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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’d been talking with DiAngelo for a year when Floyd was killed, and with other antiracism teachers for almost as long. Demand has recently spiked throughout the field, though the clamor had already been building, particularly since the election of Donald Trump

As their teaching becomes more and more widespread, antiracism educators are shaping the language that gets spoken — and the lessons being learned — about race in America.

“I will not coddle your comfort,” she went on. She gestured crisply with her hands. “I’m going to name and admit to things white people rarely name and admit.” Scattered Black listeners called out encouragement. Then she specified the predominant demographic in the packed house: white progressives. “I know you. Oh, white progressives are my specialty. Because I am a white progressive.” She paced tightly on the stage. “And I have a racist worldview.”

“White supremacy — yes, it includes extremists or neo-Nazis, but it is also a highly descriptive sociological term for the society we live in, a society in which white people are elevated as the ideal for humanity, and everyone else is a deficient version.” And Black people, she said, are cast as the most deficient. “There is something profoundly anti-Black in this culture.”

But was I being fragile? Was I being defensive or just trying to share something more personal, intimate and complex than DiAngelo’s all-encompassing sociological perspective? She taught, throughout the afternoon, that the impulse to individualize is in itself a white trait, a way to play down the societal racism all white people have thoroughly absorbed.

At some point after our answers, DiAngelo poked fun at the myriad ways that white people “credential” themselves as not-racist. I winced. I hadn’t meant to imply that I was anywhere close to free of racism, yet was I “credentialing”?

the pattern she first termed “white fragility” in an academic article in 2011: the propensity of white people to fend off suggestions of racism, whether by absurd denials (“I don’t see color”) or by overly emotional displays of defensiveness or solidarity (DiAngelo’s book has a chapter titled “White Women’s Tears” and subtitled “But you are my sister, and I share your pain!”) or by varieties of the personal history I’d provided.

White fragility, in DiAngelo’s formulation, is far from weakness. It is “weaponized.” Its evasions are actually a liberal white arsenal, a means of protecting a frail moral ego, defending a righteous self-image and, ultimately, perpetuating racial hierarchies, because what goes unexamined will never be upended

One “unnamed logic of Whiteness,” she wrote with her frequent co-author, the education professor Ozlem Sensoy, in a 2017 paper published in The Harvard Educational Review, “is the presumed neutrality of White European Enlightenment epistemology.”

she returned to white supremacy and how she had been imbued with it since birth. “When my mother was pregnant with me, who delivered me in the hospital — who owned the hospital? And who came in that night and mopped the floor?” She paused so we could picture the complexions of those people. Systemic racism, she announced, is “embedded in our cultural definitions of what is normal, what is correct, what is professionalism, what is intelligence, what is beautiful, what is valuable.”

“I have come to see white privilege as an invisible package of unearned assets that I can count on cashing in each day, but about which I was ‘meant’ to remain oblivious,” one of the discipline’s influential thinkers, Peggy McIntosh, a researcher at the Wellesley Centers for Women, has written. “White privilege is like an invisible weightless knapsack of special provisions, assurances, tools, maps, guides, codebooks, passports, visas, clothes, compass, emergency gear and blank checks.”

Borrowing from feminist scholarship and critical race theory, whiteness studies challenges the very nature of knowledge, asking whether what we define as scientific research and scholarly rigor, and what we venerate as objectivity, can be ways of excluding alternate perspectives and preserving white dominance

the Seattle Gilbert & Sullivan Society’s casting of white actors as Asians in a production of “The Mikado.” “That changed my life,” she said. The phrase “white fragility” went viral, and requests to speak started to soar; she expanded the article into a book and during the year preceding Covid-19 gave eight to 10 presentations a month, sometimes pro bono but mostly at up to $15,000 per event.

For almost everyone, she assumes, there is a mingling of motives, a wish for easy affirmation (“they can say they heard Robin DiAngelo speak”) and a measure of moral hunger.

Moore drew all eyes back to him and pronounced, “The cause of racial disparities is racism. If I show you data that’s about race, we need to be talking about racism. Don’t get caught up in detours.” He wasn’t referring to racism’s legacy. He meant that current systemic racism is the explanation for devastating differences in learning, that the prevailing white culture will not permit Black kids to succeed in school.

The theme of what white culture does not allow, of white society’s not only supreme but also almost-absolute power, is common to today’s antiracism teaching and runs throughout Singleton’s and DiAngelo’s programs

unning slightly beneath or openly on the surface of DiAngelo’s and Singleton’s teaching is a set of related ideas about the essence and elements of white culture

if we were white and happened to be sitting beside someone of color, we were forbidden to ask the person of color to speak first. It might be good policy, mostly, for white people to do more listening than talking, but, she said with knowing humor, it could also be a subtle way to avoid blunders, maintain a mask of sensitivity and stay comfortable. She wanted the white audience members to feel as uncomfortable as possible.

For DiAngelo, the elements include the “ideology of individualism,” which insists that meritocracy is mostly real, that hard work and talent will be justly rewarded. White culture, for her, is all about habits of oppressive thought that are taken for granted and rarely perceived, let alone questioned

The modern university, it says, “with its ‘experts’ and its privileging of particular forms of knowledge over others (e.g., written over oral, history over memory, rationalism over wisdom)” has “validated and elevated positivistic, White Eurocentric knowledge over non-White, Indigenous and non-European knowledges.”

the idea of a society rigged at its intellectual core underpins her lessons.

There is the myth of meritocracy. And valuing “written communication over other forms,” he told me, is “a hallmark of whiteness,” which leads to the denigration of Black children in school. Another “hallmark” is “scientific, linear thinking. Cause and effect.” He said, “There’s this whole group of people who are named the scientists. That’s where you get into this whole idea that if it’s not codified in scientific thought that it can’t be valid.”

“This is a good way of dismissing people. And this,” he continued, shifting forward thousands of years, “is one of the challenges in the diversity-equity-inclusion space; folks keep asking for data. How do you quantify, in a way that is scientific — numbers and that kind of thing — what people feel when they’re feeling marginalized?”

Moore directed us to a page in our training booklets: a list of white values. Along with “ ‘The King’s English’ rules,” “objective, rational, linear thinking” and “quantitative emphasis,” there was “work before play,” “plan for future” and “adherence to rigid time schedules.”

They’ve just refined their analysis, with the help of two Princeton researchers, Chelsey Clark and Roni Porat. “As the study quality goes up,” Paluck told me, “the effect size dwindles.”

Dobbin’s research shows that the numbers of women or people of color in management do not increase with most anti-bias education. “There just isn’t much evidence that you can do anything to change either explicit or implicit bias in a half-day session,” Dobbin warns. “Stereotypes are too ingrained.”

he noted that new research that he’s revising for publication suggests that anti-bias training can backfire, with adverse effects especially on Black people, perhaps, he speculated, because training, whether consciously or subconsciously, “activates stereotypes.”

When we spoke again in June, he emphasized an additional finding from his data: the likelihood of backlash “if people feel that they’re being forced to go to diversity training to conform with social norms or laws.”

Donald Green, a professor of political science at Columbia, and Betsy Levy Paluck, a professor of psychology and public affairs at Princeton, have analyzed almost 1,000 studies of programs to lessen prejudice, from racism to homophobia, in situations from workplaces to laboratory settings. “We currently do not know whether a wide range of programs and policies tend to work on average,

She replied that if a criterion “consistently and measurably leads to certain people” being excluded, then we have to “challenge” the criterion. “It’s the outcome,” she emphasized; the result indicated the racism.

Another critique has been aimed at DiAngelo, as her book sales have skyrocketed. From both sides of the political divide, she has been accused of peddling racial reductionism by branding all white people as supremacist

Chislett filed suit in October against Carranza and the department. At least five other high-level, white D.O.E. executives have filed similar suits or won settlements from the city over the past 14 months. The trainings lie at the heart of their claims.

Chislett eventually wound up demoted from the leadership of A.P. for All, and her suit argues that the trainings created a workplace filled with antiwhite distrust and discrimination

whatever the merits of Chislett’s lawsuit and the counteraccusations against her, she is also concerned about something larger. “It’s absurd,” she said about much of the training she’s been through. “The city has tens of millions invested in A.P. for All, so my team can give kids access to A.P. classes and help them prepare for A.P. exams that will help them get college degrees, and we’re all supposed to think that writing and data are white values? How do all these people not see how inconsistent this is?”

I talked with DiAngelo, Singleton, Amante-Jackson and Kendi about the possible problem. If the aim is to dismantle white supremacy, to redistribute power and influence, I asked them in various forms, do the messages of today’s antiracism training risk undermining the goal by depicting an overwhelmingly rigged society in which white people control nearly all the outcomes, by inculcating the idea that the traditional skills needed to succeed in school and in the upper levels of the workplace are somehow inherently white, by spreading the notion that teachers shouldn’t expect traditional skills as much from their Black students, by unwittingly teaching white people that Black people require allowances, warrant extraordinary empathy and can’t really shape their own destinies?

With DiAngelo, my worries led us to discuss her Harvard Educational Review paper, which cited “rationalism” as a white criterion for hiring, a white qualification that should be reconsidered

Shouldn’t we be hiring faculty, I asked her, who fully possess, prize and can impart strong reasoning skills to students, because students will need these abilities as a requirement for high-paying, high-status jobs?

I pulled us away from the metaphorical, giving the example of corporate law as a lucrative profession in which being hired depends on acute reasoning.

Moore expounded that white culture is obsessed with “mechanical time” — clock time — and punishes students for lateness. This, he said, is but one example of how whiteness undercuts Black kids. “The problems come when we say this way of being is the way to be.” In school and on into the working world, he lectured, tremendous harm is done by the pervasive rule that Black children and adults must “bend to whiteness, in substance, style and format.”

he said abruptly, “Capitalism is so bound up with racism. I avoid critiquing capitalism — I don’t need to give people reasons to dismiss me. But capitalism is dependent on inequality, on an underclass. If the model is profit over everything else, you’re not going to look at your policies to see what is most racially equitable.”

I was asking about whether her thinking is conducive to helping Black people displace white people on high rungs and achieve something much closer to equality in our badly flawed worl

it seemed that she, even as she gave workshops on the brutal hierarchies of here and now, was entertaining an alternate and even revolutionary reality. She talked about top law firms hiring for “resiliency and compassion.”

Singleton spoke along similar lines. I asked whether guiding administrators and teachers to put less value, in the classroom, on capacities like written communication and linear thinking might result in leaving Black kids less ready for college and competition in the labor market. “If you hold that white people are always going to be in charge of everything,” he said, “then that makes sense.”

He invoked, instead, a journey toward “a new world, a world, first and foremost, where we have elevated the consciousness, where we pay attention to the human being.” The new world, he continued, would be a place where we aren’t “armed to distrust, to be isolated, to hate,” a place where we “actually love.”

I reread “How to Be an Antiracist.” “Capitalism is essentially racist; racism is essentially capitalist,” he writes. “They were birthed together from the same unnatural causes, and they shall one day die together from unnatural causes.”

“I think Americans need to decide whether this is a multicultural nation or not,” he said. “If Americans decide that it is, what that means is we’re going to have multiple cultural standards and multiple perspectives. It creates a scenario in which we would have to have multiple understandings of what achievement is and what qualifications are. That is part of the problem. We haven’t decided, as a country, even among progressives and liberals, whether we desire a multicultural nation or a unicultural nation.”

Ron Ferguson, a Black economist, faculty member at Harvard’s John F. Kennedy School of Government and director of Harvard’s Achievement Gap Initiative, is a political liberal who gets impatient with such thinking about conventional standards and qualifications

“The cost,” he told me in January, “is underemphasizing excellence and performance and the need to develop competitive prowess.” With a soft, rueful laugh, he said I wouldn’t find many economists sincerely taking part in the kind of workshops I was writing about

“When the same group of people keeps winning over and over again,” he added, summarizing the logic of the trainers, “it’s like the game must be rigged.” He didn’t reject a degree of rigging, but said, “I tend to go more quickly to the question of how can we get prepared better to just play the game.”

But, he suggested, “in this moment we’re at risk of giving short shrift to dealing with qualifications. You can try to be competitive by equipping yourself to run the race that’s already scheduled, or you can try to change the race. There may be some things about the race I’d like to change, but my priority is to get people prepared to run the race that’s already scheduled.”

DiAngelo hopes that her consciousness raising is at least having a ripple effect, contributing to a societal shift in norms. “You’re watching network TV, and they’re saying ‘systemic racism’ — that it’s in the lexicon is kind of incredible,” she said. So was the fact that “young people understand and use language like ‘white supremacy.’”

We need a culture where a person who resists speaking up against racism is uncomfortable, and right this moment it looks like we’re in that culture.”

Under the PPP program, loans for restaurants, hotels and other small businesses would convert into federal grants if recipients adhere to a set of conditions, including spending the loan amount within the required time.

Democratic Senator Ben Cardin said that Washington had so far handed out 4.4 million forgivable loans valued at a total of $510 billion.

Congress is expected to debate additional assistance in coming weeks, possibly including more federal funds to help state and local governments whose revenues have plummeted amid higher demand for services and social lockdowns.

The bill also gives businesses more flexibility to use the loans to pay for expenses other than payrolls.

Aviation is safe in large part because it learns from its disasters. Investigators from the U.S. National Transportation Safety Board go immediately to accident sites to begin assessing evidence. After months or even years of research, their detailed reports try to lay out the “accident chain” and explain what went wrong

with respect to the coronavirus pandemic, it has suffered by far the largest number of fatalities, about one-quarter of the global total, despite having less than one-20th of the world’s population.

What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude?

This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.

Timelines of aviation disasters typically start long before the passengers or even the flight crew knew anything was wrong, with problems in the design of the airplane, the procedures of the maintenance crew, the route, or the conditions into which the captain decided to fly. In the worst cases, those decisions doomed the flight even before it took off. My focus here is similarly on conditions and decisions that may have doomed the country even before the first COVID-19 death had been recorded on U.S. soil.

What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf

As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that—when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell—will be a central part of the history of our times.

1. The Flight Plan

the most important event was the H5N1 “bird flu” outbreak, in 2005. It originated in Asia and was mainly confined there, as the SARS outbreak had been two years earlier. Bush-administration officials viewed H5N1 as an extremely close call. “

Shortly before Barack Obama left office, his administration’s Pandemic Prediction and Forecasting Science and Technology Working Group—yes, that was a thing—released a report reflecting the progress that had been made in applying remote-sensing and AI tools since the early days of Global Argus. The report is freely available online and notes pointedly that recent technological advances “provide opportunities to mitigate large-scale outbreaks by predicting more accurately when and where outbreaks are likely to occur, and how they will progress.”

“Absolutely nothing that has happened has been a surprise. We saw it coming. Not only did we see it, we ran the models and the gaming exercises. We had every bit of the structure in place. We’ve been talking about a biohazard risk like this for years. Anyone who says we did not see this coming has their head in the sand, or is lying through their teeth.”

The system the government set up was designed to warn not about improbable “black swan” events but rather about what are sometimes called “gray rhinos.” These are the large, obvious dangers that will sooner or later emerge but whose exact timing is unknown.

other U.S. leaders had dealt with foreign cover-ups, including by China in the early stages of the SARS outbreak in 2002. Washington knew enough, soon enough, in this case to act while there still was time.

During the Obama administration, the U.S. had negotiated to have its observers stationed in many cities across China, through a program called Predict. But the Trump administration did not fill those positions, including in Wuhan. This meant that no one was on site to learn about, for instance, the unexplained closure on January 1 of the city’s main downtown Huanan Seafood Wholesale Market, a so-called wet market

“It was in the briefings by the beginning of January,” a person involved in preparing the president’s briefing book told me. “On that there is no dispute.” This person went on: “But knowing it is in the briefing book is different from knowing whether the president saw it.” He didn’t need to spell out his point, which was: Of course this president did not.

To sum up: The weather forecast showed a dangerous storm ahead, and the warning came in plenty of time. At the start of January, the total number of people infected with the virus was probably less than 1,000. All or nearly all of them were in China. Not a single case or fatality had been reported in the United States.

2. The Air Traffic Controllers

In cases of disease outbreak, U.S. leadership and coordination of the international response was as well established and taken for granted as the role of air traffic controllers in directing flights through their sectors

in normal circumstances, its location in China would have been a plus. Whatever the ups and downs of political relations over the past two decades, Chinese and American scientists and public-health officials have worked together frequently, and positively, on health crises ranging from SARS during George W. Bush’s administration to the H1N1 and Ebola outbreaks during Barack Obama’s.

One U.S. official recalled the Predict program: “Getting Chinese agreement to American monitors throughout their territory—that was something.” But then the Trump administration zeroed out that program.

“We had cooperated with China on every public-health threat until now,” Susan Shirk, a former State Department official and longtime scholar of Chinese affairs at UC San Diego, told me. “SARS, AIDS, Ebola in Africa, H1N1—no matter what other disputes were going on in the relationship, we managed to carve out health, and work together quite professionally. So this case is just so anomalous and so tragic.” A significant comparison, she said, is the way the United States and the Soviet Union had worked together to eliminate smallpox around the world, despite their Cold War tensions. But now, she said, “people have definitely died because the U.S. and China have been unable to cooperate.”

What did the breakdown in U.S.-Chinese cooperation mean in practice? That the U.S. knew less than it would have otherwise, and knew it later; that its actions brought out the worst (rather than the merely bad) in China’s own approach to the disease, which was essentially to cover it up internally and stall in allowing international access to emerging data; that the Trump administration lost what leverage it might have had over Chinese President Xi Jinping and his officials; and that the chance to keep the disease within the confines of a single country was forever lost.

In addition to America’s destruction of its own advance-warning system, by removing CDC and Predict observers, the Trump administration’s bellicose tone toward China had an effect. Many U.S. officials stressed that a vicious cycle of blame and recrimination made public health an additional source of friction between the countries, rather than a sustained point of cooperation, as it had been for so many years.

“The state of the relationship meant that every U.S. request was met with distrust on the Chinese side, and every Chinese response was seen on the American side as one more attempt to cover up,”

Several officials who had experience with China suggested that other presidents might have called Xi Jinping with a quiet but tough message that would amount to: We both know you have a problem. Why don’t we work on it together, which will let you be the hero? Otherwise it will break out and become a problem for China and the whole world.

“It would have taken diplomatic pressure on the Chinese government to allow us to insert our people” into Wuhan and other disease centers, Klain said. “The question isn’t what leverage we had. The point is that we gave up leverage with China to get the trade deal done. That meant that we didn’t put leverage on China’s government. We took their explanations at face value.”

The president’s advance notice of the partial European ban almost certainly played an important part in bringing the infection to greater New York City. Because of the two-day “warning” Trump gave in his speech, every seat on every airplane from Europe to the U.S. over the next two days was filled. Airport and customs offices at the arrival airports in the U.S. were unprepared and overwhelmed. News footage showed travelers queued for hours, shoulder to shoulder, waiting to be admitted to the U.S. Some of those travelers already were suffering from the disease; they spread it to others. On March 11, New York had slightly more than 220 diagnosed cases. Two weeks later, it had more than 25,000. Genetic testing showed that most of the infection in New York was from the coronavirus variant that had come through Europe to the United States, rather than directly from China (where most of the early cases in Washington State originated).

3. The Emergency Checklist

Aviation is safe because, even after all the advances in forecasting and technology, its culture still imagines emergencies and rehearses steps for dealing with them.

Especially in the post-9/11 era of intensified concern about threats of all sorts, American public-health officials have also imagined a full range of crises, and have prepared ways to limit their worst effects. The resulting official “playbooks” are the equivalent of cockpit emergency checklists

the White House spokesperson, Kayleigh McEnany, then claimed that whatever “thin packet of paper” Obama had left was inferior to a replacement that the Trump administration had supposedly cooked up, but which has never been made public. The 69-page, single-spaced Obama-administration document is officially called “Playbook for Early Response to High-Consequence Infectious Disease Threats and Biological Incidents” and is freely available online. It describes exactly what the Trump team was determined not to do.

What I found remarkable was how closely the Obama administration’s recommendations tracked with those set out 10 years earlier by the George W. Bush administration, in response to its chastening experience with bird flu. The Bush-era work, called “National Strategy for Pandemic Influenza” and publicly available here, differs from the Obama-era playbook mainly in the simpler forms of technology on which it could draw

consider the one below, and see how, sentence by sentence, these warnings from 2005 match the headlines of 2020. The topic was the need to divide responsibility among global, national, state, and community jurisdictions in dealing with the next pandemic. The fundamental premise—so widely shared that it barely needed to be spelled out—was that the U.S. federal government would act as the indispensable flywheel, as it had during health emergencies of the past. As noted, it would work with international agencies and with governments in all affected areas to coordinate a global response. Within its own borders it would work with state agencies to detect the potential for the disease’s spread and to contain cases that did arise:

Referring to the detailed pandemic playbooks from the Bush and Obama administrations, John R. Allen told me: “The moment you get confirmation of a problem, you would move right to the timeline. Decisions by the president, actions by the secretary of defense and the CDC, right down the list. You’d start executing.”Or, in the case of the current administration, you would not. Reading these documents now is like discovering a cockpit checklist in the smoking wreckage.

4. The Pilot

a virtue of Sully is the reminder that when everything else fails—the forecasts, the checklists, the triply redundant aircraft systems—the skill, focus, and competence of the person at the controls can make the difference between life and death.

So too in the public response to a public-health crisis. The system was primed to act, but the person at the top of the system had to say, “Go.” And that person was Donald Trump.

n a resigned way, the people I spoke with summed up the situation this way: You have a head of government who doesn’t know anything, and doesn’t read anything, and is at the mercy of what he sees on TV. “And all around him, you have this carnival,”

“There would be some ballast in the relationship,” this person said. “Now all you’ve got is the trade friction”—plus the personal business deals that the president’s elder daughter, Ivanka, has made in China,

5. The Control Systems

The deadliest airline crash in U.S. history occurred in 1979. An American Airlines DC-10 took off from O’Hare Airport, in Chicago—and just as it was leaving the ground, an incorrectly mounted engine ripped away from one of the wings. When the engine’s pylon was pulled off, it cut the hydraulic lines that led from the cockpit to the control surfaces on the wings and tail. From that point on, the most skillful flight crew in the world could not have saved the flight.

The United States still possesses the strongest economy in the world, its military is by far the most powerful, its culture is diverse, and, confronted with the vicissitudes of history, the country has proved resilient. But a veteran of the intelligence world emphasized that the coronavirus era revealed a sobering reality. “Our system has a single point-of-failure: an irrational president.” At least in an airplane cockpit, the first officer can grab the controls from a captain who is steering the aircraft toward doom.

The more complex the organization, the more its success or failure turns on the skill of people in its middle layers—the ones who translate a leader’s decision to the rest of the team in order to get results. Doctors depend on nurses; architects depend on contractors and craftsmen; generals depend on lieutenants and sergeants

Because Donald Trump himself had no grasp of this point, and because he and those around him preferred political loyalists and family retainers rather than holdovers from the “deep state,” the whole federal government became like a restaurant with no cooks, or a TV station with stars but no one to turn the cameras on.

“There is still resilience and competence in the working-level bureaucracy,” an intelligence-agency official told me. “But the layers above them have been removed.”

Traditionally, the National Security Council staff has comprised a concentration of highly knowledgeable, talented, and often ambitious younger figures, mainly on their way to diplomatic or academic careers.

“There is nobody now who can play the role of ‘senior China person,’” a former intelligence official told me. “In a normal administration, you’d have a lot of people who had spent time in Asia, spent time in China, knew the goods and bads.” Also in a normal administration, he and others pointed out, China and the United States would have numerous connective strands

By the time the pandemic emerged, it may have already been too late. The hydraulic lines may already have been too damaged to transmit the signals. It was Trump himself who cut them.

Every president is “surprised” by how hard it is to convert his own wishes into government actions

Presidents cope with this discovery in varying ways. The people I spoke with had served in past administrations as early as the first George Bush’s. George H. W. Bush came to office with broad experience in the federal government—as much as any other president. He had been vice president for eight years, a CIA director, twice an ambassador, and a member of Congress. He served only four years in the Oval Office but began with a running start. Before he became president, Bill Clinton had been a governor for 12 years and had spent decades learning and talking about government policies. A CIA official told me that Clinton would not read his President’s Daily Briefs in the morning, when they arrived, but would pore over them late at night and return them with copious notes. George W. Bush’s evolution from dependence on the well-traveled Dick Cheney, in his first term, to more confident control, in his second, has been well chronicled. As for Obama, Paul Triolo told me: “By the end of his eight years, Obama really understood how to get the bureaucracy to do what he wanted done, and how to get the information he needed to make decisions.” The job is far harder than it seems. Donald Trump has been uninterested in learning the first thing about it.

In a situation like this, some of those in the “regular” government decide to struggle on. Others quit—literally, or in the giving-up sense

The ‘process’ is just so chaotic that it’s not a process at all. There’s no one at the desk. There’s no one to read the memos. No one is there.”

“If this could happen to Fauci, it makes people think that if they push too hard in the wrong direction, they’ll get their heads chopped off. There is no reason in the world something called #FireFauci should even exist. The nation’s leaders should maintain high regard for scientific empiricism, insight, and advice, and must not be professionally or personally risk averse when it comes to understanding and communicating messages about public safety and health.”

Over nearly two decades, the U.S. government had assembled the people, the plans, the connections, and the know-how to spare this nation the worst effects of the next viral mutation that would, someday, arise. That someday came, and every bit of the planning was for naught. The deaths, the devastation, the unforeseeable path ahead—they did not have to occur.

The language of an NTSB report is famously dry and clinical—just the facts. In the case of the pandemic, what it would note is the following: “There was a flight plan. There was accurate information about what lay ahead. The controllers were ready. The checklists were complete. The aircraft was sound. But the person at the controls was tweeting. Even if the person at the controls had been able to give effective orders, he had laid off people that would carry them out. This was a preventable catastrophe.”

But the American middle class is neither stable nor self-reliant. Recognizing this is the prerequisite to determining what we need to weather this storm.

The American middle class long has been presented as evidence that self-reliance leads to stability, even prosperity. The very existence of a middle class appears to prove the notion that if we work hard enough and make the right choices, everything will be OK — and also its corollary: that the poor must have somehow brought poverty upon themselves and that we, industrious workers that we are, will surely never be one of them

Before the pandemic, Americans saved approximately 8 percent of their income, which would cover a fraction of their living expenses. American households carry an average of $111,198 in debt. Even in flush times, this kind of financial exposure can be stressful. During long spells of unemployment and underemployment, it can lead to ruin.

it’s not just the design of a nation’s welfare infrastructure that matters but also its level of commitment to protecting basic human needs.

the average middle-class American family (with a before-tax household income of $66,400) receives more help from the government than it pays in federal taxes and collects more aid than the average American family in the lowest income quintile (with a before-tax household income of $24,600).

We’re all on the dole, however meager it may be.

countries with more robust welfare states have been able to respond to the recent economic downturn with a high level of competence and the kind of deep investment that the Covid-19 pandemic demands.

In nations like Britain and Germany, workers have been allowed to keep their jobs even as businesses shuttered because their governments are paying all or most of their wages.

Because Germany already had a system, known as Kurzarbeit, in place to pay workers whose hours are reduced during economic crises, it didn’t need to reinvent the wheel when the coronavirus began to spread. Other countries that didn’t have such a system in place, including Ireland and Denmark, quickly fashioned one.

virtually every American has benefited from some form of public aid, from programs widely recognized as ‘‘welfare,’’ like food stamps, to more hidden subsidies issued through the tax code, like government-subsidized retirement benefits

just as states go to war with the army they have, in a recession they tend to catch the unemployed with the safety net they have

America not only lacks many programs that buffer workers from economic calamity — such as the right to housing or universal health care — it is also bereft of a national culture characterized by social solidarity and faith in government.

About a third of Americans express trust in the government, unlike most Germans, Norwegians and Swiss.

countries that have been able to bend the curve of Covid-19 cases, both in Europe (Switzerland, France) and Asia (South Korea, Taiwan), have been those where citizens recognize the importance of strong government.

Countries that have yet to respond as effectively — including Brazil, the United Kingdom and the United States — have publics deeply skeptical of their governments as well as current heads of state (Jair Bolsonaro, Boris Johnson and Donald Trump) who share, and stoke, that sentiment.

‘‘The American public consistently expresses a desire for more government effort and higher levels of spending for almost every aspect of the welfare state,’’

The New Deal erected an institutional scaffolding designed to provide unprecedented stability and predictability for the American economy,’

The quarter century of prosperity that followed World War II was rooted in the profound structural reforms of the New Deal. A strong market was made possible by strong government intervention.

It is now widely acknowledged that the federal government should have acted sooner and spent bigger when addressing the 2008 financial crisis. In March, Neel Kashkari, who oversaw the rescue package (the Troubled Asset Relief Program) and is now president and chief executive of the Federal Reserve Bank of Minneapolis, wrote, ‘‘My experience underscores that if there is a principle policymakers need to keep in mind going forward, it’s this: Err on the side of helping as many workers and businesses as possible rather than on prudence.’’

In 2008, the government hobbled the rescue package by trying to make sure that only ‘‘deserving’’ Americans received help, slowing and narrowing relief. ‘‘The American people ultimately paid more because of our attempts to save them money,’’ Kashkari wrote with hindsight.

‘‘Adding $3 trillion in spending,’’ as the HEROES Act would, ‘‘is necessary for spending after the summer and most importantly to start helping states.’’ J. W. Mason, an associate professor of economics at John Jay College in New York, pointed out that $3 trillion corresponds to a 20 percent decline in private demand, which, based on what happened in the 2008 recession, we should prepare for.

The proposal lands in the midst of the Covid-19 pandemic, which has shed light on many inefficiencies in the American system, including banking. Take the Paycheck Protection Program, for example: It used the regular banking system as an intermediary, which ultimately meant that bigger businesses and those with preexisting relationships with those banks were prioritized over others.

guarantee a more equitable recovery by providing an alternative to Wall Street banks for state and local governments, businesses, and ordinary people,

The public banking bill also does double duty as a climate bill: It would prohibit public banks from investing in or doing business with the fossil fuel industry.

“Public banks empower states and municipalities to establish new channels of public investment to help solve systemic crises.”

But, he said, this proposal is particularly comprehensive and supportive.

If Democrats keep control of the House come 2021 and manage to flip the Senate and win the White House, they’ll be able to take some big legislative swings, including and perhaps especially on issues related to the economy.

at some point it’s just hitting a wall where it doesn’t carry them along and they’re looking for options,” said Tlaib, who represents Michigan’s 13th Congressional District, the third-poorest congressional district in the country. “So I’m putting this on the table as an option.”

To be clear, the Public Banking Act isn’t creating a federal public bank.

encourage and enable the creation of public banks across the US. It provides legitimacy to those who are pushing for more public banking, and it also includes regulators as key stakeholders who can support and provide guidance for how those banks should operate.

though different public banks would likely have different areas of emphasis.

They could also facilitate easier access to funds for state and local governments from the federal government or Federal Reserve.

“It’s basically a way to finance state and local investment that doesn’t go through Wall Street and doesn’t leave the community and turn into a windfall for shareholders,

“This is more about community development.”

Tlaib recalled hearing from her constituents when the $1,200 coronavirus stimulus checks went out this spring — people waiting days and weeks for direct deposits, or getting a check in the mail only to lose a substantial portion of it cashing it at the store down the street.

The Public Banking Act allows the Federal Reserve to charter and grant membership to public banks and creates a grant program for the Treasury secretary to provide seed money for public banks to be formed, capitalized, and developed.

Public banks need the FDIC to provide assurances that it will recognize them in accordance with the bond rating of the city or state they represent.

McConnell said the FDIC issuing guidance that it recognizes the city’s — and the state’s — public banks as an AAA rating would send a clear direction to the state financial regulators that the public bank is considered low risk.

The bill would also provide a road map for the FDIC, which insures bank deposits of up to $250,000, to insure deposits for public banks, so people feel assured they won’t lose all their money by choosing to open an account with their state bank instead of, say, Wells Fargo.

the Office of the Comptroller of the Currency (OCC) has historically been charged with chartering national banks in the US, not the Fed, meaning this is a fairly novel idea.

It prohibits the Fed and Treasury from considering the financial health of an entity that controls or owns a bank in grant-making decisions.

So here is the thing about private companies, including, yes, banks: The point of them is to make money, and that drives their decisions. It’s not necessarily evil (though sometimes it kind of is), but it’s just how they work.

The idea behind public banking isn’t that Goldman Sachs, Wells Fargo, and Morgan Stanley go away; it’s that they have to compete with a government-owned entity — and one that’s a little fairer and more ethical in how it does business.

Public banks, as imagined in the Tlaib/Ocasio-Cortez proposal, would provide loans to small businesses and governments with lower interest rates and lower fees.

Student loans are facilitated directly with BND, but other loans, called participation loans, go through a local financial institution — often with BND support.

According to a study on public banks, BND had some $2 billion in active participation loans in 2014. BND can grant larger loans at a lower risk, which fosters a healthy financial ecosystem populated by a cluster of small North Dakota banks.

Democrats have a lot of ideas, and if they take power come January 2021, there’s a lot they can do.

The Public Banking Act is meant to complement ideas such as the ABC Act and postal banking. And, of course, it’s linked to the Green New Deal, not only because it would bar public banks from financing things that hurt the environment, but also because the idea is that public banks would play a major role in financing Green New Deal and climate-friendly projects.

If former Vice President Joe Biden wins the White House and Democrats control both the House and the Senate come 2021, the talk around these ideas becomes a lot more serious.

annual

So far, the election has produced a divided Congress. Members may not have the appetite to take on immigration policy amid the coronavirus pandemic and an economic recession, says Muzaffar Chishti, with the Migration Policy Institute. The Biden administration will also be consumed by the COVID-19 crisis.

In other words, AOC can win in NY-14 but AOC-type candidates are no solution at all to the Democrats’ working class problems in most areas of the country. The grim fact is that as education polarization has played out geographically, Democratic votes are now distributed so inefficiently that the translation of these votes into political power has been severely undercut

As a result, Democrats’ hold on political power is ever on a knife’s edge even when their last election was a good one (as it is today).

Consistent with other recent research, the study finds that:

Working-class voters prefer progressive candidates who focus primarily on bread-and-butter economic issues, and who frame those issues in universal terms.

Candidates whose campaigns focused primarily on universalist policy issues such as jobs, health care, and the economy performed better than those who focused on group-specific policies, such as racial justice or immigration.

In addition, woke messaging decreased the appeal of other candidate characteristics. For example, candidates employing woke messaging who championed either centrist or progressive economic, health care, or civil rights policy priorities were viewed less favorably than their counterparts who championed the same priorities but opted for universalist messaging.

easier said than done given Democrats’ recent evolution away from universalist messaging and toward foregrounding the equity effects of unambiguously universal programs and deferring to group specific concerns around race, gender and sexuality, even where they are clearly unpopular and dubious as policy. The result has a been a shift in the Democratic party “brand” that has created barriers to Democratic party voting among broad swathes of the working class.

The grim prospects for the Democrats in 2022 and the gut-wrenching prospect of losing the White House to Donald Trump (again) in 2024 make clear the stakes.

A Democratic brand reset is clearly in order to stop the bleeding among working class voters, along the lines suggested by the Jacobin study. A good way to start would be to embrace widely-held American views and values that are particularly strong among the multiracial working class.

Equality of opportunity is a fundamental American principle; equality of outcome is not.America is not perfect but it is good to be patriotic and proud of the country.

Discrimination and racism are bad but they are not the cause of all disparities in American society.No one is completely without bias but calling all white people racists who benefit from white privilege and American society a white supremacist society is not right or fair.

America benefits from the presence of immigrants and no immigrant, even if illegal, should be mistreated. But border security is still important, as is an enforceable system that fairly decides who can enter the country.Police misconduct and brutality against people of any race is wrong and we need to reform police conduct and recruitment. But crime is a real problem so more and better policing is needed for public safety. That cannot be provided by “defunding the police”.

There are underlying differences between men and women but discrimination on the basis of gender is wrong.There are basically two genders but people who want to live as a gender different from their biological sex should have that right and not be discriminated against. However, there are issues around child consent to transitioning and participation in women’s sports that are complicated and not settled.

Racial achievement gaps are bad and we should seek to close them. However, they are not due just to racism and standards of high achievement should be maintained for people of all races.Language policing has gone too far; by and large, people should be able to express their views without fear of sanction by employer, school, institution or government. Good faith should be assumed, not bad faith.

Besides positively embracing these views it is necessary for major Democratic officeholders and candidates to actively dissociate themselves and their party from the woke stances that contradict these views and tarnish their brand among working class voters. That entails not just saying that one does not endorse now-familiar strands of cultural leftism but in some well-chosen places directly criticizing by name some who hold extreme views that are associated with the Democrats. That will be of great assistance in getting the message through to average working class voters.

these views are entirely consistent with a very progressive Democratic program in the areas of health care, education, social programs, jobs and the economy that would disproportionately benefit the poor and working class, and therefore blacks and Hispanics.

In that sense, one might respond to the inevitable accusation that a universalist, mainstream approach is tantamount to throwing loyal Democratic constituencies in need of help “under the bus”: who is throwing whom under the bus? Perhaps it is those who stand in the way of a Democratic approach that could plausibly generate the widest possible support that are throwing those who need help the most under the bus.

And this approach, unlike the Democrats’ current default setting, has the potential to make the Democrats and their progressive policies consistent winners

But $555 billion in climate programs remained.

If enacted, it would be the largest action ever taken by the United States to address climate change.

Buyers of electric vehicles would also benefit, receiving up to $12,500 in tax credits — depending on what portion of the vehicle parts were made in America.

Scientists say that nations must quickly and deeply cut emissions from burning oil, gas and coal to avert the most harrowing impacts of climate change.

a program that would have rewarded power companies that moved from fossil fuels to clean energy, and penalized those that did not.

One group of moderate House Democrats even suggested that Democrats not worry about offsetting climate spending with tax increases.

At the same time, a new generation of climate activists has been advising the president on his agenda, and warning lawmakers that they risk losing young voters if they do not act.

“Folks, we all have that obligation, an obligation to our children and to our grandchildren,” Mr. Biden said.

Showing up empty-handed would damage the United States’ credibility on the world stage.

That measure withered in the Senate after Democrats could not summon enough votes from their own party to bring the bill to the floor for a vote.

“Today, we have every major agricultural group, and food companies, and researchers supporting a climate bill.

The past two years have only underscored that case: there were 22 climate disasters that cost at least $1 billion each in the United States in 2020, according to the National Oceanic and Atmospheric Administration.

a plan that would have eliminated the country’s greenhouse gas emissions by the end of the decade.

As soon as Democrats on Capitol Hill secured a razor-thin majority in early 2020, their leaders began laying the groundwork for a climate plan.

Mr. Schumer tasked Democrats on the Senate committees responsible for tax policy to craft climate-related tax legislation that could be bundled into a larger budget bill.

they used the software to quickly identify replacement programs that would achieve similar levels of emissions cuts.

At the same time, he demanded that the overall bill be slashed, from $3.5 trillion to roughly $1.5 trillion.

The measure expands job training and other efforts aimed at reducing recidivism, expands early-release programs and modifies sentencing laws.

The law gave the Justice Department and the Bureau of Prisons leeway in interpreting some aspects of its implementation, including whether credits for good behavior and job training accrued before the law was passed could be used to apply for early release.

Critics argued that the proposed rule did not accurately reflect the intent of the lawmakers who had drafted the bill, and that it kept thousands of people behind bars who should be immediately released.

Last May, Senators Richard J. Durbin, Democrat of Illinois and the chairman of the Senate Judiciary Committee, and Charles E. Grassley of Iowa, the panel’s top Republican, pressed the Justice Department and the Bureau of Prisons to revise the proposed rule.

They said that it included limitations that were not part of the act, and penalties that were unduly harsh.

In the guidelines announced Thursday, the Justice Department said inmates could apply credits that had been earned as far back as Dec. 21, 2018, when the First Step Act was enacted, subject to the Bureau of Prisons determining eligibility.

Justice Action Network, a bipartisan criminal justice reform group, said that the new guidelines could result in the release of as many people as were freed immediately after passage of First Step Act, which was more than 3,100. The home confinement decision had already affected about 2,800 inmates. There are 157,596 federal inmates, according to the Bureau of Prisons.

Symbolic acts of sanctioning individuals and issuing sharply worded statements are nothing new in the long and troubled relationship between Tehran and Washington.

The Biden administration needs a foreign policy success, particularly after the chaotic exit from Afghanistan, and has said it prefers a diplomatic resolution to the nuclear standoff over military confrontation.

The Biden administration initially wanted to return to the original deal while following the Trump blueprint on missiles and foreign policies, but has now indicated it would accept a return to the 2015 accord without those strings attached.

initially demanded the lifting of all sanctions imposed by Mr. Trump and guarantees that a future American president would not withdraw from the deal. But Tehran has softened those demands as the negotiations have progressed in Vienna.

Former President Donald Trump withdrew from the nuclear deal in 2018 and imposed tough economic sanctions cutting off most of Iran’s oil revenues and international financial transactions. Mr. Trump’s goal was to pressure Iran into a deal that reached beyond its nuclear program, restricting its ballistic missiles and regional political and military activities.

“We will facilitate revenge on Americans in any place, even their own homes and by people close to them, even if we are not present,” he said in a video of the speech.

Yet neither side wants to seem too eager to compromise, which would risk appearing weak.

The recent jousting between Tehran and Washington is linked to Iran’s commemoration on Jan. 3 of the two-year anniversary of the U.S. assassination of General Suleimani. In speech after speech during the ceremonies, Iranian officials threatened revenge against American officials — even though Iran had retaliated five days after the assassination with a ballistic missile strike on an American military facility in Iraq.

Ebrahim Raisi, the newly elected hard-line Iranian president, said that former President Trump and his secretary of state, Mike Pompeo, should stand trial in an impartial court and face “ghesas,” a term that in Islamic jurisprudence means an “eye for an eye.” Otherwise, he warned, people would take their own revenge.

Iran’s supreme leader, Ayatollah Ali Khamenei, signaled an indirect endorsement of talks with the U.S. in a speech on Monday when he said the Islamic Republic “holding talks and negotiating with the enemy at certain junctures does not mean surrendering.”

Over a four-day period, they unleashed a series of rocket and drone attacks on a U.S. military base in western Iraq and on the living quarters of State Department employees at the Baghdad airport, according to the Iraqi military and an official with the U.S.-led anti-ISIS coalition based in Baghdad, who asked not to be named because he was not authorized to speak publicly.

In northeastern Syria, artillery rounds were fired at a Syrian-Kurdish-led base with U.S. advisers, according to the U.S.-led coalition, which issued a statement blaming the attacks on “Iran-supported malign actors.”

Tehran’s proxies were launching the attacks, Iranian officials were expressing a surprisingly optimistic view of the talks in Vienna, now in their eighth round, while the State Department was offering a more measured assessment.

An adviser to Iran’s Foreign Ministry said he believed a deal could be reached before mid-February, which would coincide with the anniversary of the 1979 Islamic revolution.

made an important concession to get things rolling by agreeing to work from a draft agreement worked out with Mr. Rouhani’s team,

Under that agreement, the U.S. would lift all sanctions related to the nuclear deal (while keeping those for human rights and other issues) and Iran would return to its technical commitments regarding its nuclear program under the old treaty.

Washington’s outlook has been more cautious than Tehran’s.

“I’m not going to put a time limit on it or give you the number of meters remaining on the runway, except to say, ‘Yes, it is getting very, very, very short,’”

Iran may have softened its initial demand for the removal of all sanctions imposed after Mr. Trump exited the deal, including those related to human rights.

Iran was pursuing “the removal of sanctions” related only to the original nuclear deal and looking to complete sanctions removal sometime in the future.

Iran has long maintained that its nuclear program is for peaceful purposes. But if the talks fail, he said, its efforts at enriching uranium since the U.S. exited the nuclear deal have put it in a position to move toward weaponization very quickly.

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.

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.

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.

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

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.

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

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

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.

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.

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.

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

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.

When I asked about Australia’s rather impressive health outcomes, he said that while “Australia’s mortality that is amenable to, or influenced by, the health care system specifically is good, it’s not fundamentally better than that seen in peer O.E.C.D. countries, the U.S. excepted. Rather, Australia’s public health, social policy and living standards are more responsible for outcomes.”

Addressing these issues in the United States would require significant investment, to the tune of hundreds of billions or even trillions of dollars a year. That seems impossible until you remember that we spent more than $4.4 trillion on health care in 2022. We just don’t think of social policies like housing, food and education as health care.

Other countries, on the other hand, recognize that these issues are just as important, if not more so, than hospitals, drugs and doctors. Our narrow view too often defines health care as what you get when you’re sick, not what you might need to remain well.

When other countries choose to spend less on their health care systems (and it is a choice), they take the money they save and invest it in programs that benefit their citizens by improving social determinants of health

In the United States, conversely, we argue that the much less resourced programs we already have need to be cut further. The recent debt limit compromise reduces discretionary spending and makes it harder for people to access government programs like food stamps.

When I asked experts in each of these countries what might improve the areas where they are deficient (for instance, the N.H.S. has been struggling quite a bit as of late), they all replied the same way: more money. Some of them lack the political will to allocate those funds. Others can’t make major investments without drawing from other priorities.

Singapore will need to spend more, it’s very unlikely to go above the 8 percent to 10 percent of G.D.P. that pretty much all developed countries have historically spent.

That is, all of them except the United States. We currently spend about 18 percent of G.D.P. on health care. That’s almost $12,000 per American. It’s about twice what other countries currently spend.

We cannot seem to do what other countries think is easy, while we’ve happily decided to do what other countries think is impossible.But this is also what gives me hope. We’ve already decided to spend the money; we just need to spend it better.

Many of these scholars, he correctly notes, adopted the German model of the research university—but, he claims, only for evil purposes. “As racist ideas jumped off their scholarly pages,” he writes, “American scholars were especially enamored with the German ideal of the disinterested, unbiased pursuit of truth through original scholarly studies, and academic freedom to propagandize African inferiority and European superiority [sic].”

just as Kendi argues in Stamped from the Beginning that the racism of some of the founding fathers irrevocably and permanently brands the United States as a racist nation, he claims that these disciplines cannot be taken seriously because of the racism of some of their founders

Kendi complains in the autobiographical sections of How to Be an Antiracist that his parents often talked the same way to him. Nor does it matter to him that the abolitionists bemoaning the condition of black people under slavery were obviously blaming slavery for it. Any negative picture of any group of black people, to him, simply fuels racism.

Two critical ideas emerge from this article. The first is the rejection of the entire western intellectual tradition on the grounds that it is fatally tainted by racism, and the need for a new academic discipline to replace that tradition.

the second—developed at far greater length in Kendi’s other works—is that anyone who finds European and white North American culture to be in any way superior to the culture of black Americans, either slave or free, is a racist, and specifically a cultural racist or an “assimilationist” who believes that black people must become more like white people if they are to progress.

Kendi, in Stamped from the Beginning, designated Phyllis Wheatley, William Lloyd Garrison, Harriet Beecher Stowe, Sojourner Truth, W. E. B. DuBois, E. Franklin Frazier, Kenneth and Mamie Clark, and other black and white champions of abolition and equal rights as purveyors of racist views. At one time or another, each of them pointed to the backward state of many black people in the United States, either under slavery or in inner-city ghettos, and suggested that they needed literacy and, in some cases, better behavior to advance.

because racism is the only issue that matters to him, he assumes—wrongly—that it was the only issue that mattered to them, and that their disciplines were nothing more than exercises in racist propaganda.

This problem started, he says, “back in the so-called Age of Enlightenment.” Elsewhere he calls the word “enlightenment” racist because it contrasts the light of Europe with the darkness of Africa and other regions.

In fact, the western intellectual tradition of the eighteenth century—the Enlightenment—developed not as an attempt to establish the superiority of the white race, but rather to replace a whole different set of European ideas based on religious faith, the privilege of certain social orders, and the divine right of kings

many thinkers recognized the contradictions between racism and the principles of the Enlightenment—as well as its contradiction to the principles of the Christian religion—from the late eighteenth century onward. That is how abolitionist movements began and eventually succeeded.

Like the last movement of Beethoven’s Ninth Symphony—which has become practically the alternate national anthem of Japan—those principles are not based upon white supremacy, but rather on a universal idea of common humanity which is our only hope for living together on earth.

The western intellectual tradition is not his only target within modern life; he feels the same way about capitalism, which in his scheme has been inextricably bound together with racism since the early modern period.

“To love capitalism,” he says, “is to end up loving racism. To love racism is to end up loving capitalism.” He has not explained exactly what kind of economic system he would prefer, and his advocacy for reparations suggests that he would be satisfied simply to redistribute the wealth that capitalism has created.

Last but hardly least, Kendi rejects the political system of the United States and enlightenment ideas of democracy as well.

I am constantly amazed at how few people ever mention his response to a 2019 Politico poll about inequality. Here it is in full.

To fix the original sin of racism, Americans should pass an anti-racist amendment to the U.S. Constitution that enshrines two guiding anti-racist principals: Racial inequity is evidence of racist policy and the different racial groups are equals. The amendment would make unconstitutional racial inequity over a certain threshold, as well as racist ideas by public officials (with “racist ideas” and “public official”

The DOA would be responsible for preclearing all local, state and federal public policies to ensure they won’t yield racial inequity, monitor those policies, investigate private racist policies when racial inequity surfaces, and monitor public officials for expressions of racist ideas. The DOA would be empowered with disciplinary tools to wield over and against policymakers and public officials who do not voluntarily change their racist policy and ideas.

In other words, to undo the impact of racism as Kendi understands it, the United States needs a totalitarian government run by unaccountable “formally trained experts in racism”—that is, people like Ibram X. Kendi—who would exercise total power over all levels of government and private enterprise

Kendi evidently realizes that the American people acting through their elected representatives will never accept his antiracist program and equalize all rewards within our society, but he is so committed to that program that he wants to throw the American political system out and create a dictatorial body to implement it.

How did a man pushing all these ideas become so popular? The answer, I am sorry to say, is disarmingly simple. He is not an outlier in the intellectual history of the last half-century—quite the contrary.

The Enlightenment, in retrospect, made a bold claim that was bound to get itself into trouble sooner or later: that the application of reason and the scientific method to human problems could improve human life. That idea was initially so exciting and the results of its application for about two centuries were so spectacular that it attained a kind of intellectual hegemony, not only in Europe, but nearly all over the world.

As the last third of the twentieth century dawned, however, the political and intellectual regime it had created was running into new problems of its own. Science had allowed mankind to increase its population enormously, cure many diseases, and live a far more abundant life on a mass scale.

But it had also led to war on an undreamed-of scale, including the actual and potential use of nuclear weapons

As higher education expanded, the original ideas of the Enlightenment—the ones that had shaped the humanities—had lost their novelty and some of their ability to excite.

last but hardly least, the claimed superiority of reason over emotion had been pushed much too far. The world was bursting with emotions of many kinds that could no longer be kept in check by the claims of scientific rationality.

A huge new generation had grown up in abundance and security.

The Vietnam War, a great symbol of enlightenment gone tragically wrong, led not only to a rebellion against American military overreach but against the whole intellectual and political structure behind it.

The black studies movement on campuses that produced Molefi Kete Asante, who in turn gave us Ibram X. Kendi, was only one aspect of a vast intellectual rebellion

Some began to argue that the Enlightenment was simply a new means of maintaining male supremacy, and that women shared a reality that men could not understand. Just five years ago in her book Sex and Secularism, the distinguished historian Joan Wallach Scott wrote, “In fact, gender inequality was fundamental to the articulation of the separation of church and state that inaugurated Western modernity. . . .Euro-Atlantic modernity entailed a new order of women’s subordination” (emphasis in original). Gay and gender activists increasingly denied that any patterns of sexual behavior could be defined as normal or natural, or even that biology had any direct connection to gender. The average graduate of elite institutions, I believe, has come to regard all those changes as progress, which is why the major media and many large corporations endorse them.

Fundamentalist religion, apparently nearly extinct in the mid-twentieth century, has staged an impressive comeback in recent decades, not only in the Islamic world but in the United States and in Israe

Science has become bureaucratized, corrupted by capitalism, and often self-interested, and has therefore lost a good deal of the citizenry’s confidence.

One aspect of the Enlightenment—Adam Smith’s idea of free markets—has taken over too much of our lives.

in the academy, postmodernism promoted the idea that truth itself is an illusion and that every person has the right to her own morality.

The American academy lost its commitment to Enlightenment values decades ago, and journalism has now followed in its wake. Ju

Another aspect of the controversy hasn’t gotten enough attention either. Kendi is a prodigious fundraiser, and that made him a real catch for Boston University.

No matter what happens to Ibram X. Kendi now, he is not an anomaly in today’s intellectual world. His ideas are quite typical, and others will make brilliant careers out of them as well

We desperately need thinkers of all ages to keep the ideas of the Enlightenment alive, and we need some alternative institutions of higher learning to cultivate them once again. But they will not become mainstream any time soon. The last time that such ideas fell off the radar—at the end of the Roman Empire—it took about one thousand years for their renaissance to begin

We do not as individuals have to give into these new ideas, but it does no good to deny their impact. For the time being, they are here to stay.

Yes, that’s right. And the discussion was very precise about details of the verse and how it worked, and how various words interacted with one another or were opposed to one another.

Not that I was able to participate! I wish I could. I took a little Greek 110 years ago and have long since forgotten it, but it was inspiring. These people were thoroughly engaged.

So that itself is an amazing piece of evidence. One might call it a piece of testimony.It seems almost impossible.

How did you know, if it was in Greek?Oh, I could tell that much. There’s a certain kind of gesturing with respect to texts that is known to any of us who have worked with texts for a while.

It’s been my mission, notably unsuccessful, for many years to make people understand that academic work, including in your writing and in your classes, is one thing and political work is another, and that the two should not be confused nor should they be intermingled. You can have any number of political issues brought into the classroom so long as they are brought into the classroom as objects of analysis or description and not as agendas either to be embraced or rejected. That’s what I’ve been arguing, one might even say preaching, for a long time.

I don’t want my classroom, or any classroom in a college or university that I’m teaching in, to be thought of as the vehicle of some program or agenda, no matter how virtuous it might be. Virtue is not the business of the academy

You have a famously minimalist definition of academic freedom — “Academics are not free in any special sense to do anything but their jobs,” as you write in Versions of Academic Freedom. Minimalist and correct.

When I was a dean at the College of Liberal Arts and Sciences at the University of Illinois at Chicago, I helped implement and inaugurate the first Native American-studies program at the University of Illinois. And I spoke at the inaugural luncheon. What I told them was, “It is without doubt the case that activism of a variety of kinds is what brought you to this point.” There wouldn’t now be a Native American-studies program at UIC if activists of a polemical kind weren’t working toward that end. “Now I want you,” I said, “to forget the history that brought you here, because now that you’re part of a university setting, you’re no longer activists, you’re academics. If you become or continue to be activists, the academics in the university will have a derisory view of you.”

It’s implausible to me that a dissertation student studying with, say, Judith Butler or Fredric Jameson is not, by definition, imbibing methods that are politically normative but also very valuable. A lot of critical traditions, in gender studies or in Marxian literary criticism — or in say, Straussian political theory — are entwined with normative political or ideological commitments. There’s no way to expel those commitments from a vibrant department of the humanities.