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But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost.

by next year, more than half of Medicare recipients will be in a private plan.

a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.

The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.

Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.

The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers

Medicare Advantage plans can limit patients’ choice of doctors, and sometimes require jumping through more hoops before getting certain types of expensive care.

At conferences, companies pitched digital services to analyze insurers’ medical records and suggest additional codes. Such consultants were often paid on commission; the more money the analysis turned up, the more the companies kept.

they often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more the plans are overpaid by Medicare, the more generous to customers they can afford to be.

Many of the fraud lawsuits were initially brought by former employees under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery.

In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been less aggressive, even as the overpayments have been described in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports and numerous news articles,

Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed in the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency.

The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans.

“You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,”

Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.

“Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,”

In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.

But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.

Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete

Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.

But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.

The insurers also began hiring agencies that sent doctors or nurses to patients’ homes, where they could diagnose them with more diseases.

Cigna hired firms to perform similar at-home assessments that generated billions in extra payments, according to a 2017 whistle-blower lawsuit, which was recently joined by the Justice Department. The firms told nurses to document new diagnoses without adjusting medications, treating patients or sending them to a specialist

Nurses were told to especially look for patients with a history of diabetes because it was not “curable,” even if the patient now had normal lab findings or had undergone surgery to treat the condition.

Adding the code for a single diagnosis could yield a substantial payoff. In a 2020 lawsuit, the government said Anthem instructed programmers to scour patient charts for “revenue-generating” codes. One patient was diagnosed with bipolar disorder, although no other doctor reported the condition, and Anthem received an additional $2,693.27, the lawsuit said. Another patient was said to have been coded for “active lung cancer,” despite no evidence of the disease in other records; Anthem was paid an additional $7,080.74. The case is continuing.

The most common allegation against the companies was that they did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.

Some of the companies took steps to ensure the extra diagnoses didn’t lead to expensive care. In an October 2021 lawsuit, the Justice Department estimated that Kaiser earned $1 billion between 2009 and 2018 from additional diagnoses, including roughly 100,000 findings of aortic atherosclerosis, or hardening of the arteries. But the plan stopped automatically enrolling those patients in a heart attack prevention program because doctors would be forced to follow up on too many people, the lawsuit said.

Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to the lawsuit.

At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. “It was an actual agenda item and how could we get this,” Dr. Taylor said.

Last year, the inspector general’s office noted that one company “stood out” for collecting 40 percent of all Medicare Advantage’s payments from chart reviews and home assessments despite serving only 22 percent of the program’s beneficiaries. It recommended Medicare pay extra attention to the company, which it did not name, but the enrollment figure matched UnitedHealth’s.

Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.

Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments.

Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.

The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposed during the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.

Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”

few analysts expect major legislative or regulatory changes to the program.

“Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”

, it’s the day to day violence that is most eroding the nation’s morale.  

Many of these new arrivals are economic migrants, willing to put in the hours and the effort that young westerners no longer are. Absenteeism levels hit record levels in Britain and France last year, with Monday and Friday the days when workers were most often not to be seen. As a consequence productivity in both countries is falling; in Britain’s case growth in output per hour worked is forecast to average 0.25 per cent a year over the next three years, down from 2 per cent in the first decade of the century. 

In his 2005 book, The Fall of Rome and the End of Civilisation, the historian Bryan Ward-Perkins concluded with a warning for the West: ‘Romans before the fall were as certain as we are today that their world would continue for ever substantially unchanged. They were wrong. We would be wise not to repeat their complacency.’

Those criteria aren’t perfect. Given how the virus has evolved, even, say, an 85 percent vaccination rate probably wouldn’t have squelched the virus in a way public-health experts were envisioning in 2021 (and wouldn’t have absolved us of booster maintenance). And even if the death toll slipped below 100 deaths a day, the virus’s chronic effects would still pose an immense threat

“I’m not sure we ever set any goals at all” to designate when we’d have the virus beat, Céline Gounder, an infectious-disease physician at NYU and an editor-at-large for public health at Kaiser Family Foundation Health News, told me. And if they had been, we probably still would not have met them: Two years out, we certainly have not.

Now, ending the emergency is less an epidemiological decision than a political one: Our tolerance for these dangers has grown to the extent that most people are doing their best to look away from the remaining risk, and will continue to until the virus forces us to turn back.

Should another SARS-CoV-2 variant sweep the world or develop resistance to Paxlovid, “we don’t have much in the way of a plan,” he said.

If and when the virus troubles us again, our lack of preparedness will be a reflection of America’s classically reactive approach to public health. Even amid a years-long emergency declaration that spanned national and international scales, we squandered the opportunity “to make the system more resilient to the next crisis,”

individuals are still largely being asked to fend for themselves—which means that as this emergency declaration ends, we are setting ourselves up for another to inevitably come, and hit us just as hard.

“Public interest is very binary—it’s either an emergency or it’s not,” says Saskia Popescu, an infection-prevention expert at George Mason University. With the PHEIC now gone, the world has officially toggled itself to “not.”

From 2015 on, the iPhone images of bad or even terrible cop interactions — amplified by the woke MSM, supercharged by social media — gave an impression of police murderousness out of all proportion to the reality. That’s how so many “very liberal” whites came to believe that over a thousand unarmed black men were killed by cops each year, instead of around a dozen.

Musk’s Twitter now pumps out as many black-crime snuff films as pink-haired trans-teacher videos. It almost doesn’t matter what they say. It’s the impressions they leave — of ubiquitous black crime and of relentless student indoctrination. Each tribe is constantly having its lizard brain primed — not by words or arguments, but by the accumulation of images that operate at a sub-rational level. That’s now Musk’s business model.

And of course this is related to our political dysfunction. The tribalization of our allegiances has led to the dehumanization of our political opponents so that, yes, decency is close to extinct

It’s a bedrock civilizational value. It’s what sets us apart from barbarism. And without it, our level of political polarization is dangerously combustible. One of the first signs of looming social conflict is mutual dehumanization: see an image of your opponent suffering and revel in it. Kick someone when they’ve just been gunned down. Mock anti-vaxxers — even as they die in a hospital bed.

It does not help, of course, that the man now ahead in the race to be president in 2024 has lowered the bar of personal decency so far it scarcely scrapes the floor. From mocking the wounded in battle to reveling in an activist’s murder is a short journey. The fish rots from the head down.

I mention Orwell’s notion of common decency because he believed this simple personal virtue was related to Western freedom and resistance to totalitarianism. Decency is not exclusively Christian, and many American Christianists seem to show little interest in it these days. But there is something Christian in not gloating over or mocking the sick or the weak or the victims of terrible crime. Who wants to live in a world where cruelty is cool, and where someone’s human pain is just another’s tribal propaganda?

World Health Organization data published in September showed there were twice as many cholera cases in 2022 than in 2021. Outbreaks were recorded in countries where cholera had been under control for years, including Yemen and Lebanon.

2. Mosquitoes on the march

Rising temperatures and frequent floods also unlock new places where disease-carrying insects thrive. The mosquitoes that carry the viruses that cause dengue fever and mala

Nor is the disease confined to developing countries. There are fears that it is spreading in southern Europe, partly owing to the warm weather. More than 8 billion people could be at risk of malaria and dengue fever by 2080, scientists have warned.

3. Human-animal contact

Many existing diseases will get more dangerous, but new illnesses could also emerge as people are increasingly forced into areas where there is wildlife. Diseases can jump from animals to humans. These diseases, such as Ebola, avian flu and Sars, are called “zoonoses” and they make up the majority of new illnesses.

Scientists have found that the climate crisis is helping to circulate diseases between species that previously did not encounter each other. As the planet heats up, many animal species are forced to move into new areas to find suitable conditions.

It has been estimated that zoonoses are responsible for as many as 2.5bn cases of human illness and 2.7m human deaths worldwide each year, and that animals have played a major part in nearly every major disease outbreak since 1970.

4. Severe weather events

Although governments are getting better at preparing for severe weather events, nine out of 10 deaths linked to weather disasters since 1970 happened in small island nations and developing countries in Africa, Asia and South America.

5. The air that we breathe

Outside air pollution has been linked to numerous cancers and diseases and is estimated to be responsible for more than 4m premature deaths globally each year.

Changing weather patterns are expected to make this already bad situation worse as more dust, rain and wildfire smoke are added to the mix. Children are especially likely to get sick from air pollution because their brains, lungs and other organs are still developing.

6. The psychological cost

Environmental deterioration has a knock-on effect on the economic and social systems that keep society productive and happy, setting in motion a downward spiral of psychological hardship.

If crops are destroyed during extreme weather events, children may get less nutritious food, the consumption of which is linked to psychological conditions such as anxiety and depression.

When people can’t get the help they need, they may self-medicate with alcohol or drugs, which in turn makes them more likely to engage in risky behaviour (such as unprotected sex) that could result in infections such as HIV, or illnesses that can result from spending time in crowded places, such as tuberculosis.

In 2021, scientists studying evidence of a potential link between heat exposure and mental health found a 2.2% increase in mental health-related mortality per 1C rise in temperature.

7. Salty water and perilous pregnancies

Drinking water is becoming saltier. One reason for this is that sea levels are rising, so there is more sea water flowing into rivers and other sources of fresh water during floods and tropical storms.

Taking in too much salt can lead to high blood pressure (hypertension). Over time, this condition damages the body’s veins, arteries and major organs (including the brain, heart, kidneys and eyes) since they’re working so much harder overall.

Hypertension is doubly dangerous for pregnant women and their babies

8. Food insecurity

More frequent and severe droughts and floods make it harder to grow the grains, fruit and vegetables that people need to eat to stay healthy. Small island states in the Caribbean, Atlantic, Pacific and Indian Ocean bear the brunt of the effects of the crisis, in part because most people live close to sea level.

As a result, people who live in one of the 39 small island nations are the most likely to die from one of the four main NCDs: cancer, diabetes, heart disease and lung disease.

9. The stress of extreme heat

The scorching temperatures this year broke records in Europe, China and North America. Heat is one of the most dangerous effects of the climate crisis and the top cause of weather-related deaths in the U

When it gets too hot, the body’s temperature rises faster than it can cool itself down, less blood flows to other organs, and the kidneys have to work harder. This puts strain on the heart and can lead to organ failure. Heatstroke is the most serious heat-related illness.

In particular, people whose jobs require long hours of physical labour in the sun face an increased risk of kidney disease as temperatures rise, research suggests. Repeated instances of heat stress can lead to permanent damage and chronic kidney disease.

In June, the Guardian revealed how young migrant workers were returning to Nepal with chronic kidney disease after working in extreme heat conditions in the Gulf and Malaysia. “One factor highlighted again and again is heat. Prolonged exposure to h

10. Millions on the move

It’s hard to predict exactly how many people will be on the move because of the climate crisis, but extreme weather events are likely to make conditions worse for the more than 100 million displaced people around the world.

If nothing changes, the number of people who need humanitarian aid to recover from floods, storms and droughts could double by 2050,

That means more than 200 million people will need aid annually. The displacement of millions of people also means cramped and often unsanitary living. For example, more than 900,000 Rohingya refugees live in makeshift shelters in Bangladesh, often built on unstable ground that’s prone to landslides.

we can’t simply replace one simplistic narrative, about the super power of mitigation policy, for another, focused only on the burdens it imposed and not at all on the costs of doing much less — or nothing at all.

Let’s start with the title. What is the big failure, as you see it?

McLean: I think it gets at things that had happened in America even before the pandemic hit. And among those things were, I think, a failure to recognize the limits of capitalism, a failure of government to set the right rules for it, particularly when it comes to our health care system; a focus on profits that may have led to an increase in the bottom line but created fragility in ways people didn’t understand; and then our growing polarization that made us incapable of talking to each other

How big is the failure? When I look at The Economist’s excess mortality data, I see the U.S. had the 53rd-worst outcome in the world — worse than all of Western Europe, but better than all of Eastern Europe.

McLean: I think one way to quantify it is to take all those numbers and then put them in the context of our spending on health care. Given the amount we spend on health care relative to other countries, the scale of the failure becomes more apparent.

o me, the most glaring example is the schools. They were closed without people thinking through the potential consequences of closing down public schools, especially for disadvantaged kids.

to compound it, in my view, public health never made the distinction that needed to be made between the vulnerabilities of somebody 70 years old and the vulnerabilities of somebody 10 years old.

In the beginning of the book you write, in what almost feels like a thesis statement for the book: “A central tenet of this book is that we could not have done better, and pretending differently is a dangerous fiction, one that prevents us from taking a much needed look in the mirror.”

This claim, that the U.S. could not have done any better, runs against your other claim, that what we observed was an American failure. It is also a pretty extreme claim, I think, and I wanted to press you on it in part because it is, in my view, undermined by quite a lot of the work you do in the book itself.

Would the U.S. not have done better if it had recognized earlier that the disease spread through the air rather than in droplets? Would it not have done better if it hadn’t bungled the rollout of a Covid test in the early months?

McLean: Everything that you mentioned — the point of the book is that those were set by the time the pandemic hit.

in retrospect, what we were doing was to try to delay as much spread as we could until people got vaccinated. All the things that we did in 2020 were functionally serving or trying to serve that purpose. Now, given that, how can you say that none of that work saved lives?

McLean: I think that the test failure was baked into the way that the C.D.C. had come to operate

But the big question I really want to ask is this one: According to the C.D.C., we’ve had almost 1.2 million deaths from Covid. Excess mortality is nearly 1.4 million. Is it really your contention that there was nothing we might’ve done that brought that total down to 1.1 million, for instance, or even 900,000?

McLean: It’s very — you’re right. If you went through each and every thing and had a crystal ball and you could say, this could have been done, this could have been moved up by a month, we could have gotten PPE …

When I came to that sentence, I thought of it in terms of human behavior: What will humans put up with? What will humans stand for? How do Americans act? And you’ve written about Sweden being sort of average, and you’ve written about China and the Chinese example. They lock people up for two years and suddenly the society just revolts. They will not take it anymore. They can’t stand it. And as a result, a million and a half people die in a month and a half.

Well, I would tell that story very differently. For me, the problem is that when China opened up, they had fully vaccinated just under two-thirds of their population over 80. So to me, it’s not a failure of lockdowns. It’s a failure of vaccinations. If the Chinese had only achieved the same elderly vaccination rate as we achieved — which by global standards was pretty poor — that death toll when they opened up would have been dramatically lower.

What do you mean by “lockdown,” though? You use the word throughout the book and suggest that China was the playbook for all countries. But you also acknowledge that what China did is not anything like what America did.

Disparities in health care access — is it a dangerous fiction to think we might address that? You guys are big champions of Operation Warp Speed — would it not have been better if those vaccines had been rolled out to the public in nine months, rather than 12

. But this isn’t “lockdown” like there were lockdowns in China or even Peru. It’s how we tried to make it safer to go out and interact during a pandemic that ultimately killed a million Americans.

McLean: I think that you’re absolutely right to focus on the definition of what a lockdown is and how we implemented them here in this country. And I think part of the problem is that we implemented them in a way that allowed people who were well off and could work from home via Zoom to be able to maintain very much of their lives while other people couldn’t

And I think it depends on who you were, whether you would define this as a lockdown or not. If you were a small business who saw your small business closed because of this, you’re going to define it as a lockdown.

n the book you’re pretty definitive. You write, “maybe the social and economic disasters that lockdowns created would have been worth it if they had saved lives, but they hadn’t.” How can you say that so flatly?

I think there are still open questions about what worked and how much. But the way that I think about all of this is that the most important intervention that anybody did anywhere in the world was vaccination. And the thing that determined outcomes most was whether your first exposure came before or after vaccination.

Here, the shelter-in-place guidelines lasted, on average, five to seven weeks. Thirty nine of the 40 states that had issued them lifted them by the end of June, three months in. By the summer, according to Google mobility data, retail and grocery activity was down about 10 percent. By the fall, grocery activity was only down about 5 percent across the country

Nocera: Well, on some level, I feel like you’re trying to have it both ways. On the one hand, you’re saying that lockdowns saved lives. On the other hand, you said they weren’t real lockdowns because everybody was out and about.

I don’t think that’s having it both ways. I’m trying to think about these issues on a spectrum rather than in binaries. I think we did interrupt our lives — everybody knows that. And I think they did have an effect on spread, and that limiting spread had an effect by delaying infections until after vaccination.

Nocera: Most of the studies that say lockdowns didn’t work are really less about Covid deaths than about excess mortality deaths. I wound up being persuaded that the people who could not get to the hospital, because they were all working, because all the doctors were working on Covid and the surgical rooms were shut down, the people who caught some disease that was not Covid and died as a result — I wound up being persuaded about that.

We’re in a pandemic. People are going to die. And then the question becomes, can we protect the most vulnerable? And the answer is, we didn’t protect the most vulnerable. Nursing homes were a complete disaster.

There was a lot of worry early on about delayed health care, and about cancer in particular — missed screenings, missed treatments. But in 2019, we had an estimated 599,600 Americans die of cancer. In 2020, it was 602,000. In 2021, it was 608,000. In 2022, it was 609,000.

Nocera: See, it went up!But by a couple of thousand people, in years in which hundreds of thousands of Americans were dying of Covid.

Nocera: I think you can’t dispute the excess mortality numbers.I’m not. But in nearly every country in the world the excess mortality curves track so precisely with Covid waves that it doesn’t make sense to talk about a massive public health problem beyond Covid. And when you add all of these numbers up, they are nowhere near the size of the footfall of Covid. How can you look back on this and say the costs were too high?

Nocera: I think the costs were too high because you had school costs, you had economic costs, you had social costs, and you had death.

McLean: I think you’re raising a really good point. We’re making an argument for a policy that might not have been doable given the preconditions that had been set. I’m arguing that there were these things that had been put in place in our country for decades leading up to the pandemic that made it really difficult for us to plant in an effective way, from the outsourcing of our PPE to the distrust in our health care system that had been created by people’s lack of access to health care with the disparities in our hospital system.

How would you have liked to see things handled differently?Nocera: Well, the great example of doing it right is San Fran

I find the San Francisco experience impressive, too. But it was also a city that engaged in quite protracted and aggressive pandemic restrictions, well beyond just protecting the elderly and vulnerable.

McLean: But are we going to go for stay-at-home orders plus protecting vulnerable communities like San Francisco did? Or simply letting everybody live their lives, but with a real focus on the communities and places like nursing homes that were going to be affected? My argument is that we probably would’ve been better off really focusing on protecting those communities which were likely to be the most severely affected.

I agree that the public certainly didn’t appreciate the age skew, and our policy didn’t reflect it either. But I also wonder what it would mean to better protect the vulnerable than we did. We had testing shortages at first. Then we had resistance to rapid testing. We had staff shortages in nursing homes.

Nocera: This gets exactly to one of our core points. We had spent 30 years allowing nursing homes to be owned by private equity firms that cut the staff, that sold the land underneath and added all this debt on

I hear you saying both that we could have done a much better job of protecting these people and that the systems we inherited at the outset of the pandemic would’ve made those measures very difficult, if not impossible, to implement.

But actually, I want to stop you there, because I actually think that that data tells the opposite story.

And then I’m trying to say at the same time, but couldn’t we have done something to have protected people despite all of that?

I want to talk about the number of lives at stake. In the book, you write about the work of British epidemiologist Neil Ferguson. In the winter of 2020, he says that in the absence of mitigation measures and vaccination, 80 percent of the country is going to get infected and 2.2 million Americans are going to die. He says that 80 percent of the U.K. would get infected, and 510,000 Brits would die — again, in the abs

In the end, by the time we got to 80 percent of the country infected, we had more than a million Americans die. We had more than 200,000 Brits die. And in each case most of the infections happened after vaccination, which suggests that if those infections had all happened in a world without vaccines, we almost certainly would have surpassed two million deaths in the U.S. and almost certainly would’ve hit 500,000 deaths in the U.K.

In the book, you write about this estimate, and you endorse Jay Bhattacharya’s criticism of Ferguson’s model. You write, “Bhattacharya got his first taste of the blowback reserved for scientists who strayed from the establishment position early. He co-wrote an article for The Wall Street Journal questioning the validity of the scary 2 to 4 percent fatality rate that the early models like Neil Ferguson’s were estimating and that were causing governments to panic. He believed, correctly as it turns out, that the true fatality rate was much lower.”

Nocera: I know where you’re going with this, because I read your story about the nine pandemic narratives we’re getting wrong. In there, you said that Bhattacharya estimated the fatality rate at 0.01 percent. But if you actually read The Wall Street Journal article, what he’s really saying is I think it’s much lower. I’ve looked at two or three different possibilities, and we really need some major testing to figure out what it actually is, because I think 2 percent to 4 percent is really high.

He says, “if our surmise of 6 million cases is accurate, that’s a mortality rate of 0.01%. That is ⅒th the flu mortality rate of 0.1%.” An I.F.R. of 0.01 percent, spread fully through the American population, yields a total American death toll of 33,000 people. We have had 1.2 million deaths. And you are adjudicating this dispute, in 2023, and saying that Neil was wrong and Jay was right.

hird, in the Imperial College report — the one projecting two million American deaths — Ferguson gives an I.F.R. estimate of 0.9 percent.

Bhattacharya’s? Yes, there is some uncertainty around the estimate he offers. But the estimate he does offer — 0.01 percent — is one hundred times lower than the I.F.R. you yourselves cite as the proper benchmark.

Nocera: In The Wall Street Journal he does not say it’s 0.01. He says, we need to test to find out what it is, but it is definitely lower than 2 to 4 percent.

Well, first of all, the 2 percent to 4 percent fatality rate is not from Neil Ferguson. It’s from the W.H.O.

But I think that fundamentally, at the outset of the pandemic, the most important question orienting all of our thinking was, how bad could this get? And it turns out that almost all of the people who were saying back then that we shouldn’t do much to intervene were extremely wrong about how bad it would be

The argument then was, more or less, “We don’t need to do anything too drastic, because it’s not going to be that big a deal.” Now, in 2023, it’s the opposite argument: “We shouldn’t have bothered with restrictions, because they didn’t have an impact; we would have had this same death toll anyway.” But the death toll turned out to be enormous.

Now, if we had supplied all these skeptics with the actual numbers at the outset of the pandemic, what kind of audience would they have had? If instead of making the argument against universal mitigation efforts on the basis of a death toll of 40,000 they had made the argument on the basis of a death toll of more than a million, do you think the country would’ve said, they’re right, we’re doing too much, let’s back off?

McLean: I think that if you had gone to the American people and said, this many people are going to die, that would’ve been one thing. But if you had gone to the American people and said, this many people are going to die and a large percentage of them are going to be over 80, you might’ve gotten a different answer.

I’m not arguing we shouldn’t have been trying to get a clearer sense of the true fatality rate, or that we shouldn’t have been clearer about the age skew. But Bhattacharya was also offering an estimate of fatality rate that turned out to be off by a factor of a hundred from the I.F.R. that you yourselves cite as correct. And then you say that Bhattacharya was right and Ferguson was wrong.

And you, too, Joe, you wrote an article in April expressing sympathy for Covid skeptics and you said ——Nocera: This April?No, 2020.Nocera: Oh, oh. That’s the one where I praised Alex Berenson.You also cited some Amherst modeling which said that we were going to have 67,000 to 120,000 American deaths. We already had, at that point, 60,000. So you were suggesting, in making an argument against pandemic restrictions, that the country as a whole was going to experience between 7,000 and 60,000 additional deaths from that point.

when I think about the combination of the economic effects of mitigation policies and just of the pandemic itself and the big fiscal response, I look back and I think the U.S. managed this storm relatively well. How about each of you?

in this case, Congress did get it together and did come to the rescue. And I agree that made a ton of difference in the short term, but the long-term effects of the fiscal rescue package were to help create inflation. And once again, inflation hits those at the bottom of the socioeconomic distribution much harder than it does those at the top. So I would argue that some of what we did in the pandemic is papering over these long-term issues.

I think as with a lot of the stuff we’ve talked about today, I agree with you about the underlying problems. But if we take for granted for a moment that the pandemic was going to hit us, when it did, under the economic conditions it did, and then think about the more narrow context of whether, given all that, we handled the pandemic well. We returned quickly to prepandemic G.D.P. trends, boosted the wealth of the bottom half of the country, cut child poverty in half, pushed unemployment to historical lows.

What sense do you make of the other countries of the world and their various mitigation policies? Putting aside China, there’s New Zealand, Australia, South Korea — these are all places that were much more aggressive than the U.S. and indeed more than Europe. And had much, much better outcomes.

Nocera: To be perfectly honest, we didn’t really look, we didn’t really spend a lot of time looking at that.

McLean: But one reason that we didn’t is I don’t think it tells us anything. When you look at who Covid killed, then you have to look at what the pre-existing conditions in a country were, what percentage of its people are elderly. How sick are people with pre-existing conditions?

I just don’t think there’s a comparison. There’s just too many factors that influence it to be able to say that, to be able to compare America to any other country, you’d have to adjust for all these factors.

But you do spend a bit of time in the book talking about Sweden. And though it isn’t precisely like-for-like, one way you can control for some of those factors is grouping countries with their neighbors and other countries with similar profiles. And Sweden’s fatality rate in 2020 was 10 times that of Norway, Finland and Iceland. Five times that of Denmark. In the vaccination era, those gaps have narrowed, but by most metrics Sweden has still done worse, overall, than all of those countries.

On the matter of omniscience. Let’s say that we can send you back in time. Let’s put you both in charge of American pandemic response, or at least American communication about the pandemic, in early 2020. What would you want to tell the country? How would you have advised us to respond?

McLean: What I would want is honesty and communication. I think we’re in a world that is awash in information and the previous methods of communication — giving a blanket statement to people that may or may not be true, when you know there’s nuance underneath it — simply doesn’t work anymore

o I would’ve been much more clear — we think masks might help, we don’t know, but it’s not that big of an ask, let’s do it. We think the early data coming out of Italy shows that these are the people who are really, really at risk from Covid, but it’s not entirely clear yet. Maybe there is spread in schools, but we don’t know. Let’s look at this and keep an open mind and look at the data as it comes in.

Add the language in these speeches to all of the programmatic changes Trump and his allies have threatened to enact once he’s back in office—establishing massive detention camps for undocumented people, using the Justice Department against anyone who dares to run against him, purging government institutions, singling out Christianity as the state’s preferred religion, and many other actions—and it’s hard to describe it all as generic “authoritarianism.” Trump no longer aims to be some garden-variety supremo; he is now promising to be a threat to every American he identifies as an enemy—and that’s a lot of Americans

Unfortunately, the overuse of fascist (among other charges) quickly wore out the part of the public’s eardrums that could process such words.

ere I want to caution my fellow citizens. Trump, whether from intention or stupidity or fear, has identified himself as a fascist under almost any reasonable definition of the word.

He is also constrained by circumstance: The country is not in disarray, or at war, or in an economic collapse

starting in the mid-2010s, those beloved blue skies began to disappear. First, the smoke came in occasional bursts, from wildfires in Canada or California or Siberia, and blew away when the wind changed direction. Within a few summers, though, it was coming in thicker, from more directions at once, and lasting longer.

Sometimes there were weeks when you were advised not to open your windows or exercise outside. Sometimes there were long stretches where you weren’t supposed to breathe the outside air at all.

Now lots of Bryant’s clients wanted to talk about climate change. They wanted to talk about how strange and disorienting and scary this new reality felt, about what the future might be like and how they might face it, about how to deal with all the strong feelings — helplessness, rage, depression, guilt — being stirred up inside them.

As a therapist, Bryant found himself unsure how to respond

while his clinical education offered lots of training in, say, substance abuse or family therapy, there was nothing about environmental crisis, or how to treat patients whose mental health was affected by it

Bryant immersed himself in the subject, joining and founding associations of climate-concerned therapists

eventually started a website, Climate & Mind, to serve as a sort of clearing house for other therapists searching for resources. Instead, the site became an unexpected window into the experience of would-be patients: Bryant found himself receiving messages from people around the world who stumbled across it while looking for help.

Over and over, he read the same story, of potential patients who’d gone looking for someone to talk to about climate change and other environmental crises, only to be told that they were overreacting — that their concern, and not the climate, was what was out of whack and in need of treatment.

“You come in and talk about how anxious you are that fossil-fuel companies continue to pump CO2 into the air, and your therapist says, ‘So, tell me about your mother.’”

In many of the messages, people asked Bryant for referrals to climate-focused therapists in Houston or Canada or Taiwan, wherever it was the writer lived.

his practice had shifted to reflect a new reality of climate psychology. His clients didn’t just bring up the changing climate incidentally, or during disconcerting local reminders; rather, many were activists or scientists or people who specifically sought out Bryant because of their concerns about the climate crisis.

could now turn to resources like the list maintained by the Climate Psychology Alliance North America, which contains more than 100 psychotherapists around the country who are what the organization calls “climate aware.”

But treating those fears also stirred up lots of complicated questions that no one was quite sure how to answer. The traditional focus of his field, Bryant said, could be oversimplified as “fixing the individual”: treating patients as separate entities working on their personal growth

It had been a challenging few years, Bryant told me when I first called to talk about his work. There were some ways in which climate fears were a natural fit in the therapy room, and he believed the field had coalesced around some answers that felt clear and useful

Climate change, by contrast, was a species-wide problem, a profound and constant reminder of how deeply intertwined we all are in complex systems — atmospheric, biospheric, economic — that are much bigger than us. It sometimes felt like a direct challenge to old therapeutic paradigms — and perhaps a chance to replace them with something better.

In one of climate psychology’s founding papers, published in 2011, Susan Clayton and Thomas J. Doherty posited that climate change would have “significant negative effects on mental health and well-being.” They described three broad types of possible impacts: the acute trauma of living through climate disasters; the corroding fear of a collapsing future; and the psychosocial decay that could damage the fabric of communities dealing with disruptive changes

All of these, they wrote, would make the climate crisis “as much a psychological and social phenomenon as a matter of biodiversity and geophysics.”

Many of these predictions have since been borne out

Studies have found rates of PTSD spiking in the wake of disasters, and in 2017 the American Psychological Association defined “ecoanxiety” as “a chronic fear of environmental doom.”

Climate-driven migration is on the rise, and so are stories of xenophobia and community mistrust.

According to a 2022 survey by Yale and George Mason University, a majority of Americans report that they spend time worrying about climate change.

Many say it has led to symptoms of depression or anxiety; more than a quarter make an active effort not to think about it.

There was little or no attention to the fact that living through, or helping to cause, a collapse of nature can also be mentally harmful.

In June, the Yale Journal of Biology and Medicine published a paper cautioning that the world at large was facing “a psychological condition of ‘systemic uncertainty,’” in which “difficult emotions arise not only from experiencing the ecological loss itself,” but also from the fact that our lives are inescapably embedded in systems that keep on making those losses worse.

Climate change, in other words, surrounds us with constant reminders of “ethical dilemmas and deep social criticism of modern society. In its essence, climate crisis questions the relationship of humans with nature and the meaning of being human in the Anthropocene.”

This is not an easy way to live.

Living within a context that is obviously unhealthful, he wrote, is painful: “a dimly intuited ‘fall’ from which we spend our lives trying to recover, a guilt we can never quite grasp or expiate” — a feeling of loss or dislocation whose true origins we look for, but often fail to see. This confusion leaves us feeling even worse.

When Barbara Easterlin first started studying environmental psychology 30 years ago, she told me, the focus of study was on ways in which cultivating a relationship with nature can be good for mental health

A poll by the American Psychiatric Association in the same year found that nearly half of Americans think climate change is already harming the nation’s mental health.

the field is still so new that it does not yet have evidence-tested treatments or standards of practice. Therapists sometimes feel as if they are finding the path as they go.

Rebecca Weston, a licensed clinical social worker practicing in New York and a co-president of the CPA-NA, told me that when she treats anxiety disorders, her goal is often to help the patient understand how much of their fear is internally produced — out of proportion to the reality they’re facing

climate anxiety is a different challenge, because people worried about climate change and environmental breakdown are often having the opposite experience: Their worries are rational and evidence-based, but they feel isolated and frustrated because they’re living in a society that tends to dismiss them.

One of the emerging tenets of climate psychology is that counselors should validate their clients’ climate-related emotions as reasonable, not pathological

it does mean validating that feelings like grief and fear and shame aren’t a form of sickness, but, as Weston put it, “are actually rational responses to a world that’s very scary and very uncertain and very dangerous for people

In the words of a handbook on climate psychology, “Paying heed to what is happening in our communities and across the globe is a healthier response than turning away in denial or disavowal.”

But this, too, raises difficult questions. “How much do we normalize people to the system we’re in?” Weston asked. “And is that the definition of health?

Or is the definition of health resisting the things that are making us so unhappy? That’s the profound tension within our field.”

“It seems to shift all the time, the sort of content and material that people are bringing in,” Alexandra Woollacott, a psychotherapist in Seattle, told the group. Sometimes it was a pervasive anxiety about the future, or trauma responses to fires or smoke or heat; other times, clients, especially young ones, wanted to vent their “sort of righteous anger and sense of betrayal” at the various powers that had built and maintained a society that was so destructive.

“I’m so glad that we have each other to process this,” she said, “because we’re humans living through this, too. I have my own trauma responses to it, I have my own grief process around it, I have my own fury at government and oil companies, and I think I don’t want to burden my clients with my own emotional response to it.”

In a field that has long emphasized boundaries, discouraging therapists from bringing their own issues or experiences into the therapy room, climate therapy offers a particular challenge: Separation can be harder when the problems at hand affect therapist and client alike

Some therapists I spoke to were worried about navigating the breakdown of barriers, while others had embraced it. “There is no place on the planet that won’t eventually be impacted, where client and therapist won’t be in it together,” a family therapist wrote in a CPA-NA newsletter. “Most therapists I know have become more vulnerable and self-disclosing in their practice.”

“If you look at or consider typical theoretical framings of something like post-traumatic growth, which is the understanding of this idea that people can sort of grow and become stronger and better after a traumatic event,” she said, then the climate crisis poses a dilemma because “there is no afterwards, right? There is no resolution anytime in our lifetimes to this crisis that we nonetheless have to build the capacities to face and to endure and to hopefully engage.”

many of her patients are also disconnected from the natural world, which means that they struggle to process or even recognize the grief and alienation that comes from living in a society that treats nature as other, a resource to be used and discarded.

“How,” she asked, “do you think about resilience apart from resolution?”

she believed this framing reflected and reinforced a bias inherent in a field that has long been most accessible to, and practiced by, the privileged. It was hardly new in the world, after all, to face the collapse of your entire way of life and still find ways to keep going.

Torres said that she sometimes takes her therapy sessions outside or asks patients to remember their earliest and deepest connections with animals or plants or places. She believes it will help if they learn to think of themselves “as rooted beings that aren’t just simply living in the human overlay on the environment.” It was valuable to recognize, she said, that “we are part of the land” and suffer when it suffers.

Torres described introducing her clients to methods — mindfulness, distress tolerance, emotion regulation — to help them manage acute feelings of stress or panic and to avoid the brittleness of burnout.

She also encourages them to narrativize the problem, including themselves as agents of change inside stories about how they came to be in this situation, and how they might make it different.

then she encourages them to find a community of other people who care about the same problems, with whom they could connect outside the therapy room. As Woollacott said earlier: “People who share your values. People who are committed to not looking away.”

Dwyer told the group that she had been thinking more about psychological adaptation as a form of climate mitigation

Therapy, she said, could be a way to steward human energy and creative capacities at a time when they’re most needed.

It was hard, Bryant told me when we first spoke, to do this sort of work without finding yourself asking bigger questions — namely, what was therapy actually about?

Many of the therapists I talked to spoke of their role not as “fixing” a patient’s problem or responding to a pathology, but simply giving their patients the tools to name and explore their most difficult emotions, to sit with painful feelings without instantly running away from them

many of the methods in their traditional tool kits continue to be useful in climate psychology. Anxiety and hopelessness and anger are all familiar territory, after all, with long histories of well-studied treatments.

They focused on trying to help patients develop coping skills and find meaning amid destabilization, to still see themselves as having agency and choice.

Weston, the therapist in New York, has had patients who struggle to be in a world that surrounds them with waste and trash, who experience panic because they can never find a place free of reminders of their society’s destruction

eston said, that she has trouble with the repeated refrain that therapist and patient experiencing the same losses and dreads at the same time constituted a major departure from traditional therapeutic practice

“I’m so excited by what you’re bringing in,” Woollacott replied. “I’m doing psychoanalytic training at the moment, and we study attachment theory” — how the stability of early emotional bonds affects future relationships and feelings of well-being. “But nowhere in the literature does it talk about our attachment to the land.”

Lately, Bryant told me, he’s been most excited about the work that happens outside the therapy room: places where groups of people gather to talk about their feelings and the future they’re facing

It was at such a meeting — a community event where people were brainstorming ways to adapt to climate chaos — that Weston, realizing she had concrete skills to offer, was inspired to rework her practice to focus on the challenge. She remembers finding the gathering empowering and energizing in a way she hadn’t experienced before. In such settings, it was automatic that people would feel embraced instead of isolated, natural that the conversation would start moving away from the individual and toward collective experiences and ideas.

There was no fully separate space, to be mended on its own. There was only a shared and broken world, and a community united in loving it.

All the empathy and humility in the world will not mean much against the pressures of intolerance and tribalism without an invaluable quality that Sulzberger did not emphasise: courage.

Sulzberger seems to underestimate the struggle he is in, that all journalism and indeed America itself is in

In describing the essential qualities of independent journalism in his essay, he unspooled a list of admirable traits – empathy, humility, curiosity and so forth. These qualities have for generations been helpful in contending with the Times’s familiar problem, which is liberal bias

on their own, these qualities have no chance against the Times’s new, more dangerous problem, which is in crucial respects the opposite of the old one.

The Times’s problem has metastasised from liberal bias to illiberal bias, from an inclination to favour one side of the national debate to an impulse to shut debate down altogether

the internet knocked the industry off its foundations. Local newspapers were the proving ground between college campuses and national newsrooms. As they disintegrated, the national news media lost a source of seasoned reporters and many Americans lost a journalism whose truth they could verify with their own eyes.

far more than when I set out to become a journalist, doing the work right today demands a particular kind of courage:

the moral and intellectual courage to take the other side seriously and to report truths and ideas that your own side demonises for fear they will harm its cause.

One of the glories of embracing illiberalism is that, like Trump, you are always right about everything, and so you are justified in shouting disagreement down.

leaders of many workplaces and boardrooms across America find that it is so much easier to compromise than to confront – to give a little ground today in the belief you can ultimately bring people around

This is how reasonable Republican leaders lost control of their party to Trump and how liberal-minded college presidents lost control of their campuses. And it is why the leadership of the New York Times is losing control of its principles.

Over the decades the Times and other mainstream news organisations failed plenty of times to live up to their commitments to integrity and open-mindedness. The relentless struggle against biases and preconceptions, rather than the achievement of a superhuman objective omniscience, is what mattered

. I thought, and still think, that no American institution could have a better chance than the Times, by virtue of its principles, its history, its people and its hold on the attention of influential Americans, to lead the resistance to the corruption of political and intellectual life, to overcome the encroaching dogmatism and intolerance.

As the country became more polarised, the national media followed the money by serving partisan audiences the versions of reality they preferred

This relationship proved self-reinforcing. As Americans became freer to choose among alternative versions of reality, their polarisation intensified.

as the top editors let bias creep into certain areas of coverage, such as culture, lifestyle and business, that made the core harder to defend and undermined the authority of even the best reporters.

here have been signs the Times is trying to recover the courage of its convictions

The paper was slow to display much curiosity about the hard question of the proper medical protocols for trans children; but once it did, the editors defended their coverage against the inevitable criticism.

As Sulzberger told me in the past, returning to the old standards will require agonising change. He saw that as the gradual work of many years, but I think he is mistaken. To overcome the cultural and commercial pressures the Times faces, particularly given the severe test posed by another Trump candidacy and possible presidency, its publisher and senior editors will have to be bolder than that.

As a Democrat from a family of Democrats, a graduate of Yale and a blossom of the imagined meritocracy, I had my first real chance, at Buchanan’s rallies, to see the world through the eyes of stalwart opponents of abortion, immigration and the relentlessly rising tide of modernity.

the Times is failing to face up to one crucial reason: that it has lost faith in Americans, too.

For now, to assert that the Times plays by the same rules it always has is to commit a hypocrisy that is transparent to conservatives, dangerous to liberals and bad for the country as a whole.

It makes the Times too easy for conservatives to dismiss and too easy for progressives to believe.

The reality is that the Times is becoming the publication through which America’s progressive elite talks to itself about an America that does not really exist.

It is hard to imagine a path back to saner American politics that does not traverse a common ground of shared fact.

It is equally hard to imagine how America’s diversity can continue to be a source of strength, rather than become a fatal flaw, if Americans are afraid or unwilling to listen to each other.

I suppose it is also pretty grandiose to think you might help fix all that. But that hope, to me, is what makes journalism worth doing.

Since Adolph Ochs bought the paper in 1896, one of the most inspiring things the Times has said about itself is that it does its work “without fear or favour”. That is not true of the institution today – it cannot be, not when its journalists are afraid to trust readers with a mainstream conservative argument such as Cotton’s, and its leaders are afraid to say otherwise.

Most important, the Times, probably more than any other American institution, could influence the way society approached debate and engagement with opposing views. If Times Opinion demonstrated the same kind of intellectual courage and curiosity that my colleagues at the Atlantic had shown, I hoped, the rest of the media would follow.

You did not have to go along with everything that any tribe said. You did not have to pretend that the good guys, much as you might have respected them, were right about everything, or that the bad guys, much as you might have disdained them, never had a point. You did not, in other words, ever have to lie.

This fundamental honesty was vital for readers, because it equipped them to make better, more informed judgments about the world. Sometimes it might shock or upset them by failing to conform to their picture of reality. But it also granted them the respect of acknowledging that they were able to work things out for themselves.

The Atlantic did not aspire to the same role as the Times. It did not promise to serve up the news of the day without any bias. But it was to opinion journalism what the Times’s reporting was supposed to be to news: honest and open to the world.

Those were the glory days of the blog, and we hit on the idea of creating a living op-ed page, a collective of bloggers with different points of view but a shared intellectual honesty who would argue out the meaning of the news of the day

They were brilliant, gutsy writers, and their disagreements were deep enough that I used to joke that my main work as editor was to prevent fistfights.

Under its owner, David Bradley, my colleagues and I distilled our purpose as publishing big arguments about big ideas

we also began producing some of the most important work in American journalism: Nicholas Carr on whether Google was “making us stupid”; Hanna Rosin on “the end of men”; Taylor Branch on “the shame of college sports”; Ta-Nehisi Coates on “the case for reparations”; Greg Lukianoff and Jonathan Haidt on “the coddling of the American mind”.

I was starting to see some effects of the new campus politics within the Atlantic. A promising new editor had created a digital form for aspiring freelancers to fill out, and she wanted to ask them to disclose their racial and sexual identity. Why? Because, she said, if we were to write about the trans community, for example, we would ask a trans person to write the story

There was a good argument for that, I acknowledged, and it sometimes might be the right answer. But as I thought about the old people, auto workers and abortion opponents I had learned from, I told her there was also an argument for correspondents who brought an outsider’s ignorance, along with curiosity and empathy, to the story.

A journalism that starts out assuming it knows the answers, it seemed to me then, and seems even more so to me now, can be far less valuable to the reader than a journalism that starts out with a humbling awareness that it knows nothing.

In the age of the internet it is hard even for a child to sustain an “innocent eye”, but the alternative for journalists remains as dangerous as ever, to become propagandists. America has more than enough of those already.

When I looked around the Opinion department, change was not what I perceived. Excellent writers and editors were doing excellent work. But the department’s journalism was consumed with politics and foreign affairs in an era when readers were also fascinated by changes in technology, business, science and culture.

Fairly quickly, though, I realised two things: first, that if I did my job as I thought it should be done, and as the Sulzbergers said they wanted me to do it, I would be too polarising internally ever to lead the newsroom; second, that I did not want that job, though no one but my wife believed me when I said that.

there was a compensating moral and psychological privilege that came with aspiring to journalistic neutrality and open-mindedness, despised as they might understandably be by partisans. Unlike the duelling politicians and advocates of all kinds, unlike the corporate chieftains and their critics, unlike even the sainted non-profit workers, you did not have to pretend things were simpler than they actually were

On the right and left, America’s elites now talk within their tribes, and get angry or contemptuous on those occasions when they happen to overhear the other conclave. If they could be coaxed to agree what they were arguing about, and the rules by which they would argue about it, opinion journalism could serve a foundational need of the democracy by fostering diverse and inclusive debate. Who could be against that?

The large staff of op-ed editors contained only a couple of women. Although the 11 columnists were individually admirable, only two of them were women and only one was a person of colour

Not only did they all focus on politics and foreign affairs, but during the 2016 campaign, no columnist shared, in broad terms, the worldview of the ascendant progressives of the Democratic Party, incarnated by Bernie Sanders. And only two were conservative.

This last fact was of particular concern to the elder Sulzberger. He told me the Times needed more conservative voices, and that its own editorial line had become predictably left-wing. “Too many liberals,” read my notes about the Opinion line-up from a meeting I had with him and Mark Thompson, then the chief executive, as I was preparing to rejoin the paper. “Even conservatives are liberals’ idea of a conservative.” The last note I took from that meeting was: “Can’t ignore 150m conservative Americans.”

As I knew from my time at the Atlantic, this kind of structural transformation can be frightening and even infuriating for those understandably proud of things as they are. It is hard on everyone

experience at the Atlantic also taught me that pursuing new ways of doing journalism in pursuit of venerable institutional principles created enthusiasm for change. I expected that same dynamic to allay concerns at the Times.

If Opinion published a wider range of views, it would help frame a set of shared arguments that corresponded to, and drew upon, the set of shared facts coming from the newsroom.

New progressive voices were celebrated within the Times. But in contrast to the Wall Street Journal and the Washington Post, conservative voices – even eloquent anti-Trump conservative voices – were despised, regardless of how many leftists might surround them.

The Opinion department mocked the paper’s claim to value diversity. It did not have a single black editor

Eventually, it sank in that my snotty joke was actually on me: I was the one ignorantly fighting a battle that was already lost. The old liberal embrace of inclusive debate that reflected the country’s breadth of views had given way to a new intolerance for the opinions of roughly half of American voters.

Out of naivety or arrogance, I was slow to recognise that at the Times, unlike at the Atlantic, these values were no longer universally accepted, let alone esteemed

After the 9/11 attacks, as the bureau chief in Jerusalem, I spent a lot of time in the Gaza Strip interviewing Hamas leaders, recruiters and foot soldiers, trying to understand and describe their murderous ideology. Some readers complained that I was providing a platform for terrorists, but there was never any objection from within the Times.

Our role, we knew, was to help readers understand such threats, and this required empathetic – not sympathetic – reporting. This is not an easy distinction but good reporters make it: they learn to understand and communicate the sources and nature of a toxic ideology without justifying it, much less advocating it.

Today’s newsroom turns that moral logic on its head, at least when it comes to fellow Americans. Unlike the views of Hamas, the views of many Americans have come to seem dangerous to engage in the absence of explicit condemnation

Focusing on potential perpetrators – “platforming” them by explaining rather than judging their views – is believed to empower them to do more harm.

After the profile of the Ohio man was published, media Twitter lit up with attacks on the article as “normalising” Nazism and white nationalism, and the Times convulsed internally. The Times wound up publishing a cringing editor’s note that hung the writer out to dry and approvingly quoted some of the criticism, including a tweet from a Washington Post opinion editor asking, “Instead of long, glowing profiles of Nazis/White nationalists, why don’t we profile the victims of their ideologies”?

the Times lacked the confidence to defend its own work

The editor’s note paraded the principle of publishing such pieces, saying it was important to “shed more light, not less, on the most extreme corners of American life”. But less light is what the readers got. As a reporter in the newsroom, you’d have to have been an idiot after that explosion to attempt such a profile

Empathetic reporting about Trump supporters became even more rare. It became a cliché among influential left-wing columnists and editors that blinkered political reporters interviewed a few Trump supporters in diners and came away suckered into thinking there was something besides racism that could explain anyone’s support for the man.

After a year spent publishing editorials attacking Trump and his policies, I thought it would be a demonstration of Timesian open-mindedness to give his supporters their say. Also, I thought the letters were interesting, so I turned over the entire editorial page to the Trump letters.

I wasn’t surprised that we got some criticism on Twitter. But I was astonished by the fury of my Times colleagues. I found myself facing an angry internal town hall, trying to justify what to me was an obvious journalistic decision

Didn’t he think other Times readers should understand the sources of Trump’s support? Didn’t he also see it was a wonderful thing that some Trump supporters did not just dismiss the Times as fake news, but still believed in it enough to respond thoughtfully to an invitation to share their views?

And if the Times could not bear to publish the views of Americans who supported Trump, why should it be surprised that those voters would not trust it?

Two years later, in 2020, Baquet acknowledged that in 2016 the Times had failed to take seriously the idea that Trump could become president partly because it failed to send its reporters out into America to listen to voters and understand “the turmoil in the country”. And, he continued, the Times still did not understand the views of many Americans

Speaking four months before we published the Cotton op-ed, he said that to argue that the views of such voters should not appear in the Times was “not journalistic”.

Conservative arguments in the Opinion pages reliably started uproars within the Times. Sometimes I would hear directly from colleagues who had the grace to confront me with their concerns; more often they would take to the company’s Slack channels or Twitter to advertise their distress in front of each other

This environment of enforced group-think, inside and outside the paper, was hard even on liberal opinion writers. One left-of-centre columnist told me that he was reluctant to appear in the New York office for fear of being accosted by colleagues.

An internal survey shortly after I left the paper found that barely half the staff, within an enterprise ostensibly devoted to telling the truth, agreed “there is a free exchange of views in this company” and “people are not afraid to say what they really think”.)

Even columnists with impeccable leftist bona fides recoiled from tackling subjects when their point of view might depart from progressive orthodoxy.

The bias had become so pervasive, even in the senior editing ranks of the newsroom, as to be unconscious

Trying to be helpful, one of the top newsroom editors urged me to start attaching trigger warnings to pieces by conservatives. It had not occurred to him how this would stigmatise certain colleagues, or what it would say to the world about the Times’s own bias

By their nature, information bubbles are powerfully self-reinforcing, and I think many Times staff have little idea how closed their world has become, or how far they are from fulfilling their compact with readers to show the world “without fear or favour”

sometimes the bias was explicit: one newsroom editor told me that, because I was publishing more conservatives, he felt he needed to push his own department further to the left.

The Times’s failure to honour its own stated principles of openness to a range of views was particularly hard on the handful of conservative writers, some of whom would complain about being flyspecked and abused by colleagues. One day when I relayed a conservative’s concern about double standards to Sulzberger, he lost his patience. He told me to inform the complaining conservative that that’s just how it was: there was a double standard and he should get used to it.

A publication that promises its readers to stand apart from politics should not have different standards for different writers based on their politics. But I delivered the message. There are many things I regret about my tenure as editorial-page editor. That is the only act of which I am ashamed.

I began to think of myself not as a benighted veteran on a remote island, but as Rip Van Winkle. I had left one newspaper, had a pleasant dream for ten years, and returned to a place I barely recognised.

The new New York Times was the product of two shocks – sudden collapse, and then sudden success. The paper almost went bankrupt during the financial crisis, and the ensuing panic provoked a crisis of confidence among its leaders. Digital competitors like the HuffPost were gaining readers and winning plaudits within the media industry as innovative. They were the cool kids; Times folk were ink-stained wrinklies.

In its panic, the Times bought out experienced reporters and editors and began hiring journalists from publications like the HuffPost who were considered “digital natives” because they had never worked in print. This hiring quickly became easier, since most digital publications financed by venture capital turned out to be bad businesses

Though they might have lacked deep or varied reporting backgrounds, some of the Times’s new hires brought skills in video and audio; others were practised at marketing themselves – building their brands, as journalists now put it – in social media. Some were brilliant and fiercely honest, in keeping with the old aspirations of the paper.

critically, the Times abandoned its practice of acculturation, including those months-long assignments on Metro covering cops and crime or housing. Many new hires who never spent time in the streets went straight into senior writing and editing roles.

All these recruits arrived with their own notions of the purpose of the Times. To me, publishing conservatives helped fulfil the paper’s mission; to them, I think, it betrayed that mission.

then, to the shock and horror of the newsroom, Trump won the presidency. In his article for Columbia Journalism Review, Sulzberger cites the Times’s failure to take Trump’s chances seriously as an example of how “prematurely shutting down inquiry and debate” can allow “conventional wisdom to ossify in a way that blinds society.

Many Times staff members – scared, angry – assumed the Times was supposed to help lead the resistance. Anxious for growth, the Times’s marketing team implicitly endorsed that idea, too.

As the number of subscribers ballooned, the marketing department tracked their expectations, and came to a nuanced conclusion. More than 95% of Times subscribers described themselves as Democrats or independents, and a vast majority of them believed the Times was also liberal

A similar majority applauded that bias; it had become “a selling point”, reported one internal marketing memo. Yet at the same time, the marketers concluded, subscribers wanted to believe that the Times was independent.

As that memo argued, even if the Times was seen as politically to the left, it was critical to its brand also to be seen as broadening its readers’ horizons, and that required “a perception of independence”.

Readers could cancel their subscriptions if the Times challenged their worldview by reporting the truth without regard to politics. As a result, the Times’s long-term civic value was coming into conflict with the paper’s short-term shareholder value

The Times has every right to pursue the commercial strategy that makes it the most money. But leaning into a partisan audience creates a powerful dynamic. Nobody warned the new subscribers to the Times that it might disappoint them by reporting truths that conflicted with their expectations

When your product is “independent journalism”, that commercial strategy is tricky, because too much independence might alienate your audience, while too little can lead to charges of hypocrisy that strike at the heart of the brand.

It became one of Dean Baquet’s frequent mordant jokes that he missed the old advertising-based business model, because, compared with subscribers, advertisers felt so much less sense of ownership over the journalism

The Times was slow to break it to its readers that there was less to Trump’s ties to Russia than they were hoping, and more to Hunter Biden’s laptop, that Trump might be right that covid came from a Chinese lab, that masks were not always effective against the virus, that shutting down schools for many months was a bad idea.

there has been a sea change over the past ten years in how journalists think about pursuing justice. The reporters’ creed used to have its foundation in liberalism, in the classic philosophical sense. The exercise of a reporter’s curiosity and empathy, given scope by the constitutional protections of free speech, would equip readers with the best information to form their own judgments. The best ideas and arguments would win out

The journalist’s role was to be a sworn witness; the readers’ role was to be judge and jury. In its idealised form, journalism was lonely, prickly, unpopular work, because it was only through unrelenting scepticism and questioning that society could advance. If everyone the reporter knew thought X, the reporter’s role was to ask: why X?

Illiberal journalists have a different philosophy, and they have their reasons for it. They are more concerned with group rights than individual rights, which they regard as a bulwark for the privileges of white men. They have seen the principle of  free speech used to protect right-wing outfits like Project Veritas and Breitbart News and are uneasy with it.

They had their suspicions of their fellow citizens’ judgment confirmed by Trump’s election, and do not believe readers can be trusted with potentially dangerous ideas or facts. They are not out to achieve social justice as the knock-on effect of pursuing truth; they want to pursue it head-on

The term “objectivity” to them is code for ignoring the poor and weak and cosying up to power, as journalists often have done.

And they do not just want to be part of the cool crowd. They need to be

To be more valued by their peers and their contacts – and hold sway over their bosses – they need a lot of followers in social media. That means they must be seen to applaud the right sentiments of the right people in social media

The journalist from central casting used to be a loner, contrarian or a misfit. Now journalism is becoming another job for joiners, or, to borrow Twitter’s own parlance, “followers”, a term that mocks the essence of a journalist’s role.

The new newsroom ideology seems idealistic, yet it has grown from cynical roots in academia: from the idea that there is no such thing as objective truth; that there is only narrative, and that therefore whoever controls the narrative – whoever gets to tell the version of the story that the public hears – has the whip hand

What matters, in other words, is not truth and ideas in themselves, but the power to determine both in the public mind.

By contrast, the old newsroom ideology seems cynical on its surface. It used to bug me that my editors at the Times assumed every word out of the mouth of any person in power was a lie.

And the pursuit of objectivity can seem reptilian, even nihilistic, in its abjuration of a fixed position in moral contests. But the basis of that old newsroom approach was idealistic: the notion that power ultimately lies in truth and ideas, and that the citizens of a pluralistic democracy, not leaders of any sort, must be trusted to judge both.

Our role in Times Opinion, I used to urge my colleagues, was not to tell people what to think, but to help them fulfil their desire to think for themselves.

It seems to me that putting the pursuit of truth, rather than of justice, at the top of a publication’s hierarchy of values also better serves not just truth but justice, too

over the long term journalism that is not also sceptical of the advocates of any form of justice and the programmes they put forward, and that does not struggle honestly to understand and explain the sources of resistance,

will not assure that those programmes will work, and it also has no legitimate claim to the trust of reasonable people who see the world very differently. Rather than advance understanding and durable change, it provokes backlash.

The impatience within the newsroom with such old ways was intensified by the generational failure of the Times to hire and promote women and non-white people

Pay attention if you are white at the Times and you will hear black editors speak of hiring consultants at their own expense to figure out how to get white staff to respect them

As wave after wave of pain and outrage swept through the Times, over a headline that was not damning enough of Trump or someone’s obnoxious tweets, I came to think of the people who were fragile, the ones who were caught up in Slack or Twitter storms, as people who had only recently discovered that they were white and were still getting over the shock.

Having concluded they had got ahead by working hard, it has been a revelation to them that their skin colour was not just part of the wallpaper of American life, but a source of power, protection and advancement.

I share the bewilderment that so many people could back Trump, given the things he says and does, and that makes me want to understand why they do: the breadth and diversity of his support suggests not just racism is at work. Yet these elite, well-meaning Times staff cannot seem to stretch the empathy they are learning to extend to people with a different skin colour to include those, of whatever race, who have different politics.

The digital natives were nevertheless valuable, not only for their skills but also because they were excited for the Times to embrace its future. That made them important allies of the editorial and business leaders as they sought to shift the Times to digital journalism and to replace staff steeped in the ways of print. Partly for that reason, and partly out of fear, the leadership indulged internal attacks on Times journalism, despite pleas from me and others, to them and the company as a whole, that Times folk should treat each other with more respect

My colleagues and I in Opinion came in for a lot of the scorn, but we were not alone. Correspondents in the Washington bureau and political reporters would take a beating, too, when they were seen as committing sins like “false balance” because of the nuance in their stories.

My fellow editorial and commercial leaders were well aware of how the culture of the institution had changed. As delighted as they were by the Times’s digital transformation they were not blind to the ideological change that came with it. They were unhappy with the bullying and group-think; we often discussed such cultural problems in the weekly meetings of the executive committee, composed of the top editorial and business leaders, including the publisher. Inevitably, these bitch sessions would end with someone saying a version of: “Well, at some point we have to tell them this is what we believe in as a newspaper, and if they don’t like it they should work somewhere else.” It took me a couple of years to realise that this moment was never going to come.

There is a lot not to miss about the days when editors like Boyd could strike terror in young reporters like me and Purdum. But the pendulum has swung so far in the other direction that editors now tremble before their reporters and even their interns. “I miss the old climate of fear,” Baquet used to say with a smile, in another of his barbed jokes.

I wish I’d pursued my point and talked myself out of the job. This contest over control of opinion journalism within the Times was not just a bureaucratic turf battle (though it was that, too)

The newsroom’s embrace of opinion journalism has compromised the Times’s independence, misled its readers and fostered a culture of intolerance and conformity.

The Opinion department is a relic of the era when the Times enforced a line between news and opinion journalism.

Editors in the newsroom did not touch opinionated copy, lest they be contaminated by it, and opinion journalists and editors kept largely to their own, distant floor within the Times building. Such fastidiousness could seem excessive, but it enforced an ethos that Times reporters owed their readers an unceasing struggle against bias in the news

But by the time I returned as editorial-page editor, more opinion columnists and critics were writing for the newsroom than for Opinion. As at the cable news networks, the boundaries between commentary and news were disappearing, and readers had little reason to trust that Times journalists were resisting rather than indulging their biases

The Times newsroom had added more cultural critics, and, as Baquet noted, they were free to opine about politics.

Departments across the Times newsroom had also begun appointing their own “columnists”, without stipulating any rules that might distinguish them from columnists in Opinion

I checked to see if, since I left the Times, it had developed guidelines explaining the difference, if any, between a news columnist and opinion columnist. The paper’s spokeswoman, Danielle Rhoades Ha, did not respond to the question.)

The internet rewards opinionated work and, as news editors felt increasing pressure to generate page views, they began not just hiring more opinion writers but also running their own versions of opinionated essays by outside voices – historically, the province of Opinion’s op-ed department.

Yet because the paper continued to honour the letter of its old principles, none of this work could be labelled “opinion” (it still isn’t). After all, it did not come from the Opinion department.

And so a newsroom technology columnist might call for, say, unionisation of the Silicon Valley workforce, as one did, or an outside writer might argue in the business section for reparations for slavery, as one did, and to the average reader their work would appear indistinguishable from Times news articles.

By similarly circular logic, the newsroom’s opinion journalism breaks another of the Times’s commitments to its readers. Because the newsroom officially does not do opinion – even though it openly hires and publishes opinion journalists – it feels free to ignore Opinion’s mandate to provide a diversity of views

When I was editorial-page editor, there were a couple of newsroom columnists whose politics were not obvious. But the other newsroom columnists, and the critics, read as passionate progressives.

I urged Baquet several times to add a conservative to the newsroom roster of cultural critics. That would serve the readers by diversifying the Times’s analysis of culture, where the paper’s left-wing bias had become most blatant, and it would show that the newsroom also believed in restoring the Times’s commitment to taking conservatives seriously. He said this was a good idea, but he never acted on it

I couldn’t help trying the idea out on one of the paper’s top cultural editors, too: he told me he did not think Times readers would be interested in that point of view.

opinion was spreading through the newsroom in other ways. News desks were urging reporters to write in the first person and to use more “voice”, but few newsroom editors had experience in handling that kind of journalism, and no one seemed certain where “voice” stopped and “opinion” began

The Times magazine, meanwhile, became a crusading progressive publication

Baquet liked to say the magazine was Switzerland, by which he meant that it sat between the newsroom and Opinion. But it reported only to the news side. Its work was not labelled as opinion and it was free to omit conservative viewpoints.

his creep of politics into the newsroom’s journalism helped the Times beat back some of its new challengers, at least those on the left

Competitors like Vox and the HuffPost were blending leftish politics with reporting and writing it up conversationally in the first person. Imitating their approach, along with hiring some of their staff, helped the Times repel them. But it came at a cost. The rise of opinion journalism over the past 15 years changed the newsroom’s coverage and its culture

The tiny redoubt of never-Trump conservatives in Opinion is swamped daily not only by the many progressives in that department but their reinforcements among the critics, columnists and magazine writers in the newsroom

They are generally excellent, but their homogeneity means Times readers are being served a very restricted range of views, some of them presented as straight news by a publication that still holds itself out as independent of any politics.

And because the critics, newsroom columnists and magazine writers are the newsroom’s most celebrated journalists, they have disproportionate influence over the paper’s culture.

By saying that it still holds itself to the old standard of strictly separating its news and opinion journalists, the paper leads its readers further into the trap of thinking that what they are reading is independent and impartial – and this misleads them about their country’s centre of political and cultural gravity.

And yet the Times insists to the public that nothing has changed.

“Even though each day’s opinion pieces are typically among our most popular journalism and our columnists are among our most trusted voices, we believe opinion is secondary to our primary mission of reporting and should represent only a portion of a healthy news diet,” Sulzberger wrote in the Columbia Journalism Review. “For that reason, we’ve long kept the Opinion department intentionally small – it represents well under a tenth of our journalistic staff – and ensured that its editorial decision-making is walled off from the newsroom.”

When I was editorial-page editor, Sulzberger, who declined to be interviewed on the record for this article, worried a great deal about the breakdown in the boundaries between news and opinion

He told me once that he would like to restructure the paper to have one editor oversee all its news reporters, another all its opinion journalists and a third all its service journalists, the ones who supply guidance on buying gizmos or travelling abroad. Each of these editors would report to him

That is the kind of action the Times needs to take now to confront its hypocrisy and begin restoring its independence.

The Times could learn something from the Wall Street Journal, which has kept its journalistic poise

It has maintained a stricter separation between its news and opinion journalism, including its cultural criticism, and that has protected the integrity of its work.

After I was chased out of the Times, Journal reporters and other staff attempted a similar assault on their opinion department. Some 280 of them signed a letter listing pieces they found offensive and demanding changes in how their opinion colleagues approached their work. “Their anxieties aren’t our responsibility,” shrugged the Journal’s editorial board in a note to readers after the letter was leaked. “The signers report to the news editors or other parts of the business.” The editorial added, in case anyone missed the point, “We are not the New York Times.” That was the end of it.

Unlike the publishers of the Journal, however, Sulzberger is in a bind, or at least perceives himself to be

The confusion within the Times over its role, and the rising tide of intolerance among the reporters, the engineers, the business staff, even the subscribers – these are all problems he inherited, in more ways than one. He seems to feel constrained in confronting the paper’s illiberalism by the very source of his authority

The paradox is that in previous generations the Sulzbergers’ control was the bulwark of the paper’s independence.

if he is going to instil the principles he believes in, he needs to stop worrying so much about his powers of persuasion, and start using the power he is so lucky to have.

Shortly after we published the op-ed that Wednesday afternoon, some reporters tweeted their opposition to Cotton’s argument. But the real action was in the Times’s Slack channels, where reporters and other staff began not just venting but organising. They turned to the union to draw up a workplace complaint about the op-ed.

The next day, this reporter shared the byline on the Times story about the op-ed. That article did not mention that Cotton had distinguished between “peaceful, law-abiding protesters” and “rioters and looters”. In fact, the first sentence reported that Cotton had called for “the military to suppress protests against police violence”.

This was – and is – wrong. You don’t have to take my word for that. You can take the Times’s

Three days later in its article on my resignation it also initially reported that Cotton had called “for military force against protesters in American cities”. This time, after the article was published on the Times website, the editors scrambled to rewrite it, replacing “military force” with “military response” and “protesters” with “civic unrest”

That was a weaselly adjustment – Cotton wrote about criminality, not “unrest” – but the article at least no longer unambiguously misrepresented Cotton’s argument to make it seem he was in favour of crushing democratic protest. The Times did not publish a correction or any note acknowledging the story had been changed.

Seeking to influence the outcome of a story you cover, particularly without disclosing that to the reader, violates basic principles I was raised on at the Times

s Rhoades Ha disputes my characterisation of the after-the-fact editing of the story about my resignation. She said the editors changed the story after it was published on the website in order to “refine” it and “add context”, and so the story did not merit a correction disclosing to the reader that changes had been made.

In retrospect what seems almost comical is that as the conflict over Cotton’s op-ed unfolded within the Times I acted as though it was on the level, as though the staff of the Times would have a good-faith debate about Cotton’s piece and the decision to publish it

Instead, people wanted to vent and achieve what they considered to be justice, whether through Twitter, Slack, the union or the news pages themselves