NY Times Nonfiction/Best SellersJune 16, 2013
Jun 09, 2013Jun 23, 2013.
This Week Last Week Hardcover Nonfiction Weeks
1 3 LEAN IN, by Sheryl Sandberg with Nell Scovell. (Knopf.) The chief operating officer of Facebook urges women to pursue their careers without ambivalence. 12
Buy Buy AmazonBarnes and NobleLocal Booksellers.
2 2 HAPPY, HAPPY, HAPPY, by Phil Robertson with Mark Schlabach. (Howard Books.) The Duck Commander pays tribute to “faith, family and ducks.” 4
Buy Buy AmazonBarnes and NobleLocal Booksellers.
3 1 ELEVEN RINGS, by Phil Jackson and Hugh Delehanty.. (Penguin Press.) An autobiography by the successful coach, who led his teams to 11 N.B.A. championships. 2
Buy Buy AmazonBarnes and NobleLocal Booksellers.
4 4 LET'S EXPLORE DIABETES WITH OWLS, by David Sedaris. (Little, Brown.) Essays from the humorist on subjects like French dentistry and a North Carolina Costco. 6
Buy Buy AmazonBarnes and NobleLocal Booksellers.
5 5 THE GUNS AT LAST LIGHT, by Rick Atkinson. (Holt.) The final volume of the Liberation Trilogy describes the Allied victory in Europe, from D-Day to the German surrender. 3
Buy Buy AmazonBarnes and NobleLocal Booksellers.
6 6 MY GREEK DRAMA, by Gianna Angelopoulos. (Greenleaf.) A memoir by a lawyer who was instrumental in rescuing the 2004 Olympic Games in Athens from possible disaster. (†) 3
Buy Buy AmazonBarnes and NobleLocal Booksellers.
7 7 KEEP IT PITHY, by Bill O'Reilly. (Crown Archetype.) A “highlight reel” of previous writings, updated, from the host of “The O’Reilly Factor.” 4
Buy Buy AmazonBarnes and NobleLocal Booksellers.
8 12 THE UNWINDING, by George Packer. (Farrar, Straus & Giroux.) The collapse of American institutions, politics and culture and their replacement by organized money, told through the stories of ordinary people and significant figures. 2
Buy Buy AmazonBarnes and NobleLocal Booksellers.
9 11 DAD IS FAT, by Jim Gaffigan. (Crown Archetype.) Life with five kids in a two-bedroom New York City apartment. 4
Buy Buy AmazonBarnes and NobleLocal Booksellers.
10 9 THE OUTSIDER, by Jimmy Connors. (Harper.) A memoir by the bad boy of 1970s tennis, who was for a time the world’s top-ranked, and probably most obnoxious, player. 3
Buy Buy AmazonBarnes and NobleLocal Booksellers.
11 8 COOKED, by Michael Pollan. (Penguin Press.) The writer masters recipes and argues that regaining control of cooking will make Americans healthier. 6
Buy Buy AmazonBarnes and NobleLocal Booksellers.
12 13 THE DUCK COMMANDER FAMILY, by Willie and Korie Robertson with Mark Schlabach. (Howard Books.) Behind the scenes at the A&E show “Duck Dynasty.” 9
Buy Buy AmazonBarnes and NobleLocal Booksellers.
13 * 14 UNBROKEN, by Laura Hillenbrand. (Random House.) An Olympic runner's story of survival as a prisoner of the Japanese in World War II. 131
Sunday Book Review
Books of The Times Review Buy Buy AmazonBarnes and NobleLocal Booksellers.
14 10 BUNKER HILL, by Nathaniel Philbrick. (Viking.) Eighteen months in pre-Revolutionary Boston, and the events leading up to the Battle of Bunker Hill. 5
Buy Buy AmazonBarnes and NobleLocal Booksellers.
15 NO EASY DAY, by Mark Owen with Kevin Maurer. (Dutton.) An account by a former member of the Navy SEALs, written pseudonymously, of the mission that killed bin Laden. 31
16 * 15 RUMSFELD'S RULES, by Donald Rumsfeld. (Broadside.) Observations about leadership and life from the Bush administration defense secretary and Iraq war defender. 3
Saturday, June 8, 2013
Friday, June 7, 2013
Rewire
June/July/Aug 2013
A Small World After All
A new book sheds light on how little of the world we see through our browsers
Astra Taylor
Rewire: Digital Cosmopolitans in the Age of Connectionby Ethan Zuckerman$26.95 List PriceFor more info visit:
At a recent conference on media reform, I found myself talking to a professional activist and technologist. He told me about some online images—customized for sharing on Facebook—that civilians in Syria had circulated to protest Bashar al-Assad’s violent crackdown on dissent in their country. The images were both powerful and deeply moving, he told me. “It’s like we are building a giant empathy machine,” he said, referring to the Internet. The effortless sharing of memes, he explained, was a crucial step toward a more peaceful world. In fact, he went so far as to insist that the invasion of Iraq would have been impossible today, given the ubiquity of social-media platforms.
He was such a pleasant and positive fellow that I felt a bit bad raining on his parade, so I resisted the urge to point out the innumerable and very popular corners of the Internet that give full and lavish attention to empathy’s enemies—xenophobia, racism, misogyny, condescension, and bullying. Instead, having just read Rewire, Ethan Zuckerman’s patient and thoughtful rebuttal to the widespread embrace of the Internet as a facilitator of global understanding, I tried to channel the author, who doesn’t denigrate the utopian impulse that fuels grand pronouncements about the revolutionary power of social media. Rather, Zuckerman carefully demolishes such assertions for “conflat[ing] what could be with what will be.”
Early on in Rewire, Zuckerman presents a paradox that I repeated to the activist: “While it’s easier than ever to share information and perspectives from different parts of the world, we may now often encounter a narrower picture of the world than in less connected days.” Zuckerman compiles compelling evidence that Americans are reading less international news now than they did in the decades before the Internet, even though it’s now technically easier than it has ever been to access information from faraway places. My interlocutor briefly considered these comments but ultimately disregarded them, as though only a curmudgeon would contradict his rosy view.
Zuckerman, however, is not a knee-jerk naysayer about all things digital. The director of the MIT Center for Civic Media and cofounder of the international bloggers’ website Global Voices, he is extremely enthusiastic about the potential of using technology to connect people across cultures. He wants the Internet to be an empathy machine. The difference between him and the full-throated apostles of cyber-utopianism is that he does not believe that the online world is foreordained to fulfill this purpose, nor does he naively assume that the outcomes of cross-cultural connections will always be desirable.
Zuckerman’s goal in the first half of the book is to reveal the degree to which disconnection persists and is even exacerbated online. His aim in the latter half is to encourage his readers to take responsibility for “rewiring” their lives so as to realize the full promise of the Internet’s battery of still largely hypothetical global connections. In the opening and closing chapters, he enumerates the advantages we stand to gain from the cosmopolitan rewiring of our lives, and offers some advice on how best to accomplish this aim. Meanwhile, the scope of Zuckerman’s counsel also reveals some of the political limitations of his project.
The world is complex and interconnected, Zuckerman rightly insists, and the evolution of our communications system from a broadcast model to a networked one has added a new dimension to the mix. The Internet has made us all less dependent on professional journalists and editors for information about the wider world, allowing us to seek out information directly via online search or to receive it from friends through social media. But Zuckerman also contends that this enhanced convenience comes with a considerable risk: that we will be exposed to what we want to know at the expense of what we need to know. While we can find virtual communities that correspond to our every curiosity and kink, there’s little pushing us beyond our comfort zones or into the unknown, even if the unknown may have serious implications for our lives. This problem was astutely satirized by a headline in The Onion that went viral after this spring’s Boston Marathon bombings: “Study: Majority of Americans Not Informed Enough to Stereotype Chechens.” (Meanwhile, in the scarcely distinguishable world outside of news satire, the embassy of the Czech Republic was forced, in the wake of evidence that the attack had been carried out by the ethnic-Chechen Tsarnaev brothers, to release a statement clarifying that “the Czech Republic and Chechnya are two very different entities.”) There are things we should probably know more about—like political and religious conflicts in Russia or basic geography. But even if we knew more than we do, there’s no guarantee that the knowledge gained would prompt us to act in a particularly admirable fashion.
As the truth embedded in that joke shows, Americans are prone to drastically overestimating just how international they are. Average citizens may be dismayed to learn that most of their clothes are made in China and that their bottled water is shipped all the way from Fiji. They may be convinced that immigration is on the rise or feel like they get plenty of foreign news. Yet Zuckerman challenges the idea that the world has been flattened. Tariffs and subsidies distort supply chains, immigration regulations and patterns are deeply uneven, and the global flow of information across borders is constrained, primarily by our limited “interest and attention.” As a consequence, we exist in a state of “imaginary cosmopolitanism,” a condition fueled by a cognitive bias that exaggerates encounters with the unusual. Day-to-day homophily—the tendency of like to congregate with like—exerts a stronger influence over us than the desire for novelty or difference. In all aspects of our lives, off-line and on-, we compulsively and mostly unconsciously sort ourselves into groups and niches, reassuring cocoons from which we rarely venture.
To put it another way, parochialism is a symptom of audience empowerment. We search for information we already want or find new things through people we know, and since these people tend to resemble ourselves, a lot happens in the world that we never hear about. For instance, Zuckerman notes that Americans may not learn about what’s happening in Zambia unless we happen to know some Zambians. And in the age of Google and Facebook, if our habits of media consumption are limited, we are to blame, not some all-powerful gatekeepers. So Zuckerman argues that if “we want digital connection to increase human connection,” we need to experiment. Specifically, he outlines three areas of digital life that could use “rewiring”: language, personal connection, and discovery. In sizing up the sphere of online language, he applauds the ongoing development of “transparent” or automated translation, which may soon allow us to seamlessly follow conversations unfolding in otherwise obscure idioms. At the same time, Zuckerman argues that translation alone is not enough, which leads to his anatomy of those he deems “bridge figures,” who have roots in multiple cultures, and xenophiles, or enthusiastic bridge crossers. Individuals who fall into these categories serve an essential purpose, transmitting ideas across cultural and national boundaries while also providing indispensible social context and mitigating misinterpretation.
Zuckerman’s case for deepening technology’s capacity for discovery is more complicated. He compares the Internet to a city and raises the possibility of “engineering serendipity” so as to encourage unexpected encounters. Architecture always has an agenda, Zuckerman observes, whether you’re talking about urban planning or software design. As a consequence, he insists, we need structural solutions—architectural adjustments, if you will—to encourage cross-cultural connection. Thus he calls for tools that will help us seek out the unfamiliar—for instance, an application that can layer online maps with annotations from a wide array of social groups, and recommendation engines that would encourage people to make riskier choices rather than merely introducing them to things that fit their established patterns.
Some may find the idea of engineering online platforms to promote diversity paternalistic, but in reality, online spaces are already engineered with specific outcomes in mind—that is to say, they are designed to serve the needs of advertisers, who want to sell us things, and Silicon Valley venture capitalists, who want a return on investment. Curiously, Rewire, for all of its emphasis on the pivotal role that individuals play via the filters they impose on the flow of information, glosses over the myriad ways social media are shaped by market forces. While Zuckerman describes traditional journalism as “hobbled by business concerns,” he never mentions the way those same concerns have carried over into a digital age, and yoked the development of private platforms to the quest for profit. For example, when talking about Netflix’s recommendation engine, he doesn’t acknowledge that the program is risk averse because it is designed to facilitate consumption of movies that customers will enjoy; he fails to reckon with the obstacles that such economic imperatives pose to the project of making our online experience less predictable. Ultimately, Zuckerman avoids political economy and emphasizes personal responsibility and choice. He argues, in essence, that we should find innovative ways to expand the repertoire of what we want.
Given this view, it makes sense that Zuckerman profiles a handful of characters who have embodied his outward-facing ideal and benefited from border crossing: Pablo Picasso, whose art was inspired by African masks; Paul Simon, who drew on similar musical influences to produce his megaselling Afro-pop album Graceland; and Matt Harding, an American who made a series of chewing-gum-sponsored YouTube videos of himself dancing with strangers around the world.
Still, there’s something discomfitingly thin about such case studies, suggesting that Zuckerman’s version of a cosmopolitan ethos is merely one of mixing styles. He maintains that these figures are more than appropriators or tourists, but it’s far from clear how they may challenge the status quo of selective and voyeuristic Western encounters with an exoticized version of the world at large. In this regard, they underscore the privileged perspective that Zuckerman himself consistently falls back on. In Rewire, he is focused on the problem of individuals choosing not to seek out information from other places, and in plumbing the issues arising from this problem, he assumes that all of us feel empowered to investigate other communities but simply don’t bother. The world’s cultures are portrayed as a buffet everyone feels equally invited to sample from. But in real life people are marginalized and excluded from this experiential banquet—in subtle and not-so-subtle ways that Rewire doesn’t account for.
Zuckerman is not unaware of social inequities. Indeed, it was his shock at the lack of coverage about Ghana, a country where he worked and lived, that motivated him to begin thinking about these issues. Nonetheless, privileged people widening their view of the world won’t necessarily make the actual world more inclusive. Likewise, increasing diversity doesn’t automatically make the world more just or fair.
Skirting these complexities, Rewire ultimately provides an unsatisfying answer to the fundamental question it raises: Why should we strive to be cosmopolitan? The book’s jacket copy offers a surprisingly mundane rationale: A “wider picture” of the world, it states, is “critical for global success.” The ability to make connections, Zuckerman writes, “is a new form of power.” Rewire’s final chapter portrays a handful of powerfully cosmopolitan individuals, including the CEOs of Pepsi, Coke, and Nissan, the latter a Brazilian of Lebanese descent who awed Japanese businessmen with his “audacity” when he laid off 14 percent of the automaker’s workforce. In an unexpected twist, multinational corporations are held up as paragons of connection, deserving praise for hiring executives from foreign countries to screw their employees. Why not praise small restaurants for “leveraging diversity” by having Mexican kitchen staffs or upper-class families for hiring Tibetan nannies?
Zuckerman comes across as a kind and generous person who wants to make space for everyone, including, it seems, the global financial elite. While I respect his openness, I’m less forgiving. If cosmopolitanism is to be a force for desirable change in this world, it has to have a purpose more profound than the vision Zuckerman describes in his final chapter. The ease of digital connection may not bring about world peace, but that doesn’t mean we have to disavow all idealism and big dreams. If we’re going to rewire, let’s try to go further.
A Small World After All
A new book sheds light on how little of the world we see through our browsers
Astra Taylor
Rewire: Digital Cosmopolitans in the Age of Connectionby Ethan Zuckerman$26.95 List PriceFor more info visit:
At a recent conference on media reform, I found myself talking to a professional activist and technologist. He told me about some online images—customized for sharing on Facebook—that civilians in Syria had circulated to protest Bashar al-Assad’s violent crackdown on dissent in their country. The images were both powerful and deeply moving, he told me. “It’s like we are building a giant empathy machine,” he said, referring to the Internet. The effortless sharing of memes, he explained, was a crucial step toward a more peaceful world. In fact, he went so far as to insist that the invasion of Iraq would have been impossible today, given the ubiquity of social-media platforms.
He was such a pleasant and positive fellow that I felt a bit bad raining on his parade, so I resisted the urge to point out the innumerable and very popular corners of the Internet that give full and lavish attention to empathy’s enemies—xenophobia, racism, misogyny, condescension, and bullying. Instead, having just read Rewire, Ethan Zuckerman’s patient and thoughtful rebuttal to the widespread embrace of the Internet as a facilitator of global understanding, I tried to channel the author, who doesn’t denigrate the utopian impulse that fuels grand pronouncements about the revolutionary power of social media. Rather, Zuckerman carefully demolishes such assertions for “conflat[ing] what could be with what will be.”
Early on in Rewire, Zuckerman presents a paradox that I repeated to the activist: “While it’s easier than ever to share information and perspectives from different parts of the world, we may now often encounter a narrower picture of the world than in less connected days.” Zuckerman compiles compelling evidence that Americans are reading less international news now than they did in the decades before the Internet, even though it’s now technically easier than it has ever been to access information from faraway places. My interlocutor briefly considered these comments but ultimately disregarded them, as though only a curmudgeon would contradict his rosy view.
Zuckerman, however, is not a knee-jerk naysayer about all things digital. The director of the MIT Center for Civic Media and cofounder of the international bloggers’ website Global Voices, he is extremely enthusiastic about the potential of using technology to connect people across cultures. He wants the Internet to be an empathy machine. The difference between him and the full-throated apostles of cyber-utopianism is that he does not believe that the online world is foreordained to fulfill this purpose, nor does he naively assume that the outcomes of cross-cultural connections will always be desirable.
Zuckerman’s goal in the first half of the book is to reveal the degree to which disconnection persists and is even exacerbated online. His aim in the latter half is to encourage his readers to take responsibility for “rewiring” their lives so as to realize the full promise of the Internet’s battery of still largely hypothetical global connections. In the opening and closing chapters, he enumerates the advantages we stand to gain from the cosmopolitan rewiring of our lives, and offers some advice on how best to accomplish this aim. Meanwhile, the scope of Zuckerman’s counsel also reveals some of the political limitations of his project.
The world is complex and interconnected, Zuckerman rightly insists, and the evolution of our communications system from a broadcast model to a networked one has added a new dimension to the mix. The Internet has made us all less dependent on professional journalists and editors for information about the wider world, allowing us to seek out information directly via online search or to receive it from friends through social media. But Zuckerman also contends that this enhanced convenience comes with a considerable risk: that we will be exposed to what we want to know at the expense of what we need to know. While we can find virtual communities that correspond to our every curiosity and kink, there’s little pushing us beyond our comfort zones or into the unknown, even if the unknown may have serious implications for our lives. This problem was astutely satirized by a headline in The Onion that went viral after this spring’s Boston Marathon bombings: “Study: Majority of Americans Not Informed Enough to Stereotype Chechens.” (Meanwhile, in the scarcely distinguishable world outside of news satire, the embassy of the Czech Republic was forced, in the wake of evidence that the attack had been carried out by the ethnic-Chechen Tsarnaev brothers, to release a statement clarifying that “the Czech Republic and Chechnya are two very different entities.”) There are things we should probably know more about—like political and religious conflicts in Russia or basic geography. But even if we knew more than we do, there’s no guarantee that the knowledge gained would prompt us to act in a particularly admirable fashion.
As the truth embedded in that joke shows, Americans are prone to drastically overestimating just how international they are. Average citizens may be dismayed to learn that most of their clothes are made in China and that their bottled water is shipped all the way from Fiji. They may be convinced that immigration is on the rise or feel like they get plenty of foreign news. Yet Zuckerman challenges the idea that the world has been flattened. Tariffs and subsidies distort supply chains, immigration regulations and patterns are deeply uneven, and the global flow of information across borders is constrained, primarily by our limited “interest and attention.” As a consequence, we exist in a state of “imaginary cosmopolitanism,” a condition fueled by a cognitive bias that exaggerates encounters with the unusual. Day-to-day homophily—the tendency of like to congregate with like—exerts a stronger influence over us than the desire for novelty or difference. In all aspects of our lives, off-line and on-, we compulsively and mostly unconsciously sort ourselves into groups and niches, reassuring cocoons from which we rarely venture.
To put it another way, parochialism is a symptom of audience empowerment. We search for information we already want or find new things through people we know, and since these people tend to resemble ourselves, a lot happens in the world that we never hear about. For instance, Zuckerman notes that Americans may not learn about what’s happening in Zambia unless we happen to know some Zambians. And in the age of Google and Facebook, if our habits of media consumption are limited, we are to blame, not some all-powerful gatekeepers. So Zuckerman argues that if “we want digital connection to increase human connection,” we need to experiment. Specifically, he outlines three areas of digital life that could use “rewiring”: language, personal connection, and discovery. In sizing up the sphere of online language, he applauds the ongoing development of “transparent” or automated translation, which may soon allow us to seamlessly follow conversations unfolding in otherwise obscure idioms. At the same time, Zuckerman argues that translation alone is not enough, which leads to his anatomy of those he deems “bridge figures,” who have roots in multiple cultures, and xenophiles, or enthusiastic bridge crossers. Individuals who fall into these categories serve an essential purpose, transmitting ideas across cultural and national boundaries while also providing indispensible social context and mitigating misinterpretation.
Zuckerman’s case for deepening technology’s capacity for discovery is more complicated. He compares the Internet to a city and raises the possibility of “engineering serendipity” so as to encourage unexpected encounters. Architecture always has an agenda, Zuckerman observes, whether you’re talking about urban planning or software design. As a consequence, he insists, we need structural solutions—architectural adjustments, if you will—to encourage cross-cultural connection. Thus he calls for tools that will help us seek out the unfamiliar—for instance, an application that can layer online maps with annotations from a wide array of social groups, and recommendation engines that would encourage people to make riskier choices rather than merely introducing them to things that fit their established patterns.
Some may find the idea of engineering online platforms to promote diversity paternalistic, but in reality, online spaces are already engineered with specific outcomes in mind—that is to say, they are designed to serve the needs of advertisers, who want to sell us things, and Silicon Valley venture capitalists, who want a return on investment. Curiously, Rewire, for all of its emphasis on the pivotal role that individuals play via the filters they impose on the flow of information, glosses over the myriad ways social media are shaped by market forces. While Zuckerman describes traditional journalism as “hobbled by business concerns,” he never mentions the way those same concerns have carried over into a digital age, and yoked the development of private platforms to the quest for profit. For example, when talking about Netflix’s recommendation engine, he doesn’t acknowledge that the program is risk averse because it is designed to facilitate consumption of movies that customers will enjoy; he fails to reckon with the obstacles that such economic imperatives pose to the project of making our online experience less predictable. Ultimately, Zuckerman avoids political economy and emphasizes personal responsibility and choice. He argues, in essence, that we should find innovative ways to expand the repertoire of what we want.
Given this view, it makes sense that Zuckerman profiles a handful of characters who have embodied his outward-facing ideal and benefited from border crossing: Pablo Picasso, whose art was inspired by African masks; Paul Simon, who drew on similar musical influences to produce his megaselling Afro-pop album Graceland; and Matt Harding, an American who made a series of chewing-gum-sponsored YouTube videos of himself dancing with strangers around the world.
Still, there’s something discomfitingly thin about such case studies, suggesting that Zuckerman’s version of a cosmopolitan ethos is merely one of mixing styles. He maintains that these figures are more than appropriators or tourists, but it’s far from clear how they may challenge the status quo of selective and voyeuristic Western encounters with an exoticized version of the world at large. In this regard, they underscore the privileged perspective that Zuckerman himself consistently falls back on. In Rewire, he is focused on the problem of individuals choosing not to seek out information from other places, and in plumbing the issues arising from this problem, he assumes that all of us feel empowered to investigate other communities but simply don’t bother. The world’s cultures are portrayed as a buffet everyone feels equally invited to sample from. But in real life people are marginalized and excluded from this experiential banquet—in subtle and not-so-subtle ways that Rewire doesn’t account for.
Zuckerman is not unaware of social inequities. Indeed, it was his shock at the lack of coverage about Ghana, a country where he worked and lived, that motivated him to begin thinking about these issues. Nonetheless, privileged people widening their view of the world won’t necessarily make the actual world more inclusive. Likewise, increasing diversity doesn’t automatically make the world more just or fair.
Skirting these complexities, Rewire ultimately provides an unsatisfying answer to the fundamental question it raises: Why should we strive to be cosmopolitan? The book’s jacket copy offers a surprisingly mundane rationale: A “wider picture” of the world, it states, is “critical for global success.” The ability to make connections, Zuckerman writes, “is a new form of power.” Rewire’s final chapter portrays a handful of powerfully cosmopolitan individuals, including the CEOs of Pepsi, Coke, and Nissan, the latter a Brazilian of Lebanese descent who awed Japanese businessmen with his “audacity” when he laid off 14 percent of the automaker’s workforce. In an unexpected twist, multinational corporations are held up as paragons of connection, deserving praise for hiring executives from foreign countries to screw their employees. Why not praise small restaurants for “leveraging diversity” by having Mexican kitchen staffs or upper-class families for hiring Tibetan nannies?
Zuckerman comes across as a kind and generous person who wants to make space for everyone, including, it seems, the global financial elite. While I respect his openness, I’m less forgiving. If cosmopolitanism is to be a force for desirable change in this world, it has to have a purpose more profound than the vision Zuckerman describes in his final chapter. The ease of digital connection may not bring about world peace, but that doesn’t mean we have to disavow all idealism and big dreams. If we’re going to rewire, let’s try to go further.
Thursday, June 6, 2013
Bobby, We Still Miss You
Sen. Robert Kennedy: Forty-five years ago today he died
Print By Charles J. Dean
cdean@al.com al.com
on June 06, 2013 at 12:50 PM, updated June 06, 2013 at 12:51 PM
BIRMINGHAM, Alabama – Forty-five years ago today Sen. Robert F. Kennedy of New York died from gunshot wounds sustained at the hands of Palestinian national Sirhan Sirhan.
Kennedy's assassination came just two months after the murder of the Rev. Martin Luther King Jr. and just 55 months shy of the assassination of his brother, President John F. Kennedy.
Robert Kennedy was shot as he walked through the kitchen of a Los Angeles hotel moments after winning the California Democratic presidential primary, a critical victory in his pursuit of the 1968 Democratic presidential nomination.
Kennedy's murder, coming as it did just a few months after King and the brutal killing of a second Kennedy in less than five years, shocked the nation.
Kennedy's death, coming less than a week before the fifth anniversary of the historic and successful desegregation of the University of Alabama, left only Gov. George Wallace as the surviving member of the three political leaders who had played leading rolls in the June 11, 1963 integration at UA – Wallace and the two Kennedy brothers.
Wallace himself was running for president in 1968, as an independent third party candidate running in large measure on the same themes he had given voice to in his schoolhouse door stand at UA almost five years before – distrust of centralize government, intellectuals, U.S. Supreme court rulings forcing the South to desegregate public services and institutions and scorn of what Wallace called the hippie culture.
Robert Kennedy and Wallace had spent much of their political lives on a collision course.
In April 1963 RFK had traveled to Montgomery to meet with Wallace and discuss what he might do regarding the expected effort to desegregate UA. Wallace had ordered state troopers to surround the Capitol ostensetively to protect Kennedy from a crowd that featured hostile and racist signs, such as "Koon Kissing Kennedy Go Home." At one point, on his way in to see Wallace, one trooper shoved a stick in his stomach."
As attorney general it was Kennedy's Justice Department that largely lead the effort to desegregate UA and the confrontation it would lead to with Wallace.
Ironically, like John and Robert Kennedy, Wallace would become the victim of an assassination attempt just four years after RFK was killed. Unlike the Kennedy's, Wallace would survive the attempt but he would never again be a force in national politics.
Print By Charles J. Dean
cdean@al.com al.com
on June 06, 2013 at 12:50 PM, updated June 06, 2013 at 12:51 PM
BIRMINGHAM, Alabama – Forty-five years ago today Sen. Robert F. Kennedy of New York died from gunshot wounds sustained at the hands of Palestinian national Sirhan Sirhan.
Kennedy's assassination came just two months after the murder of the Rev. Martin Luther King Jr. and just 55 months shy of the assassination of his brother, President John F. Kennedy.
Robert Kennedy was shot as he walked through the kitchen of a Los Angeles hotel moments after winning the California Democratic presidential primary, a critical victory in his pursuit of the 1968 Democratic presidential nomination.
Kennedy's murder, coming as it did just a few months after King and the brutal killing of a second Kennedy in less than five years, shocked the nation.
Kennedy's death, coming less than a week before the fifth anniversary of the historic and successful desegregation of the University of Alabama, left only Gov. George Wallace as the surviving member of the three political leaders who had played leading rolls in the June 11, 1963 integration at UA – Wallace and the two Kennedy brothers.
Wallace himself was running for president in 1968, as an independent third party candidate running in large measure on the same themes he had given voice to in his schoolhouse door stand at UA almost five years before – distrust of centralize government, intellectuals, U.S. Supreme court rulings forcing the South to desegregate public services and institutions and scorn of what Wallace called the hippie culture.
Robert Kennedy and Wallace had spent much of their political lives on a collision course.
In April 1963 RFK had traveled to Montgomery to meet with Wallace and discuss what he might do regarding the expected effort to desegregate UA. Wallace had ordered state troopers to surround the Capitol ostensetively to protect Kennedy from a crowd that featured hostile and racist signs, such as "Koon Kissing Kennedy Go Home." At one point, on his way in to see Wallace, one trooper shoved a stick in his stomach."
As attorney general it was Kennedy's Justice Department that largely lead the effort to desegregate UA and the confrontation it would lead to with Wallace.
Ironically, like John and Robert Kennedy, Wallace would become the victim of an assassination attempt just four years after RFK was killed. Unlike the Kennedy's, Wallace would survive the attempt but he would never again be a force in national politics.
Tuesday, June 4, 2013
3 Films
Since this blog sometimes discusses films, I will mention three that I saw recently.
Lincoln
This was a breezy and entertaining. But it gave me no lasting impression. As with any Spielberg movie, it lacked depth. I have never liked Spielberg. To me, he makes summer, popcorn movies that have never resonated with me. This movie was more of the same.
2001: A Space Odyssey
I usually do not watch older movies, but this is a classic and I figured I should give it a try. It is wonderful. It leaves me contemplating the monolith and its meaning for human evolution. The ending is vague, which prompts more thought. The special effects must have been dazzling for its time. Sparse dialogue and little action is my kind of movie.
The Loneliest Planet
Superb movie about relationships and the moments that define us. Little dialogue and little action, set against a trek through the Caucasus Mountains, it is an exploration of the human condition. A reviewer had this to say:
"If I describe Julia Loktev's second feature, The Loneliest Planet, as having some of the absolutely best shots of people walking that I have ever seen in a motion picture, I fancy that I have both demonstrated what is the general shape of the movie's appeal, while also demonstrating why that appeal is undoubtedly limited to a tiny and self-selecting audience. Nevertheless, we exist, we folks for whom "the shots of people walking in this movie are extraordinary" is absolutely a statement of sincere, downright enthusiastic praise, and not a joke about art cinema's anti-narrative content. And for us, The Loneliest Planet is cause for celebration."
A movie about what it means to exist, with people navigating their issues in their relationship, along with the societal expectations of gender roles, the parameters of love, and the reconciliation of their disappointment over their failed expectations of the other - that is my kind of movie.
Lincoln
This was a breezy and entertaining. But it gave me no lasting impression. As with any Spielberg movie, it lacked depth. I have never liked Spielberg. To me, he makes summer, popcorn movies that have never resonated with me. This movie was more of the same.
2001: A Space Odyssey
I usually do not watch older movies, but this is a classic and I figured I should give it a try. It is wonderful. It leaves me contemplating the monolith and its meaning for human evolution. The ending is vague, which prompts more thought. The special effects must have been dazzling for its time. Sparse dialogue and little action is my kind of movie.
The Loneliest Planet
Superb movie about relationships and the moments that define us. Little dialogue and little action, set against a trek through the Caucasus Mountains, it is an exploration of the human condition. A reviewer had this to say:
"If I describe Julia Loktev's second feature, The Loneliest Planet, as having some of the absolutely best shots of people walking that I have ever seen in a motion picture, I fancy that I have both demonstrated what is the general shape of the movie's appeal, while also demonstrating why that appeal is undoubtedly limited to a tiny and self-selecting audience. Nevertheless, we exist, we folks for whom "the shots of people walking in this movie are extraordinary" is absolutely a statement of sincere, downright enthusiastic praise, and not a joke about art cinema's anti-narrative content. And for us, The Loneliest Planet is cause for celebration."
A movie about what it means to exist, with people navigating their issues in their relationship, along with the societal expectations of gender roles, the parameters of love, and the reconciliation of their disappointment over their failed expectations of the other - that is my kind of movie.
Obama's Economic Rebound
Obama’s Economic Triumph
by Michael Tomasky Jun 4, 2013 4:45 AM EDT
It’s increasingly clear that the president has steered the country back from the brink—and, in the process, exposed (yet again) the central lie of conservative economics.
This Friday morning will bring the new jobs numbers. If recent months and indicators are any sign, the news will be at least pretty good, and maybe really good—
remember, the last several months have all been revised upward by significant amounts after the initial estimates. Yes, there is still a ways to go. But everything is moving in the right direction. The president and his people jumped the gun pretty badly in 2010 with their talk of “Recovery Summer.” But 2013 might finally be Recovery Summer. And by next summer, most experts say, the unemployment rate really will be back down to the normal range. In other words, the Republicans are about out of chances to do what they’ve been trying to do since Barack Obama took office—i.e., wreck the economy. Now more than ever, Obama has to ignore these people and get through the next three-plus years just trying to make sure they can’t screw up the economy any worse than they already have.
Let’s first review some recent economic news. Consumer confidence is at a five-year high. Personal debt is back to normal levels, which is a big deal. Housing investment is up, real-estate prices are rebounding everywhere, the stock market is breaking records. The political-economic news has been no less comforting to the right. Kenneth Rogoff and Carmen Reinhart’s arguments against higher deficit-spending have been debunked. And as winter melted into spring, with oddly little commentary, Obama soared past George W. Bush in the net job-creation sweepstakes: Obama has now created a net positive of more than 1.6 million jobs in four-and-a-half years, which is better than Bush’s mark of 1.08 million in all eight of his years.
Many economists believe that things would be going even better right now without the austerity imposed on us by the Republicans who run the House of Representatives. It is true—and this is one point on which liberals, me included, haven’t been entirely consistent—that “austerity” also includes the higher taxes on the rich achieved through the fiscal-cliff deal, and the end of the 2 percent payroll tax holiday. So Obama does bear some responsibility for those particular forms of austerity, although the budget cuts the GOP insisted on have had considerably more negative impact on the economy than the tax increases.
But here’s another point about those tax increases that arguably outweighs the austerity point, or is certainly far more important in historical terms: when you raise taxes, duh, you increase revenues. And so the deficit is going to tumble this year to its lowest level since 2008 ($845 billion or even lower, the way things are going), and next year to a level barely more than 2 percent of GDP, which is a level at which it’s not even worth worrying about. The deficit is going down because revenues are going up, and revenues are going up, the Congressional Budget Office says, “because of the growing economy, from policy changes that are scheduled to take effect during that period, and from policy changes that have already taken effect but whose full impact on revenues will not be felt until after this year (such as the recent increase in tax rates on income above certain thresholds).”
This is huge. Republicans, as we know, have spent years saying that raising taxes doesn’t increase revenues. It’s an argument that sits at the very core of supply-side theory. It’s been an absolute article of faith. They tried to say this when they passed the Bush tax cuts, and they’ve tried to say it since. But they were just lying. The Bush tax cuts cost the treasury $1.3 trillion by the low estimates and $1.8 trillion by the higher ones. They continued to make these claims long after the facts were in, but facts never stopped them, of course.
So let’s review. The only thing the Republicans have done to the economy since 2001 is make it worse. The tax cuts did not generate the great surge of activity that was predicted. Against Republican predictions and conservative economic belief, they drained the treasury. Later, GOP-led deregulation nearly destroyed the global economy. Then, when the new guy tried to rescue the economy, they opposed everything he tried. Today, with indicators clearly on the right track and clearly suggesting that more stimulus would help the recovery, they of course oppose that, too.
The only thing the Republicans have done to the economy since 2001 is make it worse.
Obama isn’t going to get anything out of these people. He’s just going to have to Heisman them—stiff-arm them, keep them out of the way, prevent them from doing more damage. No grand bargain. That’s obviously over. No entitlement talks or concessions. And on the debt ceiling, Obama should push them right to the wall. The Republicans want more budget cuts and/or entitlement “reform” in exchange for raising the debt limit later this summer or early in the fall. But in an improving economy, and with the public aware that we’ve already endured deep budget cuts, Obama should be sitting in the catbird’s seat.
There’s a lot that I’m sure Obama would like to do that he’s never going to have a chance to do. A carbon tax or cap-and-trade regime is probably not going to happen. Ditto comprehensive, progressive tax reform. But he is going to be the president who led the country back from the edge of economic disaster and who managed to get a tax increase that helped disprove (yet again) the key trickle-down falsehood.
And, if the economy keeps growing at the pace of the past year, he stands to leave office having created several millions net jobs. That pace is 169,000 jobs per month. Multiply that by the 42 remaining months, and you come up with 7.1 million, on top of the 1.6 million net jobs already created. Those sure aren’t Clinton numbers. But they sure aren’t Republican numbers either. And the American people will know this.
by Michael Tomasky Jun 4, 2013 4:45 AM EDT
It’s increasingly clear that the president has steered the country back from the brink—and, in the process, exposed (yet again) the central lie of conservative economics.
This Friday morning will bring the new jobs numbers. If recent months and indicators are any sign, the news will be at least pretty good, and maybe really good—
remember, the last several months have all been revised upward by significant amounts after the initial estimates. Yes, there is still a ways to go. But everything is moving in the right direction. The president and his people jumped the gun pretty badly in 2010 with their talk of “Recovery Summer.” But 2013 might finally be Recovery Summer. And by next summer, most experts say, the unemployment rate really will be back down to the normal range. In other words, the Republicans are about out of chances to do what they’ve been trying to do since Barack Obama took office—i.e., wreck the economy. Now more than ever, Obama has to ignore these people and get through the next three-plus years just trying to make sure they can’t screw up the economy any worse than they already have.
Let’s first review some recent economic news. Consumer confidence is at a five-year high. Personal debt is back to normal levels, which is a big deal. Housing investment is up, real-estate prices are rebounding everywhere, the stock market is breaking records. The political-economic news has been no less comforting to the right. Kenneth Rogoff and Carmen Reinhart’s arguments against higher deficit-spending have been debunked. And as winter melted into spring, with oddly little commentary, Obama soared past George W. Bush in the net job-creation sweepstakes: Obama has now created a net positive of more than 1.6 million jobs in four-and-a-half years, which is better than Bush’s mark of 1.08 million in all eight of his years.
Many economists believe that things would be going even better right now without the austerity imposed on us by the Republicans who run the House of Representatives. It is true—and this is one point on which liberals, me included, haven’t been entirely consistent—that “austerity” also includes the higher taxes on the rich achieved through the fiscal-cliff deal, and the end of the 2 percent payroll tax holiday. So Obama does bear some responsibility for those particular forms of austerity, although the budget cuts the GOP insisted on have had considerably more negative impact on the economy than the tax increases.
But here’s another point about those tax increases that arguably outweighs the austerity point, or is certainly far more important in historical terms: when you raise taxes, duh, you increase revenues. And so the deficit is going to tumble this year to its lowest level since 2008 ($845 billion or even lower, the way things are going), and next year to a level barely more than 2 percent of GDP, which is a level at which it’s not even worth worrying about. The deficit is going down because revenues are going up, and revenues are going up, the Congressional Budget Office says, “because of the growing economy, from policy changes that are scheduled to take effect during that period, and from policy changes that have already taken effect but whose full impact on revenues will not be felt until after this year (such as the recent increase in tax rates on income above certain thresholds).”
This is huge. Republicans, as we know, have spent years saying that raising taxes doesn’t increase revenues. It’s an argument that sits at the very core of supply-side theory. It’s been an absolute article of faith. They tried to say this when they passed the Bush tax cuts, and they’ve tried to say it since. But they were just lying. The Bush tax cuts cost the treasury $1.3 trillion by the low estimates and $1.8 trillion by the higher ones. They continued to make these claims long after the facts were in, but facts never stopped them, of course.
So let’s review. The only thing the Republicans have done to the economy since 2001 is make it worse. The tax cuts did not generate the great surge of activity that was predicted. Against Republican predictions and conservative economic belief, they drained the treasury. Later, GOP-led deregulation nearly destroyed the global economy. Then, when the new guy tried to rescue the economy, they opposed everything he tried. Today, with indicators clearly on the right track and clearly suggesting that more stimulus would help the recovery, they of course oppose that, too.
The only thing the Republicans have done to the economy since 2001 is make it worse.
Obama isn’t going to get anything out of these people. He’s just going to have to Heisman them—stiff-arm them, keep them out of the way, prevent them from doing more damage. No grand bargain. That’s obviously over. No entitlement talks or concessions. And on the debt ceiling, Obama should push them right to the wall. The Republicans want more budget cuts and/or entitlement “reform” in exchange for raising the debt limit later this summer or early in the fall. But in an improving economy, and with the public aware that we’ve already endured deep budget cuts, Obama should be sitting in the catbird’s seat.
There’s a lot that I’m sure Obama would like to do that he’s never going to have a chance to do. A carbon tax or cap-and-trade regime is probably not going to happen. Ditto comprehensive, progressive tax reform. But he is going to be the president who led the country back from the edge of economic disaster and who managed to get a tax increase that helped disprove (yet again) the key trickle-down falsehood.
And, if the economy keeps growing at the pace of the past year, he stands to leave office having created several millions net jobs. That pace is 169,000 jobs per month. Multiply that by the 42 remaining months, and you come up with 7.1 million, on top of the 1.6 million net jobs already created. Those sure aren’t Clinton numbers. But they sure aren’t Republican numbers either. And the American people will know this.
Sunday, June 2, 2013
Why US Medicine Cost So Much
Paying Till It Hurts A Case Study in High CostsPaying Till It Hurts
The $2.7 Trillion Medical BillColonoscopies Explain Why U.S. Leads the World in Health ExpendituresBy ELISABETH ROSENTHAL
Published: June 1, 2013
Source: 2012 Comparative Price Report by the International Federation of Health Plans. The average prices shown for colonoscopies do not include added fees for sedation by an anesthesiologist, a practice common in the United States, but unusual in the rest of the world. The additional charges can increase the cost significantly.
Published: June 1, 2013
How much of a factor is cost when you are deciding whether to undergo a medical test, and where to have it done?
MERRICK, N.Y. — Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.
That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.
“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”
In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.
Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system. They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system. A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories — and often by a huge margin.
Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.
.
While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones. “The U.S. just pays providers of health care much more for everything,” said Tom Sackville, chief executive of the health plans federation and a former British health minister.
Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries. Their numbers have increased manyfold over the last 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.
Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers — which were created as a step down from costly hospital care but are now often a lucrative step up from doctors’ examining rooms — where they are billed like a quasi operation. They are often prescribed and performed more frequently than medical guidelines recommend.
The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.
While several cheaper and less invasive tests to screen for colon cancer are recommended as equally effective by the federal government’s expert panel on preventive care — and are commonly used in other countries — colonoscopy has become the go-to procedure in the United States. “We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.
In coming months, The New York Times will look at common procedures, drugs and medical encounters to examine how the economic incentives underlying the fragmented health care market in the United States have driven up costs, putting deep economic strains on consumers and the country.
Hospitals, drug companies, device makers, physicians and other providers can benefit by charging inflated prices, favoring the most costly treatment options and curbing competition that could give patients more, and cheaper, choices. And almost every interaction can be an opportunity to send multiple, often opaque bills with long lists of charges: $100 for the ice pack applied for 10 minutes after a physical therapy session, or $30,000 for the artificial joint implanted in surgery.
The United States spends about 18 percent of its gross domestic product on health care, nearly twice as much as most other developed countries. The Congressional Budget Office has said that if medical costs continue to grow unabated, “total spending on health care would eventually account for all of the country’s economic output.” And it identified federal spending on government health programs as a primary cause of long-term budget deficits.
While the rise in health care spending in the United States has slowed in the past four years — to about 4 percent annually from about 8 percent — it is still expected to rise faster than the gross domestic product. Aging baby boomers and tens of millions of patients newly insured under the Affordable Care Act are likely to add to the burden.
Advertisement
.
With health insurance premiums eating up ever more of her flat paycheck, Ms. Yapalater, a customer relations specialist for a small Long Island company, recently decided to forgo physical therapy for an injury sustained during Hurricane Sandy because of high out-of-pocket expenses. She refused a dermatology medication prescribed for her daughter when the pharmacist said the co-payment was $130. “I said, ‘That’s impossible, I have insurance,’ ” Ms. Yapalater recalled. “I called the dermatologist and asked for something cheaper, even if it’s not as good.”
The more than $35,000 annually that Ms. Yapalater and her employer collectively pay in premiums — her share is $15,000 — for her family’s Oxford Freedom Plan would be more than sufficient to cover their medical needs in most other countries. She and her husband, Jeff, 63, a sales and marketing consultant, have three children in their 20s with good jobs. Everyone in the family exercises, and none has had a serious illness.
Like the Yapalaters, many other Americans have habits or traits that arguably could put the nation at the low end of the medical cost spectrum. Patients in the United States make fewer doctors’ visits and have fewer hospital stays than citizens of many other developed countries, according to the Commonwealth Fund report. People in Japan get more CT scans. People in Germany, Switzerland and Britain have more frequent hip replacements. The American population is younger and has fewer smokers than those in most other developed countries. Pushing costs in the other direction, though, is that the United States has relatively high rates of obesity and limited access to routine care for the poor.
A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor. Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide, for example.
“In the U.S., we like to consider health care a free market,” said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ”But it is a very weird market, riddled with market failures.”
Consider this:
Consumers, the patients, do not see prices until after a service is provided, if they see them at all. And there is little quality data on hospitals and doctors to help determine good value, aside from surveys conducted by popular Web sites and magazines. Patients with insurance pay a tiny fraction of the bill, providing scant disincentive for spending.
Even doctors often do not know the costs of the tests and procedures they prescribe. When Dr. Michael Collins, an internist in East Hartford, Conn., called the hospital that he is affiliated with to price lab tests and a colonoscopy, he could not get an answer. “It’s impossible for me to think about cost,” he said. “If you go to the supermarket and there are no prices, how can you make intelligent decisions?”
Instead, payments are often determined in countless negotiations between a doctor, hospital or pharmacy, and an insurer, with the result often depending on their relative negotiating power. Insurers have limited incentive to bargain forcefully, since they can raise premiums to cover costs.
“It all comes down to market share, and very rarely is anyone looking out for the patient,” said Dr. Jeffrey Rice, the chief executive of Healthcare Blue Book, which tracks commercial insurance payments. “People think it’s like other purchases: that if you pay more you get a better car. But in medicine, it’s not like that.”
The $2.7 Trillion Medical BillColonoscopies Explain Why U.S. Leads the World in Health ExpendituresBy ELISABETH ROSENTHAL
Published: June 1, 2013
Source: 2012 Comparative Price Report by the International Federation of Health Plans. The average prices shown for colonoscopies do not include added fees for sedation by an anesthesiologist, a practice common in the United States, but unusual in the rest of the world. The additional charges can increase the cost significantly.
Published: June 1, 2013
How much of a factor is cost when you are deciding whether to undergo a medical test, and where to have it done?
MERRICK, N.Y. — Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.
That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.
“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”
In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.
Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system. They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system. A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories — and often by a huge margin.
Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.
.
While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones. “The U.S. just pays providers of health care much more for everything,” said Tom Sackville, chief executive of the health plans federation and a former British health minister.
Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries. Their numbers have increased manyfold over the last 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.
Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers — which were created as a step down from costly hospital care but are now often a lucrative step up from doctors’ examining rooms — where they are billed like a quasi operation. They are often prescribed and performed more frequently than medical guidelines recommend.
The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.
While several cheaper and less invasive tests to screen for colon cancer are recommended as equally effective by the federal government’s expert panel on preventive care — and are commonly used in other countries — colonoscopy has become the go-to procedure in the United States. “We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.
In coming months, The New York Times will look at common procedures, drugs and medical encounters to examine how the economic incentives underlying the fragmented health care market in the United States have driven up costs, putting deep economic strains on consumers and the country.
Hospitals, drug companies, device makers, physicians and other providers can benefit by charging inflated prices, favoring the most costly treatment options and curbing competition that could give patients more, and cheaper, choices. And almost every interaction can be an opportunity to send multiple, often opaque bills with long lists of charges: $100 for the ice pack applied for 10 minutes after a physical therapy session, or $30,000 for the artificial joint implanted in surgery.
The United States spends about 18 percent of its gross domestic product on health care, nearly twice as much as most other developed countries. The Congressional Budget Office has said that if medical costs continue to grow unabated, “total spending on health care would eventually account for all of the country’s economic output.” And it identified federal spending on government health programs as a primary cause of long-term budget deficits.
While the rise in health care spending in the United States has slowed in the past four years — to about 4 percent annually from about 8 percent — it is still expected to rise faster than the gross domestic product. Aging baby boomers and tens of millions of patients newly insured under the Affordable Care Act are likely to add to the burden.
Advertisement
.
With health insurance premiums eating up ever more of her flat paycheck, Ms. Yapalater, a customer relations specialist for a small Long Island company, recently decided to forgo physical therapy for an injury sustained during Hurricane Sandy because of high out-of-pocket expenses. She refused a dermatology medication prescribed for her daughter when the pharmacist said the co-payment was $130. “I said, ‘That’s impossible, I have insurance,’ ” Ms. Yapalater recalled. “I called the dermatologist and asked for something cheaper, even if it’s not as good.”
The more than $35,000 annually that Ms. Yapalater and her employer collectively pay in premiums — her share is $15,000 — for her family’s Oxford Freedom Plan would be more than sufficient to cover their medical needs in most other countries. She and her husband, Jeff, 63, a sales and marketing consultant, have three children in their 20s with good jobs. Everyone in the family exercises, and none has had a serious illness.
Like the Yapalaters, many other Americans have habits or traits that arguably could put the nation at the low end of the medical cost spectrum. Patients in the United States make fewer doctors’ visits and have fewer hospital stays than citizens of many other developed countries, according to the Commonwealth Fund report. People in Japan get more CT scans. People in Germany, Switzerland and Britain have more frequent hip replacements. The American population is younger and has fewer smokers than those in most other developed countries. Pushing costs in the other direction, though, is that the United States has relatively high rates of obesity and limited access to routine care for the poor.
A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor. Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide, for example.
“In the U.S., we like to consider health care a free market,” said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ”But it is a very weird market, riddled with market failures.”
Consider this:
Consumers, the patients, do not see prices until after a service is provided, if they see them at all. And there is little quality data on hospitals and doctors to help determine good value, aside from surveys conducted by popular Web sites and magazines. Patients with insurance pay a tiny fraction of the bill, providing scant disincentive for spending.
Even doctors often do not know the costs of the tests and procedures they prescribe. When Dr. Michael Collins, an internist in East Hartford, Conn., called the hospital that he is affiliated with to price lab tests and a colonoscopy, he could not get an answer. “It’s impossible for me to think about cost,” he said. “If you go to the supermarket and there are no prices, how can you make intelligent decisions?”
Instead, payments are often determined in countless negotiations between a doctor, hospital or pharmacy, and an insurer, with the result often depending on their relative negotiating power. Insurers have limited incentive to bargain forcefully, since they can raise premiums to cover costs.
“It all comes down to market share, and very rarely is anyone looking out for the patient,” said Dr. Jeffrey Rice, the chief executive of Healthcare Blue Book, which tracks commercial insurance payments. “People think it’s like other purchases: that if you pay more you get a better car. But in medicine, it’s not like that.”
Saturday, June 1, 2013
Now You See Me
Here you have a very good summer movie. It's light, breezy, and entertaining. You have great actors, a mystery, and even good car chases! Morgan Freeman is delightful. Woody Harrelson is delightful. Michael Caine is delightful as usual. The plot is twisting, but the good thing is you don't have to worry about it. Just let it come without trying to figure out what is going on. I suppose you can the plot is confusing, but no matter. There is a final twist at the end that is satisfying. An almost perfect summer movie.
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