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"No matter who you're voting for, you should express your civic duty and vote

If Rosenow and many of her college-age peers turn out, they could have an important impact: Young people make up 37% of eligible voters, according to census data analyzed by the Brookings Institution.

And in some states, the number of college students can affect a tight race: The state university system in Wisconsin enrolls about 170,000 students, and in 2016, Hillary Clinton lost that state by 22,177 votes.

The unknown variable, of course, is the coronavirus pandemic and how it has disrupted the academic year. More than 40% of U.S. colleges are fully or primarily online for the fall semester, and that could have a big impact on turnout,

campus closures, plus the attempts to suppress the college vote by limiting polling places, could dampen the growth in voting rates researchers were expecting.

While total registration of young people has exceeded 2016 levels, in more than a dozen states registration among first-time voters — 18- and 19-year-olds — is lower than in 2016.

That doesn't surprise Rosenow at the University of Rochester. "COVID changed our whole mindset in terms of getting out the vote and trying to get students to register," she says. Usually her organization sets up tables in common spaces or on the quad, "and then I just pretty much scream at other students to get them to vote."

Rosenow says there's been a lot of confusion about mail-in voting since students live all over the country and the process can be hard to navigate.

But Thomas is still optimistic: College students thrive on social media, she notes, and have become adept at creating communities online.

Following protests this summer, Thomas also expects that many young voters are fired up: "Activism is so high right now that it may actually be counteracting some of the downside of COVID," she says, "This generation really cares, and if they can be told the many reasons why they do need to vote, I think they will."

“I’ve seen a growing awareness, a wake-up, to the systemic oppression of people of color,” said Ms. LaDuke, an enrolled member of the White Earth Ojibwe Nation. “There is a movement toward justice for Native people. People want to listen.”

“There was an event that happened in 1621,” Ms. Coombs said. “But the whole story about what occurred on that first Thanksgiving was a myth created to make white people feel comfortable.”

In the period between Indigenous People’s Day and Thanksgiving, she said she is “inundated with people who might have some awareness with the pain over the characterizations that comes with this time.”

Hiʻilei Julia Hobart, an assistant professor of anthropology at the University of Texas at Austin, said current events allow students to see more clearly the shared legacies of African-Americans, many of whose enslaved ancestors were forced to work land stolen from Native Americans, whose agricultural know-how was also co-opted.

: This is false. Biden said in an August interview with ABC that he would shut down the country if scientists told him it was necessary -

Trump seems to be referencing findings from a 2015 inspector general report that examined a backlog of healthcare applications at the Department of Veterans Affairs. The report found more than 307,000 records that remained pending in a VA enrollment system were for people who had already died, according to social security records.

It's not clear Biden even knew about Trump's China travel restrictions when he called Trump xenophobic on the day the restrictions were unveiled

Trump claimed 308,000 "military people" died because Biden "couldn't provide them proper health care."

Addressing his opponent, Trump said, "I closed it, and you said, 'He's xenophobic. He's a racist and he's xenophobic,' because you didn't think I should have closed our country."

the report did not reach conclusions about whether lack of health care caused those deaths,

Still, a growing number of studies highlight the value of social interaction to brain development. Research shows that neural networks influencing language development and broader cognitive ability get built through verbal and physical give-and-take — from the sharing of a ball to exchanges of sounds and simple phrases.

These interactions build “structure and connectivity in the brain,” said Kathryn Hirsh-Pasek, director of the Infant Language Laboratory at Temple University and a senior fellow at the Brookings Institution. “They seem to be brain feed.”

John Hagen, professor emeritus of psychology at the University of Michigan, said he would be more concerned about the effect of lockdowns on young children, “if this were to go on years and not months.”

Portland has proved a little less prohibitive place for childhood interaction in part because there is more space than in the dense neighborhoods of San Francisco, and so children can be in the same vicinity without the parents feeling they are at risk of infecting one another.

he rise of small neighborhood pods or of two or three families joining together in shared bubbles has helped to offset some parents’ worries. But new tough rules in some states, like California, have disrupted those efforts because playgrounds have been closed in the latest Covid surge and households have been warned against socializing outside their own families.

o that end, what infants, toddlers and other children growing up in the Covid era need most now is stable, nurturing and loving interaction with their parents, Dr. Volling said.

“These children are not lacking in social interaction,” she said, noting that they are getting “the most important” interaction from their parents.

Traditionally, a scientist submits her paper to a journal, which sends it to a (surprisingly small) group of peers for (several rounds of usually anonymous) comments; if the paper passes this (typically months-long) peer-review gantlet, it is published (often behind an expensive paywall). Languid and opaque, this system is ill-suited to a fast-moving outbreak. But biomedical scientists can now upload preliminary versions of their papers, or “preprints,” to freely accessible websites, allowing others to immediately dissect and build upon their results. This practice had been slowly gaining popularity before 2020, but proved so vital for sharing information about COVID‑19 that it will likely become a mainstay of modern biomedical research. Preprints accelerate science, and the pandemic accelerated the use of preprints. At the start of the year, one repository, medRxiv (pronounced “med archive”), held about 1,000 preprints. By the end of October, it had more than 12,000.

The U.S. is now catching up. In April, the NIH launched a partnership called ACTIV, in which academic and industry scientists prioritized the most promising drugs and coordinated trial plans across the country. Since August, several such trials have started.

Researchers have begun to uncover how SARS‑CoV‑2 compares with other coronaviruses in wild bats, the likely reservoir; how it infiltrates and co-opts our cells; how the immune system overreacts to it, creating the symptoms of COVID‑19. “We’re learning about this virus faster than we’ve ever learned about any virus in history,” Sabeti said.

Similar triumphs occurred last year—in other countries. In March, taking advantage of the United Kingdom’s nationalized health system, British researchers launched a nationwide study called Recovery, which has since enrolled more than 17,600 COVID‑19 patients across 176 institutions. Recovery offered conclusive answers about dexamethasone and hydroxychloroquine and is set to weigh in on several other treatments. No other study has done more to shape the treatment of COVID‑19.

SARS‑CoV‑2’s genome was decoded and shared by Chinese scientists just 10 days after the first cases were reported. By November, more than 197,000 SARS‑CoV‑2 genomes had been sequenced. About 90 years ago, no one had even seen an individual virus; today, scientists have reconstructed the shape of SARS‑CoV‑2 down to the position of individual atoms

Respiratory viruses, though extremely common, are often neglected. Respiratory syncytial virus, parainfluenza viruses, rhinoviruses, adenoviruses, bocaviruses, a quartet of other human coronaviruses—they mostly cause mild coldlike illnesses, but those can be severe. How often? Why? It’s hard to say, because, influenza aside, such viruses attract little funding or interest.

COVID‑19 has developed a terrifying mystique because it seems to behave in unusual ways. It causes mild symptoms in some but critical illness in others. It is a respiratory virus and yet seems to attack the heart, brain, kidneys, and other organs. It has reinfected a small number of people who had recently recovered. But many other viruses share similar abilities; they just don’t infect millions of people in a matter of months or grab the attention of the entire scientific community

Thanks to COVID‑19, more researchers are looking for these rarer sides of viral infections, and spotting them.

These factors pull researchers toward speed, short-termism, and hype at the expense of rigor—and the pandemic intensified that pull. With an anxious world crying out for information, any new paper could immediately draw international press coverage—and hundreds of citations.

“There’s a perception that they’re just colds and there’s nothing much to learn,” says Emily Martin of the University of Michigan, who has long struggled to get funding to study them. Such reasoning is shortsighted folly. Respiratory viruses are the pathogens most likely to cause pandemics, and those outbreaks could potentially be far worse than COVID‑19’s.

Their movements through the air have been poorly studied, too. “There’s this very entrenched idea,” says Linsey Marr at Virginia Tech, that viruses mostly spread through droplets (short-range globs of snot and spit) rather than aerosols (smaller, dustlike flecks that travel farther). That idea dates back to the 1930s, when scientists were upending outdated notions that disease was caused by “bad air,” or miasma. But the evidence that SARS‑CoV‑2 can spread through aerosols “is now overwhelming,”

Another pandemic is inevitable, but it will find a very different community of scientists than COVID‑19 did. They will immediately work to determine whether the pathogen—most likely another respiratory virus—moves through aerosols, and whether it spreads from infected people before causing symptoms. They might call for masks and better ventilation from the earliest moments, not after months of debate

They will anticipate the possibility of an imminent wave of long-haul symptoms, and hopefully discover ways of preventing them. They might set up research groups to prioritize the most promising drugs and coordinate large clinical trials. They might take vaccine platforms that worked best against COVID‑19, slot in the genetic material of the new pathogen, and have a vaccine ready within months

the single-minded focus on COVID‑19 will also leave a slew of negative legacies. Science is mostly a zero-sum game, and when one topic monopolizes attention and money, others lose out.

Long-term studies that monitored bird migrations or the changing climate will forever have holes in their data because field research had to be canceled.

negligence has left COVID‑19 long-haulers with few answers or options, and they initially endured the same dismissal as the larger ME community. But their sheer numbers have forced a degree of recognition. They started researching, cataloging their own symptoms. They gained audiences with the NIH and the World Health Organization. Patients who are themselves experts in infectious disease or public health published their stories in top journals. “Long COVID” is being taken seriously, and Brea hopes it might drag all post-infection illnesses into the spotlight. ME never experienced a pivot. COVID‑19 might inadvertently create one

Other epistemic trespassers spent their time reinventing the wheel. One new study, published in NEJM, used lasers to show that when people speak, they release aerosols. But as the authors themselves note, the same result—sans lasers—was published in 1946, Marr says. I asked her whether any papers from the 2020 batch had taught her something new. After an uncomfortably long pause, she mentioned just one.

The incentives to trespass are substantial. Academia is a pyramid scheme: Each biomedical professor trains an average of six doctoral students across her career, but only 16 percent of the students get tenure-track positions. Competition is ferocious, and success hinges on getting published

Conservationists who worked to protect monkeys and apes kept their distance for fear of passing COVID‑19 to already endangered species.

Among scientists, as in other fields, women do more child care, domestic work, and teaching than men, and are more often asked for emotional support by their students. These burdens increased as the pandemic took hold, leaving women scientists “less able to commit their time to learning about a new area of study, and less able to start a whole new research project,

published COVID‑19 papers had 19 percent fewer women as first authors compared with papers from the same journals in the previous year. Men led more than 80 percent of national COVID‑19 task forces in 87 countries. Male scientists were quoted four times as frequently as female scientists in American news stories about the pandemic.

American scientists of color also found it harder to pivot than their white peers, because of unique challenges that sapped their time and energy.

Science suffers from the so-called Matthew effect, whereby small successes snowball into ever greater advantages, irrespective of merit. Similarly, early hindrances linger. Young researchers who could not pivot because they were too busy caring or grieving for others might suffer lasting consequences from an unproductive year. COVID‑19 “has really put the clock back in terms of closing the gap for women and underrepresented minorities,”

In 1848, the Prussian government sent a young physician named Rudolf Virchow to investigate a typhus epidemic in Upper Silesia. Virchow didn’t know what caused the devastating disease, but he realized its spread was possible because of malnutrition, hazardous working conditions, crowded housing, poor sanitation, and the inattention of civil servants and aristocrats—problems that require social and political reforms. “Medicine is a social science,” Virchow said, “and politics is nothing but medicine in larger scale.”

entists discovered the microbes responsible for tuberculosis, plague, cholera, dysentery, and syphilis, most fixated on these newly identified nemeses. Societal factors were seen as overly political distractions for researchers who sought to “be as ‘objective’ as possible,” says Elaine Hernandez, a medical sociologist at Indiana University. In the U.S., medicine fractured.

New departments of sociology and cultural anthropology kept their eye on the societal side of health, while the nation’s first schools of public health focused instead on fights between germs and individuals. This rift widened as improvements in hygiene, living standards, nutrition, and sanitation lengthened life spans: The more social conditions improved, the more readily they could be ignored.

The ideological pivot away from social medicine began to reverse in the second half of the 20th century.

Politicians initially described COVID‑19 as a “great equalizer,” but when states began releasing demographic data, it was immediately clear that the disease was disproportionately infecting and killing people of color.

These disparities aren’t biological. They stem from decades of discrimination and segregation that left minority communities in poorer neighborhoods with low-paying jobs, more health problems, and less access to health care—the same kind of problems that Virchow identified more than 170 years ago.

In March, when the U.S. started shutting down, one of the biggest questions on the mind of Whitney Robinson of UNC at Chapel Hill was: Are our kids going to be out of school for two years? While biomedical scientists tend to focus on sickness and recovery, social epidemiologists like her “think about critical periods that can affect the trajectory of your life,” she told me. Disrupting a child’s schooling at the wrong time can affect their entire career, so scientists should have prioritized research to figure out whether and how schools could reopen safely. But most studies on the spread of COVID‑19 in schools were neither large in scope nor well-designed enough to be conclusive. No federal agency funded a large, nationwide study, even though the federal government had months to do so. The NIH received billions for COVID‑19 research, but the National Institute of Child Health and Human Development—one of its 27 constituent institutes and centers—got nothing.

The horrors that Rudolf Virchow saw in Upper Silesia radicalized him, pushing the future “father of modern pathology” to advocate for social reforms. The current pandemic has affected scientists in the same way

COVID‑19 could be the catalyst that fully reunifies the social and biological sides of medicine, bridging disciplines that have been separated for too long.

“To study COVID‑19 is not only to study the disease itself as a biological entity,” says Alondra Nelson, the president of the Social Science Research Council. “What looks like a single problem is actually all things, all at once. So what we’re actually studying is literally everything in society, at every scale, from supply chains to individual relationships.”

Instead of building on this goodwill and solidarity, the US launched a War on Terror, the greatest strategic disaster in its history. Thus, the US squandered an historic opportunity to undo the harm of its Cold War policies, which had led to the emergence of al-Qaeda, the group responsible for the 9/11 attacks.

In the aftermath of 9/11, the United States – victor of the Cold War and last superpower standing – suddenly looked vulnerable and sympathetic. Outsiders felt pity but also a sly hope that, after decades of running the world clumsily at arm’s length, the Americans might recalibrate and become a humbler nation.

The War on Terror was a war of choice, not necessity. What if the US had used 9/11 as a catalyst to bring about transformative change in its relations with the Arab and Muslim world, rather than doubling down by invading Afghanistan and Iraq? It could have used its soft and hard power to help resolve regional conflicts and invest in human development, making the world safer and more prosperous. 

‘The world continues to get America wrong’ Tim Stanley, Historian, columnist and leader writer for the Daily Telegraph

The War on Terror was costly in blood and reputation. The so-called leader of the free world sanctioned torture and illegally invaded Iraq, destroying a state and creating a vacuum that allowed the rise of al-Qaeda in Iraq and ISIS. With Iraq in flames, America’s standing in the world was at rock bottom.

The opposite was perceived to happen: America became more like itself, proud, unilateral, dispensing vigilante justice with a cowboy president (‘some folks look at me and see a certain swagger’, joked George W. Bush, ‘which in Texas is called walking’).

The invasions of Afghanistan and Iraq looked like repeats of Vietnam: enrolment in US history courses in the UK took off as students, like me, wanted to understand why America kept making the same mistakes.

‘That Southeast Asia became the “second front” in the War on Terror was a blunder based on bad intelligence’ Minh Bui Jones, Editor of Mekong Review

On the tenth anniversary of 9/11, I found myself in Washington DC talking to a well-known author on the legacy of the terrorist attacks. At one point he asked me about Islamic terrorism in Cambodia, where I was living at the time. The question startled me. In the seven years I lived there, I never thought of Islam and terrorism together.

That author’s question tells you one thing about 9/11 in relation to Southeast Asia. Mostly, it is paranoia wrapped in ignorance. There are about 300,000 Muslims living in Cambodia today, a little more than one per cent of the population.

That this region became the ‘second front’ in George W. Bush’s great ‘War on Terror’ – his administration sent 660 troops to the Philippines in January 2002, following the capture of al-Qaeda operatives in Singapore and Malaysia – was a strategic blunder based on bad intelligence. Of course, Cambodians and their Vietnamese neighbours know all too well where those sorts of mistakes can lead and they would have felt a sense of déjà vu as they watched US bombs raining on Afghanistan and Iraq

Growing up in Vietnam in the 1970s, I had an image of the US as impregnable and I wasn’t alone. After 9/11, it looked vulnerable; I’m sure I’m not alone here either.

‘As US troops withdraw from Afghanistan, history threatens to repeat itself’ Elisabeth Leake, Associate Professor of International History at the University of Leeds and author of Afghan Crucible: The Soviet Invasion and the Making of Modern Afghanistan (Oxford University Press, 2022)

In the aftermath of 9/11, the US led an ultimately failed invasion of Afghanistan that lacked a historical understanding of the state or its inhabitants. American policy planners and military officers seemed destined to repeat mistakes made by other foreign powers in the decades before them. This was not a case of the ‘graveyard of empires’ – itself an inappropriate moniker – striking again. Rather, it was a ready willingness to overlook Afghanistan’s complicated 20th-century history.

social scientists supported military personnel in comprehending supposedly incomprehensible Afghanistan. These policies fundamentally overlooked Afghanistan’s complex social and political relations and the dynamic ways Afghan elites and intellectuals had engaged with the international arena for decades. The US itself had fostered some of this modernisation in the era of Cold War competition, yet 21st-century narratives replaced a history of internationalism with a history of parochialism. 

a temporal frame defined by religion and monarchical sovereignty was replaced by a new perception of continuous, but eventful historical time. Individuals came to understand themselves as belonging to communities that progressed through history as quasi-organic wholes, in which individual mortality was subsumed in a collective immortality. No one could escape the collective story but it was also the ultimate source of meaning.

Nineteenth-century certainties were blown apart by the explosion of violence and of economic crisis unleashed by World War I, which threw visions of regular historical development into question. At the same time the nexus of individual and collectivity was also disturbed by the putting into question of individual subjectivity by the widespread popularity of notions derived from Freudian psychoanalysis and a fundamental renegotiation of gender roles, sexual desire and identities.

The whirlwind of the individual and collective was all the more destabilizing for the fact that individual men had suddenly come to take on a larger than life importance in world history

liberals or conservatives (had not, AT) devoted much attention to the transformative power of the individual leader.

In the final pages of Personal History, Sheean brings Rayna back to life as his guide, conceding to her the argument they left unfinished in 1927, the anniversary year of the revolution.

They were the ones fomenting the world crisis: it was happening within them and through them. When the fate of the world hinged upon a handful of men, personal pathologies became the stuff of geopolitics. The correspondents needed a new way of thinking about the role of the individual.

by the early 1930s, when Knick and John feuded in a Vienna café, it was clear that the “authority of personality,” as Hitler put it, mattered more than it ever had in their lifetimes. 9 One couldn’t account for what was happening otherwise. The individual leader, as Knick wrote, now counted for “nearly everything.”

John Gunther in particular developed an overarching theory of history shocked into motion by the happenstance of individual personality. As Cohen suggests there is an interesting contrast between Gunther’s understanding of history and that being developed at the time by anthropologists like Margaret Mead that also centered on questions of character.

Mead and her colleagues were trying to understand the workings of national character: why – say – the Germans submitted willingly to dictatorship or the Americans demonstrated a stubborn, wary, independence. Such “culture-cracking,” they believed, could be marshalled to defuse international rivalries, or to win a war. Their analysis, like John’s, was indebted to a sort of Freudianism, requiring the investigation of child-rearing practices and generational friction

As John Gunther saw it, individual personality had jolted history into a new gear. He was making an argument about accident rather than deeply ingrained patterns of culture.

the point is well taken. One of the great challenges of comprehending interwar history is how to craft a general narrative of history if it depends on individual personalities to this degree.

“I’m no revolutionary”, he imagines himself protesting. “I can’t remake the machine ..”. To which she replies: “You don’t have to! All you have to do is to talk sense, and think sense, if you can. … Everybody isn’t born with an obligation to act. … But if you see it straight, that’s the thing: see what’s happening, has happened, will happen - and if you ever manage to do a stroke of work in your life, make it fit in. … if you are in the right place. Find it and stick to it: a solid place, with a view.”

Then, as Sheean imagines Rayna continuing: “If you want to relate your own life to its time and space, the particular to the general, the part to the whole, the only way you can do it is by understanding the struggle in world terms … to see things as straight as you can and put them into words that won’t falsify them. That’s programme enough for one life, and if you can ever do it, you’ll have acquired the relationship you want between the one life you’ve got and the many of which it’s a part.”

For me Last Call reads as a brilliantly illuminating examination of the excitement and the peril of thinking and writing in medias res. How was one to cope with the forces of world history sweeping through the living room, Sheean’s long-suffering wife Dinah Forbes-Robertson was moved to wonder after his breakdown during the Spanish civil war. And as global geopolitics, pandemics, inter-generational stresses, technological change, economic crises, urban crisis, and the renegotiation of gender roles and sexuality continue to upheave our lives, those questions are still with us today.

Read through the lens offered by Deborah Cohen’s Last Call, Sheean, Thompson et al appear as our precursors, our predecessors and our contemporaries in navigating polycrisis.

roughly four-in-ten (42%) say a major reason why they have not received a four-year college degree is that they couldn’t afford college. Some 36% say needing to work to help support their family was a major reason they didn’t get their degree.

Roughly a third (34%) of men without a bachelor’s degree say a major reason they didn’t complete college is that they just didn’t want to. Only one-in-four women say the same. Non-college-educated men are also more likely than their female counterparts to say a major reason they don’t have a four-year degree is that they didn’t need more education for the job or career they wanted (26% of men say this vs. 20% of women).

Women (44%) are more likely than men (39%) to say not being able to afford college is a major reason they don’t have a bachelor’s degree. Men and women are about equally likely to say needing to work to help support their family was a major impediment.

Hispanic adults (52%) are more likely than those who are White (39%) or Black (41%) to say a major reason they didn’t graduate from a four-year college is that they couldn’t afford it. Hispanic and Black adults without a four-year degree are more likely than their White counterparts to say needing to work to support their family was a major reason.

While a third of White adults without a four-year degree say not wanting to go to school was a major reason they didn’t complete a four-year degree, smaller shares of Black (22%) and Hispanic (23%) adults say the same. White adults are also more likely to say not needing more education for the job or career they wanted is a major reason why they don’t have a bachelor’s degree.

About four-in-ten White men who didn’t complete four years of college (39%) say a major reason for this is that they just didn’t want to. This compares with 27% of White women without a degree.

Similarly, while three-in-ten White men without a college degree say a major reason they didn’t complete college is that they didn’t need more education for the job or career they wanted, only 24% of White women say the same.

Overall, 49% of four-year college graduates say their college education was extremely useful in terms of helping them grow personally and intellectually. Roughly equal shares of men (47%) and women (50%) express this view.

Some 44% of college graduates – including 45% of men and 43% of women – say their college education was extremely useful to them in opening doors to job opportunities. A somewhat smaller share of bachelor’s degree holders (38%) say college was extremely useful in helping them develop specific skills and knowledge that could be used in the workplace (38% of men and 40% of women say this).

Doctors in the top 10 percent averaged $1.3 million

And those in the top 1 percent averaged an astounding $4 million, though most of that (85 percent) came from business income or capital gains.

In certain specialties, doctors see substantially more in their peak earning years: Neurosurgeons (about $920,000), orthopedic surgeons ($789,000) and radiation oncologists ($709,000) all did especially well for themselves. Specialty incomes cover 2005 to 2017 and are expressed in 2017 dollars.

family-practice physicians made around $230,000 a year. General practice ($225,000) and preventive-medicine ($224,000) doctors earned even less — though that’s still enough to put them at the top of the heap among all U.S. earners.

“There is this sense of, well, if you show that physician incomes put them at the top of the income distribution, then you’re somehow implying that they’re instead going into medicine because they want to make money. And that narrative is uncomfortable to people.”

why did those figures ruffle so many physician feathers?

“You can want to help people and you can simultaneously want to earn money and have a nicer lifestyle and demand compensation for long hours and long training. That’s totally normal behavior in the labor market.”

Yale University economist Jason Abaluck notes that when he asks the doctors and future doctors in his health economics classes why they earn so much, answers revolve around the brutal training required to enter the profession. “Until they finish their residency, they’re working an enormous number of hours and their lifestyle is not the lifestyle of a rich person,” Abaluck told us.

why do physicians make that much?

On average, doctors — much like anyone else — behave in ways that just happen to drive up their income. For example, the economists found that graduates from the top medical schools, who can presumably write their own ticket to any field they want, tend to choose those that pay the most.

“Our analysis shows that certainly physicians respond to earnings when choosing specialties,” Polyakova told us. “And there’s nothing wrong with that, in my opinion.

“In general, U.S. physicians are making about 50 percent more than German physicians and about more than twice as much as U.K. physicians,

Grover said the widest gaps were “really driven by surgeons and a handful of procedural specialties,” doctors who perform procedures with clear outcomes, rather than preventing disease or treating chronic condition

“we’re not about prevention, you know?” he said, noting that his own PhD is in public health. “I wish it was different, but it ain’t!”

The United States has fewer doctors per person than 27 out of 31 member countries tracked by the Organization for Economic Cooperation and Development

In 1970, based on a slightly different measure that’s been tracked for longer, America had more licensed physicians per person than all but two of the 10 countries for which we have data. What caused the collapse?

the United States has far fewer residency slots than qualified med school graduates, which means thousands of qualified future physicians are annually shut out of the residency pipeline, denied their chosen career and stuck with no way to pay back those quarter-million-dollar loans.

“I’d like to see an in-depth analysis of the effect of the government capping the number of residency spots and how it’s created an artificial ‘physician shortage’ even though we have thousands of talented and graduated doctors that can’t practice due to not enough residency spots,”

Such an analysis would begin with a deeply influential 1980 report,

That report, by a federal advisory committee tasked with ensuring the nation had neither too few nor too many doctors, concluded that America was barreling toward a massive physician surplus. It came out just before President Ronald Reagan took office, and the new administration seemed only too eager to cut back on federal spending on doctor-training systems.

ssociation of American Medical Colleges (AAMC), a coalition of MD-granting medical schools and affiliated teaching hospitals, slammed the brakes on a long expansion. From 1980 to around 2004, the number of medical grads flatlined, even as the American population rose 29 percent.

Federal support for residencies was also ratcheted down, making it expensive or impossible for hospitals to provide enough slots for all the medical school graduates hitting the market each year. That effort peaked with the 1997 Balanced Budget Act which, among other things, froze funding for residencies — partially under the flawed assumption that HMOs would forever reduce the need for medical care in America, Orr writes. That freeze has yet to fully unwind.

or decades, many policymakers believed more doctors caused higher medical spending. Orr says that’s partly true, but “the early studies failed to differentiate between increased availability of valuable medical services and unnecessary treatment and services.”

“In reality, the greater utilization in places with more doctors represented greater availability, both in terms of expanded access to primary care and an ever-growing array of new and more advanced medical services,” he writes. “The impact of physician supply on levels of excessive treatment appears to be either small or nonexistent.”

“People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”

Polyakova and her collaborators find doctor pay consumes only 8.6 percent of overall health spending. It grew a bit faster than inflation over the time period studied, but much slower than overall health-care costs.

Regardless, the dramatic limits on medical school enrollment and residencies enjoyed strong support from the AAMC and the AMA. We were surprised to hear both organizations now sound the alarm about a doctor shortage. MD-granting medical schools started expanding again in 2005.

it’s because states have responded to the shortage by empowering nurse practitioners and physician assistants to perform tasks that once were the sole province of physicians. Over the past 20 years, the number of registered nurses grew almost twice as quickly as the number of doctors, and the number of physician assistants grew almost three times as rapidly, our analysis showed.

While there still aren’t enough residency positions, we’re getting more thanks in part to recent federal spending bills that will fund 1,200 more slots over the next few years.

But the federal rules do not dictate how poor a patient needs to be to qualify for free care

In exchange, the Internal Revenue Service requires Allina and thousands of other nonprofit hospital systems to benefit their local communities, including by providing free or reduced-cost care to patients with low incomes.

In 2020, thanks to its nonprofit status, Allina avoided roughly $266 million in state, local and federal taxes, according to the Lown Institute, a think tank that studies health care.

Doctors and patients described being unable to complete medical forms that children needed to enroll in day care or show proof of vaccination for school.

Allina is one of Minnesota’s largest health systems, having largely grown through acquisitions. Since 2013, its annual profits have ranged from $30 million to $380 million. Last year was the first in the past decade when it lost money, largely owing to investment losses.

The financial success has paid dividends. Allina’s president earned $3.5 million in 2021, the most recent year for which data is available. The health system recently built a $12 million conference center.

Allina sometimes plays hardball with patients. Doctors have become accustomed to seeing messages in the electronic medical record notifying them that a patient “will no longer be eligible to receive care” because of “unpaid medical balances.”

In 2020, Allina spent less than half of 1 percent of its expenses on charity care, well below the nationwide average of about 2 percent for nonprofit hospitals

Serena Gragert, who worked as a scheduler at an Allina clinic in Minneapolis until 2021, said the computer system simply wouldn’t let her book future appointments for some patients with outstanding balances.

Ms. Gragert and other Allina employees said some of the patients who were kicked out had incomes low enough to qualify for Medicaid, the federal-state insurance program for poor people. That also means those patients would be eligible for free care under Allina’s own financial assistance policy — something many patients are unaware exists when they seek treatment.

Allina says the policy applies only to debts related to care provided by its clinics, not its hospitals. But patients said in interviews that they got cut off after falling into debt for services they received at Allina’s hospitals.

Jennifer Blaido lives in Isanti, a small town outside Minneapolis, and Allina owns the only hospital there. Ms. Blaido, a mechanic, said she racked up nearly $200,000 in bills from a two-week stay at Allina’s Mercy Hospital in 2009 for complications from pneumonia, along with several visits to the emergency department for asthma flare-ups

Ms. Blaido, a mother of four, said most of the hospital stay was not covered by her health insurance and she was unable to scrounge together enough money to make a dent in the debt.

Last year, Ms. Blaido had a cancer scare and said she couldn’t get an appointment with a doctor at Mercy Hospital. She had to drive more than an hour to get examined at a health system unconnected to Allina

In court filings, the couple described how Allina canceled Ms. Anderson’s appointments and told her that she could not book new ones until she had set up three separate payment plans — one with the health system and two with its debt collectors.Even after setting up those payment plans, which totaled $580 a month, the canceled appointments were never restored. Allina allows patients to come back only after they have paid the entire debt.

When the Andersons asked in court for a copy of Allina’s policy of barring patients with unpaid bills, the hospital’s lawyers responded: “Allina does not have a written policy regarding the canceling of services or termination of scheduled and/or physician referral services or appointments for unpaid debts.”In fact, Allina’s policy, which was created in 2006, instructs employees on how to do exactly that. Among other things, it tells staff to “cancel any future appointments the patient has scheduled at any clinic.”

It does provide a few ways for patients to continue being seen despite their unpaid bills. One is by getting approved for a loan through the hospital. Another is by filing for bankruptcy.

Thanks to social-science research, we now know that children’s life chances are profoundly affected by their context—not only income and family circumstances but also their community—more so than by their genetic profile or the medical care they receive.

With this in mind, we created what we call the Index of Deep Disadvantage, which reflects two traditional measures of income (the poverty rate and the “deep poverty rate,” meaning those with incomes below half the poverty line), two markers of health (birth weight and life expectancy), and the rate of social mobility for children who grow up in low-income families. We used this index to rank the roughly 3,100 counties in the United States along with the 500 most populous cities.

Immediately, the rankings revealed a stark geographical pattern.

the most disadvantaged places on our index were primarily rural

Though some of these were majority white, most were majority Black or Hispanic.

these places resembled, well, colonies—internal colonies within the U.S.

Considerable poverty exists in Chicago, Los Angeles, and New York. But in our apples-to-apples comparison, none of those cities ranked among even the 600 most disadvantaged places in the nation

The only cities on that list were a relatively small number of industrial municipalities such as Cleveland, Detroit, and Rochester.

Those living in the 200 most disadvantaged places on our index were just as likely to have major difficulties paying for housing as those in America’s 500 largest cities.

The places that our index identified as the 200 most disadvantaged are concentrated in three regions—Appalachia, South Texas, and the southern Cotton Belt.

hese places share a history of intensive resource extraction and human exploitation not seen to the same degree elsewhere in the United States

In each place, this economic pattern emerged (or, in the case of the Cotton Belt, fully flourished) in the late 19th or early 20th century. In each place, one industry came to dominate the economy, a pattern that held, broadly, until the 1960s, when King Cotton, King Tobacco, King Coal, and South Texas agriculture, would bow to the twin forces of automation and global competition.

many places with large Native American populations ranked among the most disadvantaged in the nation

While visiting many of the nation’s most disadvantaged places, we set out to build on this work through historical research, ethnographic observations, and in-depth interviews.

For generations, the appearance of towns in South Texas followed a pattern of social hierarchy: sturdy wood-frame houses, paved streets, and enclosed sewers in the white neighborhoods; shacks, dirt roads, and privies in the Mexican parts of town. Forced to migrate to find work during the off-season, generations of Mexican American children lost their right to a decent education. Even today, adult-illiteracy rates in these places are among the highest in the nation.

in Leflore County, Mississippi, for example, Black residents told us that violence was the No. 1 problem they face. The rate of death due to interpersonal violence there was nearly four times the national average, and well above that of Cook County, Illinois, home to Chicago

Throughout these regions, we saw the same themes emerge again and again—unequal schooling, the collapse of social infrastructure, violence, entrenched public corruption, and structural racism embedded in government programs.

Overall, poverty rates in these places are very low, babies are born healthy, people live to a ripe old age, and a low-income child usually has a similar chance of making it into the middle class as any other kid.

er they were forcibly relocated onto land mostly inhospitable to human habit

hey have enjoyed the lowest rates of violent crime, income inequality, and public corruption in the nation. These counties are unusually rich in social capital: Residents are connected to one another through volunteerism, membership in civic organizations, and participation in other community activities.

Counties that rank among those of greatest advantage began as agricultural communities with modestly sized farms, many originally secured through the 1862 Homestead Act that made landownership widely available. Many of these places have built on this history of broad-based wealth by making significant investments in schools, which has contributed to high graduation and college enrollment rates over generations.

One cannot fully understand the benefits enjoyed in America’s most advantaged places without considering the historic (and ongoing) exploitation of migrant labor that has gone on in them, mostly drawn from the U.S. border regions.

these communities have been more successful than most in preventing poverty, promoting health, and ensuring a level playing field for their children.

The upper Midwest is also overwhelmingly white. When we examined the relationship between whiteness and rank on the index, we found that a higher percentage of white residents is a significant predictor of a place’s rank, which is not at all surprising when one considers that the good schools and the good jobs have long been bestowed liberally on whites while being denied to Hispanic and Black Americans.

What makes the communities that are most advantaged unique is their histories as places of broad-based wealth. How different would conditions be in other parts of the country had they followed a similar, equitable course?

The lesson is that people seem to thrive—not always in high salaries but in health and life chances—when inequality is low; when landownership is widespread; when social connection is high; and when corruption and violence are rare.

The social leveling that is characteristic of communities in the upper Midwest is more than just a quaint cultural feature. It is the foundation of a community’s well-being. Until these regions’ virtues are shared nationwide, poverty and disadvantage will continue to haunt America.

It’s only in the last few months that the number of new referrals taken on by hospitals has reached the levels seen in 2019.

Now maybe this hasn’t happened because that apparent pent-up demand wasn’t really there. Perhaps people recovered without medical assistance or found other ways to deal with it. But when you dig into the data it looks more like there is considerable demand suppression going on to try and keep numbers as manageable as possible.

For decades — and particularly since the 2008 recession — politicians in both parties have mounted a strident campaign against government funding for the liberal arts. They express a growing disdain for any courses not explicitly tailored to the job market and outright contempt for the role the liberal arts-focused university has played in American society.

Former Gov. Scott Walker’s assault on higher education in Wisconsin formed the bedrock of many later conservative attacks. His work severely undermined a state university system that was once globally admired. Mr. Walker reportedly attempted to cut phrases like “the search for truth” and “public service” — as well as a call to improve “the human condition” — from the University of Wisconsin’s official mission statement

But blue states also regularly cut higher education funding, sometimes with similar rationales. In 2016, Matt Bevin, the Republican governor of Kentucky at the time, suggested that students majoring in the humanities shouldn’t receive state funding. The current secretary of education, Miguel Cardona, a Democrat, seems to barely disagree. “Every student should have access to an education that aligns with industry demands and evolves to meet the demands of tomorrow’s global work force,” he wrote in December.

Federal funding reflects those priorities. The National Endowment for the Humanities’ budget in 2022 was just $180 million. The National Science Foundation’s budget was about 50 times greater, having nearly doubled within two decades.

What were students meant to think? As the cost of higher education rose, substantially outpacing inflation since 1990, students followed funding — and what politicians repeatedly said about employability — into fields like business and computer science. Even majors in mathematics were hit by the focus on employability.

Universities took note and began culling. One recent study showed that history faculty across 28 Midwestern universities had dropped by almost 30 percent in roughly the past decade. Classics programs, including the only one at a historically Black college, were often simply eliminated.

Higher education, with broad study in the liberal arts, is meant to create not merely good workers but good citizens

this is a grim and narrow view of the purpose of higher education, merely as a tool to train workers as replaceable cogs in America’s economic machine, to generate raw material for its largest companies.

Citizens with knowledge of their history and culture are better equipped to lead and participate in a democratic society; learning in many different forms of knowledge teaches the humility necessary to accept other points of view in a pluralistic and increasingly globalized society.

In 1947, a presidential commission bemoaned an education system where a student “may have gained technical or professional training” while being “only incidentally, if at all, made ready for performing his duties as a man, a parent and a citizen.” The report recommended funding to give as many Americans as possible the sort of education that would “give to the student the values, attitudes, knowledge and skills that will equip him to live rightly and well in a free society,” which is to say the liberal arts as traditionally understood. The funding followed.

The report is true today, too

the American higher education system is returning to what it once was: liberal arts finishing schools for the wealthy and privileged, and vocational training for the rest.

Reversing this decline requires a concerted effort by both government and educational actors

renewed funding for the liberal arts — and especially the humanities — would support beleaguered departments and show students that this study is valuable and valued.

At the university level, instituting general education requirements would guarantee that even students whose majors have nothing to do with the humanities emerged from college equipped to think deeply and critically across disciplines.

Liberal arts professors must also be willing to leave their crumbling ivory towers and the parochial debates about their own career path, in order to engage directly in public life

If Mr. Kahlenberg had his way, college admissions would be upended.

His basic recipe: Get rid of preferences for alumni children, as well as children of faculty, staff and big donors. Say goodbye to recruited athletes in boutique sports like fencing. Increase community college transfers. Give a break to students who have excelled in struggling schools, who have grown up in neighborhoods of concentrated poverty, in families with low income, or better yet, low net worth. Pump up financial aid. Look for applicants in towns that do not normally send students to highly selective colleges.

elite colleges have become fortresses for the rich, he said. Harvard had “23 times as many rich kids as poor kids,” Mr. Kahlenberg testified in 2018 at the federal court trial in the Harvard case, referring to a 2017 paper by Raj Chetty, then a Stanford economist, and colleagues.

his 2012 study that found seven of 10 leading universities were able to return to previous levels of diversity through race-neutral means.

In 2020, Berkeley boasted that it had admitted its most diverse class in 30 years, with offers to African American and Latino students rising to the highest numbers since at least the late-1980s, without sacrificing academic standards.

In a simulation of the class of 2019, he found that the share of Black students at Harvard would drop to 10 percent from 14 percent, but the share of white students would also drop, to 33 percent from percent from 40 percent, mainly because of the elimination of legacy and other preferences. The share of Hispanic students would rise to 19 percent from 14 percent and the Asian American share would rise to 31 percent from 24 percent.

The share of “advantaged” students (parents with a bachelor’s degree, family income over $80,000, living in a neighborhood not burdened by concentrated poverty) would make up about half of the class, from 82 percent. SAT scores would drop to the 98th percentile from the 99th.

In the affirmative action trial, Harvard said that Mr. Kahlenberg’s model would produce too little diversity, and water down academic quality. Its actual class of 2026 is 15.2 percent African American, 12.6 percent Hispanic and 27.9 percent Asian American.

Edward Blum, the conservative activist behind the lawsuits against Harvard and U.N.C., said Mr. Kahlenberg came to his attention when “The Remedy” was published. The focus on class seemed like a powerful bridge between the left and the right, Mr. Blum said

Dr. Laycock, of the University of Virginia, expects that once the Supreme Court rules, conservative groups that are now promoting race-neutral alternatives will claim they are racial proxies and turn against them. “Everybody knows that’s why it’s being used,” he said. (Mr. Blum said his group will not, though other conservative groups could do so.)

There is no “We Believe” sign in the yard. But on the living room wall, a sign says, “Live simply, dream big, be grateful, give love, laugh lots.”

In that spirit, his stubborn campaign might be traced to being the son of a pastor whose family could afford to make him a Harvard graduate, twice over. “I do have some measure of class guilt,” he said. “I wish people who are far richer than I am had more class guilt.”

For instance, when a Harvard scholar such as Steven Pinker speaks of “disempowering D.E.I.” as a necessary reform in American higher education, he’s not opposing diversity itself. Pinker is liberal, donates substantially to the Democratic Party and “loathes” Donald Trump. The objections he raises are shared by a substantial number of Americans across the political spectrum.

, the problem with D.E.I. isn’t with diversity, equity, or inclusion — all vital values.

First, it is a moral necessity for colleges to be concerned about hateful discourse, including hateful language directed at members of historically marginalized groups. Moreover, colleges that receive federal funds have a legal obligation

I’ll share with you three pervasive examples

In the name of D.E.I., all too many institutions have violated their constitutional commitments to free speech, due process and equal protection of the law.

Yet that is no justification for hundreds of universities to pass and maintain draconian speech codes on campus, creating a system of unconstitutional censorship that has been struck down again and again and again in federal court. Nor is it a justification for discriminating against faculty members for their political views or for compelling them to speak in support of D.E.I.

There is a better way to achieve greater diversity, equity, inclusion and related goals. Universities can welcome students from all walks of life without unlawfully censoring speech. They can respond to campus sexual violence without violating students’ rights to due process. They can diversify the student body without discriminating on the basis of race

Second, there is a moral imperative to respond to sexual misconduct on campus.

that is no justification for replacing one tilted playing field with another. Compelled in part by constitutionally problematic guidance from the Obama administration, hundreds of universities adopted sexual misconduct policies that strip the most basic due process protections from accused students. The result has been systematic injustice

The due process problem was so profound that in 2019 a state appellate court in California — hardly a bastion of right-wing jurisprudence — ruled that “fundamental fairness” entitles an accused student to cross-examine witnesses in front of a neutral adjudicator.

Third, it is urgently necessary to address racial disparities in campus admissions and faculty hiring — but, again, not at the expense of the Constitution.

it is difficult to ignore the overwhelming evidence that Harvard attempted to achieve greater diversity in part by systematically downranking Asian applicants on subjective grounds, judging them deficient in traits such as “positive personality,” likability, courage, kindness and being “widely respected.” That’s not inclusion; it’s discrimination.

Our nation has inflicted horrific injustices on vulnerable communities. And while the precise nature of the injustice has varied — whether it was slavery, Jim Crow, internment or the brutal conquest of Native American lands — there was always a consistent theme: the comprehensive denial of constitutional rights.

But one does not correct the consequences of those terrible constitutional violations by inflicting a new set of violations on different American communities in a different American era. A consistent defense of the Constitution is good for us all,

The danger posed by D.E.I. resides primarily not in these virtuous ends, but in the unconstitutional means chosen to advance them.

Virtuous goals should not be accomplished by illiberal means.

The latest study looked at data from 126,972 people over the study period. It found that in 2015, 4.2 percent of Medicaid enrollees under the age of 17 in Maryland had overlapping prescriptions of three or more different classes of psychiatric medications. That figure rose to 4.6 percent in 2020.