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Several who switched their vote between 2019 and now objected to measures they said did not specifically address strengthening NATO to help Ukraine. Rep. Barry Loudermilk (R-Ga.) found it particularly problematic that the resolution instructed NATO to be involved when a country has “internal threats from proponents on illiberalism,” which he says could be interpreted as conservatism.

Similarly, from Rep. Robert B. Aderholt (R-Ala.): “I am wholeheartedly, unequivocally, without reservation, supportive on NATO.”

Aderholt said he worried that the resolution “had some language in that I thought went on the political side. And I don’t want to see NATO go political. I want to see NATO stand up for, you know, what’s going on in Ukraine — stand up for Ukraine against Russia.”

Another sign of the party’s isolationist wing emerged Thursday, as the House passed an update to a World War II-era military bill creating a lend-lease program intended to make it easier for the United States to supply Ukraine with military aid. Only 10 lawmakers — all Republicans — voted against the measure.

For some foreign policy experts and international allies, the mere fact that nearly one-third of the Republican conference voted against a bill that fundamentally seeks to support both NATO and Ukraine highlights a marked foreign policy evolution in the Republican Party.

The vote underscores the Republican Party’s remarkable drift away from NATO in recent years, as positions once considered part of a libertarian fringe have become doctrine for a growing portion of the party.

The answer, however, is existential in Europe, where the fallout from the war in Ukraine has showcased the importance of the United States and the limits of aspirations for European autonomy on matters of technology and defense, according to lawmakers and diplomats.

“Ukraine has given new credibility to the Atlanticist wing of the Republican Party, which I find encouraging,” said Sikorski, a member of his country’s centrist Civic Platform party and a prominent critic of the ruling, right-wing Law and Justice party. “There seems to be competition in being pro-Ukrainian and wanting to stop Putin.”

A diplomat from a Baltic state, who spoke on the condition of anonymity to avoid alienating U.S. partners, called the vote a “Trump effect.”

But for some, the changes are not enough. Rep. Warren Davidson (R-Ohio), who voted against the recent resolution, said he objected not to NATO but to its future direction, which in his view places too large a burden on the United States and involves too much promotion of specific values.

Disagreements have broken out among member nations over the erosion of democracy within the alliance, with criticism directed in particular at Turkey, Hungary and Poland. A Central European diplomat said objections to the democracy center reflect admiration for the likes of Hungary’s Viktor Orban in other Western nations.

De Maizière echoed that view, saying his primary concern about upcoming U.S. elections was that “right-wing Republicans are drifting away from this common path of Western values.”

Radoslaw Sikorski, a Polish member of the European Parliament who chairs the body’s delegation for relations with the United States, said Ukraine “is the second big issue on which Republicans and Democrats agree, after China.”

Flash points are already coming into view. In 2020, NATO Secretary General Jens Stoltenberg started a working group aimed at strengthening NATO. The group’s final product, “NATO 2030: United for a New Era,” included proposals, such as the creation of a Center for Democratic Resilience, that have been scorned by pro-Trump Republicans, including many of the 63 Republicans who recently voted against the House resolution affirming support for NATO.

“We’re certainly going to have a lot of these talks with my colleagues, particularly next cycle, if there’s any assault on NATO that is launched,” Fitzpatrick said. “I will tell you that NATO needs to be reformed significantly. But it is absolutely critical that it be maintained because without NATO, dictators are going to, it’s going to be the Wild West internationally.”

Tommy Vietor, a National Security Council spokesman under Democratic President Barack Obama, said: “It’s a pretty shocking turn.”

“There’s an appropriate and important conversation to be had about the history of NATO expansion and whether it was well-thought-through,” said Vietor, now a co-host of “Pod Save America.” “But you didn’t see people in either party really fundamentally questioning the value of the alliance.

In March 1940 two more exiled German scientists working at Birmingham University, Otto Frisch and Rudolf Peierls, outlined the first practical exposition of how to build a nuclear weapon, a device “capable of unleashing an explosion at a temperature comparable to that of the interior of the sun”. Peierls recruited Fuchs to join him in the top-secret project to develop a bomb, codenamed “Tube Alloys”.

Fuchs arrived as a refugee in Britain in 1933 and, like many scientists escaping Nazism, he was warmly welcomed by the academic community. At Edinburgh University he studied under the great physicist Max Born, another German exile.

Fuchs was extremely clever and very odd: chain-smoking, obsessively punctual, myopic, gangling and solitary, the “perfect specimen of an abstracted professor”, in the words of one colleague. He kept his political beliefs entirely concealed.

The son of a Lutheran pastor, Fuchs came of age in the economic chaos and violent political conflict of Weimar Germany. Like many young Germans, he embraced communism, the creed from which he never wavered. He was studying physics at Kiel University when his father was arrested for speaking out against Hitler. His mother killed herself by drinking hydrochloric acid. Returning from an anti-Nazi rally, he was beaten up and thrown into a river by fascist brownshirts. The German Communist Party told him to flee.

When Churchill and Roosevelt agreed to collaborate on building the bomb (while excluding the Soviet Union), “Tube Alloys” was absorbed into the far more ambitious Manhattan Project. Fuchs was one of 17 British-based scientists to join Oppenheimer at Los Alamos.

“I never saw myself as a spy,” Fuchs later insisted. “I just couldn’t understand why the West was not prepared to share the atom bomb with Moscow. I was of the opinion that something with that immense destructive potential should be made available to the big powers equally.”

In June 1945 Gold was waiting on a bench in Santa Fe when Fuchs drove up in his dilapidated car and handed over what his latest biographer calls “a virtual blueprint for the Trinity device”, the codename for the first test of a nuclear bomb a month later. When the Soviet Union carried out its own test in Kazakhstan in 1949, the CIA was astonished, believing Moscow’s atomic weapons programme was years behind the West. America’s nuclear superiority evaporated; the atomic arms race was on.

Fuchs was a naive narcissist and a traitor to the country that gave him shelter. He was entirely obedient to his KGB masters, who justified his actions with hindsight. But without him, there might have been only one superpower. Some in the Truman administration argued that the bomb should be used on the Soviet Union before it developed its own. Fuchs and the other atomic spies enabled Moscow to keep nuclear pace with the West, maintaining a fragile peace.

As the father of the atomic bomb, Oppenheimer made the world markedly less secure. Fuchs, paradoxically, made it safer.

Some executives like Mr. Haeusgen are embracing transformation, testing new strategies and markets. Other businesses, however, are wary of abandoning a model that for decades enabled Germany to thrive but defied change.

Hawe’s handling of international affairs is not just a concern for its 2,700 employees. The economies of some German towns depend on it.

In Kaufbeuren, a brightly painted Bavarian town nestled below the Alps, Hawe is a top employer. In the tiny village of Sachsenkam, 60 miles to the west, Hawe provides 250 jobs — the next largest employer is the local brewery, with a staff of 17.

“It’s like we were successful for too long,” said Stefan Bosse, the mayor of Kaufbeuren, who is keen to attract other businesses to diversify the employers his town relies on. “Now, gradually, we see: ‘Uh oh — this is not a given. This can also be endangered.’

The archetypal Mittelstand company is based in a rural German town, making a piece of equipment few have heard of, but that is crucial for goods worldwide — like a screw needed for every airplane or passenger car.

The government, too, has a poor record in shedding outdated practices — like its labyrinth, paperwork-based bureaucracy. In 2017, it vowed by 2022 to digitalize its 575 most used services, like company registrations. A year past that deadline, said Mr. Bianchi, only 22 percent of those services are online.

“The German business model, particularly Mittelstand, is being extremely good at doing one thing: Slowly but steadily perfecting one product,” said Mathias Bianchi, spokesman for the German Mittelstand Association. “Because that worked so well for years, they had no need to adapt to changes. But now, they need to adjust to the new economic reality.”

Even as the tech revolution and climate change added strain in recent decades, Germany’s model plodded profitably along.

But the pillars it relied on to do that — cheap Russian natural gas and the Chinese market — are collapsing.

Staking out a socioeconomic transformation for the country, pledged by Chancellor Olaf Scholz’s coalition government, has become a source of national anxiety.

Like its population, Germany’s business owners and entrepreneurs are aging — the average Mittelstand association member is 55.

Some are resistant to adapting to new technologies and cling to a loyalty-based system that created lifetime employees — and customers

How Hawe and other midsize German companies navigate these new global forces will be critical to the country’s future prosperity. Though Germany’s 20th century success as the economic powerhouse of Europe is often seen through its biggest brands — like Volkswagen, Mercedes and Siemens — it is small and medium enterprises that are the backbone of its economy.

Such failures makes businesses wary of transformation plans the government says will be costly now, but will make Germany a diversified, digitized and climate neutral economy.

Over half the companies polled did not want to expand in Germany, and a quarter were considering relocating.

Marita Riesner, inspecting parts, said her heating costs spiked to 740 euros ($803) a month from 120 euros ($130). She and her neighbors are growing vegetable gardens to ease the pain of inflation as the country dips into recession.

“I was a very positive thinker before,” she said. “But these days, I’m sweating it. It seems a lot is going wrong.”

Should geopolitical events disrupt business with China, Mr. Haeusgen said, the consequences could eliminate more than half of Hawe’s jobs in Kaufbeuren. Currently, he said, 20 percent of Hawe’s business comes from China.

Some business groups raised alarm in recent years over Germany’s vast exposure to China — before the risks were taken seriously by former chancellor Angela Merkel’s government, which had heavily encouraged German-Chinese trade.

Today, some policymakers privately worry that an event like a Chinese attack on Taiwan would be an inescapable disaster for Germany’s economy. The government is now pushing “de-risking” by finding alternatives to trade with China.

But major brands like Volkswagen and BASF insist that China, as the world’s second-largest economy, is too important a market to give up. Such German-based multinationals are responsible for a 20 percent rise in foreign direct investment in China this year.

German officials say their strategy will maintain ties to China, but will counterbalance that by strengthening relationships with other nations, like India or Vietnam

The Mittelstand is doing the same: Hawe is investing heavily in India, where it plans to build a new plant, and other companies are looking to North America.

“It used to be that we made a majority of sales with three customers from China,” he said. “Now we have many, many smaller customers scattered all over the globe.

Instead of making a few parts at a huge scale, as cheaply as possible, Hawe must make a wide variety of parts for an array of customers, as quickly as possible.

The new socioeconomic model for Germany may be less about erecting pillars than managing an ever more intricate, international juggling act.

“Being able to live with and manage uncertainty and to handle complexity becomes, in my opinion, a core strength,” Mr. Haeusgen said. “The way my grandpa did it won’t work today.”

In that mission, it has proved remarkably successful.

Tellingly, the scale of U.S. military aid — $47 billion over the first year of the conflict — is more than double that offered by European Union countries combined.

Coinciding with the global war on terrorism, the “big bang” expansion of 2004 — in which seven countries acceded — saw counterterrorism supersede democracy and human rights in alliance rhetoric. Stress on the need for liberalization and public sector reforms remained a constant.

In the realm of defense, the alliance was not as advertised. For decades, the United States has been the chief provider of weapons, logistics, air bases and battle plans

The organization pushed would-be partners to adhere to a liberal, pro-market creed, according to which — as President Bill Clinton’s national security adviser put it — “the pursuit of democratic institutions, the expansion of free markets” and “the promotion of collective security” marched in lock step. European military professionals and reform-minded elites formed a willing constituency, their campaigns boosted by NATO’s information apparatus.

By forbidding duplication of existing capabilities and prodding allies to accept niche roles, NATO has stymied the emergence of any semiautonomous European force capable of independent action. As for defense procurement, common standards for interoperability, coupled with the sheer size of the U.S. military-industrial sector and bureaucratic impediments in Brussels, favor American firms at the expense of their European competitors. The alliance, paradoxically, appears to have weakened allies’ ability to defend themselves.

Yet the paradox is only superficial. In fact, NATO is working exactly as it was designed by postwar U.S. planners, drawing Europe into a dependency on American power that reduces its room for maneuver. Far from a costly charity program, NATO secures American influence in Europe on the cheap

U.S. contributions to NATO and other security assistance programs in Europe account for a tiny fraction of the Pentagon’s annual budget — less than 6 percent by a recent estimate.

Surging demand has exacerbated this tendency as buyers rush to acquire tanks, combat aircraft and other weapons systems, locking into costly, multiyear contracts. Europe may be remilitarizing, but America is reaping the rewards.

In Ukraine, the pattern is clear. Washington will provide the military security, and its corporations will benefit from a bonanza of European armament orders, while Europeans will shoulder the cost of postwar reconstruction — something Germany is better poised to accomplish than the buildup of its military

The war also serves as a dress rehearsal for U.S. confrontation with China, in which European support cannot be so easily counted on. Limiting Beijing’s access to strategic technologies and promoting American industry are hardly European priorities, and severing European and Chinese trade is still difficult to imagine. Yet already there are signs that NATO is making headway in getting Europe to follow its lead in the theater

No matter their ascendance, Atlanticists fret over support for the organization being undermined by disinformation and cybermeddling.

Today, dissent is less audible than ever before.

Left parties in Europe, historically critical of militarism and American power, have overwhelmingly enlisted in the defense of the West: The trajectory of the German Greens, from fierce opponents of nuclear weapons to a party seemingly willing to risk atomic war, is a particularly vivid illustration

a project of national greatness liberalism will require a big tent approach to voters, sizable legislative majorities with more victories in moderate-to-conservative states and districts, and a willingness to place national projects of economic development ahead of narrower ideological goals.

“Migration is a bigger divide for the European Union. And it could be a dissolving force for the European Union.” Despite establishing a shared common external border, “we have not been able until now to agree on a common migration policy”, he said.

he also acknowledged the harsh choices Europe faced in curbing migration by reaching deals with countries such as Tunisia, pointing out it was his duty to defend not just European values but at the same time European interests. “The life of the diplomat is full of uncomfortable choices … Foreign policy is working for the values and the interests of the European Union. And these require, in some cases, difficult choices trying all the time to respect international law and human rights.”

“The issue is that migration pressure has been increasing, mainly due to wars – not the war against Ukraine … It is the Syrian war, the Libyan war, the military coups in Sahel.

He said other countries, such as Spain, have a long history of accepting migrants. “The paradox is that Europe needs migrants because we have so low demographic growth. If we want to survive from a labour point of view, we need migrants.”

“We are herbivores in a world of carnivores. It is a power politics world, yet we still have in mind that through trade and preaching the rule of law we can have influence on the world. We must still preach the rule of law but we have to be aware there are some leaders that need to be dealt with in a different way.”

Borrell predicted the war in Ukraine, and the eventual outcome, would be one of the three driving forces creating a new world order, alongside competition between China and the US, and the rise of the global south.

“There is no clear hegemon in the world but instead a growing number of actors.” The paradox, he said, was that this growth in actors had not been accompanied by a stronger multilateralism.

“Look at all these countries, South Africa, Brazil, Indonesia, India – you cannot ignore this new reality. In 20 years, at the current trend, there will be three big countries in the world, China, India and the US. Each of these powers will be a $50tn economy, and the EU will be much less, about $30tn

“For Europe this represents a huge long-term challenge. Europeans have to be prepared to be part of the new world in which we will be a smaller part of the population, certainly, and also in proportion to the size of the world economy. It means that we have to look for political influence, technological capacity and unity. Unity is the key word. Europeans have to be more united.”

Now it’s hard to imagine a near- or even a medium-term future where crypto has a fraction of the influence it did six months ago.

the future of crypto as an institution—as something that might one day destabilize the big banks, or at least operate in parallel—has never been less certain.

This battalion of free-market thinkers has now been welcomed into 10 Downing Street. Five of the new prime minister’s closest advisers are Tufton Street alumni, including Ms. Truss’s chief economic adviser and her political secretary, and at least nine Tufton Street alumni are scattered across other major government departments. Tellingly, Mr. Littlewood says that Ms. Truss has spoken at his think tank’s events more than “any other politician over the past 12 years.”

Notoriously opaque about their sources of funding, something they defend as a right to privacy for donors, they have been found by investigative reporters to have financial links to the oil giants BP and Exxon Mobil, big tobacco companies and American libertarian groups. But the picture depicted is only partial. We simply do not know who is bankrolling the groups now at the heart of the British government.

First and foremost, they are significant operatives in Conservative circles: The Center for Policy Studies, for example, claims that it was “responsible for developing the bulk of the policy agenda that became known as Thatcherism.” Given that Margaret Thatcher herself co-founded the think tank, it’s not an idle boast. In the decades since, groups like it have multiplied as the Tufton Street network evolved from a pseudo-academic forum to an orchestrated lobbying outfit whose influence stretches well beyond the Conservative Party.

It’s common for a representative from these groups to appear on flagship current affairs programs, blandly presented as an impartial expert. There are striking parallels with America, where — as described by Jane Mayer in “Dark Money” — libertarian billionaires fund an assembly line of anti-tax, anti-regulation politics, gamely diffused through the media. In setting the terms of political debate, skewing perceptions of the state and the economy to the right, it has been a remarkably successful strategy.

Under Ms. Truss, once nicknamed the “human hand grenade” for her ideological obduracy, the libertarian right has detonated the British economy. The cost, for all but the richest, could be incalculable.

the broader economic and cultural landscape is so different now than it was just a few years ago that public investments of even this somewhat smaller scale appear poised to make an enormous difference.

That’s because those public investments are being made not against dirty-energy headwinds but with the support of much broader tailwinds

Thanks to technological change and the plunging cost of renewables, a growing political and cultural focus on decarbonization and increasing awareness of the public health costs of pollution and market trends for things like electric vehicles and heat pumps, it’s genuinely a whole new world out there. Not that long ago, the upfront cost of a green transition looked almost incalculably large. Today it seems plausible that quite dramatic emissions gains can be achieved for just, say, $369 billion

For 90 percent of the world, clean energy is now cheaper than dirty alternatives, and while countries like Spain are boasting about more than tripling solar power capacity by 2030, in Texas, solar output has grown 39-fold in just six years. Globally, renewable output has grown fourfold in the past decade

Ten years ago, when the United States endeavored to tackle the problem of climate change, it tried to do so largely by punishing the cost of dirty energy with a cap-and-trade system. This time, it’s giving a kick-start, or a boost of momentum, to an already ongoing green transition.

this strategic choice of carrots rather than sticks has received some deserved praise: It’s better and more popular to subsidize cheap, clean energy than it is to make the bad stuff more expensive

A “fair share” analysis suggests the United States — today the world’s second largest emitter, and historically the largest by far — should be moving faster than any nation in the world.

The models may ultimately prove optimistic, given the complications of infrastructure build-out

it is fair to wonder about the uncertain economics of some of the bill’s technological bets, like carbon capture and storage, which could allow emissions from industry and power generation to be trapped and sequestered, and which some climate activists and environmental justice advocates distrust

Jesse Jenkins, who leads the REPEAT Project, says he believes that the tech problems of C.C.S. have been solved and that, with tax credits, the bill will address its cost problem, leading to a dramatic scale-up in use. Julio Friedmann, a former Obama-era Energy Department official turned carbon removal advocate, says that a rapid scale-up of C.C.S. would be, while miraculous, also plausible.

the fact that this much climate progress appears even remotely possible for less than the annualized budget of the State Department, as Ben Dreyfuss recently put it, is a remarkable reflection of the state of green energy today, even without the new law. When it comes to emissions, we are no longer fighting an uphill battle, at least in the United States and many other countries like it. We are deciding how quickly to race downhill.

at the risk of playing Pollyanna, I think it is also possible to see the size of the bill — its relative smallness — as at least a mark of good news

The headline projection of the I.R.A. impact appears, if inadequate by the standards of the Paris agreement, nevertheless impressive: a 40 percent reduction in just eight years

already today the United States has reduced emissions 20 percent from 2005 levels, and was projected to reduce them further even without the benefit of the I.R.A. As recently as a few weeks ago, before the bill was revived, it might have felt like the United States was permanently stalled on climate action, but in fact the country was already moving to decarbonize, if not fast enough.

peed really matters; as the writer and activist Bill McKibben put it, when it comes to warming, “winning slowly is the same as losing.” Simply moving in the right direction isn’t enough, and too much time has been squandered — within the United States and globally — to avoid what was once described as a catastrophic climate future.

If the United States achieves that 40 percent reduction, that’s still well short of the country’s target of a 50-52 percent reduction by 2030. The gap may seem relatively small, but it represents more than half a billion tons of carbon each year. That’s a lot.

the I.R.A. is a compromise, obviously and outwardly, tying new leases for wind power development to new ones for oil and gas, only moderately reducing the country’s demand for oil and gas over the next decade and investing less in environmental justice measures than Biden himself promised not too long ago

But its basic bet — that many of these markets and technologies are close enough to tipping points that relatively small public support can get them racing toward inevitability — also means the ultimate impacts could be larger and far-reaching.

The effects on prices and markets could make state and local action cheaper and easier, and even federal regulation more palatable

the bill includes some unheralded provisions to help retire coal power more quickly, as Keane Bhatt, the policy director for the Progressive Caucus, has pointed out, as well as an under-discussed “stick” in the form of a fee for methane

The impact of its “green bank” and Energy Department loans could be quite large — some estimates have suggested they could run into the hundreds of billions, and the $27 billion handed to the Green Bank could catalyze ten times as much private capital

because much of the I.R.A.’s top-line “investment” comes in the form of tax credits, its outlays — and impacts — could ultimately grow substantially if certain sectors (wind, solar and C.C.S., for instance) really do take off.

This might not ultimately be just a $369 billion package, in other words, but something quite a bit bigger. Enough to get us to 50 percent by 2030? “I think we have a pretty good chance,” Jenkins says.

it is striking that, given where we were not that long ago, such a proposition seems credible at all. Here’s hoping.

The provisions tying future auctions for wind power to leases for oil and gas development have been called “poison pills,” because they appear to lock in future emissions. But the ultimate impact is likely to be quite small. (Energy Innovation estimates at most 50 million tons of additional annual carbon emissions, compared with a billion in reductions from other measures in the bill.)

But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost.

by next year, more than half of Medicare recipients will be in a private plan.

a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.

The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.

Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.

The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers

Medicare Advantage plans can limit patients’ choice of doctors, and sometimes require jumping through more hoops before getting certain types of expensive care.

At conferences, companies pitched digital services to analyze insurers’ medical records and suggest additional codes. Such consultants were often paid on commission; the more money the analysis turned up, the more the companies kept.

they often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more the plans are overpaid by Medicare, the more generous to customers they can afford to be.

Many of the fraud lawsuits were initially brought by former employees under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery.

In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been less aggressive, even as the overpayments have been described in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports and numerous news articles,

Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed in the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency.

The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans.

“You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,”

Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.

But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.

In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.

But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.

Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete

Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.

“Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,”

The insurers also began hiring agencies that sent doctors or nurses to patients’ homes, where they could diagnose them with more diseases.

Cigna hired firms to perform similar at-home assessments that generated billions in extra payments, according to a 2017 whistle-blower lawsuit, which was recently joined by the Justice Department. The firms told nurses to document new diagnoses without adjusting medications, treating patients or sending them to a specialist

Nurses were told to especially look for patients with a history of diabetes because it was not “curable,” even if the patient now had normal lab findings or had undergone surgery to treat the condition.

Adding the code for a single diagnosis could yield a substantial payoff. In a 2020 lawsuit, the government said Anthem instructed programmers to scour patient charts for “revenue-generating” codes. One patient was diagnosed with bipolar disorder, although no other doctor reported the condition, and Anthem received an additional $2,693.27, the lawsuit said. Another patient was said to have been coded for “active lung cancer,” despite no evidence of the disease in other records; Anthem was paid an additional $7,080.74. The case is continuing.

The most common allegation against the companies was that they did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.

Some of the companies took steps to ensure the extra diagnoses didn’t lead to expensive care. In an October 2021 lawsuit, the Justice Department estimated that Kaiser earned $1 billion between 2009 and 2018 from additional diagnoses, including roughly 100,000 findings of aortic atherosclerosis, or hardening of the arteries. But the plan stopped automatically enrolling those patients in a heart attack prevention program because doctors would be forced to follow up on too many people, the lawsuit said.

Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to the lawsuit.

At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. “It was an actual agenda item and how could we get this,” Dr. Taylor said.

few analysts expect major legislative or regulatory changes to the program.

Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.

Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments.

Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.

The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposed during the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.

Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”

Last year, the inspector general’s office noted that one company “stood out” for collecting 40 percent of all Medicare Advantage’s payments from chart reviews and home assessments despite serving only 22 percent of the program’s beneficiaries. It recommended Medicare pay extra attention to the company, which it did not name, but the enrollment figure matched UnitedHealth’s.

“Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”

Germany would promote economic links with Russia and China under the doctrine of “Wandel durch Handel” — change through trade — which asserted that integration with the world economy would promote democratization and rule of law.

And rather than forcing nations to get along, globalization seems to have created new frontiers for international confrontation.

Three years ago the international relations experts Henry Farrell and Abraham Newman published a prescient paper titled “Weaponized Interdependence: How Global Economic Networks Shape State Coercion.” They argued, in effect, that conventional trade wars — in which nations try to exert economic power by restricting access to their markets — are no longer where the action is. Instead, economic power comes from the ability to restrict other countries’ access to crucial goods, services, finance and information.

the big surprise on the economic side of the Ukraine war was the early success of the United States and its allies in strangling Russian access to crucial industrial and capital goods. Russian imports have begun to recover, but sanctions probably dealt a crucial blow to Vladimir Putin’s war-making ability.

Katherine Tai, the U.S. trade representative, gave a fairly startling speech calling for U.S. industrial policy aimed in part at protecting national security. She denounced China’s “state-directed industrial dominance policies” and declared that the efficiency gains from trade liberalization “cannot come at the cost of further weakening our supply chains [and] exacerbating high-risk reliances.” On the same day, the Biden administration announced its new export controls aimed at China. Suddenly, America is taking a much harder line on globalization.

it’s a dangerous world out there, and I can’t fault the Biden administration for its turn toward toughness — genuine toughness, not the macho preening of its predecessor.

Admiral Lee Hsi-ming, who was chief of Taiwan’s General Staff from 2017 to 2019, has championed the shift to asymmetric capabilities and has emerged as a Cassandra-like figure in his warnings that Taiwan is not preparing fast enough

You may not be able to stop an invasion, Lee says, but you can stop China from subjugating Taiwan. This entails denying China the ability to control the battle space. The Chinese haven’t fought a war in several decades, and Taiwan has geographic advantages—including ample mountains and few beaches suitable for amphibious operations

the first three section headings: “I. Taiwan Is Part of China—This Is an Indisputable Fact,” “II. Resolute Efforts of the CPC to Realize China’s Complete Reunification,” and “III. 2fChina’s Complete Reunification Is a Process That Cannot Be Halted.”

Lee points to two possible scenarios. The first is a coercive approach in which China encircles and pressures Taiwan—perhaps even seizing outlying islands and engaging in missile strikes. The second is a full-scale invasion.

Politically, Lee said, the message from China to the U.S. and Taiwan is simple: “I can do whatever I want in Taiwan, and there’s nothing the U.S. can do about it.” This message came across unequivocally in a white paper that Beijing released in August.

Anti-ship missiles, anti-tank weapons, shoulder-fired surface-to-air missiles, drones, long-range artillery, and small arms could wreak havoc on an invading force, and disrupt the supply chains necessary to sustain an occupation.

Lee also argues that Taiwan’s civilian population should be organized into a trained Territorial Defense Force, so that any attempted occupation would be met by the broadest possible resistance. “As long as China fails, Taiwan wins the war,”

“The purpose is to make China believe that if you want to invade Taiwan, you will suffer huge losses,” Lee said. “And if you still invade Taiwan, you will not be able to succeed.

as Lee sees it, the pace must quicken. “Taiwan needs a strategic paradigm shift,”

When Chiang fled to Taiwan—with roughly 2 million Chinese from the mainland—there were some 6 million people already living on an island that was just emerging from 50 years of Japanese rule. Most of the people living on the island when Chiang arrived could claim roots in Taiwan going back hundreds of years. They had their own languages and culture. So too did the island’s many Indigenous groups, such as the Amis, the Atayal, and the Paiwan.

To subjugate the island, Chiang killed and imprisoned tens of thousands over decades—a period known as the White Terror. He set up a military dictatorship under the leadership of his Chinese nationalist Kuomintang Party (KMT) and, from this offshore platform, vowed to reclaim mainland China.

After the election of President Ma Ying-jeou, in 2008, links of trade, investment, and travel helped reduce tensions with China. Ma was from the KMT, and the party’s Chinese heritage and its ties to Taiwan’s business elite eased the way to détente with Beijing.

But many Taiwanese, particularly the young, feared that forging too close a connection could ultimately give Beijing leverage over Taiwan. In 2014, in what became known as “the Sunflower Movement,” named for the flower that served as a symbol of hope, students occupied the Taiwan legislature to oppose a free-trade agreement with China. After a tense standoff, they succeeded in stopping the deal.

tus quo is really interesting, because in the American context that is what it mean

But the idea of it here is: There is no need to declare independence, because we are already independent. This country functions like an independent nation, but someone else says it is not.” Recent polling suggests that fewer than 5 percent of people in Taiwan identify as “only Chinese.”

n Chinese and KMT officials 30 years ago, an outcome

at represents anything but consensus. To the Chinese Communist Party, the consensus is that there is one China, and the government in Beijing is the sole legitimate authority. To the KMT, the consensus is that there is one China, but the Republic of China in Taiwan is the legitimate government. To the DPP, there is no consensus, only a fraught political reality to be managed

China proposes a “one country, two systems” regime, in which Taiwan becomes a formal part of China but maintains an autonomous political system. There is one big problem with this proposal: Hong Kong

in 2020, several “national-security laws” were passed giving the authorities broad powers to crush dissent. Activists were rounded up. Independent media were shut down. One country, two systems was dead. The fate of Hong Kong has had a profound impact on Taiwan.

Ukraine inspired the Taiwanese society a lot, including how Zelensky told their story,” Chiang said. He was almost matter-of-fact when he told me, “I would say war between China and Taiwan will definitely happen. We want to win.”

In our conversation, Tsai talked about what she had learned from Ukraine. One lesson is simply the need for international support—to defend itself or, better, to avoid a war in the first place

Another lesson of Ukraine is the importance of national character. Outside support, Tsai emphasized, depends on qualities only Taiwan can provide. “You need to have good leadership,” she said, “but more important is the people’s determination to defend themselves, and the Ukrainian people showed that.

Hanging over all of this is the role of the United States. As one Taiwanese ex

ert pointedly asked me: “We can make ourselves a porcupine, but what are you going to do?”

Would the U.S. risk the biggest naval battle since World War II to break a Chinese blockade? Would the U.S. attack an invading Chinese force knowing that U.S. military personnel in Japan, Guam, and possibly Hawaii are within range of Chinese rockets? Would the American people really support a war with the world’s most populous country in order to defend Taiwan?

how the U.S. can help prepare Taiwan than on what the U.S. would do in a conflict.

small victories only point up the scale of the challenge. Wu himself has used the term cognitive warfare to describe the comprehensive nature of China’s pressure on Taiwan. “They use missiles, air, ships, disinformation, cyberattacks, and economic coercion,” he told me. As a warning sign, China has banned hundreds of exported products from Taiwan. “They claimed that our mangoes tested positive for COVID,”

. If China takes Taiwan, Wu suggested that the Chinese Communist Party’s ambitions could extend to the East China Sea, threatening Japan; to the South China Sea, where China has built militarized islands and claims an entire body of water bordering several nations; to the Indian Ocean, where China is expanding influence and could establish military bases; and to the Pacific Ocean, where China is working to establish security pacts with island nations

I sat there reading message after message, all posted in closed chat rooms, meant to bend Taiwanese minds to Beijing’s worldview. The meanings of buzzwords like cognitive warfare and resilience came into sharper focus. Facing the seemingly bottomless resources of a massive totalitarian state, here were two young people working for free on a Wednesday night, quietly insisting on the notion that there is indeed such a thing as objective reality.

to preserve this, Taiwan has to find some mix of the approaches that I’d heard about: preparing for a war while avoiding it; talking to China without being coerced by it; drawing closer to the U.S. without being reduced to a chess piece on the board of a great game; tending to a young democracy without letting divisions weaken it; asserting a unique identity without becoming an independent country.

in its brevity—and its provenance—it offers hints of where this is coming from and where they want it to go. “Risk of extinction” leaps straight to the usual Defcon 1 hysteria that demands immediate action. “Global priority” establishes the proper regulatory geography. Bracketing AI with the familiar nightmares of “pandemics and nuclear war” points to the sorts of authority required.

Many of the signatories also represent something of a giveaway: Oodles of Google execs, Bill Gates, a Democratic politician or two, many of the same people who have breathed the rarefied West Coast air of progressive technocratic orthodoxy for decades.

many of those who share their sentiments, are genuinely concerned about the risks of AI and are simply trying to raise a red flag about a matter of real concern—though we should probably note that techno-hysteria through history has rarely proved to be justified

nuclear annihilation has failed to materialize.

I suspect attempts to impose a world government would have been much more likely to result in an extinction-level nuclear war than the exercise by nations of their right to self-determination to resolve conflicts through the usual combination of diplomacy and force.

Climate change is the ne plus ultra of justifications for global regulation. It probably isn’t a coincidence that climate extremism and the demands for mandatory global controls exploded at exactly the moment old-fashioned Marxism was discredited for good in the 1990

the left suddenly found a climate threat it could use as a golden opportunity to regulate economic activity on a scale larger than anything Karl Marx could have imagined.

As for pandemics, our public-health masters showed by their actions over the past three years that they would like to encase us in a rigid panoply of rules to remediate a supposed extinction-level threat.

None of this is to diminish the challenges posed by AI. Thorough investigation into it, and healthy debate about how to maximize its opportunities and minimize its risks, are essential.

The economist Thomas Malthus, now dismissed by mainstream economics as an interesting crank, is resurrected by Galor as the man who correctly saw that for millennia humanity had been trapped by its own fertility into subsistence, starvation and famine. As soon as material matters improved, the birthrate went up, so did the population, and the pressure on food resources exploded – returning humanity to starvation

great sections of Galor’s book are to be applauded

What broke the Malthusian armlock on humanity’s destiny, argues Galor, is the gradual quickening in the introduction of technologies that required mass education for their successful implementation. This triggered a virtuous circle of more innovation, more investment in education, more need to invest in the quality of children rather than quantity, so that birthrates declined sufficiently to allow living standards and life expectancy to rise. Because it was now rational to invest in children’s education rather than get them working, child labour and exploitation fell away

Above all he shows how cultural attitudes persist long after whatever concatenation of events brought them into being, so that countries and cultures that get ahead tend to stay ahead

He is scathing about the shock programmes of market liberalisation that accompanied the “Washington consensus”, ignorant of these persistent traits. Effective market economies can’t be built spontaneously in cultures that are hostile to the very conception.

his optimism about humanity shines through – prize its diversity, commit to educate its children and they will find their way to innovate and create a culture of growth

It’s a great way to look at the world, but a healthy recognition that power, capitalism, finance, the existence and structure of states and public philosophies – some right, some wrong – are all part of the brew would have made his account more realistic

agents will open up many more learning opportunities.

Already, AI can help you pick out a new TV and recommend movies, books, shows, and podcasts. Likewise, a company I’ve invested in, recently launched Pix, which lets you ask questions (“Which Robert Redford movies would I like and where can I watch them?”) and then makes recommendations based on what you’ve liked in the past

Productivity

copilots can do a lot—such as turn a written document into a slide deck, answer questions about a spreadsheet using natural language, and summarize email threads while representing each person’s point of view.

I don’t think any single company will dominate the agents business--there will be many different AI engines available.

Helping patients and healthcare workers will be especially beneficial for people in poor countries, where many never get to see a doctor at all.

To create a new app or service, you won’t need to know how to write code or do graphic design. You’ll just tell your agent what you want. It will be able to write the code, design the look and feel of the app, create a logo, and publish the app to an online store

Agents will do even more. Having one will be like having a person dedicated to helping you with various tasks and doing them independently if you want. If you have an idea for a business, an agent will help you write up a business plan, create a presentation for it, and even generate images of what your product might look like

For decades, I’ve been excited about all the ways that software would make teachers’ jobs easier and help students learn. It won’t replace teachers, but it will supplement their work—personalizing the work for students and liberating teachers from paperwork and other tasks so they can spend more time on the most important parts of the job.

Mental health care is another example of a service that agents will make available to virtually everyone. Today, weekly therapy sessions seem like a luxury. But there is a lot of unmet need, and many people who could benefit from therapy don’t have access to it.

Entertainment and shopping

The real shift will come when agents can help patients do basic triage, get advice about how to deal with health problems, and decide whether they need to seek treatment.

They’ll replace word processors, spreadsheets, and other productivity apps.

Education

For example, few families can pay for a tutor who works one-on-one with a student to supplement their classroom work. If agents can capture what makes a tutor effective, they’ll unlock this supplemental instruction for everyone who wants it. If a tutoring agent knows that a kid likes Minecraft and Taylor Swift, it will use Minecraft to teach them about calculating the volume and area of shapes, and Taylor’s lyrics to teach them about storytelling and rhyme schemes. The experience will be far richer—with graphics and sound, for example—and more personalized than today’s text-based tutors.

your agent will be able to help you in the same way that personal assistants support executives today. If your friend just had surgery, your agent will offer to send flowers and be able to order them for you. If you tell it you’d like to catch up with your old college roommate, it will work with their agent to find a time to get together, and just before you arrive, it will remind you that their oldest child just started college at the local university.

To see the dramatic change that agents will bring, let’s compare them to the AI tools available today. Most of these are bots. They’re limited to one app and generally only step in when you write a particular word or ask for help. Because they don’t remember how you use them from one time to the next, they don’t get better or learn any of your preferences.

Agents will affect how we use software as well as how it’s written. They’ll replace search sites because they’ll be better at finding information and summarizing it for you

Businesses that are separate today—search advertising, social networking with advertising, shopping, productivity software—will become one business.

other issues won’t be decided by companies and governments. For example, agents could affect how we interact with friends and family. Today, you can show someone that you care about them by remembering details about their life—say, their birthday. But when they know your agent likely reminded you about it and took care of sending flowers, will it be as meaningful for them?

In the computing industry, we talk about platforms—the technologies that apps and services are built on. Android, iOS, and Windows are all platforms. Agents will be the next platform.

A shock wave in the tech industry

Agents won’t simply make recommendations; they’ll help you act on them. If you want to buy a camera, you’ll have your agent read all the reviews for you, summarize them, make a recommendation, and place an order for it once you’ve made a decision.

The current state of the art is Khanmigo, a text-based bot created by Khan Academy. It can tutor students in math, science, and the humanities—for example, it can explain the quadratic formula and create math problems to practice on. It can also help teachers do things like write lesson plans.

they’ll be dramatically better. You’ll be able to have nuanced conversations with them. They will be much more personalized, and they won’t be limited to relatively simple tasks like writing a letter.

Companies will be able to make agents available for their employees to consult directly and be part of every meeting so they can answer questions.

AI agents that are well trained in mental health will make therapy much more affordable and easier to get. Wysa and Youper are two of the early chatbots here. But agents will go much deeper. If you choose to share enough information with a mental health agent, it will understand your life history and your relationships. It’ll be available when you need it, and it will never get impatient. It could even, with your permission, monitor your physical responses to therapy through your smart watch—like if your heart starts to race when you’re talking about a problem with your boss—and suggest when you should see a human therapist.

If the number of companies that have started working on AI just this year is any indication, there will be an exceptional amount of competition, which will make agents very inexpensive.

Agents are smarter. They’re proactive—capable of making suggestions before you ask for them. They accomplish tasks across applications. They improve over time because they remember your activities and recognize intent and patterns in your behavior. Based on this information, they offer to provide what they think you need, although you will always make the final decisions.

Agents are not only going to change how everyone interacts with computers. They’re also going to upend the software industry, bringing about the biggest revolution in computing since we went from typing commands to tapping on icons.

In the distant future, agents may even force humans to face profound questions about purpose. Imagine that agents become so good that everyone can have a high quality of life without working nearly as much. In a future like that, what would people do with their time? Would anyone still want to get an education when an agent has all the answers? Can you have a safe and thriving society when most people have a lot of free time on their hands?

The ramifications for the software business and for society will be profound.

In the next five years, this will change completely. You won’t have to use different apps for different tasks. You’ll simply tell your device, in everyday language, what you want to do. And depending on how much information you choose to share with it, the software will be able to respond personally because it will have a rich understanding of your life. In the near future, anyone who’s online will be able to have a personal assistant powered by artificial intelligence that’s far beyond today’s technology.

You’ll also be able to get news and entertainment that’s been tailored to your interests. CurioAI, which creates a custom podcast on any subject you ask about, is a glimpse of what’s coming.

An agent will be able to help you with all your activities if you want it to. With permission to follow your online interactions and real-world locations, it will develop a powerful understanding of the people, places, and activities you engage in. It will get your personal and work relationships, hobbies, preferences, and schedule. You’ll choose how and when it steps in to help with something or ask you to make a decision.

even the best sites have an incomplete understanding of your work, personal life, interests, and relationships and a limited ability to use this information to do things for you. That’s the kind of thing that is only possible today with another human being, like a close friend or personal assistant.

The most exciting impact of AI agents is the way they will democratize services that today are too expensive for most people

They’ll have an especially big influence in four areas: health care, education, productivity, and entertainment and shopping.

Degrowth

notice I said the word “some”. Many progressive visions, like greater economic equality, the closing of racial wealth gaps, and the reversal of climate change, are things I want!

what I’m arguing is that some of the big ideas progressives embraced in the heady rush of the 2010s are misguided and should be discarded, in order to work toward utopias that human beings would actually like to live in.

Here’s a list of four such visions.

When Brad challenged me to list some examples of dystopian progressive visions, I immediately said “degrowth”, and he agreed.

halting or reversing economic growth — an idea that has become fashionable among some progressive circles in the past decade — is both unworkable and undesirable as a way to limit humanity’s environmental impact

First, I argued that the drop in living standards that degrowth would require makes it a political nonstarter, and the amount of global central planning involved would be impossible to implement:

I also argued that solving climate change requires growth, since it’ll take a lot of economic output to replace our energy sources with solar and wind and batteries. And then once we do switch to those energy sources, they’ll be so cheap (thanks to learning curves) that we’ll actually have sustainably higher consumption than before.

As I explained in that second post, I view degrowth partly as an attempt to valorize national decline, which is why the idea is much more popular in Europe than in the U.S.

The expulsion of “colonizers”

ome progressives in the U.S. have begun to talk about an entirely different type of “decolonization” — the expulsion of “settler colonial” populations from regions that their ancestors settled in.

Mr. Mitsotakis said, “Geography and history have ensured that we live together, and I feel a historic duty to bring the two states side by side, like our borders. We owe it to the next generations to build a tomorrow with calm waters where a tailwind blows.”

The countries signed a total of 15 agreements in areas including education, exports and agriculture, according to the Greek prime minister’s office. They vowed to hold continuing talks on political and economic issues like energy and tourism, and they agreed on confidence-building measures to eliminate unwarranted sources of tension.

They pledged to keep communication channels open and to refrain from any act or statement that might undermine the friendly spirit of the pact. If any dispute emerges, they vowed, both countries will try to solve it by peaceful means.

Mr. Mitsotakis said that resolutions to longstanding disputes over the so-called continental shelf and mineral rights in the Aegean and eastern Mediterranean would be explored as a “next step” once high-level talks had progressed.

The only moment of slight unease was when Mr. Mitsotakis responded to Mr. Erdogan’s reference to a “Turkish minority” in Greece, noting that the international treaty that set the countries’ modern borders refers to a “Muslim” minority in Greece rather than a Turkish one, as the latter is perceived in Greece as implying territorial aspirations.

For Turkey, improving ties with Greece is also a way to fix relations with the West, according to Ahmet Kasim Han, a professor of international relations at Beykoz University in Istanbul. “Turkey basically cannot afford to have a further point of tension with the West” because of its domestic economic difficulties, he said. “And Greece is presenting a great window of opportunity in that sense.”

Turkey also wants to protect its interests in the eastern Mediterranean, an important route for natural gas to Europe that borders other important regional players like Israel and Egypt. That is particularly critical given Turkey’s strained relations with Israel over the war in Gaza.