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Javier E

Opinion | The Green Transition Is Happening Fast. The Climate Bill Will Only Speed It U... - 0 views

  • Among the first things you likely heard about the Inflation Reduction Act was its size.The bill, signed into law by President Biden on Tuesday, makes $369 billion in climate and energy investments — by far the largest such investment in American history.
  • But there are several ways to measure the size of a bill, and given how high the country’s emissions targets are, even many of the I.R.A.’s supporters will openly concede that it is, on its own, inadequate
  • it is ultimately how much carbon we put into the atmosphere and not how much solar power we produce that determines the future of warming. But the power of carrots also just reflects some new realities: To simplify radically, a 90 percent reduction in the cost of solar power over the last decade means that the same amount of money now goes ten times as far.
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  • the broader economic and cultural landscape is so different now than it was just a few years ago that public investments of even this somewhat smaller scale appear poised to make an enormous difference.
  • That’s because those public investments are being made not against dirty-energy headwinds but with the support of much broader tailwinds
  • Thanks to technological change and the plunging cost of renewables, a growing political and cultural focus on decarbonization and increasing awareness of the public health costs of pollution and market trends for things like electric vehicles and heat pumps, it’s genuinely a whole new world out there. Not that long ago, the upfront cost of a green transition looked almost incalculably large. Today it seems plausible that quite dramatic emissions gains can be achieved for just, say, $369 billion
  • For 90 percent of the world, clean energy is now cheaper than dirty alternatives, and while countries like Spain are boasting about more than tripling solar power capacity by 2030, in Texas, solar output has grown 39-fold in just six years. Globally, renewable output has grown fourfold in the past decade
  • Ten years ago, when the United States endeavored to tackle the problem of climate change, it tried to do so largely by punishing the cost of dirty energy with a cap-and-trade system. This time, it’s giving a kick-start, or a boost of momentum, to an already ongoing green transition.
  • this strategic choice of carrots rather than sticks has received some deserved praise: It’s better and more popular to subsidize cheap, clean energy than it is to make the bad stuff more expensive
  • A “fair share” analysis suggests the United States — today the world’s second largest emitter, and historically the largest by far — should be moving faster than any nation in the world.
  • The models may ultimately prove optimistic, given the complications of infrastructure build-out
  • it is fair to wonder about the uncertain economics of some of the bill’s technological bets, like carbon capture and storage, which could allow emissions from industry and power generation to be trapped and sequestered, and which some climate activists and environmental justice advocates distrust
  • Jesse Jenkins, who leads the REPEAT Project, says he believes that the tech problems of C.C.S. have been solved and that, with tax credits, the bill will address its cost problem, leading to a dramatic scale-up in use. Julio Friedmann, a former Obama-era Energy Department official turned carbon removal advocate, says that a rapid scale-up of C.C.S. would be, while miraculous, also plausible.
  • the fact that this much climate progress appears even remotely possible for less than the annualized budget of the State Department, as Ben Dreyfuss recently put it, is a remarkable reflection of the state of green energy today, even without the new law. When it comes to emissions, we are no longer fighting an uphill battle, at least in the United States and many other countries like it. We are deciding how quickly to race downhill.
  • at the risk of playing Pollyanna, I think it is also possible to see the size of the bill — its relative smallness — as at least a mark of good news
  • The headline projection of the I.R.A. impact appears, if inadequate by the standards of the Paris agreement, nevertheless impressive: a 40 percent reduction in just eight years
  • already today the United States has reduced emissions 20 percent from 2005 levels, and was projected to reduce them further even without the benefit of the I.R.A. As recently as a few weeks ago, before the bill was revived, it might have felt like the United States was permanently stalled on climate action, but in fact the country was already moving to decarbonize, if not fast enough.
  • peed really matters; as the writer and activist Bill McKibben put it, when it comes to warming, “winning slowly is the same as losing.” Simply moving in the right direction isn’t enough, and too much time has been squandered — within the United States and globally — to avoid what was once described as a catastrophic climate future.
  • If the United States achieves that 40 percent reduction, that’s still well short of the country’s target of a 50-52 percent reduction by 2030. The gap may seem relatively small, but it represents more than half a billion tons of carbon each year. That’s a lot.
  • the I.R.A. is a compromise, obviously and outwardly, tying new leases for wind power development to new ones for oil and gas, only moderately reducing the country’s demand for oil and gas over the next decade and investing less in environmental justice measures than Biden himself promised not too long ago
  • But its basic bet — that many of these markets and technologies are close enough to tipping points that relatively small public support can get them racing toward inevitability — also means the ultimate impacts could be larger and far-reaching.
  • The effects on prices and markets could make state and local action cheaper and easier, and even federal regulation more palatable
  • the bill includes some unheralded provisions to help retire coal power more quickly, as Keane Bhatt, the policy director for the Progressive Caucus, has pointed out, as well as an under-discussed “stick” in the form of a fee for methane
  • The impact of its “green bank” and Energy Department loans could be quite large — some estimates have suggested they could run into the hundreds of billions, and the $27 billion handed to the Green Bank could catalyze ten times as much private capital
  • because much of the I.R.A.’s top-line “investment” comes in the form of tax credits, its outlays — and impacts — could ultimately grow substantially if certain sectors (wind, solar and C.C.S., for instance) really do take off.
  • This might not ultimately be just a $369 billion package, in other words, but something quite a bit bigger. Enough to get us to 50 percent by 2030? “I think we have a pretty good chance,” Jenkins says.
  • it is striking that, given where we were not that long ago, such a proposition seems credible at all. Here’s hoping.
  • The provisions tying future auctions for wind power to leases for oil and gas development have been called “poison pills,” because they appear to lock in future emissions. But the ultimate impact is likely to be quite small. (Energy Innovation estimates at most 50 million tons of additional annual carbon emissions, compared with a billion in reductions from other measures in the bill.)
Javier E

Opinion | With Covid, Is It Really Possible to Say We Went Too Far? - The New York Times - 0 views

  • In 2020, many Americans told themselves that all it would take to halt the pandemic was replacing the president and hitting the “science button.”
  • In 2023, it looks like we’re telling ourselves the opposite: that if we were given the chance to run the pandemic again, it would have been better just to hit “abort” and give up.
  • you can see it in Bethany McLean and Joe Nocera’s book “The Big Fail: What the Pandemic Revealed About Who America Protects and Who It Leaves Behind,” excerpted last month in New York magazine under the headline “Covid Lockdowns Were a Giant Experiment. It Was a Failure.”
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  • we can’t simply replace one simplistic narrative, about the super power of mitigation policy, for another, focused only on the burdens it imposed and not at all on the costs of doing much less — or nothing at all.
  • Let’s start with the title. What is the big failure, as you see it?
  • McLean: I think it gets at things that had happened in America even before the pandemic hit. And among those things were, I think, a failure to recognize the limits of capitalism, a failure of government to set the right rules for it, particularly when it comes to our health care system; a focus on profits that may have led to an increase in the bottom line but created fragility in ways people didn’t understand; and then our growing polarization that made us incapable of talking to each other
  • How big is the failure? When I look at The Economist’s excess mortality data, I see the U.S. had the 53rd-worst outcome in the world — worse than all of Western Europe, but better than all of Eastern Europe.
  • McLean: I think one way to quantify it is to take all those numbers and then put them in the context of our spending on health care. Given the amount we spend on health care relative to other countries, the scale of the failure becomes more apparent.
  • o me, the most glaring example is the schools. They were closed without people thinking through the potential consequences of closing down public schools, especially for disadvantaged kids.
  • to compound it, in my view, public health never made the distinction that needed to be made between the vulnerabilities of somebody 70 years old and the vulnerabilities of somebody 10 years old.
  • In the beginning of the book you write, in what almost feels like a thesis statement for the book: “A central tenet of this book is that we could not have done better, and pretending differently is a dangerous fiction, one that prevents us from taking a much needed look in the mirror.”
  • This claim, that the U.S. could not have done any better, runs against your other claim, that what we observed was an American failure. It is also a pretty extreme claim, I think, and I wanted to press you on it in part because it is, in my view, undermined by quite a lot of the work you do in the book itself.
  • Would the U.S. not have done better if it had recognized earlier that the disease spread through the air rather than in droplets? Would it not have done better if it hadn’t bungled the rollout of a Covid test in the early months?
  • McLean: Everything that you mentioned — the point of the book is that those were set by the time the pandemic hit.
  • in retrospect, what we were doing was to try to delay as much spread as we could until people got vaccinated. All the things that we did in 2020 were functionally serving or trying to serve that purpose. Now, given that, how can you say that none of that work saved lives?
  • McLean: I think that the test failure was baked into the way that the C.D.C. had come to operate
  • But the big question I really want to ask is this one: According to the C.D.C., we’ve had almost 1.2 million deaths from Covid. Excess mortality is nearly 1.4 million. Is it really your contention that there was nothing we might’ve done that brought that total down to 1.1 million, for instance, or even 900,000?
  • McLean: It’s very — you’re right. If you went through each and every thing and had a crystal ball and you could say, this could have been done, this could have been moved up by a month, we could have gotten PPE …
  • When I came to that sentence, I thought of it in terms of human behavior: What will humans put up with? What will humans stand for? How do Americans act? And you’ve written about Sweden being sort of average, and you’ve written about China and the Chinese example. They lock people up for two years and suddenly the society just revolts. They will not take it anymore. They can’t stand it. And as a result, a million and a half people die in a month and a half.
  • Well, I would tell that story very differently. For me, the problem is that when China opened up, they had fully vaccinated just under two-thirds of their population over 80. So to me, it’s not a failure of lockdowns. It’s a failure of vaccinations. If the Chinese had only achieved the same elderly vaccination rate as we achieved — which by global standards was pretty poor — that death toll when they opened up would have been dramatically lower.
  • What do you mean by “lockdown,” though? You use the word throughout the book and suggest that China was the playbook for all countries. But you also acknowledge that what China did is not anything like what America did.
  • Disparities in health care access — is it a dangerous fiction to think we might address that? You guys are big champions of Operation Warp Speed — would it not have been better if those vaccines had been rolled out to the public in nine months, rather than 12
  • . But this isn’t “lockdown” like there were lockdowns in China or even Peru. It’s how we tried to make it safer to go out and interact during a pandemic that ultimately killed a million Americans.
  • McLean: I think that you’re absolutely right to focus on the definition of what a lockdown is and how we implemented them here in this country. And I think part of the problem is that we implemented them in a way that allowed people who were well off and could work from home via Zoom to be able to maintain very much of their lives while other people couldn’t
  • And I think it depends on who you were, whether you would define this as a lockdown or not. If you were a small business who saw your small business closed because of this, you’re going to define it as a lockdown.
  • n the book you’re pretty definitive. You write, “maybe the social and economic disasters that lockdowns created would have been worth it if they had saved lives, but they hadn’t.” How can you say that so flatly?
  • I think there are still open questions about what worked and how much. But the way that I think about all of this is that the most important intervention that anybody did anywhere in the world was vaccination. And the thing that determined outcomes most was whether your first exposure came before or after vaccination.
  • Here, the shelter-in-place guidelines lasted, on average, five to seven weeks. Thirty nine of the 40 states that had issued them lifted them by the end of June, three months in. By the summer, according to Google mobility data, retail and grocery activity was down about 10 percent. By the fall, grocery activity was only down about 5 percent across the country
  • Nocera: Well, on some level, I feel like you’re trying to have it both ways. On the one hand, you’re saying that lockdowns saved lives. On the other hand, you said they weren’t real lockdowns because everybody was out and about.
  • I don’t think that’s having it both ways. I’m trying to think about these issues on a spectrum rather than in binaries. I think we did interrupt our lives — everybody knows that. And I think they did have an effect on spread, and that limiting spread had an effect by delaying infections until after vaccination.
  • Nocera: Most of the studies that say lockdowns didn’t work are really less about Covid deaths than about excess mortality deaths. I wound up being persuaded that the people who could not get to the hospital, because they were all working, because all the doctors were working on Covid and the surgical rooms were shut down, the people who caught some disease that was not Covid and died as a result — I wound up being persuaded about that.
  • We’re in a pandemic. People are going to die. And then the question becomes, can we protect the most vulnerable? And the answer is, we didn’t protect the most vulnerable. Nursing homes were a complete disaster.
  • There was a lot of worry early on about delayed health care, and about cancer in particular — missed screenings, missed treatments. But in 2019, we had an estimated 599,600 Americans die of cancer. In 2020, it was 602,000. In 2021, it was 608,000. In 2022, it was 609,000.
  • Nocera: See, it went up!But by a couple of thousand people, in years in which hundreds of thousands of Americans were dying of Covid.
  • Nocera: I think you can’t dispute the excess mortality numbers.I’m not. But in nearly every country in the world the excess mortality curves track so precisely with Covid waves that it doesn’t make sense to talk about a massive public health problem beyond Covid. And when you add all of these numbers up, they are nowhere near the size of the footfall of Covid. How can you look back on this and say the costs were too high?
  • Nocera: I think the costs were too high because you had school costs, you had economic costs, you had social costs, and you had death.
  • McLean: I think you’re raising a really good point. We’re making an argument for a policy that might not have been doable given the preconditions that had been set. I’m arguing that there were these things that had been put in place in our country for decades leading up to the pandemic that made it really difficult for us to plant in an effective way, from the outsourcing of our PPE to the distrust in our health care system that had been created by people’s lack of access to health care with the disparities in our hospital system.
  • How would you have liked to see things handled differently?Nocera: Well, the great example of doing it right is San Fran
  • I find the San Francisco experience impressive, too. But it was also a city that engaged in quite protracted and aggressive pandemic restrictions, well beyond just protecting the elderly and vulnerable.
  • McLean: But are we going to go for stay-at-home orders plus protecting vulnerable communities like San Francisco did? Or simply letting everybody live their lives, but with a real focus on the communities and places like nursing homes that were going to be affected? My argument is that we probably would’ve been better off really focusing on protecting those communities which were likely to be the most severely affected.
  • I agree that the public certainly didn’t appreciate the age skew, and our policy didn’t reflect it either. But I also wonder what it would mean to better protect the vulnerable than we did. We had testing shortages at first. Then we had resistance to rapid testing. We had staff shortages in nursing homes.
  • Nocera: This gets exactly to one of our core points. We had spent 30 years allowing nursing homes to be owned by private equity firms that cut the staff, that sold the land underneath and added all this debt on
  • I hear you saying both that we could have done a much better job of protecting these people and that the systems we inherited at the outset of the pandemic would’ve made those measures very difficult, if not impossible, to implement.
  • But actually, I want to stop you there, because I actually think that that data tells the opposite story.
  • And then I’m trying to say at the same time, but couldn’t we have done something to have protected people despite all of that?
  • I want to talk about the number of lives at stake. In the book, you write about the work of British epidemiologist Neil Ferguson. In the winter of 2020, he says that in the absence of mitigation measures and vaccination, 80 percent of the country is going to get infected and 2.2 million Americans are going to die. He says that 80 percent of the U.K. would get infected, and 510,000 Brits would die — again, in the abs
  • In the end, by the time we got to 80 percent of the country infected, we had more than a million Americans die. We had more than 200,000 Brits die. And in each case most of the infections happened after vaccination, which suggests that if those infections had all happened in a world without vaccines, we almost certainly would have surpassed two million deaths in the U.S. and almost certainly would’ve hit 500,000 deaths in the U.K.
  • In the book, you write about this estimate, and you endorse Jay Bhattacharya’s criticism of Ferguson’s model. You write, “Bhattacharya got his first taste of the blowback reserved for scientists who strayed from the establishment position early. He co-wrote an article for The Wall Street Journal questioning the validity of the scary 2 to 4 percent fatality rate that the early models like Neil Ferguson’s were estimating and that were causing governments to panic. He believed, correctly as it turns out, that the true fatality rate was much lower.”
  • Nocera: I know where you’re going with this, because I read your story about the nine pandemic narratives we’re getting wrong. In there, you said that Bhattacharya estimated the fatality rate at 0.01 percent. But if you actually read The Wall Street Journal article, what he’s really saying is I think it’s much lower. I’ve looked at two or three different possibilities, and we really need some major testing to figure out what it actually is, because I think 2 percent to 4 percent is really high.
  • He says, “if our surmise of 6 million cases is accurate, that’s a mortality rate of 0.01%. That is ⅒th the flu mortality rate of 0.1%.” An I.F.R. of 0.01 percent, spread fully through the American population, yields a total American death toll of 33,000 people. We have had 1.2 million deaths. And you are adjudicating this dispute, in 2023, and saying that Neil was wrong and Jay was right.
  • hird, in the Imperial College report — the one projecting two million American deaths — Ferguson gives an I.F.R. estimate of 0.9 percent.
  • Bhattacharya’s? Yes, there is some uncertainty around the estimate he offers. But the estimate he does offer — 0.01 percent — is one hundred times lower than the I.F.R. you yourselves cite as the proper benchmark.
  • Nocera: In The Wall Street Journal he does not say it’s 0.01. He says, we need to test to find out what it is, but it is definitely lower than 2 to 4 percent.
  • Well, first of all, the 2 percent to 4 percent fatality rate is not from Neil Ferguson. It’s from the W.H.O.
  • But I think that fundamentally, at the outset of the pandemic, the most important question orienting all of our thinking was, how bad could this get? And it turns out that almost all of the people who were saying back then that we shouldn’t do much to intervene were extremely wrong about how bad it would be
  • The argument then was, more or less, “We don’t need to do anything too drastic, because it’s not going to be that big a deal.” Now, in 2023, it’s the opposite argument: “We shouldn’t have bothered with restrictions, because they didn’t have an impact; we would have had this same death toll anyway.” But the death toll turned out to be enormous.
  • Now, if we had supplied all these skeptics with the actual numbers at the outset of the pandemic, what kind of audience would they have had? If instead of making the argument against universal mitigation efforts on the basis of a death toll of 40,000 they had made the argument on the basis of a death toll of more than a million, do you think the country would’ve said, they’re right, we’re doing too much, let’s back off?
  • McLean: I think that if you had gone to the American people and said, this many people are going to die, that would’ve been one thing. But if you had gone to the American people and said, this many people are going to die and a large percentage of them are going to be over 80, you might’ve gotten a different answer.
  • I’m not arguing we shouldn’t have been trying to get a clearer sense of the true fatality rate, or that we shouldn’t have been clearer about the age skew. But Bhattacharya was also offering an estimate of fatality rate that turned out to be off by a factor of a hundred from the I.F.R. that you yourselves cite as correct. And then you say that Bhattacharya was right and Ferguson was wrong.
  • And you, too, Joe, you wrote an article in April expressing sympathy for Covid skeptics and you said ——Nocera: This April?No, 2020.Nocera: Oh, oh. That’s the one where I praised Alex Berenson.You also cited some Amherst modeling which said that we were going to have 67,000 to 120,000 American deaths. We already had, at that point, 60,000. So you were suggesting, in making an argument against pandemic restrictions, that the country as a whole was going to experience between 7,000 and 60,000 additional deaths from that point.
  • when I think about the combination of the economic effects of mitigation policies and just of the pandemic itself and the big fiscal response, I look back and I think the U.S. managed this storm relatively well. How about each of you?
  • in this case, Congress did get it together and did come to the rescue. And I agree that made a ton of difference in the short term, but the long-term effects of the fiscal rescue package were to help create inflation. And once again, inflation hits those at the bottom of the socioeconomic distribution much harder than it does those at the top. So I would argue that some of what we did in the pandemic is papering over these long-term issues.
  • I think as with a lot of the stuff we’ve talked about today, I agree with you about the underlying problems. But if we take for granted for a moment that the pandemic was going to hit us, when it did, under the economic conditions it did, and then think about the more narrow context of whether, given all that, we handled the pandemic well. We returned quickly to prepandemic G.D.P. trends, boosted the wealth of the bottom half of the country, cut child poverty in half, pushed unemployment to historical lows.
  • What sense do you make of the other countries of the world and their various mitigation policies? Putting aside China, there’s New Zealand, Australia, South Korea — these are all places that were much more aggressive than the U.S. and indeed more than Europe. And had much, much better outcomes.
  • Nocera: To be perfectly honest, we didn’t really look, we didn’t really spend a lot of time looking at that.
  • McLean: But one reason that we didn’t is I don’t think it tells us anything. When you look at who Covid killed, then you have to look at what the pre-existing conditions in a country were, what percentage of its people are elderly. How sick are people with pre-existing conditions?
  • I just don’t think there’s a comparison. There’s just too many factors that influence it to be able to say that, to be able to compare America to any other country, you’d have to adjust for all these factors.
  • But you do spend a bit of time in the book talking about Sweden. And though it isn’t precisely like-for-like, one way you can control for some of those factors is grouping countries with their neighbors and other countries with similar profiles. And Sweden’s fatality rate in 2020 was 10 times that of Norway, Finland and Iceland. Five times that of Denmark. In the vaccination era, those gaps have narrowed, but by most metrics Sweden has still done worse, overall, than all of those countries.
  • On the matter of omniscience. Let’s say that we can send you back in time. Let’s put you both in charge of American pandemic response, or at least American communication about the pandemic, in early 2020. What would you want to tell the country? How would you have advised us to respond?
  • McLean: What I would want is honesty and communication. I think we’re in a world that is awash in information and the previous methods of communication — giving a blanket statement to people that may or may not be true, when you know there’s nuance underneath it — simply doesn’t work anymore
  • o I would’ve been much more clear — we think masks might help, we don’t know, but it’s not that big of an ask, let’s do it. We think the early data coming out of Italy shows that these are the people who are really, really at risk from Covid, but it’s not entirely clear yet. Maybe there is spread in schools, but we don’t know. Let’s look at this and keep an open mind and look at the data as it comes in.
Javier E

What Is Middle Class in Manhattan? - NYTimes.com - 0 views

  • middle-class neighborhoods do not really exist in Manhattan
  • “When we got here, I didn’t feel so out of place, I didn’t have this awareness of being middle class,” she said. But in the last 5 or 10 years an array of high-rises brought “uberwealthy” neighbors, she said, the kind of people who discuss winter trips to St. Barts at the dog run, and buy $700 Moncler ski jackets for their children.
  • Even the local restaurants give Ms. Azeez the sense that she is now living as an economic minority in her own neighborhood. “There’s McDonald’s, Mexican and Nobu,” she said, and nothing in between.
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  • In a city like New York, where everything is superlative, who exactly is middle class?
  • “My niece just bought a home in Atlanta for $85,000,” she said. “I almost spend that on rent and utilities in a year.
  • “It’s overwhelmingly housing — that’s the big distortion relative to other places,” said Frank Braconi, the chief economist in the New York City comptroller’s office. “Virtually everything costs more, but not to the degree that housing does.”
  • “Housing has always been one of the ways the middle class has defined itself, by the ability to own your own home. But in New York, you didn’t have to own.” There is no stigma, he said, to renting a place you can afford only because it is rent-regulated; such a situation is even considered enviable.
  • The average Manhattan apartment, at $3,973 a month, costs almost $2,800 more than the average rental nationwide. The average sale price of a home in Manhattan last year was $1.46 million, according to a recent Douglas Elliman report, while the average sale price for a new home in the United States was just under $230,000.
  • New Yorkers also live in a notably unequal place. Household incomes in Manhattan are about as evenly distributed as they are in Bolivia or Sierra Leone — the wealthiest fifth of Manhattanites make 40 times more than the lowest fifth, according to 2010 census data.
  • There is no single, formal definition of class status in this country. Statisticians and demographers all use slightly different methods to divvy up the great American whole into quintiles and median ranges. Complicating things, most people like to think of themselves as middle class. It feels good, after all, and more egalitarian than proclaiming yourself to be rich or poor. A $70,000 annual income is middle class for a family of four, according to the median response in a recent Pew Research Center survey, and yet people at a wide range of income levels, including those making less than $30,000 and more than $100,000 a year, said they, too, belonged to the middle.
  • “You could still go into a bar in Manhattan and virtually everyone will tell you they’re middle class,” said Daniel J. Walkowitz, an urban historian at New York University.
  • The price tag for life’s basic necessities — everything from milk to haircuts to Lipitor to electricity, and especially housing — is more than twice the national average.
  • Without the clear badge of middle-class membership — a home mortgage — it is hard to say where a person fits on the class continuum. So let’s consider the definition of “middle class” through five different lenses.
  • If the money you live on is coming from any kind of investment or dividend, you are probably not middle class, according to Mr. Braconi.
  • If you live in Manhattan and you are making more than $790,000 a year, then congratulations, you are the 1 percent.
  • By one measure, in cities like Houston or Phoenix — places considered by statisticians to be more typical of average United States incomes than New York — a solidly middle-class life can be had for wages that fall between $33,000 and $100,000 a year.
  • By the same formula — measuring by who sits in the middle of the income spectrum — Manhattan’s middle class exists somewhere between $45,000 and $134,000.
  • But if you are defining middle class by lifestyle, to accommodate the cost of living in Manhattan, that salary would have to fall between $80,000 and $235,000. This means someone making $70,000 a year in other parts of the country would need to make $166,000 in Manhattan to enjoy the same purchasing power.
  • Using the rule of thumb that buyers should expect to spend two and a half times their annual salary on a home purchase, the properties in Manhattan that could be said to be middle class would run between $200,000 and $588,000.
  • On the low end, the pickings are slim. The least expensive properties are mostly uptown, in neighborhoods like Yorkville, Washington Heights and Inwood. The most pleasing options in this range, however, are one-bedroom apartments not designed for children or families.
  • “There’s no room for the earlier version of the middle class,” Mr. Walkowitz said. Firefighter, police officer, teacher and manufacturing worker all used to be professions that could lift a family into its ranks. But those kinds of jobs have long left people unable to keep up with soaring real estate prices.
  • Positions that would nudge a family into the upper class elsewhere — say, vice president or director of strategy — and professions like psychologist are solidly middle class in Manhattan.
  • The same holds true for jobs in higher education, a growth sector for the city. The average tenured university professor at New York University or Columbia makes more than $180,000 a year, according to a 2012 survey by The Chronicle of Higher Education. Sweetening the deal for those looking to buy, N.Y.U. has offered mortgage assistance and discounted loans, while qualified Columbia faculty are eligible for a subsidy of up to $40,000 a year. Some faculty members benefit from university housing that rents well below the market rate, in prime locations on the Upper West Side and in Greenwich Village.
  • Because her building is owned by Columbia, her rent, about $1,800 a month, is manageable on an associate professor’s salary, which averages about $125,000. A similar market-rate apartment on the Upper West Side costs about $6,000 a month,
  • One way to stay in Manhattan as a member of the middle class is to be in a relationship. Couples can split the cost of a one-bedroom apartment, along with utilities and takeout meals. But adding small roommates, especially the kind that do not contribute to rent, creates perhaps the single greatest obstacle to staying in the city.
  • Only 17 percent of Manhattan households have children, according to census data. That is almost half the national average, making little ones the ultimate deal-breaker for otherwise die-hard middle-class Manhattanites.
  • “Understanding who is middle class, in New York, but especially Manhattan, is all about when you got into the real estate market,” he said. “If you bought an apartment prior to 2000, or have long been in a rent-stabilized apartment, you could probably be a teacher in Manhattan and be solidly middle class. But if you bought or started renting in a market-rate apartment over the last 5 or 10 years, you could probably be a management consultant and barely have any savings.”
  • “The only artists I know now who are still in Manhattan,” she said, “either made it big and bought, or are still in the rent-controlled studios they landed in 1976, and will leave in a coffin.”
  • People define class as much by association and culture as they do by raw numbers — a sense, more than anything, of baseline financial security garnished by an occasional luxury like a vacation, and a belief that things can get better through hard work and determination.
  • In the last decade, the percentage of people who are paying “unaffordable rents” (defined as more than 30 percent of their income) has increased significantly, according to a report issued in September by the city’s comptroller.
  • The only young people she sees moving in around her are often buoyed by parental support, given an apartment at graduation the way she was given a Seiko watch. As her own friends and neighbors age or die out, she wonders, “who is going to take our place?”
Javier E

Examinations of Health Care Overlook Mergers - NYTimes.com - 0 views

  • What is missing from the stampede of policy innovation is something to tackle one of the best-known causes of high costs in the book: excessive market concentration.
  • The share of metropolitan areas with highly concentrated hospital markets, by the standards of antitrust enforcers at the Justice Department and the Federal Trade Commission, rose to 77 percent from 63 percent over the period.
  • If there is one thing that economists know, it is that market concentration drives prices up — and quality and innovation down.
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  • And consolidation is continuing. Professor Gaynor counts more than 1,000 hospital system mergers since the mid-1990s, often involving dozens of hospitals. In 2002 doctors owned about three in four physician practices. By 2008 more than half were owned by hospitals.
  • hospitals raise prices by about 40 percent after the merger of nearby rivals.
  • recent evidence suggests that health care costs are not being driven by intensive use of high-tech procedures as much as by rising prices for even the most humdrum treatments, which are today among the most expensive in the world.
  • Other studies have found that hospital mergers increase the number of uninsured in the vicinity. Still others even suggest that market concentration may hurt the quality of care.
  • the rising health care spending of Americans under 65 in the last two years has been driven entirely by rising prices; not by more use. The unit price of inpatient care jumped 5.9 percent last year, while the price for outpatient services increased 9.6 percent.
  • Corporate America could help more. Large companies, like Wal-Mart Stores, Lowe’s and PepsiCo, have cut deals with hospitals like the Mayo Clinic or the Cleveland Clinic to provide specialized care, including cardiac care or spinal surgery, for all their workers across the nation. This will allow them to get around the market power of local hospitals. Others could follow their example.
  • The Affordable Care Act could help reduce prices too. Forced to compete on price, plans in the new health insurance exchanges will pressure medical providers to limit costs, much as H.M.O.’s did briefly in the 1990s. The “Cadillac tax” on high-end health plans will also encourage some companies to drop high-priced policies.
  • Merger activity has jumped in anticipation of the law’s coming fully into effect. “Hospitals want to maintain their revenue streams and enhance their bargaining leverage,” said Professor Gaynor. “This is a way to do so.”
Javier E

The EpiPen, a Case Study in Health System Dysfunction - The New York Times - 0 views

  • the story of EpiPens can also explain so much of what’s wrong with our health care system.
  • Epinephrine is very, very cheap. Even in the developing world, it costs less than a dollar per milliliter, and there’s less than a third of that in an EpiPen.
  • The EpiPen isn’t new; it has been in use since 1977. Research and development costs were recouped long ago. Nine years ago, it was bought by the pharmaceutical company Mylan, which then began to sell the device. When Mylan bought it, EpiPens cost about $57 each.
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  • Unfortunately, epinephrine is inherently unstable. Research shows that it degrades pretty quickly over time, and it’s recommended that EpiPens be replaced every year.
  • Mylan stopped selling individual EpiPens and began to sell only twin-packs.It also raised the price.
  • Kids need them in many places. They need them at home. They need them at school. They need them at camp. They may even want to stash one at Grandma’s house. So people often need to buy quite a few.More revenue for Mylan. And it raised the price.
  • Then in 2010, federal guidelines changed to recommend that two EpiPens be sold in a package instead of one
  • People in anaphylaxis need a full dose every time. They therefore need to replace all their EpiPens every year, again and again.
  • In 2013, the government went further. It passed a law that gave funding preferences for asthma treatment grants to states that maintained an emergency supply of EpiPens. As the near sole supplier of the devices, Mylan stood to make even more money. Advertisement Continue reading the main story That year, Mylan raised the price again.
  • Of course, competition would bring the price down. But it’s very hard to bring such a device to market.
  • setbacks, all in the last year, have once again left Mylan with a veritable run of the market. It raised the price of EpiPens again. As of this May, they cost more than $600 a pack. Since 2004, after adjusting for inflation, the price of EpiPens has risen more than 450 percent.
  • An alternative still exists. The Adrenaclick, while still not cheap, is back and less expensive than the EpiPen. Some think it’s harder to use, though. It’s not on the accepted list for many health insurance plans. More important, few physicians think of it. Because of that, they write prescriptions for EpiPens. Since the Adrenaclick is not a generic version of the EpiPen, pharmacists can’t substitute one for the other. A prescription for an EpiPen must be filled with an EpiPen, regardless of what consumers might want.
  • you could argue that they’re an alternative when the “Cadillac” EpiPens are financially out of reach. Write A Comment But those are unsatisfactory arguments. Epinephrine isn’t an elective medication. It doesn’t last, so people need to purchase the drug repeatedly. There’s little competition, but there are huge hurdles to enter the market, so a company can raise the price again and again with little pushback. The government encourages the product’s use, but makes no effort to control its cost. Insurance coverage shields some from the expense, allowing higher prices, but leaves those most at-risk most exposed to extreme out-of-pocket outlays. The poor are the most likely to consider going without because they can’t afford it.
  • EpiPens are a perfect example of a health care nightmare. They’re also just a typical example of the dysfunction of the American health care system.
Javier E

Essay-Grading Software, as Teacher's Aide - Digital Domain - NYTimes.com - 0 views

  • AS a professor and a parent, I have long dreamed of finding a software program that helps every student learn to write well. It would serve as a kind of tireless instructor, flagging grammatical, punctuation or word-use problems, but also showing the way to greater concision and clarity.
  • The standardized tests administered by the states at the end of the school year typically have an essay-writing component, requiring the hiring of humans to grade them one by one.
  • the Hewlett Foundation sponsored a study of automated essay-scoring engines now offered by commercial vendors. The researchers found that these produced scores effectively identical to those of human graders.
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  • humans are not necessarily ideal graders: they provide an average of only three minutes of attention per essa
  • We are talking here about providing a very rough kind of measurement, the assignment of a single summary score on, say, a seventh grader’s essay
  • “A few years back, almost all states evaluated writing at multiple grade levels, requiring students to actually write,” says Mark D. Shermis, dean of the college of education at the University of Akron in Ohio. “But a few, citing cost considerations, have either switched back to multiple-choice format to evaluate or have dropped writing evaluation altogether.”
  • As statistical models for automated essay scoring are refined, Professor Shermis says, the current $2 or $3 cost of grading each one with humans could be virtually eliminated, at least theoretically.
  • the cost of commercial essay-grading software is now $10 to $20 a student per year. But as the technology improves and the costs drop, he expects that it will be incorporated into the word processing software that all students use
  • As essay-scoring software becomes more sophisticated, it could be put to classroom use for any type of writing assignment throughout the school year, not just in an end-of-year assessment. Instead of the teacher filling the essay with the markings that flag problems, the software could do so. The software could also effortlessly supply full explanations and practice exercises that address the problems — and grade those, too.
  • “Providing students with instant feedback about grammar, punctuation, word choice and sentence structure will lead to more writing assignments,” Mr. Vander Ark says, “and allow teachers to focus on higher-order skills.”
  • When sophisticated essay-evaluation software is built into word processing software, Mr. Vander Ark predicts “an order-of-magnitude increase in the amount of writing across the curriculum.”
  • the essay-scoring software that he and his teammates developed uses relatively small data sets and ordinary PCs — so the additional infrastructure cost for schools could be nil.
  • the William and Flora Hewlett Foundation sponsored a competition to see how well algorithms submitted by professional data scientists and amateur statistics wizards could predict the scores assigned by human graders. The winners were announced last month — and the predictive algorithms were eerily accurate.
  • wanted to create a neutral and fair platform to assess the various claims of the vendors. It turns out the claims are not hype.”
rachelramirez

The Cost of Mobile Ads on 50 News Websites - The New York Times - 0 views

  • The Cost of Mobile Ads on 50 News Websites
  • Data is also expensive. We estimated that on an average American cell data plan, each megabyte downloaded over a cell network costs about a penny. Visiting the home page of Boston.com every day for a month would cost the equivalent of about $9.50 in data usage just for the ads.
  • Here are all the files that made up the Boston.com data during one visit, including one large video ad and many script files used by ad networks. With an ad blocker, those files were gone.
Javier E

Generation Later, Poor Are Still Rare at Elite Colleges - NYTimes.com - 0 views

  • critics contend that on the whole, elite colleges are too worried about harming their finances and rankings to match their rhetoric about wanting economic diversity with action.
  • “A lot of it is just about money, because each additional low-income student you enroll costs you a lot in financial aid,” said Michael N. Bastedo, director of the Center for the Study of Higher and Postsecondary Education at the University of Michigan. “No one is going to talk openly and say, ‘Oh, we’re not making low-income students a priority.’ But enrollment management is so sophisticated that they know pretty clearly how much each student would cost.”
  • The rankings published by U.S. News and World Report, and others, also play a major role. The rankings reward spending on facilities and faculty, but most pay little or no attention to financial aid and diversity.
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  • Sustaining one poor student who needs $45,000 a year in aid requires $1 million in endowment devoted to that purpose; 100 of them require $100 million. Only the wealthiest schools can do that, and build new laboratories, renovate dining halls, provide small classes and bid for top professors.
  • College presidents are under constant pressure to meet budgets, improve graduation rates and move up in the rankings,” Dr. Carnevale said. “The easiest way to do it is to climb upstream economically — get students whose parents can pay more.”
  • A big part of that climb has been the rise of “merit aid,” price breaks offered to desirable students regardless of their parents’ wealth. A few dozen top schools give no merit aid, but they are the exception. Historically, American colleges gave far more need-based aid, but it is outweighed today by merit aid.
  • In 2006, at the 82 schools rated “most competitive” by Barron’s Profiles of American Colleges, 14 percent of American undergraduates came from the poorer half of the nation’s families, according to researchers at the University of Michigan and Georgetown University who analyzed data from federal surveys. That was unchanged from 1982.
  • What distinguishes those who apply to elite schools is not family income or their parents’ level of education, according to a groundbreaking study published last year, but location. Exposure to just a few high-achieving peers or attending a high school with just a few teachers or recent alumni who went to highly selective colleges makes a huge difference in where low-income students apply.
  • Cost remains a barrier, but so does perception, he said, adding, “It’s a psychology and sociology thing, as well as a pricing thing.”
  • Public colleges remain less expensive, but in an era of declining state support, their prices have risen faster than those of private colleges, and they vary widely from state to state. Private colleges have sharply increased financial aid since the turn of the century, so that the average net price that families really pay has barely changed over the last decade, adjusted for inflation — and for low-income students, it has actually dropped.
  • even top private colleges with similar sticker prices differ enormously in net prices, related to how wealthy they are, so a family can find that an elite education is either dauntingly expensive or surprisingly affordable. In 2011-12, net prices paid by families with incomes under $48,000 averaged less than $4,000 at Harvard, which has the nation’s largest endowment, for example, and more than $27,000 at New York University, according to data compiled by the Department of Education.
Javier E

12 Rules for Life: An Antidote to Chaos (Jordan B. Peterson) - 0 views

  • RULES? MORE RULES? REALLY? Isn’t life complicated enough, restricting enough, without abstract rules that don’t take our unique, individual situations into account? And given that our brains are plastic, and all develop differently based on our life experiences, why even expect that a few rules might be helpful to us all?
  • “I’ve got some good news…and I’ve got some bad news,” the lawgiver yells to them. “Which do you want first?” “The good news!” the hedonists reply. “I got Him from fifteen commandments down to ten!” “Hallelujah!” cries the unruly crowd. “And the bad?” “Adultery is still in.”
  • Maps of Meaning was sparked by Jordan’s agonized awareness, as a teenager growing up in the midst of the Cold War, that much of mankind seemed on the verge of blowing up the planet to defend their various identities. He felt he had to understand how it could be that people would sacrifice everything for an “identity,”
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  • the story of the golden calf also reminds us that without rules we quickly become slaves to our passions—and there’s nothing freeing about that.
  • And the story suggests something more: unchaperoned, and left to our own untutored judgment, we are quick to aim low and worship qualities that are beneath us—in this case, an artificial animal that brings out our own animal instincts in a completely unregulated way.
  • Similarly, in this book Professor Peterson doesn’t just propose his twelve rules, he tells stories, too, bringing to bear his knowledge of many fields as he illustrates and explains why the best rules do not ultimately restrict us but instead facilitate our goals and make for fuller, freer lives.
  • Peterson wasn’t really an “eccentric”; he had sufficient conventional chops, had been a Harvard professor, was a gentleman (as cowboys can be) though he did say damn and bloody a lot, in a rural 1950s sort of way. But everyone listened, with fascination on their faces, because he was in fact addressing questions of concern to everyone at the table.
  • unlike many academics who take the floor and hold it, if someone challenged or corrected him he really seemed to like it. He didn’t rear up and neigh. He’d say, in a kind of folksy way, “Yeah,” and bow his head involuntarily, wag it if he had overlooked something, laughing at himself for overgeneralizing. He appreciated being shown another side of an issue, and it became clear that thinking through a problem was, for him, a dialogic process.
  • for an egghead Peterson was extremely practical. His examples were filled with applications to everyday life: business management, how to make furniture (he made much of his own), designing a simple house, making a room beautiful (now an internet meme) or in another, specific case related to education, creating an online writing project that kept minority students from dropping out of school by getting them to do a kind of psychoanalytic exercise on themselves,
  • These Westerners were different: self-made, unentitled, hands on, neighbourly and less precious than many of their big-city peers, who increasingly spend their lives indoors, manipulating symbols on computers. This cowboy psychologist seemed to care about a thought only if it might, in some way, be helpful to someone.
  • I was drawn to him because here was a clinician who also had given himself a great books education, and who not only loved soulful Russian novels, philosophy and ancient mythology, but who also seemed to treat them as his most treasured inheritance. But he also did illuminating statistical research on personality and temperament, and had studied neuroscience. Though trained as a behaviourist, he was powerfully drawn to psychoanalysis with its focus on dreams, archetypes, the persistence of childhood conflicts in the adult, and the role of defences and rationalization in everyday life. He was also an outlier in being the only member of the research-oriented Department of Psychology at the University of Toronto who also kept a clinical practice.
  • Maps of Meaning, published nearly two decades ago, shows Jordan’s wide-ranging approach to understanding how human beings and the human brain deal with the archetypal situation that arises whenever we, in our daily lives, must face something we do not understand.
  • The brilliance of the book is in his demonstration of how rooted this situation is in evolution, our DNA, our brains and our most ancient stories. And he shows that these stories have survived because they still provide guidance in dealing with uncertainty, and the unavoidable unknown.
  • this is why many of the rules in this book, being based on Maps of Meaning, have an element of universality to them.
  • We are ambivalent about rules, even when we know they are good for us. If we are spirited souls, if we have character, rules seem restrictive, an affront to our sense of agency and our pride in working out our own lives. Why should we be judged according to another’s rule?
  • And he felt he had to understand the ideologies that drove totalitarian regimes to a variant of that same behaviour: killing their own citizens.
  • Ideologies are simple ideas, disguised as science or philosophy, that purport to explain the complexity of the world and offer remedies that will perfect it.
  • Ideologues are people who pretend they know how to “make the world a better place” before they’ve taken care of their own chaos within.
  • Ideologies are substitutes for true knowledge, and ideologues are always dangerous when they come to power, because a simple-minded I-know-it-all approach is no match for the complexity of existence.
  • To understand ideology, Jordan read extensively about not only the Soviet gulag, but also the Holocaust and the rise of Nazism. I had never before met a person, born Christian and of my generation, who was so utterly tormented by what happened in Europe to the Jews, and who had worked so hard to understand how it could have occurred.
  • I saw what now millions have seen online: a brilliant, often dazzling public speaker who was at his best riffing like a jazz artist; at times he resembled an ardent Prairie preacher (not in evangelizing, but in his passion, in his ability to tell stories that convey the life-stakes that go with believing or disbelieving various ideas). Then he’d just as easily switch to do a breathtakingly systematic summary of a series of scientific studies. He was a master at helping students become more reflective, and take themselves and their futures seriously. He taught them to respect many of the greatest books ever written. He gave vivid examples from clinical practice, was (appropriately) self-revealing, even of his own vulnerabilities, and made fascinating links between evolution, the brain and religious stories.
  • Above all, he alerted his students to topics rarely discussed in university, such as the simple fact that all the ancients, from Buddha to the biblical authors, knew what every slightly worn-out adult knows, that life is suffering.
  • chances are, if you or someone you love is not suffering now, they will be within five years, unless you are freakishly lucky. Rearing kids is hard, work is hard, aging, sickness and death are hard, and Jordan emphasized that doing all that totally on your own, without the benefit of a loving relationship, or wisdom, or the psychological insights of the greatest psychologists, only makes it harder.
  • focused on triumphant heroes. In all these triumph stories, the hero has to go into the unknown, into an unexplored territory, and deal with a new great challenge and take great risks. In the process, something of himself has to die, or be given up, so he can be reborn and meet the challenge. This requires courage, something rarely discussed in a psychology class or textbook.
  • Jordan
  • views of his first YouTube statements quickly numbered in the hundreds of thousands. But people have kept listening because what he is saying meets a deep and unarticulated need. And that is because alongside our wish to be free of rules, we all search for structure.
  • the first generation to have been so thoroughly taught two seemingly contradictory ideas about morality, simultaneously—at their schools, colleges and universities, by many in my own generation. This contradiction has left them at times disoriented and uncertain, without guidance and, more tragically, deprived of riches they don’t even know exist.
  • morality and the rules associated with it are just a matter of personal opinion or happenstance, “relative to” or “related to” a particular framework, such as one’s ethnicity, one’s upbringing, or the culture or historical…
  • The first idea or teaching is that morality is relative, at best a…
  • So, the decent thing to do—once it becomes apparent how arbitrary your, and your society’s, “moral values” are—is to show tolerance for people who think differently, and…
  • for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an adult can…
  • That emphasis on tolerance is so paramount that for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an…
  • And so a generation has been raised untutored in what was once called, aptly, “practical wisdom,” which guided previous generations. Millennials, often told they have received the finest education available anywhere, have actually…
  • professors, chose to devalue thousands of years of human knowledge about how to acquire virtue, dismissing it as passé, “…
  • They were so successful at it that the very word “virtue” sounds out of date, and someone using it appears…
  • The study of virtue is not quite the same as the study of morals (right and wrong, good and evil). Aristotle defined the virtues simply as the ways of behaving that are most conducive to happiness in life. Vice was…
  • Cultivating judgment about the difference between virtue and vice is the beginning of wisdom, something…
  • By contrast, our modern relativism begins by asserting that making judgments about how to live is impossible, because there is no real good, and no…
  • Thus relativism’s closest approximation to “virtue” is “tolerance.” Only tolerance will provide social cohesion between different groups, and save us from harming each other. On Facebook and other forms of social media, therefore, you signal your so-called…
  • Intolerance of others’ views (no matter how ignorant or incoherent they may be) is not simply wrong; in a world where there is no right or wrong, it is worse: it is a sign you are…
  • But it turns out that many people cannot tolerate the vacuum—the chaos—which is inherent in life, but made worse by this moral relativism; they cannot live without a moral compass,…
  • So, right alongside relativism, we find the spread of nihilism and despair, and also the opposite of moral relativism: the blind certainty offered by ideologies…
  • Dr. Norman Doidge, MD, is the author of The Brain That Changes Itself
  • so we arrive at the second teaching that millennials have been bombarded with. They sign up for a humanities course, to study the greatest books ever written. But they’re not assigned the books; instead they are given…
  • (But the idea that we can easily separate facts and values was and remains naive; to some extent, one’s values determine what one will pay…
  • For the ancients, the discovery that different people have different ideas about how, practically, to live, did not paralyze them; it deepened their understanding of humanity and led to some of the most satisfying conversations human beings have ever had, about how life might be lived.
  • Modern moral relativism has many sources. As we in the West learned more history, we understood that different epochs had different moral codes. As we travelled the seas and explored the globe, we learned of far-flung tribes on different continents whose different moral codes made sense relative to, or within the framework of, their societies. Science played a role, too, by attacking the religious view of the world, and thus undermining the religious grounds for ethics and rules. Materialist social science implied that we could divide the world into facts (which all could observe, and were objective and “real”) and values (…
  • it seems that all human beings are, by some kind of biological endowment, so ineradicably concerned with morality that we create a structure of laws and rules wherever we are. The idea that human life can be free of moral concerns is a fantasy.
  • given that we are moral animals, what must be the effect of our simplistic modern relativism upon us? It means we are hobbling ourselves by pretending to be something we are not. It is a mask, but a strange one, for it mostly deceives the one who wears it.
  • Far better to integrate the best of what we are now learning with the books human beings saw fit to preserve over millennia, and with the stories that have survived, against all odds, time’s tendency to obliterate.
  • these really are rules. And the foremost rule is that you must take responsibility for your own life. Period.
  • Jordan’s message that each individual has ultimate responsibility to bear; that if one wants to live a full life, one first sets one’s own house in order; and only then can one sensibly aim to take on bigger responsibilities.
  • if it’s uncertain that our ideals are attainable, why do we bother reaching in the first place? Because if you don’t reach for them, it is certain you will never feel that your life has meaning.
  • And perhaps because, as unfamiliar and strange as it sounds, in the deepest part of our psyche, we all want to be judged.
  • Instead of despairing about these differences in moral codes, Aristotle argued that though specific rules, laws and customs differed from place to place, what does not differ is that in all places human beings, by their nature, have a proclivity to make rules, laws and customs.
  • Freud never argued (as do some who want all culture to become one huge group therapy session) that one can live one’s entire life without ever making judgments, or without morality. In fact, his point in Civilization and Its Discontents is that civilization only arises when some restraining rules and morality are in place.
  • Aleksandr Solzhenitsyn, the great documenter of the slave-labour-camp horrors of the latter, once wrote that the “pitiful ideology” holding that “human beings are created for happiness” was an ideology “done in by the first blow of the work assigner’s cudgel.”1 In a crisis, the inevitable suffering that life entails can rapidly make a mockery of the idea that happiness is the proper pursuit of the individual. On the radio show, I suggested, instead, that a deeper meaning was required. I noted that the nature of such meaning was constantly re-presented in the great stories of the past, and that it had more to do with developing character in the face of suffering than with happiness.
  • I proposed in Maps of Meaning that the great myths and religious stories of the past, particularly those derived from an earlier, oral tradition, were moral in their intent, rather than descriptive. Thus, they did not concern themselves with what the world was, as a scientist might have it, but with how a human being should act.
  • I suggested that our ancestors portrayed the world as a stage—a drama—instead of a place of objects. I described how I had come
  • to believe that the constituent elements of the world as drama were order and chaos, and not material things.
  • Order is where the people around you act according to well-understood social norms, and remain predictable and cooperative. It’s the world of social structure, explored territory, and familiarity. The state of Order is typically portrayed, symbolically—imaginatively—as masculine.
  • Chaos, by contrast, is where—or when—something unexpected happens.
  • As the antithesis of symbolically masculine order, it’s presented imaginatively as feminine. It’s the new and unpredictable suddenly emerging in the midst of the commonplace familiar. It’s Creation and Destruction,
  • Order is the white, masculine serpent; Chaos, its black, feminine counterpart. The black dot in the white—and the white in the black—indicate the possibility of transformation: just when things seem secure, the unknown can loom, unexpectedly and large. Conversely, just when everything seems lost, new order can emerge from catastrophe and chaos.
  • For the Taoists, meaning is to be found on the border between the ever-entwined pair. To walk that border is to stay on the path of life, the divine Way. And that’s much better than happiness.
  • trying to address a perplexing problem: the reason or reasons for the nuclear standoff of the Cold War. I couldn’t understand how belief systems could be so important to people that they were willing to risk the destruction of the world to protect them. I came to realize that shared belief systems made people intelligible to one another—and that the systems weren’t just about belief.
  • People who live by the same code are rendered mutually predictable to one another. They act in keeping with each other’s expectations and desires. They can cooperate. They can even compete peacefully, because everyone knows what to expect from everyone else.
  • Shared beliefs simplify the world, as well, because people who know what to expect from one another can act together to tame the world. There is perhaps nothing more important than the maintenance of this organization—this simplification. If it’s threatened, the great ship of state rocks.
  • It isn’t precisely that people will fight for what they believe. They will fight, instead, to maintain the match between what they believe, what they expect, and what they desire. They will fight to maintain the match between what they expect and how everyone is acting. It is precisely the maintenance of that match that enables everyone
  • There’s more to it, too. A shared cultural system stabilizes human interaction, but is also a system of value—a hierarchy of value, where some things are given priority and importance and others are not. In the absence of such a system of value, people simply cannot act. In fact, they can’t even perceive, because both action and perception require a goal, and a valid goal is, by necessity, something valued.
  • We experience much of our positive emotion in relation to goals. We are not happy, technically speaking, unless we see ourselves progressing—and the very idea of progression implies value.
  • Worse yet is the fact that the meaning of life without positive value is not simply neutral. Because we are vulnerable and mortal, pain and anxiety are an integral part of human existence. We must have something to set against the suffering that is intrinsic to Being.*2 We must have the meaning inherent in a profound system of value or the horror of existence rapidly becomes paramount. Then, nihilism beckons, with its hopelessness and despair.
  • So: no value, no meaning. Between value systems, however, there is the possibility of conflict. We are thus eternally caught between the most diamantine rock and the hardest of places:
  • loss of group-centred belief renders life chaotic, miserable, intolerable; presence of group-centred belief makes conflict with other groups inevitable.
  • In the West, we have been withdrawing from our tradition-, religion- and even nation-centred cultures, partly to decrease the danger of group conflict. But we are increasingly falling prey to the desperation of meaninglessness, and that is no improvement at all.
  • While writing Maps of Meaning, I was (also) driven by the realization that we can no longer afford conflict—certainly not on the scale of the world conflagrations of the twentieth century.
  • I came to a more complete, personal realization of what the great stories of the past continually insist upon: the centre is occupied by the individual.
  • It is possible to transcend slavish adherence to the group and its doctrines and, simultaneously, to avoid the pitfalls of its opposite extreme, nihilism. It is possible, instead, to find sufficient meaning in individual consciousness and experience.
  • How could the world be freed from the terrible dilemma of conflict, on the one hand, and psychological and social dissolution, on the other? The answer was this: through the elevation and development of the individual, and through the willingness of everyone to shoulder the burden of Being and to take the heroic path. We must each adopt as much responsibility as possible for individual life, society and the world.
  • We must each tell the truth and repair what is in disrepair and break down and recreate what is old and outdated. It is in this manner that we can and must reduce the suffering that poisons the world. It’s asking a lot. It’s asking for everything.
  • the alternative—the horror of authoritarian belief, the chaos of the collapsed state, the tragic catastrophe of the unbridled natural world, the existential angst and weakness of the purposeless
  • individual—is clearly worse.
  • a title: 12 Rules for Life: An Antidote to Chaos. Why did that one rise up above all others? First and foremost, because of its simplicity. It indicates clearly that people need ordering principles, and that chaos otherwise beckons.
  • We require rules, standards, values—alone and together. We’re pack animals, beasts of burden. We must bear a load, to justify our miserable existence. We require routine and tradition. That’s order. Order can become excessive, and that’s not good, but chaos can swamp us, so we drown—and that is also not good. We need to stay on the straight and narrow path.
  • I hope that these rules and their accompanying essays will help people understand what they already know: that the soul of the individual eternally hungers for the heroism of genuine Being, and that the willingness to take on that responsibility is identical to the decision to live a meaningful life.
  • RULE 1   STAND UP STRAIGHT WITH YOUR SHOULDERS BACK
  • Because territory matters, and because the best locales are always in short supply, territory-seeking among animals produces conflict. Conflict, in turn, produces another problem: how to win or lose without the disagreeing parties incurring too great a cost.
  • It’s winner-take-all in the lobster world, just as it is in human societies, where the top 1 percent have as much loot as the bottom 50 percent11—and where the richest eighty-five people have as much as the bottom three and a half billion.
  • This principle is sometimes known as Price’s law, after Derek J. de Solla Price,13 the researcher who discovered its application in science in 1963. It can be modelled using an approximately L-shaped graph, with number of people on the vertical axis, and productivity or resources on the horizontal.
  • Instead of undertaking the computationally difficult task of identifying the best man, the females outsource the problem to the machine-like calculations of the dominance hierarchy. They let the males fight it out and peel their paramours from the top.
  • The dominant male, with his upright and confident posture, not only gets the prime real estate and easiest access to the best hunting grounds. He also gets all the girls. It is exponentially more worthwhile to be successful, if you are a lobster, and male.
  • dominance hierarchies have been an essentially permanent feature of the environment to which all complex life has adapted. A third of a billion years ago, brains and nervous systems were comparatively simple. Nonetheless, they already had the structure and neurochemistry necessary to process information about status and society. The importance of this fact can hardly be overstated.
  • evolution works, in large part, through variation and natural selection. Variation exists for many reasons, including gene-shuffling (to put it simply) and random mutation. Individuals vary within a species for such reasons. Nature chooses from among them, across time. That theory, as stated, appears to account for the continual alteration of life-forms over the eons.
  • But there’s an additional question lurking under the surface: what exactly is the “nature” in “natural selection”? What exactly is “the environment” to which animals adapt?
  • Nature “selects.” The idea of selects contains implicitly nested within it the idea of fitness. It is “fitness” that is “selected.” Fitness, roughly speaking, is the probability that a given organism will leave offspring (will propagate its genes through time). The “fit” in “fitness” is therefore the matching of organismal attribute to environmental demand.
  • But nature, the selecting agent, is not a static selector—not in any simple sense.
  • As the environment supporting a species transforms and changes, the features that make a given individual successful in surviving and reproducing also transform and change. Thus, the theory of natural selection does not posit creatures matching themselves ever more precisely to a template specified by the world. It is more that creatures are in a dance with nature, albeit one that is deadly.
  • Nature is not simply dynamic, either. Some things change quickly, but they are nested within other things that change less quickly (music
  • It’s chaos, within order, within chaos, within higher order. The order that is most real is the order that is most unchanging—and that is not necessarily the order that is most easily seen. The leaf, when perceived, might blind the observer to the tree. The tree can blind him to the forest.
  • It is also a mistake to conceptualize nature romantically.
  • Unfortunately, “the environment” is also elephantiasis and guinea worms (don’t ask), anopheles mosquitoes and malaria, starvation-level droughts, AIDS and the Black Plague.
  • It is because of the existence of such things, of course, that we attempt to modify our surroundings, protecting our children, building cities and transportation systems and growing food and generating power.
  • this brings us to a third erroneous concept: that nature is something strictly segregated from the cultural constructs that have emerged within it.
  • It does not matter whether that feature is physical and biological, or social and cultural. All that matters, from a Darwinian perspective, is permanence—and the dominance hierarchy, however social or cultural it might appear, has been around for some half a billion years.
  • The dominance hierarchy is not capitalism. It’s not communism, either, for that matter. It’s not the military-industrial complex. It’s not the patriarchy—that disposable, malleable, arbitrary cultural artefact. It’s not even a human creation; not in the most profound sense. It is instead a near-eternal aspect of the environment, and much of what is blamed on these more ephemeral manifestations is a consequence of its unchanging existence.
  • We were struggling for position before we had skin, or hands, or lungs, or bones. There is little more natural than culture. Dominance hierarchies are older than trees.
  • The part of our brain that keeps track of our position in the dominance hierarchy is therefore exceptionally ancient and fundamental.17 It is a master control system, modulating our perceptions, values, emotions, thoughts and actions. It powerfully affects every aspect of our Being, conscious and unconscious alike.
  • The ancient part of your brain specialized for assessing dominance watches how you are treated by other people. On that evidence, it renders a determination of your value and assigns you a status. If you are judged by your peers as of little worth, the counter restricts serotonin availability. That makes you much more physically and psychologically reactive to any circumstance or event that might produce emotion, particularly if it is negative. You need that reactivity. Emergencies are common at the bottom, and you must be ready to survive. Unfortunately, that physical hyper-response, that constant alertness, burns up a lot of precious energy and physical resources.
  • It will leave you far more likely to live, or die, carelessly, for a rare opportunity at pleasure, when it manifests itself. The physical demands of emergency preparedness will wear you down in every way.21
  • If you have a high status, on the other hand, the counter’s cold, pre-reptilian mechanics assume that your niche is secure, productive
  • You can delay gratification, without forgoing it forever. You can afford to be a reliable and thoughtful citizen.
  • Sometimes, however, the counter mechanism can go wrong. Erratic habits of sleeping and eating can interfere with its function. Uncertainty can throw it for a loop. The body, with its various parts,
  • needs
  • to function like a well-rehearsed orchestra. Every system must play its role properly, and at exactly the right time, or noise and chaos ensue. It is for this reason that routine is so necessary. The acts of life we repeat every day need to be automatized. They must be turned into stable and reliable habits, so they lose their complexity and gain predictability and simplicity.
  • It is for such reasons that I always ask my clinical clients first about sleep. Do they wake up in the morning at approximately the time the typical person wakes up, and at the same time every day?
  • The next thing I ask about is breakfast. I counsel my clients to eat a fat and protein-heavy breakfast as soon as possible after they awaken (no simple carbohydrates, no sugars,
  • I have had many clients whose anxiety was reduced to subclinical levels merely because they started to sleep on a predictable schedule and eat breakfast.
  • Other bad habits can also interfere with the counter’s accuracy.
  • There are many systems of interaction between brain, body and social world that can get caught in positive feedback loops. Depressed people, for example, can start feeling useless and burdensome, as well as grief-stricken and pained. This makes them withdraw from contact with friends and family. Then the withdrawal makes them more lonesome and isolated, and more likely to feel useless and burdensome. Then they withdraw more. In this manner, depression spirals and amplifies.
  • If someone is badly hurt at some point in life—traumatized—the dominance counter can transform in a manner that makes additional hurt more rather than less likely. This often happens in the case of people, now adults, who were viciously bullied during childhood or adolescence. They become anxious and easily upset. They shield themselves with a defensive crouch, and avoid the direct eye contact interpretable as a dominance challenge.
  • With their capacity for aggression strait-jacketed within a too-narrow morality, those who are only or merely compassionate and self-sacrificing (and naïve and exploitable) cannot call forth the genuinely righteous and appropriately self-protective anger necessary to defend themselves. If you can bite, you generally don’t have to. When skillfully integrated, the ability to respond with aggression and violence decreases rather than increases the probability that actual aggression will become necessary.
  • Naive, harmless people usually guide their perceptions and actions with a few simple axioms: people are basically good; no one really wants to hurt anyone else; the threat (and, certainly, the use) of force, physical or otherwise, is wrong. These axioms collapse, or worse, in the presence of
  • individuals who are genuinely malevolent.27
  • I have had clients who were terrified into literally years of daily hysterical convulsions by the sheer look of malevolence on their attackers’ faces. Such individuals typically come from hyper-sheltered families, where nothing
  • terrible is allowed to exist, and everything is fairyland wonderful (or else).
  • When the wakening occurs—when once-naïve people recognize in themselves the seeds of evil and monstrosity, and see themselves as dangerous (at least potentially)— their fear decreases. They develop more self-respect. Then, perhaps, they begin to resist oppression. They see that they have the ability to withstand, because they are terrible too. They see they can and must stand up, because they begin to understand how genuinely monstrous they will become, otherwise,
  • There is very little difference between the capacity for mayhem and destruction, integrated, and strength of character. This is one of the most difficult lessons of life.
  • even if you came by your poor posture honestly—even if you were unpopular or bullied at home or in grade school28—it’s not necessarily appropriate now. Circumstances change. If you slump around, with the same bearing that characterizes a defeated lobster, people will assign you a lower status, and the old counter that you share with crustaceans, sitting at the very base of your brain, will assign you a low dominance number.
  • the other, far more optimistic lesson of Price’s law and the Pareto distribution: those who start to have will probably get more.
  • Some of these upwardly moving loops can occur in your own private, subjective space.
  • If you are asked to move the muscles one by one into a position that looks happy, you will report feeling happier. Emotion is partly bodily expression, and can be amplified (or dampened) by that expression.29
  • To stand up straight with your shoulders back is to accept the terrible responsibility of life, with eyes wide open.
  • It means deciding to voluntarily transform the chaos of potential into the realities of habitable order. It means adopting the burden of self-conscious vulnerability, and accepting the end of the unconscious paradise of childhood, where finitude and mortality are only dimly comprehended. It means willingly undertaking the sacrifices necessary to generate a productive and meaningful reality (it means acting to please God, in the ancient language).
  • So, attend carefully to your posture. Quit drooping and hunching around. Speak your mind. Put your desires forward, as if you had a right to them—at least the same right as others. Walk tall and gaze forthrightly ahead. Dare to be dangerous. Encourage the serotonin to flow plentifully through the neural pathways desperate for its calming influence.
  • Thus emboldened, you will embark on the voyage of your life, let your light shine, so to speak, on the heavenly hill, and pursue your rightful destiny. Then the meaning of your life may be sufficient to keep the corrupting influence of mortal despair at bay. Then you may be able to accept the terrible burden of the World, and find joy.
  • RULE 2   TREAT YOURSELF LIKE SOMEONE YOU ARE RESPONSIBLE FOR HELPING
  • People are better at filling and properly administering prescription medication to their pets than to themselves. That
  • It is difficult to conclude anything from this set of facts except that people appear to love their dogs, cats, ferrets and birds (and maybe even their lizards) more than themselves. How horrible is that? How much shame must exist, for something like that to be true? What could it be about people that makes them prefer their pets to themselves?
  • To understand Genesis 1, the Priestly story, with its insistence on speech as the fundamental creative force, it is first necessary to review a few fundamental, ancient assumptions (these are markedly different in type and intent from the assumptions of science, which are, historically speaking, quite novel).
  • those who existed during the distant time in which the foundational epics of our culture emerged were much more concerned with the actions that dictated survival (and with interpreting the world in a manner commensurate with that goal) than with anything approximating what we now understand as objective truth.
  • Before the dawn of the scientific worldview, reality was construed differently. Being was understood as a place of action, not a place of things.31 It was understood as something more akin to story or drama. That story or drama was lived, subjective experience, as it manifested itself moment to moment in the consciousness of every living person.
  • subjective pain. That’s something so real no argument can stand against it. Everyone acts as if their pain is real—ultimately, finally real. Pain matters, more than matter matters. It is for this reason, I believe, that so many of the world’s traditions regard the suffering attendant upon existence as the irreducible truth of Being.
  • In any case, that which we subjectively experience can be likened much more to a novel or a movie than to a scientific description of physical reality.
  • The Domain, Not of Matter, but of What Matters
  • the world of experience has primal constituents, as well. These are the necessary elements whose interactions define drama and fiction. One of these is chaos. Another is order. The third (as there are three) is the process that mediates between the two, which appears identical to what modern people call consciousness.
  • Chaos is the domain of ignorance itself. It’s unexplored territory. Chaos is what extends, eternally and without limit, beyond the boundaries of all states, all ideas, and all disciplines. It’s the foreigner, the stranger, the member of another gang, the rustle in the bushes in the night-time,
  • It is, in short, all those things and situations we neither know nor understand.
  • Chaos is also the formless potential from which the God of Genesis 1 called forth order using language at the beginning of time. It’s the same potential from which we, made in that Image, call forth the novel and ever-changing moments of our lives. And Chaos is freedom, dreadful freedom, too.
  • Order, by contrast, is explored territory. That’s the hundreds-of-millions-of-years-old hierarchy of place, position and authority. That’s the structure of society. It’s the structure provided by biology, too—particularly insofar as you are adapted, as you are, to the structure of society. Order is tribe, religion, hearth, home and country.
  • Order is the public façade we’re called upon to wear, the politeness of a gathering of civilized strangers, and the thin ice on which we all skate. Order is the place where the behavior of the world matches our expectations and our desires; the place where all things turn out the way we want them to.
  • But order is sometimes tyranny and stultification, as well, when the demand for certainty and uniformity and purity becomes too one-sided.
  • In order, we’re able to think about things in the long term. There, things work, and we’re stable, calm and competent. We seldom leave places we
  • understand—geographical or conceptual—for that reason, and we certainly do not like it when we are compelled to or when it happens accidentally.
  • When the same person betrays you, sells you out, you move from the daytime world of clarity and light to the dark underworld of chaos, confusion and despair. That’s the same move you make, and the same place you visit, when the company you work for starts to fail and your job is placed in doubt.
  • Before the Twin Towers fell—that was order. Chaos manifested itself afterward. Everyone felt it. The very air became uncertain. What exactly was it that fell? Wrong question. What exactly remained standing? That was the issue at hand.
  • Chaos is the deep ocean bottom to which Pinocchio voyaged to rescue his father from Monstro, whale and fire-breathing dragon. That journey into darkness and rescue is the most difficult thing a puppet must do, if he wants to be real; if he wants to extract himself from the temptations of deceit and acting and victimization and impulsive pleasure and totalitarian subjugation; if he wants to take his place as a genuine Being in the world.
  • Chaos is the new place and time that emerges when tragedy strikes suddenly, or malevolence reveals its paralyzing visage, even in the confines of your own home. Something unexpected or undesired can always make its appearance, when a plan is being laid out, regardless of how familiar the circumstances.
  • Our brains respond instantly when chaos appears, with simple, hyper-fast circuits maintained from the ancient days, when our ancestors dwelled in trees, and snakes struck in a flash.32 After that nigh-instantaneous, deeply reflexive bodily response comes the later-evolving, more complex but slower responses of emotions—and, after that, comes thinking, of the higher order, which can extend over seconds, minutes or years. All that response is instinctive, in some sense—but the faster the response, the more instinctive.
  • Things or objects are part of the objective world. They’re inanimate; spiritless. They’re dead. This is not true of chaos and order. Those are perceived, experienced and understood (to the degree that they are understood at all) as personalities—and that is just as true of the perceptions, experiences and understanding of modern people as their ancient forebears. It’s just that moderners don’t notice.
  • Perception of things as entities with personality also occurs before perception of things as things. This is particularly true of the action of others,34 living others, but we also see the non-living “objective world” as animated, with purpose and intent.
  • This is because of the operation of what psychologists have called “the hyperactive agency detector” within us.35 We evolved, over millennia, within intensely social circumstances. This means that the most significant elements of our environment of origin were personalities, not things, objects or situations.
  • The personalities we have evolved to perceive have been around, in predictable form, and in typical, hierarchical configurations, forever, for all intents and purposes. They have been…
  • the category of “parent” and/or “child” has been around for 200 million years. That’s longer than birds have existed. That’s longer than flowers have grown. It’s not a billion years, but it’s still a very long time. It’s plenty long enough for male and female and parent and child to serve as vital and fundamental parts of the environment to which we have adapted. This means that male and female and parent and child are…
  • Our brains are deeply social. Other creatures (particularly, other humans) were crucially important to us as we lived, mated and evolved. Those creatures were…
  • From a Darwinian perspective, nature—reality itself; the environment, itself—is what selects. The environment cannot be defined in any more fundamental manner. It is not mere inert matter. Reality itself is whatever we contend with when we are striving to survive and reproduce. A…
  • as our brain capacity increased and we developed curiosity to spare, we became increasingly aware of and curious about the nature of the world—what we eventually conceptualized as the objective…
  • “outside” is not merely unexplored physical territory. Outside is outside of what we currently understand—and understanding is dealing with and coping with…
  • when we first began to perceive the unknown, chaotic, non-animal world, we used categories that had originally evolved to represent the pre-human animal social world. Our minds are far older than mere…
  • Our most…
  • category—as old, in some sense, as the sexual act itself—appears to be that of sex, male and female. We appear to have taken that primordial knowledge of structured, creative opposition and…
  • Order, the known, appears symbolically associated with masculinity (as illustrated in the aforementioned yang of the Taoist yin-yang symbol). This is perhaps because the primary…
  • Chaos—the unknown—is symbolically associated with the feminine. This is partly because all the things we have come to know were born, originally, of the unknown, just as all beings we encounter were born of mothers. Chaos is mater, origin, source, mother; materia, the substance from which all things are made.
  • In its positive guise, chaos is possibility itself, the source of ideas, the mysterious realm of gestation and birth. As a negative force, it’s the impenetrable darkness of a cave and the accident by the side of the road.
  • Chaos, the eternal feminine, is also the crushing force of sexual selection.
  • Most men do not meet female human standards. It is for this reason that women on dating sites rate 85 percent of men as below average in attractiveness.40
  • Women’s proclivity to say no, more than any other force, has shaped our evolution into the creative, industrious, upright, large-brained (competitive, aggressive, domineering) creatures that we are.42 It is Nature as Woman who says, “Well, bucko, you’re good enough for a friend, but my experience of you so far has not indicated the suitability of your genetic material for continued propagation.”
  • Many things begin to fall into place when you begin to consciously understand the world in this manner. It’s as if the knowledge of your body and soul falls into alignment with the knowledge of your intellect.
  • And there’s more: such knowledge is proscriptive, as well as descriptive. This is the kind of knowing what that helps you know how. This is the kind of is from which you can derive an ought. The Taoist juxtaposition of yin and yang, for example, doesn’t simply portray chaos and order as the fundamental elements of Being—it also tells you how to act.
  • The Way, the Taoist path of life, is represented by (or exists on) the border between the twin serpents. The Way is the path of proper Being. It’s the same Way as that referred to by Christ in John 14:6: I am the way, and the truth and the life. The same idea is expressed in Matthew 7:14: Because strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it.
  • We eternally inhabit order, surrounded by chaos. We eternally occupy known territory, surrounded by the unknown. We experience meaningful engagement when we mediate appropriately between them. We are adapted, in the deepest Darwinian sense, not to the world of objects, but to the meta-realities of order and chaos, yang and yin. Chaos and order make up the eternal, transcendent environment of the living.
  • To straddle that fundamental duality is to be balanced: to have one foot firmly planted in order and security, and the other in chaos, possibility, growth and adventure.
  • Chaos and order are fundamental elements because every lived situation (even every conceivable lived situation) is made up of both.
  • you need to place one foot in what you have mastered and understood and the other in what you are currently exploring and mastering. Then you have positioned yourself where the terror of existence is under control and you are secure, but where you are also alert and engaged. That is where there is something new to master and some way that you can be improved. That is where meaning is to be found.
  • The serpent in Eden therefore means the same thing as the black dot in the yin side of the Taoist yin/yang symbol of totality—that is, the possibility of the unknown and revolutionary suddenly manifesting itself where everything appears calm.
  • The outside, chaos, always sneaks into the inside, because nothing can be completely walled off from the rest of reality. So even the ultimate in safe spaces inevitably harbours a snake.
  • We have seen the enemy, after all, and he is us. The snake inhabits each of our souls.
  • The worst of all possible snakes is the eternal human proclivity for evil. The worst of all possible snakes is psychological, spiritual, personal, internal. No walls, however tall, will keep that out. Even if the fortress were thick enough, in principle, to keep everything bad whatsoever outside, it would immediately appear again within.
  • I have learned that these old stories contain nothing superfluous. Anything accidental—anything that does not serve the plot—has long been forgotten in the telling. As the Russian playwright Anton Chekhov advised, “If there is a rifle hanging on the wall in act one, it must be fired in the next act. Otherwise it has no
  • business being there.”50
  • Eve immediately shares the fruit with Adam. That makes him self-conscious. Little has changed. Women have been making men self-conscious since the beginning of time. They do this primarily by rejecting them—but they also do it by shaming them, if men do not take responsibility. Since women bear the primary burden of reproduction, it’s no wonder. It is very hard to see how it could be otherwise. But the capacity of women to shame men and render them self-conscious is still a primal force of nature.
  • What does it mean to know yourself naked
  • Naked means vulnerable and easily damaged. Naked means subject to judgment for beauty and health. Naked means unprotected and unarmed in the jungle of nature and man. This is why Adam and Eve became ashamed, immediately after their eyes were opened. They could see—and what they first saw was themselves.
  • In their vulnerability, now fully realized, they felt unworthy to stand before God.
  • Beauty shames the ugly. Strength shames the weak. Death shames the living—and the Ideal shames us all.
  • He tells the woman that she will now bring forth children in sorrow, and desire an unworthy, sometimes resentful man, who will in consequence lord her biological fate over her, permanently. What might this mean? It could just mean that God is a patriarchal tyrant, as politically motivated interpretations of the ancient story insist. I think it’s merely descriptive.
  • women pay a high price for pregnancy and child-rearing, particularly in the early stages, and that one of the inevitable consequences is increased dependence upon the sometimes unreliable and always problematic good graces of men.
  • then God banishes the first man and the first woman from Paradise, out of infancy, out of the unconscious animal world, into the horrors of history itself. And then He puts cherubim and a flaming sword at the gate of Eden, just to stop them from eating the Fruit of the Tree of Life.
  • Perhaps Heaven is something you must build, and immortality something you must earn.
  • so we return to our original query: Why would someone buy prescription medication for his dog, and then so carefully administer it, when he would not do the same for himself?
  • Why should anyone take care of anything as naked, ugly, ashamed, frightened, worthless, cowardly, resentful, defensive and accusatory as a descendant of Adam? Even if that thing, that being, is himself?
  • We know how we are naked, and how that nakedness can be exploited—and that means we know how others are naked, and how they can be exploited. We can terrify other people, consciously. We can hurt and humiliate them for faults we understand only too well. We can torture them—literally—slowly, artfully and terribly. That’s far more than predation. That’s a qualitative shift in understanding. That’s a cataclysm as large as the development of self-consciousness itself. That’s the entry of the knowledge of Good and Evil into the world.
  • Only man could conceive of the rack, the iron maiden and the thumbscrew. Only man will inflict suffering for the sake of suffering. That is the best definition of evil I have been able to formulate.
  • with this realization we have well-nigh full legitimization of the idea, very unpopular in modern intellectual circles, of Original Sin.
  • Human beings have a great capacity for wrongdoing. It’s an attribute that is unique in the world of life. We can and do make things worse, voluntarily, with full knowledge of what we are doing (as well as accidentally, and carelessly, and in a manner that is willfully blind). Given that terrible capacity, that proclivity for malevolent actions, is it any wonder we have a hard time taking care of ourselves, or others—or even that we doubt the value of the entire human enterprise?
  • The juxtaposition of Genesis 1 with Genesis 2 & 3 (the latter two chapters outlining the fall of man, describing why our lot is so tragedy-ridden and ethically torturous) produces a narrative sequence almost unbearable in its profundity. The moral of Genesis 1 is that Being brought into existence through true speech is Good.
  • The original Man and Woman, existing in unbroken unity with their Creator, did not appear conscious (and certainly not self-conscious). Their eyes were not open. But, in their perfection, they were also less, not more, than their post-Fall counterparts. Their goodness was something bestowed, rather than deserved or earned.
  • Maybe, even in some cosmic sense (assuming that consciousness itself is a phenomenon of cosmic significance), free choice matters.
  • here’s a proposition: perhaps it is not simply the emergence of self-consciousness and the rise of our moral knowledge of Death and the Fall that besets us and makes us doubt our own worth. Perhaps it is instead our unwillingness—reflected in Adam’s shamed hiding—to walk with God, despite our fragility and propensity for evil.
  • The entire Bible is structured so that everything after the Fall—the history of Israel, the prophets, the coming of Christ—is presented as a remedy for that Fall, a way out of evil. The beginning of conscious history, the rise of the state and all its pathologies of pride and rigidity, the emergence of great moral figures who try to set things right, culminating in the Messiah Himself—that is all part of humanity’s attempt, God willing, to set itself right. And what would that mean?
  • And this is an amazing thing: the answer is already implicit in Genesis 1: to embody the Image of God—to speak out of chaos the Being that is Good—but to do so consciously, of our own free choice.
  • Back is the way forward—as T. S. Eliot so rightly insisted
  • We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time.
  • If we wish to take care of ourselves properly, we would have to respect ourselves—but we don’t, because we are—not least in our own eyes—fallen creatures.
  • If we lived in Truth; if we spoke the Truth—then we could walk with God once again, and respect ourselves, and others, and the world. Then we might treat ourselves like people we cared for.
  • We might strive to set the world straight. We might orient it toward Heaven, where we would want people we cared for to dwell, instead of Hell, where our resentment and hatred would eternally sentence everyone.
  • Then, the primary moral issue confronting society was control of violent, impulsive selfishness and the mindless greed and brutality that accompanies it.
  • It is easy to believe that people are arrogant, and egotistical, and always looking out for themselves. The cynicism that makes that opinion a universal truism is widespread and fashionable.
  • But such an orientation to the world is not at all characteristic of many people. They have the opposite problem: they shoulder intolerable burdens of self-disgust, self-contempt, shame and self-consciousness. Thus, instead of narcissistically inflating their own importance, they don’t value themselves at all, and they don’t take care of themselves with attention and skill.
  • Christ’s archetypal death exists as an example of how to accept finitude, betrayal and tyranny heroically—how to walk with God despite the tragedy of self-conscious knowledge—and not as a directive to victimize ourselves in the service of others.
  • To sacrifice ourselves to God (to the highest good, if you like) does not mean to suffer silently and willingly when some person or organization demands more from us, consistently, than is offered in return. That means we are supporting tyranny, and allowing ourselves to be treated like slaves.
  • I learned two very important lessons from Carl Jung, the famous Swiss depth psychologist, about “doing unto others as you would have them do unto you” or “loving your neighbour as yourself.”
  • The first lesson was that neither of these statements has anything to do with being nice. The second was that both are equations, rather than injunctions.
  • If I am someone’s friend, family member, or lover, then I am morally obliged to bargain as hard on my own behalf as they are on theirs.
  • there is little difference between standing up and speaking for yourself, when you are being bullied or otherwise tormented and enslaved, and standing up and speaking for someone else.
  • you do not simply belong to yourself. You are not simply your own possession to torture and mistreat. This is partly because your Being is inexorably tied up with that of others, and your mistreatment of yourself can have catastrophic consequences for others.
  • metaphorically speaking, there is also this: you have a spark of the divine in you, which belongs not to you, but to God. We are, after all—according to Genesis—made in His image.
  • We can make order from chaos—and vice versa—in our way, with our words. So, we may not exactly be God, but we’re not exactly nothing, either.
  • In my own periods of darkness, in the underworld of the soul, I find myself frequently overcome and amazed by the ability of people to befriend each other, to love their intimate partners and parents and children, and to do what they must do to keep the machinery of the world running.
  • It is this sympathy that should be the proper medicament for self-conscious self-contempt, which has its justification, but is only half the full and proper story. Hatred for self and mankind must be balanced with gratefulness for tradition and the state and astonishment at what normal, everyday people accomplish
  • You have some vital role to play in the unfolding destiny of the world. You are, therefore, morally obliged to take care of yourself.
  • To treat yourself as if you were someone you are responsible for helping is, instead, to consider what would be truly good for you. This is not “what you want.” It is also not “what would make you happy.”
  • You must help a child become a virtuous, responsible, awake being, capable of full reciprocity—able to take care of himself and others, and to thrive while doing so. Why would you think it acceptable to do anything less for yourself?
  • You need to know who you are, so that you understand your armament and bolster yourself in respect to your limitations. You need to know where you are going, so that you can limit the extent of chaos in your life, restructure order, and bring the divine force of Hope to bear on the world.
  • You need to determine how to act toward yourself so that you are most likely to become and to stay a good person.
  • Don’t underestimate the power of vision and direction. These are irresistible forces, able to transform what might appear to be unconquerable obstacles into traversable pathways and expanding opportunities.
  • Once having understood Hell, researched it, so to speak—particularly your
  • own individual Hell—you could decide against going there or creating that.
  • You could, in fact, devote your life to this. That would give you a Meaning, with a capital M. That would justify your miserable existence.
  • That would atone for your sinful nature, and replace your shame and self-consciousness with the natural pride and forthright confidence of someone who has learned once again to walk with God in the Garden.
  • RULE 3   MAKE FRIENDS WITH PEOPLE WHO WANT THE BEST FOR YOU
  • It would be more romantic, I suppose, to suggest that we would have all jumped at the chance for something more productive, bored out of our skulls as we were. But it’s not true. We were all too prematurely cynical and world-weary and leery of responsibility to stick to the debating clubs and Air Cadets and school sports that the adults around us tried to organize. Doing anything wasn’t cool.
  • When you move, everything is up in the air, at least for a while. It’s stressful, but in the chaos there are new possibilities. People, including you, can’t hem you in with their old notions. You get shaken out of your ruts. You can make new, better ruts, with people aiming at better things. I thought this was just a natural development. I thought that every person who moved would have—and want—the same phoenix-like experience.
  • What was it that made Chris and Carl and Ed unable (or, worse, perhaps, unwilling) to move or to change their friendships and improve the circumstances of their lives? Was it inevitable—a consequence of their own limitations, nascent illnesses and traumas of the past?
  • Why did he—like his cousin, like my other friends—continually choose people who, and places that, were not good for him?
  • perhaps, they don’t want the trouble of better. Freud called this a “repetition compulsion.” He thought of it as an unconscious drive to repeat the horrors of the past
  • People create their worlds with the tools they have directly at hand. Faulty tools produce faulty results. Repeated use of the same faulty tools produces the same faulty results.
  • It is in this manner that those who fail to learn from the past doom themselves to repeat it. It’s partly fate. It’s partly inability. It’s partly…unwillingness to learn? Refusal to learn? Motivated refusal to learn?
  • People choose friends who aren’t good for them for other reasons, too. Sometimes it’s because they want to rescue someone.
  • it is not easy to distinguish between someone truly wanting and needing help and someone who is merely exploiting a willing helper. The distinction is difficult even for the person who is wanting and needing and possibly exploiting.
  • When it’s not just naïveté, the attempt to rescue someone is often fuelled by vanity and narcissism.
  • But Christ himself, you might object, befriended tax-collectors and prostitutes. How dare I cast aspersions on the motives of those who are trying to help? But Christ was the archetypal perfect man. And you’re you.
  • How do you know that your attempts to pull someone up won’t instead bring them—or you—further down?
  • The same thing happens when well-meaning counsellors place a delinquent teen among comparatively civilized peers. The delinquency spreads, not the stability.65 Down is a lot easier than up.
  • maybe you’re saving someone because you want to convince yourself that the strength of your character is more than just a side effect of your luck and birthplace. Or maybe it’s because it’s easier to look virtuous when standing alongside someone utterly irresponsible.
  • Or maybe you have no plan, genuine or otherwise, to rescue anybody. You’re associating with people who are bad for you not because it’s better for anyone, but because it’s easier.
  • You know it. Your friends know it. You’re all bound by an implicit contract—one aimed at nihilism, and failure, and suffering of the stupidest sort.
  • Before you help someone, you should find out why that person is in trouble. You shouldn’t merely assume that he or she is a noble victim of unjust circumstances and exploitation. It’s the most unlikely explanation, not the most probable.
  • Besides, if you buy the story that everything terrible just happened on its own, with no personal responsibility on the part of the victim, you deny that person all agency in the past (and, by implication, in the present and future, as well).
  • It is far more likely that a given individual has just decided to reject the path upward, because of its difficulty. Perhaps that should even be your default assumption, when faced with such a situation.
  • failure is easy to understand. No explanation for its existence is required. In the same manner, fear, hatred, addiction, promiscuity, betrayal and deception require no explanation. It’s not the existence of vice, or the indulgence in it, that requires explanation. Vice is easy.
  • Failure is easy, too. It’s easier not to shoulder a burden. It’s easier not to think, and not to do, and not to care. It’s easier to put off until tomorrow what needs to be done today,
  • Success: that’s the mystery. Virtue: that’s what’s inexplicable. To fail, you merely have to cultivate a few bad habits. You just have to bide your time. And once someone has spent enough time cultivating bad habits and biding their time, they are much diminished.
  • I am not saying that there is no hope of redemption. But it is much harder to extract someone
  • from a chasm than to lift him from a ditch. And some chasms are very deep. And there’s not much left of the body at the bottom.
  • Carl Rogers, the famous humanistic psychologist, believed it was impossible to start a therapeutic relationship if the person seeking help did not want to improve.67 Rogers believed it was impossible to convince someone to change for the better. The
  • none of this is a justification for abandoning those in real need to pursue your narrow, blind ambition, in case it has to be said.
  • Here’s something to consider: If you have a friend whose friendship you wouldn’t recommend to your sister, or your father, or your son, why would you have such a friend for yourself?
  • You are not morally obliged to support someone who is making the world a worse place. Quite the opposite. You should choose people who want things to be better, not worse. It’s a good thing, not a selfish thing, to choose people who are good for you.
  • It is for this reason that every good example is a fateful challenge, and every hero, a judge. Michelangelo’s great perfect marble David cries out to its observer: “You could be more than you are.”
  • Don’t think that it is easier to surround yourself with good healthy people than with bad unhealthy people. It’s not. A good, healthy person is an ideal. It requires strength and daring to stand up near such a person.
  • RULE 4   COMPARE YOURSELF TO WHO YOU WERE YESTERDAY, NOT TO WHO SOMEONE ELSE IS TODAY
  • IT WAS EASIER FOR PEOPLE to be good at something when more of us lived in small, rural communities. Someone could be homecoming queen. Someone else could be spelling-bee champ, math whiz or basketball star. There were only one or two mechanics and a couple of teachers. In each of their domains, these local heroes had the opportunity to enjoy the serotonin-fuelled confidence of the victor.
  • Our hierarchies of accomplishment are now dizzyingly vertical.
  • No matter how good you are at something, or how you rank your accomplishments, there is someone out there who makes you look incompetent.
  • We are not equal in ability or outcome, and never will be. A very small number of people produce very much of everything.
  • People are unhappy at the bottom. They get sick there, and remain unknown and unloved. They waste their lives there. They die there. In consequence, the self-denigrating voice in the minds of people weaves a devastating tale. Life is a zero-sum game. Worthlessness is the default condition.
  • It is for such reasons that a whole generation of social psychologists recommended “positive illusions” as the only reliable route to mental health.69 Their credo? Let a lie be your umbrella. A more dismal, wretched, pessimistic philosophy can hardly be imagined:
  • Here is an alternative approach (and one that requires no illusions). If the cards are always stacked against you, perhaps the game you are playing is somehow rigged (perhaps by you, unbeknownst to yourself). If the internal voice makes you doubt the value of your endeavours—or your life, or life itself—perhaps you should stop listening.
  • There will always be people better than you—that’s a cliché of nihilism, like the phrase, In a million years, who’s going to know the difference? The proper response to that statement is not, Well, then, everything is meaningless. It’s, Any idiot can choose a frame of time within which nothing matters.
  • Standards of better or worse are not illusory or unnecessary. If you hadn’t decided that what you are doing right now was better than the alternatives, you wouldn’t be doing it. The idea of a value-free choice is a contradiction in terms. Value judgments are a precondition for action.
  • Furthermore, every activity, once chosen, comes with its own internal standards of accomplishment. If something can be done at all, it can be done better or worse. To do anything at all is therefore to play a game with a defined and valued end, which can always be reached more or less efficiently and elegantly.
  • We might start by considering the all-too-black-and-white words themselves: “success” or “failure.” You are either a success, a comprehensive, singular, over-all good thing, or its opposite, a failure, a comprehensive, singular, irredeemably bad thing.
  • There are vital degrees and gradations of value obliterated by this binary system, and the consequences are not good.
  • there is not just one game at which to succeed or fail. There are many games and, more specifically, many good games—
  • if changing games does not work, you can invent a new one. I
  • and athletic pursuits. You might consider judging your success across all the games you play.
  • When we are very young we are neither individual nor informed. We have not had the time nor gained the wisdom to develop our own standards. In consequence, we must compare ourselves to others, because standards are necessary.
  • As we mature we become, by contrast, increasingly individual and unique. The conditions of our lives become more and more personal and less and less comparable with those of others. Symbolically speaking, this means we must leave the house ruled by our father, and confront the chaos of our individual Being.
  • We must then rediscover the values of our culture—veiled from us by our ignorance, hidden in the dusty treasure-trove of the past—rescue them, and integrate them into our own lives. This is what gives existence its full and necessary meaning.
  • What is it that you actually love? What is it that you genuinely want? Before you can articulate your own standards of value, you must see yourself as a stranger—and then you must get to know yourself. What
  • Dare to be truthful. Dare to articulate yourself, and express (or at least become aware of) what would really justify your life.
  • Consult your resentment. It’s a revelatory emotion, for all its pathology. It’s part of an evil triad: arrogance, deceit, and resentment. Nothing causes more harm than this underworld Trinity. But resentment always means one of two things. Either the resentful person is immature, in which case he or she should shut up, quit whining, and get on with it, or there is tyranny afoot—in which case the person subjugated has a moral obligation to speak up.
  • Be cautious when you’re comparing yourself to others. You’re a singular being, once you’re an adult. You have your own particular, specific problems—financial, intimate, psychological, and otherwise.
  • Those are embedded in the unique broader context of your existence. Your career or job works for you in a personal manner, or it does not, and it does so in a unique interplay with the other specifics of your life.
  • We must see, but to see, we must aim, so we are always aiming. Our minds are built on the hunting-and-gathering platforms of our bodies. To hunt is to specify a target, track it, and throw at it.
  • We live within a framework that defines the present as eternally lacking and the future as eternally better. If we did not see things this way, we would not act at all. We wouldn’t even be able to see, because to see we must focus, and to focus we must pick one thing above all else on which to focus.
  • The disadvantage to all this foresight and creativity is chronic unease and discomfort. Because we always contrast what is with what could be, we have to aim at what could be.
  • The present is eternally flawed. But where you start might not be as important as the direction you are heading. Perhaps happiness is always to be found in the journey uphill, and not in the fleeting sense of satisfaction awaiting at the next peak.
  • Called upon properly, the internal critic will suggest something to set in order, which you could set in order, which you would set in order—voluntarily, without resentment, even with pleasure.
  • “Excuse me,” you might say to yourself, without irony or sarcasm. “I’m trying to reduce some of the unnecessary suffering around here. I could use some help.” Keep the derision at bay. “I’m wondering if there is anything that you would be willing to do? I’d be very grateful for your service.” Ask honestly and with humility. That’s no simple matter.
brookegoodman

The Guardian view on fast fashion: it can't cost the earth | Editorial | Opinion | The ... - 0 views

  • Fashion operates on desire. How we dress feeds off cravings to be different as well as part of a tribe; to be en vogue but ahead of the pack. The message from the high street is that such wishes can be fulfilled, and fast fashion plays on the idea that hunger can be sated immediately. But to overcome such urges we need to reflect on the fragility of our planet. This means accepting that there is a better way to keep the pleasures of fashion open to all parts of society than promoting disposable clothes as desirable. This is not just about the high cost of the £4 dress; luxury retailers such as Louis Vuitton have offered small collections every two weeks.
  • Fashion shouldn’t cost the earth. But the industry has for too long promoted overconsumption as a good thing. About a fifth of mass-produced clothing does not even sell and ends up being buried, shredded or burned. Garments now account for 8% of global greenhouse gas emissions. Synthetic fibres are being found in Arctic sea ice and in fish.
  • New research shows that 51% of Britons are opting to purchase expensive but longer-lasting clothes rather than cheaper throwaway items, up from 33% a year ago.
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  • At no other time in human history has fashion been so accessible to so many people. Technology will help to make fashion greener. Better regulation of supply chains will help too. There is a discernible shift from discarding clothes to repairing, reusing or even renting them. However, it is hard to see how this will be enough to make fashion truly sustainable if the industry still produces more and more clothes. Once normal service is resumed, we need to think again about the wisdom of fostering competitive consumption, which upholds the persistent demand for expansion, in our society.
katherineharron

Elizabeth Warren has a real opportunity to make this right (Opinion) - CNN - 0 views

  • Sen. Elizabeth Warren's silence on how she plans to pay for Medicare for All has turned into a problem at an important moment in her campaign. Right as she has become one of the clear frontrunners in the Democratic race — if not the frontrunner — she walked out of the fourth Democratic debate a bit bruised from her unwillingness to answer the question about whether she would raise taxes to pay for the benefits.
  • The plan will likely involve a package that mixes higher taxes and other revenue streams in exchange for eliminating the deductibles and premiums as well as other out-of-pocket expenses. Warren might make some adjustments to proposed benefits to lower the high estimates that are currently being projected. But to take control of this debate, Warren needs to offer more than a policy brief about finance. She has the chance to turn this challenge into an opportunity to make this part of her signature issue — restoring security to middle class Americans. It's an issue that has gotten drowned out with all the emphasis on health care.
  • While Barack Obama was in office, Warren made a name for herself by fighting for middle-class families and offering real solutions to the economic struggles that they faced on matters such as debt. At the Consumer Financial Protection Bureau, she fought to protect the rights of average Americans in the world in the financial sector.
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  • To win this debate among Democrats and in the national electorate, she needs to show that her plan will provide the most efficient, cost-effective and equitable health care system possible. Given the increased costs that patients are continuing to experience, even with the Affordable Care Act, Warren needs to explain why costs would rise even more dramatically if Congress doesn't go big. It will be crucial to demonstrate that by providing the public with immense leverage over providers, through government insurance, the country would finally be able to contain and drive down costs in the long-term and make the obligations from patients more predictable.
  • Solving the tax question is not enough. The only way to turn Medicare for All into a campaign theme that can win broad political support in the fall election will be to reframe the issue toward something greater than costs. Warren has an opportunity to make the case that this is not a left-of-center idea but in fact a way to bring greater security to all middle-class families.
rerobinson03

The Vaccines Are Supposed to Be Free. Surprise Bills Could Happen Anyway. - The New Yor... - 0 views

  • Congress passed legislation this spring that bars insurers from applying any cost sharing, such as a co-payment or deductible. It layered on additional protections barring pharmacies, doctors and hospitals from billing patients.
  • To consumer advocates, the rules seem nearly ironclad — yet they still fear that surprise vaccine bills will find their way to patients, just as they did with coronavirus testing and treatment earlier this year.
  • Americans vaccinated this year and next generally will not pay for the vaccine itself, because the federal government has purchased hundreds of millions of doses on patients’ behalf.
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  • The Affordable Care Act provides additional protections, because it requires most health insurers to fully cover all federally recommended preventive care.
  • Some insurers, including Aetna and certain Blue Cross Blue Shield plans, have already announced that they will not bill patients for the vaccine or its administration.
  • The federal government has used other levers to curtail surprise vaccine bills. When it offered enhanced Medicaid payment rates this spring, it required states to fully cover coronavirus vaccines for all their enrollees as a condition of receipt. All 50 states accepted the extra funding, and are now subject to those
  • requirements.
  • That’s different from the rules around coronavirus treatment, which regulated insurers’ cost sharing but did not take steps to curtail billing by doctors and hospitals. That meant some patients received bills they didn’t expect.
  • What makes the vaccine protections unique is that there are requirements on both the insurers and the providers,”
  • Experts also worry about uninsured Americans. The United States does not have a national program to cover vaccination costs for them. For coronavirus, it is instructing health providers to submit costs associated with vaccination to a $175 billion Provider Relief Fund created last spring.
  • Additional fees could accompany a vaccine. Some providers are accustomed to charging a visit fee for all in-person patients. Most emergency rooms charge “facility fees,” the price of coming in the door and seeking care, as do some hospital-based doctors.
  • Federal law is quite clear that patients should not have to pay for the vaccine and its administration. But there isn’t language that defines what counts as “vaccine administration,” and whether the visit fee makes the cut.
  • The question that I’m still not clear on is what happens if someone walks into an outpatient department that charges a facility fee and gets a vaccine,” said Kao-Ping Chua, an assistant professor of pediatrics at the University of Michigan who has studied coronavirus medical billing. “Is there a possibility they could get charged? I think the answer is yes.”
woodlu

Biden to Announce Expansion of Port of Los Angeles's Hours - The New York Times - 0 views

  • President Biden will announce on Wednesday that the Port of Los Angeles will begin operating around the clock as his administration struggles to relieve growing backlogs in the global supply chains that deliver critical goods to the United States.
  • Mr. Biden is set to give a speech on Wednesday addressing the problems in ports, factories and shipping lanes that have helped produce shortages, long delivery times and rapid price increases for food, televisions, automobiles and much more.
  • The resulting inflation has chilled consumer confidence and weighed on Mr. Biden’s approval ratings. The Labor Department is set to release a new reading of monthly inflation on Wednesday morning.
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  • brokered a deal to move the Port of Los Angeles toward 24/7 operations, joining Long Beach, which is already operating around the clock, and that they are encouraging states to accelerate the licensing of more truck drivers.
  • On Wednesday, the White House will host leaders from the Port of Los Angeles, the Port of Long Beach, and the International Longshore and Warehouse Union to discuss the difficulties at ports, as well as hold a round table with executives from Walmart, UPS and Home Depot.
  • Imports for the fourth quarter are on pace to be 4.7 percent higher than in the same period last year, which was also a record-breaking holiday season,
  • Companies are exacerbating the situation by rushing to obtain products and bidding up their own prices.
  • Administration officials acknowledged on Tuesday in a call with reporters that the $1.9 trillion economic aid package Mr. Biden signed into law in March had contributed to supply chain issues by boosting demand for goods, but said the law was the reason the U.S. recovery has outpaced those of other nations this year.
  • Consumer demand for exercise bikes, laptops, toys, patio furniture and other goods is booming, fueled by big savings amassed over the course of the pandemic.
  • The blockages stretch up and down supply chains, from foreign harbors to American rail yards and warehouses.
  • the average anchorage time had stretched to more than 11 days.
  • Home Depot, Costco and Walmart have taken to chartering their own ships to move products across the Pacific Ocean.
  • Companies that had been trying to avoid passing on higher costs to customers may find that they need to as higher costs become longer lived.
  • worsening supplier delivery times and conditions at ports suggested that product shortages would persist into mid- to late next year.
  • the pandemic has shut down factories and slowed production around the world. Port closures, shortages of shipping containers and truck drivers, and pileups in rail and ship yards have led to long transit times and unpredictable deliveries for a wide range of products
  • “But to some extent, they need to let markets do their work,” she said.
  • a Transportation Department official gathering information on what the administration could do to address the supply chain shortages had contacted his company. Flexport offered the administration suggestions on changing certain regulations and procedures to ease the blockages, but warned that the problem was a series of choke points “stacked one on top of the other.”
  • from the whole big picture, the supply capacity is really hard to change in a noteworthy way.”
  • The shortages have come as a shock for many American shoppers, who are used to buying a wide range of global goods with a single click, and seeing that same product on their doorstep within hours or days.
  • The political risk for the administration is that shortfalls, mostly a nuisance so far, turn into something more existential. Diapers are already in short supply. As aluminum shortages develop, packaging pharmaceuticals could become a problem,
  • slow deliveries could make for slim pickings this Christmas and Hanukkah.
  • Consumer price inflation probably climbed by 5.3 percent in the year through September, data from the Bureau of Labor Statistics is expected to show on Wednesday.
  • They often point out that much of the surge has been spurred by a jump in car prices, caused by a lack of computer chips that delayed vehicle production.
  • governments around the world could help to smooth some shortages and dampen some price increases, for example by encouraging workers to move into industries with labor shortages, like trucking
  • Tesla, for instance, had been hoping to reduce the cost of its electric vehicles and has struggled to do that amid the bottlenecks.
  • the concern is that today’s climbing prices could prompt consumers to expect rapid inflation to last. If people believe that their lifestyles will cost more, they may demand higher wages — and as employers lift pay, they may charge more to cover the cost.
  • If demand slumps as households spend away government stimulus checks and other savings they stockpiled during the pandemic downturn, that could leave purveyors of couches and lawn furniture with fewer production backlogs and less pricing power down the road.
  • If buying stays strong, and shipping remains problematic, inflation could become more entrenched.
  • To get their own orders fulfilled, companies have placed bigger orders and offered to pay higher prices.
Javier E

Who's Afraid of Early Cancer Detection? - WSJ - 0 views

  • A diagnosis of pancreatic cancer usually means a quick death—but not for Roger Royse, who was in Stage II of the disease when he got the bad news in July 2022. The five-year relative survival rate for late-stage metastatic pancreatic cancer is 3%—which means that patients are 3% as likely to live five years after their diagnosis as other cancer-free individuals. But if pancreatic cancer is caught before it has spread to other organs, the survival rate is 44%.
  • some public-health experts think that’s just as well. They fret that widespread use of multicancer early-detection tests would cause healthcare spending to explode. Those fears have snarled Galleri and similar tests in a web of red tape.
  • Early diagnosis is the best defense against most cancers,
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  • But only a handful of cancers—of the breast, lung, colon and cervix—have screening tests recommended by the U.S. Preventive Services Task Force
  • Many companies are developing blood tests that can detect cancer signals before symptoms occur, and Grail’s is the most advanced. A study found it can identify more than 50 types of cancer 52% of the time and the 12 deadliest cancers in Stages I through III 68% of the time.
  • There’s a hitch. The test costs $949 and isn’t covered by Medicare or most private insurance.
  • The trouble is that this cancer is almost never caught early. There’s no routine screening for it, and symptoms don’t develop until it is advanced. Mr. Royse, 64, had no idea he was sick until he took a blood test called Galleri, produced by the Menlo Park, Calif., startup Grail. He had surgery and chemotherapy and is now cancer-free.
  • Mr. Royse visited Grail’s website, which referred him to a telemedicine provider who ordered a test. Another telemedicine doctor walked him through his results, which showed a cancer signal likely emanating from the pancreas, gallbladder, stomach or esophagus.
  • An MRI revealed a suspicious mass on his pancreas, which a biopsy confirmed was cancerous. Mr. Royse had three months of chemotherapy, surgery and another three months of chemotherapy, which ended last February. Because pancreatic cancer often recurs, he gets CT and MRI scans every three months. In addition, he has signed up for startup Natera’s Signatera customized blood test, which checks DNA specific to the patient’s cancer and can signal its return before signs are visible on the scans
  • Grail’s test likewise looks for DNA shed by cancer cells, which is tagged by molecules called methyl groups that are specific to a cancer’s origin. Grail uses genetic sequencing and machine learning to recognize links between DNA methyl groups and particular cancers
  • The test “is based on how much DNA is being shed by tumor,” Grail’s president, Josh Ofman, says. “Some tumors shed a lot of DNA. Some shed almost none.
  • ut slow-growing tumors typically aren’t shedding a lot of DNA.” That reduces the probability that Grail’s test will identify indolent cancers that pose no immediate danger.
  • Grail’s test has a roughly 0.5% false-positive rate, meaning 1 in 200 patients who don’t have cancer will get a positive signal
  • Its positive predictive value is 43%, so that of every 100 patients with a positive signal, 43 actually have cancer
  • the legislation’s price tag could reduce political support. According to one private company’s estimate, the test could cost the government $39 billion to $145 billion over a decade. Mr. Goldman counters that analysts usually overestimate the costs and underestimate the benefits of medical interventions.
  • Because Grail uses machine learning to detect DNA-methylation cancer linkages, the Grail test’s accuracy should improve as more tests and patient data are collected
  • regulators may balk at approving the test, and insurers at covering it, until it becomes cheaper and more reliable.
  • How would the FDA weigh the risk that a false positive on a test like Grail’s could require invasive follow-up testing against the dire but hard-to-quantify risk that a deadly cancer wouldn’t be caught until it’s much harder to treat? It’s unclear.
  • some experts urge the FDA to require large randomized controlled trials before approving blood cancer tests. “Multicancer screening would entail tremendous costs and potentially substantial harms,” H. Gilbert Welch and Tanujit Dey of Brigham and Women’s Hospital wrote
  • Dr. Welch and Mr. Dey also suggested that companies should be required to prove their tests reduce overall mortality, even though the FDA doesn’t require drugmakers to prove their products reduce deaths or extend life. Clinical trials for the mRNA Covid vaccines didn’t show they reduced deaths.
  • One alternative is to rely on real-world studies, which Grail is already doing. One study of patients 50 and older without signs of cancer showed that the test doubled the number of cancers detected.
  • One recurring problem he has seen: “Epidemiologists are always getting cancer wrong,” he says. “Epidemiologists a decade ago said U.S. overtreats cancers. Well, no, the EU undertreats cancer.”
  • A 2012 study that he co-authored found that the higher U.S. spending on cancer care relative to Europe between 1983 and 1999 resulted in significantly higher survival rates for American patients than for those in Europe
  • By his study’s calculation, U.S. spending on cancer treatments during that period resulted in $556 billion in net benefits owing to reduced mortality.
  • He expects Galleri and other multicancer early-detection tests to reduce deaths and produce public-health and economic benefits that exceed their monetary costs
  • Expanding access to multicancer early-detection tests could also help solve the chicken-and-egg problem of drug development. Because few patients are diagnosed at early stages of some cancers, it’s hard to develop treatments for them
  • the positive predictive value for some recommended cancer screenings is far lower. Fewer than 1 in 10 women with an abnormal finding on a mammogram are diagnosed with breast cancer.
  • Mr. Royse makes the same point with personal force. “I would be dead right now if not for multicancer early-detection testing,” Mr. Royse told an FDA advisory committee last fall. “The longer the FDA waits, the more people are going to die. It’s that simple.”
Javier E

Middle-Class Miami Spends 72%(!) of Its Income on Housing and Transportation - Derek Th... - 0 views

  • Food and clothes consumed 60% of consumer spending in 1900, but as we found more efficient ways to make burgers and socks, that number fell all the way to 17% in 2003.
  • in most major cities, we spend the majority of our income on planes, trains, automobiles, and dwellings.
  • In the Miami metro area, middle-lower-income families spend a whopping 72% of their income on housing and transportation
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  • The Least Affordable Neighborhood in the U.S.? From the report: "In the Philadelphia region, moderate-income households are faced with average housing and transportation costs exceeding 90 percent of their income in some neighborhoods."
  • The Price of Density: Housing in Houston isn't so bad -- it's the 8th most affordable large city to own a home in. But the same thing that helps make it an affordable place to own a home (lots of space!) also raises its commuting costs. Factor in transportation, and it's the 8th least affordable large city to live.
  • dense expensive cities like San Francisco, Boston and New York are considerably more affordable when you add in transportation costs because of their superior public transit.
  • Nationwide, Housing Grew 2X as Fast as Income: Combined H&T expenses average $30,296 for a median-income household, according to the report. But they're growing much faster than median household income.
Javier E

Life After Oil and Gas - NYTimes.com - 0 views

  • To what extent will we really “need” fossil fuel in the years to come? To what extent is it a choice?
  • Thirteen countries got more than 30 percent of their electricity from renewable energy in 2011, according to the Paris-based International Energy Agency, and many are aiming still higher.
  • Could we? Should we?
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  • the United States could halve by 2030 the oil used in cars and trucks compared with 2005 levels by improving the efficiency of gasoline-powered vehicles and by relying more on cars that use alternative power sources, like electric batteries and biofuels.
  • New York State — not windy like the Great Plains, nor sunny like Arizona — could easily produce the power it needs from wind, solar and water power by 2030
  • “You could power America with renewables from a technical and economic standpoint. The biggest obstacles are social and political — what you need is the will to do it.”
  • “There is plenty of room for wind and solar to grow and they are becoming more competitive, but these are still variable resources — the sun doesn’t always shine and the wind doesn’t always blow,” said Alex Klein, the research director of IHS Emerging Energy Research, a consulting firm on renewable energy. “An industrial economy needs a reliable power source, so we think fossil fuel will be an important foundation of our energy mix for the next few decades.”
  • improving the energy efficiency of homes, vehicles and industry was an easier short-term strategy. He noted that the 19.5 million residents of New York State consume as much energy as the 800 million in sub-Saharan Africa (excluding South Africa)
  • a rapid expansion of renewable power would be complicated and costly. Using large amounts of renewable energy often requires modifying national power grids, and renewable energy is still generally more expensive than using fossil fuels
  • Promoting wind and solar would mean higher electricity costs for consumers and industry.
  • many of the European countries that have led the way in adopting renewables had little fossil fuel of their own, so electricity costs were already high. Others had strong environmental movements that made it politically acceptable to endure higher prices
  • countries could often get 25 percent of their electricity from renewable sources like wind and solar without much modification to their grids. A few states, like Iowa and South Dakota, get nearly that much of their electricity from renewable power (in both states, wind), while others use little at all.
  • America is rich in renewable resources and (unlike Europe) has the empty space to create wind and solar plants. New York State has plenty of wind and sun to do the job, they found. Their blueprint for powering the state with clean energy calls for 10 percent land-based wind, 40 percent offshore wind, 20 percent solar power plants and 18 percent solar panels on rooftops
  • the substantial costs of enacting the scheme could be recouped in under two decades, particularly if the societal cost of pollution and carbon emissions were factored in
Javier E

Bill Gates: 'Death is something we really understand extremely well' - 0 views

  • how do you know what’s actually working when you’re in failed states with very little data-collection capacity? Bill Gates: Of all the statistics in health, death is the easiest, because you can go out and ask people, “Hey, have you had any children who died, did your siblings have any children who died?” People don’t forget that.
  • you can save a lot of lives. One thing about the childhood death rate is you really can split it into the first 30 days of life versus 30 days to 5 years. Thirty days to 5 years is all vaccine preventable stuff — it’s diarrhea, respiratory and malaria.
  • BG: I was completely surprised that nobody was funding some of these vaccines. When I first looked at this I thought, well, all the good stuff will have been done. It was mind-blowing me to find things like Rotavirus vaccine were going unfunded. One hundred percent of rich kids were getting it and no poor kids were. So over a quarter million kids a year were dying of Rotavirus-caused diarrhea. You could save those lives for $800 per life. That’s like $20 or $30 per year of life.
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  • The low-income, middle-income and high-income health systems have extremely different problems. You know, in low-income countries, getting to a health post is hard. It’s very expensive. Whereas in rich countries, yes, you can get to your doctor. In low-income countries, the main problems you have is infectious diseases. We’re dealing with countries that in the worst case where kids have death rates of 20 percent and that’s all infectious disease. And nothing else. In the U.S., in terms of kids under 5, other than premature birth, you really don’t have big problems. Kids just don’t die of infectious disease.
  • in the U.S., what do people die of? From age 5 till age 50, you’ve got suicide, you’ve got traffic accidents. There’s very little cancer and heart disease before age 50.
  • what’s a year of life worth? They call it a disability-adjusted life year (DALY). When you’re running a poor country health-care system, you can’t treat a year of life as being worth more than, say, $200, $300 or else you’ll bankrupt your health system immediately. So, with very few exceptions, you do nothing for cancer. If you get cancer, you’re going to die. And so none of the stuff that’s going on in the U.S. about $300,000 a year chemotherapy drugs is relevant.
  • If you spend the less than 2 percent of what the rich countries spend, but you spend it on vaccinations and antibiotics, you get over half of all that healthcare does to extend life. So you spend 2 percent and you get 50 percent. If you spend another 80 percent you’re at over 90 percent.
  • in rich-world health, innovation is both your friend and your enemy. Innovation is inventing organ replacement, joint replacement. We’re inventing ways of doing new things that cost $300,000 and take people in their 70s and, on average, give them an extra, say, two or three years of life. And then you have to say, given finite resources, should we fire two or three teachers to do this operation? And with chemotherapies, we’ve got things where we’ll spend our dollars on treatments where you’re valuing a life here at over $10 to $20 million. Really big, big numbers, which if you were infinitely rich, of course that would be fine. So most innovations, unfortunately, actually increase the net costs of the healthcare system. There’s a few, particularly having to do with chronic diseases, that are an exception. If you could cure Alzheimer’s, if you could avoid diabetes — those are gigantic in terms of saving money. But the incentive regime doesn’t favor them.
  • We’re very uncomfortable putting a value on human life. The way I see our health system is we’ve chosen to pay a huge premium in order to avoid these questions. A prerequisite for the kind of cost-cutting innovations you’re talking about it is being willing to make judgments about what a human life is worth, or even what a few months of a human life are worth. Because if you can’t decide that, then of course you just pay for everything. But if you start trying to make those choices, or even get people to think about those choices, people cry “death panels!”
  • BG. Yes, someone in the society has to deal with the reality that there are finite resources and we’re making trade-offs, and be explicit about that. When the car companies were found to have a memo that actually said, “This safety feature costs X and saved Y lives,” the very existence of that memo was considered damning. It was “Oh, you think human life is only a bank account.” Or when you made it reimbursable for a doctor to ask, “Do you want heroic care at the end-of-life,” that was a death panel. No, it wasn’t a death panel! It was asking somebody to make a decision.
julia rhodes

North Koreans Question Test Costs - 0 views

  • Pyongyang’s third nuclear test which they say underscores a diversion of scarce funds towards weapons programs instead of coping with chronic food shortages.
  • the people are frustrated that precious resources are being diverted from efforts to address economic impoverishment, North Korean defectors and rights groups told RFA’s Korean service.
  • “North Koreans cannot understand the nuclear test when they see hunger in the country,” Song said.
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  • “It’s unacceptable because there are many North Koreans starving to death while the authorities are wasting a lot of money—several hundred million dollars—on the test.”
  • Pyongyang had spent U.S. $1.3 billion on its rocket program in 2012.
  • he official estimated that the cost was the equivalent of 4.6 million tons of corn, which could have fed North Koreans for “four to five years
  • The leadership change has created a stir at the lowest levels of the military,” said the source, speaking on condition of anonymity.
  • “Not only me, but many North Korean defectors in South Korea, knew that Kim Jong Un was young and had studied abroad, so we believed that he would be different from his father and grandfather [national founder Kim Il Sung] in terms of policy making,” she said.“But our initial hope has clearly not materialized, making us sad
  • “The North Korean regime has no consideration for human rights—it is only concerned with maintaining political power.”
  • “The reason for the test is to divert or soothe the people’s discontent over the malfunctioning of the regime. In order to do that they must find an enemy from outside,” Jang said.
  • f North Korea’s Yanggang province, which borders China, told RFA that anger within the regime following the removal of several generals from the ranks of government during a broad political reshuffle had forced Kim Jong Un to test the device as an overture to the military
  • the regime was attempting to assuage the anger and fears of the North Korean people, who he said no longer trust their government
  • China’s Liaoning province said that the action is likely to affect North Korea’s trade with China, valued at U.S. $5.64 billion in 2011.
  • it is surprising
  • that North Korea conducted the test during the Chinese Lunar New Year [China’s most important holiday of the yea
  • “I’m worried about the possibility that I might not get back money for the goods I gave to my North Korean counterparts on credit, because they are likely to say that the country is in a state of emergency and that they are unable to pay me back due to political reasons
Javier E

Beware of Romneycare : The New Yorker - 0 views

  • In most areas of the economy, free-market principles insure that products and services keep improving, and that consumers get better and better deals. But the free market, though it may be the best way of allocating new TVs and cars, falters when it comes to paying for bypass surgery or chemotherapy. The reasons for this were established nearly fifty years ago, by the economist Kenneth Arrow, in a classic article entitled “Uncertainty and the Welfare Economics of Medical Care.” Arrow showed that health care is distinctive in ways that limit the power of the market. Because people don’t have the expertise to evaluate doctors, hospitals, or treatments, it’s hard for them to comparison-shop. Because they can’t pay for major care out of pocket, they must rely on insurance, thereby often losing the final say in what to buy or how much to spend. More fundamentally, markets work only when consumers have the power to say no if the price isn’t right. Yet it’s very hard for people to say no in the case of things like end-of-life care or brain surgery.
  • the truth is that, despite the rhetoric, Romney’s main concern isn’t to bring down over-all health-care costs. In fact, he has regularly attacked one of the Affordable Care Act’s most aggressive cost-cutting measures—the independent board that can make binding recommendations on how to cut Medicare spending. What he wants is just to have the government less involved in health care. Insofar as his plans would lower federal health-care spending, it’s not because of the power of the free market; it’s because a Romney Administration would simply have the government do less. Romney would eliminate the Obamacare subsidies for health insurance. He would turn Medicaid into a block grant to the states and trim its annual budget, with the result that its funding would lag behind the rise in health-care costs. And, if he adopts his running mate Paul Ryan’s premium-support plan for Medicare, he would make Medicare recipients pay higher premiums. With these changes, the government would spend less, but only because it would provide less, and Americans would get less. It’s like saving on defense by protecting only two-thirds of the country.
  • The real issue, come November 6th, isn’t about who has the best ideas for controlling health-care costs. It’s about who has the right idea of what government should do. ♦
Javier E

Vladimir Putin may have done us a big favor - The Washington Post - 0 views

  • it’s just possible that Vladimir Putin has done us a great favor. He has alerted us to the true threat of cyberwarfare in a way that — again, just possibly — might prompt us to view it as a serious national danger and begin to take effective countermeasures.
  • So far, cyberattacks have not endangered our economy or way of life. The breaches mainly represent a new form of crime whose costs are exasperating but manageable. The truth is that most cyberattacks fail.
  • A 2014 report by the Center for Strategic and International Studies puts the worldwide cost of cybercrime at more than $400 billion. Although that’s a lot of money, it’s only about one-half of 1 percent of global output, estimated at $78 trillion in 2014
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  • Until now, the Internet has mainly created new avenues for old behaviors. Roughly nine of 10 computer breaches involve theft or business espionage,
  • You cannot do a cost-benefit analysis of something that imperils society’s economic and political foundations. The plausible cost is infinite
  • It does jeopardize our way of life. It undermines the integrity of our political institutions and popular faith in them.
  • More than this, it warns us that our physical safety and security are at risk. Hostile hackers can hijack power grids, communication networks, transportation systems and much more.
  • What Putin and Russian hackers allegedly did shatters this pattern. Their hacking — as interpreted by both the CIA and the FBI — qualifies as state-sponsored aggression
  • The rise of cyberattacks, says a recent report from the American Enterprise Institute, ranks with three great strategic shifts in military history — first, the rise of sea power; next, the advent of air power; and most recently, the opening of space.
  • The emergence of cyberspace “poses the most daunting challenge yet . . . [because] its implications are more sweeping,” AEI asserts. It touches almost every aspect of society and alters the nature of global conflict.
  • We could move some vital data networks offline — that is, we could build systems independent of the Internet.
  • Another possibility is to impose security standards on the “Internet of things
  • It’s also possible to streamline agencies overseeing cyberspace.
  • Americans are of two minds about the Internet. They love social media and gadgets, such as smartphones. Meanwhile, they hate its threat to privacy and the dangers of hacking. Putin’s gift to America is that he is forcing us to face the contradictions.
  • The problem is not just Russia’s bad behavior. It’s the nature of the Internet. If we don’t acknowledge that, we will increasingly become its victim.
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