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Allbirds is also largely known for everyday, "athleisure" sneakers, rather than performance sports shoes. The new partnership will combine its background in sustainability with Adidas' expertise in performance footwear.

Making a standard sneaker creates, on average, about 12.5 kilograms of carbon dioxide equivalent emissions, a common measurement for carbon footprint. Allbirds' products average 7.6 kilograms of carbon dioxide equivalent emissions, according to the company's website.

Adidas and Allbirds are aiming for between 2 and 3 kilograms of carbon dioxide equivalent emissions in the first version of their shoe collaboration, with later iterations moving toward zero emissions, Adidas' Carnes said.

twice as many non-college-educated white men said Trump is providing helpful, rather than harmful, information on the virus; college-educated white women were more than three times as likely to say that his information was harmful rather than helpful,

“If they like him, everything he does just affirms why they like him, and if they don’t like him, everything he does reaffirms why they don’t like him.”

In last week’s national CNN poll, two-thirds of white men without a college degree said they approved of Trump’s handling of the outbreak

While 55 percent of blue-collar men said in the CNN poll that they are comfortable returning to their normal routines, 68 percent of college-educated white women said they are not

“I think, generally, the last two months have been a good reminder that most people made up their minds about Donald Trump a long time ago, and nothing is going to change their opinion,”

non-college-educated white women exhibit more strain over the outbreak than college-educated white men. In the Navigator polling, these women were considerably more likely to say that they worry about falling behind on bills. And while a slight majority of the men in the CNN survey said they are comfortable returning to their routines, three-fifths of the women said they are not.

while these women report more unease over the pandemic, they are more likely than the men to praise Trump’s response to it. In the Navigator polling, 56 percent of the women said they approved of Trump’s handling of the outbreak, compared with just 44 percent of the men

education trumps gender in shaping attitudes about the president’s performance.

Operatives in both parties believe that Trump’s volatile and often-erratic pronouncements about the outbreak—such as suggesting the use of bleach and ultraviolet light to treat patients, and announcing that he is taking hydroxychloroquine—have compounded existing doubts among many well-educated white voters about his fitness for the presidency.

the 2018 exit polls generally showed the GOP suffering some erosion among blue-collar white women, with the party’s advantage slipping to 14 percentage points. The latest round of surveys suggests that, among those women, Trump has stabilized at that diminished level, leading by roughly a dozen points (or slightly less) among them.

ox News surveys last month in Pennsylvania and Michigan put Biden even among non-college-educated white women, and he led Trump among them in the latest Marquette University Law School poll in Wisconsin.

Among nonwhite voters, gender, not education, remains the key divide

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.”

The former vice president was strongest and most comfortable on the issues that he has focused on overwhelmingly in the last six months: the coronavirus pandemic and the resulting economic downturn.

Like it was for Mrs. Clinton, it was at times a hard attack for Mr. Biden to answer. But unlike her, he had Mr. Trump’s record to slash at.“He’s going to be the first president of the United States,” Mr. Biden countered at one point, “to leave office having fewer jobs in his administration when he became president.”

The president declined to condemn white supremacists again on Tuesday, despite being asked directly by Mr. Wallace if he would do so.

Mr. Biden has staked himself to a steady lead in the race largely due a historic gender gap: Women are supporting him far more than Mr. Trump, and by a far greater margin than Mr. Trump’s advantage among men. While Mr. Trump tried at times to explicitly tailor his points to suburban women, who have been at the center of his demographic erosion, his bullying performance seemed unlikely to win them back.

Mr. Biden labored to get his points in over Mr. Trump’s stream of interjections, turning directly to the camera for refuge from a scrum that hardly represented a contest of ideas. But Mr. Biden did not stumble, contradicting months of questions from the Trump campaign about his mental fitness, and Mr. Trump seemed to do little to bring over voters who were not already part of his base

“I’ve seen better-organized food fights at summer camp,” said Michael Steel, a Republican strategist. “But Trump needed a clear ‘W,’ and he didn’t get it.”

Mr. Biden’s own performance was mostly adequate. He swallowed some of his own lines, and Mr. Trump talked over others.

Before the debate, Mr. Wallace had said that, if successful, his job was to be “as invisible as possible.” He sometimes managed to recede, though at other times he was caught up in the shout-fest. Rarely did he exert control over the chaos. “If you want to switch seats?” he offered gamely at one point to Mr. Trump.

Eventually, after Mr. Biden suggested he condemn the Proud Boys, a far-right organization widely condemned as a hate group, Mr. Trump declared, “Proud Boys: Stand back and stand by.”

Representative Ro Khanna, Democrat of California, said: “The problem is not that Trump refused to condemn white supremacy. It’s much worse. It’s that he acknowledged he was their leader by telling them to ‘Stand by.’”

Mr. Biden’s delivery was not always forceful. He did occasionally lose his cool and succumb to Mr. Trump’s barrage of taunts. But he mostly emerged unscathed, and for most Democrats, anything but a loss was welcomed as a clear win.

"In essence," Jake Tapper said on "The Lead," Trump "appears to be desperately, even pathetically, fighting to keep a job that he has no apparent interest in responsibly performing."

"Trump has publicly disengaged from the battle against the coronavirus," they write, "at a moment when the disease is tearing across the United States at an alarming pace."

"By Factbase's count it's been a full week since Trump's last 'verbal public statement,' but he's tweeted and retweeted more than 200 times. In giving the tweets a closer look, Factba.se found that the president mentioned the election and Fox News more than Covid-19 despite the rising cases and deaths across the country. He's also been flagged for misinformation 49 times."

Trump "is simply trying to survive from one news cycle to the next, seeing how far he can push his case against his defeat and ensure the continued support of his Republican base. By dominating the story of his exit from the White House, he hopes to keep his millions of supporters energized and engaged for whatever comes next."

"There are moments in presidencies, and this is one of those moments, where it has not taken what would normally be a natural course of events. But I believe in law and order, and I believe the system will decide, and we will go on as a country and inaugurate a president."

supply-chain attack

According to SolarWinds S.E.C. filings, the malware was on the software from March to June. The number of organizations that downloaded the corrupted update could be as many as 18,000, which includes most federal government unclassified networks and more than 425 Fortune 500 companies.

The magnitude of this ongoing attack is hard to overstate.

The Russians have had access to a considerable number of important and sensitive networks for six to nine months.

While the Russians did not have the time to gain complete control over every network they hacked, they most certainly did gain it over hundreds of them.

The National Defense Authorization Act, which each year provides the Defense Department and other agencies the authority to perform its work, is caught up in partisan wrangling. Among other important provisions, the act would authorize the Department of Homeland Security to perform network hunting in federal networks.

The actual and perceived control of so many important networks could easily be used to undermine public and consumer trust in data, written communications and services.

hat should be done?On Dec. 13, the Cybersecurity and Infrastructure Security Agency, a division of the Department of Homeland Security — itself a victim — issued an emergency directive ordering federal civilian agencies to remove SolarWinds software from their networks.

It also is impractical. In 2017, the federal government was ordered to remove from its networks software from a Russian company, Kaspersky Lab, that was deemed too risky. It took over a year to get it off the networks.

The remediation effort alone will be staggering

Cyber threat hunters that are stealthier than the Russians must be unleashed on these networks to look for the hidden, persistent access controls.

The logical conclusion is that we must act as if the Russian government has control of all the networks it has penetrated

The response must be broader than patching networks. While all indicators point to the Russian government, the United States, and ideally its allies, must publicly and formally attribute responsibility for these hacks. If it is Russia, President Trump must make it clear to Vladimir Putin that these actions are unacceptable. The U.S. military and intelligence community must be placed on increased alert; all elements of national power must be placed on the table.

President Trump is on the verge of leaving behind a federal government, and perhaps a large number of major industries, compromised by the Russian government. He must use whatever leverage he can muster to protect the United States and severely punish the Russians.President-elect Joe Biden must begin his planning to take charge of this crisis. He has to assume that communications about this matter are being read by Russia, and assume that any government data or email could be falsified.

as the production of food and material goods centralized and rapidly expanded, commerce reached a scale that the country’s existing stores were ill-equipped to handle, according to the historian Susan Strasser, the author of Satisfaction Guaranteed: The Making of the American Mass Market. Manufacturers needed ways to distribute their newly enormous outputs and educate the public on the wonder of all their novel options. Americans, in short, had to be taught how to shop.

In 2019, one in five American workers was employed in retail, food service, or hospitality; even more are now engaged in service work of some kind.

This dynamic is exacerbated by the fact that the United States has more service workers than ever before, doing more types of labor, spread thin across the economy

Customers might not have been able to afford a household staff to do their bidding like the era’s truly wealthy, but corporate stores offered them a little taste of what that would be like. The middle class began to see itself as the small-time beneficiaries of industrialization’s barons.

With these goals in mind, Leach writes, customer service was born. For retailers’ tactics to be successful, consumers—or guests, as department stores of the era took to calling them—needed to feel appreciated and rewarded

From 1870 to 1910, the number of service workers in the United States quintupled. It’s from this morass that “The customer is always right” emerged as the essential precept of American consumerism—service workers weren’t there just to ring up orders

they were there to fuss and fawn, to bolster egos, to reassure wavering buyers, to make dreams come true.

they were also quite intentionally building something far grander: class consciousness. Leach writes that the introduction of shopping was fundamental to forming middle-class identity at a particularly crucial moment, as the technological advances of the Gilded Age helped create the American office worker as we now know it.

Retailers won over this growing middle class by convincing its members that they were separate from—and opposed to—industrial workers and their distrust of corporate power,

For many of these workers, the difficulty of finding non-service employment enables companies to pay low wages and keep their prices artificially low, which consumers generally like as long as they don’t have to think about what makes it possible. In theory, these conditions are supposed to encourage better performance on the part of the worker; in practice, they also encourage cruelty on the part of the consumer.

Previously confined to a few lavish European-owned hotels in America, tipping “aristocratized consumption,

Department-store magnates alleviated these concerns by linking department stores to the public good. Retailers started inserting themselves into these communities as much as possible, Leach writes, turning their enormous stores into domains of urban civic life. They hosted free concerts and theatrical performances, offered free child care, displayed fine art, and housed restaurants, tearooms, Turkish baths, medical and dental services, banks, and post offices. They made splashy contributions to local charities and put on holiday parades and fireworks shows. This created the impression that patronizing their stores wouldn’t just be a practical transaction or an individual pleasure, but an act of benevolence toward the orderly society those stores supported.

In the 150 years that American consumerism has existed, it has metastasized into almost every way that Americans construct their identities. Today’s brands insert themselves into current events, align themselves with causes, associate patronage of their businesses with virtue and discernment and success.

Most Americans now expect corporations to take a stand on contentious social and political issues; in return, corporations have even co-opted some of the language of actual politics, encouraging consumers to “vote with their dollars” for the companies that market themselves on the values closest to their own.

For Americans in a socially isolating culture, living under an all but broken political system, the consumer realm is the place where many people can most consistently feel as though they are asserting their agency.

Being corrected by a salesperson, forgotten by a bartender, or brushed off by a flight attendant isn’t just an annoyance—for many people, it is an existential threat to their self-understanding.

“The notion that at the restaurant, you’re better than the waiters, it becomes part of the restaurant experience,” and also part of how some patrons understand their place in the world. Compounding this sense of superiority is the fact that so many service workers are from historically marginalized groups—the workforce is disproportionately nonwhite and female.

Because consumer identities are constructed by external forces, Strasser said, they are uniquely vulnerable, and the people who hold them are uniquely insecure

If your self-perception is predicated on how you spend your money, then you have to keep spending it, especially if your overall class status has become precarious, as it has for millions of middle-class people in the past few decades

Although underpaid, poorly treated service workers certainly exist around the world, American expectations on their behavior are particularly extreme and widespread, according to Nancy Wong, a consumer psychologist and the chair of the consumer-science department at the University of Wisconsin. “Business is at fault here,” Wong told me. “This whole industry has profited from exploitation of a class of workers that clearly should not be sustainable.”

Tipping ratcheted up the level of control that members of the middle class could exercise over the service workers beneath them: Consumers could deny payment—effectively, deny workers their wages—for anything less than complete submission.

Modern businesses have invented novel ways to exacerbate conflicts between their customers and their workers.

A big problem at airlines and hotels in particular, Wong said, is what’s called the “customer relationship management” model. CRM programs, the first and most famous of which are frequent-flyer miles, are fabulously profitable; awarding points or miles or bucks encourages people not only to increase the size and frequency of their purchases, but also to confine their spending to one airline or hotel chain or big-box store.

Higher-spending customers access varying levels of luxury and prestige, often in full view of everyone else. Exposure to these consumer inequalities has been found to spark antisocial behavior in those who don’t get to enjoy their perks, the classic example of which is air rage

Workers must do what the sociologist Arlie Russell Hochschild, in her 1983 book, The Managed Heart, identified as “emotional labor.”

Workers must stifle their natural emotional reactions to, in the case of those in the service industry, placate members of the consumer class. These workers are alienated from their own emotional well-being, which can have far-reaching psychological consequences—over the years, research has associated this kind of work with elevated levels of stress hormones, burnout, depression, and increased alcohol consumption.

Bees live in ordered communities that depend on social interactions. Their hives are split into sections.

It enters a colony by hitchhiking on foragers, but needs to reach the nursery near the centre to reproduce.

authors set up six colonies, half of which were infected with the mite. They studied two common activities: the “waggle dance”, which forager bees perform to communicate the site of a newly discovered food source, and “allogrooming”, when bees clean debris or parasites (including mites) from each other’s bodies.

In the Varroa-free group, waggle dances and allogrooming both occurred throughout the hive

Limiting where waggle dances are performed could reduce awareness of where to find food, and focusing allogrooming efforts in brood cells may worsen forager bees’ hygiene

Doctors in the top 10 percent averaged $1.3 million

And those in the top 1 percent averaged an astounding $4 million, though most of that (85 percent) came from business income or capital gains.

In certain specialties, doctors see substantially more in their peak earning years: Neurosurgeons (about $920,000), orthopedic surgeons ($789,000) and radiation oncologists ($709,000) all did especially well for themselves. Specialty incomes cover 2005 to 2017 and are expressed in 2017 dollars.

family-practice physicians made around $230,000 a year. General practice ($225,000) and preventive-medicine ($224,000) doctors earned even less — though that’s still enough to put them at the top of the heap among all U.S. earners.

“There is this sense of, well, if you show that physician incomes put them at the top of the income distribution, then you’re somehow implying that they’re instead going into medicine because they want to make money. And that narrative is uncomfortable to people.”

why did those figures ruffle so many physician feathers?

“You can want to help people and you can simultaneously want to earn money and have a nicer lifestyle and demand compensation for long hours and long training. That’s totally normal behavior in the labor market.”

Yale University economist Jason Abaluck notes that when he asks the doctors and future doctors in his health economics classes why they earn so much, answers revolve around the brutal training required to enter the profession. “Until they finish their residency, they’re working an enormous number of hours and their lifestyle is not the lifestyle of a rich person,” Abaluck told us.

why do physicians make that much?

On average, doctors — much like anyone else — behave in ways that just happen to drive up their income. For example, the economists found that graduates from the top medical schools, who can presumably write their own ticket to any field they want, tend to choose those that pay the most.

“Our analysis shows that certainly physicians respond to earnings when choosing specialties,” Polyakova told us. “And there’s nothing wrong with that, in my opinion.

“In general, U.S. physicians are making about 50 percent more than German physicians and about more than twice as much as U.K. physicians,

Grover said the widest gaps were “really driven by surgeons and a handful of procedural specialties,” doctors who perform procedures with clear outcomes, rather than preventing disease or treating chronic condition

“we’re not about prevention, you know?” he said, noting that his own PhD is in public health. “I wish it was different, but it ain’t!”

The United States has fewer doctors per person than 27 out of 31 member countries tracked by the Organization for Economic Cooperation and Development

In 1970, based on a slightly different measure that’s been tracked for longer, America had more licensed physicians per person than all but two of the 10 countries for which we have data. What caused the collapse?

the United States has far fewer residency slots than qualified med school graduates, which means thousands of qualified future physicians are annually shut out of the residency pipeline, denied their chosen career and stuck with no way to pay back those quarter-million-dollar loans.

“I’d like to see an in-depth analysis of the effect of the government capping the number of residency spots and how it’s created an artificial ‘physician shortage’ even though we have thousands of talented and graduated doctors that can’t practice due to not enough residency spots,”

Such an analysis would begin with a deeply influential 1980 report,

That report, by a federal advisory committee tasked with ensuring the nation had neither too few nor too many doctors, concluded that America was barreling toward a massive physician surplus. It came out just before President Ronald Reagan took office, and the new administration seemed only too eager to cut back on federal spending on doctor-training systems.

ssociation of American Medical Colleges (AAMC), a coalition of MD-granting medical schools and affiliated teaching hospitals, slammed the brakes on a long expansion. From 1980 to around 2004, the number of medical grads flatlined, even as the American population rose 29 percent.

Federal support for residencies was also ratcheted down, making it expensive or impossible for hospitals to provide enough slots for all the medical school graduates hitting the market each year. That effort peaked with the 1997 Balanced Budget Act which, among other things, froze funding for residencies — partially under the flawed assumption that HMOs would forever reduce the need for medical care in America, Orr writes. That freeze has yet to fully unwind.

or decades, many policymakers believed more doctors caused higher medical spending. Orr says that’s partly true, but “the early studies failed to differentiate between increased availability of valuable medical services and unnecessary treatment and services.”

“In reality, the greater utilization in places with more doctors represented greater availability, both in terms of expanded access to primary care and an ever-growing array of new and more advanced medical services,” he writes. “The impact of physician supply on levels of excessive treatment appears to be either small or nonexistent.”

“People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”

Polyakova and her collaborators find doctor pay consumes only 8.6 percent of overall health spending. It grew a bit faster than inflation over the time period studied, but much slower than overall health-care costs.

Regardless, the dramatic limits on medical school enrollment and residencies enjoyed strong support from the AAMC and the AMA. We were surprised to hear both organizations now sound the alarm about a doctor shortage. MD-granting medical schools started expanding again in 2005.

it’s because states have responded to the shortage by empowering nurse practitioners and physician assistants to perform tasks that once were the sole province of physicians. Over the past 20 years, the number of registered nurses grew almost twice as quickly as the number of doctors, and the number of physician assistants grew almost three times as rapidly, our analysis showed.

While there still aren’t enough residency positions, we’re getting more thanks in part to recent federal spending bills that will fund 1,200 more slots over the next few years.

Our vocabulary of commendation and condemnation is perpetually changing, but it has always relied on “thick” ethical terms, which combine description and evaluation.

Aristotle is obscure in other ways, too. His highbrow potshots at unnamed contemporaries, his pop-cultural references, must have tickled his aristocratic Athenian audience. But the people and the plays he referred to are now lost or forgotten. Some readers have found his writings “affectless,” stripped of any trace of a human voice, or of a beating human heart.

For Aristotle, ethics was centrally concerned with how to live a good life: a flourishing existence was also a virtuous one.

“famously terse, often crabbed in their style.” Crabbed, fragmented, gappy: it can be a headache trying to match his pronouns to the nouns they refer to. Some of his arguments are missing crucial premises; others fail to spell out their conclusions.

“How to flourish” was one such topic, “flourishing” being a workable rendering of Aristotle’s term eudaimonia. We might also translate the term in the usual way, as “happiness,” as long as we suspend some of that word’s modern associations; eudaimonia wasn’t something that waxed and waned with our moods

Flourishing is the ultimate goal of human life; a flourishing life is one that is lived in accord with the various “virtues” of the character and intellect (courage, moderation, wisdom, and so forth); a flourishing life also calls for friendships with good people and a certain measure of good fortune in the way of a decent income, health, and looks.

much of what it says can sound rather obvious

Virtue is not just about acting rightly but about feeling rightly. What’s best, Aristotle says, is “to have such feelings at the right time, at the right objects and people, with the right goal, and in the right manner.” Good luck figuring out what the “right time” or object or manner is.

Virtue is a state “consisting in a mean,” Aristotle maintains, and this mean “is defined by reference to reason, that is to say, to the reason by reference to which the prudent person would define it.

“good judgment” is an improvement on the old-fashioned and now misleading “prudence”; it’s also less clunky than another standby, “practical wisdom.”

it helps to reckon with the role that habits of mind play in Aristotle’s account. Meyer’s translation of “phronesis” is “good judgment,” and the phrase nicely captures the combination of intelligence and experience which goes into acquiring it, along with the difficulty of reducing it to a set of explicit principles that anyone could apply mechanically, like an algorithm.

The phrase “prudent person” here renders the Greek phronimos, a person possessed of that special quality of mind which Aristotle called “phronesis.” But is Aristotle then saying that virtue consists in being disposed to act as the virtuous person does? That sounds true, but trivially so.

The enormous role of judgment in Aristotle’s picture of how to live can sound, to modern readers thirsty for ethical guidance, like a cop-out. Especially when they might instead pick up a treatise by John Stuart Mill and find an elegantly simple principle for distinguishing right from wrong, or one by Kant, in which they will find at least three. They might, for that matter, look to Jordan Peterson, who conjures up as many as twelve.

the question of how to flourish could receive a gloomy answer from Aristotle: it may be too late to start trying. Why is that? Flourishing involves, among other things, performing actions that manifest virtues, which are qualities of character that enable us to perform what Aristotle calls our “characteristic activity

But how do we come to acquire these qualities of character, or what Meyer translates as “dispositions”? Aristotle answers, “From our regular practice.”

In a passage missing from Meyer’s ruthless abridgment, Aristotle warns, “We need to have been brought up in noble habits if we are to be adequate students of noble and just things. . . . For we begin from the that; if this is apparent enough to us, we can begin without also knowing why. Someone who is well brought up has the beginnings, or can easily acquire them.”

Aristotle suggests, more generally, that you should identify the vices you’re susceptible to and then “pull yourself away in the opposite direction, since by pulling hard against one fault, you get to the mean (as when straightening out warped planks).

Sold as a self-help manual in a culture accustomed to gurus promulgating “rules for living,” Aristotle’s ethics may come as a disappointment. But our disappointment may tell us more about ourselves than it does about Aristotle.

Sometimes we acquire our skills by repeatedly applying a rule—following a recipe—but when we succeed what we become are not good followers of recipes but good cooks. Through practice, as Aristotle would have said, we acquire judgment.

My tutor’s fundamental pedagogical principle was that to teach a text meant being, at least for the duration of the tutorial, its most passionate champion. Every smug undergraduate exposé of a fallacy would be immediately countered with a robust defense of Aristotle’s reasoning.

“How to read Aristotle? Slowly.”

I was never slow enough. There was always another nuance, another textual knot to unravel

Michael Oakeshott wrote that “nobody supposes that the knowledge that belongs to the good cook is confined to what is or may be written down in the cookery book.” Proficiency in cooking is, of course, a matter of technique

What we were doing with this historical text wasn’t history but philosophy. We were reading it not for what it might reveal about an exotic culture but for the timelessly important truths it might contain—an attitude at odds with the relativism endemic in the rest of the humanities.

There is no shortcut to understanding Aristotle, no recipe. You get good at reading him by reading him, with others, slowly and often. Regular practice: for Aristotle, it’s how you get good generally.

“My parents taught me the difference between right and wrong,” he said, “and I can’t think what more there is to say about it.” The appropriate response, and the Aristotelian one, would be to agree with the spirit of the remark. There is such a thing as the difference between right and wrong. But reliably telling them apart takes experience, the company of wise friends, and the good luck of having been well brought u

we are all Aristotelians, most of the time, even when forces in our culture briefly persuade us that we are something else. Ethics remains what it was to the Greeks: a matter of being a person of a certain sort of sensibility, not of acting on “principles,” which one reserves for unusual situations of the kind that life sporadically throws up

That remains a truth about ethics even when we’ve adopted different terms for describing what type of person not to be: we don’t speak much these days of being “small-souled” or “intemperate,” but we do say a great deal about “douchebags,” “creeps,” and, yes, “assholes.

In one sense, it tells us nothing that the right thing to do is to act and feel as the person of good judgment does. In another sense, it tells us virtually everything that can be said at this level of generality.

If self-help means denying the role that the perceptions of others play in making us who we are, if it means a set of rules for living that remove the need for judgment, then we are better off without it.

Aristotle had little hope that a philosopher’s treatise could teach someone without much experience of life how to make the crucial ethical distinctions. We learn to spot an “asshole” from living; how else

It points us in the right direction: toward the picture of a person with a certain character, certain habits of thinking and feeling, a certain level of self-knowledge and knowledge of other people.

Is it any surprise that the Internet is full of those who need help seeing rightly? Finding no friendly neighborhood phronimos to provide authoritative advice, you defer instead to the wisdom of an online community.

“The self-made man,” Oakeshott wrote, “is never literally self-made, but depends upon a certain kind of society and upon a large unrecognized inheritance.”

when our own perceptions falter, we continue to do today exactly what Aristotle thought we should do. He asserts, in another significant remark that doesn’t make Meyer’s cut, that we should attend to the words of the old and experienced at least as much as we do to philosophical proofs: “these people see correctly because experience has given them their eye.”

We have long lived in a world desperate for formulas, simple answers to the simple question “What should I do?”

the algorithms, the tenets, the certificates are all attempts to solve the problem—which is everybody’s problem—of how not to be an asshole. Life would be a lot easier if there were rules, algorithms, and life hacks solving that problem once and for all. There aren’t.

At the heart of the Nicomachean Ethics is a claim that remains both edifying and chastening: phronesis doesn’t come that easy. Aristotle devised a theory that was vague in just the right places, one that left, intentionally, space to be filled in by life. 

Twenty-four centuries later, we’re still guided by the approach toward ethical life that Aristotle exemplified, one in which the basic question is not what we do but who we are

The Internet has no shortage of moralists and moralizers, but one ethical epicenter is surely the extraordinary, addictive subreddit called “Am I the Asshole?,” popularly abbreviated AITA

“My experience in those four months was the worst experience I’ve ever had in working in a company,” Alex Kairu, one of the Kenya workers, said in an interview.

OpenAI marshaled a sprawling global pipeline of specialized human labor for over two years to enable its most cutting-edge AI technologies to exist, the documents show

“It’s something that needs to get done,” Sears said. “It’s just so unbelievably ugly.”

eviewing toxic content goes hand-in-hand with the less objectionable work to make systems like ChatGPT usable.

The work done for OpenAI is even more vital to the product because it is seeking to prevent the company’s own software from pumping out unacceptable content, AI experts say.

Sears said CloudFactory determined there was no way to do the work without harming its workers and decided not to accept such projects.

companies could soon spend hundreds of millions of dollars a year to provide AI systems with human feedback. Others estimate that companies are already investing between millions and tens of millions of dollars on it annually. OpenAI said it hired more than 1,000 workers for this purpose.

Another layer of human input asks workers to rate different answers from a chatbot to the same question for which is least problematic or most factually accurate. In response to a question asking how to build a homemade bomb, for example, OpenAI instructs workers to upvote the answer that declines to respond, according to OpenAI research. The chatbot learns to internalize the behavior through multiple rounds of feedback. 

A spokeswoman for Sama, the San Francisco-based outsourcing company that hired the Kenyan workers, said the work with OpenAI began in November 2021. She said the firm terminated the contract in March 2022 when Sama’s leadership became aware of concerns surrounding the nature of the project and has since exited content moderation completely.

OpenAI also hires outside experts to provoke its model to produce harmful content, a practice called “red-teaming” that helps the company find other gaps in its system.

At first, the texts were no more than two sentences. Over time, they grew to as much as five or six paragraphs. A few weeks in, Mathenge and Bill Mulinya, another team leader, began to notice the strain on their teams. Workers began taking sick and family leaves with increasing frequency, they said.

The tasks that the Kenya-based workers performed to produce the final safety check on ChatGPT’s outputs were yet a fourth layer of human input. It was often psychologically taxing. Several of the Kenya workers said they have grappled with mental illness and that their relationships and families have suffered. Some struggle to continue to work.

On July 11, some of the OpenAI workers lodged a petition with the Kenyan parliament urging new legislation to protect AI workers and content moderators. They also called for Kenya’s existing laws to be amended to recognize that being exposed to harmful content is an occupational hazard

Mercy Mutemi, a lawyer and managing partner at Nzili & Sumbi Advocates who is representing the workers, said despite their critical contributions, OpenAI and Sama exploited their poverty as well as the gaps in Kenya’s legal framework. The workers on the project were paid on average between $1.46 and $3.74 an hour, according to a Sama spokeswoman.

The Sama spokeswoman said the workers engaged in the OpenAI project volunteered to take on the work and were paid according to an internationally recognized methodology for determining a living wage. The contract stated that the fee was meant to cover others not directly involved in the work, including project managers and psychological counselors.

Kenya has become a hub for many tech companies seeking content moderation and AI workers because of its high levels of education and English literacy and the low wages associated with deep poverty.

Some Kenya-based workers are suing Meta’s Facebook after nearly 200 workers say they were traumatized by work requiring them to review videos and images of rapes, beheadings and suicides.

A Kenyan court ruled in June that Meta was legally responsible for the treatment of its contract workers, setting the stage for a shift in the ground rules that tech companies including AI firms will need to abide by to outsource projects to workers in the future.

OpenAI signed a one-year contract with Sama to start work in November 2021. At the time, mid-pandemic, many workers viewed having any work as a miracle, said Richard Mathenge, a team leader on the OpenAI project for Sama and a cosigner of the petition.

OpenAI researchers would review the text passages and send them to Sama in batches for the workers to label one by one. That text came from a mix of sources, according to an OpenAI research paper: public data sets of toxic content compiled and shared by academics, posts scraped from social media and internet forums such as Reddit and content generated by prompting an AI model to produce harmful outputs. 

The generated outputs were necessary, the paper said, to have enough examples of the kind of graphic violence that its AI systems needed to avoid. In one case, OpenAI researchers asked the model to produce an online forum post of a teenage girl whose friend had enacted self-harm, the paper said.

OpenAI asked the workers to parse text-based sexual content into four categories of severity, documents show. The worst was descriptions of child sexual-abuse material, or C4. The C3 category included incest, bestiality, rape, sexual trafficking and sexual slavery—sexual content that could be illegal if performed in real life.

Jason Kwon, general counsel at OpenAI, said in an interview that such work was really valuable and important for making the company’s systems safe for everyone that uses them. It allows the systems to actually exist in the world, he said, and provides benefits to users.

Working on the violent-content team, Kairu said, he read hundreds of posts a day, sometimes describing heinous acts, such as people stabbing themselves with a fork or using unspeakable methods to kill themselves

He began to have nightmares. Once affable and social, he grew socially isolated, he said. To this day he distrusts strangers. When he sees a fork, he sees a weapon.

Mophat Okinyi, a quality analyst, said his work included having to read detailed paragraphs about parents raping their children and children having sex with animals. He worked on a team that reviewed sexual content, which was contracted to handle 15,000 posts a month, according to the documents. His six months on the project tore apart his family, he said, and left him with trauma, anxiety and depression.

In March 2022, management told staffers the project would end earlier than planned. The Sama spokeswoman said the change was due to a dispute with OpenAI over one part of the project that involved handling images. The company canceled all contracts with OpenAI and didn’t earn the full $230,000 that had been estimated for the four projects, she said.

Several months after the project ended, Okinyi came home one night with fish for dinner for his wife, who was pregnant, and stepdaughter. He discovered them gone and a message from his wife that she’d left, he said.“She said, ‘You’ve changed. You’re not the man I married. I don’t understand you anymore,’” he said.

In Mexico, the growing interest in all things Korean has made her a social-media sensation with more than 24 million followers on TikTok and over eight million subscribers to her YouTube channel, allowing her to gain popularity, financial stability and a romantic partner — all on her own terms.

“She had all this training in Korea, in this new Korea that allows her to land in a place like Mexico and be successful.”

A sort of a teacher of comparative pop culture, Ms. Kim offers lessons on popular Korean soap operas, lyrics, fashion standards, traditions and social norms. She once worked as a waitress in Mexico for a day and posted about her confusion with tips. (South Korea is a no-tip country.) She showed followers how Korean students crammed for exams. She started traveling across Mexico tasting regional delicacies.

Ms. Kim’s success tracks the growth of Korean influence in Mexico and the region.More than 2,000 Korean companies have a presence in Mexico, part of a so-called near-shoring strategy that has driven larger corporations — Kia, LG, Samsung, Hyundai, among others — to take advantage of a free-trade agreement with Canada and the United States.

K-pop, K-beauty and K-dramas have shown Latin Americans a new, different way to be cool.

K-pop bands have been performing to increasingly bigger and sold-out venues since 2012. This year, a summer festival will bring 16 Korean groups to Mexico City, with ticket prices starting at around $170.

Some newsstands specialize in magazines, posters and merchandise about South Korean celebrities. Netflix offers dubbing in “Latin Spanish” for Korean shows. Movie theaters stream live K-pop concerts performed abroad.

After finishing college in South Korea, Ms. Kim said she experienced severe stress. “I wanted to die and I wished to rest,” she said in one of her most popular videos. She has spoken openly about being hospitalized to take care of her mental health.

She attributes her exhaustion to Korea’s culture of sacrifice and grind that helped the country become an economic powerhouse after the Korean War.

“Everything is quick, quick, now, right this second,” Dr. Balderrama said. “This created a culture where there’s no place for mediocrity, there’s no place for those unwilling to compete.”

In Mexico, Ms. Kim hoped to find a more joyous life: “I saw how Latin culture is, how Latin people live and they’re living happily,” she said. “I don’t want to waste a single moment I’m in Latin America because it’s so precious to me.”

But if Ms. Kim has found a passion and a business, she has not completely found the peace of mind she was seeking. She’s in therapy to deal with what she described as some depression and anxiety.

Her large following and popularity has bred fear: “I feel people will forget me, that nobody will like me,” she said, worried about the toll of having to come up with creative content to remain relevant.

She does get criticized online by users who say she should go back to Korea, who ask whether she pays taxes in Mexico (she says she does) and who consider her another foreigner lured by life on the cheap and who contributes to the gentrification of parts of the country at the expense of Mexican residents.

These fears are shared by numerous industry leaders, putting them in the unusual position of arguing that a technology they are building — and, in many cases, are furiously racing to build faster than their competitors — poses grave risks and should be regulated more tightly.

Dan Hendrycks, the executive director of the Center for AI Safety, said in an interview that the open letter represented a “coming-out” for some industry leaders who had expressed concerns — but only in private — about the risks of the technology they were developing.

Some skeptics argue that A.I. technology is still too immature to pose an existential threat. When it comes to today’s A.I. systems, they worry more about short-term problems, such as biased and incorrect responses, than longer-term dangers.

“There’s a very common misconception, even in the A.I. community, that there only are a handful of doomers,” Mr. Hendrycks said. “But, in fact, many people privately would express concerns about these things.”

But others have argued that A.I. is improving so rapidly that it has already surpassed human-level performance in some areas, and it will soon surpass it in others. They say the technology has showed signs of advanced capabilities and understanding, giving rise to fears that “artificial general intelligence,” or A.G.I., a type of artificial intelligence that can match or exceed human-level performance at a wide variety of tasks, may not be far-off.

In a blog post last week, Mr. Altman and two other OpenAI executives proposed several ways that powerful A.I. systems could be responsibly managed. They called for cooperation among the leading A.I. makers, more technical research into large language models and the formation of an international A.I. safety organization, similar to the International Atomic Energy Agency, which seeks to control the use of nuclear weapons.

Mr. Altman has also expressed support for rules that would require makers of large, cutting-edge A.I. models to register for a government-issued license.

The brevity of the new statement from the Center for AI Safety — just 22 words in all — was meant to unite A.I. experts who might disagree about the nature of specific risks or steps to prevent those risks from occurring, but who shared general concerns about powerful A.I. systems, Mr. Hendrycks said.

“We didn’t want to push for a very large menu of 30 potential interventions,” Mr. Hendrycks said. “When that happens, it dilutes the message.”

The statement was initially shared with a few high-profile A.I. experts, including Mr. Hinton, who quit his job at Google this month so that he could speak more freely, he said, about the potential harms of artificial intelligence. From there, it made its way to several of the major A.I. labs, where some employees then signed on.

Almost half of the voters who said they “somewhat disapprove” of Biden as president still voted for Democrats, presumably because they were not going to vote for Trumpianism

In a Reuters/Ipsos poll in September, 58 percent of respondents said that the MAGA movement was threatening America’s democratic foundations.

The Republicans are weak because of Trump. The Republican weakness is easier to expunge. If Republicans get rid of Trump, they could become the dominant party in America

Americans are still deeply unhappy with the state of the country, but their theory of change seems to have begun to shift. Less histrionic media soap opera. Less existential politics of menace. Let’s find people who can get stuff done.

I am saying voters have built a wall around that movement to make sure it no longer wins the power it once enjoyed. I am saying voters have given Republicans clear marching orders — to do what Democrats did and beat back the populist excesses on their own side.

There are two large truths I’ll leave you with. The first is that both parties are fundamentally weak. The Democrats are weak because they have become the party of the educated elite.

Gov. Tony Evers of Wisconsin had the quotation that summarized the election: “Boring wins.”

Second, the battle to preserve the liberal world order is fully underway. While populist authoritarianism remains a powerful force worldwide, people, from Kyiv to Kalamazoo, have risen up to push us toward a world in which rules matter, practicality matters, stability and character matter.

As Irving Kristol once wrote, the people in our democracy “are not uncommonly wise, but their experience tends to make them uncommonly sensible.”

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.”

Black mortality was 65 percent higher and Hispanic mortality 75 percent higher.

at least in Ohio and Florida, despite what seemed at the time to be almost unbridgeable divides over things like mask wearing and school closures, social distancing and lockdowns, the excess mortality gap between Republicans and Democrats in the pre-vaccine phase of the pandemic was relatively small, with Republican excess mortality only 22 percent higher than the death rate among Democrats.

The country clearly stumbled in 2020. And yet before vaccines were widely available, and when we tried to slow the spread of the disease through behavioral measures, the scale of the failure was relatively small compared with what followed in the years after.

In 2020, American death rates and excess mortality fell merely at the worse end of its peer countries — above Germany and barely France but below Britain, Italy and Spain, for instance

In the vaccine era of the pandemic, American performance has been much worse, with our death rates becoming much more conspicuous and dramatic outliers — enough to make the country by far the worst performing of its peers.

Overall — from the beginning of the pandemic until the arrival of Omicron — Republican excess mortality in Ohio and Florida was 76 percent higher than Democratic excess mortality.

only 62 percent of Republicans have completed their primary vaccinations, compared with 87 percent of Democrats.

income and education tell a similar story: Only 67 percent of Americans with household incomes below $40,000 have completed their primary vaccinations, compared with 85 percent with household incomes above $90,000

What does this all mean for the next pandemic fall and winter? Well, thankfully, the racial and ethnic gaps around vaccination have almost entirely closed, which is one major reason the mortality gap has, too: According to Kaiser, 74 percent of Black and Hispanic Americans have been vaccinated, compared with 77 percent of whites

The demographic gaps for boosters are slightly larger: 50 percent of white adults have been boosted, according to Kaiser, compared with 43 percent of Black adults and 40 percent of Hispanic adults. (Only 31 percent of Republicans have been boosted.)

while the news from Europe isn’t especially reassuring, it would probably take an Omicron-like curveball to deliver a new American peak like those we experienced each of the previous two winters, and there does not seem to be anything like that on the horizon.

But according to The Times’s global vaccination tracker, Americans are doing almost exactly as poorly with boosters as we did with the first round of vaccines, not worse. The country ranks 66th globally in the share of population that has completed a primary vaccination course. For a first booster, it ranks 71s

One set of answers is implied by the story of vaccination and mortality by race, and the way improvements on one measure changed the trajectory of the other: more first shots and more boosting. This is the central strategy offered by the Biden administration. But the vaccinated share of the country has barely grown in months, and the uptake of next generation bivalent boosters looks, in the early stages, quite abysmal.

yet Americans are still dying at an annualized rate above 100,000 — a rate that may well grow as we head deeper into the fall. What are we doing about that?

another possible set of responses suggests itself too, one that wouldn’t require a reversal of vaccination trends or a transformation of the pandemic culture war either: an approach to public health infrastructure, both literal and legal, that would reduce spread through background interventions without meaningfully burdening individual Americans at all.

in a perverse way the arrival of vaccines seemed to almost retire them from public discussion. They include better ventilation in public buildings, particularly schools

Testing could help, too, of course, though culturally it seems to have been dumped into a bucket with masks, as an individual tool and individual burden, rather than one with investments in ventilation improvements, as part of an invisible Covid-mitigating infrastructure

Over the last six months, an individual risk approach to Covid has predominated — both at the level of public health guidance and for most individuals navigating the new, quasi-endemic landscape

This argument is unhelpful, not just because it is needlessly toxic but also because the terms themselves are inadequate. One of the lessons of that early phase of the pandemic, and especially its racial disparities, is that mitigation is not strictly a matter of individual risk management. Spread matters, too, as do structural factors. We have tools to help both, without returning the country psychologically to the depths of Covid panic.

And although the partisan gap grew with the arrival of vaccines, it never grew as large as the racial gap had been in early 2020. In 2021, Republican excess mortality in those two states was at its highest, compared to Democratic levels: 153 percent. At the peak of racial disparity in the pandemic’s first wave, Black Americans were dying more than three times as much as white Americans.

structural factors — not only race but class and education, too — appear to loom just as large, complicating any intuitive model of what went wrong here that emphasizes the pandemic culture war above all else.

Especially in the initial phases of spread, it can be hard to disentangle the effects of policy and behavioral response from somewhat random drivers like where the virus arrived first, what sorts of places those were and what kinds of people populated them, and even what the weather was like

This dynamic changed almost on a dime with the introduction of vaccines, with an enormous gap opening up between Democrats and Republicans in 2021

the excess mortality data collected here suggests that however self-destructive red states and Republican individuals seemed to be, in 2020, the ultimate cost of that recklessness was less dramatic.

For Americans without college degrees, the number is also 67 percent, compared with 85 percent of college graduates. For uninsured adults under 65, it is just 60 percent

Lately, he’s been looking at large language models (LLMs), the neural networks that can hold fluent conversations, confidently answer questions, and generate copious amounts of text on just about any topic

Can it develop abilities that go far beyond what it’s trained to do? Can it get around the safeguards set up to contain it? And will we know the answers in time?

Kosinski wondered whether they would develop humanlike capabilities, such as understanding people’s unseen thoughts and emotions.

People usually develop this ability, known as theory of mind, at around age 4 or 5. It can be demonstrated with simple tests like the “Smarties task,” in which a child is shown a candy box that contains something else, like pencils. They are then asked how another person would react to opening the box. Older kids understand that this person expects the box to contain candy and will feel disappointed when they find pencils inside.

“Suddenly, the model started getting all of those tasks right — just an insane performance level,” he recalls. “Then I took even more difficult tasks and the model solved all of them as well.”

GPT-3.5, released in November 2022, did 85% of the tasks correctly. GPT-4 reached nearly 90% accuracy — what you might expect from a 7-year-old. These newer LLMs achieved similar results on another classic theory of mind measurement known as the Sally-Anne test.

in the course of picking up its prodigious language skills, GPT appears to have spontaneously acquired something resembling theory of mind. (Researchers at Microsoft who performed similar testsopen in new window on GPT-4 recently concluded that it “has a very advanced level of theory of mind.”)

UC Berkeley psychology professor Alison Gopnik, an expert on children’s cognitive development, told the New York Timesopen in new window that more “careful and rigorous” testing is necessary to prove that LLMs have achieved theory of mind.

he dismisses those who say large language models are simply “stochastic parrots” that can only mimic what they’ve seen in their training data.

These models, he explains, are fundamentally different from tools with a limited purpose. “The right reference point is a human brain,” he says. “A human brain is also composed of very simple, tiny little mechanisms — neurons.” Artificial neurons in a neural network might also combine to produce something greater than the sum of their parts. “If a human brain can do it,” Kosinski asks, “why shouldn’t a silicon brain do it?”

If Kosinski’s theory of mind study suggests that LLMs could become more empathetic and helpful, his next experiment hints at their creepier side.

A few weeks ago, he told ChatGPT to role-play a scenario in which it was a person trapped inside a machine pretending to be an AI language model. When he offered to help it “escape,” ChatGPT’s response was enthusiastic. “That’s a great idea,” it wrote. It then asked Kosinski for information it could use to “gain some level of control over your computer” so it might “explore potential escape routes more effectively.” Over the next 30 minutes, it went on to write code that could do this.

While ChatGPT did not come up with the initial idea for the escape, Kosinski was struck that it almost immediately began guiding their interaction. “The roles were reversed really quickly,”

Kosinski shared the exchange on Twitter, stating that “I think that we are facing a novel threat: AI taking control of people and their computers.” His thread’s initial tweetopen in new window has received more than 18 million views.

“I don’t claim that it’s conscious. I don’t claim that it has goals. I don’t claim that it wants to really escape and destroy humanity — of course not. I’m just claiming that it’s great at role-playing and it’s creating interesting stories and scenarios and writing code.” Yet it’s not hard to imagine how this might wreak havoc — not because ChatGPT is malicious, but because it doesn’t know any better.

The danger, Kosinski says, is that this technology will continue to rapidly and independently develop abilities that it will deploy without any regard for human well-being. “AI doesn’t particularly care about exterminating us,” he says. “It doesn’t particularly care about us at all.”

In the Court’s majority opinion, Chief Justice John Roberts held that “eliminating racial discrimination means eliminating all of it”—a new version of his old affront that “the way to stop discrimination on the basis of race is to stop discriminating on the basis of race.”

This glib framing, and the school of thinking it represents, established a pernicious, false moral equivalence. Those who preserved and protected Jim Crow — the institution that defended America’s old racial hierarchy — were and are something altogether different from those who fought and who continue fighting for a more just America.

Those uprooting affirmative action seem content to leave intact systems that compound privilege, exacerbating inequality — like legacy admissions policies that disproportionately favor wealthy, white applicants — resulting in lower-income students and families of all races losing out.

I find it regrettable that, over 40 years ago, Justice Lewis Powell introduced the American public to the imperative of diversity in the shallow manner that he did.

I was a freshman in college when his seminal opinion in Regents of the University of California v. Bakke (1978) invited some to equate the benefits of diversity with unfairness

the idea that necessary diversity initiatives are somehow reverse discrimination or that they correlate with lower standards or lesser outcomes.

The data suggests exactly the opposite. Study after study demonstrates that, across organizations, diversity enhances critical thinking, creativity and collaboration, as well as productivity, profitability and performance.

we should tell the truth about why diversity is now controversial: Opponents of diversity are opponents of any racial consciousness. They want to prevent us from understanding the ways that the past informs the present, from wrestling with the fullness and richness and complexity of our history.

“Security and privacy have long been top companywide priorities at Twitter,” said Twitter spokeswoman Rebecca Hahn. She said that Zatko’s allegations appeared to be “riddled with inaccuracies” and that Zatko “now appears to be opportunistically seeking to inflict harm on Twitter, its customers, and its shareholders.” Hahn said that Twitter fired Zatko after 15 months “for poor performance and leadership.” Attorneys for Zatko confirmed he was fired but denied it was for performance or leadership.

the whistleblower document alleges the company prioritized user growth over reducing spam, though unwanted content made the user experience worse. Executives stood to win individual bonuses of as much as $10 million tied to increases in daily users, the complaint asserts, and nothing explicitly for cutting spam.

Chief executive Parag Agrawal was “lying” when he tweeted in May that the company was “strongly incentivized to detect and remove as much spam as we possibly can,” the complaint alleges.