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At the risk of oversimplifying, take the example of a family with a diabetic member who must pay for insulin on a regular basis

The family also happens to own stock in the three powerful pharmaceutical companies that manufacture insulin in the United States

price increases have resulted in higher profits for company executives and their shareholders.

Whether those price hikes ultimately harm or benefit the family depends on two factors: how much they spend on insulin and how much of a stake in the insulin companies they own through the stock market.

researchers use data from the federal Survey of Consumer Finances and the Consumer Expenditure Survey to calculate the distribution of corporate equity (e.g., stocks and business equity) and of total consumer expenditures. They find that corporate equity is much more unequally distributed than expenditures.

The top 20 percent of U.S. households own nearly 90 percent of the country’s total equity, according to their calculations. But those households account for a hair under 40 percent of total consumer spending

the bottom 80 percent of the country owns just 10 percent of the equity but spends 60 percent of the money.

On net, that means it’s nearly impossible for the typical U.S. family to make up for higher prices via the performance of their stock portfolio. When prices rise, low- and middle-class families pay. Wealthy families profit

They find that monopolistic pricing takes a bite out of every income group’s share of national income, with the notable exception of the top 20 percent, whose incomes rise. In effect, companies are using their market power to extract wealth from poor and middle-class households and deposit it in the pockets of the wealthy, to the tune of about 3 percent of national household income in 2016.

The implication of these findings is that antitrust enforcement has potential to be a tool in the fight against rising inequality by reducing the ability of large companies to set high prices that primarily benefit the wealthy. Conversely, the findings suggest that a recent lapse in that enforcement is contributing to the growing gap between the rich and poor.

But now all that is over; facing the catastrophe of pandemic, our national government stands naked in its mediocrity and impotence. In a call with governors this week, the president made it plain: “Respirators, ventilators, all of the equipment — try getting it yourselves,”

The incompetence we see now is by design. Over the last 40 years, America has been deliberately stripped of governmental expertise. This is what happens when you starve the beast. This is what happens when you shrink government down to the size that you can drown it in a bathtub. The plain ineptitude we see now is the end result of a decades-long effort to systematically plunder the federal government of professionalism and expertise and rigor and ability.

Much of this project, of course, originated on the political right. It was Ronald Reagan who quipped that the most terrifying words in the English language were “I’m from the government, and I’m here to help.” A parade of Republican-led Congresses sought to shrink federal budgets and stymie federal power.

Then, as Michael Lewis documented in “The Fifth Risk,” Trump came to power and began to take a sledgehammer to the government’s core functions. His administration gutted some services deliberately — among them the National Security Council’s pandemic-response team — while leaving other agencies, like the State Department, to shrivel out of neglect.

But it would be wrong to pin the government’s incompetence only on partisan ideology. Bill Clinton, celebrating cuts to the safety net, promised that the era of big government was over. Barack Obama pushed for and got an enormous government stimulus passed, but he, too, often seemed uncomfortable with federal power. When it came to creating a universal health care plan, Obama relied on private insurers to get it done; when he wanted to solve the financial crisis, he looked to titans on Wall Street for the solution.

The diminution of governmental expertise in favor of corporate power, then, may have less to with ideology than with diminished expectations on the part of all of us

The incompetence feeds on itself — the less the government seems to be able to do, the less citizens expect it to do, a downward spiral of ineptitude.

Meanwhile, corporations rush in to fill the competence void. Today, it’s the technology industry, not the federal government, that is building tomorrow’s national infrastructure (see Tesla, SpaceX, Amazon or Blue Origin).

Rather than letting regulators make weighty decisions about political speech or health care or election spending, we’ve turned over governance to the private sector

Facebook, not the Federal Election Commission, decides who gets to run political ads, while health care monopolies decide how much you’ll pay for insulin.

The coronavirus crisis should be our wake-up call. The brands can’t help us. The brands won’t help us

The most comforting words I can think of now, amid so much uncertainty, chaos and confusion, are these: “I’m from the government, and I’m here to help.”

When you see someone spooning sugar onto a bowl of cornflakes or Cheerios, you should not see the act as sweetening something that’s good for you, you should see it as someone spooning sugar onto sugar.

the biggest culprits in America’s bad health are sugar and refined grains, in that order. Sugar, a carbohydrate, now seems to be the chief villain. (In his recent book “The Case Against Sugar,” Taubes suggests it should be considered toxic in the same way cigarettes are.) But its nutritional cousin, the refined-grain carbohydrate, may be a close second.

Cereal was not always the morning staple that it is today. It only became so at about the same time that our health problems began to be documented, in the 1960s. A coincidence?

cereal was initially eaten on Sundays, when the women of our churchgoing nation didn’t have time to make the family breakfast. Once women entered the workforce, though, we began pouring our convenient breakfasts out of a box in significant numbers daily, a trend that peaked in 1995,

it may not even just be cereal that’s had such a huge impact on American health. “Maybe the problem,” Sukol said, “is the huge quantity of nutritionally bankrupt foods that are supposed to stand in for breakfast.”

By this she means anything composed primarily of refined wheat, which would be, um, 90 percent of the American breakfast repertoire: pancakes, waffles, bagels, toast, muffins, biscuits, scones, croissants, and so on.

eating this stuff on an empty stomach (i.e. in the morning), may be especially bad for your system, as there is little fiber, fat or protein in your system to slow the sugar absorption. Our breakfast staples might all best be considered as a single category of food: sugar bomb.

she nevertheless recommends that all her patients avoid what she calls “stripped” carbs, carbohydrates stripped of their fiber matrix, before noon.

What does she recommend for breakfast? Steel-cut oats, not cooked but rather soaked overnight with a dash of vinegar. I add whole-fat Greek yogurt and some nuts if I have them

Beans are great too. I had a delicious dish of lentils and a small amount of basmati rice

An egg and some cheese are also a nourishing and satisfying way to begin the day.

it throws a different light on the cereal aisle. That hulking behemoth in the middle of the grocery store, the racks of cereal, is stripped-carb and sugar ground zero, representing a kind of unrecognized terrorism wrought on parents by our own food makers

The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s.

“You could not enact a real-world study that would be more conclusive than this one.”

for every 12 ounces of sugar-sweetened beverage introduced per person per day into a country’s food system, the rate of diabetes goes up 1 percent. (The study found no significant difference in results between those countries that rely more heavily on high-fructose corn syrup and those that rely primarily on cane sugar.)

The study controlled for poverty, urbanization, aging, obesity and physical activity. It controlled for other foods and total calories. In short, it controlled for everything controllable, and it satisfied the longstanding “Bradford Hill” criteria for what’s called medical inference of causation by linking dose (the more sugar that’s available, the more occurrences of diabetes); duration (if sugar is available longer, the prevalence of diabetes increases); directionality (not only does diabetes increase with more sugar, it decreases with less sugar); and precedence (diabetics don’t start consuming more sugar; people who consume more sugar are more likely to become diabetics).

the closest thing to causation and a smoking gun that we will see.

just as tobacco companies fought, ignored, lied and obfuscated in the ’60s (and, indeed, through the ’90s), the pushers of sugar will do the same now.

it isn’t simply overeating that can make you sick; it’s overeating sugar.

Perhaps most important, as a number of scientists have been insisting in recent years, all calories are not created equal. By definition, all calories give off the same amount of energy when burned, but your body treats sugar calories differently, and that difference is damaging.

it’s become clear that obesity itself is not the cause of our dramatic upswing in chronic disease. Rather, it’s metabolic syndrome, which can strike those of “normal” weight as well as those who are obese. Metabolic syndrome is a result of insulin resistance, which appears to be a direct result of consumption of added sugars

The next steps are obvious, logical, clear and up to the Food and Drug Administration. To fulfill its mission, the agency must respond to this information by re-evaluating the toxicity of sugar, arriving at a daily value — how much added sugar is safe? — and ideally removing fructose (the “sweet” molecule in sugar that causes the damage) from the “generally recognized as safe” list,

A study published in the Feb. 27 issue of the journal PLoS One links increased consumption of sugar with increased rates of diabetes by examining the data on sugar availability and the rate of diabetes in 175 countries over the past decade

In other words, according to this study, it’s not just obesity that can cause diabetes: sugar can cause it, too, irrespective of obesity. And obesity does not always lead to diabetes.

But as Lustig says, “This study is proof enough that sugar is toxic. Now it’s time to do something about it.”

This explains why there’s little argument from scientific quarters about the “obesity won’t kill you” studies; technically, they’re correct, because obesity is a marker for metabolic syndrome, not a cause.

The study found that increased sugar in a population’s food supply was linked to higher rates of diabetes — independent of obesity rates — but stopped short of stating that sugar caused diabetes.

Obesity is, in fact, a major risk factor for Type 2 diabetes, as the study noted.

What is most galling about this economy is that we are supposed to proffer compliance and complicity as companies profit amorally off of us. Facebook unveils supposedly robust privacy protections on the same day it launches a service to connect you with your “secret crush.”

You’re supposed to pay whatever rent landlords want, whatever bills hospitals charge, whatever price surge the car-share makes up.

From Apple to John Deere, digital-rights-management technology has made us “tenants on our own devices.” The terms of service turn us into the servants. And what recourse do we have? We ask to speak with the manager, vent to Yelp, endure the hold muzak and hack our way to rival bargains. But let’s be honest: We don’t have power.

“How can you treat us like this? Do you think that this is normal?” Hundreds in the line broke into applause. At no point in those 12 hours did a United employee walk up and down the line to see how we were doing, offer blankets or water, or get our customer service session started early, the way they do in long lines at, say, Starbucks.

“What you need to do,” Benilda said, “is buy a new ticket. Because now you’ll just be on standby for the next flight and the next. That could last for days.”

For those of us living hand-to-mouth — which is to say, most of us — it takes years of nothing going wrong to earn your way out of poverty. I had gone wrong: I had slept, awaking back at square one

Maybe a few of us were in dire straits because we were confused or uninformed or lazy or irresponsible, a common argument about why people remain poor. But not all of us. Besides, personal fortitude is no match for structural inequalities.

Fifty-three hours after arriving at the airport in Newark, I landed in San Francisco; I’d scored a standby seat. My trip took almost triple the time it would have in 1933, when the transcontinental Boeing 247 debuted. Driving across the country would have been nine hours faster.

What is strangest and saddest about the broad brokenness of America is that, actually, this is the way it works. Have-not consumers pay to be complicit in our own fleecing. That is the toxic marrow in America’s bones. More than a century after conquering the onetime impossibility of flight, we have yet to master the long-time impossibility of fairness.

Now, to the East, this behaviour is both jaw-dropping and bewildering. It goes beyond mere irresponsibility, and is considered something more like stupidity, ignorance, malice, deceit, or all four

That is what civilization is, and where it begins: the presence of the very first kind of enlightened mind, which can nourish, protect, and elevate another

What does Mead’s Femur have do with the West’s stunning failure that let Covid spiral out of control? As it turns out, everything.

These days, the tourists are gone, mostly. But — and here’s the point — the bars, restaurants, and clubs are still full. I pass by them on my daily walk to the park and wonder: what are these people doing? How are they sitting there so close to one another, with no social distancing in place, laughing, joking in the middle of a literal pandemic that’s exploding all around them? What the?

The people I pass by in the bars are made of two social groups, largely. Young people, and the working class. That’s the same group, in a sense, since most young people are working class, until they amass enough wealth to rise beyond it

They have made a choice. Their beer and burger or cocktail and steak matters more than stopping the spread of a deadly disease. What the?

This group is putting the most vulnerable in society at profound risk. Those who are already ill, and immunocompromised. Those even lower down the socioeconomic ladder than them — minorities, the underclass, and so forth, among whom death rates are astronomical. The elderly, the frail, the aged.

Certain groups in Western society have made the decision that the vulnerable’s lives matter less than their right to party, to have a beer and a burger, a cocktail and a steak, a laugh at the pub with friends. What the?

The groups who are now apparently completely indifferent to spreading Covid seem to have taken their cues from leaders. Young people and the working class seem to have no conscience or compunction left whatsoever about spreading Covid

To act in such a way as to put your elders, or the ill, especially, at risk, is something that is a grave violation of social norms. Easterners can’t understand why Westerners are behaving like…spoiled children. Are they right?

There is a kind of toxic indifference that seems to have spread through Western societies. Life itself is treated with a kind of shrugging fatalism — especially those of the vulnerable. It is literally valued less than a night out at the pub by much of society.

The attitude of toxic indifference is what the West seems to share in common now, and that is why it has been brought to its knees by Covid.

the West” is not monolithic. Certainly, toxic indifference is not at the same level across all of it

let me discuss the most extreme examples — America and Britain — to highlight where toxic indifference comes from: leadership.

In Britain and America, Covid cases have now exploded well past their first peak. America is approaching 100,000 cases per day — the point at which social breakdown will begin. Britain is hitting more than that, on a per capita basis. And yet neither of these societies has a national lockdown.

uccessful societies — New Zealand, Taiwan, Vietnam, and many more — deliberately crunched the curve. Their strategy was to eradicate Covid, through what’s now a global template of best practices — lock down, test, trace, quarantine, isolate, and so forth.

The approach of Western leaders, in other words, was reactive, hesitant, and cautious, not decisive, swift, and proactive:

Margaret Mead once said that the beginning of human civilisation was found in a healed femur. That that single, simple discovery meant that someone took the time to invest in healing someone else’s broken leg — without which they surely would have died

Western leaders, in other words, modelled toxic indifference for their societies. They gave people a license to be indifferent, by acting largely indifferent themselves.

Young people justify it by saying that “they need to have social lives” — as if they weren’t spending most of their social lives online before Covid, and the working class by saying they need to work. Both of those arguments are partially true. But it’s truer to say that these are groups which have become dangerously indifferent to preserving the value of the lives of the vulnerable.

The young and the working class are punching down, as American leftists would put it.

More formally, more accurately, Covid has made Western societies predatory ones. The young and working class are exploiting and abusing those more powerless than them

Neither group seems to consider the possibility much that society needs to come together to defeat the pandemic, once and for all, and the only way that can be done is to put the vulnerable first.

America treating Covid indifferently is no surprise, after all — it’s a nation where kids are gunned down in schools, diabetics are simply left to die, people beg strangers online for money to pay for crippling healthcare costs

But it’s more surprising to see Europe turning predatory due to Covid, or having Covid expose its vulnerability to becoming predatory

I don’t mean to single the young and working class out. That is missing my point. What I am saying is that toxic indifference is trickling down in the West. From elites, like leaders, to the bourgeois — that’s been the case for the last few decades

Indifference is trickling down from the elite and the bourgeois, to the working class and the young.

we know where a society of indifference ends. It ends in America. In stupidity, ignorance, violence, hate, racism, brutality, and the poverty and despair which underlies it all.

The indifferent cannot act collectively, therefore they cannot invest, transform, change, unite, come together, and therefore they cannot live in a modern, functioning society, with an expansive, sophisticated, supportive, generous social contract

So what about climate change? Mass extinction? Ecological collapse? The massive waves of depression and ruin those will unleash — in the next decade? How can societies that can’t unite, act wisely, behave responsibly to fight Covid come together to do much about even larger catastrophes?

Covid reveals the decivilizing of the West. As I mentioned, Margaret Mead said the fundamental test of civilization is the healed femur: that someone took the time and effort to heal someone else. It is the absence of indifference and the presence of care, in other words

What made the West special, once upon a time, was not its brutality, but its idea of civilization, as the elevation and nourishment of every life, with dignity, purpose, belonging, truth, justice, and, more crucially, the idea that freedom was a society that was able to act in a civilised way.

freedom became free-dumb: the idea that my right to be abusive, exploitative, ignorant, violent, selfish — to carry a gun to Starbucks or deny you healthcare and retirement — came to prevail

If the pattern of the West’s decaying attitudes, the spread of the foolish American idea of free-dumb as “freedom,” is what Covid has revealed — I punch down, on the person below me, I exploit and abuse the person even lower than me in the socioeconomic hierarchy, because that is what I must do to survive, or at least what I have been taught to do to feel good and worthy — then the simple fact is that the West has little future

Their failure teaches us something. Civilization matters. When a society gives up on the idea of being civilized, it collapses harder and faster than its most learned wise men often imagine. That is because no society can withstand a tidal wave of stupidity and violence. Is that where the West is headed?

In a simpler way, maybe the simplest, what I am talking about is a lack of simple human goodness. That is what Mead’s Femur points to — the presence of goodness — and it is what is missing in America and Britain. They are now societies with a massive, gaping, jaw-dropping lack of human goodness, and Covid is just the latest example. But that deficit spells real trouble — it isn’t some kind of abstract moral concern.

Covid is a cold wind, and it shows that the flame is flickering. If anything, it shows us the future of civilization — in Mead’s sense, as the absence of violence, and the presence of decency, dignity, care, nourishment, equality, of human goodness realized — may lie in the East.

aging equipment, lack of maintenance and past mismanagement and corruption of an inefficient system.

We’re in 2021. We have internet on our TV. Why don’t we have electricity?”

Many Puerto Ricans are diabetic and need refrigerated insulin to survive. The coronavirus pandemic has also put some people on respiratory therapies requiring electrical power at home for oxygen machines. Some Puerto Ricans are still studying or working at home.

The system is so frail that a power plant recently went offline because sargassum — seaweed — blocked its filters.

Crews patched Puerto Rico’s grid with $3.2 billion in emergency repairs after Hurricane Maria, which shredded the island’s power lines as a Category 4 storm in September 2017. Congress earmarked about $10 billion through the Federal Emergency Management Agency to rebuild the system. Those projects will be contracted out by the new consortium, with the aim of restoring the grid to how it was before the storm, with some modernization.

LUMA took over in June, with its top officials saying they were prepared to handle a Category 2 hurricane. (None have hit the island this year.) Almost immediately, huge outages began.

“The Puerto Rico electric system is arguably the worst in the United States and has been for a very long time, even prior to the devastating hurricanes in 2017,” Mr. Stensby said.

There would also be price limits on insulin, rebates on drugs whose prices rise faster than inflation and some limited government power to negotiate drug prices.

Democrats have shrunk their proposal considerably — from $3.5 trillion to about half that size — largely to win his support and that of Senator Kyrsten Sinema of Arizona, another centrist holdout.

Mr. Manchin found fault not only with the overall price tag, but the way the bill is structured. Its authors have phased in some policies over time and abruptly ended most of the programs — some of them after a single year — in hopes of showing that over 10 years, the plan would not raise the deficit.

Mr. Manchin called dishonest gimmickry that he said would threaten the future of Social Security and Medicare. (Those programs are financed through dedicated trust funds, which are not directly affected by the bill.)

Joe Manchin does not get to dictate the future of our country,” Representative Cori Bush, Democrat of Missouri, said in a statement. “I do not trust his assessment of what our communities need the most.

Mr. Biden’s framework omitted any mention of prescription savings, infuriating some Democrats, animating the older Americans’ lobby AARP and prompting late negotiations that lasted through the weekend.

Many Democratic lawmakers ran on a promise to lower prescription drug prices, a popular message supported by majorities of both Democratic and Republican voters. But that pledge has encountered strong resistance from the powerful pharmaceutical industry, which has been spending millions in television advertisements and deploying lobbyists to Capitol Hill to plead its case.

Over the past four decades, governments have slashed budgets and privatized basic services. This has two important consequences for public health

First, people are unlikely to trust institutions that do little for them.

second, public health is no longer viewed as a collective endeavor, based on the principle of social solidarity and mutual obligation. People are conditioned to believe they’re on their own and responsible only for themselves.

an important source of vaccine hesitancy is the erosion of the idea of a common good.

“People are thinking, ‘If the government isn’t going to do anything for us,’” said Elden, “‘then why should we participate in vaccines?’”

Since the spring, when most American adults became eligible for Covid vaccines, the racial gap in vaccination rates between Black and white people has been halved. In September, a national survey found that vaccination rates among Black and white Americans were almost identical.

Other surveys have determined that a much more significant factor was college attendance: Those without a college degree were the most likely to go unvaccinated.

Education is a reliable predictor of socioeconomic status, and other studies have similarly found a link between income and vaccination.

It turns out that the real vaccination divide is class.

compared with white Americans, communities of color do experience the American health care system differently. But a closer look at the data reveals a more complicated picture.

during the 1950s polio campaigns, for example, most people saw vaccination as a civic duty.

But as the public purse shrunk in the 1980s, politicians insisted that it’s no longer the government’s job to ensure people’s well-being; instead, Americans were to be responsible only for themselves and their own bodies

Entire industries, such as self-help and health foods, have sprung up on the principle that the key to good health lies in individuals making the right choices.

Without an idea of the common good, health is often discussed using the language of “choice.”

there are problems with reducing public health to a matter of choice. It gives the impression that individuals are wholly responsible for their own health.

This is despite growing evidence that health is deeply influenced by factors outside our control; public health experts now talk about the “social determinants of health,” the idea that personal health is never simply just a reflection of individual lifestyle choices, but also the class people are born into, the neighborhood they grew up in and the race they belong to.

food deserts and squalor are not easy problems to solve — certainly not by individuals or charities — and they require substantial government action.

Many medical schools teach “motivational interviewing,”

the deeper problem:

Being healthy is not cheap. Studies indicate that energy-dense foods with less nutritious value are more affordable, and low-cost diets are linked to obesity and insulin resistance.

This isn’t surprising, since we shop for doctors and insurance plans the way we do all other goods and services

Another problem with reducing well-being to personal choice is that this treats health as a commodity.

mothers devoted many hours to “researching” vaccines, soaking up parental advice books and quizzing doctors. In other words, they act like savvy consumers

When thinking as a consumer, people tend to downplay social obligations in favor of a narrow pursuit of self-interest. As one parent told Reich, “I’m not going to put my child at risk to save another child.”

Such risk-benefit assessments for vaccines are an essential part of parents’ consumer research.

Vaccine uptake is so high among wealthy people because Covid is one of the gravest threats they face. In some wealthy Manhattan neighborhoods, for example, vaccination rates run north of 90 percent.

For poorer and working-class people, though, the calculus is different: Covid-19 is only one of multiple grave threats.

When viewed in the context of the other threats they face, Covid no longer seems uniquely scary.

Most of the people we interviewed in the Bronx say they are skeptical of the institutions that claim to serve the poor but in fact have abandoned them.

he and his friends find reason to view the government’s sudden interest in their well-being with suspicion. “They are over here shoving money at us,” a woman told us, referring to a New York City offer to pay a $500 bonus to municipal workers to get vaccinated. “And I’m asking, why are you so eager, when you don’t give us money for anything else?”

These views reinforce the work of social scientists who find a link between a lack of trust and inequality. And without trust, there is no mutual obligation, no sense of a common good.

The experience of the 1960s suggests that when people feel supported through social programs, they’re more likely to trust institutions and believe they have a stake in society’s health.

Research shows that private systems not only tend to produce worse health outcomes than public ones, but privatization creates what public health experts call “segregated care,” which can undermine the feelings of social solidarity that are critical for successful vaccination drives

In one Syrian city, for example, the health care system now consists of one public hospital so underfunded that it is notorious for poor care, a few private hospitals offering high-quality care that are unaffordable to most of the population, and many unlicensed and unregulated private clinics — some even without medical doctors — known to offer misguided health advice. Under such conditions, conspiracy theories can flourish; many of the city’s residents believe Covid vaccines are a foreign plot.

In many developing nations, international aid organizations are stepping in to offer vaccines. These institutions are sometimes more equitable than governments, but they are often oriented to donor priorities, not community needs.

“We have starvation and women die in childbirth.” one tribal elder told us, “Why do they care so much about polio? What do they really want?”

In America, anti-vaccine movements are as old as vaccines themselves; efforts to immunize people against smallpox prompted bitter opposition in the turn of the last century. But after World War II, these attitudes disappeared. In the 1950s, demand for the polio vaccine often outstripped supply, and by the late 1970s, nearly every state had laws mandating vaccinations for school with hardly any public opposition.

What changed? This was the era of large, ambitious government programs like Medicare and Medicaid.

The anti-measles policy, for example, was an outgrowth of President Lyndon Johnson’s Great Society and War on Poverty initiatives.

While the reasons vary by country, the underlying causes are the same: a deep mistrust in local and international institutions, in a context in which governments worldwide have cut social services.

Only then do the ideas of social solidarity and mutual obligation begin to make sense.

The types of social programs that best promote this way of thinking are universal ones, like Social Security and universal health care.

If the world is going to beat the pandemic, countries need policies that promote a basic, but increasingly forgotten, idea: that our individual flourishing is bound up in collective well-being.