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"But I just think these are hypotheticals at this point, there's a long way to go."

Phone-card sellers also tend to push whatever makes them the most money. Mr. Khan noted that another carrier had recently awarded him his choice of a Hero motorcycle or 45,000 rupees — nearly $700 — for signing up 1,000 customers. Reliance offered nothing similar.

“This is a program that is working to bring people online, and working incredibly well.” Mr. Daniels said. “Connectivity is something that improves people’s lives. It’s an enabler for people to be able to help themselves find jobs, help themselves improve their health situation, improve their education for themselves and their children.”

The Telecom Regulatory Authority of India is still mulling potential regulations. In a recent interview, however, the agency’s chairman, Ram Sewak Sharma, was skeptical of Internet.org. “Maybe they have wonderful objectives, but the way it is being implemented, that’s not really appropriate,” he said.

Some blame politics and polarization for causing people to feel more anxiety and bitterness toward work colleagues and family. There's a constant narrative of division in the country between Republicans and Democrats, gun-rights supporters and gun-control advocates, the religious and the nonreligious, and so on. And there are near daily headlines about chaos in the White House.

“We don’t know what is going to happen next. There’s no clear path toward stabilizing either the country or the world.”

Almost every demographic group dropped in well-being in 2017 — except for wealthy white men. Women, African Americans, Hispanics and lower-income households (those earning less than $48,000 a year) all saw substantial drops in their perception of their well-being.

Democrats also showed far bigger declines than Republicans or independents. “Switching out the person in the Oval Office can and does have an effect on well-being,”

While consumer confidence is at the highest level since 2004, polls that look at broader issues than income and spending power don't appear as rosy.

Forty percent of American adults now say they are lonely, double the share of people who said that in the 1980s, according to AARP. Some people are even struggling to feel connected to their work colleagues

In 2017, the No. 1 fear was corrupt government officials followed by the overall state of health care and worries about pollution. There was also a significant jump last year in fears about the United States getting into another world war.

In 2017, half of Americans said one of their top fears was “not having enough money for the future,” a reminder that even if people have jobs now, they remain anxious because they aren't sure how long that will last.

“People are feeling more economically insecure, even if they have a job and a salary,” said Rachel Schneider, co-author of “The Financial Diaries: How American Families Cope in a World of Uncertainty.” “I think it's a combination of knowing you're responsible for your own retirement, knowing you're responsible for your own health care and knowing that you don't have any significant job security.”

There's a growing push from academics and even Wall Street bankers, such as hedge fund billionaire Ray Dalio, to get politicians to look beyond the national statistics on jobs and economic. Those numbers aren't painting the full picture of how Americans are doing, let alone feeling, experts say.

Despite the improving economy, the fear of running out of money down the road jumped nearly 10 points from the year before, and it was followed closely by fears of “high medical bills.”

Federal agencies, including the Department of Homeland Security, also will partner with states and local governments to support a public awareness campaign modeled on the department's "see something, say something" anti-terrorism campaign to encourage the awareness and reporting of suspicious activity, the administration announced.

Trump is proposing an expansion and overhaul of mental health programs, including those that help identify and treat those who may be a threat to themselves or others, the administration announced.

Trump is also calling for a review of the statutory and regulatory privacy protections to determine if any changes or clarifications are needed to improve coordination between mental health and other health care professionals, school officials, and law enforcement personnel.

The commission plans to focus on several areas, including age restrictions for certain firearm purchases; current entertainment rating systems; youth consumption of violent entertainment; best practices for school building and campus security and threat assessment and violence prevention; plans for integration and coordination of federal resources to help prevent and mitigate shootings at schools; and opportunities to improve access to mental health treatment, including through efforts to raise awareness of mental illness and the effectiveness of treatment.

While the congressman says the recommendations for congressional actions would be "a small, positive first step," he said he believes they are "insufficient."

in the places where support for Mr. Trump runs the strongest, the proportion of the white population that didn’t finish high school is relatively high. So is the proportion of working-age adults who neither have a job nor are looking for one. The third-strongest correlation among hundreds of variables tested: the preponderance of mobile homes.

Trump counties include places that have voted for both Republicans and Democrats, and the strongest predictors of Trump support include how a county responded to two very different third-party candidates: Trump territory showed stronger support for the segregationist George Wallace in the 1968 election than the rest of the country, and substantially weaker support for the centrist former Republican John B. Anderson in 1980.

the economic problems that line up with strong Trump support have long been in the making, and defy simple fixes.

have any of the individuals commenting ever met or talked to the uneducated trailer dwellers referred to in this article. I think not. This poor pitiful underclass that we must now fix as true liberals has been making poor decisions for decades. Serial children withe serial mothers and resulting large child support payments. Job hopping and laying around the house all winter when laid off while waiting for the Wife to get home from work and make dinner. Gun purchases for thousands of dollars and 45,000 dollar trucks on an annual income of 35,000. Cashing in 401ks. To buy the latest 4 Wheeler. Oh and don't forget the biannual trips to Disney world or to hunt out west on credit cards. I sprang from uneducated people of another generation and the men by and large did not engage in self destructive behavior like this. sorry you make your bed and don't expect me to cry about it.

I think at least half of the American political class, the republican half, wants Americans to be ignorant. The ignorant are easily duped and manipulated. The GOP establishment clearly knows that, but they never expected someone like Trump to beat them at their own game. That explains why the GOP is generally unwilling to adequately fund public education and is content to punish the non-rich who seek higher education by burying them in debt.

Until now I had deceived myself into believing that I am a college educated hard working East coast Caucasian with moderate views and a penchant for reading a multi-faceted world class newspaper. However, the continued biased reports concerning Mr. Trump and his campaign are quite distasteful and have completely lost objectivity.Now, the journalistic attacks have moved toward his supporters and potential voters. Well, as with many of my fellow unintelligent white trash friends this only cements my unwavering support for the Trump campaign.

I have seen technology take jobs from people more than immigrants. It is a terrible feeling. Most of my peers and I are now working freelance jobs. Sometimes its voluntary but often times it is because we can't find full time jobs with benefits. For those of us over 60 it is the only work available. If you have never been independent you are in for a shock at how hard it can be to run a small sole proprietor business from scratch.

Enormous advances in technology have made the trans-oceanic distances disappear. Foreign-based administrative jobs are now transparent, meaning that "back-room" corporate jobs such as payroll, accounting and corporate management can be off-shored. Jobs in this category also include computer software development and computer system help-line support. The concept of the "virtual corporation", which maintains low levels of "project managers" can scale up or down, and only a small "corporate core" needs to be physically in the USA.

Trump has said that he hires people from other countries over American citizens and thinks Americans are already overpaid. So, why is he so popular with the angry voters who are living from paycheck to paycheck or were forced to retire? Trump is part of the problem, not the solution. The working class voters need wage insurance or a living wage solution and they need the government to step in and help them. Remember the WPA programs from the 30s? My guess is that Trump's supporters don't want to be the takers after years of thinking they were above that and were the makers. Surprise, we are all in the same boat.

there is a much bigger issue than creating jobs for these people. It is figuring out why so many are incapable of learning at a college level and beyond. I refuse to believe that it is nature dictating such a limitation. My money is on nurture; therefore, my money is on being able to solve that problem too.

Until we as a country stop treating intelligence as a disease and take steps to improve education across the board, this is what the fall-out will be. It was only a matter of time before someone figured out they could get to the White House by courting the angry white people vote.

among high school or less, 40% some college, but 33% among college graduates, and 19% among the post-graduates. In no election did Trump get the vote of the majority of college graduates or postgraduates. The education gap is consistent and steady. The gender gap is equally consistent.

The jobs engine the drove the US to its post war boom was the manufacturing sector. That has been gutted - by US consumer decisions.FDR did not practice racial identity politics.

Racism lurks - always - near the surface for ALL human beings. Don't believe me? Go take Harvard's Project Implicit tests (free) and learn about your own racist proclivities!By nature, all human beings tend toward tribalism; we are *wired* to notice and react to "difference". Civilization is the mass awareness of that proclivity towards shunning or rejecting "the other" and creating laws to stop it from becoming reality.When people become stressed, the veneer of civilization starts to break down - our more primitive, wired behaviors take over. That's what is happening now.We also have a huge propensity - as a species - towards cooperation. We have to somehow keep pursuing that "Better Angel of Our Nature" to keep the tide from turning permanently ugly.

As I read this article I began to confront an uncomfortable reality. We, as a society are to blame for Mr. Trump's support. Apparently we have ignored or overlooked the tragic plight faced by a sizable minority. Imagine the unemployed coal minor in West Virgina. His financial life is probably a shambles and he has no realistic prospect of recovering. He feels hopeless and abandoned. He sees publicized efforts to address problems of ethnic minorities and immigrants, yet he sits cold and jobless without anyone clamoring to address his situation. He starts getting angry and frustrated.Then, out of nowhere someone comes who appears to want to fight for him. Finally, someone who might champion his cause. Bring back jobs. Stop cheap labor from coming in.

Nationally, 23 percent of the 25-to-54-year-old population was not working in March, up from 18 percent in 2000. The areas where Trump is most popular appear to be at the forefront of that trend.

Don't people realize that technology, computers, automation and especially robots have replaced more manufacturing and more factories than all the illegal immigrants ever have? On many factory floors you hardly see any human beings at all. Every product is whisked along conveyor belts and assembled (or cooked), and then inspected, labeled, packaged and shipped with a minimum of human intervention. That's today's world. What are we to do? Protest against computers and robots.Also, American corporations have zero loyalty to the USA. Their loyalty is to their bottom line. They take advantage of every tax loophole they can; and if their product is labor intensive they would much rather pay 5000 workers a dollar a day with no benefits rather than stay in America and have to pay someone $18 an hour will vacation time, holiday time off, Soc Sec taxes and Medicare taxes.

This is the Party of Stupid the Republican carefully constructed through painstaking racism, defunding of public education, defunding of infrastructure, hate radio, Fox-Henhouse News and trickle-down poverty.Donald Trump's supporters are the direct result of the Republican's decades-long efforts at dumbing down a large swath of Americans.The Republican Party needs to take a giant proud bow as their electorate walks down the runway of nationally-assisted-suicide.

The irony of all this is that, yes, the world is shifting out from under the feet of the less-educated poor, but none of us face a really BIG or YUGE problem like slavery, Civil War, total war, a Great Depression, or even a gold/silver conflict. Yet Ken Lay and others can seriously muse over the possibility of secession from the union.The goals that so many of T's supporters are crying for are already in the process of being achieved -- the debt is too high but the national deficit has been cut in half under Obama. Millions now have health care that they didn't have before. "Taxed Enough Already" couldn't be more of an inept slogan.I wonder sometimes if the collapse of the USSR was such a good thing. Having a common enemy provided a kind of glue that held us together. Now some of us seem -- recklessly., hysterically, feverishly -- anxious to find an equally powerful enemy in our own ranks.

I can't count the number of my husband's uneducated white southern relations who have taken extensive advantage, repeatedly, of both state and federal programs, including unemployment, food stamps, occasional welfare, and (sometimes specious) "disability." (My husband's mother was one of 11 born to poor sharecroppers, and the only one to leave her subculture

Oh, and about the "myth" that opposition to Islam is only is by simplistic Islamophobes. Let me suggest for those who didn't get to it, this article about about the premier public intellectual of France: "Once Hopeful for Harmony, a Philosopher Voices Discord in France" It said that he has concluded that Islam is not comparable with 'Western enlightenment values."

It's obvious that the changing economy has structurally disadvantaged many less educated people across America. But, it is also true that economically distressed whites enjoy access to exactly the same programs that assist minorities. They just don't "feel" like this is true.

Truth be told, Trump is supported by numerous highly educated people who choose not to support known liars and/or socialists. These same people are tired of candidates who are bought and paid for by secret and evil Super PACs-- Trump is not controlled by these groups. Rubio, Kasich, Cruz and C;inton are.

The counties where Trump is most popular also have the lowest employment participation rates. Ordinarily, those folks would be expected to vote Democratic, which is more likely to continue the government spending that sustains them. Trump followers are willing to support him even though it is probably against their economic interest.So how to explain this? The strong correlation to previous support for George Wallace suggests it's about identity. A certain segment of the population does not accept diversity and change. They cling to white supremacy. The irony, as the article notes, is that these are the same folks who self-identify their heritage as "American," rather than, say "English" or "German." However, to me, they seem very un-American.

If policy hadn't been influenced by campaign funding, perhaps we would be in a better situation. Maybe congress would have paid more attention to improving the education system. It's a shame that most people don't understand that their only true weapon is voting for someone that isn't in debt to an industry. If we don't change our campaign finance system, nothing will change. Our voices will never be heard, our needs will never be met and policy will continue to favor profit, not people.

You are misinterpreting the analysis. This is a correlation analysis and what it says is that there is a moderately strong positive correlation between the % of people in a county that are white and have no high school and the % of people that support Trump. The 61 number is the correlation coefficient. The analysis does NOT show that folks in mobile homes vote for Trump.

There is only one interesting question regarding Trump: can he win Ohio and Florida in the national elections? Otherwise his campaign will turn into a footnote in American history like the campaign of many other unsuccessful candidates (Dukakis someone?). His voters, then, will be forgotten, as they usually are, until the next elections. That's the only time America's, winner takes it all culture, remembers those people exist.

However crude his message, on trade Trump has a legitimate point, which is that the US (not US companies, which don't care about international boundaries, but US workers) has got the short end of trade deals for decades. Whatever benefits the US has gleaned from these deals, they are minuscule compared to their utterly transformative effects on India, Mexico and especially China, which begs the question of why we couldn't have negotiated a better deal, one less devastating to old-line manufacturing. It often seems US negotiators are driven more by a religious belief in and devotion to free-trade principles, than by national self-interest. Trump may be unfit to be president, but I don't doubt he would have driven a harder bargain and come out with a better deal, if only because, unlike US negotiators, he'd be fully prepared to walk away from a deal he didn't like.

It's high time we re-engage in our communities with love and empathy. We need less talk of the theoretical economics underpinning trade deals and the credibility of climate science. It's not because these things are unimportant or irrelevant to governing in a complex world, but because our neighbors are afraid we've forgotten them in all our sophistication. They need to hear and see that we care about them. Our ideas about common efforts to improve their lives need to be less about class and more about community. We need to be clear that even the least among us are important to our common future

So many of the comments on this piece seem to fall into the category of subliminal rationales for long held prejudices that many of us have but don't understand.

this analysis didn’t show a particularly powerful relationship between the racial breakdown of a county and its likelihood of voting for Trump. There are Trump-supporting counties where very high proportions of the population are African-American and others where it was very low, for example.

There's a very powerful stigma associated with being poor in this country. Frankly, it makes it nearly impossible for an elite institution like the Times to write about poor populations without those same people perceiving a condescending tone. At the first mention of trailer parks--even if that is an apt descriptor for a type of housing--the words begin to cut and defenses rise. When spoken by a rich person, those words demean, even if they're not meant to by the speaker

The problem is that "Thug Trump," just so happens to touch on some truths, and existing bi-partisan defects that we ignore. Funny, as different as they are, Ralph Nader made the same point, that the major defects of our country are supported by both parties and thus untouchable. I guess the nature of a revolutionary is part misfit but also sensing the time is ripe for a drastic change. It may be better to look less at the person, and more that the endemic defects that he promises to change. From Huey Long to Norman Thomas, outsiders have had positive effects.

These relatives, who are very pleasant to talk to on a one-to-one basis, are the same people who send us rabid chain emails about how Obama hates America, how we need to "take back our country," etc. "The blacks" are "parasites and takers" and the real reason they invariably vote Republican. They see no relationship between their own "taking" and the "taking" by blacks and Hispanics.

Whether Trump can appeal to enough independent or even blue collar Democrats is problematic absent some sensational catastrophe in the economy or in government. But you never know. Recall the charge of "Rum, Romanism, and rebellion" late in the 1884 election. It changed history

I bought into that "it's the fault of freeloaders" shtick for years, until i was laid off at age 50. Suddenly, I was one of those "freeloaders" with a 30 year impeccable work history and it changed my mind drastically. I've run into people like me from all walks of life; people with degrees and skills who lost jobs and are cut out of returning to the world of employment. I found something eventually, but at half the pay with no benefits. I don't support Trump but he's tapped into the lives of people like me. Globalization has showed us that for those at the very top, the elites, our country and it's workers don't matter much as long as the money keeps flowing. Unfortunately, I can't see that Trump would do much to change that

racism in the US is complicated. Some people who say the right things do the worst things, and vice versa. What gets you in trouble is saying blue-collar stuff like "nappy-headed ho's" White liberals are the most politically correct and the most critical of crude speech. But white liberals often have less contact with blacks than any other whites. Bigotry is not easily identified.

One of the strongest predictors of Trump support is the proportion of the population that is native-born. Relatively few people in the places where Trump is strong are immigrants — and, as their answers on their ancestry reveal, they very much wear Americanness on their sleeve.

The point is that now, the entire middle class and working class have been fleeced by the Repubs AND the Dems, elected representatives who have shirked their duties and spent their time helping their billionaire puppetmasters.

Bernie supporters and Trump supporters have something big in common: their basic grievance, which is that the economy is rigged for the 1%. It's helpful to understand our differences, but then we should be finding common ground, not calling each other names. We're all people; we all deserve dignity and respect.

We are in the early throes of another revolution now, and this one will even more dramatically favor those with superior cognitive abilities and education over those with average or below average cognitive abilities and education. Yet all people at all levels need to eat, have shelter, and pursue lives of dignity and meaning. It remains unclear what kind of society will emerge from the current disruptions, but it is increasingly obvious that the transition will not be pretty.

The 2021 report card also had excellent news, Schade said. Despite the pressures and economic uncertainties brought on by the pandemic, some 70% of the companies improved their scores since they were first evaluated, according to the report.

Some of the greatest gains by companies evaluated by the report card were in the beauty and personal care sector. The report named Ulta Beauty as the most improved retailer -- rising from an F result in 2019 to a C grade today. Sephora showed the greatest improvement over time, the report card found, moving from a D in 2017 to an A today.

In an "unprecedented move" in the history of the report card, Target and Rite Aid announced they will now look for toxic chemicals in beauty products marketed to women of color, including skin lightening creams, hair straighteners and relaxers, Schade said.

"Research shows that women of color have higher levels of toxic chemicals related to beauty products in their bodies, and this is linked to higher incidences of cancer, poor infant and maternal health outcomes, learning disabilities, obesity, asthma, and other serious health concerns," said Taylor Morton, director of environmental health and education at WE ACT for Environmental Justice, in a statement.

"In 2018, nearly half of the retailers received failing grades. But that number dropped to nearly one-third in 2019 and to one-quarter this year," Schade said.

Federal action may be forthcoming. When running for office, President Joe Biden pledged to "tackle PFAS pollution by designating PFAS as a hazardous substance, setting enforceable limits for PFAS in the Safe Drinking Water Act, prioritizing substitutes through procurement, and accelerating toxicity studies and research."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.”

What if a segment of the population actually supported, or at least tolerated, the CCP? And even if that segment involved both myth and fact, it behooves the CCP to keep the myth alive.

How does the CCP garner popular support in an information era? How does a dictatorship explain to its population that its unchallenged rule is wise, just, and socially beneficial?

All of this takes place against a backdrop of family and social developments in which we can explore household dynamics, dating habits, and professional aspirations—all within social norms for those honest party members and seemingly violated by those who are not so honest.

watch the television series Renmin de Mingyi (“In the Name of the People”), publicly available with English subtitles.

In the Name of the People is a primetime drama about a local prosecutor’s efforts to root out corruption in a modern-day, though fictional, Chinese city. Beyond the anti-corruption narrative, the series also goes into local CCP politics as some of the leaders are (you guessed it) corrupt and others are simply bureaucratic time-servers, guarding their own privileges and status without actually helping the people they purport to serve.

the series boasts one of Xi’s other main themes, “common prosperity,” a somewhat elastic term that usually means the benefits of prosperity should be shared throughout all segments of society.

The historical tools used to generate support such as mass rallies and large-scale hectoring no longer work with a more educated and communications-oriented citizenry.

the central themes are quite clear: The party has brought historical prosperity to the community and there are a few bad apples who are unfairly trying to benefit from this wealth. There are also various sluggards and mediocrities who have no capacity for improvement or sense of public responsibilities.

So we see government officials pondering if they can ever find a date (being the workaholics that they are), or discussing housework with their spouses, or sharing kitchen duties, or reviewing school work with their child.

The show makes clear that the vast majority of party members and government officials are dedicated souls who work to improve peoples’ lives. And in the end, virtue triumphs, the party triumphs, China triumphs, and most (not all) of the personal issues are resolved as well.

The show’s version of the CCP eagerly and uncynically supports Chinese culture: The same union leader from the wildcat strike also writes and publishes poetry. Calligraphy is as prized as specialty teas. And all of this is told in a lively style, similar to the Hollywood fare Americans might watch.

n the Name of the People was first broadcast in 2017 as a lead-up to the last Communist Party Congress, China’s most important decision-making gathering, held every five years. The show’s launch was a huge hit, achieving the highest broadcast ratings of any show in a decade.

Within a month, the first episode had been seen over 350 million times and just one of the streaming platforms, iQIYI, reported a total of 5.9 billion views for the show’s 55 episodes.

All of this must come as good news for the prosecutors featured so favorably in the series—for their real-life parent government body, the Supreme People’s Protectorate, commissioned and provided financing for the show.

At a minimum, these shows illustrate a stronger self-awareness in the CCP and considerable improvement in communication strategy.

Most important, it provides direction to current party members. Indeed, in some cities viewing was made obligatory and the basis for “study sessions” for party cadres

Second, the enormous public success of the series and acknowledging deficiencies of the party allows the party to control the criticism without ever addressing the fundamental question of whether a one-party system is intrinsically susceptible to corruption or poor performance.

As communication specialists like to say, There is already a conversation taking place about your brand—the only question is whether you will lead the conversation. The CCP is leading in its communications strategy and making it as easy as possible for Chinese citizens to support Xi.

it is not difficult to see that in this area, as in many others, China is breaking with tactics from the past and is playing its cards increasingly well. Whether the CCP can renew itself, reestablish that social contract, and live up to its television image is another question.

versky died in 1996. Kahneman won the 2002 Nobel Prize in Economics for the work the two men did together, which he summarized in his 2011 best seller, Thinking, Fast and Slow. Another best seller, last year’s The Undoing Project, by Michael Lewis, tells the story of the sometimes contentious collaboration between Tversky and Kahneman

Another key figure in the field is the University of Chicago economist Richard Thaler. One of the biases he’s most linked with is the endowment effect, which leads us to place an irrationally high value on our possessions.

In an experiment conducted by Thaler, Kahneman, and Jack L. Knetsch, half the participants were given a mug and then asked how much they would sell it for. The average answer was $5.78. The rest of the group said they would spend, on average, $2.21 for the same mug. This flew in the face of classic economic theory, which says that at a given time and among a certain population, an item has a market value that does not depend on whether one owns it or not. Thaler won the 2017 Nobel Prize in Economics.

“The question that is most often asked about cognitive illusions is whether they can be overcome. The message … is not encouraging.”

Kahneman and others draw an analogy based on an understanding of the Müller-Lyer illusion, two parallel lines with arrows at each end. One line’s arrows point in; the other line’s arrows point out. Because of the direction of the arrows, the latter line appears shorter than the former, but in fact the two lines are the same length.

In this context, his pessimism relates, first, to the impossibility of effecting any changes to System 1—the quick-thinking part of our brain and the one that makes mistaken judgments tantamount to the Müller-Lyer line illusion

that’s not so easy in the real world, when we’re dealing with people and situations rather than lines. “Unfortunately, this sensible procedure is least likely to be applied when it is needed most,” Kahneman writes. “We would all like to have a warning bell that rings loudly whenever we are about to make a serious error, but no such bell is available.”

Because biases appear to be so hardwired and inalterable, most of the attention paid to countering them hasn’t dealt with the problematic thoughts, judgments, or predictions themselves

Is it really impossible, however, to shed or significantly mitigate one’s biases? Some studies have tentatively answered that question in the affirmative.

what if the person undergoing the de-biasing strategies was highly motivated and self-selected? In other words, what if it was me?

I met with Kahneman

Over an apple pastry and tea with milk, he told me, “Temperament has a lot to do with my position. You won’t find anyone more pessimistic than I am.”

Confirmation bias shows up most blatantly in our current political divide, where each side seems unable to allow that the other side is right about anything.

“I see the picture as unequal lines,” he said. “The goal is not to trust what I think I see. To understand that I shouldn’t believe my lying eyes.” That’s doable with the optical illusion, he said, but extremely difficult with real-world cognitive biases.

he most effective check against them, as Kahneman says, is from the outside: Others can perceive our errors more readily than we can.

“slow-thinking organizations,” as he puts it, can institute policies that include the monitoring of individual decisions and predictions. They can also require procedures such as checklists and “premortems,”

A premortem attempts to counter optimism bias by requiring team members to imagine that a project has gone very, very badly and write a sentence or two describing how that happened. Conducting this exercise, it turns out, helps people think ahead.

“My position is that none of these things have any effect on System 1,” Kahneman said. “You can’t improve intuition.

Perhaps, with very long-term training, lots of talk, and exposure to behavioral economics, what you can do is cue reasoning, so you can engage System 2 to follow rules. Unfortunately, the world doesn’t provide cues. And for most people, in the heat of argument the rules go out the window.

Kahneman describes an even earlier Nisbett article that showed subjects’ disinclination to believe statistical and other general evidence, basing their judgments instead on individual examples and vivid anecdotes. (This bias is known as base-rate neglect.)

over the years, Nisbett had come to emphasize in his research and thinking the possibility of training people to overcome or avoid a number of pitfalls, including base-rate neglect, fundamental attribution error, and the sunk-cost fallacy.

When Nisbett has to give an example of his approach, he usually brings up the baseball-phenom survey. This involved telephoning University of Michigan students on the pretense of conducting a poll about sports, and asking them why there are always several Major League batters with .450 batting averages early in a season, yet no player has ever finished a season with an average that high.

about half give the right answer: the law of large numbers, which holds that outlier results are much more frequent when the sample size (at bats, in this case) is small. Over the course of the season, as the number of at bats increases, regression to the mean is inevitabl

When Nisbett asks the same question of students who have completed the statistics course, about 70 percent give the right answer. He believes this result shows, pace Kahneman, that the law of large numbers can be absorbed into System 2—and maybe into System 1 as well, even when there are minimal cues.

Nisbett’s second-favorite example is that economists, who have absorbed the lessons of the sunk-cost fallacy, routinely walk out of bad movies and leave bad restaurant meals uneaten.

we’ve tested Michigan students over four years, and they show a huge increase in ability to solve problems. Graduate students in psychology also show a huge gain.”

, “I know from my own research on teaching people how to reason statistically that just a few examples in two or three domains are sufficient to improve people’s reasoning for an indefinitely large number of events.”

isbett suggested another factor: “You and Amos specialized in hard problems for which you were drawn to the wrong answer. I began to study easy problems, which you guys would never get wrong but untutored people routinely do … Then you can look at the effects of instruction on such easy problems, which turn out to be huge.”

Nisbett suggested that I take “Mindware: Critical Thinking for the Information Age,” an online Coursera course in which he goes over what he considers the most effective de-biasing skills and concepts. Then, to see how much I had learned, I would take a survey he gives to Michigan undergraduates. So I did.

he course consists of eight lessons by Nisbett—who comes across on-screen as the authoritative but approachable psych professor we all would like to have had—interspersed with some graphics and quizzes. I recommend it. He explains the availability heuristic this way: “People are surprised that suicides outnumber homicides, and drownings outnumber deaths by fire. People always think crime is increasing” even if it’s not.

When I finished the course, Nisbett sent me the survey he and colleagues administer to Michigan undergrads

It contains a few dozen problems meant to measure the subjects’ resistance to cognitive biases

I got it right. Indeed, when I emailed my completed test, Nisbett replied, “My guess is that very few if any UM seniors did as well as you. I’m sure at least some psych students, at least after 2 years in school, did as well. But note that you came fairly close to a perfect score.”

In 2006, seeking to prevent another mistake of that magnitude, the U.S. government created the Intelligence Advanced Research Projects Activity (iarpa), an agency designed to use cutting-edge research and technology to improve intelligence-gathering and analysis. In 2011, iarpa initiated a program, Sirius, to fund the development of “serious” video games that could combat or mitigate what were deemed to be the six most damaging biases: confirmation bias, fundamental attribution error, the bias blind spot (the feeling that one is less biased than the average person), the anchoring effect, the representativeness heuristic, and projection bias (the assumption that everybody else’s thinking is the same as one’s own).

For his part, Nisbett insisted that the results were meaningful. “If you’re doing better in a testing context,” he told me, “you’ll jolly well be doing better in the real world.”

The New York–based NeuroLeadership Institute offers organizations and individuals a variety of training sessions, webinars, and conferences that promise, among other things, to use brain science to teach participants to counter bias. This year’s two-day summit will be held in New York next month; for $2,845, you could learn, for example, “why are our brains so bad at thinking about the future, and how do we do it better?”

Nevertheless, I did not feel that reading Mindware and taking the Coursera course had necessarily rid me of my biases

One of the most important ingredients is what Tetlock calls “the outside view.” The inside view is a product of fundamental attribution error, base-rate neglect, and other biases that are constantly cajoling us into resting our judgments and predictions on good or vivid stories instead of on data and statistics

most promising are a handful of video games. Their genesis was in the Iraq War

Philip E. Tetlock, a professor at the University of Pennsylvania’s Wharton School, and his wife and research partner, Barbara Mellers, have for years been studying what they call “superforecasters”: people who manage to sidestep cognitive biases and predict future events with far more accuracy than the pundits

Together with collaborators who included staff from Creative Technologies, a company specializing in games and other simulations, and Leidos, a defense, intelligence, and health research company that does a lot of government work, Morewedge devised Missing. Some subjects played the game, which takes about three hours to complete, while others watched a video about cognitive bias. All were tested on bias-mitigation skills before the training, immediately afterward, and then finally after eight to 12 weeks had passed.

he said he saw the results as supporting the research and insights of Richard Nisbett. “Nisbett’s work was largely written off by the field, the assumption being that training can’t reduce bias,

“The literature on training suggests books and classes are fine entertainment but largely ineffectual. But the game has very large effects. It surprised everyone.”

even the positive results reminded me of something Daniel Kahneman had told me. “Pencil-and-paper doesn’t convince me,” he said. “A test can be given even a couple of years later. But the test cues the test-taker. It reminds him what it’s all about.”

Morewedge told me that some tentative real-world scenarios along the lines of Missing have shown “promising results,” but that it’s too soon to talk about them.

In the future, I will monitor my thoughts and reactions as best I can

On the left, what gets termed “wokeness” is indissociable from self-help. How should we understand superficial, performative expressions of “anti-racism” or preening social-media politics if not as a way for self-described good-hearted liberals to make grand public displays of pruning their moral shrubbery?

We might call this turbocharged version of authenticity culture “therapeutic libertarianism”: the belief that self-improvement is the ultimate goal of life, and that no formal or informal constraints—whether imposed by states, faith systems, or other people—should impede each of us from achieving personal growth

This attitude is therapeutic because it is invariably couched in self-help babble. And it is libertarian not only because it makes a cult out of personal freedom, but because it applies market logic to human beings. We are all our own start-ups. We must all adopt a pro-growth mindset for our personhood and deregulate our desires.

We must all assess and reassess our own “fulfillment,” a kind of psychological Gross Domestic Product, on a near-constant basis. And like the GDP, our fulfillment must always increase.

Among the right, a new kind of reactionary self-help is ascendant. Its mainstream version is legible in the manosphere misogyny of Jordan Peterson, Joe Rogan, and Andrew Tate, while more eldritch currents lurk just beneath the surface. The Nietzscheanism of internet personalities like Bronze Age Pervert—who combines ethnonationalist chauvinism in politics and personal life with a Greco-Roman obsession with physical fitness—is only one of many examples of the trend the social critic Maya Vinokour has called “lifestyle fascism.”

Stewart’s response to the UTIs is not concern for his wife but irritation: “This guy is breaking all my toys,” he grumbles. When she gets upset that her husband keeps calling her a “cunt” and a “whore” during sex—something he professes not being able to help—Stewart does not change this habit. Instead they strike a preposterous bargain: “He will try his best not to scream cunt during sex, and I will do my best to ignore him if he does.”

What the author is trying to find in her open relationship is not sex, but self-understanding—what it means, how we get it, whether sex can provide it. And although the answers Molly arrives at are not cheaply won, they are cheap all the same.

his concept doesn’t quite capture the extent to which this relentless quest for self-optimizing authenticity has infused our social and even political sensibilities.

though Molly may tell herself and her readers that she is on a journey of learning and growth, the ugly truth is that More feels like a 290-page cry for help. Molly does not come off as a woman boldly finding herself, but rather as someone who is vulnerable to psychological manipulation and does not enjoy her open marriage.

if it seems like Molly Roden Winter does not want to be in an open marriage, it is because she often lets us know that she doesn’t want to be in an open marriage.

When a couples therapist asks the pair why they’re in counseling halfway through the book—prompted by a breakdown Molly experiences that stems from their marital arrangement—she explains: “We’re here because I don’t want to be in an open marriage anymore, but Stewart does.”

There are precious few sex scenes where Molly seems to be enjoying herself. When Molly is in the middle of a squirmy threesome she’s been dreading, she literally dissociates from her body, pretending that she is a director staging a scene in which her physical person is merely an actor. Molly describes how she performs her role with “a clinician’s detachment” and leaves the apartment rapidly so as not “to be pulled back into this scene.” After one of her dates repeatedly removes his condom without her consent—an act known as “stealthing,” which is considered a sex crime in a number of countries and the state of California—she contracts a series of urinary tract infections

Near the end of the memoir, the author’s mother provides the empty epiphany toward which the text careens. “Everything that happens in life,” her mom offers, “is an opportunity to learn about yourself. Marriage. Motherhood. Relationships. Even anger and illness. Nothing that happens is good or bad in and of itself. It’s all just an opportunity to learn and grow.” With this maternal revelation, Molly’s “skin starts to tingle.” She relates that the advice “feels almost holy.”

Winter is trapped in her therapeutic worldview, one imposed on her by an American culture that has made narcissism into not simply a virtue, but a quasi-religion that turns external obstacles into opportunities for internal self-improvement.

These obstacles include, in her case, profound gender inequality relating to Molly’s life as a parent to two sons, and a troubling family history. Molly’s mother joined a cult—and indoctrinated the author into it as a child—at the urging of a male partner in her own open marriage. The book makes tacit comparisons between Molly’s mother’s initiation into a cult at the behest of an extramarital partner, and Molly’s own initiation into an open marriage at the behest of her husband.

throughout More, the dominant emotion Molly reports is not lust but rage—primarily at the deeply unequal child-care burdens that are placed upon her. “I think about all the years I’ve spent my night alone with the kids—the dinners, the bedtimes, the dishes, the loneliness of doing it all by myself—because Stew had to work,” she laments at one point. That Stewart is now spending late nights not working (if he ever was) but rather schtupping his endless reserve of mistresses pushes Molly further to the brink: “I feel my jealousy mingle with the resentment I’ve kept at bay for years,”

Molly doubles down on her quest for self-actualization through the relentless pursuit of bitter novelty: new sexual experiences that she rarely seems to enjoy, new partners who rarely treat her kindly.

The only solution Molly can imagine is to persist in an open marriage, rather than push for an equal one. Inward sexual revolution plainly feels more possible than a revolution in who does the dishes.

the United States could halve by 2030 the oil used in cars and trucks compared with 2005 levels by improving the efficiency of gasoline-powered vehicles and by relying more on cars that use alternative power sources, like electric batteries and biofuels.

New York State — not windy like the Great Plains, nor sunny like Arizona — could easily produce the power it needs from wind, solar and water power by 2030

“You could power America with renewables from a technical and economic standpoint. The biggest obstacles are social and political — what you need is the will to do it.”

“There is plenty of room for wind and solar to grow and they are becoming more competitive, but these are still variable resources — the sun doesn’t always shine and the wind doesn’t always blow,” said Alex Klein, the research director of IHS Emerging Energy Research, a consulting firm on renewable energy. “An industrial economy needs a reliable power source, so we think fossil fuel will be an important foundation of our energy mix for the next few decades.”

improving the energy efficiency of homes, vehicles and industry was an easier short-term strategy. He noted that the 19.5 million residents of New York State consume as much energy as the 800 million in sub-Saharan Africa (excluding South Africa)

a rapid expansion of renewable power would be complicated and costly. Using large amounts of renewable energy often requires modifying national power grids, and renewable energy is still generally more expensive than using fossil fuels

Promoting wind and solar would mean higher electricity costs for consumers and industry.

many of the European countries that have led the way in adopting renewables had little fossil fuel of their own, so electricity costs were already high. Others had strong environmental movements that made it politically acceptable to endure higher prices

countries could often get 25 percent of their electricity from renewable sources like wind and solar without much modification to their grids. A few states, like Iowa and South Dakota, get nearly that much of their electricity from renewable power (in both states, wind), while others use little at all.

America is rich in renewable resources and (unlike Europe) has the empty space to create wind and solar plants. New York State has plenty of wind and sun to do the job, they found. Their blueprint for powering the state with clean energy calls for 10 percent land-based wind, 40 percent offshore wind, 20 percent solar power plants and 18 percent solar panels on rooftops

the substantial costs of enacting the scheme could be recouped in under two decades, particularly if the societal cost of pollution and carbon emissions were factored in

new research by the Harvard political scientist Robert D. Putnam and his colleagues shows that the rich-poor gaps in student participation in sports, extracurricular activities, volunteer work and church attendance have grown sharply as well.

average test scores on the National Assessment of Educational Progress, the so-called Nation’s Report Card, have been rising — substantially in math and very slowly in reading — since the 1970s.

The most potent development over the past three decades is that the test scores of children from high-income families have increased very rapidly.

the rich now outperform the middle class by as much as the middle class outperform the poor. Just as the incomes of the affluent have grown much more rapidly than those of the middle class over the last few decades, so, too, have most of the gains in educational success accrued to the children of the rich.

For the past few years, alongside other scholars, I have been digging into historical data to understand

It’s not just that the rich have more money than they used to, it’s that they are using it differently. This is where things get really interesting.

The widening income disparity in academic achievement is not a result of widening racial gaps in achievement, either. The achievement gaps between blacks and whites, and Hispanic and non-Hispanic whites have been narrowing slowly over the last two decade

schools don’t seem to produce much of the disparity in test scores between high- and low-income students.

That isn’t to say that there aren’t important differences in quality between schools serving low- and high-income students — there certainly are — but they appear to do less to reinforce the trends than conventional wisdom would have us believe.

The academic gap is widening because rich students are increasingly entering kindergarten much better prepared to succeed in school than middle-class students. This difference in preparation persists through elementary and high school.

one part of the explanation for this is rising income inequality

the incomes of the rich have grown faster over the last 30 years than the incomes of the middle class and the poor. Money helps families provide cognitively stimulating experiences for their young children because it provides more stable home environments, more time for parents to read to their children, access to higher-quality child care and preschool

The average 9-year-old today has math skills equal to those her parents had at age 11, a two-year improvement in a single generation. The gains are not as large in reading and they are not as large for older students, but there is no evidence that average test scores have declined over the last three decades for any age or economic group.

High-income families are increasingly focusing their resources — their money, time and knowledge of what it takes to be successful in school — on their children’s cognitive development and educational success. They are doing this because educational success is much more important than it used to be, even for the rich.

even though middle-class and poor families are also increasing the time and money they invest in their children, they are not doing so as quickly or as deeply as the rich.

from 1972 to 2006 high-income families increased the amount they spent on enrichment activities for their children by 150 percent, while the spending of low-income families grew by 57 percent over the same time period

the amount of time parents spend with their children has grown twice as fast since 1975 among college-educated parents as it has among less-educated parents.

much of our public conversation about education is focused on the wrong culprits: we blame failing schools and the behavior of the poor for trends that are really the result of deepening income inequality and the behavior of the rich.

not only are the children of the rich doing better in school than even the children of the middle class, but the changing economy means that school success is increasingly necessary to future economic success, a worrisome mutual reinforcement of trends that is making our society more socially and economically immobile.

the rapid growth in the rich-poor educational gap provides a ray of hope: if the relationship between family income and educational success can change this rapidly, then it is not an immutable, inevitable pattern. What changed once can change again. Policy choices matter more than we have recently been taught to think.

how can we move toward a society in which educational success is not so strongly linked to family background? Maybe we should take a lesson from the rich and invest much more heavily as a society in our children’s educational opportunities from the day they are born. Investments in early-childhood education pay very high societal dividends. That means investing in developing high-quality child care and preschool that is available to poor and middle-class children. It also means recruiting and training a cadre of skilled preschool teachers and child care providers.

improving the quality of our parenting and of our children’s earliest environments may be even more important. Let’s invest in parents so they can better invest in their children.

Fundamentally, it means rethinking our still-persistent notion that educational problems should be solved by schools alone.

Accomplishing that requires overturning economic orthodoxy and capitalism as we know it, he says. “We have to do this,” he says. “With climate change, and the exhaustion of the planet’s resources. I believe the alternative is apocalypse.”

Mr. Lasn is an analog man in a digital world. He favors spoken conversations, not e-mail or text messages, and owns only a simple cellphone — no iPhone or iPad for him.

Mr. Lasn says his lifestyle isn’t really sustainable. He commutes 30 minutes each way from the magazine to his home on five acres of countryside. He and his wife are occupying too much land, and his little Toyota Echo burns too much fuel for the planet’s health, he says: “What can I do? Living there helps to keep me sane.”

Advocating a life of material simplicity and spiritual richness, Mr. Enns urges people to “make things for others themselves, not to just go out and buy.” He says he and his wife make gifts like wooden figurines and animal dolls for children, and salsa and relish for adults.

Mr. Lasn does the initial design and editing of Adbusters on paper. Digitally savvy colleagues transfer his work online. The magazine’s paid circulation, which Mr. Lasn says is 60,000 to 70,000 worldwide, is overwhelmingly print, not digital. Digital subscriptions and downloads are cumbersome and must be improved, he says, although he doesn’t understand the processes.

Such apparent inconsistencies, and the magazine’s incendiary tone, can be maddening and even offensive, yet this rambunctious approach is also deeply appealing, some critics say. As Mr. Haiven, of New York University, puts it: “I’ve certainly been very critical of them but I’m also very glad they exist. I think they do very important work sometimes, in their own way.”

If the best evidence suggests that health insurance is most helpful in protecting people’s pocketbooks from similar disasters, and that more comprehensive coverage often just pays for doctor visits that don’t improve people’s actual health, then shouldn’t we be promoting catastrophic health coverage, rather than expanding Medicaid?

If the marginal dollar of health care coverage doesn’t deliver better health, isn’t this a place where policy makers should be stingy, while looking for more direct ways to improve the prospects of the working poor?

The changes mirror what is happening inside many large companies, where “performance management” reflects the conviction that a sharpened focus on creating a high-performing workforce is a vital tool to generate revenue and profit.

Performance management shifts companies away from backward-looking, once-a-year reviews framed largely as compliance requirements—a paper trail for potential job cuts and salary decisions—to a process that is real-time, continuous and focused on helping people meet ambitious goals, or move out of the company faster.

The last recession led many employers to rethink the nearly automatic merit raises they had been doling out, forcing them to do a better job identifying high and low performers when giving raises and bonuses. Millennial workers, meanwhile, demand more feedback, more coaching and a stronger sense of their career path.

systems let managers track workers’ progress via dashboards that display their goals, accomplishments, attendance, peer feedback and other data.

Executives’ use of phrases like “performance culture” in conference calls with analysts and investors has doubled in the past five years, according to a review of transcripts in the Factiva news database. Firms that set goals and hold workers accountable “clearly outperform,” said Nicholas Bloom, an economist at Stanford University and co-author of a recent paper that used Census data to examine more than 32,000 U.S. manufacturing plants. He said they have faster growth, higher profitability and are less likely to go bankrupt.

Some academics say constant monitoring can feel intrusive and threatening to workers, especially those who value stability. But human-resources experts largely agree that the traditional review process is a waste of time and needs an overhaul.

Remaining employees are expected to work “smarter” and meet regularly raised targets. “We have to routinely shuffle the resources and say, what’s the most important thing we need to do today, this week, this month, to drive this objective?”

Using the Workday tool, Kimberly-Clark’s salaried employees set goals and report their progress, record accomplishments or mistakes, and solicit and send feedback

The system collects and archives feedback, which can be seen by employees’ managers. It also holds data on staffers’ strengths and development needs, their performance ratings and the risk they might leave the company.

“It’s certainly more challenging” for employees, said Mr. Herbert, the retired sales director. “If you really don’t have the mettle, you’re asked to get on with your life’s work [elsewhere].”

In 2015, Kimberly-Clark retained 95% of its top performers. Among the employees whose work was rated “unacceptable” or “inconsistent,” 44% left the company voluntarily or were let go. Ms. Gottung said she is “pretty pleased” that low-performer turnover has been rising.

Mr. Falk, the CEO, reviews 100 senior managers’ performance plans every year to make sure their goals are ambitious and reflect company priorities. Managers are instructed to begin every meeting with a story about how someone demonstrated one of the six behaviors the company promotes, such as “build trust” or “think customer.”

Regular “culture of accountability” sessions train employees in giving and receiving difficult feedback. When a colleague suggests improvements, “the proper response was ‘thank you for the feedback,’ not defensiveness,” Mr. Luettgen said. Employees also practice reinforcing positive behaviors, such as praising a colleague who had given up a weekend to solve a customer complaint.

More than 10,000 of Kimberly-Clark’s workers used the feedback feature in Workday in 2014, and about 25% of the comments were considered “constructive,” while the rest were positive or neutral, said Sandy Allred, a senior director on the talent management team. Staffers can send feedback to peers or workers above or below them

Historically, boom times are the exception, not the norm.

Over the past two centuries, per capita incomes in all advanced economies, from Sweden to Japan, have grown at compound rates of around 1.5% to 2% a year

these distinctly non-euphoric averages mean that most of the time, over the long sweep of history, people’s incomes typically take about 40 years to double.

looking from one year to the next, the improvements in living standards that come from higher incomes are glacial. The data may show that life is getting better, but average families feel no reason to break out the champagne.

that is no longer good enough. Americans expect the economy to be buoyant, not boring. Yet this expectation is shaped not by prosaic economic realities but by a most unusual period in history: the quarter-century that began in the ashes of World War II, when the world economy performed better than at any time before or since.

The Golden Age was the first sustained period of economic growth in most countries since the 1920s. But it was built on far more than just pent-up demand and the stimulus of the postwar baby boom. Unprecedented productivity growth around the world made the Golden Age possible. In the 25 years that ended in 1973, the amount produced in an hour of work roughly doubled in the U.S. and Canada, tripled in Europe and quintupled in Japan.

Many factors played a role in this achievement.

The workforce everywhere became vastly more educated.

As millions of laborers shifted from tending sheep and hoeing potatoes to working in factories and construction sites, they could create far more economic value.

New motorways boosted productivity in the transportation sector by letting truck drivers cover longer distances with larger vehicles. Faster ground transportation made it practical, in turn, for farms and factories to expand to sell not just locally but regionally or nationally, abandoning craft methods in favor of machinery that could produce more goods at lower cost.

Six rounds of tariff reductions brought a massive increase in cross-border trade, putting even stronger competitive pressure on manufacturers to become more efficient.

Above all, technological innovation helped to create new products and offered better ways for workers to do their jobs.

The 1973 oil crisis meant more than just gasoline lines and lowered thermostats. It shocked the world economy.

But it wasn’t the price of gasoline that brought the long run of global prosperity to an end. It just diverted attention from a more fundamental problem: Productivity growth had slowed sharply.

The consequences of the productivity bust were severe. Full employment vanished. It would be 24 years before the U.S. unemployment rate would again reach the low levels of late 1973

and the infinitesimal unemployment rates in France, Germany and Japan would never be reached again. Through the rest of the 20th century, the jobless rate in 28 wealthy economies would average nearly 7%.

the world’s overall economic growth rate dropped from 4.9% a year from 1951 through 1973 to an average of just 3.1% for the balance of the century.

With economic planners and central bankers unable to steady their economies, voters turned sharply to the right

Conservative politicians such as Margaret Thatcher in the U.K., Ronald Reagan in the U.S. and Helmut Kohl in West Germany swept into power, promising that freer markets and smaller government would reverse the decline, spur productivity and restore rapid growth.

But these leaders’ policies—deregulation, privatization, lower tax rates, balanced budgets and rigid rules for monetary policy—proved no more successful at boosting productivity than the statist policies that had preceded them

Some insist that the conservative revolution stimulated an economic renaissance, but the facts say otherwise: Great Britain’s productivity grew far more slowly under Thatcher’s rule than during the miserable 1970s, and Reagan’s supply-side tax cuts brought no productivity improvement at all.

It is tempting to think that we know how to do better, that there is some secret sauce that governments can ladle out to make economies grow faster than the norm. But despite glib talk about “pro-growth” economic policies, productivity growth is something over which governments have very little control