Longreads Pick
In the first four years as the first black president, Obama has largely avoided addressing race directly. Some historical context:
“Thus the myth of ‘twice as good’ that makes Barack Obama possible also smothers him. It holds that African Americans—enslaved, tortured, raped, discriminated against, and subjected to the most lethal homegrown terrorist movement in American history—feel no anger toward their tormentors. Of course, very little in our history argues that those who seek to tell bold truths about race will be rewarded. But it was Obama himself, as a presidential candidate in 2008, who called for such truths to be spoken. ‘Race is an issue that I believe this nation cannot afford to ignore right now,’ he said in his ‘More Perfect Union’ speech, which he delivered after a furor erupted over Reverend Wright’s ‘God Damn America’ remarks. And yet, since taking office, Obama has virtually ignored race.
“Whatever the political intelligence of this calculus, it has broad and deep consequences. The most obvious result is that it prevents Obama from directly addressing America’s racial history, or saying anything meaningful about present issues tinged by race, such as mass incarceration or the drug war. There have been calls for Obama to take a softer line on state-level legalization of marijuana or even to stand for legalization himself. Indeed, there is no small amount of inconsistency in our black president’s either ignoring or upholding harsh drug laws that every day injure the prospects of young black men—laws that could have ended his own, had he been of another social class and arrested for the marijuana use he openly discusses. But the intellectual argument doubles as the counterargument. If the fact of a black president is enough to racialize the wonkish world of health-care reform, what havoc would the Obama touch wreak upon the already racialized world of drug policy?”
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Published: Aug 23, 2012
Length: 38 minutes (9,709 words)
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How the 42-year-old Wisconsin representative (and now Mitt Romney VP pick) took a leading role in the Republican Party’s budget battle with President Obama:
Three days later, the White House started a livelier debate with Ryan. In a press briefing, Peter Orszag, the budget director at the time, dismantled Ryan’s plan, point by point. Ryan’s proposal would turn Medicare ‘into a voucher program, so that individuals are on their own in the health-care market,’ he said. Over time, the program wouldn’t keep pace with rising medical costs, so seniors would have to pay thousands of dollars more a year for health care. The Roadmap would revive Bush’s plan to privatize Social Security and ‘provide large tax benefits to upper-income households … while shifting the burden onto middle- and lower-income households. It is a dramatically different approach in which much more risk is loaded onto individuals.’ Ryan, who had always had a good relationship with Orszag, later described the briefing as the moment when ‘the budget director took that olive branch and hit me in the face with it.’
But the confrontation enhanced Ryan’s credibility among conservatives. He became the face of the opposition, someone who could attack the President’s policies with facts and figures. Indeed, at the retreat, Obama had mischaracterized Ryan’s Medicare plan, and Ryan politely corrected him. The two men sparred again the next month, at a summit at Blair House, over the President’s health-care plan. The details of Ryan’s proposals and his critiques of Obama’s mattered less than the fact that he was taking on the President.
“Fussbudget.” — Ryan Lizza, New Yorker
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Longreads Pick
How the 42-year-old Wisconsin representative (and now Mitt Romney VP pick) took a leading role in the Republican Party’s budget battle with President Obama:
“Three days later, the White House started a livelier debate with Ryan. In a press briefing, Peter Orszag, the budget director at the time, dismantled Ryan’s plan, point by point. Ryan’s proposal would turn Medicare ‘into a voucher program, so that individuals are on their own in the health-care market,’ he said. Over time, the program wouldn’t keep pace with rising medical costs, so seniors would have to pay thousands of dollars more a year for health care. The Roadmap would revive Bush’s plan to privatize Social Security and ‘provide large tax benefits to upper-income households . . . while shifting the burden onto middle- and lower-income households. It is a dramatically different approach in which much more risk is loaded onto individuals.’ Ryan, who had always had a good relationship with Orszag, later described the briefing as the moment when ‘the budget director took that olive branch and hit me in the face with it.’
“But the confrontation enhanced Ryan’s credibility among conservatives. He became the face of the opposition, someone who could attack the President’s policies with facts and figures. Indeed, at the retreat, Obama had mischaracterized Ryan’s Medicare plan, and Ryan politely corrected him. The two men sparred again the next month, at a summit at Blair House, over the President’s health-care plan. The details of Ryan’s proposals and his critiques of Obama’s mattered less than the fact that he was taking on the President.”
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Published: Aug 6, 2012
Length: 26 minutes (6,504 words)
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What can hospitals learn from a national restaurant chain like Cheesecake Factory?
‘It is unbelievable to me that they would not manage this better,’ Luz said. I asked him what he would do if he were the manager of a neurology unit or a cardiology clinic. ‘I don’t know anything about medicine,’ he said. But when I pressed he thought for a moment, and said, ‘This is pretty obvious. I’m sure you already do it. But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.’
This is not at all the normal way of doing things in medicine. (‘You’re scaring me,’ he said, when I told him.) But it’s exactly what the new health-care chains are now hoping to do on a mass scale. They want to create Cheesecake Factories for health care. The question is whether the medical counterparts to Mauricio at the broiler station—the clinicians in the operating rooms, in the medical offices, in the intensive-care units—will go along with the plan. Fixing a nice piece of steak is hardly of the same complexity as diagnosing the cause of an elderly patient’s loss of consciousness. Doctors and patients have not had a positive experience with outsiders second-guessing decisions. How will they feel about managers trying to tell them what the ‘best practices’ are?
“Big Med.” — Atul Gawande, The New Yorker
More from Gawande
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Longreads Pick
What can hospitals learn from a national restaurant chain like Cheesecake Factory?
“‘It is unbelievable to me that they would not manage this better,’ Luz said. I asked him what he would do if he were the manager of a neurology unit or a cardiology clinic. ‘I don’t know anything about medicine,’ he said. But when I pressed he thought for a moment, and said, ‘This is pretty obvious. I’m sure you already do it. But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.’
“This is not at all the normal way of doing things in medicine. (‘You’re scaring me,’ he said, when I told him.) But it’s exactly what the new health-care chains are now hoping to do on a mass scale. They want to create Cheesecake Factories for health care. The question is whether the medical counterparts to Mauricio at the broiler station—the clinicians in the operating rooms, in the medical offices, in the intensive-care units—will go along with the plan. Fixing a nice piece of steak is hardly of the same complexity as diagnosing the cause of an elderly patient’s loss of consciousness. Doctors and patients have not had a positive experience with outsiders second-guessing decisions. How will they feel about managers trying to tell them what the ‘best practices’ are?”
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Published: Aug 6, 2012
Length: 39 minutes (9,881 words)
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A minute-by-minute account of the Supreme Court’s ruling on the American Care Act, and how some news organizations initially got it wrong:
Into his conference call, the CNN producer says (correctly) that the Court has held that the individual mandate cannot be sustained under the Commerce Clause, and (incorrectly) that it therefore ‘looks like’ the mandate has been struck down. The control room asks whether they can ‘go with’ it, and after a pause, he says yes.
The Fox producer reads the syllabus exactly the same way, and reports that the mandate has been invalidated. Asked to confirm that the mandate has been struck down, he responds: ‘100%.’
The Bloomberg team finishes its review, having read the Commerce Clause holding and then turned the page to see that the Court accepted the government’s alternative argument that the individual mandate is constitutional under Congress’s tax power. At 10:07:32 – 52 seconds after the Chief Justice began speaking – Bloomberg issues an alert: ’OBAMA’S HEALTH-CARE OVERHAUL UPHELD BY U.S.SUPREME COURT.’ Bloomberg is first, and it is right.
“We’re Getting Wildly Differing Assessments.” — Tom Goldstein, SCOTUSblog
More #longreads on health care
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Longreads Pick
A minute-by-minute account of the Supreme Court’s ruling on the American Care Act, and how some news organizations got it initially wrong:
“Into his conference call, the CNN producer says (correctly) that the Court has held that the individual mandate cannot be sustained under the Commerce Clause, and (incorrectly) that it therefore ‘looks like’ the mandate has been struck down. The control room asks whether they can ‘go with’ it, and after a pause, he says yes.
“The Fox producer reads the syllabus exactly the same way, and reports that the mandate has been invalidated. Asked to confirm that the mandate has been struck down, he responds: ‘100%.’
“The Bloomberg team finishes its review, having read the Commerce Clause holding and then turned the page to see that the Court accepted the government’s alternative argument that the individual mandate is constitutional under Congress’s tax power. At 10:07:32 – 52 seconds after the Chief Justice began speaking – Bloomberg issues an alert: ‘OBAMA’S HEALTH-CARE OVERHAUL UPHELD BY U.S.SUPREME COURT.’ Bloomberg is first, and it is right.”
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Published: Jul 7, 2012
Length: 28 minutes (7,137 words)
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Most attention has been on the Supreme Court fight over The Affordable Care Act’s mandate to expand health insurance to 30 million more Americans. But what’s overshadowed is what the rest of the law is doing to change the business model for health care:
The program launched in June 2009 with a checklist of quality metrics. To earn a bonus, surgeons would, among other things, need to ensure that antibiotics were administered an hour before surgery and halted 24 hours after, reducing the chances of costly complications.
Only three doctors hit the metrics that first month, but their bonuses caught the attention of others. “There was a lot of, ‘Why are those doctors getting more, and I’m not?’” Zucker says. Eight doctors got bonus payments in July; two dozen got them in August. Compliance with certain quality metrics steadily climbed from 89 percent to 98 percent in three months.
“Health Reform at 2: Why American Health Care Will Never Be the Same.” — Sarah Kliff, Washington Post
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Paul Clement, a former solicitor general under George W. Bush, is representing state attorneys general in the Supreme Court fight against Obama’s health care law—and it’s just one of seven cases he’ll be arguing before the court:
There are two ways to assess a Supreme Court argument. One is to view it as an act of persuasion. You can read Clement’s brief primarily as a letter to Justice Anthony Kennedy, who’ll likely be the deciding vote if the Court overturns Obamacare. Clement quotes Kennedy’s previous opinions throughout his brief, and he leans on broad themes rather than legalistic detail, which is a style that has worked to good effect on the justice in past cases. The other, more cynical way to view a Supreme Court argument is as an act of manipulation—to provide the justices with a plausible rationale for reaching a decision they’re already predisposed to make. If you believe that the Court’s conservative majority is itching to strike down Obamacare, then the task is to launder this decision of partisan motivation. And so Clement argues that there are, in fact, other ways to fix America’s health-care system without an individual mandate; it’s just that Congress chose not to avail itself of those means because they were politically unpopular.
“The GOP’s Great Hope for Supreme Court Season.” — Jason Zengerle, New York magazine
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Longreads Pick
Paul Clement, a former solicitor general under George W. Bush, is representing state attorneys general in the Supreme Court fight against Obama’s health care law—and it’s just one of seven cases he’ll be arguing before the court:
“There are two ways to assess a Supreme Court argument. One is to view it as an act of persuasion. You can read Clement’s brief primarily as a letter to Justice Anthony Kennedy, who’ll likely be the deciding vote if the Court overturns Obamacare. Clement quotes Kennedy’s previous opinions throughout his brief, and he leans on broad themes rather than legalistic detail, which is a style that has worked to good effect on the justice in past cases. The other, more cynical way to view a Supreme Court argument is as an act of manipulation—to provide the justices with a plausible rationale for reaching a decision they’re already predisposed to make. If you believe that the Court’s conservative majority is itching to strike down Obamacare, then the task is to launder this decision of partisan motivation. And so Clement argues that there are, in fact, other ways to fix America’s health-care system without an individual mandate; it’s just that Congress chose not to avail itself of those means because they were politically unpopular.”
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Published: Mar 19, 2012
Length: 17 minutes (4,362 words)
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