Lanky, charismatic, and a rising star in the health-care industry, [Wright] Lassiter could have become just one more executive casualty when he took the job as CEO of the Alameda County Medical Center in Oakland, California, and its flagship, Highland Hospital. Instead, he did what seemed impossible: He turned a shockingly mismanaged urban safety-net hospital system in one of America’s most violent cities into a model for other public hospitals. He trimmed costs without any significant cutback in services — in fact, services have been greatly expanded. A new $668 million hospital building is under construction. Six years on, the center has turned a positive margin every year but the last, when a new auditor required it to set aside more money for pension costs; so far, it is on target to break even this year.
Category Archives: Economics
For a century, liberals have been chasing the same organizing idea: to perfect the welfare state—the soaringly aspirational, deeply flawed apparatus of Social Security, public health insurance, and progressive taxation designed to guarantee a secure middle class—and to extend its protections to every American. A year ago, after Obama’s health-care reforms became law, that project looked closer to completion. Now we are debating the terms of its erosion—with Republican proposals to cut the benefits of Medicare and Medicaid, conservative efforts to repeal protections for labor unions, and an emerging Washington consensus that the costs of a broad welfare state may be beyond what Americans will willingly pay. The White House meeting this past December [with Paul Krugman and other left-of-center economists], viewed in retrospect, seemed to mark the end of the expansive first part of Obama’s administration and the beginning of an austere second phase. Krugman, departing, found himself left in the position that every purist fears, holding blueprints for impossible buildings.
“I think what people like Paul Ryan are trying to do is set us on a glide path to a much harsher society,” Krugman now says. “A country in which, step by step, more and more people are cast out into a situation of not having health insurance and poverty, and so we slide back to a Victorian notion that life is full of evils and that’s too bad but that’s the way that God made the world. That large numbers of the poor, large numbers of the elderly just live in dire poverty and don’t have health care because life is tough.” For two years, Krugman has been arguing that this trajectory might have been averted if only Obama had been a little less deferential, a little more demanding, a little more alarmed. And so Krugman has given the debate on the left its shape: whether the president could have mounted a more effective defense of the welfare state, and whether liberalism’s tragic flaw is Obama’s instinct for conciliation or his leading critic’s naïveté.
Mike Konczal, on the 100th anniversary of International Women’s Day:
A contract, like a marriage contract or like a labor contract, can be “freely” entered into but still contain elements of coercion to it. Coercion can still be the central characteristic of it. That the market is a series of voluntary transactions, and any outcome of it just, is an illusion. How to pull away that veil is the project, and feminist thought gives us a start on it.
Chad Harbach in Slate:
This situation—of two complementary economic systems of roughly matched strength—is a new one for American fiction. As the mass readership of literary fiction has peaked and subsided, and the march of technology sends the New York publishing world into spasms of perpetual anxiety, if not its much-advertised death throes, the MFA program has picked up the financial slack and then some, offering steady payment to more fiction writers than, perhaps, have ever been paid before.
Everyone knows this. But what’s remarked rarely if at all is the way that this balance has created, in effect, two literary cultures (or, more precisely, two literary fiction cultures) in the United States: one condensed in New York, the other spread across the diffuse network of provincial college towns that spans from Irvine, Calif., to Austin, Texas, to Ann Arbor, Mich., to Tallahassee, Fla. (with a kind of wormhole at the center, in Iowa City, into which one can step and reappear at the New Yorker offices on 42nd Street). The superficial differences between these two cultures can be summed up charticle-style: short stories vs. novels; Amy Hempel vs. Jonathan Franzen; library copies vs. galley copies; Poets & Writers vs. the New York Observer; Wonder Boys vs. The Devil Wears Prada; the Association of Writers and Writing Programs conference vs. the Frankfurt Book Fair; departmental parties vs. publishing parties; literary readings vs. publishing parties; staying home vs. publishing parties. But the differences also run deep. Each culture has its own canonical works and heroic figures; each has its own logic of social and professional advancement. Each affords its members certain aesthetic and personal freedoms while restricting others; each exerts its own subtle but powerful pressures on the work being produced.
Reporter Charlie LeDuff, on seven-year-old Aiyana Stanley-Jones, who was shot and killed during a botched police raid last May:
Was it inevitable … that abject poverty would lead to Aiyana’s death and so many others? Was it death by TV? By police incompetence? By parental neglect? By civic malfeasance? About 350 people are murdered each year in Detroit. There are some 10,000 unsolved homicides dating back to 1960. Many are as fucked up and sad as Aiyana’s. But I felt unraveling this one death could help diagnose what has gone wrong in this city, so I decided to retrace the events leading up to that pitiable moment on the porch on Lillibridge Street.
LeDuff, who left The Detroit News in October, “made national headlines in January 2009 when he and News photographer Max Ortiz produced a front-page story and photo of a corpse partially frozen in the bottom of an elevator shaft in an abandoned Detroit warehouse.”
The left, to be quite blunt about it, has something to conserve. It is the right that has inherited the ambitious modernist urge to destroy and innovate in the name of a universal project. Social democrats, characteristically modest in style and ambition, need to speak more assertively of past gains. The rise of the social service state, the century-long construction of a public sector whose goods and services illustrate and promote our collective identity and common purposes, the institution of welfare as a matter of right and its provision as a social duty: these were no mean accomplishments.
That these accomplishments were no more than partial should not trouble us. If we have learned nothing else from the twentieth century, we should at least have grasped that the more perfect the answer, the more terrifying its consequences. Imperfect improvements upon unsatisfactory circumstances are the best that we can hope for, and probably all we should seek. Others have spent the last three decades methodically unraveling and destabilizing those same improvements: this should make us much angrier than we are. It ought also to worry us, if only on prudential grounds: Why have we been in such a hurry to tear down the dikes laboriously set in place by our predecessors? Are we so sure that there are no floods to come?
(Quoted in n+1’s appreciation)
At the moment everything going through my head is colored by the fact of Haiti. Who gets to decide what help Haiti needs and how to rebuild? I’m not sure Haitians will. Who gets to decide what contemporary Caribbean literature is? Publishers in New York and London and literary scholars in American, British, and Canadian universities. Those two questions aren’t comparable in degree, but are bound together in a common dilemma.