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Javier E

George Conway: Trump Is Unfit for Office - The Atlantic - 0 views

  • Behavior like this is unusual, a point that journalists across the political spectrum have made. “This is not normal,” Megan McArdle wrote in late August. “And I don’t mean that as in, ‘Trump is violating the shibboleths of the Washington establishment.’ I mean that as in, ‘This is not normal for a functioning adult.’” James Fallows observed, also in August, that Trump is having “episodes of what would be called outright lunacy, if they occurred in any other setting,” and that if he “were in virtually any other position of responsibility, action would already be under way to remove him from that role.”
  • Simply put, Trump’s ingrained and extreme behavioral characteristics make it impossible for him to carry out the duties of the presidency in the way the Constitution requires. To see why first requires a look at what the Constitution demands of a president, and then an examination of how Trump’s behavioral characteristics preclude his ability to fulfill those demands.
  • Though the Constitution’s drafters could hardly have foreseen how the system would evolve, they certainly knew the kind of person they wanted it to produce. “The process of election affords a moral certainty,” Hamilton wrote, “that the office of President will never fall to the lot of any man who is not in an eminent degree endowed with the requisite qualifications.
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  • “Talents for low intrigue, and the little arts of popularity,” might suffice for someone to be elected to the governorship of a state, but not the presidency. Election would “require other talents, and a different kind of merit,” to gain “the esteem and confidence of the whole Union,” or enough of it to win the presidency. As a result, there would be “a constant probability of seeing the station filled by characters pre-eminent for ability and virtue.” This was the Framers’ goal in designing the system that would make “the choice of the person to whom so important a trust was to be confided.”
  • In a nutshell, while carrying out his official duties, a president has to put the country, not himself, first; he must faithfully follow and enforce the law; and he must act with the utmost care in doing all that.
  • can Trump do all that? Does his personality allow him to? Answering those questions doesn’t require mental-health expertise, nor does it really require a diagnosis. You can make the argument for Trump’s unfitness without assessing his mental health: Like James Fallows, for example, you could just ask whether Trump would have been allowed to retain any other job in light of his bizarre conduct
  • More than a diagnosis, what truly matters, as Lincoln’s case shows, is the president’s behavioral characteristics and personality traits. And understanding how people behave and think is not the sole province of professionals; we all do it every day, with family members, co-workers, and others.
  • its criteria for personality disorders—they don’t require a person to lie on a couch and confess his or her innermost thoughts. They turn on how a person behaves in the wild, so to speak.
  • Donald Trump, as president of the United States, is probably the most observable and observed person in the world. I’ve personally met and spoken with him only a few times, but anyone who knows him will tell you that Trump, in a way, has no facade: What you see of him publicly is what you get all the time, although you may get more of it in private
  • accounts of a person’s behavior from laypeople who observe him might be more accurate than information from a clinical interview, and that this is especially true when considering two personality disorders in particular—what the DSM calls narcissistic personality disorder and antisocial personality disorde
  • These two disorders just happen to be the ones that have most commonly been ascribed to Trump by mental-health professionals over the past four years. Of these two disorders, the more commonly discussed when it comes to Trump is narcissistic personality disorder, or NPD—pathological narcissism
  • it touches directly upon whether Trump has the capacity to put anyone’s interests—including the country’s and the Constitution’s—above his own.
  • A certain amount of narcissism is healthy, and helpful—it brings with it confidence, optimism, and boldness. Someone with more than an average amount of narcissism may be called a narcissist. Many politicians, and many celebrities, could be considered narcissists
  • “Pathological narcissism begins when people become so addicted to feeling special that, just like with any drug, they’ll do anything to get their ‘high,’ including lie, steal, cheat, betray, and even hurt those closest to them,”
  • The “fundamental life goal” of an extreme narcissist “is to promote the greatness of the self, for all to see,
  • To many mental-health professionals, Donald Trump provides a perfect example of such extreme, pathological narcissism: One clinical psychologist told Vanity Fair that he considers Trump such a “classic” pathological narcissist that he is actually “archiving video clips of him to use in workshops because there’s no better example”
  • The goal of a diagnosis is to help a clinician guide treatment. The question facing the public is very different: Does the president of the United States exhibit a consistent pattern of behavior that suggests he is incapable of properly discharging the duties of his office?
  • Even Trump’s own allies recognize the degree of his narcissism. When he launched racist attacks on four congresswomen of color, Senator Lindsey Graham explained, “That’s just the way he is. It’s more narcissism than anything else.” So, too, do skeptics of assigning a clinical diagnosis. “No one is denying,” Frances told Rolling Stone, “that he is as narcissistic an individual as one is ever likely to encounter.” The president’s exceptional narcissism is his defining characteristic—and understanding that is crucial to evaluating his fitness for office
  • The DSM-5 describes its conception of pathological narcissism this way: “The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts.”
  • The diagnostic criteria offer a useful framework for understanding the most remarkable features of Donald Trump’s personality, and of his presidency. (1) Exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements?
  • (2) Preoccupied with fantasies of unlimited success, power, brilliance
  • (3) Believes that he or she is “special” and unique and should only associate with other special or high-status people?
  • Trump claims to be an expert—the world’s greatest—in anything and everything. As one video mash-up shows, Trump has at various times claimed—in all seriousness—that no one knows more than he does about: taxes, income, construction, campaign finance, drones, technology, infrastructure, work visas, the Islamic State, “things” generally, environmental-impact statements, Facebook, renewable energy, polls, courts, steelworkers, golf, banks, trade, nuclear weapons, tax law, lawsuits, currency devaluation, money, “the system,” debt, and politicians.
  • (4) Requires excessive admiration? Last Thanksgiving, Trump was asked what he was most thankful for. His answer: himself, of course. A number of years ago, he made a video for Forbes in which he interviewed two of his children. The interview topic: how great they thought Donald Trump wa
  • (5) A sense of entitlement? (9) Arrogant, haughty behaviors? Trump is the man who, on the infamous Access Hollywood tape, said, “When you’re a star, they let you do it. You can do anything you want”—including grabbing women by their genitals. He’s the man who also once said, “I could stand in the middle of Fifth Avenue and shoot somebody and I wouldn’t lose any voters.”
  • (8) Envious of others? Here’s a man so unable to stand the praise received by a respected war hero and statesman, Senator John McCain, that he has continued to attack McCain months after McCain’s death;
  • (6) Interpersonally exploitative? Just watch the Access Hollywood tape, or ask any of the hundreds of contractors and employees Trump the businessman allegedly stiffed, or speak with any of the two dozen women who have accused Trump of sexual misconduct, sexual assault, or rape.
  • Finally, (7) Lacks empathy: is unwilling to recognize or identify with the feelings or needs of others? One of the most striking aspects of Trump’s personality is his utter and complete lack of empathy
  • The notorious lawyer and fixer Roy Cohn, who once counseled Trump, said that “Donald pisses ice water,” and indeed, examples of Trump’s utter lack of normal human empathy abound.
  • “It made no sense, Priebus realized, unless you understood … ‘The president has zero psychological ability to recognize empathy or pity in any way.’
  • What kind of human being, let alone politician, would engage in such unempathetic, self-centered behavior while memorializing such horrible tragedies? Only the most narcissistic person imaginable—or a person whose narcissism would be difficult to imagine if we hadn’t seen it ourselves. The evidence of Trump’s narcissism is overwhelming—indeed, it would be a gargantuan task to try to marshal all of it, especially as it mounts each and every day.
  • A second disorder also frequently ascribed to Trump by professionals is sociopathy—what the DSM-5 calls antisocial personality disorder
  • Central to sociopathy is a complete lack of empathy—along with “an absence of guilt.” Sociopaths engage in “intentional manipulation, and controlling or even sadistically harming others for personal power or gratification. People with sociopathic traits have a flaw in the basic nature of human beings … They are lacking an essential part of being human.” For its part, the DSM-5 states that the “essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”
  • Trump’s sociopathic characteristics sufficiently intertwine with his narcissistic ones that they deserve mention here. These include, to quote the DSM-5, “deceitfulness, as indicated by repeated lying, use of aliases, or conning others.” Trump’s deceitfulness—his lying—has become the stuff of legend; journalists track his “false and misleading claims” as president by the thousands upon thousands.
  • Other criteria for antisocial personality disorder include “failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest”; “impulsivity or failure to plan ahead”; and “lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
  • As for impulsivity, that essentially describes what gets him into trouble most: It was his “impulsiveness—actually, total recklessness”—that came close to destroying him in the 1980s
  • And lack of remorse? That’s a hallmark of sociopathy, and goes hand in hand with a lack of human conscience. In a narcissistic sociopath, it’s intertwined with a lack of empathy. Trump hardly ever shows remorse, or apologizes, for anything. The one exception: With his presidential candidacy on the line in early October
  • In a way, Trump’s sociopathic tendencies are simply an extension of his extreme narcissism
  • articular, “They change reality to suit themselves in their own mind.” Although Trump “lies because of his sociopathic tendencies,” telling falsehoods to fool others, Dodes argues, he also lies to himself, to protect himself from narcissistic injury. And so Donald Trump has lied about his net worth, the size of the crowd at his inauguration, and supposed voter fraud in the 2016 election.
  • The latter kind of lying, Dodes says, “is in a way more serious,” because it can indicate “a loose grip on reality”—and it may well tell us where Trump is headed in the face of impeachment hearings. Lying to prevent narcissistic injury can metastasize to a more significant loss of touch with reality
  • Experts haven’t suggested that Trump is psychotic, but many have contended that his narcissism and sociopathy are so inordinate that he fits the bill for “malignant narcissism.” Malignant narcissism isn’t recognized as an official diagnosis; it’s a descriptive term coined by the psychoanalyst Erich Fromm, and expanded upon by another psychoanalyst, Otto Kernberg, to refer to an extreme mix of narcissism and sociopathy, with a degree of paranoia and sadism mixed in
  • In the view of some in the mental-health community, such as John Gartner, Trump “exhibits all four” components of malignant narcissism: “narcissism, paranoia, antisocial personality and sadism.”
  • Mental-health professionals have raised a variety of other concerns about Trump’s mental state; the last worth specifically mentioning here is the possibility that, apart from any personality disorder, he may be suffering cognitive decline.
  • His “mental state,” according to Justin A. Frank, a former clinical professor of psychiatry and physician who wrote a book about Trump’s psychology, “include[s] so many psychic afflictions” that a “working knowledge of psychiatric disorders is essential to understanding Trump.” Indeed, as Gartner puts it: “There are a lot of things wrong with him—and, together, they are a scary witch’s brew.”
  • when you line up what the Framers expected of a president with all that we know about Donald Trump, his unfitness becomes obvious. The question is whether he can possibly act as a public fiduciary for the nation’s highest public trust. To borrow from the Harvard Law Review article, can he follow the “proscriptions against profit, bad faith, and self-dealing,” manifest “a strong concern about avoiding ultra vires action” (that is, action exceeding the president’s legal authority), and maintain “a duty of diligence and carefulness”? Given that Trump displays the extreme behavioral characteristics of a pathological narcissist, a sociopath, or a malignant narcissist—take your pick—it’s clear that he can’t.
  • To act as a fiduciary requires you to put someone else’s interests above your own, and Trump’s personality makes it impossible for him to do that. No president before him, at least in recent memory, has ever displayed such obsessive self-regard
  • Indeed, Trump’s view of his presidential powers can only be described as profoundly narcissistic, and his narcissism has compelled him to disregard the Framers’ vision of his constitutional duties in every respect
  • Trump’s incapacity affects all manner of subjects addressed by the presidency, but can be seen most acutely in foreign affairs and national security.
  • All in all, Trump sought to impede and end a significant counterintelligence and criminal investigation—one of crucial importance to the nation—and did so for his own personal reasons. He did precisely the opposite of what his duties require. Indeed, he has shown utter contempt for his duties to the nation
  • hat constitutional mechanisms exist for dealing with a president who cannot or does not comply with his duties, and how should they take the president’s mental and behavioral characteristics into account?
  • it turns out that impeachment is a more practical mechanism
  • In short, now that the House of Representatives has embarked on an impeachment inquiry, one of the most important judgments it must make is whether any identified breaches of duty are likely to be repeated. And if a Senate trial comes to pass, that issue would become central as well to the decision to remove the president from office. That’s when Trump’s behavioral and psychological characteristics should—must—come into pla
  • One of the most compelling arguments about the meaning of those words is that the Framers, in Article II’s command that a president faithfully execute his office, imposed upon him fiduciary obligations. As the constitutional historian Robert Natelson explained in the Federalist Society Review, the “founding generation [understood] ‘high … Misdemeanors’ to mean ‘breach of fiduciary duty.’
  • Eighteenth-century lawyers instead used terms such as breach of trust—which describes the same thing. “Parliamentary articles of impeachment explicitly and repetitively described the accused conduct as a breach of trust,” Natelson argues, and 18th-century British legal commentators explained how impeachment for “high Crimes and Misdemeanors” was warranted for all sorts of noncriminal violations that were, in essence, fiduciary breaches.
  • why the discussion of Morris’s suggestion was so brief—the drafters knew what the words historically meant, because, as a House Judiciary Committee report noted in 1974, “at the time of the Constitutional Convention the phrase ‘high Crimes and Misdemeanors’ had been in use for over 400 years in impeachment proceedings in Parliament
  • Certainly Alexander Hamilton knew by the time he penned “Federalist No. 65,” in which he explained that impeachment was for “those offenses which proceed from the misconduct of public men, or, in other words, from the abuse or violation of some public trust.
  • What constitutes such an abuse or violation of trust is up to Congress to decide: First the House decides to bring impeachment charges, and then the Senate decides whether to convict on those charges. The process of impeachment by the House and removal by trial in the Senate is thus, in some ways, akin to indictment by a grand jury and trial by a petit jury
  • As Laurence Tribe and Joshua Matz explain in their recent book on impeachment, “the Constitution explicitly states that Congress may not end a presidency unless the president has committed an impeachable offense. But nowhere does the Constitution state or otherwise imply that Congress must remove a president whenever that standard is met … In other words, it allows Congress to exercise judgment.”
  • As Tribe and Matz argue, that judgment presents a “heavy burden,” and demands that Congress be “context-sensitive,” and achieve “an understanding of all relevant facts.” A president might breach his trust to the nation once in some small, inconsequential way and never repeat the misbehavior, and Congress could reasonably decide that the game is not worth the candle.
  • It’s also an appropriate mechanism, because the constitutional magic words (other than Treason and Bribery) that form the basis of an impeachment charge—high Crimes and Misdemeanors, found in Article II, Section 4 of the Constitution—mean something other than, and more than, offenses in the criminal-statute books. High Crimes and Misdemeanors is a legal term of art, one that historically referred to breaches of duties—fiduciary duties—by public officeholders. In other words, the question of what constitutes an impeachable offense for a president coincides precisely with whether the president can execute his office in the faithful manner that the Constitution requires.
  • there’s another reason as well. The people have a right to know, and a need to see. Many people have watched all of Trump’s behavior, and they’ve drawn the obvious conclusion. They know something’s wrong, just as football fans knew that the downed quarterback had shattered his leg. Others have changed the channel, or looked away, or chosen to deny what they’ve seen. But if Congress does its job and presents the evidence, those who are in denial won’t be able to ignore the problem any longer.
Javier E

School's End Clears Up New York Students' Mystery Twitching - NYTimes.com - 0 views

  • A total of 20 patients - almost all of them girls enrolled at Le Roy Junior/Senior High School - first began exhibiting involuntary movements in October 2011 in this working class town about 50 miles east of Buffalo. Doctors and state health department officials made the quick but controversial diagnoses of conversion disorder, in which psychological stress causes patients to suffer physical symptoms, and mass psychogenic illness, in which members of a tight-knit group subconsciously copy behavior
  • As the problem spiraled in the tiny community, celebrity doctors like Dr. Drew Pinsky hosted some of the girls on national television, others girls appeared regularly on local television and in print media with headlines about their "mystery illness." The girls posted updates on their seemingly bizarre condition to Facebook and videos of their symptoms to YouTube. "We noticed that the kids who were not in the media were getting better; the kids who were in the media were still very symptomatic," Mechtler said. "One thing we've learned is how social media and mainstream media can worsen the symptoms," he said. "The mass hysteria was really fueled by the national media, social media - all this promoted the worsening of symptoms by putting these people at the national forefront."
  • The psychological diagnosis was a hard sell to parents of the students whose suburban lives were suddenly turned upside down. Fitzsimmons said while she agrees with Mechtler's diagnosis, she understands the difficulty other patients' have accepting it. "Because it's considered a psychological diagnosis, they think psychological issues mean they're crazy, she said. "I just never understood how connected the mind and body actually are."
Javier E

Greta Thunberg responds to Asperger's critics: 'It's a superpower' | Environment | The ... - 0 views

  • Thunberg, the public face of the school climate strike movement said on Twitter that before she started her climate action campaign she had “no energy, no friends and I didn’t speak to anyone. I just sat alone at home, with an eating disorder.” She said she had not been open about her diagnosis of being on the autism spectrum in order to “hide” behind it, but because she knew “many ignorant people still see it as an ‘illness’, or something negative”.
  • “When haters go after your looks and differences, it means they have nowhere left to go. And then you know you’re winning!” she wrote, using the hashtag #aspiepower. While acknowledging that her diagnosis has limited her before, she said it “sometimes makes me a bit different from the norm” and she sees being different as a “superpower”.
  • Asperger’s syndrome was named after the Austrian paediatrician, Hans Asperger, who, in the 1940s, described some of its characteristics, including difficulties in social interaction and nonverbal communication, including difficulties reading body language. In 2013, Asperger’s was folded into the wider diagnosis of autism spectrum disorder. Tony Attwood, a world authority on Asperger’s, has said people diagnosed are “usually renowned for being direct, speaking their mind and being honest and determined and having a strong sense of social justice”.
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  • Bolt repeatedly referred to Greta’s mental health, saying she was “deeply disturbed”.
  • Greta Thunberg (@GretaThunberg) I am indeed ”deeply disturbed” about the fact that these hate and conspiracy campaigns are allowed to go on and on and on just because we children communicate and act on the science. Where are the adults? pic.twitter.com/xDSlN0VgtZ
clairemann

Court allows execution of Corey Johnson to proceed after COVID-19 diagnosis - SCOTUSblog - 0 views

  • The justices on Thursday night denied two last-minute appeals by Corey Johnson, who sought to postpone his execution so that he could recover from COVID-19, which he contracted in prison after spending most of his life on death row. Johnson also argued that he was ineligible for the death penalty on the basis of intellectual disability and that he should have been allowed to seek a sentencing reduction under a 2018 prison-reform law.
  • The two appeals were the subject of a flurry of last-minute litigation, in multiple federal courts, that reached the justices minutes before Johnson’s originally scheduled execution time of 6 p.m. on Thursday. In two unsigned orders issued around 10 p.m. (available here and here), the court denied both appeals.
  • Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan indicated that they would have put the execution on hold based on Johnson’s COVID diagnosis. Sotomayor and Kagan separately indicated that they also would have granted a stay based on Johnson’s other legal arguments.
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  • In their first appeal, Johnson’s lawyers raised two issues: intellectual disability and eligibility for resentencing.
  • In the second appeal, lawyers for Johnson and Higgs contended that putting their clients to death by lethal injection while their lungs were still recovering from damage due to the coronavirus would subject them to unconstitutional levels of suffering, in violation of the Eighth Amendment’s ban on cruel and unusual punishment.
Javier E

Why Britain Failed Its Coronavirus Test - The Atlantic - 0 views

  • Britain has not been alone in its failure to prevent mass casualties—almost every country on the Continent suffered appalling losses—but one cannot avoid the grim reality spelled out in the numbers: If almost all countries failed, then Britain failed more than most.
  • The raw figures are grim. Britain has the worst overall COVID-19 death toll in Europe, with more than 46,000 dead according to official figures, while also suffering the Continent’s second-worst “excess death” tally per capita, more than double that in France and eight times higher than Germany’s
  • The British government as a whole made poorer decisions, based on poorer advice, founded on poorer evidence, supplied by poorer testing, with the inevitable consequence that it achieved poorer results than almost any of its peers. It failed in its preparation, its diagnosis, and its treatment.
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  • In the past two decades, the list of British calamities, policy misjudgments, and forecasting failures has been eye-watering: the disaster of Iraq, the botched Libyan intervention in 2011, the near miss of Scottish independence in 2014, the woeful handling of Britain’s divorce from the European Union from 2016 onward
  • What emerges is a picture of a country whose systemic weaknesses were exposed with appalling brutality, a country that believed it was stronger than it was, and that paid the price for failures that have built up for years
  • The most difficult question about all this is also the simplest: Why?
  • Like much of the Western world, Britain had prepared for an influenza pandemic, whereas places that were hit early—Hong Kong, South Korea, Singapore, Taiwan—had readied themselves for the type of respiratory illness that COVID-19 proved to be.
  • Britain’s pandemic story is not all bad. The NHS is almost universally seen as having risen to the challenge; the University of Oxford is leading the race to develop the first coronavirus vaccine for international distribution, backed with timely and significant government cash; new hospitals were built and treatments discovered with extraordinary speed; the welfare system did not collapse, despite the enormous pressure it suddenly faced; and a national economic safety net was rolled out quickly.
  • One influential U.K. government official told me that although individual mistakes always happen in a fast-moving crisis, and had clearly taken place in Britain’s response to COVID-19, it was impossible to escape the conclusion that Britain was simply not ready. As Ian Boyd, a professor and member of SAGE, put it: “The reality is, there has been a major systemic failure.”
  • “It’s obvious that the British state was not prepared for” the pandemic, this official told me. “But, even worse, many parts of the state thought they were prepared, which is significantly more dangerous.”
  • When the crisis came, too much of Britain’s core infrastructure simply failed, according to senior officials and experts involved in the pandemic response
  • The human immune system actually has two parts. There is, as Cummings correctly identifies, the adaptive part. But there is also an innate part, preprogrammed as the first line of defense against infectious disease. Humans need both. The same is true of a state and its government, said those I spoke with—many of whom were sympathetic to Cummings’s diagnosis. Without a functioning structure, the responsive antibodies of the government and its agencies cannot learn on the job. When the pandemic hit, both parts of Britain’s immune system were found wanting.
  • The consequences may be serious and long term, but the most immediately tragic effect was that creating space in hospitals appears to have been prioritized over shielding Britain’s elderly, many of whom were moved to care homes, part of what Britain calls the social-care sector, where the disease then spread. Some 25,000 patients were discharged into these care homes between March 17 and April 16, many without a requirement that they secure a negative coronavirus test beforehand.
  • There was a bit too much exceptionalism about how brilliant British science was at the start of this outbreak, which ended up with a blind spot about what was happening in Korea, Taiwan, Singapore, where we just weren’t looking closely enough, and they turned out to be the best in the world at tackling the coronavirus,” a former British cabinet minister told me.
  • The focus on influenza pandemics and the lack of a tracing system were compounded by a shortfall in testing capacity.
  • Johnson’s strategy throughout was one that his hero Winston Churchill raged against during the First World War, when he concluded that generals had been given too much power by politicians. In the Second World War, Churchill, by then prime minister and defense secretary, argued that “at the summit, true politics and strategy are one.” Johnson did not take this approach, succumbing—as his detractors would have it—to fatalistic management rather than bold leadership, empowering the generals rather than taking responsibility himself
  • “It was a mixture of poor advice and fatalism on behalf of the experts,” one former colleague of Johnson’s told me, “and complacency and boosterism on behalf of the PM.”
  • What it all adds up to, then, is a sobering reality: Institutional weaknesses of state capacity and advice were not corrected by political judgment, and political weaknesses were not corrected by institutional strength. The system was hardwired for a crisis that did not come, and could not adapt quickly enough to the one that did.
  • Britain’s NHS has come to represent the country itself, its sense of identity and what it stands for. Set up in 1948, it became known as the first universal health-care system of any major country in the world (although in reality New Zealand got there first). Its creation, three years after victory in the Second World War, was a high-water mark in the country’s power and prestige—a time when it was a global leader, an exception.
  • Every developed country in the world, apart from the United States, has a universal health-care system, many of which produce better results than the NHS.
  • When the pandemic hit, then, Britain was not the strong, successful, resilient country it imagined, but a poorly governed and fragile one. The truth is, Britain was sick before it caught the coronavirus.
  • In asking the country to rally to the NHS’s defense, Johnson was triggering its sense of self, its sense of pride and national unity—its sense of exceptionalism.
  • Before the coronavirus, the NHS was already under considerable financial pressure. Waiting times for appointments were rising, and the country had one of the lowest levels of spare intensive-care capacity in Europe. In 2017, Simon Stevens, the NHS’s chief executive, compared the situation to the time of the health sevice’s founding decades prior: an “economy in disarray, the end of empire, a nation negotiating its place in the world.”
  • Yet from its beginnings, the NHS has occupied a unique hold on British life. It is routinely among the most trusted institutions in the country. Its key tenet—that all Britons will have access to health care, free at the point of service—symbolizes an aspirational egalitarianism that, even as inequality has risen since the Margaret Thatcher era, remains at the core of British identity.
  • In effect, Britain was rigorously building capacity to help the NHS cope, but releasing potentially infected elderly, and vulnerable, patients in the process. By late June, more than 19,000 people had died in care homes from COVID-19. Separate excess-death data suggest that the figure may be considerably higher
  • Britain failed to foresee the dangers of such an extraordinary rush to create hospital capacity, a shift that was necessary only because of years of underfunding and decades of missed opportunities to bridge the divide between the NHS and retirement homes, which other countries, such as Germany, had found the political will to do.
  • Ultimately, the scandal is a consequence of a political culture that has proved unable to confront and address long-term problems, even when they are well known.
  • other health systems, such as Germany’s, which is better funded and decentralized, performed better than Britain’s. Those I spoke with who either are in Germany or know about Germany’s success told me there was an element of luck about the disparity with Britain. Germany had a greater industrial base to produce medical testing and personal protective equipment, and those who returned to Germany with the virus from abroad were often younger and healthier, meaning the initial strain on its health system was less.
  • However, this overlooks core structural issues—resulting from political choices in each country—that meant that Germany proved more resilient when the crisis came, whether because of the funding formula for its health system, which allows individuals more latitude to top up their coverage with private contributions, or its decentralized nature, which meant that separate regions and hospitals were better able to respond to local outbreaks and build their own testing network.
  • Also unlike Britain, which has ducked the problem of reforming elderly care, Germany created a system in 1995 that everyone pays into, avoids catastrophic costs, and has cross-party support.
  • A second, related revelation of the crisis—which also exposed the failure of the British state—is that underneath the apparent simplicity of the NHS’s single national model lies an engine of bewildering complexity, whose lines of responsibility, control, and accountability are unintelligible to voters and even to most politicians.
  • Britain, I was told, has found a way to be simultaneously overcentralized and weak at its center. The pandemic revealed the British state’s inability to manage the nation’s health:
  • Since at least the 1970s, growing inequality between comparatively rich southeast England (including London) and the rest of the country has spurred all parties to pledge to “rebalance the economy” and make it less reliant on the capital. Yet large parts remain poorer than the European average. According to official EU figures, Britain has five regions with a per capita gross domestic product of less than $25,000. France, Germany, Ireland, Austria, the Netherlands, Denmark, and Sweden have none
  • If Britain were part of the United States, it would be anywhere from the third- to the eighth-poorest state, depending on the measure.
  • Britain’s performance in this crisis has been so bad, it is damaging the country’s reputation, both at home and abroad.
  • Inside Downing Street, officials believe that the lessons of the pandemic apply far beyond the immediate confines of elderly care and coronavirus testing, taking in Britain’s long-term economic failures and general governance, as well as what they regard as its ineffective foreign policy and diplomacy.
  • the scale of the task itself is enormous. “We need a complete revamp of our government structure because it’s not fit for purpose anymore,” Boyd told me. “I just don’t know if we really understand our weakness.”
  • In practice, does Johnson have the confidence to match his diagnosis of Britain’s ills, given the timidity of his approach during the pandemic? The nagging worry among even Johnson’s supporters in Parliament is that although he may campaign as a Ronald Reagan, he might govern as a Silvio Berlusconi, failing to solve the structural problems he has identified.
  • This is not a story of pessimistic fatalism, of inevitable decline. Britain was able to partially reverse a previous slump in the 1980s, and Germany, seen as a European laggard in the ‘90s, is now the West’s obvious success story. One of the strengths of the Westminster parliamentary system is that it occasionally produces governments—like Johnson’s—with real power to effect change, should they try to enact it.
  • It has been overtaken by many of its rivals, whether in terms of health provision or economic resilience, but does not seem to realize it. And once the pandemic passes, the problems Britain faces will remain: how to sustain institutions so that they bind the country together, not pull it apart; how to remain prosperous in the 21st century’s globalized economy; how to promote its interests and values; how to pay for the ever-increasing costs of an aging population.
  • “The really important question,” Boyd said, “is whether the state, in its current form, is structurally capable of delivering on the big-picture items that are coming, whether pandemics or climate change or anything else.”
aidenborst

White House Is Not Contact Tracing 'Super-Spreader' Trump Rose Garden Event - The New Y... - 0 views

  • Despite almost daily disclosures of new coronavirus infections among President Trump’s close associates, the White House is making little effort to investigate the scope and source of its outbreak.
  • The White House has decided not to trace the contacts of guests and staff members at the Rose Garden celebration 10 days ago for Judge Amy Coney Barrett, where at least eight people, including the president, may have become infected, according to a White House official familiar with the plans.Instead, it has limited its efforts to notifying people who came in close contact with Mr. Trump in the two days before his Covid diagnosis Thursday evening.
  • Even the contact tracing efforts within the two-day window have been limited, consisting mostly of emails notifying people of potential exposure, rather than the detailed phone conversations to warn anyone who may have been exposed, coach them on which symptoms to look for and counsel them to isolate if they do begin to show symptoms.
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  • “I guess an email is notification of exposure,” said Erin Sanders, a nurse practitioner and certified contact tracer in Boston. “But that is not contact tracing,” she said, “and not how a responsible public health agency handles a super-spreading cluster of a deadly virus.”
  • an internal C.D.C. email on Friday asked the agency’s scientists to be ready to go to Washington for contact tracing, but a request from the White House for assistance never came, according to two senior C.D.C. scientists.
  • Experts at the C.D.C. could have immediately put in place contact tracing for President Trump and others who have been infected, working with health departments of the states to which Mr. Trump and others have traveled. But regulations require that the C.D.C. be asked to step in.
  • During the 48-hour window before Mr. Trump’s diagnosis that White House contact tracers are focusing on, the president debated former Vice President Joseph R. Biden Jr. in Cleveland; traveled to a rally of thousands in Minnesota; met with supporters and donors at his golf club in Bedminster, N.J.; and conferred with dozens of aides at the White House, all while not wearing a mask.
  • The timing of the diagnosis of Mr. Trump’s illness makes it highly likely that he and the others became infected on Saturday, medical experts said. Symptoms typically appear around five days after exposure to the virus; Mr. Trump began showing symptoms on Thursday, “right smack dab in the day” he would be expected to, Dr. Maldonado said.
  • “Staff should not go to the White House Medical Unit clinic for any Covid-19 testing inquiries,” the memo said. But some officials have continued to go to work.
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

To Cure the Economy - Joseph E. Stiglitz - Project Syndicate - 0 views

  • As the economic slump that began in 2007 persists, the question on everyone’s minds is obvious: Why? Unless we have a better understanding of the causes of the crisis, we can’t implement an effective recovery strategy. And, so far, we have neither.
  • To understand what needs to be done, we have to understand the economy’s problems before the crisis hit.
  • America and the world were victims of their own success. Rapid productivity increases in manufacturing had outpaced growth in demand, which meant that manufacturing employment decreased. Labor had to shift to services.
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  • not only is the total number of manufacturing jobs limited globally, but a smaller share of those jobs will be local.
  • Shifting income from those who would spend it to those who won’t lowers aggregate demand. By the same token, soaring energy prices shifted purchasing power from the United States and Europe to oil exporters, who, recognizing the volatility of energy prices, rightly saved much of this income.
  • while the buildup of reserves – currently around $7.6 trillion in emerging and developing economies – protected them, money going into reserves was money not spent.
  • ith oil prices back above $100 a barrel this summer – and still high – money is once again being transferred to the oil-exporting countries. And the structural transformation of the advanced economies, implied by the need to move labor out of traditional manufacturing branches, is occurring very slowly.
  • Government plays a central role in financing the services that people want, like education and health care. And government-financed education and training, in particular, will be critical in restoring competitiveness in Europe and the US. But both have chosen fiscal austerity, all but ensuring that their economies’ transitions will be slow.
  • The prescription for what ails the global economy follows directly from the diagnosis: strong government expenditures, aimed at facilitating restructuring, promoting energy conservation, and reducing inequality, and a reform of the global financial system that creates an alternative to the buildup of reserves.
Javier E

The Banality of Trumpism - The New York Times - 0 views

  • The basic liberal diagnosis of modern conservatism has long been that it was a plutocratic movement that won elections by appealing to the racism and general anger-at-the-other of whites
  • the people most taken by surprise, least able to handle the phenomenon, are the self-proclaimed centrists, the both-sides-do-it crowd, who denounced the plutocrats-and-racists diagnosis as “shrill,” insisting that we are having a real debate with just a few fringe characters on either side.
  • Some of those people are still trying to portray the parties as symmetric: Bernie Sanders calling for single-payer health insurance is just like Trump calling for mass deportations and a ban on Muslims.
Javier E

Opinion | The Hard Road to Conservative Reform - The New York Times - 0 views

  • And while Trump was winning, a certain amount of evidence emerged to confirm his darker view of the American situation — the surging opioid epidemic
  • “deaths of despair” among lower-income white Americans, growing evidence that the opening to China had worked out far better for Beijing’
  • All of this has left conservative policy wonks, the erstwhile reformocons and others, with a dilemma. Should they defend the post-Reagan economic order against Trump’s blustering, blundering assault — defend the benefits of “neoliberalism” and free trade and global openness, warn against the sclerosis that protectionism and industrial policy often bring, champion the innovative culture of Silicon Valley against its populist despisers? Or should they take Trump’s success as evidence that even reform conservatism was ultimately too sanguine and too moderate, and that there are deeper problems in the economic order that require a more-than-moderate conservative response?
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  • the vigorous intra-conservative debate over a new book, “The Once and Future Worker,” written by the former Mitt Romney domestic policy director Oren Cass. In certain ways the book is an extension of the reform-conservative project, an argument for policies that support “a foundation of productive work” as the basis for healthy communities and flourishing families and robust civic life. But Cass is more dramatic in his criticism of Western policymaking since the 1970s, more skeptical of globalization’s benefits to Western workers, and more dire in his diagnosis of the real socioeconomic condition of the working class.
  • Cass’s bracing tone reads like (among other things) an attempt to fix reform conservatism’s political problem, as it manifested itself in 2016 — a problem of lukewarmness
  • The critics’ concerns vary, but a common thread is that Cass’s diagnosis overstates the struggles of American workers and exaggerates the downsides of globalization, and in so doing risks giving aid and comfort to populist policies — or, for that matter, socialist policies, from the Ocasio-Cortezan left — that would ultimately choke off growth.
  • the best reason to bet on Cass’s specific vision is that the social crisis he wants to address it itself a major long-term drag on growth — because a society whose working class doesn’t work or marry or bear children will age, even faster than the West is presently aging, into stagnation and decline.
  • Cass’s book also raises a larger question that both right and left are wrestling with in our age of populist discontent: Namely, is the West’s post-1980 economic performance a hard-won achievement and pretty much the best we could have done, or is there another economic path available, populist or social democratic or something else entirely, that doesn’t just lead back to stagnation?
  • If you emphasize the disappointment, then experimenting with a different policy orientation — be it Cass’s work-and-family conservatism or an Ocasio-Cortezan democratic socialism or something else — seems like a risk worth taking; after all things aren’t that great under neoliberalism as it is.
  • if you focus on the possible fragility of the growth we have achieved, the ease with which left-wing and right-wing populisms can lead to Venezuela, then you’ll share the anxieties of Cass’s conservative critic
  • In a sense the debate reproduces the larger argument about whether a post-Trump conservative politics should seek to learn something from his ascent or simply aim to repudiate him — with Cass offering a reform conservatism that effectively bids against Trump for populist support, and his critics warning that he’s conceding way too much to Trumpist demagogy.
  • it might well be, as some of his critics think, that the working class’s social crisis is mostly or all cultural, a form of late-modern anomie detached from material privation. In which case political-economy schemes to “fix” the problem won’t have social benefits to match their potential economic costs.
kaylynfreeman

A Full Guide to the Kamala Harris vs Mike Pence Debate - The New York Times - 0 views

  • The debate between Vice President Mike Pence and Senator Kamala Harris will begin at 9 p.m. Eastern on Wednesday and run for 90 minutes without commercial interruptions. This will be their only debate.
    • kaylynfreeman
       
      Hopefully, they are more civilized than the first presidential debate.
  • Mr. Pence is also likely to be pressed to defend Mr. Trump’s actions since his illness was diagnosed — leaving the hospital against the counsel of many medical professionals, minimizing the threat of the virus and dramatically removing his mask when he returned to the White House. The president has offered himself as evidence that Covid-19 can be beaten; does Mr. Pence agree with that?
  • But that basic rule of thumb got a little more tricky for Ms. Harris. With Mr. Trump’s Covid-19 diagnosis and him just being back at the White House after three nights in a hospital, harsh attacks against an ailing president might be politically unwise. The Biden campaign pulled down its negative advertising attacking Mr. Trump as soon as he disclosed his diagnosis. Joseph R. Biden Jr. has stepped carefully in talking about the president.
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  • Ms. Harris, a former prosecutor and a member of the Senate Judiciary Committee, has established her credentials as a tough interrogator with her questioning of officials like William P. Barr, the attorney general. She knows how to make a case. But can she attack Mr. Trump’s handling of the virus — which has come to define his presidency — without veering toward an overly personal attack on a president battling a potentially lethal disease?
  • Mrs. Clinton, the only woman to serve as a major-party presidential nominee, warned Ms. Harris, in so many words, about the corrosive role that sexism will play onstage.
  • “You should also be prepared for the slights, the efforts to diminish you, you personally, you as a woman, who is about to be our next vice president,” Mrs. Clinton said on her podcast. “So I do think there will be a lot of maneuvering on the other side to try to put you in a box.”
  • Ms. Harris is not just a woman but also the first woman of color on a major-party ticket.
  • Don’t look too angry’ line,” Ms. Lawless said. “These are cliché. But they’re cliché because they’re true.”
  • “She symbolizes everything that ‘Make America Great Again’ wants to push back on by virtue of being a Black woman,” Ms. Lawless said.
  • (Step 1); moved quickly to talk about the aspirations of a Trump presidency (Step 2); and swung into an attack on the Democrats (Step 3).
    • kaylynfreeman
       
      This was clearly effective
  • because so many vice presidents, and vice-presidential candidates, eventually run for president.
carolinehayter

Back At White House, Trump Still Faces Serious Health Risks : Live Updates: Trump Tests... - 0 views

  • President Trump was discharged from Walter Reed National Military Medical Center and returned to the White House Monday evening
  • But he's a few days into his diagnosis with COVID-19, a novel disease that doctors are still learning how best to treat. And medical experts say, he may still be in a danger zone.
  • though largely optimistic about the President's condition,
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  • "may not be out of the woods yet."
  • just because he's going home, he's not completely out of the woods,
  • some of these patients have long-term lung impact
  • Trump's oxygen levels were healthy and he was breathing well, but he declined to answer a reporter question about whether there is evidence of pneumonia on the President's lung scans
  • Masud notes that recovering COVID-19 patients who were hospitalized need to be closely monitored in case they get worse, especially older adults.
  • It's a good sign that he was well enough to be discharged
  • "Individuals that have mild disease to start out with, just mild symptoms, they can in a week or so feel worse, worse enough to be in an ICU," she says.
  • most people with mild symptoms don't get the kind of aggressive treatment that Trump received. He's received an experimental antibody treatment, a course of remdesivir and the steroid dexamethasone, all treatments generally reserved for patients hospitalized with severe symptoms.
  • The President did have a fever, fatigue and a mild cough late last week, but hasn't had fever in 72 hours, his doctors said.
  • he'll be getting his vitals checked at least every day or every couple times a day in order to make sure nothing is happening." He will also need to complete his course of medications — the Remdesivir and dexamethasone
  • "It's possible that [the interventions] could make him better sooner," she says. "[But] we don't know really what happens to people that have mild disease and then get treatment with antibody medications, antivirals or steroids. I think we're sort of a little bit in a data-free zone, where we're not sure."
  • confusion, issues with memory, fatigue and not being able to catch their breath
  • Though Trump is not on oxygen now, his physicians did disclose he had "several little temporary drops in his oxygen" and took supplemental oxygen twice.
  • Masud says if he had a patient with Trump's profile — male, over 70 years and overweight — who was hospitalized for a few days and received aggressive treatments, he would want to monitor the patient's oxygen levels closely even after they went home.
  • We like to watch them for a day or two to make sure there's no relapse because we've had patients who relapsed also and required oxygen, especially when they become active ... they get tired and they can't catch their breath."
  • also monitor markers of inflammation
  • When speaking with reporters, Conley said the President would be closely monitored by the medical team at the White House at least through the weekend. "If we can get through Monday with him remaining the same or improving, better yet, then we will all take that final, big sigh of relief," he said.
  • one of the key things which has been shown to help patients recover is having good sleep, long duration of sleep
  • With a grueling election season ahead of him, lack of sleep and adequate breaks could hurt Trump's recovery, he adds.
anonymous

Trump Tests Positive for Coronavirus: This Week in the 2020 Race - The New York Times - 0 views

  • Trump Tests Positive for Coronavirus
  • a coronavirus diagnosis for President Trump that has thrown the White House and the November presidential race into flux.
  • 49.5 million over the past week, more than double what the Trump campaign spent — about $21.3 million — according to Advertising Analytics, an ad tracking firm.
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  • oe Biden by at least five percentage points
  • Melania Trump, the first lady, said that they had tested positive for the coronavirus, throwing the White House and the presidential race into upheaval.
  • Here how the diagnosis will impact the Trump campaign, and a caution:
  • eyond that, the origin of their cases is unknown,
  • Mr. Biden’s running mate, all tested negative for the coronavirus in the past 24 hours.
  • Oct. 15.
  • Maybe a debate over Zoom?
  • white supremacy group, the Proud Boys, telling them to “stand back and stand by.”
  • “losers” and “suckers.” But Mr. Trump, who has previously dismissed that news report as false, did not take the time to do it onstage or affirm his support for service members. H
  • even some Republicans said that moment crossed the line.
  • But the growing momentum for reforms like ending the filibuster faces a six-foot roadblock: Mr. Biden.
Javier E

Greta Thunberg: 'I really see the value of friendship. Apart from the climate, almost n... - 0 views

  • Despite the climate crisis deepening by the day, Greta Thunberg has learned how to be happy.
  • Thunberg is now 18 years old and campaigning as ferociously as ever, while living in her own apartment (where she is speaking from), hanging out with friends and having fun. She is turning into the kind of young woman that neither she nor her parents could have ever envisaged.
  • At the age of 11 she fell into a deep depression and stopped eating and talking. Why does she think she was so unhappy? “One of the reasons was I couldn’t wrap my head around the fact that people didn’t seem to care about anything, that everyone just cared about themselves rather than everything that was happening with the world. And being an oversensitive child with autism, it was definitely something I thought about a lot, and it made me sad.”
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  • Was it also because she had been bullied at school? “Yeah, to some extent.” I ask if she literally stopped talking. “I spoke to my parents, my sister and a bit to my teacher,” she says. Why did she stop? “I don’t know. I just couldn’t.”
  • The only aspiration he had for Greta back then was for her to get better. As for himself, he knew little about the climate crisis, wasn’t convinced by what he did know and just wanted to get a nice big car – an SUV or pick-up truck. Over time, Greta changed his mind.
  • “The way she got us interested was a bit by force. She hijacked us. She started turning off lights. She cut the electricity bill in half.” He laughs. “She’d say, ‘Why have you got the lights on in this room, you’re not even in here?’ and I’d say, ‘Because we live in a country where it’s dark all the time and it makes me feel nice’ and she’d say, ‘Why? It doesn’t make any sense.’ Of course, she was right.”
  • Did he get pissed off with her? “Oh hell, yeah. She can be very, very, very annoying. But because we were in this crisis we had to react, so we became aware and began to do stuff for the environment, but not because we wanted to save the environment; we did it to save our child.”
  • By the time she was ready to return to school (initially a specialist autism school, then grammar school), she had been diagnosed with Asperger’s, obsessive compulsive disorder and selective mutism. Thunberg says the diagnosis came as a relief. “When I felt the most sad, I didn’t know that I had autism. I just thought, I don’t want to be like this. The diagnosis was almost only positive for me. It helped me get the support I needed and made me understand why I was like this.”
  • Does she feel guilty about stymying her mother’s career? She seems surprised by the question. “It was her choice. I didn’t make her do anything. I just provided her with the information to base her decision on.” At times like this you can see how unyielding she is – while it’s the source of her strength, you can imagine just how tough it may have been for her parents. “Of course, you could argue one person’s career is not more important than the climate, but to her it was a very big thing,” she says.
  • She describes her autism as her superpower. I ask why. “A lot of people with autism have a special interest that they can sit and do for an eternity without getting bored. It’s a very useful thing sometimes. Autism can be something that holds you back, but if you get to the right circumstance, if you are around the right people, if you get the adaptations that you need and you feel you have a purpose, then it can be something you can use for good. And I think that I’m doing that now.”
  • she says, she’s got loads of hobbies. “I also do a lot of jigsaw puzzles. The biggest was 3,000 pieces, but that didn’t fit on the table so it was very complicated to finish. And I also spend time with my two dogs [a golden retriever and black labrador] and talk lots to friends. We are very silly. Maybe people have an idea that climate activists are serious, but that’s not the case.” She hiccups another giggle.
  • Do you really speak to your climate activist friends every day? “Yes, many times a day.” Do you have parties? “Since we are spread all over the world it’s hard to do that, but we have Zoom calls and movie nights online and lots of chats where we just spam each other.”
  • She says she can’t think of a single politician who has impressed her. “Nobody has surprised me.” What about, say, New Zealand prime minister Jacinda Ardern, who said that the climate crisis was a matter of “life or death” at the June launch of her new roadmap to control global heating? She looks sceptical. “It’s funny that people believe Jacinda Ardern and people like that are climate leaders. That just tells you how little people know about the climate crisis.” Why? “Obviously the emissions haven’t fallen. It goes without saying that these people are not doing anything.” In April, it was revealed that New Zealand’s greenhouse-gas emissions had increased by 2% in 2019.
  • When she didn’t have friends, did she want them? “I think I did, but I didn’t have the courage to get friends,” she says. “Now, when I have got many friends, I really see the value of friendship. Apart from the climate, almost nothing else matters. In your life, fame and your career don’t matter at all when you compare them with friendship.”
  • She believes the reason that so many autistic people have become climate activists is because they cannot avert their gaze – they have a compulsion to tell the truth as they see it. “I know lots of people who have been depressed, and then they have joined the climate movement or Fridays for Future and have found a purpose in life and found friendship and a community that they are welcome in.”
  • So the best thing that has come out of your activism has been friendship? “Yes,” she says. And now there is no mistaking her smile. “Definitely. I am very happy now.”
Javier E

How Insurers Exploited Medicare Advantage for Billions - The New York Times - 0 views

  • The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.
  • Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
  • Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed.
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  • But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.
  • Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost.
  • by next year, more than half of Medicare recipients will be in a private plan.
  • a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.
  • The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.
  • As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.
  • Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.
  • The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.
  • Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.
  • The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers
  • Medicare Advantage plans can limit patients’ choice of doctors, and sometimes require jumping through more hoops before getting certain types of expensive care.
  • At conferences, companies pitched digital services to analyze insurers’ medical records and suggest additional codes. Such consultants were often paid on commission; the more money the analysis turned up, the more the companies kept.
  • they often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more the plans are overpaid by Medicare, the more generous to customers they can afford to be.
  • Many of the fraud lawsuits were initially brought by former employees under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery.
  • In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been less aggressive, even as the overpayments have been described in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports and numerous news articles,
  • Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed in the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency.
  • The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans.
  • “You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,”
  • Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.
  • “Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,”
  • In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.
  • But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.
  • Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete
  • Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.
  • But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.
  • The insurers also began hiring agencies that sent doctors or nurses to patients’ homes, where they could diagnose them with more diseases.
  • Cigna hired firms to perform similar at-home assessments that generated billions in extra payments, according to a 2017 whistle-blower lawsuit, which was recently joined by the Justice Department. The firms told nurses to document new diagnoses without adjusting medications, treating patients or sending them to a specialist
  • Nurses were told to especially look for patients with a history of diabetes because it was not “curable,” even if the patient now had normal lab findings or had undergone surgery to treat the condition.
  • Adding the code for a single diagnosis could yield a substantial payoff. In a 2020 lawsuit, the government said Anthem instructed programmers to scour patient charts for “revenue-generating” codes. One patient was diagnosed with bipolar disorder, although no other doctor reported the condition, and Anthem received an additional $2,693.27, the lawsuit said. Another patient was said to have been coded for “active lung cancer,” despite no evidence of the disease in other records; Anthem was paid an additional $7,080.74. The case is continuing.
  • The most common allegation against the companies was that they did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.
  • Some of the companies took steps to ensure the extra diagnoses didn’t lead to expensive care. In an October 2021 lawsuit, the Justice Department estimated that Kaiser earned $1 billion between 2009 and 2018 from additional diagnoses, including roughly 100,000 findings of aortic atherosclerosis, or hardening of the arteries. But the plan stopped automatically enrolling those patients in a heart attack prevention program because doctors would be forced to follow up on too many people, the lawsuit said.
  • Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to the lawsuit.
  • At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. “It was an actual agenda item and how could we get this,” Dr. Taylor said.
  • Last year, the inspector general’s office noted that one company “stood out” for collecting 40 percent of all Medicare Advantage’s payments from chart reviews and home assessments despite serving only 22 percent of the program’s beneficiaries. It recommended Medicare pay extra attention to the company, which it did not name, but the enrollment figure matched UnitedHealth’s.
  • Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.
  • Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments.
  • Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.
  • The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposed during the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.
  • Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”
  • few analysts expect major legislative or regulatory changes to the program.
  • “Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”
Javier E

How did the Tavistock gender scandal unfold? | The Spectator - 0 views

  • I couldn’t quite believe the diagnosis made of trans people, which, in my view, effectively amounted to being ‘trapped in the wrong body’. As far as us feminists were concerned, this view of gender and sex looked like the most insidious type of sexism and promotion of 1950s gender roles. How could this perspective still be so prevalent so long after the women’s liberation movement had made its mark?
  • The ‘girls like pink, boys like blue’ sex stereotype nonsense should surely have been dead in the water by the turn of the millennium. But it seemed that some medical professionals who thought they knew best – and believed there is something like a ‘sexed brain’ – were keeping it alive and well.
  • When we met, Claudia told me that, despite ‘passing really well’ as a woman, they had always deeply regretted transitioning. ‘If only I had been supported to live in the body I had, I am certain I could have had a good life,’ Claudia said.
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  • Today, there are many more people like Claudia who regret transitioning, and who feel their mental health problems were ignored when their condition was put in a neat box marked ‘gender dysphoria’.
  • some mental health professionals were deeply concerned with the medicalisation of children. They believed these children required talking therapies, not irreversible hormonal and surgical interventions. But these staff were in a difficult position: they were under pressure from ‘powerful lobbies’ to opt for medication
  • the service was coming under pressure to recommend the prescription of drugs more often and more quickly, and that the independence of professional judgement was also coming under increasing pressure. Young patients may threaten suicide if their anxieties are not immediately addressed. Parents and others may threaten to complain and there are powerful lobbies from older patients pressing for the use of medication, which even more worryingly, is now available without regulation via the internet.
  • Clinicians feared the consequences if they refused to comply with what patients, and their parents, wanted. Sonia Appleby, a former safeguarding lead, told Barnes that those who spoke out against the transition of children were ‘demonised’.
Javier E

Opinion | The 100-Year Extinction Panic Is Back, Right on Schedule - The New York Times - 0 views

  • The literary scholar Paul Saint-Amour has described the expectation of apocalypse — the sense that all history’s catastrophes and geopolitical traumas are leading us to “the prospect of an even more devastating futurity” — as the quintessential modern attitude. It’s visible everywhere in what has come to be known as the polycrisis.
  • Climate anxiety, of the sort expressed by that student, is driving new fields in psychology, experimental therapies and debates about what a recent New Yorker article called “the morality of having kids in a burning, drowning world.”
  • The conviction that the human species could be on its way out, extinguished by our own selfishness and violence, may well be the last bipartisan impulse.
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  • a major extinction panic happened 100 years ago, and the similarities are unnerving.
  • The 1920s were also a period when the public — traumatized by a recent pandemic, a devastating world war and startling technological developments — was gripped by the conviction that humanity might soon shuffle off this mortal coil.
  • It also helps us see how apocalyptic fears feed off the idea that people are inherently violent, self-interested and hierarchical and that survival is a zero-sum war over resources.
  • Either way, it’s a cynical view that encourages us to take our demise as a foregone conclusion.
  • What makes an extinction panic a panic is the conviction that humanity is flawed and beyond redemption, destined to die at its own hand, the tragic hero of a terrestrial pageant for whom only one final act is possible
  • What the history of prior extinction panics has to teach us is that this pessimism is both politically questionable and questionably productive. Our survival will depend on our ability to recognize and reject the nihilistic appraisals of humanity that inflect our fears for the future, both left and right.
  • As a scholar who researches the history of Western fears about human extinction, I’m often asked how I avoid sinking into despair. My answer is always that learning about the history of extinction panics is actually liberating, even a cause for optimism
  • Nearly every generation has thought its generation was to be the last, and yet the human species has persisted
  • As a character in Jeanette Winterson’s novel “The Stone Gods” says, “History is not a suicide note — it is a record of our survival.”
  • Contrary to the folk wisdom that insists the years immediately after World War I were a period of good times and exuberance, dark clouds often hung over the 1920s. The dread of impending disaster — from another world war, the supposed corruption of racial purity and the prospect of automated labor — saturated the period
  • The previous year saw the publication of the first of several installments of what many would come to consider his finest literary achievement, “The World Crisis,” a grim retrospective of World War I that laid out, as Churchill put it, the “milestones to Armageddon.
  • Bluntly titled “Shall We All Commit Suicide?,” the essay offered a dismal appraisal of humanity’s prospects. “Certain somber facts emerge solid, inexorable, like the shapes of mountains from drifting mist,” Churchill wrote. “Mankind has never been in this position before. Without having improved appreciably in virtue or enjoying wiser guidance, it has got into its hands for the first time the tools by which it can unfailingly accomplish its own extermination.”
  • The essay — with its declaration that “the story of the human race is war” and its dismay at “the march of science unfolding ever more appalling possibilities” — is filled with right-wing pathos and holds out little hope that mankind might possess the wisdom to outrun the reaper. This fatalistic assessment was shared by many, including those well to Churchill’s left.
  • “Are not we and they and all the race still just as much adrift in the current of circumstances as we were before 1914?” he wondered. Wells predicted that our inability to learn from the mistakes of the Great War would “carry our race on surely and inexorably to fresh wars, to shortages, hunger, miseries and social debacles, at last either to complete extinction or to a degradation beyond our present understanding.” Humanity, the don of sci-fi correctly surmised, was rushing headlong into a “scientific war” that would “make the biggest bombs of 1918 seem like little crackers.”
  • The pathbreaking biologist J.B.S. Haldane, another socialist, concurred with Wells’s view of warfare’s ultimate destination. In 1925, two decades before the Trinity test birthed an atomic sun over the New Mexico desert, Haldane, who experienced bombing firsthand during World War I, mused, “If we could utilize the forces which we now know to exist inside the atom, we should have such capacities for destruction that I do not know of any agency other than divine intervention which would save humanity from complete and peremptory annihilation.”
  • F.C.S. Schiller, a British philosopher and eugenicist, summarized the general intellectual atmosphere of the 1920s aptly: “Our best prophets are growing very anxious about our future. They are afraid we are getting to know too much and are likely to use our knowledge to commit suicide.”
  • Many of the same fears that keep A.I. engineers up at night — calibrating thinking machines to human values, concern that our growing reliance on technology might sap human ingenuity and even trepidation about a robot takeover — made their debut in the early 20th century.
  • The popular detective novelist R. Austin Freeman’s 1921 political treatise, “Social Decay and Regeneration,” warned that our reliance on new technologies was driving our species toward degradation and even annihilation
  • Extinction panics are, in both the literal and the vernacular senses, reactionary, animated by the elite’s anxiety about maintaining its privilege in the midst of societal change
  • There is a perverse comfort to dystopian thinking. The conviction that catastrophe is baked in relieves us of the moral obligation to act. But as the extinction panic of the 1920s shows us, action is possible, and these panics can recede
  • To whatever extent, then, that the diagnosis proved prophetic, it’s worth asking if it might have been at least partly self-fulfilling.
  • today’s problems are fundamentally new. So, too, must be our solutions
  • It is a tired observation that those who don’t know history are destined to repeat it. We live in a peculiar moment in which this wisdom is precisely inverted. Making it to the next century may well depend on learning from and repeating the tightrope walk — between technological progress and self-annihilation — that we have been doing for the past 100 years
  • We have gotten into the dangerous habit of outsourcing big issues — space exploration, clean energy, A.I. and the like — to private businesses and billionaires
  • That ideologically varied constellation of prominent figures shared a basic diagnosis of humanity and its prospects: that our species is fundamentally vicious and selfish and our destiny therefore bends inexorably toward self-destruction.
  • Less than a year after Churchill’s warning about the future of modern combat — “As for poison gas and chemical warfare,” he wrote, “only the first chapter has been written of a terrible book” — the 1925 Geneva Protocol was signed, an international agreement banning the use of chemical or biological weapons in combat. Despite the many horrors of World War II, chemical weapons were not deployed on European battlefields.
  • As for machine-age angst, there’s a lesson to learn there, too: Our panics are often puffed up, our predictions simply wrong
  • In 1928, H.G. Wells published a book titled “The Way the World Is Going,” with the modest subtitle “Guesses and Forecasts of the Years Ahead.” In the opening pages, he offered a summary of his age that could just as easily have been written about our turbulent 2020s. “Human life,” he wrote, “is different from what it has ever been before, and it is rapidly becoming more different.” He continued, “Perhaps never in the whole history of life before the present time, has there been a living species subjected to so fiercely urgent, many-sided and comprehensive a process of change as ours today. None at least that has survived. Transformation or extinction have been nature’s invariable alternatives. Ours is a species in an intense phase of transition.”
Javier E

Gun Violence in America: The 13 Key Questions (With 13 Concise Answers) - Jonathan Stra... - 0 views

  • There were 8,583 homicides by firearms in 2011, out of 12,664 homicides total, according to the FBI. This means that more than two-thirds of homicides involve a firearm
  • Gun violence also affects more than its victims. In areas where it is prevalent, just the threat of violence makes neighborhoods poorer. It's very difficult to quantify the total harm caused by gun violence, but by asking many people how much they would pay to avoid this threat -- a technique called contingent valuation -- researchers have estimated a cost to American society of $100 billion dollars.
  • 19,392 of 38,264 suicides in 2010 involved a gun (50%), according to the CDC.
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  • There were 606 firearm-related accidents in the same year -- about 5% of the number of intentional gun deaths.
  • There are about 310 million guns in the country. About 40% of households have them, a fraction that has been slowly declining over the last few decades, down from about 50% in the 1960s.
  • gun ownership has gotten much more concentrated among fewer households: if you own one gun, you probably own several
  • The most comprehensive public list of U.S. mass shootings is the spreadsheet of 62 incidents from 1982-2012, compiled by Mother Jones. Their list shows:
  • Mass shootings happen all over the country. Killers used a semi-automatic handgun in 75% of incidents, which is about the same percentage as the 72% in overall gun violence. Killers used an assault weapon in 40% of incidents. This is much higher than overall assault weapon use in crimes, estimated at less than 2%. The guns were obtained legally in 79% of mass shootings. Many of the shooters showed signs of mental illness, but in only two cases was there a prior diagnosis. There were no cases where an armed civilian fired back.
  • they account for only a small fraction of gun violence in the United States.
  • It's also possible that gun ownership is a deterrent to crime, because criminals must consider the possibility that their intended victim is armed.
  • . In 2010, different researchers re-examined Lott's work, the NRC report, and additional data up through 2006, and reaffirmed that there is no evidence that right-to-carry laws reduce crime.
  • The most comprehensive estimate is that a 10% reduction in U.S. households with guns would result in a 3% reduction in homicides.
  • current federal gun regulation (see above) contains an enormous loophole: While businesses that deal in guns are required to keep records and run background checks, guns can be transferred between private citizens without any record. This makes straw purchases easy.
  • There's abundant evidence that under the current system, guns flow easily between legal and illegal markets.
  • guns are used to commit a crime about 10 times as often as they are used for self-defense.
  • Won't criminals kill with other weapons if they don't have guns? The crux of this question is whether most homicides are planned, or whether killers more often confront their victims with no clear intention. In the second case, adding a gun could result in a fatal shooting that would otherwise have been avoided.
  • In 1968, Franklin Zimring examined cases of knife assaults versus gun assaults in Chicago. The gun attacks were five times more deadly
  • Here are some approaches that don't seem to work, at least not by themselves, or in the ways they've been tried so far: Stiffer prison sentences for gun crimes. Gun buy-backs: In a country with one gun per person, getting a few thousand guns off the street in each city may not mean very much. Safe storage laws and public safety campaigns.
  • We don't really have good enough evidence to evaluate these strategies: Background checks, such as the Brady Act requires. Bans on specific weapons types, such as the expired 1994 assault weapons ban or the handgun bans in various cities.
  • These policies do actually seem to reduce gun violence, at least somewhat or in some cases: More intensive probation strategies: increased contact with police, probation officers and social workers. Changes in policing strategies, such increased patrols in hot spots. Programs featuring cooperation between law enforcement, community leaders, and researchers, such as Project Safe Neighborhoods.
  • Removing legal restrictions that prevent the Centers for Disease Control and other agencies from tracking and researching gun violence is also a sensible idea, and follows a long history of calls from scientists (see: what don't we know).
  • We lack some of the most basic information we need to have a sensible gun policy debate, partially because researchers have been prevented by law from collecting it. The 2004 National Research Council report discussed above identified several key types of missing data: systematic reporting of individual gun incidents and injuries, gun ownership at the local level, and detailed information on the operation of firearms markets. We don't even have reliable data on the number of homicides in each county.
  • Centers for Disease Control, the main U.S. agency that tracks and studies American injuries and death, has been effectively prevented from studying gun violence, due to a law passed by Congress in 1996.
  • anonymized hospital reporting systems are the main ways we know about many other types of injuries, but the Affordable Care Act prevents doctors from gathering information about their patients' gun use. A 2011 law restricts gun violence research at the National Institutes of Health. The legal language prevents these agencies from using any money "to advocate or promote gun control."
marleymorton

Cancer Survivor Tells Paul Ryan: 'I'd Be Dead' Without Obamacare - 0 views

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    A man who survived cancer despite a grim diagnosis challenged House Speaker Paul Ryan (R-Wis.) on his efforts to repeal Obamacare. "Because of the Affordable Care Act, I'm standing here today," Jeff Jeans told Ryan at a CNN town hall event on Thursday.
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