it would rein in vaccination appointments and add work hours for pharmacy technicians, though it had not increased their pay.CVS said several Kansas City-area pharmacists had called in sick on certain days in September, “resulting in about 10 unexpected pharmacy closures” on one day and part of another. In response, it said, executives met with pharmacists to listen to and address their concerns.During an interview in October, while Dr. Smith and his colleagues were still awaiting the company’s response, he made clear that his patience had run out. “I’ve been asking and asking and asking for improvements for years,” he said. “Now we’re not asking any more — we’re demanding it.” More

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    At COP28, More Than 20 Nations Pledge to Triple Nuclear Capacity

    The group, including Britain, France and the United States, said the agreement was critical to meeting nations’ climate commitments.The United States and 21 other countries pledged on Saturday at the United Nations climate summit in Dubai to triple nuclear energy capacity by 2050, saying the revival of nuclear power was critical for cutting carbon emissions to near zero in the coming decades.Proponents of nuclear energy, which supplies 18 percent of electricity in the United States, say it is a clean, safe and reliable complement to wind and solar energy. But a significant hurdle is funding.Last month, a developer of small nuclear reactors in Idaho said it was canceling a project that had been expected to be part of a new wave of power plants. The cost of building the reactors had risen to $9.3 billion from $5.3 billion because of increasing interest rates and inflation.Britain, Canada, France, Ghana, South Korea, Sweden and the United Arab Emirates were among the 22 countries that signed the declaration to triple capacity from 2020 levels.Tripling nuclear energy capacity by 2050, which would also help Europe reduce its dependence on Russia oil and gas, would require significant investment. In advanced economies, which have nearly 70 percent of global nuclear capacity, investments has stalled as construction costs have soared, projects have run over budget and faced delays. On top of cost, another hurdle to expanding nuclear capacity is that plants are slower to build than many other forms of power.Addressing the issue of financing, John Kerry, President Biden’s climate envoy, said that there were “trillions of dollars” available that could be used for investment in nuclear. “We are not making the argument to anybody that this is absolutely going to be the sweeping alternative to every other energy source — no, that’s not what brings us here,” he said. But, he added, the science has shown that “you can’t get to net-zero 2050 without some nuclear.”Nuclear power does not emit carbon, and an International Energy Agency report last year that said nuclear was crucial to helping to reduce carbon emissions in line with the Paris Agreement goals outlined in 2015. President Emmanuel Macron of France said nuclear energy, including small modular reactors, was an “indispensable solution” to efforts to curb climate change. France, Europe’s biggest producer of nuclear power, gets about 70 percent of its own electricity from nuclear stations.Mr. Macron and other leaders, including Prime Minister Ulf Kristersson of Sweden, called on the World Bank and international financial institutions to help finance nuclear projects. Mr. Kristersson said that governments must “assume a role in sharing the financial risks to strengthen the conditions and provide additional incentives for investments in nuclear energy.”While world leaders on Saturday called nuclear the most effective alternative to fossil fuels, some climate activists said nuclear energy was not a panacea.David Tong, a researcher at Oil Change International, said the pledge was divorced from the reality of nuclear energy — that it was too costly and too slow. “It’s a self-serving political pledge that doesn’t reflect the role that nuclear is likely to play in the energy transition, which is menial,” he said. “There is very small growth in nuclear — certainly nothing like tripling.” He said he rejected the stance that there was no pathway to limit global warming to 1.5 degrees Celsius above preindustrial levels, a goal set in the Paris Agreement to avoid the worst effects of global warming, without nuclear. Masayoshi Iyoda, an activist from Japan with 350.org, an international climate action campaign, cited the nuclear disaster at Fukushima in 2011 and said that nuclear power was a dangerous distraction from decarbonization goals. “It is simply too costly, too risky, too undemocratic, and too time-consuming,” he said in a statement.“We already have cheaper, safer, democratic, and faster solutions to the climate crisis, and they are renewable energy and energy efficiency,” Mr. Iyoda said.All but four of the 31 reactors that have begun construction since 2017 were designed by Russia or China, with China poised to become the leading nuclear power producer by 2030, the International Energy Agency said. This year, Germany shut its last three nuclear plants.Nuclear capacity rose in the 1980s, particularly in Europe and North America, but dropped sharply over the subsequent years after accidents at Three Mile Island in Pennsylvania in 1979 and Chernobyl in 1986. New technology and tighter regulations have been put in place since then. Americans are conflicted about nuclear power, but a growing number favor expansion compared with a few years ago, according to a Pew Research Center study published in August. More

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    U.S. Limits China’s Ability to Benefit From Electric Vehicle Subsidies

    The Biden administration issued new rules to prevent Chinese firms from supplying parts for electric cars set to receive billions of dollars in tax credits.The Biden administration proposed new rules on Friday aimed at shifting more production of electric vehicle batteries and the materials that power them to the United States, in an attempt to build up a strategic industry now dominated by China.The rules are meant to limit the role that firms in China can play in supplying materials for electric vehicles that qualify for federal tax credits. They will also discourage companies that seek federal funding to build battery factories in the United States from sourcing materials from China or Russia.The rules could encourage shifts in automotive supply chains, which continue to rely heavily on China for materials and components of electric vehicles. Automakers are also facing intense cost pressures as they try to modify their factories to make electric cars, and China offers some of the most advanced and lowest-priced battery technology in the world.The Biden administration is trying to use billions of dollars in new federal funding to change that dynamic and create a U.S. supply chain for electric vehicles.The climate law that President Biden signed in 2022 includes up to $7,500 in tax credits to consumers who buy electric vehicles made in the United States using largely domestic materials. The law also included a general ban on Chinese products. Lawmakers mandated that firms in China, Russia, North Korea and Iran be prohibited from providing certain materials to cars that received those tax breaks.But the law left open several questions, including what constitutes a Chinese or Russian company. Administration officials said those definitions included any entity that was incorporated or had headquarters in China or Russia, as well as any firm in which 25 percent of the board seats or equity interest was held by Chinese or Russian governments.Chinese companies that set up operations outside China appear to be able to benefit from the rules as long as the Chinese government is not a significant shareholder. That provision came as a relief to some automakers, which feared that the Biden administration might bar them from contracting with Chinese-owned mines or factories in the United States or other parts of the world.Lithium hydroxide is processed at a facility in Bessemer City, N.C. American companies are investing in factories and technologies aimed at developing the materials needed for electric vehicle.Travis Dove for The New York TimesThe law also requires battery makers that strike contracts or licensing agreements with Chinese firms to ensure that they are retaining certain rights over their projects. That provision is intended to make sure a Chinese firm is not effectively in control of such a project.Some conservative lawmakers had challenged Ford Motor’s plans to license technology from the Chinese battery giant known as CATL for a plant in Marshall, Mich., arguing that such a partnership should not be eligible for federal tax credits. Some Republican lawmakers suggested on Friday that the Treasury Department’s guidance did not go far enough to lessen the country’s dependence on China.“At a time when China is using massive subsidies to undercut U.S. manufacturers and throttle the global market for battery components, Treasury’s naïve new regulations would open the floodgates for American tax dollars to flow to Chinese companies complicit in trade violations and forced labor abuses,” said Representative Mike Gallagher of Wisconsin, chairman of the House Select Committee on the Chinese Communist Party. The rules kick in for battery components in 2024, and in 2025 for critical minerals like lithium, cobalt and nickel. They could be adjusted depending on industry comment.The rules could have a profound impact on the U.S. electric vehicle market, which is rapidly growing — battery-powered vehicles made up about 8 percent of new cars sold in the third quarter. Car and battery makers said Friday that they were still reviewing the rules, and that it would take time to determine how many models would qualify for tax credits.Tesla said on Friday that the two least expensive versions of its Model 3 sedan would qualify for only half the $7,500 credit starting in January. The Model Y sport utility vehicle also might not qualify for the full credit after Dec. 31, Tesla said. The Model Y and Model 3 are the top two electric vehicles by sales in the United States. Tesla buys some batteries from CATL.John Bozzella, the chief executive of Alliance for Automotive Innovation, wrote in a blog post Friday that the rules struck “a pragmatic balance,” including by exempting trace materials. If the administration had banned all minor Chinese parts from the supply chain, no car models might have qualified for tax credits next year, he said.Many cars have already been disqualified from purchase credits by other rules, like a requirement that vehicles be assembled in North America. Only about 20 vehicles currently qualify for the program out of more than 100 electric vehicles sold in the United States.The rules also raised new questions about whether stricter requirements for supply chains could continue a trend of driving more shoppers to lease, rather than buy, vehicles.The prohibition on sourcing from China applies only to vehicles that are sold, not to those that are leased. Consumers can receive tax credits for electric vehicles they lease from auto dealers, and that has led to a boom in E.V. leasing.Jack Fitzgerald, chairman of Fitzgerald Auto Malls, which operates dealerships in Florida, Maryland and Pennsylvania, said he had seen a spike in customers leasing electric vehicles. But he said concern about electric vehicle range and the availability of chargers, more than price, was holding back electric vehicle sales.“That’s the principal thing,” Mr. Fitzgerald said.Auto industry lobbyists have warned that extremely strict rules could stifle electric vehicle sales, and they have urged the administration to strike more trade deals to secure supplies of scarce battery minerals. But Paul Jacobson, the chief financial officer of General Motors, said the company had structured its electric vehicle operations to be successful regardless of the federal rules.“We’re not anchoring the business on saying this has to happen” with regard to regulations, Mr. Jacobson told reporters on Thursday. If regulations change, he added, “it’s not a backbreaking thing for us.”While the rules may create headaches for automakers, they are likely to benefit companies planning to supply batteries from factories in the United States.“It’s actually good news for us,” said Siyu Huang, chief executive of Factorial, a Massachusetts company that is developing next-generation electric vehicle batteries with support from Mercedes-Benz, Hyundai and Stellantis, the owner of Dodge, Jeep and Ram.Acquiring large amounts of lithium, an essential ingredient in batteries, could be difficult because most of the metal is processed in China, Ms. Huang said. But the rules will encourage investment in U.S.-based refineries, she continued. “Its definitely going to be another incentive to build more domestic supply,” Ms. Huang said.John DeMaio, chief executive of Graphex Technologies, which is building a factory in Michigan to process graphite for batteries, said the rules might temporarily slow electric vehicle sales by making it harder to qualify for the tax credit. But in the long run, he added, they will encourage investment in domestic suppliers.“It might be a hiccup,” he said, “but in general it provides certainty and clarity to get people off the fence.”Wally Adeyemo, the deputy secretary of the Treasury Department, said in a briefing with reporters that the rules would help advance the administration’s goals of building up an American clean energy supply chain while also cutting emissions in the transportation sector.“These changes take time, but companies are making the investments and Americans are buying these cars,” he said.Over the past year, companies have invested $213 billion in the manufacturing and deployment of clean energy, clean vehicles, building electrification and carbon management technology in the United States, according to tracking by the Rhodium Group and the Center for Energy and Environmental Policy Research at the Massachusetts Institute of Technology. That is a 37 percent increase from a year earlier..A lithium mine in northern Quebec. A majority of the world’s lithium and cobalt is processed in China.Brendan George Ko for The New York TimesStill, the global electric vehicle industry remains heavily anchored in China, which is the world’s largest producer and exporter of electric vehicles. China produces about two-thirds of the world’s battery cells, and refines most of the minerals that are key to powering an electric vehicle.The rules also restrict automakers from sourcing nickel used in their batteries from Russia, which is one of the world’s largest nickel producers.One of the challenges for automakers will be developing systems to track all the components of their battery through a long, and often opaque, supply chain.Vehicles that are reported incorrectly will be subtracted from an automaker’s eligibility for tax credits, Treasury said, and automakers that commit fraud or intentionally disregard the rules could be declared ineligible for the credit in the future. More