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Washington Monthly | How the Right Wing Convinces Itself That Liberals Are Evil

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If you spend any time consuming right-wing media in America, you quickly learn the following: Liberals are responsible for racism, slavery, and the Ku Klux Klan. They admire Mussolini and Hitler, and modern liberalism is little different from fascism or, even worse, communism. The mainstream media and academia cannot be trusted because of the pervasive, totalitarian nature of liberal culture. 

This belief in a broad liberal conspiracy is standard in the highest echelons of the conservative establishment and right-wing media. The Russia investigation is dismissed, from the president on down, as a politicized witch hunt. George Soros supposedly paid $300 to each participant in the “March for Our Lives” in March. (Disclosure: I marched that day, and I’m still awaiting my check.) What is less well appreciated by liberals is that the language of conspiracy is often used to justify similar behavior on the right. The Russia investigation is not just a witch hunt, it’s the product of the real scandal, which is Hillary-Russia-Obama-FBI collusion, so we must investigate that. Soros funds paid campus protestors, so Turning Point USA needs millions of dollars from Republican donors to win university elections. The liberal academic establishment prevents conservative voices from getting plum faculty jobs, so the Koch Foundation needs to give millions of dollars to universities with strings very much attached.

This did not begin with Donald Trump. The modern Republican Party may be particularly apt to push conspiracy theories to rationalize its complicity with a staggeringly corrupt administration, but this is an extension of, not a break from, a much longer history. Since its very beginning, in the 1950s, members of the modern conservative movement have justified bad behavior by convincing themselves that the other side is worse. One of the binding agents holding the conservative coalition together over the course of the past half century has been an opposition to liberalism, socialism, and global communism built on the suspicion, sometimes made explicit, that there’s no real difference among them. 

In 1961, the American Medical Association produced an LP in which an actor opened a broadside against the proposed Medicare program by attributing to Norman Thomas, a six-time Socialist Party candidate for president, a made-up quote that “under the name of liberalism the American people will adopt every fragment of the socialist program.” Because these ideologies were so interchangeable in the imaginations of many conservatives—and were covertly collaborating to enact their nefarious agenda—this meant that it was both important and necessary to fight back through equally underhanded means. 

One of the binding agents holding the conservative coalition together over the course of the past half century has been an opposition to liberalism, socialism, and global communism built on the suspicion, sometimes made explicit, that there’s no real difference among them.

The title of that LP? Ronald Reagan Speaks Out Against Socialized Medicine. The American left is used to waiting for liberals to finally get ruthless. Through the eyes of the right, they always have been. 

Long before Fox News, conservatives began forming their own explicitly right-wing media landscape. Supporters of Franklin D. Roosevelt and the New Deal dominated the “mainstream” press, which meant that conservative dissidents needed a home. The conservative magazine Human Events was launched in 1944 as an alternative to what its cofounder, Felix Morley, believed was a stifling conformity in the American press. The same was true of the American Mercury in 1950, when under the ownership of William Bradford Huie the formerly social-democratic magazine moved to the right. “There is now far too much ‘tolerance’ in America,” Huie declared in the first issue of the new Mercury. “We shall cry a new crusade of intolerance . . . the intolerance of bores, morons, world-savers, and damn fools.”

Both Morley and Huie felt victimized by a liberal press establishment that stifled alternative voices—and, after all, liberals had the New Republic and leftists the Nation as journals of opinion—but their charge of mainstream “bias” was more complicated. One of the largest newspapers in the United States, the Chicago Tribune, owned by conservative businessman Robert McCormick, had militantly opposed the New Deal and American entry into World War II. Fulton Lewis Jr., a Washington, D.C.–based political journalist who was, by 1950, one of Wisconsin Senator Joseph McCarthy’s biggest supporters, had one of the most listened-to radio programs in the country. And both Morley and Huie had had illustrious careers before launching their magazines. Morley won a Pulitzer Prize when he edited the Washington Post in the 1930s; Huie had a solid reputation as a freelance journalist. But they clung to the belief that dissenters from the liberal orthodoxy were being hounded out of media, which more than justified questionable acts, particularly on Huie’s part. Desperate to keep his magazine afloat, Huie sold the American Mercury in 1952 to far-right businessman Russell Maguire, who was closely tied to prominent anti-Semites and was one himself. Huie told a reporter at Time that he knew all about Maguire’s unsavory views, but believed his financial backing was necessary in order to ensure a conservative voice in American letters. “If I suddenly heard Adolf Hitler was alive in South America and wanted to give a million dollars to the American Mercury, I would go down and get it.”

Even more alarming to conservatives than the bias of the mainstream press was the number of liberals, radicals, and communists alleged to be in higher education. In a 1952 American Mercury article, a twenty-seven-year-old William F. Buckley accused liberal historians of a “conspiracy against giving the American people the facts” about Franklin Roosevelt, and claimed that they thus “betrayed the American people.” In his debut book, God and Man at Yale, published the year before, Buckley had dismissed academic freedom as a cynical shield wielded by left-wing faculty to protect themselves from the political consequences of their views; he advocated using the threat of withholding alumni donations as a weapon against the liberalism and leftism running amok in the academy. Buckley would soon become the gatekeeper of “respectable” conservatism by pushing back against the conspiratorial excesses of the John Birch Society. But he began his career by indulging in some of those rhetorical flourishes himself, along with a plan of action on how to fight back against the stranglehold of leftists on the academy. 

Buckley was also one of McCarthy’s most vociferous defenders. Although popularly remembered today as a drunken punch line discredited by crusading journalists like Edward R. Murrow in the 1950s, McCarthy is actually an important figure in the development of American conservatism. Almost every major conservative journalist and politician in the 1950s defended him. Senator Barry Goldwater voted against McCarthy’s censure in 1954. Conservative radio pundit Fulton Lewis defended McCarthyism in his broadcasts even after the senator’s death. William F. Buckley was no exception: he went to the bat for McCarthy in the 1954 book McCarthy and His Enemies. Buckley applauded McCarthy for recognizing that “coercive measures” were necessary to enforce a new anticommunist “conformity.” While Buckley—unlike many of his peers—did distinguish between “the Liberals” and “the Communists,” he suggested that “atheistic, soft-headed, anti-anti-Communist liberals” were ultimately little better than communists, and by far a greater danger to American democracy than any supposed excesses of McCarthyism. And indeed, Buckley never abandoned his defense of McCarthy and repeatedly attempted to rehabilitate the senator in the eyes of the broader public. In 1999 he published a pro-McCarthy novel, The Redhunter, which incorporated large swaths of McCarthy and His Enemies almost verbatim.

Still, Buckley was comparatively moderate next to other conservatives, who suggested that the answer to the communist threat might be to adopt the communists’ own tactics. Fred Schwarz, an Australian-born doctor who founded the Christian Anti-Communist Crusade in 1953, wrote in his book You Can Trust the Communists (to be Communists) that liberals were effectively “protectors and runners of interference for the Communist conspirators.” Why? Because liberals resisted efforts to purge communists and their sympathizers from schools and universities, and insisted on pesky legal technicalities like the Fifth Amendment. “[O]rganization is the genius of Communism,” Schwarz continued, and so “an anti-Communist program needs organization.” Just as communists “operate through a great number of front organizations, each of which is tuned to some specific motivating dynamic,” so must “every religious, professional, economic, and cultural group” adopt this model to “organize an anti-Communist program.”

A full-blown Leninist approach was tempting, Schwarz wrote, but he preferred a decentralized organization based on “voluntary choice and free will.” Not all on the anticommunist right were so circumspect. Robert Welch, a wealthy retired candy manufacturer and right-wing activist, organized the John Birch Society in 1958 explicitly along the lines of what he called “international communism.” Welch wrote in the society’s founding document, The Blue Book, that this was simply a savvy political decision: the communist conspiracy was, after all, “incredibly well organized,” and “so well financed that it has billions of dollars annually just to spend on propaganda.” The Birchers would, like the communists, organize themselves into cells (or, as Welch preferred to call them, “chapters”), set up front organizations, and distribute propaganda (by which Welch meant conservative magazines and journals, including National Review, Human Events, and his own American Opinion). The goal was not to become a mere “organization” like the Democratic or Republican Parties, but to become a movement, in the same sense as communism or its close ideological ally, organized labor. And indeed, at its peak in the early 1960s the John Birch Society claimed around 100,000 members, more than the Communist Party USA at its height in the 1940s, easily making it the largest and best-organized group on the right. The Birchers’ on-the-ground presence certainly dwarfed the reach of the National Review, which in 1961 counted only 29,000 weekly subscribers. 

One of the Birchers’ most prominent campaigns was a drive to impeach Supreme Court Chief Justice Earl Warren, who had presided over a Court that made dramatic rulings in favor of civil rights, ranging from establishing a right to birth control to abolishing mandatory school prayer to the greatest sin of all, desegregating public schools. In August 1963, Welch accused the civil rights movement of being a communist plot to create a “Soviet Negro Republic” in the South, with Martin Luther King Jr. as president, and blamed Brown v. Board of Education for poisoning race relations in America. “What we want to do,” Welch wrote in the Birch Society’s bulletin, “is to concentrate the whole opposition to what is happening in the South, and resentment of it, into one course of action: The Movement to Impeach Earl Warren.”  

The conflation of communism and the NAACP was not accidental. Of all of the supposedly communistic liberal front groups, none drew conservative scorn more fiercely than the civil rights movement. William F. Buckley, who opposed the impeachment as a tactic against the Warren Court, nonetheless infamously wrote in 1957 that the “advanced” white race in the South was justified in taking “such measures as are necessary to prevail, politically and culturally,” in areas where “it does not predominate numerically.” His magazine, National Review, repeatedly suggested that the civil rights movement was communist inspired, riddled by communist infiltration, or composed of communist front organizations. Martin Luther King himself was suspect—National Review called him the “source of violence in others” in 1965.

Robert Welch, a wealthy retired candy manufacturer and right-wing activist, organized the John Birch Society in 1958 explicitly along the lines of what he called “international communism.”

King was far more radical than his sanitized popular memory today—he spoke out against American imperialism in Vietnam, called for a guaranteed basic income, and was murdered while visiting Memphis to support a strike by public-sector sanitation workers—but he was no doctrinaire Marxist-Leninist. “Communism forgets that life is individual,” he said in a 1967 speech, while also condemning capitalism for forgetting “that life is social.” These distinctions were lost on the civil rights movement’s right-wing opponents. By painting civil rights activists as communists, or at the minimum dupes of an international communist conspiracy, segregationist southerners were making a bid for the support of conservative anticommunists elsewhere in the country.

They got it. Barry Goldwater, whose anti-liberal and anticommunist political bona fides were so secure he could get away with criticizing the John Birch Society without losing the support of its members, voted against the Civil Rights Act in 1964. The vast majority of conservative publications opposed the bill’s passage, on the grounds both that it was an unacceptable expansion of federal power and that the “mobocratic” and “unruly” civil rights agitators were in effect advocating for socialism. George Wallace, the hyper-segregationist governor of Alabama, recognized the potency of this conspiratorial rhetoric during his third-party run for president in 1968. Shunned by Buckley and the conservative establishment on the basis of his sympathy for New Deal–style welfare programs, Wallace was embraced by the Birchers because of his unwavering opposition to the “communists,” “radicals,” and “agitators” in the civil rights movement.

The rise in prominence of the religious right in the 1970s and ’80s did little to tamp down paranoid political rhetoric. Evangelicals like Jerry Falwell and Francis Schaeffer—as well as Catholics like Paul Weyrich and Mormons like W. Cleon Skousen—conflated liberalism, socialism, and communism under the broader umbrella of “secularism” and built alliances with one another to combat this scourge. Often, this merely meant consolidating preexisting activism: Falwell had been an outspoken opponent of the civil rights movement in the 1960s, and Skousen was a key propagandist for the John Birch Society in the 1960s and early ’70s before penning in 1981 The 5,000 Year Leap, a book that codified many of the shibboleths of the religious right to the present day. The evangelicals and their allies in other denominations were united in their opposition to abortion, gay rights, and feminism—the tangible realities of the nefarious left-liberal agenda. 

Anti-Clinton paranoia may have been a necessity for Republicans who yearned to regain power in the 1990s. With relatively little substantive disagreement on policy, the easiest way to maintain energetic opposition was to construct a narrative of criminality and anti-American perfidy that must be countered at all costs.

Increasingly, the communist fingerprints to be found on these cultural changes were not to be found in an overarching conspiracy directed from Moscow—after all, the sexual politics of radical American feminists were hardly those of Leonid Brezhnev—but from a more nebulous grouping of student radicals, intellectuals, and activists. Although the term “cultural Marxism” would not be used to describe this new, somewhat murkier conspiracy until the 2000s, the outlines of the charge were already evident by the late 1970s. In 1980, televangelist James Robison declared in a speech that he was “sick and tired of hearing about all of the radicals, and the perverts, and the liberals, and the leftists, and the communists coming out of the closet,” and called for “God’s people” to fight back.

The collapse of the Soviet Union accelerated these trends. It was no longer possible to accuse liberals and remnants of the left of being in Moscow’s pocket, but this did not stop conservatives from invoking the specter of left-wing radicalism to rally support and justify extremism. It just took more creativity. Pat Buchanan deftly shifted midsentence in his infamous 1992 speech at the Republican National Convention from the Cold War to the “cultural war,” the “religious war . . . for the soul of America,” suggesting that the fight against liberalism, feminism, and the “gay agenda” was not just the equivalent, but in fact the continuation, of the Cold War itself.

The “culture war” was the basis of the Clinton hatred phenomenon in the 1990s, which—as in 2016—was particularly focused on Hillary Clinton. She was the worst of all possible worlds: an elitist big-government liberal with degrees from Wellesley and Yale Law, a feminist who initially refused to change her name after marrying Bill, declined to embrace the image of a mother and housewife in the White House, and was rumored to be the real powerhouse next to her husband.

Bill Clinton had run in 1992 as a “different kind of Democrat,” and after losing Congress in 1994 tacked even more to the right. Clinton embraced financial deregulation, effectively abolished the existing welfare program, and even signaled his openness to partially privatizing Social Security and Medicare. Yet Clinton’s policy concessions to conservatives won him little goodwill from across the aisle. Congressional Republicans embraced scorched-earth legislative tactics under firebrand House Speaker Newt Gingrich, including the 1995 government shutdown, a preview of the right’s nihilistic resistance to Barack Obama over a decade later.Gingrich was a veteran partisan bruiser—as House minority whip he led the successful effort to oust Texas Democrat Jim Wright as speaker for minor ethics infractions in 1989, suggesting for good measure that Wright and other Democrats harbored socialist sympathies given their willingness to negotiate with the Sandinista government to end the Nicaraguan civil war. 

But in another sense, the fervid anti-Clinton paranoia may have been a psychic and political necessity for Republicans who yearned to regain power. With Clinton offering real policy conciliations to conservatives, the easiest way to maintain energetic opposition was to construct a narrative of criminality and anti-American perfidy that must be countered at all costs. Right-wing attacks against the Clintons could and did backfire—the president’s approval ratings actually rose during his impeachment—and accusations against Bill Clinton for affairs, sexual harassment, and even rape were easier to dismiss as part of a “vast right-wing conspiracy,” as Hillary Clinton put it, when right-wing magazines were also accusing her of murder. Bill Clinton weathered the Monica Lewinsky scandal, but Clinton hatred never went away. It reappeared with a vengeance in 2016.

The bitter partisan battles of the 1990s intensified trends that had existed on the political right since World War II. Indeed, the creation of Fox News in 1996 was a supercharged throwback to the days of Human Events and the American Mercury. Fox News was necessary, the argument went, because conservative journalists and conservative perspectives were shut out of mainstream broadcasters. Never mind that even Bill O’Reilly had enjoyed a career at CBS and ABC before joining Fox News in its debut year. But while conservative media in the 1950s and ’60s either had a limited reach—the National Review in 1960 had less than a tenth as many subscribers as Time—or were counterbalanced by the FCC’s fairness doctrine, which was on the books between 1949 and 1987, Fox News presented an unchallenged right-wing worldview to millions of viewers twenty-four hours a day, 365 days a year.

Conservative pundits repackaged Cold War–era attacks equating liberals with communists during the Bush years. In 2003, Ann Coulter, a frequent Fox News talking head, published Treason: Liberal Treachery from the Cold War to the War on Terrorism, which was a full-throated defense of Joseph McCarthy that accused liberals of being, well, traitors who hated America. The book sold 500,000 copies in its first three weeks. Even the racially charged birther myth—that Barack Obama was not a U.S. citizen, and was a covert Muslim, to boot—was a riff on the old John Birch Society charge that liberals, including moderate Republicans like Dwight Eisenhower, were secret members of the international communist conspiracy. The cry that Obama was a Marxist, Maoist, Muslim Kenyan socialist was almost interchangeable with right-wing attacks directed against the civil rights movement in the 1960s. And the idea that a vast left-liberal conspiracy was both undermining the country and using dirty, underhanded tactics to do so rhetorically justified an anything-goes strategy on the part of the right. Shutting down government. Refusing confirmation votes. Supporting Donald Trump for president.

So-called Never Trump conservatives lament that the Republican Party and, indeed, the conservative movement have ceased to be about ideas beyond slavish devotion to Trump’s cult of personality. But this critique ignores the centrality of the idea of liberal nefariousness even in the self-consciously intellectual corners of the conservative movement. Jonah Goldberg, who has been affiliated with National Review for twenty years, has called for a revived conservative intellectual vigor to tackle the policy challenges of the twenty-first century. He was also the author, in 2008, of the book Liberal Fascism, which—until a last-minute change by Goldberg—bore the subtitle The Totalitarian Temptation from Mussolini to Hillary Clinton.

Even the theory-heavy Chicago School movement that undergirded the post-Reagan shift to laissez-faire economic policy derived its momentum from the perceived need to rescue the “free enterprise system” from the clutches of liberalism, which would otherwise inevitably lead to communism. Robert Bork, the academic, judge, and Nixon administration official who was perhaps the preeminent ideological conduit between academia and government—and whose 1996 book Slouching Towards Gomorrah: Modern Liberalism and American Decline is exactly what it sounds like—described his antitrust theories as an antidote to the “reckless and primitive egalitarianism” of the Warren Court. 

Trump is, in many ways, the ultimate embodiment of this long-standing tendency on the right. His transformation from New York Democrat to Republican Party celebrity began by embracing the birther conspiracy; he even took credit for Obama’s eventual decision to release his long-form birth certificate. As president, he has wondered aloud why Attorney General Jeff Sessions hasn’t personally defended him from the Russia investigation in the same way that, in Trump’s Fox News–fueled fantasies, Eric Holder once shielded Obama from “scandals” like “Fast and Furious.” 

The idea that the left is depraved, corrupt, and ruthless has been an important strain of American conservatism since the movement began. But in the Trump era, it has metastasized. Right-wing policy ideas have been so thoroughly discredited—does anyone even argue anymore that trickle-down economics will ensure mass prosperity?—that the only apparent reason for conservatism’s existence is to fight back against evil liberals. This is, of course, not the sign of a healthy political movement. The right’s support for McCarthy has been a long-standing embarrassment for American conservatism. Its embrace of Trump may be history repeating itself.

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veganconnor: valsyrie: I’m going to say something super controversial here: billionaires shouldn’t...

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veganconnor:

valsyrie:

I’m going to say something super controversial here: billionaires shouldn’t exist

i used to think billionaires were like. slightly richer millionaires but for reference: a million seconds is 12 days, a billion seconds is THIRTY TWO YEARS.

no one can convince me that it’s possible to possess a billion dollars, much less dozens of billions of dollars, and not be a disgusting terrible shitty unethical heartless human being

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Treasure Planet - Disney's Biggest Mistake

I'm Still Not Over Disney's Treasure Planet

Why aren't we still talking about Treasure Planet?
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Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

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To an outsider, the fancy booths at last month’s health insurance industry gathering in San Diego aren’t very compelling. A handful of companies pitching “lifestyle” data and salespeople touting jargony phrases like “social determinants of health.”

But dig deeper and the implications of what they’re selling might give many patients pause: A future in which everything you do — the things you buy, the food you eat, the time you spend watching TV — may help determine how much you pay for health insurance.

With little public scrutiny, the health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans, including, odds are, many readers of this story. The companies are tracking your race, education level, TV habits, marital status, net worth. They’re collecting what you post on social media, whether you’re behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.

Are you a woman who recently changed your name? You could be newly married and have a pricey pregnancy pending. Or maybe you’re stressed and anxious from a recent divorce. That, too, the computer models predict, may run up your medical bills.

Are you a woman who’s purchased plus-size clothing? You’re considered at risk of depression. Mental health care can be expensive.

Low-income and a minority? That means, the data brokers say, you are more likely to live in a dilapidated and dangerous neighborhood, increasing your health risks.  

“We sit on oceans of data,” said Eric McCulley, director of strategic solutions for LexisNexis Risk Solutions, during a conversation at the data firm’s booth. And he isn’t apologetic about using it. “The fact is, our data is in the public domain,” he said. “We didn’t put it out there.”

Insurers contend they use the information to spot health issues in their clients — and flag them so they get services they need. And companies like LexisNexis say the data shouldn’t be used to set prices. But as a research scientist from one company told me: “I can’t say it hasn’t happened.”

At a time when every week brings a new privacy scandal and worries abound about the misuse of personal information, patient advocates and privacy scholars say the insurance industry’s data gathering runs counter to its touted, and federally required, allegiance to patients’ medical privacy. The Health Insurance Portability and Accountability Act, or HIPAA, only protects medical information.

“We have a health privacy machine that’s in crisis,” said Frank Pasquale, a professor at the University of Maryland Carey School of Law who specializes in issues related to machine learning and algorithms. “We have a law that only covers one source of health information. They are rapidly developing another source.”

Patient advocates warn that using unverified, error-prone “lifestyle” data to make medical assumptions could lead insurers to improperly price plans — for instance raising rates based on false information — or discriminate against anyone tagged as high cost. And, they say, the use of the data raises thorny questions that should be debated publicly, such as: Should a person’s rates be raised because algorithms say they are more likely to run up medical bills? Such questions would be moot in Europe, where a strict law took effect in May that bans trading in personal data.

This year, ProPublica and NPR are investigating the various tactics the health insurance industry uses to maximize its profits. Understanding these strategies is important because patients — through taxes, cash payments and insurance premiums — are the ones funding the entire health care system. Yet the industry’s bewildering web of strategies and inside deals often have little do with patients’ needs. As the series’ first story showed, contrary to popular belief, lower bills aren’t health insurers’ top priority. 

Inside the San Diego Convention Center last month, there were few qualms about the way insurance companies were mining Americans’ lives for information — or what they planned do with the data.


The sprawling convention center was a balmy draw for one of America’s Health Insurance Plans’ marquee gatherings. Insurance executives and managers wandered through the exhibit hall, sampling chocolate-covered strawberries, champagne and other delectables designed to encourage deal-making.

Up front, the prime real estate belonged to the big guns in health data: The booths of Optum, IBM Watson Health and LexisNexis stretched toward the ceiling, with flat screen monitors and some comfy seating. (NPR collaborates with IBM Watson Health on national polls about consumer health topics.)

To understand the scope of what they were offering, consider Optum. The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993, according to its marketing materials. (UnitedHealth Group provides financial support to NPR.) The company says it uses the information to link patients’ medical outcomes and costs to details like their level of education, net worth, family structure and race. An Optum spokesman said the socioeconomic data is de-identified and is not used for pricing health plans.

Optum’s marketing materials also boast that it now has access to even more. In 2016, the company filed a patent application to gather what people share on platforms like Facebook and Twitter, and link this material to the person’s clinical and payment information. A company spokesman said in an email that the patent application never went anywhere. But the company’s current marketing materials say it combines claims and clinical information with social media interactions.

I had a lot of questions about this and first reached out to Optum in May, but the company didn’t connect me with any of its experts as promised. At the conference, Optum salespeople said they weren’t allowed to talk to me about how the company uses this information.

It isn’t hard to understand the appeal of all this data to insurers. Merging information from data brokers with people’s clinical and payment records is a no-brainer if you overlook potential patient concerns. Electronic medical records now make it easy for insurers to analyze massive amounts of information and combine it with the personal details scooped up by data brokers.

Justin Volz, special to ProPublica

It also makes sense given the shifts in how providers are getting paid. Doctors and hospitals have typically been paid based on the quantity of care they provide. But the industry is moving toward paying them in lump sums for caring for a patient, or for an event, like a knee surgery. In those cases, the medical providers can profit more when patients stay healthy. More money at stake means more interest in the social factors that might affect a patient’s health.

Some insurance companies are already using socioeconomic data to help patients get appropriate care, such as programs to help patients with chronic diseases stay healthy. Studies show social and economic aspects of people’s lives play an important role in their health. Knowing these personal details can help them identify those who may need help paying for medication or help getting to the doctor.

But patient advocates are skeptical health insurers have altruistic designs on people’s personal information.

The industry has a history of boosting profits by signing up healthy people and finding ways to avoid sick people — called “cherry-picking” and “lemon-dropping,” experts say. Among the classic examples: A company was accused of putting its enrollment office on the third floor of a building without an elevator, so only healthy patients could make the trek to sign up. Another tried to appeal to spry seniors by holding square dances. 

The Affordable Care Act prohibits insurers from denying people coverage based on pre-existing health conditions or charging sick people more for individual or small group plans. But experts said patients’ personal information could still be used for marketing, and to assess risks and determine the prices of certain plans. And the Trump administration is promoting short-term health plans, which do allow insurers to deny coverage to sick patients.  

Robert Greenwald, faculty director of Harvard Law School’s Center for Health Law and Policy Innovation, said insurance companies still cherry-pick, but now they’re subtler. The center analyzes health insurance plans to see if they discriminate. He said insurers will do things like failing to include enough information about which drugs a plan covers — which pushes sick people who need specific medications elsewhere. Or they may change the things a plan covers, or how much a patient has to pay for a type of care, after a patient has enrolled. Or, Greenwald added, they might exclude or limit certain types of providers from their networks — like those who have skill caring for patients with HIV or hepatitis C.

If there were concerns that personal data might be used to cherry-pick or lemon-drop, they weren’t raised at the conference.

At the IBM Watson Health booth, Kevin Ruane, a senior consulting scientist, told me that the company surveys 80,000 Americans a year to assess lifestyle, attitudes and behaviors that could relate to health care. Participants are asked whether they trust their doctor, have financial problems, go online, or own a Fitbit and similar questions. The responses of hundreds of adjacent households are analyzed together to identify social and economic factors for an area.

Ruane said he has used IBM Watson Health’s socioeconomic analysis to help insurance companies assess a potential market. The ACA increased the value of such assessments, experts say, because companies often don’t know the medical history of people seeking coverage. A region with too many sick people, or with patients who don’t take care of themselves, might not be worth the risk.

Ruane acknowledged that the information his company gathers may not be accurate for every person. “We talk to our clients and tell them to be careful about this,” he said. “Use it as a data insight. But it’s not necessarily a fact.”

In a separate conversation, a salesman from a different company joked about the potential for error. “God forbid you live on the wrong street these days,” he said. “You’re going to get lumped in with a lot of bad things.”

Justin Volz, special to ProPublica

The LexisNexis booth was emblazoned with the slogan “Data. Insight. Action.” The company said it uses 442 non-medical personal attributes to predict a person’s medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people’s cellphone numbers, criminal records, bankruptcies, property records, neighborhood safety and more. The information is used to predict patients’ health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy and their stress levels.

People who downsize their homes tend to have higher health care costs, the company says. As do those whose parents didn’t finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won’t share its methods and hasn’t published the work in peer-reviewed journals. 

McCulley, LexisNexis’ director of strategic solutions, said predictions made by the algorithms about patients are based on the combination of the personal attributes. He gave a hypothetical example: A high school dropout who had a recent income loss and doesn’t have a relative nearby might have higher than expected health costs. 

But couldn’t that same type of person be healthy? I asked.

“Sure,” McCulley said, with no apparent dismay at the possibility that the predictions could be wrong.

McCulley and others at LexisNexis insist the scores are only used to help patients get the care they need and not to determine how much someone would pay for their health insurance. The company cited three different federal laws that restricted them and their clients from using the scores in that way. But privacy experts said none of the laws cited by the company bar the practice. The company backed off the assertions when I pointed that the laws did not seem to apply.

LexisNexis officials also said the company’s contracts expressly prohibit using the analysis to help price insurance plans. They would not provide a contract. But I knew that in at least one instance a company was already testing whether the scores could be used as a pricing tool.

Before the conference, I’d seen a press release announcing that the largest health actuarial firm in the world, Milliman, was now using the LexisNexis scores. I tracked down Marcos Dachary, who works in business development for Milliman. Actuaries calculate health care risks and help set the price of premiums for insurers. I asked Dachary if Milliman was using the LexisNexis scores to price health plans and he said: “There could be an opportunity.”

The scores could allow an insurance company to assess the risks posed by individual patients and make adjustments to protect themselves from losses, he said. For example, he said, the company could raise premiums, or revise contracts with providers. 

It’s too early to tell whether the LexisNexis scores will actually be useful for pricing, he said. But he was excited about the possibilities. “One thing about social determinants data — it piques your mind,” he said. 

Dachary acknowledged the scores could also be used to discriminate. Others, he said, have raised that concern. As much as there could be positive potential, he said, “there could also be negative potential.” 


It’s that negative potential that still bothers data analyst Erin Kaufman, who left the health insurance industry in January. The 35-year-old from Atlanta had earned her doctorate in public health because she wanted to help people, but one day at Aetna, her boss told her to work with a new data set.

To her surprise, the company had obtained personal information from a data broker on millions of Americans. The data contained each person’s habits and hobbies, like whether they owned a gun, and if so, what type, she said. It included whether they had magazine subscriptions, liked to ride bikes or run marathons. It had hundreds of personal details about each person. 

The Aetna data team merged the data with the information it had on patients it insured. The goal was to see how people’s personal interests and hobbies might relate to their health care costs. But Kaufman said it felt wrong: The information about the people who knitted or crocheted made her think of her grandmother. And the details about individuals who liked camping made her think of herself. What business did the insurance company have looking at this information? “It was a dataset that really dug into our clients’ lives,” she said. “No one gave anyone permission to do this.”

In a statement, Aetna said it uses consumer marketing information to supplement its claims and clinical information. The combined data helps predict the risk of repeat emergency room visits or hospital admissions. The information is used to reach out to members and help them and plays no role in pricing plans or underwriting, the statement said.

Justin Volz, special to ProPublica

Kaufman said she had concerns about the accuracy of drawing inferences about an individual’s health from an analysis of a group of people with similar traits. Health scores generated from arrest records, home ownership and similar material may be wrong, she said.

Pam Dixon, executive director of the World Privacy Forum, a nonprofit that advocates for privacy in the digital age, shares Kaufman’s concerns. She points to a study by the analytics company SAS, which worked in 2012 with an unnamed major health insurance company to predict a person’s health care costs using 1,500 data elements, including the investments and types of cars people owned. 

The SAS study said higher health care costs could be predicted by looking at things like ethnicity, watching TV and mail order purchases.  

“I find that enormously offensive as a list,” Dixon said. “This is not health data. This is inferred data.” 

Data scientist Cathy O’Neil said drawing conclusions about health risks on such data could lead to a bias against some poor people. It would be easy to infer they are prone to costly illnesses based on their backgrounds and living conditions, said O’Neil, author of the book “Weapons of Math Destruction,” which looked at how algorithms can increase inequality. That could lead to poor people being charged more, making it harder for them to get the care they need, she said. Employers, she said, could even decide not to hire people with data points that could indicate high medical costs in the future.

O’Neil said the companies should also measure how the scores might discriminate against the poor, sick or minorities.

American policymakers could do more to protect people’s information, experts said. In the United States, companies can harvest personal data unless a specific law bans it, although California just passed legislation that could create restrictions, said William McGeveran, a professor at the University of Minnesota Law School. Europe, in contrast, passed a strict law called the General Data Protection Regulation, which went into effect in May.

“In Europe, data protection is a constitutional right,” McGeveran said. 

Pasquale, the University of Maryland law professor, said health scores should be treated like credit scores. Federal law gives people the right to know their credit scores and how they’re calculated. If people are going to be rated by whether they listen to sad songs on Spotify or look up information about AIDS online, they should know, Pasquale said. “The risk of improper use is extremely high. And data scores are not properly vetted and validated and available for scrutiny.”


As I reported this story I wondered how the data vendors might be using my personal information to score my potential health costs. So, I filled out a request on the LexisNexis website for the company to send me some of the personal information it has on me. A week later a somewhat creepy, 182-page walk down memory lane arrived in the mail. Federal law only requires the company to provide a subset of the information it collected about me. So that’s all I got.

LexisNexis had captured details about my life going back 25 years, many that I’d forgotten. It had my phone numbers going back decades and my home addresses going back to my childhood in Golden, Colorado. Each location had a field to show whether the address was “high risk.” Mine were all blank. The company also collects records of any liens and criminal activity, which, thankfully, I didn’t have.

My report was boring, which isn’t a surprise. I’ve lived a middle-class life and grown up in good neighborhoods. But it made me wonder: What if I had lived in “high risk” neighborhoods? Could that ever be used by insurers to jack up my rates — or to avoid me altogether?

I wanted to see more. If LexisNexis had health risk scores on me, I wanted to see how they were calculated and, more importantly, whether they were accurate. But the company told me that if it had calculated my scores it would have done so on behalf of their client, my insurance company. So, I couldn’t have them.

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Journalistic Deficiencies: Metaphors Differ

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David Roberts argues that journalists' desire to appear unbiased impacts their ability to understand the substance:
[I]magine covering substantive disputes every day but not allowing yourself to develop opinions about them. It takes will & effort!  [ . . . ] Political/policy analysis, when done well, is developed through dialog. [ . . . ] It's a muscle that requires exercise. And "objective" reporters don't exercise it. [ . . . ]  I've seen it again & again: when I can cajole "objective" reporters into sharing their opinions on, oh, the national debt, or climate policy, or electoral dynamics, those opinions are almost always shockingly flat-footed & childlike.
[Threadreader link for the twitter averse]

This overlaps with an earlier point by Jay Rosen who coined the term Cult of the Savvy and complained how reporting on the horse race leads to contempt for actual policy and principles:
. . . the cult of the savvy, my term for the ideology and political style that journalists like Chris Cillizza and Mark Halperin spread through their work. The savvy severs any lingering solidarity between journalists as the providers of information, and voters as decision-makers in need of it. The savvy sets up — so it can speak to and cultivate — a third group between these two: close followers of the game. [ . . . ][Political junkies] get to feel superior to ordinary voters, who are the objects of technique and of the savvy analyst's smart read on what is likely to work in the next election. [ . . . ] Whereas the junkies can hope for admission to the secrets of the game (by taking cues from Chris Cillizza and Mark Halperin and the guys at Politico) the activists are hopelessly deluded, always placing their own ideology before the cold hard facts. 

If you follow the Twitter feeds of Ron Fournier of National Journal and Chuck Todd of NBC you routinely see people they call "partisans" described as silly, insane, overheated, unreasonable. Somewhere in their dinosaur brains those who "live off" politics understand that the people who live for it could steal their constituency and turn the savvy into the absurd creatures. Thus the constant ridicule of partisans.
Complaints about false equivalence or both sides do it journalism are common enough, especially when discussing science policy reporting. It's also called Broderism in the political context, after the famous "Dean of the Washington Press Corps".  But I think Roberts and Rosen are interesting in focusing not how this skews individual stories or topics but impacts the journalists themselves.

Regardless, frustration with this approach has been going on a while. The title of this post reference's Krugman complaint from the 2000 election: If a presidential candidate were to declare that the earth is flat, you would be sure to see a news analysis under the headline ''Shape of the Planet: Both Sides Have a Point.''
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The original Mac OS Control Panel done in cross-stitch

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Mac OS Control Panel Cross Stitch

iOS programmer Glenda Adams made a cross-stitch embroidery of the original Control Panel for the Macintosh. Lots of parallels between designing cross-stitch patterns and pixel drawings & fonts. For instance, check out designer Susan Kare’s drawings for some of the original Mac OS icons and compare them to cross-stitch patterns. (P.S. Check out that date…)

See also this Lego Macintosh.

Tags: Apple   design   Glenda Adams   Macintosh   Susan Kare
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acdha
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Washington, DC
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