Group items tagged

Covid-19 is crushing the healthcare system, with the California Department of Public Health reporting around 39,000 daily new cases and hundreds of deaths a day as of December 23

First and foremost, it is important to adhere to the key public health measures: masks, social distancing, avoidance of crowds. This approach remains effective, even if it has been adopted unevenly across the country. After 11 months, however, adhering to these measures can be extremely tedious and at times seemingly intolerable -- even for the most ardent public health fans, including myself.

Yes, it has given hope to the world, but it also may seduce people into thinking wrongly that it will be OK to ease up on preventative measures before the vaccine is widely available.

Forgoing masks and social distancing will only compound this national tragedy. We are currently seeing roughly 200,000 daily new cases and more than 2,500 deaths in the U.S. per day

Of the Trump administration's many Covid-19 failures, its inability to develop a modern, convenient and reliable national testing program is the most unforgivable.

Germany and South Korea have made this the cornerstone of their effective control programs, while Hong Kong has placed test kit vending machines in subway stations. And professional sport leagues have made testing several times a week a core approach to their containment strategy.

Yet we are only performing averages of less than 2 million tests per day in the U.S. While this is about double the rate in September, it still falls far short of what is necessary. In April, experts called for at least 5 million tests a day by early June to ensure a safe social opening, and 20 million tests a day by mid-summer to remobilize the economy. Others have hoped for even more aggressive goals to "test nearly everyone, nearly every day."

President-elect Joe Biden appears to understand the value of this strategy, which could bridge the many vulnerable months between now and the development of vaccine-induced herd immunity.

In a 2014 report, a bipartisan commission on election administration concluded that no one should have to wait longer than 30 minutes to vote, finding that wait times longer than that are “an indication that something is amiss and that corrective measures should be deployed.”

The S.P.A.E. found that 14 percent of Election Day voters waited more than 30 minutes to vote, an increase from 2016.

In Monday's rally, Trump repeated those claims. "They're not going to take the White House. We're going to fight like hell," he said. "When you win in a landslide and they steal it and it's rigged, it's not acceptable."

He added, "One state can chart the course not just for the next four years but for the next generation."

Seven days earlier, about 41,000 people were hospitalized in the U.S. The hospitalization rate has risen sharply since September, when it hovered around 30,000 new patients on many days.

The U.S. is now poised to report a total of 9 million coronavirus cases, the most in the world. This week, India joined the U.S. as the only two countries with more than 8 million confirmed cases.

Explorers learned more about areas such as Africa and the Americas and brought that knowledge back to Europe.Massive wealth accrued to European colonizers due to trade in goods, spices, and precious metals.Methods of navigation and mapping improved, switching from traditional portolan charts to the world's first nautical maps.New food, plants, and animals were exchanged between the colonies and Europe.Indigenous people were decimated by Europeans, from a combined impact of disease, overwork, and massacres.The workforce needed to support the massive plantations in the New World, led to the trade of enslaved people, which lasted for 300 years and had an enormous impact on Africa.

When the Ottoman Empire took control of Constantinople in 1453, it blocked European access to the area, severely limiting trade. In addition, it also blocked access to North Africa and the Red Sea, two very important trade routes to the Far East.

Portuguese explorers discovered the Madeira Islands in 1419 and the Azores in 1427. Over the coming decades, they would push farther south along the African coast, reaching the coast of present-day Senegal by the 1440s and the Cape of Good Hope by 1490. Less than a decade later, in 1498, Vasco da Gama would follow this route all the way to India.

Christopher Columbus, an Italian working for the Spanish monarchy, made his first journey in 1492. Instead of reaching India, Columbus found the island of San Salvador in what is known today as the Bahamas.

Columbus would lead three more voyages to the Caribbean, exploring parts of Cuba and the Central American coast.

Great Britain and France also began seeking new trade routes and lands across the ocean. In 1497, John Cabot, an Italian explorer working for the English, reached what is believed to be the coast of Newfoundland. A number of French and English explorers followed, including Giovanni da Verrazano, who discovered the entrance to the Hudson River in 1524, and Henry Hudson, who mapped the island of Manhattan first in 1609.

Over the next decades, the French, Dutch, and British would all vie for dominance. England established the first permanent colony in North America at Jamestown, Va., in 1607.

Other important voyages of exploration during this era included Ferdinand Magellan's attempted circumnavigation of the globe, the search for a trade route to Asia through the Northwest Passage, and Captain James Cook's voyages that allowed him to map various areas and travel as far as Alaska.

The Age of Exploration ended in the early 17th century after technological advancements and increased knowledge of the world allowed Europeans to travel easily across the globe by sea. The creation of permanent settlements and colonies created a network of communication and trade, therefore ending the need to search for new routes.

The Age of Exploration had a significant impact on geography. By traveling to different regions around the globe, explorers were able to learn more about areas such as Africa and the Americas and bring that knowledge back to Europe.

As technology advanced and known territory expanded, maps and mapmaking became more and more sophisticated.

The Age of Exploration served as a stepping stone for geographic knowledge. It allowed more people to see and study various areas around the world, which increased geographic study, giving us the basis for much of the knowledge we have today

"I had to pray that my insurance would approve of my transplant just in the nick of time," she says. "I had that Stage 4 label attached to my name and that has dollar signs. Who wants to invest in someone with stage four?"

After doing her research, Rafieei says she intends to vote for Joe Biden, who helped get the ACA passed in this first place.

Even ten years after the Affordable Care Act locked in a health care protection that Americans now overwhelmingly support — guarantees that insurers cannot deny coverage or charge more based on preexisting medical conditions — voters once again face contradicting campaign promises over which candidate will preserve the law's legacy.

A majority of Democrats, Independents and Republicans say they want their new president to preserve the ACA's provision that protects as many as 135 million people from potentially being unable to get health care because of their medical history.

President Donald Trump has pledged to keep this in place, even as his Administration heads to the U.S Supreme Court the week after Election Day to argue the entire law should be struck down.

And yet the Trump administration has not unveiled a health care plan or identified any specific components it might include. In 2017, the administration joined with Congressional Republicans to dismantle the Affordable Care Act, but none of the GOP-backed replacement plans could summon enough votes. The Republicans' final attempt, a limited "skinny repeal" of parts of the ACA, failed in the Senate because of resistance within their own party.

But the state's governor also embraced the Republican effort to repeal and replace the law in 2017, and now Arizona's Attorney General is part of the lawsuit — that will be heard by the Supreme Court on Nov. 10 — that could topple the entire law.

Republicans have often tried to skirt health care as a major issue this election cycle because there isn't the same political advantage to pushing the repeal and replace argument, says Mark Peterson, a professor of public policy, political science and law at UCLA.

"Not everybody, particularly Republicans, associates the ACA with protecting preexisting conditions," he says. "But it is pretty striking that overwhelmingly Democrats and Independents do — and a number of Republicans — that's enough to give a significant national supermajority."

they have been subject to injustices and disadvantages such as fraudulent lending practices, housing discrimination and aggressive policing and prosecution.

During the Great Recession of 2007 to 2010, the unemployment rate among the black population peaked at 16.8 percent, while the highest rate for the white population was 9.2 percent. During the current economic crisis, fewer than half of black adults are able to keep their jobs.

This is the element that those of us who agree with the Harper’s letter find most frustrating. We think the debate over where the discourse’s parameters should be (which is what the Harper’s letter is fundamentally about), and, more specifically, the debate over sex and gender identity that J. K. Rowling and her critics have been engaging in, are and should continue to be intellectually in bounds.

It’s no surprise that, when a move like that is made, the only thing the internet can produce in response is a torrential downpour of replyrage.

The move has the effect of disarming a would-be critic’s capacity to engage in counterargument.

We now have a case in which affirming the importance of intellectual openness is met with severe professional discomfort. A journalist has accused her colleague of inflicting harm, complicating her job, selfishly disvaluing her person, violating their shared employer’s aims, and more.

I don’t think it’s credible to suggest Yglesias’s signing of the letter complicates his employer’s ability to “build a more diverse and more thoughtful workplace.” If anything, the opposite is true — for Vox not to have a single staffer sign the letter harms its ability to do so. Diversity and thoughtfulness require … diversity and thoughtfulness, not uniformity and groupthink.

he reality is that the clinching move here is not an argument

Rather, it’s an assertion without supporting evidence that the letter’s contents are so damaging that, by signing it, you increase the likelihood that trans colleagues incur harm.

There is no support offered for this claim. There is no attempt to connect the letter’s contents, or the act of agreeing with the letter’s contents, to the incidence of harms experienced by trans people now. No attempt to chart out how the letter might lead to harms in the future.

the connection between signing a letter about discourse values and a colleague subsequently being more vulnerable to harm does need the dots connected. That can’t merely be asserted and the matter closed.

But the suggestion that taking the contrary position literally endangers those on the opposing side has a clinching effect — the debate can’t continue. It is shut down because of safety concerns.

(7) VanDerWerff claimed the letter contains “many dog whistles toward anti-trans positions.”

It’s about the letter itself. It’s a claim about the letter’s subtext.

It follows that, on some occasions, our “cancel culture totally exists!/cancel culture is totally nonexistent!” back-and-forths are really just disguised ways of saying “I think this view should continue to be debated!/I think this view should not be up for discussion!”

I understand it but I disagree with it. Because Rowling was not the only person who signed it — there were over 150 others, including some trans people, and including many who disagree with Rowling’s stance on trans issues.

In any event, I disagree with the characterization that the letter, either explicitly or implicitly, is “anti-trans.” Some people obviously think some of the signatories are “anti-trans,” but that doesn’t tell us much except that those signatories’ critics find their views deeply morally troubling.

Here is a brief account of what I take cancel culture to be

I take cancel culture to be person-variable, or community-variable, in the sense that what counts as an act of cancellation differs from person to person, or community to community, based on certain underlying beliefs. What beliefs are those?

I think we see a targeting as a cancellation when the person who is in the crosshairs is there for views we think should continue to be seen as discourse legitimate

Blake Neff, a longtime senior writer for Tucker Carlson’s show on Fox News, was fired when his relentlessly racist and sexist online comments under a pseudonym came to light. Is this a cancellation? This one isn’t hard at all. It’s manifestly not.None of us think his views on black people or women are discourse legitimate.

But David Shor, who was fired for tweeting research findings that were taken to suggest the post-Floyd riots could harm Democratic electoral interests, does count as an act of cancellation. The protests’ effects on the political prospects of Biden unseating Trump is absolutely a live question. It follows that someone who gets fired, as a data analyst, for tweeting about it constitutes a prima facie case of cancellation.

This is also what explains why a standard skeptical response to asserting the existence of “cancel culture” is to counteranalyze it as “people merely being held accountable.”

How does this connect with the letter? I understand how, in seeing Rowling’s name next to the letter, a critic of Rowling’s stance on sex and gender could believe Rowling’s involvement shapes, in a very real way, the semantic content of the letter beyond what its linguistic elements strictly and independently suggest.

A harder thing to pin down is when exactly reputational damage, rather than employment status, counts as “cancel culture.”

is tough when the name itself, “cancel,” is a success term. If someone has not actually been canceled, then how can their targeting be called a cancellation? It makes intuitive sense to require a cancellation to involve a genuine canceling.

I want to move away from this understanding of it because, often times, the outcomes are predicated on arbitrary factors like whether the target is independently wealthy, or how amenable their boss is to outspokenness, or how fearful their university is of lawsuits, or any number of other luck-based factors that take us away from the supposedly inappropriate actions.

Rowling is impervious to cancellation, but that doesn’t mean the manner in which her critics have engaged her is meaningfully different than the way others who have had their livelihoods impacted have been engaged. Gillian Philip, a bestselling children’s author, was sacked from a group-publishing collective for tweeting #IStandWithJKRowling.

It’s a style of challenge that assumes the wrongness of the views and moves directly to affixing a culturally odious label, seeking a deplatforming or shrinking of the offender’s channels, or outright firing. It’s not the sort of challenge where evidence of the offending view’s wrongness is brought forward and an invitation to respond is either explicitly or implicitly offered.

Again, there are many occasions where I’d move straight to no-platforming. I would never publish Richard Spencer. I said, above, that Neff’s firing was absolutely the right call.

“Medical care is one of the less important determinants of life expectancy,” said Joseph Newhouse, a health economist at Harvard. “Socioeconomic status and other social factors exert larger influences on longevity.”

The United States has relied more on market forces, which have been less effective.

For spending, many experts point to differences in public policy on health care financing. “Other countries have been able to put limits on health care prices and spending” with government policies

One result: Prices for health care goods and services are much higher in the United States.

“The differential between what the U.S. and other industrialized countries pay for prescriptions and for hospital and physician services continues to widen over time,”

The degree of competition, or lack thereof, in the American health system plays a role

periods of rapid growth in U.S. health care spending coincide with rapid growth in markups of health care prices. This is what one would expect in markets with low levels of competition.

Although American health care markets are highly consolidated, which contributes to higher prices, there are also enough players to impose administrative drag. Rising administrative costs — like billing and price negotiations across many insurers — may also explain part of the problem.

The additional costs associated with many insurers, each requiring different billing documentation, adds inefficiency

“We have big pharma vs. big insurance vs. big hospital networks, and the patient and employers and also the government end up paying the bills,”

Though we have some large public health care programs, they are not able to keep a lid on prices. Medicare, for example, is forbidden to negotiate as a whole for drug prices,

once those spending constraints eased, “suppliers of medical inputs marketed very costly technological innovations with gusto,”

, all across the world, one sees constraints on payment, technology, etc., in the 1970s and 1980s,” he said. The United States is not different in kind, only degree; our constraints were weaker.

Mr. Starr suggests that the high inflation of the late 1970s contributed to growth in health care spending, which other countries had more systems in place to control

These are all highly valuable, but they came at very high prices. This willingness to pay more has in turn made the United States an attractive market for innovation in health care.

The last third of the 20th century or so was a fertile time for expensive health care innovation

being an engine for innovation doesn’t necessarily translate into better outcomes.

international differences in rates of smoking, obesity, traffic accidents and homicides cannot explain why Americans tend to die younger.

Some have speculated that slower American life expectancy improvements are a result of a more diverse population

But Ms. Glied and Mr. Muennig found that life expectancy growth has been higher in minority groups in the United States

even accounting for motor vehicle traffic crashes, firearm-related injuries and drug poisonings, the United States has higher mortality rates than comparably wealthy countries.

The lack of universal health coverage and less safety net support for low-income populations could have something to do with it

“The most efficient way to improve population health is to focus on those at the bottom,” she said. “But we don’t do as much for them as other countries.”

The effectiveness of focusing on low-income populations is evident from large expansions of public health insurance for pregnant women and children in the 1980s. There were large reductions in child mortality associated with these expansions.

A report by RAND shows that in 1980 the United States spent 11 percent of its G.D.P. on social programs, excluding health care, while members of the European Union spent an average of about 15 percent. In 2011 the gap had widened to 16 percent versus 22 percent.

“Social underfunding probably has more long-term implications than underinvestment in medical care,” he said. For example, “if the underspending is on early childhood education — one of the key socioeconomic determinants of health — then there are long-term implications.”

Slow income growth could also play a role because poorer health is associated with lower incomes. “It’s notable that, apart from the richest of Americans, income growth stagnated starting in the late 1970s,”

History demonstrates that it is possible for the U.S. health system to perform on par with other wealthy countries

That doesn’t mean it’s a simple matter to return to international parity. A lot has changed in 40 years. What began as small gaps in performance are now yawning chasms

“For starters, we could have a lot more competition in health care. And government programs should often pay less than they do.” He added that if savings could be reaped from these approaches, and others — and reinvested in improving the welfare of lower-income Americans — we might close both the spending and longevity gaps.

Race, Stevens writes,has defined the modern Republican Party. After Goldwater carried only southern states and received a record low of 7 percent of the black vote, the party faced a basic choice: do what was necessary to appeal to more nonwhite voters, or build a party to win with white voters. It chose the latter, and when most successfully executed, a race-based strategy was the foundation of many of the Republican Party’s biggest victories, from Nixon to Trump.

In fact, Stevens told me, “race is the original sin of the modern Republican Party:”With Trump, the Party has grown comfortable as a white grievance party. Is that racist? Yes, I think it is. Are 63 million plus people who supported Trump racist? No, absolutely not. But to support Trump is to make peace with white grievance and hate.

Stevens’s comment demonstrates the difficulty many analysts have pinning down the meaning of racism and the distinction — if there is one — between being a racist and voting for a racist

To further examine this complexity, I questioned a range of experts.

Ashley Jardina, a political scientist at Duke and the author of “White Identity Politics,” put it this way:The use of these terms is complicated, messy, and without consensus. There are a number of important distinctions we can make. We think of ‘racial prejudice’ as an individual-level sense of hostility, animus, set of negative stereotypes, or other negative attitudes that one person has toward members of a group by way of their race. We refer to a person as racist when they have some degree of racial prejudice. For most Americans, this is generally what they think of when they hear the term racism or racist. A racist is a person who uses racial slurs directed at racial out-groups and thinks their own racial group is superior.

Davis argues that the debate has become clouded, that even though individual and group motives may not be racist, the outcomes achieved can be identical to the ones that racists would seek:My overall point is that we have forgotten what racism means. In doing so, we have focused attention on bigots and white nationalists and not held ordinary citizens accountable for beliefs that achieve the same ends.

Chloe Thurston, in turn, cited as specific examplesPresident Trump’s or Steve King’s comments about certain types of immigrants being unassimilable or not sufficiently American and suggesting that other (e.g. white) immigrants do not have those characteristics.

While both Trump and King, an anti-immigrant congressman from Iowa, “balk at the label ‘racist,’ she continued, “it is descriptively accurate and necessary from the standpoint of keeping track of the role and uses of racism in American society and politics.”

Like Davis, Thurston sought to address “the more difficult question” of “when it is legitimate to use that label for everyday behaviors.”Her answer:People can participate in and perpetuate racist systems without necessarily subscribing to those beliefs. People can recognize something they participate in or contribute to as racist but decide it’s not disqualifying. And people can design racist policies and systems. These are distinctive manifestations of racism but not all of them require us to know whether a person is expressly motivated by racism.

Because of the wide variety of possible motivations, Kam wrote in her email, she “would hesitate to label an action as ‘racist’ — unless racial considerations seem to be the only or the massively determinative consideration at play, based upon statistical modeling or carefully calibrated experiments.”

Kam notes that she worries “about excessive use of these labels” because describing someone or some action as racist “can easily escalate conflict beyond the point of return.”

Eric Kaufmann voiced similar caution, noting that racism and racist are highly charged words, the deployment of which can in some cases prove damaging to liberals and the left. He cited the “unwillingness to talk about immigration for fear of being labeled racist,” giving free rein to populists who do address immigration “and thus get elected. Trump’s election is exhibit A.”

In addition, according to Kaufmann, thefear of being labeled racist may be pushing left parties toward immigration policies, or policies on affirmative action, reparations, etc., that make them unelectable. Finally, overuse of the word “racist” may lead to a “cry wolf” effect whereby real racists can hide due to exhaustion of public with norm over-policing.

None of the examples I cited, in Kaufmann’s view, “are racist” unless it could be explicitly demonstrated “in a survey that those espousing the policies were mainly motivated by racism.” If not, he said, the “principle of charity should apply.”

many whites see accusations of racism as disingenuous. They believe that Democrats in particular “play the race card” by calling people or beliefs racist as a political strategy, rather than as a sincere effort to combat racism.There is, in fact, a huge partisan divide over what is considered racist and what is not.

Three Harvard political scientists — Meredith Dost, Enos and Jennifer L. Hochschild — conducted a survey in September 2017 that asked 2,296 American adults to rank, on a five point scale ranging from racist to not racist, 10 statements. These statements included “wanting to wave the Confederate flag,” “saying immigrants commit too many crimes,” “agreeing that welfare recipients should have to take a job to receive benefits,” and “voting for Donald Trump.”

As the accompanying chart shows, the gulf between Democrats and Republicans was 20 percentage points or more on seven out of ten questions. At the extreme, 82 percent of “strong Republicans” said it was “not racist” to vote for Trump, compared with 22 percent of “strong Democrats.” who said it was, a 60-point difference.

With the 2020 election approaching, one of the most relevant questions before the electorate is whether voters agree with Stuart Stevens on whether Donald Trump is a racist.

The answer to that question, according to a July 2019 Quinnipiac University national poll, is that 51 percent say Trump is a racist; 45 percent say he is not.

here are huge racial, partisan, gender and religious differences: whites say Trump is not racist 50-46; blacks say he is racist 80-11; Democrats 86-9 say yes, Republicans 91-8 say no; men 55-41 say no, women 59-36 say yes; white evangelicals say no 76-21, Catholics 50-48 say no; the unaffiliated say yes, 63-30.

What this boils down to is that racism is detected, determined and observed through partisan and ideological lenses.

Is the modern Republican Party built on race prejudice, otherwise known as racism?

It was only in July, when case counts began soaring in a trio of populous, Republican-leaning states — Arizona, Florida and Texas — and polls showed a majority of Americans disapproving of Trump’s handling of the pandemic, that the president and his top aides renewed their public activity related to the virus.

Trump and many of his top aides talk about the virus not as a contagion that must be controlled through social behavior but rather as a plague that eventually will dissipate on its own. Aides view the coronavirus task force — which includes Fauci, Birx and relevant agency heads — as a burden that has to be managed, officials said.

. An internal model by Trump’s Council on Economic Advisers predicts a looming disaster, with the number of infections projected to rise later in August and into September and October in the Midwest and elsewhere, according to people briefed on the data.

As the nation confronts a once­in-a-century health crisis that has killed at least 158,000 people, infected nearly 5 million and devastated the economy, the atmosphere in the White House is as chaotic as at any other time in Trump’s presidency — “an unmitigated disaster,” in the words of a second former senior administration official.

“It’s extraordinary that a country that helped eradicate smallpox, promoted HIV/AIDS treatment worldwide and suppressed Ebola — we were the world’s leader in public health and medicine, and now we can’t even protect our own people from the most devastating epidemic in decades.”

Asked who was to blame for the pandemic’s dark summer turn, Pelosi said, “1600 Pennsylvania Avenue.”“The delay, the denial . . . the hoax that it’s going to go away magically, a miracle is going to happen, we’ll be in church together by Easter, caused death,” Pelosi added.

In Trump’s White House, there is little process that guides decision-making on the pandemic. The president has been focused first and foremost on his reelection chances and reacting to the daily or hourly news cycle as opposed to making long-term strategy, with Meadows and other senior aides indulging his impulses rather than striving to impose discipline.

“He sits in the Oval Office and says, ‘Do this,’ or, ‘Do that,’ and there was always a domino blocker. It was John Bolton or H.R. McMaster on national security or John Kelly. Now there are no domino blockers.”

What’s more, with polls showing Trump’s popularity on the decline and widespread disapproval of his management of the viral outbreak, staffers have concocted a positive feedback loop for the boss. They present him with fawning media commentary and craft charts with statistics that back up the president’s claim that the administration has done a great — even historically excellent — job fighting the virus.

“Everyone is busy trying to create a Potemkin village for him every day. You’re not supposed to see this behavior in liberal democracies that are founded on principles of rule of law. Everyone bends over backwards to create this Potemkin village for him and for his inner circle.”

Although Fauci, Birx and other medical professionals sit on the coronavirus task force, many of the more pressing decisions lately have been made by the smaller group that huddles in the morning and mostly prioritizes politics. The cadre includes Meadows, senior adviser Jared Kushner and strategic communications director Alyssa Farah.

The policy process has fallen apart around Meadows, according to four White House officials, with the chief of staff fixated on preventing leaks and therefore unwilling to expand meetings to include experts or to share documents with senior staffers who had been excluded from discussions.

Luciana Borio, a director for medical and biodefense preparedness at the National Security Council during the first two years of the Trump administration, decried “a response in disarray hampered by a lack of clear, consistent public health-oriented guidance to the public.

“It’s very difficult to know who to trust,” Borio said. “To expect the public to sort out the facts in a time of tremendous stress leads to inconsistent and disparate actions, and that really hurts our collective effort to fight the virus.”

What also has frustrated a number of the president’s allies and former aides is that he simply seems uninterested in asserting full leadership over the crisis, instead deferring to state leaders to make the more difficult decisions while using his presidential bully pulpit to critique their performances.

“A suppression-level effort to shrink and not just mitigate the spread of covid requires a national strategy that includes standards and significant federal funding. Such a strategy is lacking right now.”

The Trump administration has resisted devising a national testing program and instead ceded the task to state governments, even as cases of infection average more than 60,000 a day and some people wait 10 days or longer for test results, delays that render the results essentially useless.

While some states have been able to largely meet the needs of their populations, the federal government is the only entity with the power to coordinate testing across state lines, push and enable manufacturers to increase production of test kits and supplies, surge those supplies as needed and ensure fair payment.

Without federal coordination, states, businesses, hospitals — and soon schools and universities — find themselves competing with each other for limited supplies, often overpaying as a result.

Despite repeated calls to invoke the Defense Production Act to help resolve testing-supply shortages, the administration has resisted doing so. Trump and several White House aides have instead continued to think that it is politically advantageous to cede the issue to the states to avoid taking ownership or blame for the issue, even though testing shortages are largely seen as a federal failure.

“Other countries have taken this virus seriously, trusted their public health officials and scientists, and now they’ve flattened the curve,” he said. “Meanwhile, our situation gets worse and worse every day and some Americans think, ‘Oh, that’s just the way it is.’ But that isn’t how it has to be.

He’s just not oriented towards things that even in the short term look like they’re involving something that’s hard or negative or that involves sacrifice or pain,” a former senior administration official explained. “He is always anxious to get to a place of touting achievements and being the messenger for good news.”

Fandoms have trained themselves for years to understand how attention works on social media and how to funnel it to things they care about. They easily can reach millions of people in a day—albeit with slightly more complicated methods than a major pop group like BTS, which can speak to all of its 26 million followers at once—and they know it.

by 2018, young Harry Styles fans were exerting pressure from the bottom-up: They started bringing Black Lives Matter flags to his concerts and urging him on Twitter to recognize the cause

Now fans are moving beyond asking pop stars if they can borrow their influence. When they’re seeking attention for a cause, “the audience is no longer our stars, but ourselves,” Gross told me in an email. The pandemic has laid bare the limits of celebrities, she suggested

Fans still think celebrities have an obligation to support certain causes, but right now they’re more interested in seeing a mass movement come from the fandom itself. And they’re well equipped to create one. “Fandoms are dispersed, often digital, and already organized, all of which aid and support their using their platforms to shift the locus of attention,”

Today, in the case of COVID-19, “all states face the same essential threat, and each government’s response is a kind of laboratory experiment,” Tierney said.

“The United States had the advantage of being struck relatively late by the virus, and this gave [us] a priceless chance to copy best practices and avoid the mistakes of others,” he noted.

When China began confining millions of people to their homes in January, the U.S. government should have gotten the message that the Chinese were grappling with a grave threat to the wider world, the Yale sociologist and physician Nicholas Christakis told me in March.

We lost six weeks” in the United States to prepare—“to build ventilators, get protective equipment, organize our ICUs, get tests ready, prepare the public for what was going to happen so that our economy didn’t tank as badly. None of this was done adequately by our leaders.”

By one estimate, from the epidemiologists Britta L. Jewell and Nicholas P. Jewell, if social-distancing policies had been implemented just two weeks earlier in March, 90 percent of the cumulative coronavirus deaths in the United States during the first wave of the pandemic might have been prevented.

Rather than using diagnostic tests that the World Health Organization had distributed to other countries early in the global outbreak, the Centers for Disease Control and Prevention insisted on developing its own, only to botch the rollout of those tests.

Even now, as a number of countries have swum feverishly toward safer ground, the United States has spent the past couple of months of near-nationwide lockdown merely treading water. It has yet to roll out robust testing across the country

It has also failed to develop proper contact-tracing systems, as other nations have, and to meaningfully flatten the curve outside New York.

Amid all this, Trump has exhibited more hubris than humility. The president has repeatedly claimed that the United States is leading the world in testing, which in part is an unflattering reflection of the U.S. outbreak’s huge scale and also is not true on a per-capita basis

As an example of ideas the United States could borrow from other countries, Tierney cited the fact that 750,000 people in Britain, which would be equivalent to nearly 4 million Americans, responded to the British government’s request to enlist in a “volunteer army” to help deliver food to vulnerable populations and provide other assistance.

A number of countries that have had more success against the coronavirus have demonstrated greater open-mindedness about learning from their peers. Taiwanese officials are watching Iceland’s mass-testing efforts, while the German government is explicitly modeling its response after South Korea’s “trace, test, and treat” campaign.

“Things have moved so quickly that there hasn't been much time for considered lesson-drawing,” he noted. Some countries were slow to institute strict lockdowns, despite witnessing the horrifying spread of the virus in Italy, while others “embraced approaches that broke with the broader consensus,” including “Sweden’s proposal

New Zealand’s record of learning

His colleague at the University of Otago, Michael Baker, told me that as a government adviser on the nation’s coronavirus taskforce, he was personally very influenced by a February 2020 WHO-China Joint Mission report, which suggested that the pandemic could be contained, and led him to advocate for New Zealand’s current strategy of eliminating the virus entirely from the country.

Yet Wilson added that New Zealand has lagged behind Asian countries in encouraging mass mask wearing, in rigorously quarantining incoming travelers, and in using digital technologies for contact tracing

In the United States too, even before the virus hit, attitudes toward learning from other countries were beginning to change

“The No. 1 place to live out the American Dream right now is Denmark,” Pete Buttigieg stated during one debate.

as a senator, Romney is urging the U.S. government to follow South Korea’s lead and “learn from those countries that were successful” in dealing with their outbreaks. Conservatives are championing Sweden’s laissez-faire approach as a blueprint for how to mitigate public-health damage while preserving freedom and the economy.

with the exception of the U.S. Paycheck Protection Program, “most of our economic-policy response has ignored useful lessons from abroad, explaining why our unemployment rate is skyrocketing above those in many other affected countries.”

Kelemen noted that the coronavirus crisis has led to a surge in interest among the American public and U.S. policy makers in harvesting lessons from other countries, most evident in the fact that everyone is following “the comparative charts of how countries are doing over time on infection rates or changes in year-on-year death counts.

With its pages and pages of statistical charts, Race Traits helped catapult Hoffman into national and international prominence as the “dean” of American statisticians. In his day, Hoffman “achieved greatness,” assessed his biographer. “His career illustrates the fulfillment of the ‘American dream.’”

e don’t see any American dream,” Malcolm X said in 1964. “We’ve experienced only the American nightmare.”

A nightmare is essentially a horror story of danger, but it is not wholly a horror story. Black people experience joy, love, peace, safety. But as in any horror story, those unforgettable moments of toil, terror, and trauma have made danger essential to the black experience in racist America. What one black American experiences, many black Americans experience. Black Americans are constantly stepping into the toil and terror and trauma of other black Americans

Because they know: They could have been them; they are them. Because they know it is dangerous to be black in America, because racist Americans see blacks as dangerous.

To be black and conscious of anti-black racism is to stare into the mirror of your own extinction.

Ask the souls of the 10,000 black victims of COVID-19 who might still be living if they had been white. Ask the souls of those who were told the pandemic was the “great equalizer.” Ask the souls of those forced to choose between their low-wage jobs and their treasured life. Ask the souls of those blamed for their own death. Ask the souls of those who disproportionately lost their jobs and then their life as others disproportionately raged about losing their freedom to infect us all. Ask the souls of those ignored by the governors reopening their states.

The American nightmare has everything and nothing to do with the pandemic. Ask the souls of Breonna Taylor, Ahmaud Arbery, and George Floyd. Step into their souls.

History ignored you. Hoffman ignored you. Racist America ignored you. The state did not want you to breathe. But your loved ones did not ignore you. They did not ignore your nightmare. They share the same nightmare.

Your loved ones are protesting your murder, and the president calls for their murder, calls them “THUGS,” calls them “OUT OF STATE” agitators. Others call the violence against property senseless—but not the police violence against you that drove them to violence. Others call both senseless, but take no immediate steps to stem police violence against you, only to stem the violence against property and police.

Hoffman compiled racial health disparities to argue that black Americans are, by their very nature and behavior, a diseased and dying people. Hoffman cataloged higher black mortality rates and showed that black Americans were more likely to suffer from syphilis, tuberculosis, and other infectious diseases than white Americans.

perhaps the worst of the nightmare is knowing that racist Americans will never end it. Anti-racism is on you, and only you. Racist Americans deny your nightmare, deny their racism, claim you have a dream like a King, when even his dream in 1967 “turned into a nightmare.”

Black people are supposed to be feared by all, murdered by police officers, lynched by citizens, and killed by COVID-19 and other lethal diseases. It has been proved. No there there. Black life is the “hopeless problem,” as Hoffman wrote.

In the first nationwide compilation of racial crime data, Hoffman used the higher arrest and incarceration rates of black Americans to argue that they are, by their very nature and behavior, a dangerous and violent people—as racist Americans still say today.

Mayors issue curfews. Governors rattle their sabers. The National Guard arrives to protect property and police. Where was the National Guard when you faced violent police officers, violent white terrorists, the violence of racial health disparities, the violence of COVID-19—all the racist power and policy and ideas that kept the black experience in the American nightmare for 400 years?

While black Americans view their experience as the American nightmare, racist Americans view black Americans as the American nightmare.

Racist Americans, especially those racists who are white, view themselves as the embodiment of the American dream. All that makes America great. All that will make America great again. All that will keep America great.

Their American dream—that this is a land of equal opportunity, committed to freedom and equality, where police officers protect and serve—is a lie. Their American dream—that they have more because they are more, that when black people have more, they were given more—is a lie. Their American dream—that they have the civil right to kill black Americans with impunity and that black Americans do not have the human right to live—is a lie.

Take Minneapolis. Black residents are more likely than white residents to be pulled over, arrested, and victimized by its police force. Even as black residents account for 20 percent of the city’s population, they make up 64 percent of the people Minneapolis police restrained by the neck since 2018, and more than 60 percent of the victims of Minneapolis police shootings from late 2009 to May 2019. According to Samuel Sinyangwe of Mapping Police Violence, Minneapolis police are 13 times more likely to kill black residents than to kill white residents, one of the largest racial disparities in the nation. And these police officers rarely get prosecuted.

A typical black family in Minneapolis earns less than half as much as a typical white family—a $47,000 annual difference that is one of the largest racial disparities in the nation. Statewide, black residents are 6 percent of the Minnesota population, but 30 percent of the coronavirus cases as of Saturday, one of the largest black case disparities in the nation, according to the COVID Racial Data Tracker.

In April, many Americans chose the racist explanation: saying black people were not taking the coronavirus as seriously as white people, until challenged by survey data and majority-white demonstrations demanding that states reopen. Then they argued that black Americans were disproportionately dying from COVID-19 because they have more preexisting conditions, due to their uniquely unhealthy behaviors. But according to the Foundation for AIDS Research, structural factors such as employment, access to health insurance and medical care, and the air and water quality in neighborhoods are drivers of black infections and deaths, and not “intrinsic characteristics of black communities or individual-level factors.”

Americans should be asking: Why are so many unarmed black people being killed by police while armed white people are simply arrested? Why are officials addressing violent crime in poorer neighborhoods by adding more police instead of more jobs? Why are black (and Latino) people during this pandemic less likely to be working from home; less likely to be insured; more likely to live in trauma-care deserts, lacking access to advanced emergency care; and more likely to live in polluted neighborhoods? The answer is what the Frederick Hoffmans of today refuse to believe: racism.

In the past two decades, the list of British calamities, policy misjudgments, and forecasting failures has been eye-watering: the disaster of Iraq, the botched Libyan intervention in 2011, the near miss of Scottish independence in 2014, the woeful handling of Britain’s divorce from the European Union from 2016 onward

What emerges is a picture of a country whose systemic weaknesses were exposed with appalling brutality, a country that believed it was stronger than it was, and that paid the price for failures that have built up for years

The most difficult question about all this is also the simplest: Why?

Like much of the Western world, Britain had prepared for an influenza pandemic, whereas places that were hit early—Hong Kong, South Korea, Singapore, Taiwan—had readied themselves for the type of respiratory illness that COVID-19 proved to be.

Britain’s pandemic story is not all bad. The NHS is almost universally seen as having risen to the challenge; the University of Oxford is leading the race to develop the first coronavirus vaccine for international distribution, backed with timely and significant government cash; new hospitals were built and treatments discovered with extraordinary speed; the welfare system did not collapse, despite the enormous pressure it suddenly faced; and a national economic safety net was rolled out quickly.

One influential U.K. government official told me that although individual mistakes always happen in a fast-moving crisis, and had clearly taken place in Britain’s response to COVID-19, it was impossible to escape the conclusion that Britain was simply not ready. As Ian Boyd, a professor and member of SAGE, put it: “The reality is, there has been a major systemic failure.”

“It’s obvious that the British state was not prepared for” the pandemic, this official told me. “But, even worse, many parts of the state thought they were prepared, which is significantly more dangerous.”

When the crisis came, too much of Britain’s core infrastructure simply failed, according to senior officials and experts involved in the pandemic response

The human immune system actually has two parts. There is, as Cummings correctly identifies, the adaptive part. But there is also an innate part, preprogrammed as the first line of defense against infectious disease. Humans need both. The same is true of a state and its government, said those I spoke with—many of whom were sympathetic to Cummings’s diagnosis. Without a functioning structure, the responsive antibodies of the government and its agencies cannot learn on the job. When the pandemic hit, both parts of Britain’s immune system were found wanting.

The consequences may be serious and long term, but the most immediately tragic effect was that creating space in hospitals appears to have been prioritized over shielding Britain’s elderly, many of whom were moved to care homes, part of what Britain calls the social-care sector, where the disease then spread. Some 25,000 patients were discharged into these care homes between March 17 and April 16, many without a requirement that they secure a negative coronavirus test beforehand.

There was a bit too much exceptionalism about how brilliant British science was at the start of this outbreak, which ended up with a blind spot about what was happening in Korea, Taiwan, Singapore, where we just weren’t looking closely enough, and they turned out to be the best in the world at tackling the coronavirus,” a former British cabinet minister told me.

The focus on influenza pandemics and the lack of a tracing system were compounded by a shortfall in testing capacity.

Johnson’s strategy throughout was one that his hero Winston Churchill raged against during the First World War, when he concluded that generals had been given too much power by politicians. In the Second World War, Churchill, by then prime minister and defense secretary, argued that “at the summit, true politics and strategy are one.” Johnson did not take this approach, succumbing—as his detractors would have it—to fatalistic management rather than bold leadership, empowering the generals rather than taking responsibility himself

“It was a mixture of poor advice and fatalism on behalf of the experts,” one former colleague of Johnson’s told me, “and complacency and boosterism on behalf of the PM.”

What it all adds up to, then, is a sobering reality: Institutional weaknesses of state capacity and advice were not corrected by political judgment, and political weaknesses were not corrected by institutional strength. The system was hardwired for a crisis that did not come, and could not adapt quickly enough to the one that did.

Britain’s NHS has come to represent the country itself, its sense of identity and what it stands for. Set up in 1948, it became known as the first universal health-care system of any major country in the world (although in reality New Zealand got there first). Its creation, three years after victory in the Second World War, was a high-water mark in the country’s power and prestige—a time when it was a global leader, an exception.

Every developed country in the world, apart from the United States, has a universal health-care system, many of which produce better results than the NHS.

When the pandemic hit, then, Britain was not the strong, successful, resilient country it imagined, but a poorly governed and fragile one. The truth is, Britain was sick before it caught the coronavirus.

In asking the country to rally to the NHS’s defense, Johnson was triggering its sense of self, its sense of pride and national unity—its sense of exceptionalism.

Before the coronavirus, the NHS was already under considerable financial pressure. Waiting times for appointments were rising, and the country had one of the lowest levels of spare intensive-care capacity in Europe. In 2017, Simon Stevens, the NHS’s chief executive, compared the situation to the time of the health sevice’s founding decades prior: an “economy in disarray, the end of empire, a nation negotiating its place in the world.”

Yet from its beginnings, the NHS has occupied a unique hold on British life. It is routinely among the most trusted institutions in the country. Its key tenet—that all Britons will have access to health care, free at the point of service—symbolizes an aspirational egalitarianism that, even as inequality has risen since the Margaret Thatcher era, remains at the core of British identity.

In effect, Britain was rigorously building capacity to help the NHS cope, but releasing potentially infected elderly, and vulnerable, patients in the process. By late June, more than 19,000 people had died in care homes from COVID-19. Separate excess-death data suggest that the figure may be considerably higher

Britain failed to foresee the dangers of such an extraordinary rush to create hospital capacity, a shift that was necessary only because of years of underfunding and decades of missed opportunities to bridge the divide between the NHS and retirement homes, which other countries, such as Germany, had found the political will to do.

Ultimately, the scandal is a consequence of a political culture that has proved unable to confront and address long-term problems, even when they are well known.

other health systems, such as Germany’s, which is better funded and decentralized, performed better than Britain’s. Those I spoke with who either are in Germany or know about Germany’s success told me there was an element of luck about the disparity with Britain. Germany had a greater industrial base to produce medical testing and personal protective equipment, and those who returned to Germany with the virus from abroad were often younger and healthier, meaning the initial strain on its health system was less.

However, this overlooks core structural issues—resulting from political choices in each country—that meant that Germany proved more resilient when the crisis came, whether because of the funding formula for its health system, which allows individuals more latitude to top up their coverage with private contributions, or its decentralized nature, which meant that separate regions and hospitals were better able to respond to local outbreaks and build their own testing network.

Also unlike Britain, which has ducked the problem of reforming elderly care, Germany created a system in 1995 that everyone pays into, avoids catastrophic costs, and has cross-party support.

A second, related revelation of the crisis—which also exposed the failure of the British state—is that underneath the apparent simplicity of the NHS’s single national model lies an engine of bewildering complexity, whose lines of responsibility, control, and accountability are unintelligible to voters and even to most politicians.

Britain, I was told, has found a way to be simultaneously overcentralized and weak at its center. The pandemic revealed the British state’s inability to manage the nation’s health:

Since at least the 1970s, growing inequality between comparatively rich southeast England (including London) and the rest of the country has spurred all parties to pledge to “rebalance the economy” and make it less reliant on the capital. Yet large parts remain poorer than the European average. According to official EU figures, Britain has five regions with a per capita gross domestic product of less than $25,000. France, Germany, Ireland, Austria, the Netherlands, Denmark, and Sweden have none

If Britain were part of the United States, it would be anywhere from the third- to the eighth-poorest state, depending on the measure.

Britain’s performance in this crisis has been so bad, it is damaging the country’s reputation, both at home and abroad.

Inside Downing Street, officials believe that the lessons of the pandemic apply far beyond the immediate confines of elderly care and coronavirus testing, taking in Britain’s long-term economic failures and general governance, as well as what they regard as its ineffective foreign policy and diplomacy.

the scale of the task itself is enormous. “We need a complete revamp of our government structure because it’s not fit for purpose anymore,” Boyd told me. “I just don’t know if we really understand our weakness.”

In practice, does Johnson have the confidence to match his diagnosis of Britain’s ills, given the timidity of his approach during the pandemic? The nagging worry among even Johnson’s supporters in Parliament is that although he may campaign as a Ronald Reagan, he might govern as a Silvio Berlusconi, failing to solve the structural problems he has identified.

This is not a story of pessimistic fatalism, of inevitable decline. Britain was able to partially reverse a previous slump in the 1980s, and Germany, seen as a European laggard in the ‘90s, is now the West’s obvious success story. One of the strengths of the Westminster parliamentary system is that it occasionally produces governments—like Johnson’s—with real power to effect change, should they try to enact it.

It has been overtaken by many of its rivals, whether in terms of health provision or economic resilience, but does not seem to realize it. And once the pandemic passes, the problems Britain faces will remain: how to sustain institutions so that they bind the country together, not pull it apart; how to remain prosperous in the 21st century’s globalized economy; how to promote its interests and values; how to pay for the ever-increasing costs of an aging population.

“The really important question,” Boyd said, “is whether the state, in its current form, is structurally capable of delivering on the big-picture items that are coming, whether pandemics or climate change or anything else.”