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julia rhodes

Photos Link Masked Men in East Ukraine to Russia - NYTimes.com - 0 views

  • For two weeks, the mysteriously well-armed, professional gunmen known as “green men” have seized Ukrainian government sites in town after town, igniting a brush fire of separatist unrest across eastern Ukraine. Strenuous denials from the Kremlin have closely followed each accusation by Ukrainian officials that the world was witnessing a stealthy invasion by Russian forces.Now, photographs and descriptions from eastern Ukraine endorsed by the Obama administration on Sunday suggest that many of the green men are indeed Russian military and intelligence forces — equipped in the same fashion as Russian special operations troops involved in annexing the Crimea region in February.
  • The question of Russia’s role in eastern Ukraine has a critical bearing on the agreement reached Thursday in Geneva among Russian, Ukrainian, American and European diplomats to ease the crisis. American officials have said that Russia would be held responsible for ensuring that the Ukrainian government buildings were vacated, and that it could face new sanctions if the terms were not met.
  • The Kremlin insists that Russian forces are in no way involved, and that Mr. Strelkov does not even exist, at least not as a Russian operative sent to Ukraine with orders to stir up trouble. “It’s all nonsense,” President Vladimir V. Putin said Thursday during a four-hour question-and-answer session on Russian television. “There are no Russian units, special services or instructors in the east of Ukraine.” Pro-Russian activists who have seized government buildings in at least 10 towns across eastern Ukraine also deny getting help from professional Russian soldiers or intelligence agents.But masking the identity of its forces, and clouding the possibilities for international denunciation, is a central part of the Russian strategy, developed over years of conflict in the former Soviet sphere, Ukrainian and American officials say.
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  • Russia’s flair for “maskirovka” — disguised warfare — has become even more evident under Mr. Putin, a former K.G.B. officer whose closest advisers are mostly from that same Soviet intelligence agency.
  • When a Ukrainian armored column approached the town last Wednesday and then swiftly surrendered, a group of disciplined green men suddenly appeared on the scene and stood guard. Over the course of several hours, several of them told bystanders in the sympathetic crowd that they were Russians. They allowed themselves to be photographed with local girls, and drove an armored personnel carrier in circles to please the crowd.
  • What is happening in eastern Ukraine is a military operation that is well planned and organized, and we assess that it is being carried out at the direction of Russia.”
  • Another character in Ukraine’s case against Russia is Mr. Strelkov, the alleged military intelligence officer who Kiev says took part in a furtive Russian operation to prepare for the annexation of Crimea and, more recently, in insurgent action in Slovyansk.No photographs have yet emerged of Mr. Strelkov, but the Security Service of Ukraine, the successor organization to what used to be Ukraine’s local branch of the K.G.B., has released a sketch of what it says is his face.
  • In the recording, a man nicknamed “Strelok” — who the Ukrainian agency says is Mr. Strelkov — and others can be heard discussing weapons, roadblocks and how to hold on to captured positions in and near Slovyansk with a superior in Russia.
  • Military analysts say the Russian tactics show a disturbing amount of finesse that speak to long-term planning.“The Russians have used very specialized, very effective forces,” said Jacob W. Kipp, an expert on the Russian military and the former deputy director of the United States Army’s School of Advanced Military Studies at Fort Leavenworth, Kan.“They don’t assume that civilians are cluttering up the battlefield; they assume they are going to be there,” he said. “They are trained to operate in these kind of environments.”
Javier E

A Long Obedience - NYTimes.com - 0 views

  • When John Adams, Thomas Jefferson and Benjamin Franklin wanted to put Moses as a central figure on the Great Seal of the United States, they were not celebrating him as a liberator, but as a re-binder. It wasn’t just that he led the Israelites out of one set of unjust laws. It was that he re-bound them with another set of laws. Liberating to freedom is the easy part. Re-binding with just order and accepted compulsion is the hard part.
  • when you are creating a social order, the first people who need to be bound down are the leaders themselves.
  • Moses was to exemplify the quality of “anivut.” Anivut, Rabbi Norman Lamm once wrote, “means a soft answer to a harsh challenge; silence in the face of abuse; graciousness when receiving honor; dignity in response to humiliation; restraint in the presence of provocation; forbearance and quiet calm when confronted with calumny and carping criticism.”
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  • Exodus is a reminder that statecraft is soulcraft, that good laws can nurture better people.
  • the general vision is that the laws serve many practical and spiritual purposes.
  • The laws tame the ego and create habits of deference by reminding you of your subordination to something permanent. The laws spiritualize matter, so that something very normal, like having a meal, has a sacred component to it. The laws build community by anchoring belief in common practices. The laws moderate religious zeal; faith is not expressed in fiery acts but in everyday habits. The laws moderate the pleasures; they create guardrails that are meant to restrain people from going off to emotional or sensual extremes
  • The 20th-century philosopher Eliyahu Dessler wrote, “the ultimate aim of all our service is to graduate from freedom to compulsion.”
  • Exodus provides a vision of movement that is different from mere escape and liberation. The Israelites are simultaneously moving away and being bound upward.
Javier E

Suburbs Try to Prevent an Exodus as Young Adults Move to Cities and Stay - NYTimes.com - 0 views

  • A recent report on the suburb-dotted New York counties of Westchester, Nassau and Suffolk, based on United States census data, found that those young people seem to be lingering longer in New York City, sometimes forsaking suburban life entirely.
  • Since 2000, Westchester, Nassau and Suffolk have experienced a drop in the number of 25- to 44-year-olds, with the declines particularly sharp in more affluent communities. Between 2000 and 2011, Rye, for example, had a 63 percent decrease in 25- to 34-year-old residents and a 16 percent decrease in 35- to 44-year-olds.
  • The greatest population losses, he said, were in “the least diverse communities with the most expensive housing, which happen also to be those that have almost no affordable multifamily housing.”
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  • One reason, he theorized, is that 20- and 30-somethings are having a harder time finding the full-time jobs they need to afford their homes and real estate taxes. Nationwide, he said, the proportion of 25- to 34-year-olds who own homes has declined sharply.
  • the city is safer and more energized than it was a generation ago, and its allure has grown. Cities like Baltimore, Washington and Boston have also revitalized rundown or desolate neighborhoods.
  • Unless downtowns become livelier, he said, the island’s “long-term sustainability” will be hurt because new businesses will not locate in places where they cannot attract young professionals.
  • But he said there is also survey data that seems to show “that younger adults are becoming more drawn to denser, more compact urban environments that offer a number of amenities within walking distance of where they live.” And, he said, more ethnically mixed communities — with more rental housing and immigrants — are gaining population.
  • His theory is that young people are marrying later and moving to the suburbs later. Others say that young people seem to be taking more time finding themselves, and are willing to flounder at home for a time, pushing the traditional arc of adult life into the future. Continue reading the main story 21 Comments “Parents used to be 35ish, now they’re 45ish,” Mr. McCormack said. “What we’re seeing is not so much an exodus as a later arrival.”
julia rhodes

Russia Is Quick to Bend Truth About Ukraine - NYTimes.com - 0 views

  • “Blood has been spilled in Ukraine again,” wrote Mr. Medvedev, once favored in the West for playing good cop to the hard-boiled president, Vladimir V. Putin. “The threat of civil war looms.”
  • It is an extraordinary propaganda campaign that political analysts say reflects a new brazenness on the part of Russian officials. And in recent days, it has largely succeeded — at least for Russia’s domestic audience — in painting a picture of chaos and danger in eastern Ukraine, although it was pro-Russian forces themselves who created it by seizing public buildings and setting up roadblocks.
  • In a report released Tuesday, the Office of the United Nations High Commissioner for Human Rights said that threats to ethnic Russians in eastern Ukraine, cited repeatedly by Russian officials and in the Russian news media as a potential rationale for Russian military action, were exaggerated and that some participants in the protests in the region came from Russia.
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  • . “The Russia leadership doesn’t care about how it’s being perceived in the outside world, in the world of communication, in the world where we have plurality of information and where information can be confirmed and checked. This is a radical change in attitude toward the West.”
  • Adding to the public frenzy about imminent Kiev-ordered violence, Life News, a pro-Kremlin tabloid television station, offered a bounty of 15,000 rubles, or slightly more than $400, for video of Ukrainian military forces mobilizing in eastern Ukraine — suggesting that such activity was secretly underway.
  • Russia has flatly denied any role in the unrest in eastern Ukraine, and the Russian Foreign Ministry, which normally champions the authority of the United Nations, dismissed the new humans rights report as biased. In a statement, Aleksandr Lukashevich, a Foreign Ministry spokesman, called it “one-sided, politicized and unobjective.”
  • Still, he said the propaganda was strikingly effective in Crimea, throwing the West off-balance and buying Russian forces just enough time to solidify their control over the peninsula.
  • Mr. Putin said in a phone call Tuesday with the German chancellor, Angela Merkel, that Ukraine was on the brink of civil war, a point Mr. Medvedev also made at a news conference later in Moscow, adding that the government in Kiev was to blame. Mr. Medvedev also repeated the Kremlin’s frequent assertion that Russian speakers were under threat in Ukraine — the very claim United Nations officials rejected in their report.“The only way to preserve Ukraine and calm the situation,” Mr. Medvedev said, requires “recognizing that Russian citizens are the same as Ukrainians and, therefore, can use their own language in everyday life.”
Javier E

In Many Cities, Rent Is Rising Out of Reach of Middle Class - NYTimes.com - 0 views

  • Even dual-income professional couples are being priced out of the walkable urban-core neighborhoods where many of them want to live. Stuart Kennedy, 29, a senior program officer at a nonprofit group, said he and his girlfriend, a lawyer, will be losing their $2,300 a month rental house in Buena Vista in June. Since they found the place a year ago, rents in the area have increased sharply.
  • But demand has shown no signs of slackening. And as long as there are plenty of upper-income renters looking for apartments, there is little incentive to build anything other than expensive units. As a result, there are in effect two separate rental markets that are so far apart in price that they have little impact on each other. In one extreme case, a glut of new luxury apartments in Washington has pushed high-end rents down, even while midrange rents continue to rise.
  • “Increasing the supply is not going to increase the number of affordable units; that is a complete and utter fallacy,” said Jaimie Ross, the president of the Florida Housing Coalition. “People say if there really was a great need, the market would provide it; the market would correct itself. Well, the market has never corrected itself and it’s only getting worse.”
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  • ut a seemingly insatiable demand for luxury condos in Miami, created in part by wealthy Latin Americans, has caused land prices to soar, making affordable housing projects harder to build anywhere close to downtown. Moving farther out is cheaper, but the cost savings on housing can be quickly wiped out by transportation costs. A 2012 study by the Center for Housing Policy found that Miami was the most expensive metropolitan area in the country when housing and transportation costs were combined.
  • n many markets, buying a home is considerably cheaper than renting, and Miami is no exception. But many people are shut out of buying because their income is too low, they don’t qualify for a mortgage or they are burdened by other debt. In 2008, a quarter of rental applicants were still paying off student loans, according to CoreLogic, but as of last fall half of them were doing so.
Javier E

Three Expensive Milliseconds - NYTimes.com - 0 views

  • society is devoting an ever-growing share of its resources to financial wheeling and dealing, while getting little or nothing in return.
  • How much waste are we talking about? A paper by Thomas Philippon of New York University puts it at several hundred billion dollars a year.
  • the share of G.D.P. accruing to bankers, traders, and so on has nearly doubled since 1980, when we started dismantling the system of financial regulation created as a response to the Great Depression.
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  • the financial industry has grown much faster than either the flow of savings it channels or the assets it manages.
  • Defenders of modern finance like to argue that it does the economy a great service by allocating capital to its most productive uses — but that’s a hard argument to sustain after a decade in which Wall Street’s crowning achievement involved directing hundreds of billions of dollars into subprime mortgages.
  • Wall Street’s friends also used to claim that the proliferation of complex financial instruments was reducing risk and increasing the system’s stability, so that financial crises were a thing of the past. No, really.
  • if our supersized financial sector isn’t making us either safer or more productive, what is it doing? One answer is that it’s playing small investors for suckers, causing them to waste huge sums in a vain effort to beat the market.
  • Another answer is that a lot of money is going to speculative activities that are privately profitable but socially unproductive.
  • n short, we’re giving huge sums to the financial industry while receiving little or nothing — maybe less than nothing — in return. Mr. Philippon puts the waste at 2 percent of G.D.P.
  • et even that figure, I’d argue, understates the true cost of our bloated financial industry. For there is a clear correlation between the rise of modern finance and America’s return to Gilded Age levels of inequality.
Javier E

Death Knell for Opera in San Diego After 49 Years - NYTimes.com - 0 views

  • y the end, nightly attendance at the 2,500-seat Civic Theater here — the opera did not have its own hall — had fallen below 70 percent, even with seats discounted to fill the house. Ticket sales dropped to 34,674 last year from 41,355 in 2010.
  • “Even if we sold out, the tickets are only covering 38 percent of the cost,” Ms. Cohn said. “Our donors are passing away; I don’t know if people are not being raised with opera in the United States any longer, but we are not selling out the operas anymore. Not even close.”
Javier E

How LBJ Saved the Civil Rights Act - Michael O'Donnell - The Atlantic - 0 views

  • the times also called for a leader who could subdue the vast political and administrative forces arrayed against change—for someone with the strategic and tactical instincts to overcome the most-entrenched opponents, and the courage to decide instantly, in a moment of great uncertainty and doubt, to throw his full weight behind progress. The civil-rights movement had the extraordinary figure of Lyndon Johnson.
  • Days after Kennedy’s murder, Johnson displayed the type of leadership on civil rights that his predecessor lacked and that the other branches could not possibly match. He made the bold and exceedingly risky decision to champion the stalled civil-rights bill. It was a pivotal moment: without Johnson, a strong bill would not have passed. Caro writes that during a searching late-night conversation that lasted into the morning of November 27, when somebody tried to persuade Johnson not to waste his time or capital on the lost cause of civil rights, the president replied, “Well, what the hell’s the presidency for?” He grasped the unique possibilities of the moment and saw how to leverage the nation’s grief by tying Kennedy’s legacy to the fight against inequality.
  • The best hope of moving the civil-rights bill from the House Rules Committee—whose segregationist chairman, Howard Smith of Virginia, had no intention of relinquishing it—was a procedure called a “discharge petition.” If a majority of House members sign a discharge petition, a bill is taken from the committee, to the chagrin of its chairman. Johnson made the petition his own personal crusade
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  • Johnson kept the bill moving in the Senate by dislodging President Kennedy’s tax-cut bill from the Finance Committee.
  • Evidence presented by Purdum and Caro suggests that Johnson’s importuning, bribing, and threatening may have made an impact on closer to a dozen. The Senate invoked cloture on June 10, breaking the longest filibuster in the institution’s history.
  • Risen is simply wrong to portray Johnson as some hapless operator for trying multiple tactics and targets, some of them unsuccessfully. Johnson’s very comprehensiveness is what jarred the sluggish and paralyzed Capitol into action and ultimately moved the bill.
Javier E

Mystery Surrounds Death of Fiery Ukrainian Activist - NYTimes.com - 0 views

  • Mr. Muzychko’s family, friends and former comrades in Right Sector, a coalition of once-fringe Ukrainian nationalist groups, believe that he was killed in order to silence an uncompromising rebel who wanted to oust not only Mr. Yanukovych, but an entire class of politicians and civil servants he viewed as irredeemably corrupt.
  • “This is an unfinished revolution and he wanted to carry it through to its logical conclusion,” said Yuriy Shukhevych, a veteran Ukrainian nationalist leader whose father, Roman, commanded the Ukrainian Insurgent Army against the Polish and Soviet authorities in the 1930s and ’40s. Mr. Muzychko’s death, said Mr. Shukhevych, who spent more than three decades in Soviet prisons and labor camps, was a “pre-ordered hit” orchestrated by establishment forces fearful of a thorough break with the past and who were “afraid of him because he was so determined and so decisive.”
Javier E

Report Finds a Los Angeles in Decline - NYTimes.com - 0 views

  • the most worrisome blow by far is a scathing verdict on Los Angeles’s civic health that was delivered in a one-two punch — the second on Wednesday — by a committee of lawyers, developers, labor leaders and former elected officials who make up something of the Old Guard here. The Los Angeles 2020 Commission presented a catalog of failings that it said were a unique burden to the city: widespread poverty and job stagnation, huge municipal pension obligations, a struggling port and tourism industry and paralyzing traffic that would not be eased even with a continuing multibillion-dollar mass transit initiative.
  • Their conclusions amounted to an indictment of a city and its culture, a place that the commission said was brimming with talent and resources but was nonetheless falling behind other major cities across the globe.
  • “Year by year, our city — which once was a beacon of innovation and opportunity to the world — is becoming less livable,”
Javier E

Dick Cheney, Rand Paul, and the Possibility of Malign Leaders - Conor Friedersdorf - Th... - 0 views

  • Every American sees that leaders in foreign countries sometimes behave immorally. Yet we often seem averse to believing that our own leaders can be just as malign.
  • That's certainly my bias: Judging the character of U.S. officials, my gut impulse is to give them the benefit of the doubt.
  • But I know that my gut is sometimes wrong, that our institutions rather than anything intrinsic to our compatriots explains the comparative lack of corruption and tyranny in the United States, and that it's important to stay open to the possibility of malign or corrupt leaders—because otherwise, it's impossible to adequately guard against them. The Founders understood this. So did generations of traditional conservatives.
julia rhodes

Claims of French Complicity in Rwanda's Genocide Rekindle Mutual Resentment - NYTimes.com - 0 views

  • The acrimony between their political leaders centers on France’s role in the tragedy, which was thrust back into the open by sharp remarks from Rwanda’s president, Paul Kagame, on the eve of somber ceremonies to mark the 1994 genocide. France, he said, bore part of the responsibility for the carnage that killed more than 800,000 people, mostly members of the Tutsi minority.
  • In the years leading up to the genocide, the French government supported the government of Rwanda, which was then dominated by the Hutu majority, helping to equip, arm and, according to many, train the Rwandan military
  • Varying views have emerged on whether the French presence simply proved insufficient, or whether the French were actually countenancing or even supporting the Hutu attackers
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  • the area where French forces were assigned to protect civilians, both Tutsis and Hutus fleeing the violence, became the site of further killing by Hutu forces.
  • France has long struggled with confronting polarizing periods in its history, including the war in Algeria from 1954 to 1962 and the period of Nazi collaboration during World War II.
  • Intensifying France’s anger was that the accusations came from Mr. Kagame, a complex leader who has been accused of supporting rebel movements in the Democratic Republic of Congo and ruthlessly suppressing political rivals. He is alternately viewed as a savior of his b
  • Mr. Kouchner urged the French government to follow the example of Belgium and hold an open parliamentary debate with a judicial commission. The Green Party called for an opening of France’s government archives, and the lead editorial on Tuesday in Le Monde, viewed as France’s newspaper of record, advised the same.
Javier E

How to Secede From the Union, One Judicial Vacancy at a Time - Andrew Cohen - The Atlantic - 0 views

  • Some Republican senators and a few Democrats as well are starving the federal courts of the trial judges they need to serve the basic legal need
  • One federal-trial seat in Texas has been vacant for 1,951 days, to give just one example. The absence of these judges, in one district after another around the country, has created a continuing vacuum of federal authority that is a kind of secession, because federal law without judges to impose it in a timely way is no federal law at all.
  • A recent study from the Center for American Progress identified a backlog of more than 12,000 federal cases exists in Texas alone because the two current senators there, both conservative Republicans and ardent foes of the Obama Administration's legal views, have slow-walked trial judge nominations.
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  • The reason there are so many vacancies without nominees is that certain senators are making strategic choices not to recommend federal trial-court nominees to the White House. These lawmakers are saying that they would rather have no one interpreting federal law in their states than to have more Obama-appointed judges interpreting the law.
  • The easy response, offered up recently by the Texas delegation, is that it's the White House's fault, too. But it's not.
  • It's an intentional act by the legislative branch to keep the judicial branch from effectively performing its constitutionally mandated functions. And it's a neutering of a co-equal branch achieved without a constitutional amendment or statute, or even much public debate, about expressly limiting judicial power.
  • What's happening here is part of a blunt political and ideological strategy: These particular senators have maneuvered so that the citizens of red states have less federal judicial oversight than citizens of blue states and purple states. This is great news if you are a secessionist or hate the idea of federal power exercised through the judiciary.
  • There are currently 59 federal court vacancies for which there are no pending nominees. This number represents more than half the number of current vacancies in total
  • By subverting this goal, by seceding from federal judicial authority by attrition, these senators are dooming their constituents to a third-world legal system.
  • The facts behind these statistics are just some of the newest arguments against one of the worst and most self-defeating Senate "traditions": the granting to local senators of what amounts to veto power over federal judicial nominees.
  • The reason this important story isn't covered well on television is because there are no dramatic images attached to it. The reason the White House doesn't highlight the problem more often is because it still needs to work with these intransigent senators on future nominations.
Javier E

'He Hated Error More Than He Loved Truth' - Ta-Nehisi Coates - The Atlantic - 0 views

  • I first began seriously considering the immortality of white supremacy after listening to Nell Irvin Painter.
  •  Here are a couple interviews on that point--one with Phoebe Judge at WUNC in the Research Triangle in North Carolina, the other with Jonathan Judaken before a lecture at Rhodes College in Memphis.
  • The two that really pushed me over were were Edmund Morgan's American Slavery, American Freedom and Barbara and Karen Fields' Racecraft. Morgan is indispensable. There is no single book I've found myself reviewing more over the past five years. 
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  • the basic argument is that Americans tend to speak of "race" as a biological constant, which it isn't. That notion it, itself, a product of racism.
  • we say that we need a "conversation on race" or "race divides America" or we speak of "different races." Another way to say this is we need to have a "conversation on racism" or "racism divides America," or to speak of "historical victims of racism." This is very key. The was no white and black race until we created one, and this creation was--itself--an act of racism, done to justify other acts of racism. Presuming that there is biological constant called "white" and "black" removes human actors, elides responsibility, and annihilates history.
Javier E

What American Healthcare Can Learn From Germany - Olga Khazan - The Atlantic - 0 views

  • Every German resident must belong to a sickness fund, and in turn the funds must insure all comers. They’re also mandated to cover a standard set of benefits, which includes most procedures and medications. Workers pay half the cost of their sickness fund insurance, and employers pay the rest. The German government foots the bill for the unemployed and for children. There are also limits on out-of-pocket expenses, so it’s rare for a German to go into debt because of medical bills.
  • this is very similar to the health-insurance regime that Americans are now living under, now that the Affordable Care Act is four years old and a few days past its first enrollment deadline.
  • There are, of course, a few key differences. Co-pays in the German system are minuscule, about 10 euros per visit. Even those for hospital stays are laughably small by American standards: Sam payed 40 euro for a three-day stay for a minor operation a few years ago
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  • nearly five million Americans fall into what’s called the “Medicaid gap”
  • In Germany, employees' premiums are a percentage of their incomes, so low-wage workers simply pay rock-bottom insurance rates.
  • Germany actually pioneered this type of insurance—it all started when Otto von Bismarck signed his Health Insurance Bill of 1883 into law. (It’s still known as the “Bismarck model” because of his legacy, and other parts of Europe and Asia have adopted it over the years.)
  • You can think of this setup as the Goldilocks option among all of the possible ways governments can insure health. It's not as radical as single-payer models like the U.K.’s, where the government covers everyone. And it's also not as brutal as the less-regulated version of the insurance market we had before the ACA.
  • Since there are no provider networks in Germany, doctors don’t know what other providers patients have seen, so there are few ways to limit repeat procedures.
  • All things considered, it’s good to be a sick German. There are no network limitations, so people can see any doctor they want. There are no deductibles, so Germans have no fear of spending hundreds before their insurance ever kicks in.
  • There’s also no money that changes hands during a medical appointment. Patients show their insurance card at the doctor’s office, and the doctors' association pays the doctor using money from the sickness funds. "You don’t have to sit at home and sort through invoices or wonder if you overlooked fine print,”
  • That insurance card, by the way, is good for hospital visits anywhere in Europe.
  • of all of the countries studied, Germans were the most likely to be able to get a same-day or next-day appointment and to hear back from a doctor quickly if they had a question. They rarely use emergency rooms, and they can access doctors after-hours with ease.
  • And Germany manages to put its health-care dollars to relatively good use: For each $100 it spends on healthcare, it extends life by about four months, according to a recent analysis in the American Journal of Public Health. In the U.S., one of the worst-performing nations in the ranking, each $100 spent on healthcare resulted in only a couple of extra weeks of longevity.
  • those differences aside, it’s fair to say the U.S. is moving in the direction of systems like Germany’s—multi-payer, compulsory, employer-based, highly regulated, and fee-for-service.
  • The German government is similarly trying to push more people into “family physician” programs, in which just one doctor would serve as a gatekeeper.
  • like the U.S., Germany may see a shortage of primary-care doctors in the near future, both because primary-care doctors there don’t get paid as much as specialists, and because entrenched norms have prevented physician assistants from shouldering more responsibility
  • With limitations on how much they can charge, German doctors and hospitals instead try to pump up their earnings by performing as many procedures as possible, just like American providers do.
  • Similarly, “In Germany, it will always be an operation,” Göpffarth said. “Meanwhile, France and the U.K. tend to try drugs first and operations later.”
  • With few resource constraints, healthcare systems like America's and Germany's tend to go with the most expensive treatment option possible. An American might find himself in an MRI machine for a headache that a British doctor would have treated with an aspirin and a smile.
  • Perhaps the biggest difference between our two approaches is the extent to which Germany has managed to rein in the cost of healthcare for consumers. Prices for procedures there are lower and more uniform because doctors’ associations negotiate their fees directly with all of the sickness funds in each state. That's part of the reason why an appendectomy costs $3,093 in Germany, but $13,000 in the U.S.
  • Now, Maryland is going a step further still, having just launched a plan to cap the amount each hospital can spend, total, each year. The state's hospital spending growth will be limited to 3.58 percent for the next five years. “We know that right now, the more [doctors] do, the more they get paid,” John Colmers, executive director of Maryland’s Health Services Cost Review Commission, told me. “We want to say, ‘The better you do, the better you get paid.’”
  • certain U.S. states have tried a more German strategy, attempting to keep costs low by setting prices across the board. Maryland, for example, has been regulating how much all of the state’s hospitals can charge since 1977. A 2009 study published in Health Affairs found that we would have saved $2 trillion if the entire country’s health costs had grown at the same rate as Maryland’s over the past three decades.
  • “In Germany, there is a uniform fee schedule for all physicians that work under the social code,” Schlette said. “There’s a huge catalogue where they determine meticulously how much is billed for each procedure. That’s like the Bible.”
  • “The red states are unlikely to follow their lead. The notion that government may be a big part of the solution, instead of the problem, is anathema, and Republican controlled legislatures, and their governors, would find it too substantial a conflict to pursue with any vigor.”
  • no other state has Maryland’s uniform, German-style payment system in place, “so Maryland starts the race nine paces ahead of the other 46 states,” McDonough said.
  • the unique spirit of each country is what ultimately gets in its way. Germany’s more orderly system can be too rigid for experimentation. And America’s free-for-all, where hospitals and doctors all charge different amounts, is great for innovation but too chaotic to make payment reforms stick.
  • rising health costs will continue to be the main problem for Americans as we launch into our more Bismarckian system. “The main challenge you’ll have is price control,” he said. “You have subsidies in health exchanges now, so for the first time, the federal budget is really involved in health expenditure increases in the commercial market. In order to keep your federal budget under control, you’ll have to control prices.”
Javier E

American History [ushistory.org] - 0 views

  •  
    Online US History textbook, free!
Javier E

Bye-Bye, Baby - NYTimes.com - 0 views

  • Very high national fertility rates have not disappeared, but they are now mostly concentrated in a single region: sub-Saharan Africa. Last year, all five countries with estimated total fertility rates (the average number of births per woman) at six or higher — Niger, Mali, Somalia, Uganda and Burkina Faso — were there. So were nearly all of the 18 countries with fertility rates of five or more (the exceptions were Afghanistan and East Timor).
  • Sub-Saharan Africa also makes up a substantial portion of countries with estimated fertility rates between three and four: Notable exceptions include Iraq, Jordan, the Philippines and Guatemala
  • In reality, slower population growth creates enormous possibilities for human flourishing. In an era of irreversible climate change and the lingering threat from nuclear weapons, it is simply not the case that population equals power, as so many leaders have believed throughout history. Lower fertility isn’t entirely a function of rising prosperity and secularism; it is nearly universal.
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  • The new hand-wringing stems from a gross misunderstanding of the glacial nature of population change.
  • Even when the total fertility rate falls below 2.1 children, the “momentum” effects of earlier fertility trends will keep a population growing for many decades. In cases when the absolute size of a national population declines, the drop often turns out to be short-lived, and in aggregate numbers usually is so slight as to be of little significance.
  • young women especially, but also young men, increasingly see marriage and childbearing as major risks, given high divorce rates and the responsibility to support aging parents, who are enjoying longer lives.
  • it also can provide substantial benefits that have received less attention.
  • fertility decline is associated nearly everywhere with greater rights and opportunities for women.
  • the work forces of societies with low-to-moderate fertility rates often achieve higher levels of productivity than do higher fertility societies.
  • Substantial fertility declines in southern India, notably in the state of Kerala, have been associated with significant economic and educational gains. It is not hard to figure out why. Children, teenagers and young adults are generally less productive than middle-aged workers with more experience,
  • The fewer children who need primary and secondary education, the more resources there are that can be invested in higher-quality education per child
  • by enhancing the employment and career experiences of young adults, lower fertility can also bring about greater social and political stability
  • There are, in fact, ways that low fertility can be moderated, or even reversed, over time.
  • lower fertility rates may gradually reduce the incentives that have led a surprisingly large number of governments to encourage the emigration of their own young citizens,
  • France provides subsidized day care for children, starting at 2 1/2 months. Fees are on a sliding scale based on family income. Other countries have been reconsidering traditional school schedules, such as half-days and early closing times that impose serious work-family conflicts for parents, and housing subsidies for young families.
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