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reene on Wednesday said she was trying to stop Congress from passing President BidenJoe BidenManchin cements key-vote status in 50-50 Senate The Memo: How the COVID year upended politics Post-pandemic plans for lawmakers: Chuck E. Cheese, visiting friends, hugging grandkids MORE’s $1.9 trillion COVID-19 relief package, a “massive woke progressive Democrat wish list.”

But most Republicans — nearly 150 on this vote — still stuck with Greene, who began deploying these procedural tactics after Democrats voted last month to strip her of her two committee assignments over offensive social media posts. 

Like the other futile Greene votes, Wednesday’s motion to adjourn failed, by a roll call of 149-235. 

But Greene’s antics did little more than stall Biden’s relief bill for an hour or so. The Democratic-controlled House is on track to pass the package on a party-line vote and send it to Biden’s desk later Wednesday.  

The irony is that abortion foes have seen this movie before. More than anyone, those in the antiabortion movement should know that obsessing over the Supreme Court can get you only so far. After all, way back in 1973, Justice Harry Blackmun issued a decision he firmly believed would end conflicts about abortion. That decision was called Roe v. Wade.

Whether a federal habeas court may grant relief based solely on its conclusion that the test from Brecht v. Abrahamson is satisfied

Whether the U.S. Court of Appeals for the 9th Circuit erred when it rejected the United States’ assertion of the state-secrets privilege based on the court’s own assessment of potential harms to the national security, and required discovery to proceed further under 28 U.S.C. 1782(a) against former Central Intelligence Agency contractors on matters concerning alleged clandestine CIA activities.

“It’s not only women whom you’re bringing to the streets, it’s the whole nation that has had enough,” said Rafał Trzaskowski, the mayor of Warsaw, adding the decision to publish the ruling “against the will of Poles” was a “conscious and calculated acting to the detriment of the state.”

Poland already had one of Europe’s most restrictive abortion laws, with the procedure legal in only three instances: fetal abnormalities, pregnancies resulting from rape or incest, and threats to a woman’s life. The latter two remain legal. But with 1,074 of 1,100 abortions performed in the country last year because of fetal abnormalities, the ban would outlaw abortion in most cases, and critics say many women will resort to illegal procedures or travel abroad to obtain abortions.

“For them it is not about protecting life,” said Donald Tusk, an opposition Polish lawmaker and former president of the European Council said of the Law and Justice Party. “Under their rule more and more Poles are dying, and less are being born.”

Behind the scenes, though, Mr. Trump’s team were bracing for a potentially damaging period, inviting conservative activists to the White House to plot strategy for the coming impeachment fight.

Mr. Schiff’s presentation appeared to be based on the procedures from President Bill Clinton’s impeachment trial in 1999. Mr. McConnell has said he plans to adopt similar procedures this time, but he has yet to release a detailed proposal, leaving the House in the dark about what is to come.

many people overlook other things that could flow from new U.S. jurisprudence on abortion — such as erasing the right to birth control that the court recognized in a 1965 case, Griswold v. Connecticut.

includes same-sex marriage, contraception and abortion. You can't just take Roe out and not unravel the whole fabric."

ut the court could go a step further and recognize "fetal personhood" — the idea that a fetus is a person with full constitutional rights from the moment of fertilization. That would create a constitutional bar to abortion, among other things, meaning even the most liberal states could not allow the procedure.

opponents argued that recognizing life at fertilization would outlaw not just abortion, without exceptions, but also things like in vitro fertilization and many forms of contraception, including some birth control pills, "morning after" pills, and intrauterine devices (IUDs)

An abortion law passed in Georgia in 2019 not only includes a ban on abortion at the point a heartbeat can be detected — often before a woman is aware she is pregnant — but also has a fetal personhood provision.

Riley says, "all that's saying is they agree that states can regulate or ban abortion at 15 weeks. What we want to do is have the factual reality that life begins at conception recognized in law."

States could effectively ban contraception by arguing that some contraceptives act as abortifacients

Medical groups and the federal government don't consider any form of contraception approved by the Food and Drug Administration an abortion-equivalent, because the standard medical definition of the start of pregnancy is when a fertilized egg implants in the uterus

"personhood has always been the endgame" for abortion foes, not simply overturning Roe

With Georgia voters set to decide control of the US Senate in Tuesday's runoffs, the challenges to the voting rolls in Hancock County, whose residents have long fought for their right to vote, remain under the supervision of a court-appointed examiner. Legal experts say the US Supreme Court pulling teeth from the Voting Rights Act is to blame.

Black households had a median income of $22,056 ($37,083 for White); almost 34% of Black residents lived in poverty (22% for White); and 26% of Black households received food benefits (6% for White).

Ahead of the 2015 Sparta elections, the lawsuit said, BOER Vice Chairwoman Nancy Stephens, who is White, began filing voter challenges as a citizen, then voting on them as a board member. When concerns were raised, a local resident began filing challenges "in a format that closely resembled the format of those filed by the Vice Chair," the lawsuit said.

The challengers "consistently failed to provide credible evidence based upon personal knowledge that the challenged voters were not qualified to vote," the lawsuit said.

The BOER, responding to the lawsuit, "vigorously" and "strenuously" denied illegally targeting Black voters or violating state laws.

He went through the 2014 voting roll and pulled voters he knew were dead or had moved and submitted 14 challenges.

"Sitting after two of the meetings, I thought, 'What would they do if someone challenged some White voters?'" recalled Webb, who is Black.

Thornton can't understand why the BOER would claim he didn't live in the county, or why the board would try to remove him from the rolls. His catfish farm is in unincorporated Mayfield, 20 minutes outside Sparta, and he wasn't eligible to vote in the city elections.

BOER members didn't take Webb's challenges seriously and defended White voters.

The BOER determined before the hearing that four of Webb's challenged voters were dead and removed them from the rolls. Of the remaining challenges, the board nixed one voter from the rolls and moved another to inactive status. Both were Asian American, the lawsuit said.

"What they did was beyond voter suppression. If something is wrong with your voter registration, they should call you and tell you what's wrong. What they were doing is taking you off the rolls, and you wouldn't find out until the election," Webb told CNN. "They were making Black votes disappear."

Since the death of the Georgia civil rights icon US Rep. John Lewis, politicians and activists have called for Congress to honor Lewis by crafting an updated coverage formula, as permitted by the high court, but it hasn't come to pass.

Julie Houk with the Lawyers Committee for Civil Rights Under Law, who worked on the Hancock County case, disagrees with the Supreme Court's finding "that the conditions that originally justified these measures no longer characterize voting in the covered jurisdictions."

The Lawyers' Committee has also challenged restrictive absentee ballot rules and fought voter purges, redistricting decisions and efforts to limit ballot drop boxes -- which tend to burden minorities the most.

In Macon-Bibb County, Georgia, Houk said, elections officials moved a Black voting precinct -- in a community that had rocky relations with law enforcement -- to the sheriff's office, which she called "very problematic" as it threatened to dissuade African Americans from voting.

In 2015, Georgia's then-Secretary of State Brian Kemp cited Shelby in informing counties they were "no longer required to submit polling place changes to the Department of Justice."

The ACLU of Georgia reported in September that of 313,243 voters removed from the state rolls in 2019, almost 200,000 were likely erroneously purged.

Two weeks before the November general election, ProPublica, in collaboration with public broadcasters, reported, "The state's voter rolls have grown by nearly 2 million since the US Supreme Court gutted the Voting Rights Act in 2013, but polling locations have been cut by almost 10%, with Metro Atlanta hit particularly hard."

This is why preclearance was so important: Discriminating against Black voters would've been rejected

The truth about 2015 "depends on what side you talk to," he said. No candidate could win in the city, now estimated at 89% African American, without securing a swath of the Black vote, said Haywood, who is White and is certain he was elected on his promise of reform, he said.

"We are way past problems with Black and White here," Haywood said. "Now, people are excited things are getting fixed."

Before the Voting Rights Act of 1965, it had no Black elected officials until John McCown -- an activist more in the mold of Stokely Carmichael than Martin Luther King Jr. -- came to town, luring investment and ushering Black residents to power.

McCown remains revered among many Black residents, despite investigations into his alleged misspending of grant money and other improprieties. They consider his achievements landmarks, including an affordable housing project and job creators like a cinder block factory and Thornton's now-defunct catfish farm. McCown's antebellum home still stands, abandoned and in need of upkeep.

A 1976 plane crash killed McCown, and a federal investigation into his fundraising killed the county's resurrected prosperity, but his legacy survived in the Black leaders succeeding him. "He created a political strategy, and African Americans voted themselves into power," Thornton said. "It has come to a point where (Hancock County) is one of the most impoverished in America. There is a wives' tale -- I don't know if it's true or not -- that some political leaders in Georgia have always said that if we can't vote the people of Hancock County out, we'll starve them out -- and there's been a disproportionate lack of growth to this particular community."

The BOER "strenuously denied" that it was illegally targeting Black voters with its challenges but agreed to enter the consent decree and abide by the standards and procedures the decree lays out. The court also ordered the defendants to pay more than $500,000 in attorneys' fees and other expenses, court documents show.As part of the consent decree, the BOER agreed to "not engage in discriminatory challenges to voters' eligibility," and to adhere to certain procedures in such challenges, according to court documents. It also restored certain voters to its rolls and agreed not to take action on other voters restored to the rolls for at least two federal election cycles.

"It had a chilling effect on voters," she said. "A lot of folks decided voting wasn't worth it."

"It will affect several elections down the road because people will say that I'm not going to be bothered by this ever again. I'm not going to vote," Warren said. "You have virtually destroyed their whole trust in the system altogether."

The county has submitted voters it wants removed, as instructed, and during the November election, the NAACP "seemed to think everything went OK," he said. Spencer's team is "always concerned," he said, and events happening at the state and national level, including Georgia's secretary of state calling to end no-excuse absentee voting and President Donald Trump challenging elections results, only exacerbate his worry.

"I am definitely worried that once the consent decree ends that the BOER will start its same antics again," he said. "They can say, 'Hey, we'll get everybody except Johnny Thornton, and the other people that we go for might not have the legal means or expertise to push back or to fight against the system.'"

Warren, in addition to previously serving as Sparta's registrar, is a Black county resident who began filming BOER meetings in 2015 when he learned of the challenges. He had trouble last year, he said, when applying for a mail-in ballot. A county elections official told him his home wasn't his registered address, he said. He isn't alleging any misbehavior -- he was able to sort it out before the general election -- but such a county notice might have been enough to deter a less-resolute voter from casting her or his ballot. In poor, rural areas like Hancock County, minor hiccups such as a rainy day or a washed-out road can have major effects on voting.

There are worst-case scenarios, and the President’s conduct has made them less unthinkable than usual. But the chances of their coming to pass are remote. Benjamin Ginsberg, who represented the GOP candidate in the 2000 recount, cautions against hysteria. “The panic seems to me to be way overblown,” he says.

What exactly are the worst-case scenarios? They start with the absence of a clear outcome on election night. Many states will be dealing with a massive increase in mail and absentee ballots, which take longer to process than in-person votes: they have to be removed from their envelopes, flattened for tabulation and checked for signatures and other technical requirements before they can be counted.

Three states loom largest in this concern: Michigan, Wisconsin and Pennsylvania. All three are key battlegrounds that have made a rapid and politically fraught push to expand voting by mail this year.

Other quirks, like a “naked ballot”–a legitimate ballot that a voter has failed to enclose in the required security envelope–may cause further uncertainty; a Pennsylvania court ruled this year that such ballots would not be counted in that state, which Trump won by just 44,000 votes. It all could add up to a presidential race that’s too close to call for days or weeks.

Current polls do not show a particularly tight race in those states, nor nationwide. And the polls have been far more stable, with far fewer undecided voters, than they were in 2016. Faster-counting states like Florida and Arizona, which have demonstrated the ability to rapidly tabulate large volumes of mail ballots, could well decide the election, rendering any uncertainty in the Rust Belt irrelevant.

The election’s outcome is unclear after days or weeks, and Trump is muddying the waters–lobbing lawsuits, disputing the count, accusing his opponents of cheating and convincing large swaths of the electorate that something untoward is going on behind the scenes.

Even if this happens, experts stress that Trump does not have the power to circumvent the nation’s labyrinthine election procedures by tweet. Elections are administered by state and local officials in thousands of jurisdictions, most of whom are experienced professionals with records of integrity.

There are well-tested processes in place for dealing with irregularities, challenges and contests. A candidate can’t demand a recount, for example, unless the tally is within a certain margin, which varies by state.

“While people may make claims to powers and make threats about what they may or may not do, the reality is that the candidates don’t have the power to determine the outcome of the election. It’s really important that voters understand that while a lot about our system is complicated, this isn’t a free-for-all.”

There’s a legal process to get there. The oft-invoked Bush v. Gore, the Supreme Court case that resolved the 2000 standoff, was decided narrowly, specific to a particular situation in a particular place, notes Joshua Geltzer, executive director of the Institute for Constitutional Advocacy and Protection at Georgetown Law. “These things Trump is saying–toss all the ballots, end the counting–those are not legal arguments,” he says.

Some fear a scenario in which, after weeks of uncertainty, the time comes for states to name electors to the Electoral College, and Republican legislators try to appoint their own rosters, overruling their state’s voters and forcing courts or Congress to resolve the matter.

“It’s unthinkably undemocratic to hold a popular vote for President and then nullify it if you don’t like the result,” says Adav Noti, chief of staff at the nonpartisan Campaign Legal Center. While the possibility can’t be entirely dismissed given Republicans’ fealty to Trump, judges would likely take a dim view of such an effort, not to mention the political storm that would ensue.

The past few years have convinced many Americans to expect the unlikely, haunted by failures of imagination past. But when it comes to post-election mayhem, people’s imaginations may be getting the better of them.

“But by amplifying it as if it’s realistic, you create a very real problem of people not having faith in the system by which we choose our leaders. And that’s really harmful.”

SARS doesn’t explain the success of every country that has handled covid-19 well, but it reveals an important aspect of the story.

Consider, on the other hand, countries that have handled covid-19 badly. Anthropologist Martha Lincoln, writing in Nature, points out that several of these countries tend to think of themselves as exceptional in some way. She notes that the United States, Britain, Brazil and Chile all have strong national narratives that see themselves as separate, distinct and better than others.

That sense of being special makes a country unlikely to adopt the standard attitude of any business when confronting a challenge — to look for best practices.

Bill Gates recently wrote that he has always approached problem-solving by starting with two fundamental questions: “Who has dealt with this problem well? And what can we learn from them?

And yet the United States is remarkably uninterested in how other countries approach similar challenges.

Dozens of advanced countries have health-care systems that deliver better results at half the cost of America’s. Most have a fraction of our homicide rates. Many much poorer countries have better infrastructure, which they build at far lower cost. They ensure that money does not dominate their elections. Not only do we not learn from them, we barely bother to look.

In an essay in Foreign Affairs, Jeremy Konyndyk argues that “American exceptionalism — the notion that the United States is unique among nations and that the American way is invariably the best — has blinded the country’s leaders (and many of its citizens) to potentially lifesaving lessons from other countries.

He quotes the eminent U.S. historian Eric Foner, who once explained that American exceptionalism translates into “hubris and closed-mindedness, and . . . ignorance about the rest of the world. Since the United States is so exceptional, there is no point in learning about other societies.” Konyndyk concludes: “That mentality is now costing American lives.”

Pentagon leaders have been concerned Trump may invoke the Insurrection Act to deploy active duty troops as well as civilian law enforcement to quell protests sparked by the killing of George Floyd in June.

"Those who suggest that the military would have any role in transition, they are being equally irresponsible," he added, saying "the military should have nothing to do with partisan politics and nothing to do even with any talk of a transition between administrations."

While Trump has not suggested he'd call on the military to decide the election, his opponent, former Vice President Joe Biden, has publicly floated the idea of top military leaders playing a role in ousting Trump should he refuse to leave office following an electoral defeat, a suggestion that drew pushback from Pentagon officials and experts on civilian military relations.

While the Insurrection Act does empower a president to deploy armed forces in certain situations to restore law and order, some experts believe doing so would be problematic in the event of an electoral dispute.

Defense Secretary Mark Esper made the Pentagon's position on the Insurrection Act clear in a June press conference. "The option to use active duty forces in a law enforcement role should only be used as a matter of last resort, and only in the most urgent and dire of situations. We are not in one of those situations now. I do not support invoking the Insurrection Act," he told reporters.

"While the President could invoke the Act on his own relating to an election dispute, that invocation would be immediately subject to legal challenge and, barring drastic and completely unforeseen circumstances, would be struck down in the courts," Elie Honig, a CNN legal analyst, said.

"All this bulls--- about how the president is going to stay in office and seize power? I've never heard of any of that crap. I mean, I'm the attorney general. I would think I would have heard about it," Barr told the Chicago Tribune earlier this month.

"Our laws and history make clear that the military has no formal role in resolving electoral disputes; that job falls in various manifestations to voters, the states, Congress, and the courts, and if there is any need for enforcement of electoral procedures or security, that is the job of civilian law enforcement in the first place, not the military," Honig said.

"It is not entirely certain that the president holds power to declare martial law -- particularly relating to his own election -- and any such attempt by a president almost certainly would be challenged in court and deemed illegal hence, not recognized by the military," Honing said.

"There is the mechanism of governing, I have spoken to our defense leaders about this issue," the Chairman of the House Armed Services Committee, Democrat Rep. Adam Smith, told CNN's Erin Burnett Thursday.

"No matter what, President Trump is going to be President until January 20.

In his closing remarks during a virtual town hall Thursday, Milley encouraged US troops to remain apolitical.

In 2014, the Pew Research Center asked Americans to rank the “greatest dangers in the world.” A plurality put inequality first, ahead of “religious and ethnic hatred,” nuclear weapons, and environmental degradation. And yet people don’t agree about what, exactly, “equality” means.

One side argues that the city should guarantee procedural equality: it should insure that all students and families are equally informed about and encouraged to study for the entrance exam. The other side argues for a more direct, representation-based form of equality: it would jettison the exam, adopting a new admissions system designed to produce student bodies reflective of the city’s demography

In the past year, for example, New York City residents have found themselves in a debate over the city’s élite public high schools

The complexities of egalitarianism are especially frustrating because inequalities are so easy to grasp. C.E.O.s, on average, make almost three hundred times what their employees make; billionaire donors shape our politics; automation favors owners over workers; urban economies grow while rural areas stagnate; the best health care goes to the richest.

It’s not just about money. Tocqueville, writing in 1835, noted that our “ordinary practices of life” were egalitarian, too: we behaved as if there weren’t many differences among us. Today, there are “premiere” lines for popcorn at the movies and five tiers of Uber;

Inequality is everywhere, and unignorable. We’ve diagnosed the disease. Why can’t we agree on a cure?

In a book based on those lectures, “One Another’s Equals: The Basis of Human Equality,” Waldron points out that people are also marked by differences of skill, experience, creativity, and virtue. Given such consequential differences, he asks, in what sense are people “equal”?

According to the Declaration of Independence, it is “self-evident” that all men are created equal. But, from a certain perspective, it’s our inequality that’s self-evident.

More than twenty per cent of Americans, according to a 2015 poll, agree: they believe that the statement “All men are created equal” is false.

In Waldron’s view, though, it’s not a binary choice; it’s possible to see people as equal and unequal simultaneously. A society can sort its members into various categories—lawful and criminal, brilliant and not—while also allowing some principle of basic equality to circumscribe its judgments and, in some contexts, override them

Egalitarians like Dworkin and Waldron call this principle “deep equality.” It’s because of deep equality that even those people who acquire additional, justified worth through their actions—heroes, senators, pop stars—can still be considered fundamentally no better than anyone else.

In the course of his search, he explores centuries of intellectual history. Many thinkers, from Cicero to Locke, have argued that our ability to reason is what makes us equals.

Other thinkers, including Immanuel Kant, have cited our moral sense.

Some philosophers, such as Jeremy Bentham, have suggested that it’s our capacity to suffer that equalizes us

Waldron finds none of these arguments totally persuasive.

In various religious traditions, he observes, equality flows not just from broad assurances that we are all made in God’s image but from some sense that everyone is the protagonist in a saga of error, realization, and redemption: we’re equal because God cares about how things turn out for each of us.

Waldron himself is taken by Hannah Arendt’s related concept of “natality,” the notion that what each of us share is having been born as a “newcomer,” entering into history with “the capacity of beginning something anew, that is, of acting.”

equality may be not a self-evident fact about human beings but a human-made social construction that we must choose to put into practice.

In the end, Waldron concludes that there is no “small polished unitary soul-like substance” that makes us equal; there’s only a patchwork of arguments for our deep equality, collectively compelling but individually limited.

Equality is a composite idea—a nexus of complementary and competing intuitions.

The blurry nature of equality makes it hard to solve egalitarian dilemmas from first principles. In each situation, we must feel our way forward, reconciling our conflicting intuitions about what “equal” means.

The communities that have the easiest time doing that tend to have some clearly defined, shared purpose. Sprinters competing in a hundred-metre dash have varied endowments and train in different conditions; from a certain perspective, those differences make every race unfair.

By embracing an agreed-upon theory of equality before the race, the sprinters can find collective meaning in the ranked inequalities that emerge when it ends

Perhaps because necessity is so demanding, our egalitarian commitments tend to rest on a different principle: luck.

“Some people are blessed with good luck, some are cursed with bad luck, and it is the responsibility of society—all of us regarded collectively—to alter the distribution of goods and evils that arises from the jumble of lotteries that constitutes human life as we know it.” Anderson, in an influential coinage, calls this outlook “luck egalitarianism.”

This sort of artisanal egalitarianism is comparatively easy to arrange. Mass-producing it is what’s hard. A whole society can’t get together in a room to hash things out. Instead, consensus must coalesce slowly around broad egalitarian principles.

No principle is perfect; each contains hidden dangers that emerge with time. Many people, in contemplating the division of goods, invoke the principle of necessity: the idea that our first priority should be the equal fulfillment of fundamental needs. The hidden danger here becomes apparent once we go past a certain point of subsistence.

a core problem that bedevils egalitarianism—what philosophers call “the problem of expensive tastes.”

The problem—what feels like a necessity to one person seems like a luxury to another—is familiar to anyone who’s argued with a foodie spouse or roommate about the grocery bil

The problem is so insistent that a whole body of political philosophy—“prioritarianism”—is devoted to the challenge of sorting people with needs from people with wants

the line shifts as the years pass. Medical procedures that seem optional today become necessities tomorrow; educational attainments that were once unusual, such as college degrees, become increasingly indispensable with time

Some thinkers try to tame the problem of expensive tastes by asking what a “normal” or “typical” person might find necessary. But it’s easy to define “typical” too narrowly, letting unfair assumptions influence our judgment

an odd feature of our social contract: if you’re fired from your job, unemployment benefits help keep you afloat, while if you stop working to have a child you must deal with the loss of income yourself. This contradiction, she writes, reveals an assumption that “the desire to procreate is just another expensive taste”; it reflects, she argues, the sexist presumption that “atomistic egoism and self-sufficiency” are the human norm. The word “necessity” suggests the idea of a bare minimum. In fact, it sets a high bar. Clearing it may require rethinking how society functions.

One way or another, everyone pays for health care. It accounts for about 18 percent of G.D.P. — nearly $11,000 per person. Individuals directly pay about a quarter, the federal and state governments pay nearly half, and most of the rest is paid by employers.

Many Americans think their health insurance is a gift from their employers — a “benefit” bestowed on lucky workers by benevolent corporations. It would be more accurate to think of employer-provided health insurance as a tax.

Rising health care costs account for much of the half-century decline in the earnings of men without a college degree, and contribute to the decline in the number of less-skilled jobs.

Employer-based health insurance is a wrecking ball, destroying the labor market for less-educated workers and contributing to the rise in “deaths of despair.”

We face a looming trillion-dollar federal deficit caused almost entirely by the rising costs of Medicaid and Medicare, even without the recent coronavirus relief bill.

Rising costs are an untenable burden on our government, too. States’ payments for Medicaid have risen from 20.5 percent of their spending in 2008 to 28.9 percent in 2019. To meet those rising costs, states have cut their financing for roads, bridges and state universities. Without those crucial investments, the path to success for many Americans is cut off

Every year, the United States spends $1 trillion more than is needed for high quality care.

executives at hospitals, medical device makers and pharmaceutical companies, and some physicians, are very well paid.

American doctors control access to their profession through a system that limits medical school admissions and the entry of doctors trained abroad — an imbalance that was clear even before the pandemic

Hospitals, many of them classified as nonprofits, have consolidated, with monopolies over health care in many cities, and they have used that monopoly power to raise prices

These are all strategies that lawmakers and regulators could put a stop to, if they choose.

The health care industry has armored itself, employing five lobbyists for each elected member of Congress. But public anger has been building — over drug prices, co-payments, surprise medical bills — and now, over the fragility of our health care system, which has been laid bare by the pandemic

A single-payer system is just one possibility. There are many systems in wealthy countries to choose from, with and without insurance companies, with and without government-run hospitals. But all have two key characteristics: universal coverage — ideally from birth — and cost control.

In the United States, public funding is likely to play a significant role in any treatments or vaccines that are eventually developed for Covid-19. Americans should demand that they be available at a reasonable price to everyone — not in the sole interest of drug companies.

We are believers in free-market capitalism, but health care is not something it can deliver in a socially tolerable way.

They choose not to. And so we Americans have too few doctors, too few beds and too few ventilators — but lots of income for providers

America is a rich country that can afford a world-class health care system. We should be spending a lot of money on care and on new drugs. But we need to spend to save lives and reduce sickness, not on expensive, income-generating procedures that do little to improve health. Or worst of all, on enriching pharma companies that feed the opioid epidemic.

Medical device manufacturers have also consolidated, in some cases using a “catch and kill” strategy to swallow up nimbler start-ups and keep the prices of their products high.

Ambulance services and emergency departments that don’t accept insurance have become favorites of private equity investors because of their high profits

Britain, for example, has the National Institute for Health and Care Excellence, which vets drugs, devices and procedures for their benefit relative to cost

At the very least, America must stop financing health care through employer-based insurance, which encourages some people to work but it eliminates jobs for less-skilled workers

Our system takes from the poor and working class to generate wealth for the already wealthy.

passed a coronavirus bill including $3.1 billion to develop and produce drugs and vaccines.

The industry might emerge as a superhero of the war against Covid-19, like the Royal Air Force in the Battle of Britain during World War II.

illions have lost their paychecks and their insurance

Lawyers for Mr. Moyo attributed the adjournment to procedural delays at the outset of the trial, scheduling conflicts, and longer-than-expected witness testimony and cross-examination.

The defense lawyers have said Mr. Moyo did nothing wrong and followed proper procedures in securing the accreditation documents. They have argued that the Zimbabwe authorities have no evidence to prove the documents were faked

“The theory that was put to the witness,” Mr. Coltart said, “was that the real reason why they deported the two foreign nationals is not because they had fake accreditation cards but precisely because they wanted to prevent them from doing their work as journalists and reporting.”

only photo images. These included an image of an image on a cellphone that had been taken on a cellphone belonging to the state’s first witness, Bothwell Nkopilo, an immigration compliance official.

Asked if he could provide the cellphone that contained document images, Mr. Nkopilo said he no longer possessed it. Asked if he could provide a diary that the immigration authorities were required to keep of the May 8 events, Mr. Nkopilo said it had been stolen from his car.

Mr. Nkopilo asserted he had hearing problems and could not understand some of the questions, prompting a rebuke from Judge Mark Nzira, a senior justice hearing the case, who said: “I know you can hear.”

Prosecutors acknowledged in court papers when Mr. Moyo was granted bail last June that their case was on “shaky ground.”

“they certainly would have seized those cards as evidence of the commission of an offense.”

The Times and the Committee to Protect Journalists have criticized the prosecution of Mr. Moyo as a chilling message from the government of President Emmerson Mnangagwa on the ability of journalists to do their work.

“We are behind him and do believe, in the end, media freedom would trump,” said the group’s executive director, Reggy Moalusi. “We reiterate Moyo is a legitimate journalist and his credentials are above board. His right to practice as a journalist must be upheld and respected by Zimbabwean authorities.”

Escobar had fought two years for his right to euthanasia in the face of opposition from doctors, clinics and courts, even though the Constitutional Court last year recognized the procedure should not be available just for the terminally ill.

Colombia's Constitutional Court removed penalties for euthanasia under certain circumstances in 1997 and ordered the procedure to be regulated in 2014. The first person in Colombia with a terminal illness to die under those rules was in 2015.

As of October 15 last year, 178 people with terminal illnesses had been legally euthanized in Colombia since 2015, according to Colombian legal rights advocacy group DescLAB.

The principle of the equality of taxation was maintained, all citizens were liable. This reflected a confirmation of the abolition of feudalism and an expressed belief in “career open to talent”. There was to be both formal legal equality and equality of opportunities, holding office would depend on ability, loyalty and experience, not accident of birth.

Analysis of the massive votes in favour had undermined their credibility. The organiser of the 1800 plebiscite, Napoleon’s brother, perhaps worried at the Jacobin sympathies of many soldiers, simply added 500,000 votes to the “yes” column for the army. What is more, the system of voting was open rather than by secret ballot and the question in the plebiscite only sought approval for a decision that had already been taken.

In the government Napoleon agreed with Sieyes concept, there should be authority from above and trust from below, of the general nature of the Constitution but instead of 3 Consuls as Sieyes thought Napoleon wanted political authority in his own hand. At the end he accepted maintaining the government with 3 consuls but he named himself the First Consul and ordered that the other two would have no independent executive authority. This showed how Napoleon wanted power. He reinforced his power when in the 2 Constitution he was made the First Consul for life and in the 3 Constitution named himself Emperor. Moreover, Napoleon established effective control over the legislative process. He established a similar control over the executive. Under the Constitution he could appoint the second and third consuls, government ministers, the prefects of the departments of France and the mayor of larger communes. The first three were appointed from the national list and the last from the communal lists. At the centre there was no cabinet system, individual ministers reported directly to Napoleon. All effective decision making was concentrated in his hands, no minister or prefect, for instance, could take action unless sure that it was authorised by Napoleon. This was top-down government, centralised and authoritarian. Even at the local level, holders of government posts were appointed from above, not elected from below. Napoleon’s control of the government system was more absolute than that of the monarchy that ruled in France before 1789.

In terms of liberty, it could be argued that Napoleon fundamentally violated revolutionary principles. Whilst he allowed religious freedom by tolerating all religions, as is expressed in the Organic Articles, the hierarchies of the various churches were under his control. What is more, there was no freedom of speech. Censorship was a key element of Napoleonic rule of France, and those suspected of sedition could be tried and punished outside the normal framework of the law. Nor was there freedom of movement for workers compelled to carry their livret. It also affected Napoleon’s view about the subordinate position of women and children. Whilst a man could imprison an adulterous wife or disobedient child, a married woman had few property rights and could only sue for divorce if a husband insisted on his mistress sharing the family home.

Secondary education was largely restricted to the middle classes and sons of officers in the army. In the 37 schools that were found in France the curriculum was closed supervised. Free thinking was discouraged. Schools taught a utilitarian curriculum based around France, mathematics, history, geography and science and inculcated both military values and loyalty to the regime. Alongside this state system, independent and Catholic schools continued to flourish, despite high fees. In order to bring such schools under closer government supervision, in 1806 Napoleon set up the Imperial University, which was in some respects a kind of nineteenth-century Ofsted, to oversee the curriculum and inspect schools.

On Friday, the justices of the Texas Supreme Court, all Republicans, said that those officials did not, in fact, have any power to enforce the law, “either directly or indirectly,” and so could not be sued.

“This measure, which has saved thousands of unborn babies, remains fully in effect, and the pro-abortion plaintiffs’ lawsuit against the state is essentially finished,” he wrote on Twitter.

The law allows no exceptions for abortion even in the case of women who have been raped or are victims of incest. It has thrown Texas abortion providers into crisis, and similar legislation is pending around the country.

“If conservative states want to do things that may not look constitutional even to this Supreme Court, they can use a bounty system to achieve that,” Professor Ziegler said. “The message sent by the Texas litigation was that if you have concerns that you might lose a constitutional challenge, that shouldn’t hold you back. Because you can use this road map to keep the case out of federal court entirely.”

“We’ve known that this lawsuit all along was just invalid and should have been dismissed, and now the fact that we’re on that trajectory now is encouraging,” Ms. Schwartz said, adding that the movement “is not going to let our foot off the gas yet.”

Amy Hagstrom Miller, the chief executive of Whole Woman’s Health, the clinic that sued to stop S.B. 8, said “the courts have failed us.”

“This ban does not change the need for abortion in Texas, it just blocks people from accessing the care they need,” she said. “The situation is becoming increasingly dire,”

Many women have traveled to Oklahoma for the procedure, but this week the State Senate passed its own six-week ban modeled on the Texas law. The Idaho Senate passed a similar law last week. Lawmakers in other states have proposed similar bans, but have held off in hopes that the Supreme Court decision, expected in June, will allow them to ban abortion entirely.

Doctors in the top 10 percent averaged $1.3 million

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

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

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

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

why did those figures ruffle so many physician feathers?

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

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

why do physicians make that much?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started

Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.

The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.

Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”

Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.

In the United States, an estimated 189 million adults are classified as having obesity or being overweight

The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight

For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.

The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify

if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”

How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk

The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years

the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.

adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?

“All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”

in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.

The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.

But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.

Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.

Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent

National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.

Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.

In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”

In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.

It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.

the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”

News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.

Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.

“I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”

She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”

For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.

In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.

In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.

he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.

Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.

Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.

An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.

when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.

The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.

although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.

sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,

that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.

Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.

From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.

obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”

she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions

Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.

if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it

She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.

Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.

“Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.

Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.

As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid

By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners

But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.

Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look

The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.

In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”

that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.

That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism

But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”

Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.

As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.

Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.

In the meantime, thinness was coming back into fashion

In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.

Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.

If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.

Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.

Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”

When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.

the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now

Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.

“The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”

The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways

When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”

why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.

Firewalls around the engines, nitrogen pumps in fuel tanks that help prevent immediate burning, and fire-resistant materials on seats and flooring most likely helped to keep the rising flames at bay, said Sonya A. Brown, a senior lecturer in aerospace design at the University of New South Wales in Sydney, Australia.

“Really, the Japan Airlines crew in this case performed extremely well,” Dr. Brown said. The fact that passengers did not stop to retrieve carry-on luggage or otherwise slow down the exit was “really critical,” she added.

Tadayuki Tsutsumi, an official at Japan Airlines, said the most important component of crew performance during an emergency was “panic control” and determining which exit doors were safe to use.

Former flight attendants described the rigorous training and drills that crew members undergo to prepare for emergencies. “When training for evacuation procedures, we repeatedly used smoke/fire simulation to make sure we could be mentally ready when situations like those occurred in reality,” Yoko Chang, a former cabin attendant and an instructor of aspiring crew members, wrote in an Instagram message.

Ms. Chang, who did not work for JAL, added that airlines require cabin crew members to pass evacuation exams every six months.