Month: February 2023

“Nonprofit” Hospitals “Enjoy Lucrative Tax Exemptions” but Often Pressure Poor to Pay More

(p. 1) More than half the nation’s roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.

But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.

To understand the shift, The Times reviewed thousands of pages of court records, internal hospital financial records and memos, tax filings, and complaints filed with regulators, and interviewed dozens of patients, lawyers, current and former hospital executives, doctors, nurses and consultants.

The Times found that the consequences have been stark. Many nonprofit hospitals were ill equipped for a flood of critically sick Covid-19 patients because they had been operating with skeleton staffs in an effort to cut costs and boost profits. Others lacked intensive care units and other resources to weather a pandemic because the nonprofit chains that owned them had focused on investments in rich communities at the expense of poorer ones.

And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in (p. 22) the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.

Founded by nuns in the 1850s, Providence says its mission is to be “steadfast in serving all, especially those who are poor and vulnerable.” Today, based in Renton, Wash., Providence is one of the largest nonprofit health systems in the country, with 51 hospitals and more than 900 clinics. Its revenue last year exceeded $27 billion.

Providence is sitting on $10 billion that it invests, Wall Street-style, alongside top private equity firms. It even runs its own venture capital fund.

For the full story, see:

Jessica Silver-Greenberg and Katie Thomas. “Entitled to Free Treatment But Hounded by Hospitals.” The New York Times, First Section (Sunday, September 25, 2022): 1 & 22-23.

(Note: the online version of the story was updated Dec. [sic] 15, 2022, and has the title “They Were Entitled to Free Care. Hospitals Hounded Them to Pay.”)

As People Die of “Old Age” Will the FDA Ever Approve Longevity Drugs?

The FDA has required that new drugs be proven to be effective against a disease, and the FDA has refused to consider old age to be a disease. Perhaps as more government institutions give “old age” as the reason for a death, the FDA will reconsider.

(p. A6) LONDON — Queen Elizabeth II died of “old age,” according to her death certificate, which was released on Thursday by the registrar general of Scotland. The certificate, which lists her occupation as Her Majesty the Queen, also notes that the queen died at 3:10 p.m. on Sept. 8 [2022] at Balmoral Castle.

The first fact is indisputable, given that the queen was 96. But the report offers no further details about the cause of her death, which came two days after she was photographed standing and smiling as she greeted Britain’s new prime minister, Liz Truss.

For the full story, see:

Mark Landler. “Record Says Queen Died of ‘Old Age’.” The New York Times (Friday, September 30, 2022): A6.

(Note: bracketed year added.]

(Note: the online version of the story has the date Sept. 29, 2022, and has the title “Queen’s Death Certificate Reveals Cause and Time of Death.”)

United Nations “Innovation Matters” Podcast Posts Episode on Diamond’s Openness to Creative Destruction

The United Nations’s “Innovation Matters” podcast on 2/24/23 posted Part 1 of a discussion of my book Openness to Creative Destruction.  Anders and I had an animated conversation, and a lengthy one, so the United Nations says we can look forward to them posting a Part 2 and a Part 3.

You can listen to the podcast on the following platforms: SoundCloud, Spotify, Apple Music, and Amazon Music.

New York City and State Government Workers “Stole More Than $1.5 Million” of Federal Covid Loan Subsidies

(p. A19) A New York City correction official, eight Police Department employees and eight other current and former city and state workers schemed to defraud Covid relief programs that were intended to provide money to struggling business owners, the authorities said on Wednesday.

The defendants submitted phony applications for disaster relief loans on behalf of hair and nail salons and day care programs that did not exist, federal prosecutors in Manhattan said. The prosecutors said many defendants spent the proceeds of their loans on personal expenses, like casino gambling, stocks, furniture and luxury clothing.

They collectively stole more than $1.5 million from the federal Small Business Administration and financial institutions that issued guaranteed loans, and the intent was to steal hundreds of thousands of dollars more, the prosecutors said.

. . .

The charges unsealed on Wednesday [Nov. 30, 2022] are part of wave of fraud prosecutions around the country related to the trillions of dollars that the government has pumped into programs to bolster the economy and provide assistance to people who had lost their jobs. The New York Times reported in August that the government had charged 1,500 people with defrauding programs that provide pandemic aid, with more than 450 convictions resulting from the cases. The Small Business Administration’s inspector general’s office has agents going through two million potentially fraudulent loan applications.

For the full story, see:

Benjamin Weiser, Chelsia Rose Marcius and Jan Ransom. “17 Public Workers Are Charged With Stealing Covid Funds.” The New York Times (Thursday, December 1, 2022): A19.

(Note: ellipsis, and bracketed date, added.]

(Note: the online version of the story has the date Nov. 30, 2022, and has the title “17 Public Employees Charged in Schemes to Steal Covid Relief Funds.”)

Flourishing Is the End, Profit Can Be a Means

Glen Hubbard has long been a thoughtful defender of entrepreneurial capitalisms. The article quoted below from The New York Times suggests that he is moving away from that. Is that true, or is The New York Times misrepresenting the development of Hubbard’s thoughts? I suspect the latter, but I have not kept up with Hubbard’s recent articles or lectures. Profits are a key means to enable human flourishing. The two are not inconsistent. Flourishing is the end, profit can be a means.

(p. C1) One zigs, the other zags. One teases the passer-by with bands of translucent glass wrapping a core of clear windows; the other, with floors angled in and out — a gentle architectural mambo. The pair of buildings that comprise Columbia University’s new business school, on its growing Manhattanville campus, exude a nervous off-kilter energy.

. . .

(p. C4) Glenn Hubbard, the former business school dean who brought the project to fruition, saw the need to break free from fealty to the unregulated free market economy that over decades has led to extraordinary wealth concentration. The idea that business should focus only on making money, attributed to the economist Milton Friedman, “was a simple and direct idea that took over business, banking, even corporate law,” Hubbard explained. “We are trying to come up with a framework that can be more about flourishing, not just profit.”

“The vision now is to bring people together and debate issues going on in the world,” said Costis Maglaras, who was on the faculty as the project was being designed and who succeeded Hubbard.

For the full story, see:

James S. Russell. “A Temple of Capitalism Opens Itself Up.” The New York Times (Saturday, January 7, 2023): C1 & C4.

(Note: ellipsis added.)

(Note: the online version of the story was updated Jan. 9, 2023, and has the title “At Columbia’s $600 Million Business School, Time to Rethink Capitalism.”)

One Cause of Increasing Burnout of Physicians Is “the Politicization of Science”

(p. A25) Ten years of data from a nationwide survey of physicians confirm another trend that’s worsened through the pandemic: Burnout rates among doctors in the United States, which were already high a decade ago, have risen to alarming levels.

Results released this month and published in Mayo Clinic Proceedings, a peer-reviewed journal, show that 63 percent of physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022, an increase from 44 percent in 2017 and 46 percent in 2011. Only 30 percent felt satisfied with their work-life balance, compared with 43 percent five years earlier.

“This is the biggest increase of emotional exhaustion that I’ve ever seen, anywhere in the literature,” said Bryan Sexton, the director of Duke University’s Center for Healthcare Safety and Quality, who was not involved in the survey efforts.

. . .

The increase in burnout is most likely a mix of new problems and exacerbated old ones, Dr. Shanafelt said. For instance, the high number of messages doctors received about patients’ electronic health records was closely linked to increased burnout before the pandemic. After the pandemic, the number of messages from patients coming into physicians’ In Baskets, a health care closed messaging system, increased by 157 percent.

And physicians pointed to the politicization of science, labor shortages and the vilification of health care workers as significant issues.

For the full story, see:

Oliver Whang. “New Survey Suggests An Alarming Increase In Physician Burnout.” The New York Times (Friday, September 30, 2022): A25.

(Note: ellipsis added.]

(Note: the online version of the story has the date Sept. 29, 2022, and has the title “Physician Burnout Has Reached Distressing Levels, New Research Finds.”)

Long-Distance Trade May Help Explain Why Sapiens Flourished More Than Neanderthals

(p. 47) Sykes explains that Neanderthals were sophisticated and competent human beings who adapted to diverse habitats and climates.

. . .

At the time when they encountered the Neanderthals, Sapiens too lived in small bands, but different Sapiens bands probably cooperated on a regular basis. There is much more evidence for long-distance trade among Sapiens, and spectacular burials like the 32,000-year-old Sunghir graves clearly reflect the combined effort of more than one band.

Large-scale cooperation did not necessarily mean that a horde of 500 Sapiens united to wipe out a band of 20 Neanderthals. Cooperation isn’t just about violence. Sapiens could more easily benefit from the discoveries and inventions of other people. If somebody in a neighboring band discovered a new way to locate beehives, to make a tunic or to heal a wound, such knowledge could spread much more quickly among Sapiens than among Neanderthals. While individual Neanderthals were perhaps as inquisitive, imaginative and creative as individual Sapiens, superior networking enabled Sapiens to swiftly outcompete Neanderthals.

This, however, is largely speculation. We still don’t know enough about the psychology, society and politics of Neanderthals to be sure. Perhaps the most surprising fact in Sykes’s book is that even if we count every bone fragment and every isolated tooth, so far we have found the remains of fewer than 300 Neanderthals.

For the full review, see:

Yuval Noah Harari. “Ancient Cousins.” The New York Times Book Review (Sunday, December 6, 2020): 47.

(Note: ellipsis added.)

(Note: the online version of the review was updated Nov. [sic] 9, 2020, and has the title “At Home With Our Ancient Cousins, the Neanderthals.”)

The book under review is:

Sykes, Rebecca Wragg. Kindred: Neanderthal Life, Love, Death and Art. London: Bloomsbury Sigma, 2020.

Entrepreneur Andy Yen’s Technology Enables Russians to Elude Censors

(p. A1) After Moscow erected a digital barricade in March [2022], blocking access to independent news sites and social media platforms to hide information about its unfolding invasion of Ukraine, many Russians looked for a workaround. One reliable route they found came from a small Swiss company based nearly 2,000 miles away.

The company, Proton, provides free software that masks a person’s identity and location online. That gives a user in Russia access to the open web by making it appear that the person is logging in from the Netherlands, Japan or the United States. A couple of weeks after the internet blockade, about 850,000 people inside Russia used Proton each day, up from fewer than 25,000.

That is, until the end of March, when the Russian government found a way to block Proton, too.

Targeting Proton was the opening salvo of a continuing back-and-forth battle, pitting a team of about 25 engineers against a country embarking on one of the most aggressive censorship campaigns in recent memory.

Working from a Geneva office where the company keeps its name off the building directory, Proton has spent nine pressure-packed months repeatedly tweaking its technology to avoid Russian blocks, only to be countered again by government censors in Moscow. Some employees took (p. A9) Proton off their social media profiles out of concern that they would be targeted personally.

The high-stakes chess match mirrors what is playing out with growing frequency in countries facing coups, wars and authoritarian rule, where restricting the internet is a tool of repression. The blocks drive citizens to look for workarounds. Engineers at companies like Proton think up new ways for those people to secretly reach the open web. And governments, in turn, seek out new technical tricks to plug leaks.

. . .

Companies rarely discuss being targeted by an authoritarian government out of fear of escalating the conflict. But Andy Yen, Proton’s founder and chief executive, said that after a period of trying to keep its “head down,” Proton wanted to raise awareness about the increasing sophistication of governments, in Russia and elsewhere, to block citizens from reaching the open web and the need for technologists, companies and governments to push back.

. . .

“We’re gearing up for a long fight,” Mr. Yen said in an interview at the company’s office. “Everybody hopes this will have a happy ending, but it’s not guaranteed. We don’t see the light at the end of the tunnel, in fact, but you keep going because if we don’t do it, then maybe nobody else will.”

. . .

The battle took on a “Spy vs. Spy” dynamic in Proton’s headquarters. Mr. Yen said a network of people within the government, telecommunications firms and civil society groups had helped Proton operate in Russia, providing access to local networks and sharing intelligence about how the censorship system worked. But those contacts began to go dark as the Kremlin’s crackdown on dissent intensified.

. . .

Mr. Yen was interrupted during a staff meeting in mid-July with news that Russian censors had come up with an even more elaborate block. A corporate chart from the time shows use dropping off a cliff. Russian engineers had identified what is known as an authentication “handshake,” the vital moment when Proton’s VPN connection gets established before reaching the wider web. Blocking the link made Proton’s service essentially unusable.

“We had no idea what was happening and how they were doing it,” Mr. Cesarano said.

By August, after working around the clock for days to find a fix, Proton acknowledged defeat and pulled its app from Russia. The company has spent the months since then developing a new architecture that makes its VPN service harder to identify because it looks more like a regular website to censorship software scanning a country’s internet traffic. Proton has been successfully testing the system in Iran, where Proton has seen a sharp increase in VPN use during recent political demonstrations.

In Russia, Proton has reintroduced its apps using the new system. Mr. Yen acknowledged that it probably wasn’t a long-term fix. He has confidence in the new technology, but figures Russian engineers will eventually figure out a new way to push back, and the game will continue.

For the full story, see:

Adam Satariano and Paul Mozur. “The Cat-and-Mouse Battle for Russia’s Internet.” The New York Times (Wednesday, December 7, 2022): A1 & A9.

(Note: ellipses, and bracketed year, added.]

(Note: the online version of the story was updated Dec. 9, 2022, and has the title “Inside the Face-Off Between Russia and a Small Internet Access Firm.” )

In Poor Country Where “Few People Have Air Conditioning” Heat Reduces Ability of Children to Learn and Parents to Produce

A growing movement among intellectuals opposes economic growth. I doubt that the movement will catch on in Freetown, Sierra Leone, where economic growth would allow more citizens to afford air conditioning.

(p. A4) . . . Eugenia Kargbo . . . [is] Freetown’s first chief heat officer, a post created in 2021, . . .

. . .

“Heat is invisible but it’s killing people silently,” Ms. Kargbo said in an interview on one of the top floors of Freetown’s city hall, a massive air-conditioned building that towers over the dozens of informal settlements dotting the capital of the small West African nation.

“Children are not sleeping at night because of extreme temperature,” she said. “It affects their ability to learn and their parents’ productivity.”

. . .

The country is one of the world’s poorest; few people have air conditioning; . . .

For the full story, see:

Elian Peltier. “In West African Hub, She Works to Counter Rising Temperatures.” The New York Times (Tuesday, January 7, 2023): A4.

(Note: ellipses added.)

(Note: the online version of the story has the date January 6, 2023, and has the title “She Is Africa’s First Heat Officer. Can She Make Her City Livable?”)

Taiwanese Engineers Who Built Dictator Xi’s Computer Chips, Are Voting With Their Feet for Taiwan’s Democracy and Freedom

(p. B1) TAIPEI, Taiwan — The job offer from a Chinese semiconductor company was appealing. A higher salary. Work trips to explore new technologies.

No matter that it would be less prestigious for Kevin Li than his job in Taiwan at one of the world’s leading chip makers. Mr. Li eagerly moved to northeast China in 2018, taking part in a wave of corporate migration as the Chinese government moved aggressively to build up its semiconductor industry.

He went back to Taiwan after two years, as Covid-19 swept through China and global tensions intensified. Other highly skilled Taiwanese engineers are going home, too.

For many, the strict pandemic measures have been tiresome. Geopolitics has made the job even more fraught, with China increasingly vocal about staking its claim on Taiwan, a self-ruled democracy.

. . .

(p. B4) For now, Mr. Li is staying in Taiwan, working for an American chip company operating there and siding with the invigorated patriotic sentiment and the ethos of individual liberty.

“The advantage of working in Taiwan is that you don’t have to worry about officials shutting down the whole company because of one thought,” he said. “The atmosphere is very important. At least I can watch all kinds of programs criticizing the governments on both sides of the Taiwan Strait without worrying about being arrested.”

For the full story, see:

Jane Perlez, Amy Chang Chien and John Liu. “Taiwanese Who Built Up Chip Sector in China Are Fed Up and Going Home.” The New York Times (Tuesday, November 22, 2022): B1 & B4.

(Note: the online version of the story has the date Nov. 16, 2022, and has the title “Engineers From Taiwan Bolstered China’s Chip Industry. Now They’re Leaving.” The online version says that the title of the print version is “They Built Up China’s Chip Sector. Now, They’re Going Home to Taiwan” but the title of my national edition copy is “Taiwanese Who Built Up Chip Sector in China Are Fed Up and Going Home.”)

Lethality of Ebola in West Africa Mainly Due to “the Contingent History of a Population Made Vulnerable”

(p. 22) As Farmer writes in his new book, “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History,” by the time he arrived in the capital city of Freetown in late September, “western Sierra Leone was ground zero of the epidemic, and Upper West Africa was just about the worst place in the world to be critically ill or injured.”

. . .

Farmer notes that even severe cases of Ebola rarely produce the horror-film symptoms featured so prominently in Preston’s “Hot Zone”: patients bleeding from their eyeballs, their organs liquefied in a matter of hours. Most cases instead involve fluid and electrolyte loss caused by vomiting and diarrhea, which can often be treated with basic supportive and critical care, like intravenous fluid replenishment or dialysis. Ebola was so lethal in upper West Africa not because the virus itself conveyed an inevitable death sentence, but because countries like Liberia and Sierra Leone lacked these health care essentials. “For all their rainfall,” Farmer writes, “their citizens are stranded in the medical desert.”

. . .

“This was not,” Farmer writes, “a history of inevitable mortality that resulted from ancient evolutionary forces.  . . .   It was the contingent history of a population made vulnerable.”

For the full review, see:

Steven Johnson “A Preventable Epidemic.” The New York Times Book Review (Sunday, December 13, 2020): 22.

(Note: ellipses between paragraphs, added; ellipsis internal to last paragraph, in original.)

(Note: the online version of the review has the date Nov. 17, 2020, and has the title “The Deadliness of the 2014 Ebola Outbreak Was Not Inevitable.”)

The book under review is:

Farmer, Paul. Fevers, Feuds, and Diamonds: Ebola and the Ravages of History. New York: Farrar, Straus and Giroux, 2020.