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As the US descends into chaos, what better time for Britain to go the same way? | US Ca... - 0 views

  • It was nice to hear from Mark Zuckerberg, who grandly announced he’d blocked Trump’s Facebook and Instagram accounts. This is not so much a case of shutting the stable door after the horse has bolted as doping the horse, whipping it into a frenzy, encouraging it to bolt, fostering a world in which humans are subjugated by horses, monetising every snort and whinny, allowing the very existence of “humans” and “horses” to become just one of a bunch of competing opinions, and then – only when that one particular horse has outlived its usefulness and seems destined for the glue factory – gently closing the stable door with a self-satisfied little “click”.
  • there would never have been a Trump presidency without Fox News, with the channel spending years before his election pushing his birtherism, boomer-bait and belief that the news is really just another TV show whose ratings were his primary obsession. Doubling down on all its worst instincts from the moment Barack Obama was elected, Fox News terrified and radicalised with wild disinformation, creating a post-fact black hole so powerful that even previously mild-mannered rivals got sucked into it.
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Opinion: Criminal justice reform can start with employers who give felons a second chan... - 0 views

  • We waste far too much human capital in a system that penalizes too many people for too long.
  • About 19 million Americans are burdened with a felony record, yet fewer than half of those transgressions were serious enough to require an actual prison sentence.
  • An improved criminal justice environment fosters prosperity and builds a society of stronger workers and consumers. For too long, the business community has had only a peripheral role in debates about how to reform our criminal justice system, but Corporate America should recognize that it has a strong business interest in the outcomes and must take a greater leadership role. It must embrace second chance hiring, the employment of people with criminal records.
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  • This is also critical if we are to overcome the demographic hurdles our labor market faces as Baby Boomers retire and the influx of Millennials slows.
  • The ugly truth of our criminal justice system is that one in three Black men in the United States has a felony record, putting them at a severe disadvantage.
  • Admirable commitments by companies to be more inclusive in hiring must be coupled with an intentional process for second chance hiring. My research has shown that "disposable employee" labor, in which the employer is trying to get the cheapest effective wage possible through minimum wage jobs that are subsidized by temporary tax credits (Work Opportunity Tax Credits), will not work because they do not adequately distinguish who is ready for reemployment nor do they make the sufficient investment to support rehabilitation.
  • Done right, second chance hiring that offers the needed training and support repays the required investment with loyal, productive and profitable employees (the upfront costs can even effectively be offset by tax credits). Without such an approach, our labor force cannot hope to reflect the diversity of our population.
  • Employment is foundational to rehabilitation for the millions of Americans with records and the more than 600,000 who exit prisons each year.
  • Even those businesses such as schools, defense contractors and financial institutions that have regulatory constraints on who they can hire have important roles to play. They can support education, reentry and workforce development nonprofits or advocate for policies that improve employment outcomes. 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Opinion | Gen X, Right-Wing Bastion? - The New York Times - 0 views

  • my generation, so often passed over, merits some ideological analysis. And Noah Smith, the economics writer for Bloomberg and an edge-of-Generation-Xer (born in 1980), offered the beginnings of one last week on Twitter.
  • The formative world of Gen X, he pointed out, was one of Republican dominance in presidential politics, evangelical revival in American religion and diminishing social conflict overall.
  • “Xers grew up in a nation that was rapidly stabilizing under conservative rule,” he writes, suggesting that many Americans now in midlife associate the G.O.P. with that stability and the subsequent trends pushing the country leftward with disorder and decline.
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  • I’d add a few more: the conservative influence of John Paul II’s papacy for Generation-X Catholics
  • the seemingly positive trendlines on race relations (visible in polls of African-Americans as well as whites) from the 1990s through the early Obama years
  • By virtue of having “adulted” more successfully than millennials — marrying, homebuying and having kids earlier and in larger numbers — Generation X enjoys a certain bourgeois realism about what sustains human societies, what choices in your 20s will make you happiest in your 40s, that’s absent from the very-online progressivism of the young
  • the characteristic Gen X weakness on race is a complacent assumption that the Clinton-to-Obama period resolved issues like the wealth gap or police misconduct, instead of just tabling them
  • On economics, meanwhile, Gen X conservatives can be tempted into uncharity toward younger Americans, interpreting their struggles and sympathies for socialism as a moral failure, as opposed to a response to a more hostile economic landscape than we faced
  • Zombie Reaganism, sticking with a conservative policy agenda that’s lost much of its relevance, precisely because the Reagan agenda helped make the world in which we came of age.
  • and the effects of the Reagan and Clinton economic growth spurts, which enabled my generation to enter adulthood under more prosperous conditions than the Great Recession-era landscape that hobbled millennials
  • There is an emotivism and narcissism that millennial liberalism and boomer liberalism seem to share, and in strong doses it’s poison for institutions.
  • The ironic communitarianism of Gen-X conservatism probably isn’t the perfect antidote, but it may be all we’ve got.
  • To grow up in the ’70s or ’80s was to come of age just after liberalism’s last high tide, and to see evidence of its failures all around — from the urban blight and ugliness left by utopian renewal projects to the adult disarray and childhood misery sowed by the ideology of sexual liberation in its Hefnerian phase.
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The Trump Death Star Implodes - 0 views

  • My sense (as a younger boomer) of what drives young people’s concerns is a combination of anxiety about where we’re headed, and their beliefs regarding the absolute inadequacy of status quo institutions for navigating present and future perils.  They are done, exhausted, and completely devoid of patience and tolerance for any pleas to “let the system work”.
  • In addition, they seem more attuned to how profoundly unprepared (still, to this day) we all are for handling aggressive manipulation via social and traditional media. 
  • They seem to intuit that legacy standards of civil discourse have been corrupted and weaponized, and that some new standard is required.  Decades of bad faith arguments, predominantly from right wing media and the Republican party, whether about climate change, racism, health care, tax policy, worker protections, or social disparities, are a major factor in that disenchantment.  The traditional standards of evenhanded, open discourse have been turned against democracies around the world, at times with very negative consequences (Hungary, Poland, Chile, Venezuela, Brazil, etc.).
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  • Impatience with stubborn faith in past American experience is hardly a vice in this context.  Democracy is not guaranteed, and is perhaps much more fragile than we’re comfortable admitting.  The Trump presidency is prima facie evidence these concerns are justified.
  • Perhaps there’s way more to this story than we know, and perhaps the perceived intolerance of these situations is really the early emergence of new ideas about the scope of freedom of speech, one that balances freedom of expression with social equity and the protection of democracy.
  • This is where the younger generation falls short, so far:  the rationale for their discomfort isn’t well articulated.  Consider the discord in the media the first step in a process of recognizing the problem, if only at an intuitive, emotional level, and the beginnings of (hopefully) a clearly delineated, more rational process of figuring out where the new boundaries of First Amendment rights and responsibilities lie in our lovely new age of weaponized social discourse.
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Opinion | Gen Z Will Not Save Us - The New York Times - 0 views

  • Gen Z activism so far skews both idealist and dystopian. A common thread between that idealism and dystopianism is most likely a deep feeling of alienation
  • Joe Bernstein at BuzzFeed News argued last year was one of the definitive effects of technology throughout the 2010s: “Feelings of powerlessness, estrangement, loneliness, and anger created or exacerbated by the information age are so general it can be easy to think they are just a state of nature, like an ache that persists until you forget it’s there.”
  • He cites the Harris Poll’s long-running alienation index, which asks respondents to agree or disagree with five blunt statements:What you think doesn’t count very much anymore.The rich get richer and the poor get poorer.Most people with power try to take advantage of people like yourself.The people running the country don’t really care what happens to you.You’re left out of things going on around you.
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  • these statements are an apt description of much of American life since Gen Z was born. It has been witness to a financial crisis that deferred or destroyed dreams and wealth with little consequence to those who caused it; the whiplash of the Obama and Trump presidencies; political gridlock; an information ecosystem built atop viral advertising platforms that have democratized information, allowing it to be weaponized to the point of blurring reality; seemingly endless digitally documented police violence; and forever wars. They were born into a time of stark and widening inequality, a time when voter suppression is both called out but rarely acted upon.
  • Alienation is not a feature of Gen Z experience — it is the overarching context.
  • it is likely to have profound impacts on their politics and all of our lives.
  • What, for example, are the results of a year or two of young adulthood lost to social distancing due to a pandemic? Or of graduating into a potential economic depression behind a generation that graduated into a recession?
  • “ … older generations of liberals are now talking about teens and Kpop fans in the same way that Trump boomers talk about 4chan: as vigilante forces they love but don’t understand.”
  • Keidra Chaney, a culture writer, who notes that white K-pop fans have received the bulk of credit in the press for the fandom’s anti-racist activism, obscuring the contributions and experiences of black fans. Ms. Chaney told Ms. Ohlheiser that it “feels like a punch in the gut — that we are being used for our social currency and then discarded.”
  • members of the same generation are most likely also fueling far-right message board trolls, nihilist “Doomer” groups and extremist online communities with a disdain for political correctness. Their platforms of choice like TikTok still brim with unchecked extremist content and far-right conspiracy theories.
  • s a recent Pew Research Center survey suggests, “members of Gen Z look similar to millennials in their political preferences,” which suggests that online extremism associated with millennials is likely to evolve in this successive generation.
  • A 2019 Business Insider survey of over 1,800 Gen Zers revealed that a majority did not identify as either conservative or liberal, a result of either indecision or disillusion or both.
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The mess Merkel leaves behind | The Economist - 0 views

  • Mrs Merkel’s achievements are more modest. In her 16 years in the chancellery she has weathered a string of crises, from economic to pandemic. Her abilities as a consensus-forger have served her country and Europe well.
  • But her government has neglected too much, nationally and internationally.
  • when a new government forms after an election this weekend, admiration for her steady leadership should be mixed with frustration at the complacency she has bred.
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  • The public sector has failed to invest adequately or wisely, falling behind its peers in building infrastructure, especially the digital sort.
  • Penny-pinching is hard-wired into the state. In 2009, on Mrs Merkel’s watch, Germany hobbled itself with a constitutional amendment that makes it illegal to run more than a minute deficit. With interest rates so low, sensible governments ought to have been borrowing for investment, not fainting at the first spot of red ink.
  • Germany’s most severe domestic problem is a failure to reform its pension system. Germans are ageing fast, and the baby-boomers will place an even heavier burden on the budget later this decade as they retire
  • Germany has also been sluggish, and still emits more carbon per head than any other big EU country, not helped by Mrs Merkel’s shutdown of Germany’s nuclear industry after the Fukushima disaster in Japan in 2011.
  • The EU has not grappled sufficiently with the weakness of its indebted southern members. Only during the pandemic did it create a financial instrument that lets the EU issue jointly guaranteed debt, and dispense some of the cash as grants, rather than yet more loans.
  • Worse, the “stability” rules that will force countries back into austerity to shrink their stocks of debt are ready to revive, unless amended.
  • China is an increasingly challenging economic and strategic rival, Russia an unpredictable threat and America a distracted and uncertain ally.
  • Despite recent increases, it spends too little on defence. It cosies up to Beijing in the hope of better trading terms. It is giving Vladimir Putin, Russia’s president, a chokehold over European energy supplies by backing the new Nord Stream 2 gas pipeline which, as it happens, makes landfall in Mrs Merkel’s own constituency.
  • The polls suggest that Germany is set for a messy new parliament, with no single party, or even two, able to form a government. Instead, some sort of ideologically incoherent three-way coalition is on the cards—one that, by combining high-spending greens and pro-business liberals, may struggle to agree on anything ambitious.
  • Comfortable, cautious Germans seem uninterested in serious debate about the future. Crisis-management has become a substitute for initiative. Candidates have no incentive to highlight their country’s looming problems.
  • One is a coalition headed by Mrs Merkel’s party, the Christian Democrats and their Bavarian sister-party (the CDU/CSU), led by Armin Laschet. The other is a coalition led by Olaf Scholz, of the Social Democrats (SPD), who is Germany’s finance minister. In either case, the coalition would be joined by the Greens and by the pro-business Free Democrats.
  • Sixteen years in power has been enough. The party has run out of ideas and drive, as its decision to choose the gaffe-prone and uninspiring Mr Laschet for chancellor makes clear. An affable lightweight, he has run a dismal campaign, and is predicted to lead his team to its worst result since the second world war. The polls say that Mr Scholz is preferred by twice as many voters.
  • The problem is that although he belongs to the business-friendly wing of his party, the SPD is stuffed with left-wingers.
  • They may try to drag him further in their direction than the Free Democrats will wear and enterprise can comfortably bear.
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'The Fourth Turning' Enters Pop Culture - The New York Times - 0 views

  • According to “fourth turning” proponents, American history goes through recurring cycles. Each one, which lasts about 80 to 100 years, consists of four generation-long seasons, or “turnings.” The winter season is a time of upheaval and reconstruction — a fourth turning.
  • The theory first appeared in “The Fourth Turning,” a work of pop political science that has had a cult following more or less since it was published in 1997. In the last few years of political turmoil, the book and its ideas have bubbled into the mainstream.
  • According to “The Fourth Turning,” previous crisis periods include the American Revolution, the Civil War and World War II. America entered its latest fourth turning in the mid-2000s. It will culminate in a crisis sometime in the 2020s — i.e., now.
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  • One of the book’s authors, Neil Howe, 71, has become a frequent podcast guest. A follow-up, “The Fourth Turning Is Here,” comes out this month.
  • The book’s outlook on the near future has made it appealing to macro traders and crypto enthusiasts, and it is frequently cited on the podcasts “Macro Voices,” “Wealthion” and “On the Margin.”
  • He described it as “this almost fun theory about history,” but added: “And yet there’s something deeply menacing about it.”
  • Mr. Arbery, who said he does not subscribe to the theory, sees parallels between the fourth turning and other nonscientific beliefs. “I modeled the way that Teresa talks about the fourth turning on the way that young liberals talk about astrology,” he said.
  • The play’s author, Will Arbery, 33, said he heard about “The Fourth Turning” while researching Stephen K. Bannon, the right-wing firebrand and former adviser to President Donald J. Trump, who is a longtime fan of the book and directed a 2010 documentary based on its ideas.
  • “I’ve read ‘The Fourth Turning,’ and indeed found it useful from a macroeconomic investing perspective,” Lyn Alden, 35, an investment analyst, wrote in an email. “History doesn’t repeat, but it kind of gives us a loose framework to work with.”
  • “The Fourth Turning” captured a mood of decline in recent American life. “I remember feeling safe in the ’90s, and then as soon as 9/11 hit, the world went topsy-turvy,” he said. “Every time my cohort got to the point where we were optimistic, another crisis happened. When I read the book, I was like, ‘That makes sense.’”
  • “The Fourth Turning” was conceived during a period of relative calm. In the late 1980s, Mr. Howe, a Washington, D.C., policy analyst, teamed with William Strauss, a founder of the political satire troupe the Capitol Steps.
  • Their first book, “Generations,” told a story of American history through generational profiles going back to the 1600s. The book was said to have influenced Bill Clinton to choose a fellow baby boomer, Al Gore, as his running mate
  • when the 2008 financial crisis hit at almost exactly the point when the start of the fourth turning was predicted, it seemed to many that the authors might have been onto something. Recent events — the pandemic, the storming of the Capitol — have seemingly provided more evidence for the book’s fans.
  • Historically, a fourth turning crisis has always translated into a civil war, a war of great nations, or both, according to the book. Either is possible over the next decade, Mr. Howe said. But he is a doomsayer with an optimistic streak: Each fourth turning, in his telling, kicks off a renaissance in civic life.
  • In the new book, he describes what a coming civil war or geopolitical conflict might look like — though he shies away from casting himself as a modern-day Nostradamus.
  • “This big tidal shift is arriving,” Mr. Howe said. “But if you’re asking me which wave is going to knock down the lighthouse, I can’t do that. I can just tell you that this is the time period. It gives you a good idea of what to watch for.”
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The Fourth Turning: What past generations can teach us about our future - YouTube - 0 views

  • a 2022 conversation in front of a small audience with historian and demographer, Neil Howe, as we discuss: the patterns of human history, a long-view perspective on the current charge of events, and, most importantly, hope for our future.
  • ANTICIPATION IS POWER and PATTERN RECOGNITION is a huge key to intelligent decision making
  • Neil Howe’s theory is all about the patterns of the past and what they suggest we can anticipate in the future.
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  • Howe and his co-author William Strauss wrote two extremely impactful books – Generations (published in 1991) and The Fourth Turning (published in 1997).
  • Strauss and Howe theory considers the 4-stage cycle that repeats every 80-100 years (approximately the length of a human life, also referred to as a saeculum).
  • Their books suggest four turnings of history: 1. A High 2. An Awakening 3. An Unravelling 4. (Culminating in) A Crisis
  • What can be helpful to remember in these times is that no storm lasts forever, and this too shall pass
  • Additionally, one can consider four generational archetypes (a fancy word for patterns) of people born in the same era and coming of age shaped by the same historical events
  • The four archetypes Strauss and Howe use to describe generational cohorts are: Prophets, Nomads, Heroes, and Artists
  • So, for example, Millennials fall into the Hero archetype, while Gen Xers are Nomads, and Baby Boomers are Prophets. The generation born in or after 2005 are Artists.
  • As each archetypal generation reaches the end of its 80-year lifespan, the cycle repeats.
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Opinion | The Crypto Collapse and the End of Magical Thinking - The New York Times - 0 views

  • I have come to view cryptocurrencies not simply as exotic assets but as a manifestation of a magical thinking that had come to infect part of the generation who grew up in the aftermath of the Great Recession — and American capitalism, more broadly.
  • magical thinking is the assumption that favored conditions will continue on forever without regard for history.
  • It is the minimizing of constraints and trade-offs in favor of techno-utopianism and the exclusive emphasis on positive outcomes and novelty.
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  • It is the conflation of virtue with commerce.
  • Where did this ideology come from? An exceptional period of low interest rates and excess liquidity provided the fertile soil for fantastical dreams to flourish.
  • Cryptocurrency is the most ideal vessel of these impulses. A speculative asset with a tenuous underlying predetermined value provides a blank slate that meaning can be imposed onto
  • Anger after the 2008 global financial crisis created a receptivity to radical economic solutions, and disappointment with traditional politics displaced social ambitions onto the world of commerce.
  • The hothouse of Covid’s peaks turbocharged all these impulses as we sat bored in front of screens, fueled by seemingly free money.
  • The unwinding of magical thinking will dominate this decade in painful but ultimately restorative ways — and that unwinding will be most painful to the generation conditioned to believe these fantasies.
  • Pervasive consumer-facing technology allowed individuals to believe that the latest platform company or arrogant tech entrepreneur could change everything.
  • illusory and ridiculous promises share a common anti-establishment sentiment fueled by a technology that most of us never understood. Who needs governments, banks, the traditional internet or homespun wisdom when we can operate above and beyond?
  • Mainstream financial markets came to manifest these same tendencies, as magical thinking pervaded the wider investor class. During a period of declining and zero interest rates, mistakes and mediocrities were obscured or forgiven, while speculative assets with low probabilities of far-off success inflated in value enormously.
  • For an extended period, many investors bought the equivalent of lottery tickets. And many won.
  • The real economy could not escape infection. Companies flourished by inflating their scope and ambition to feed the desire for magical thinking.
  • Most broadly, many corporations have come to embrace broader social missions in response to the desire of younger investors and employees to use their capital and employment as instruments for social change.
  • Another manifestation of magical thinking is believing that the best hope for progress on our greatest challenges — climate change, racial injustice and economic inequality — are corporations and individual investment and consumption choices, rather than political mobilization and our communities.
  • Every business problem, I am told, can be solved in radically new and effective ways by applying artificial intelligence to ever-increasing amounts of data with a dash of design thinking. Many graduates coming of age in this period of financial giddiness and widening corporate ambition have been taught to chase these glittery objects with their human and financial capital instead of investing in sustainable paths — a habit that will be harder to instill at later ages.
  • The fundamentals of business have not changed merely because of new technologies or low interest rates. The way to prosper is still by solving problems in new ways that sustainably deliver value to employees, capital providers and customers.
  • What comes next? Hopefully, a revitalization of that great American tradition of pragmatism will follow. Speculative assets without any economic function should be worth nothing. Existing institutions, flawed as they are, should be improved upon rather than being displaced
  • Corporations are valuable socially because they solve problems and generate wealth. But they should not be trusted as arbiters of progress and should be balanced by a state that mediates political questions
  • Trade-offs are everywhere and inescapable. Navigating these trade-offs, rather than ignoring them, is the recipe for a good life.
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Housing markets face a brutal squeeze | The Economist - 0 views

  • interest-rate rises have now returned mortgage rates to levels not seen for decades. A year ago the 30-year fixed-rate mortgage in America was below 3%. Today it is only a little shy of 7%
  • Three factors will determine where the pain is most acute, and thus where these consequences are most likely. The first is recent price growth. Housing markets where prices have surged since the pandemic are especially vulnerable to cooling demand
  • Borrowing levels are the second factor. The higher household debt is as a share of income, the more vulnerable owners are to higher mortgage payments and defaults.
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  • The third factor is the speed with which higher interest rates pass through to homeowners. The biggest risk is to borrowers on floating-rate mortgages
  • not all fixed-term loans are alike. In America the bulk of them are fixed for two or three decades. In other countries, even fixed-rate borrowers will face soaring mortgage costs soon enough
  • all the ingredients for a deep housing slump are in place. This time, though, it is likely to be led not by America, but by Canada, the Netherlands, Australia, New Zealand and Norway
  • First-time buyers and recent borrowers are especially vulnerable. Many stretched their finances to buy a home, leaving less spare cash to cover a jump in mortgage costs
  • First-time buyers have also had less time to accumulate equity. Oxford Economics estimates that a 15% drop in house prices in America over a year would cancel out two-thirds of the housing equity they have accumulated since the start of the pandemic
  • the housing squeeze will have profound consequences. “The housing cycle IS the business cycle”, wrote Edward Leamer of the University of California, Los Angeles, in a paper published in 2007
  • The link between the two cycles arises because housing confers “wealth effects” on owner occupiers. When house prices rise, people feel good about their financial situation, so borrow and spend more.
  • It noted that housing slowdowns had preceded eight of the past ten recessions in America
  • 2019 research by the Bank of England found that a 10% increase in house prices raises consumption by 0.35–0.5%
  • Another important channel between the housing market and the rest of the economy is investment. Capital spending associated with housing, especially house building, can be extremely volatile—and is often the difference between a growing or shrinking economy.
  • Some people see an upside to a housing crash. They hope lower prices will allow young folk to buy their first houses. These hopes are almost certain to be dashed. In housing corrections, and sometimes for years after, home ownership rates tend to fall, rather than rise
  • Economic conditions that cause house prices to fall simultaneously imperil the chances of would-be homeowners. Unemployment rises and wages decline. If interest rates jump, people are able to borrow less and mortgage lenders tend to become more skittish about lending
  • The biggest effect of a housing downturn may be in politics
  • In countries where home ownership is seen as a rite of passage, lower prices without any increase in affordability will rub salt in already sore wounds. “Falling to what? Falling to absurdly grotesque prices instead of just unthinkable?”
  • For years more established homeowners took comfort in the thought that, even if real-wage growth was terrible, at least the price of their house was rising. Those days are over. Even baby-boomers, the great winners from a decade of price growth, now face the prospect of living off a smaller nest-egg in retirement, as downsizing becomes less lucrative
  • All this means rising interest rates will have unpredictable political repurcussions, as people who once benefited from the status quo discover what it feels like to lose out.
  • Do not be surprised, then, if policymakers launch enormous rescue operations
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How Insurers Exploited Medicare Advantage for Billions - The New York Times - 0 views

  • The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.
  • Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
  • Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed.
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  • 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.
  • “Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,”
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.”
  • few analysts expect major legislative or regulatory changes to the program.
  • “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.”
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(1) Republicans Get Angry When You Do the Right Thing - 0 views

  • We are living in, as George F. Will recently put it, “the most dangerous U.S. moment since World War II, more menacing than the October 1962 Cuban missile crisis”—because then the country was dealing with just one reckless nuclear power, and today it is dealing with three (China, Iran, Russia). Our national debt is dangerously high. Any serious discussion of the viability of Medicare and Social Security is sidelined indefinitely, even as the tidal wave of Baby Boomers reaches retirement age. The Southern border is indeed in crisis. Emerging technologies such as AI threaten to, at a minimum, have a significant economic impact.
  • Such a time requires clarity, forward thinking, and moral leadership. But it is abundantly clear that Republicans are not up these challenges—which was not lost on Buck. “It is impossible for the Republican party to confront our problems and offer a course correction for the future while being fixated on retribution and vengeance for contrived injustices of the past.” Indeed, those issues decided the speakership election. They are the raison d’être of the party’s prohibitive nominee for president.
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The One Parenting Decision That Really Matters - The Atlantic - 0 views

  • Hillary Clinton, then the first lady of the United States, published It Takes a Village: And Other Lessons Children Teach Us. Clinton’s book—and the proverb the title referenced—argue that children’s lives are shaped by many people in their neighborhood: firefighters and police officers, garbage collectors, teachers and coaches.
  • Dole said, “I am here to tell you: It does not take a village to raise a child. It takes a family to raise a child.” The crowd roared.
  • So who was right, Bob Dole or Hillary Clinton?
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  • some neighborhoods produce more successful kids: One in every 864 Baby Boomers born in Washtenaw, Michigan, the county that includes the University of Michigan, did something notable enough to warrant an entry in Wikipedia, while just one in 31,167 kids born in Harlan County, Kentucky, achieved that distinction
  • The results showed that some large metropolitan areas give kids an edge. They get a better education. They earn more money: The best cities can increase a child’s future income by about 12 percent. They found that the five best metropolitan areas are: Seattle; Minneapolis; Salt Lake City; Reading, Pennsylvania; and Madison, Wisconsin.
  • a website, The Opportunity Atlas, that allows anyone to find out how beneficial any neighborhood is expected to be for kids of different income levels, genders, and races.
  • We find that one factor about a home—its location—accounts for a significant fraction of the total effect of that home.
  • I have estimated that some 25 percent—and possibly more—of the overall effects of a parent are driven by where that parent raises their child. In other words, this one parenting decision has much more impact than many thousands of others.
  • Three of the biggest predictors that a neighborhood will increase a child’s success are the percent of households in which there are two parents, the percent of residents who are college graduates, and the percent of residents who return their census forms.
  • These are neighborhoods, in other words, with many role models: adults who are smart, accomplished, engaged in their community, and committed to stable family lives.
  • Data can be liberating. It can’t make decisions for us, but it can tell us which decisions really matter. When it comes to parenting, the data tells us, moms and dads should put more thought into the neighbors they surround their children with—and lighten up about everything else.
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Gen Z isn't interested in driving. Will that last? - The Washington Post - 0 views

  • a growing trend among Generation Z, loosely defined as people born between the years of 1996 and 2012. Equipped with ride-sharing apps and social media, “zoomers,” as they are sometimes called, are getting their driver’s licenses at lower rates than their predecessors. Unlike previous generations, they don’t see cars as a ticket to freedom or a crucial life milestone.
  • Those phases “are consistently getting later,” said Noreen McDonald, a professor of urban planning at the University of North Carolina at Chapel Hill. Gen Zers are more likely to live at home for longer, more likely to pursue higher education and less likely to get married in their 20s.
  • The trend is most pronounced for teens, but even older members of Gen Z are lagging behind their millennial counterparts. In 1997, almost 90 percent of 20- to 25 year-olds had licenses; in 2020, it was only 80 percent.
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  • Others point to driving’s high cost. Car insurance has skyrocketed in price in recent years, increasing nearly 14 percent between 2022 and 2023. (The average American now spends around 3 percent of their yearly income on car insurance.) Used and new car prices have also soared in the last few years, thanks to a combination of supply chain disruptions and high inflation.
  • E-scooters, e-bikes and ride-sharing also provide Gen Zers options that weren’t available to earlier generations. (Half of ride-sharing users are between the ages of 18 and 29, according to a poll from 2019.) And Gen Zers have the ability to do things online — hang out with friends, take classes, play games — which used to be available only in person.
  • Whether this shift will last depends on whether Gen Z is acting out of inherent preferences, or simply postponing key life milestones that often spur car purchases. Getting married, having children, or moving out of urban centers are all changes that encourage (or, depending on your view of the U.S. public transit system, force) people to drive more.
  • In 1997, 43 percent of 16-year-olds and 62 percent of 17-year-olds had driver’s licenses. In 2020, those numbers had fallen to 25 percent and 45 percent.
  • Millennials went through a similar phase. Around a decade ago, many newspaper articles and research papers noted that the millennial generation — often defined as those born between 1981 and 1996 — were shunning cars. The trend was so pronounced that some researchers dubbed millennials the “go-nowhere” generation.
  • The average number of vehicle miles driven by young people dropped 24 percent between 2001 and 2009, according to a report from the Frontier Group and the U.S. Public Interest Research Group. And at the same time, vehicle miles traveled per person in the United States — which had been climbing for more than 50 years — began to plateau.
  • adult millennials continue to drive around 8 percent less every day than members of Generation X and baby boomers. As millennials have grown up, got married and had kids, the distance they travel in cars has increased — but they haven’t fully closed the gap with previous generations.
  • data has shown that U.S. car culture isn’t as strong as it once was. “Up through the baby boom generation, every generation drove more than the last,” Dutzik said. Forecasters expected that trend to continue, with driving continuing to skyrocket well into the 2030s. “But what we saw with millennials, I think very clearly, is that trend stopped,”
  • If Gen Zers continue to eschew driving, it could have significant effects on the country’s carbon emissions. Transportation is the largest source of CO2 emissions in the United States. There are roughly 66 million members of Gen Z living in the United States. If each one drove just 10 percent less than the national average — that is, driving 972 miles less every year — that would save 25.6 million metric tons of carbon dioxide from spewing into the atmosphere. That’s the equivalent to the annual emissions of more than six coal-fired power plants.
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The Petulant King - The Atlantic - 0 views

  • In 1997, Prime Minister Tony Blair began relaxing immigration laws in hopes of creating an England imbued with the best traditions of a range of cultures, an England that was no longer fortified against the world but wide open to it, an oasis of people eating fusion cuisine and voting Labour.
  • To watch contestants from every racial, ethnic, and religious background tell the hosts the secret ingredient in “me gran’s sponge” from inside a giant white tent pitched on the green lawns of a country house in Berkshire is to see “England” smacked down to a set of consumer preferences: Emma Bridgewater, strings of fluttering Union Jacks, cake.
  • the old lessons of empire were not lost on the newcomers, a few of whom brought to England the same thing that England had once brought them: contemptuous disregard of the religion, customs, habits, traditions, and shared beliefs of the native population. And that’s how you get Sharia councils in modern England.
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  • to try to maintain the fantasy of a continuous England that could absorb within it wildly different cultures. What she relied upon was the West. The Englishmen who caused so much devastation around the world did not bring any miracles with them; they brought only bloodshed and cruelty and plunder, the same forces that had ruled the world since the beginning.
  • But by the time of Elizabeth’s reign, England understood itself as a Western nation, identifiable by its commitment to individual rights, equality, and self-determination. These values created the free world, and to the very limited extent that a Queen can stand for them—the Queen of a country with such a terrible imperial history—she was determined to do so.
  • she often acknowledged how Britain was changing, never once disparaged it, and found within it a plausible case for continuity. What she did was locate—or possibly create—a unifying culture of Englishness as defined by the values of the Blitz: courage, calm, resolve.
  • Elizabeth spoke of Englishness and its enduring character, not of racial composition or traditional custom. She—of all people—said England’s greatness wasn’t in its past. It lies in its present and its future.
  • now this whole delicate operation of creating a Britain in which the old and the new don’t merely coexist, or inform each other, but are together part of a cohesive narrative of greatness, in which the monarch is both the defender of the Church of England and the symbolic leader of a country with 3 million Muslims—all of this has fallen to … Charles?
  • Weak, selfish, petulant Charles?
  • This is not an era of reconciliation and bygones being bygones. This is an era of reparations. A lot of people around the world don’t want to “celebrate diversity,” a concept wholly born of the dying West. They want their treasures back, and they know where to find them.
  • Most of them were stolen, and in the most sadistic way possible. Will Charles—Boomer Zero—be able to keep hold not merely of the things but of the idea of England that his mother helped create?Doubtful.
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Review: 'The Free World' by Louis Menand - The Atlantic - 0 views

  • ouis Menand’s big new book on art, literature, music, and thought from 1945 to 1965 instills the conviction that the 20th century is well and truly over
  • For those of us who lived through any portion of this period and its immediate aftermath, the book is a rather amazing compendium of the scholarly research, revision, and demythologizing that have been accomplished in recent decades.
  • Interweaving post-1945 art history, literary history, and intellectual history, Menand provides a familiar outline; the picture he presents is one of cultural triumph backed by American wealth and aggressive foreign policy.
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  • guided by a fascination with the wayward paths to fame, he half-unwittingly sows doubt about the justice of the American rise to artistic leadership in the postwar era. In his erudite account, artistic success owes little to vision and purpose, more to self-promotion, but most to unanticipated adoption by bigger systems with other aims, principally oriented toward money, political advantage, or commercial churn
  • For the greatness and inevitability of artistic consecration, Menand substitutes the arbitrary confluences of forces at any given moment.
  • The curriculum runs chapter by chapter through George Kennan, George Orwell, Jean-Paul Sartre, Hannah Arendt, Jackson Pollock, Lionel Trilling, Allen Ginsberg, Claude Lévi-Strauss, Robert Rauschenberg and John Cage, Elvis and the Beatles, Isaiah Berlin, James Baldwin, Jack Kerouac, Andy Warhol, Susan Sontag, and Pauline Kael. Each biography opens a door to a school or trend of work
  • Menand’s is not a “great man” view of history, because no one seems particularly great. One gets a feeling for Sartre as a person, a limited knowledge of how Sartre made Being and Nothingness, and a vivid sense of how the book made Sartre a celebrity. Then one learns how a troupe of others came along and rode his success like a sled.
  • Menand zooms in and out between individual egomaniacs and the milieus that facilitated their ascent and profited from their publicity.
  • group biographies, in miniature, of the existentialists, the Beats, the action painters, the Black Mountain School, the British Invasion, the pop artists, and many coteries more—are enchanting singly but demoralizing as they pile up
  • All of these enterprises look like hives of social insects, not selfless quests for truth or beauty. Menand is a world-class entomologist: He can name every indistinguishable drone, knows who had an oversize mandible, who lost a leg, who carried the best crumbs.
  • From this vantage, the monuments really are just anthills.
  • Menand is truly one of the great explainers. He quotes approvingly a lesson taken by Lionel Trilling from his editor Elliot Cohen: “No idea was so difficult and complex but that it could be expressed in a way that would make it understood by anyone to whom it might conceivably be of interest.”
  • The underlying theory of the book rests on a picture of what makes for “cultural winners,” works and ideas that Menand defines as
  • He is accurate, he is insightful, and he is not a dumber-downer
  • Menand’s account of each is an abbreviated tour de force. His explanations work at all levels: interpretation for scholars, review for general readers, introductions for neophytes. Where another writer would take 20 pages to tell us why someone or something mattered historically, Menand does it in two.
  • goods or styles that maintain market share through “generational” taste shifts—that is, through all the “the king is dead; long live the king” moments that mark the phases of cultural history for people living through it.
  • Menand’s recountings are less concerned with the changing meanings of individual works than with their successive adoptions and co-optations, in defiance of depth and meaning. It is a process of “winning” often based on cults of personality, indifference to complex origins, and the fortune or misfortune of timing
  • Menand is notably excellent on how commercial, regulatory, and technological changes determined which kinds of artwork made it to the public. His analysis helps demystify trends in commercial forms like film and pop music, especially when they otherwise seemed to run against the grain of pure profit
  • Often Menand’s point seems to be that the culture’s reigning talkers and salespeople and debaters need to conjure figures to venerate and attack (in ceaseless alternation) for short-range purposes of attention and competition. Any given work—1984, say, or Bonnie and Clyde—isn’t much of anything until it becomes a counter in other people’s games.
  • The central question of this period in culture might be whether U.S. artists lived up to expectations
  • In 1945, Europe was in ruins. America was rich and productive and dictated the terms of the postwar economic and political order. Certainly the U.S. had the power to pretend to cultural glory, too. But was it a pretense, or did Americans really continue and exceed the prewar triumphs of European modernism?
  • Most histories of the arts after 1945 assume that the greatest American successes deserved their fame.
  • The thrust of many of Menand’s retellings is that “in the business of cultural exchange, misprision is often the key to transmission.” Fame comes through misreadings, fantasies, unintended resonances, charisma, and publicity.
  • Menand’s book bequeaths the sense that the last laugh may truly have been on the self-seriousness of a whole historical period, one that treated its most publicized and successful arts figures far too generously, giving them too much credit for depth and vision, while missing the cynical forces by which they’d been buoyed up and marketed
  • “Foreign film” in America in the ’50s and ’60s—when independent art cinemas emerged, showing imports such as work by Ingmar Bergman and the French New Wave—proves to have been energized by a successful federal-government antitrust action against the monopolistic Hollywood studios
  • The idea of a “culture industry”
  • is used unironically by Menand to name the vastly scaled-up production and consumption of all artistic experience. “The culture industries, as they expanded, absorbed and commercialized independent and offbeat culture-makers, and the university, as it expanded, swallowed up the worlds of creative writing and dissident political opinion.”
  • With his eye on this process, we miss out on artists and thinkers who dug deep and stayed home, who produced as hermits or eccentrics or introverted students of their art
  • Where did rock ’n’ roll come from?” Menand wonders. He answers that it was “the by-product of a number of unrelated developments in the American music business” that redirected sales to teenagers, and also the result of new radio-station competition, the partial racial desegregation of the music charts, and the arrival of 200-disc jukeboxes
  • I can imagine The Free World leaving my hypothetical college senior, denizen of the bleak attention economy of the 21st century, feeling liberated to discover that culture was no better—no more committed to a quest for what is true, noble, lasting, and beautiful—in the world of the Baby Boomers and beaming grandparents.
  • The book is so masterful, and exhibits such brilliant writing and exhaustive research, that I wonder whether Menand could truly have intended where his history of the postwar era landed me. I learned so much, and ended up caring so much les
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