The long-term lessons America learns from the coronavirus pandemic will spell life or death.
- As the US commences its early stages of COVID-19 vaccinations, Michael Dowling, president and CEO of Northwell Health, argues that now is not the time to relax. "There are lessons to be learned by systems like ours based upon our experience," says Dowling, adding that "we know what these lessons are, and we're working on them."
- The four major takeaways that Dowling has identified are that the United States was unprepared and slow to react, that we need a domestic supply chain so that we aren't relying on other countries, that there needs to be more domestic and international cooperation, and that leadership roles in public health must be filled by public health experts.
- If and when another pandemic hits (in the hopefully distant future), the country—and by extension the world—will be in a much better place to deal with it.
For centuries, universities have advanced humanity toward truth. Professor Jonathan Haidt speaks to why college campuses are suddenly heading in the opposite direction.
- In a lecture at UCCS, NYU professor Jonathan Haidt considers the 'telos' or purpose of universities: To discover truth.
- Universities that prioritize the emotional comfort of students over the pursuit of truth fail to deliver on that purpose, at a great societal cost.
- To make that point, Haidt quotes CNN contributor Van Jones: "I don't want you to be safe ideologically. I don't want you to be safe emotionally. I want you to be strong—that's different."
CNN contributor Van Jones speaks onstage at the EMA IMPACT Summit in 2018.
Credit: Michael Kovac/Getty Images for Environmental Media Association<p>There are many places and institutions whose purpose, or <em>telos</em>, is comfort. But a university is not one of those places. To make that point, Haidt quotes CNN contributor Van Jones:</p><p style="margin-left: 20px;">I don't want you to be safe ideologically. I don't want you to be safe emotionally. I want you to be strong—that's different. I'm not going to pave the jungle for you. Put on some boots and learn how to deal with adversity. I'm not going to take all the weights out of the gym. That's the whole point of the gym. <em>This</em> is the gym.</p><p>By prioritizing comfort over the pursuit of truth, universities are ignoring their purpose. Higher education should be an arena of open inquiry and free expression, where ideas are exchanged, tested, and scrutinized. A liberal education should be "an invitation to be concerned not with the employment of what is familiar but with understanding what is not yet understood," <a href="https://books.google.com/books?id=Jpu7BAAAQBAJ&pg=PT286&lpg=PT286&dq=%22an+invitation+to+be+concerned+not+with+the+employment+of+what+is+familiar+but+with+understanding+what+is+not+yet+understood.%E2%80%9D&source=bl&ots=bmqaS1BxSm&sig=ACfU3U0aOokPZOGJlLFUVO9-a8VBV50tCw&hl=en&sa=X&ved=2ahUKEwi_u-jd1_btAhWqzVkKHSdKBMsQ6AEwAnoECAEQAg#v=onepage&q=%22an%20invitation%20to%20be%20concerned%20not%20with%20the%20employment%20of%20what%20is%20familiar%20but%20with%20understanding%20what%20is%20not%20yet%20understood.%E2%80%9D&f=false" target="_blank">according</a> to philosopher Michael Oakeshott.</p>
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A new survey shows who believes what and how it differs from what Americans believe as a whole.
- The newest survey of congressional religious beliefs shows our representatives aren't quite like us.
- Members of Congress are much more religious and more Christian than the general population.
- The effects of this disconnect are debatable.
The demographics of Congress and their constituents<p> A whopping 88 percent of Representatives and Senators are Christians. Breaking this down, 55 percent of them identify as some sort of Protestant, and another 30 percent are Catholic. Mormons make up around 2 percent of the legislature, with Orthodox Christians following at just above 1 percent. This puts them well behind the Jews, which 6 percent of the body identified as. </p><p>Behind them came the Buddhist, Hindu, Muslim, Humanist, and Unaffiliated members. Each of these categories amounts to under one percent of Congress by themselves, for a collective total of 12 members. </p><p>Eighteen members refused to answer the survey; many of them also refused to answer two years ago—speculation as to why this is and what they actually believe continues elsewhere. </p><p>For comparison, only 65 percent of the general public identifies as a Christian. Beyond that, only 20 percent of the population is Catholic, and another 43 percent Protestant. People with no religious affiliation make up another 26 percent. Judaism is three times as common in Congress as it is elsewhere in the country, with only 2 percent of the population identifying as such. </p><p>Mormons and Orthodox Christians enjoy nearly propositional representation, as they make up 2 percent and just under 1 percent of the population nationally. The remaining represented religions are in a similar situation. They are under-represented but not nearly as much as the non-religious—Buddhists, Muslims, and Hindus each make up about one percent of the general population. Unitarian Universalists are seated in Congress at the same rate as the aforementioned faiths but are just under one percent of the population. </p><p>Some trends emerge in this data. Since 1961, the year this survey was first sent out, the percentage of Christians has fallen, though by far less than the population overall. Like the rest of Protestant America, members of Congress are increasingly likely not to name a denomination, such as Lutheran or Baptist, but to instead identify with the more general term of Protestant. </p><p> It is also worth mentioning that there may be more to this topic than these questions can reveal.</p><p>Many Jewish people identify as such while also being agnostic or even <a href="https://en.wikipedia.org/wiki/Jewish_atheism" target="_blank" rel="noopener noreferrer">atheistic</a>. It is possible that the degree of actual belief among some of the members of Congress using the term varies dramatically. Likewise, the one "unaffiliated" member has stated before that they don't want to be bound by <a href="https://friendlyatheist.patheos.com/2012/11/09/breaking-kyrsten-sinema-is-not-an-atheist/" target="_blank" rel="noopener noreferrer">labels</a>, further reducing the usefulness of a survey that tries to label everybody.</p>
Why might this be?<iframe width="730" height="430" src="https://www.youtube.com/embed/Yz8VbAxkaDw" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> In addition to the previously mentioned difficulties of having an entirely representative legislature, some religious groups are still more electable than others.</p><p>A recent <a href="https://news.gallup.com/poll/285563/socialism-atheism-political-liabilities.aspx" target="_blank" rel="noopener noreferrer">Gallop poll</a> demonstrates that only about 60 percent of Americans would vote for a qualified atheist and that only a few more would support a similarly capable Muslim. While these numbers have increased over time and differ greatly based on party affiliation, it is probable that many non-Christian potential candidates justify not running on the grounds of these numbers. </p><p> Before you point out that these are majorities, that is who is <em>willing</em> to vote for such a person at all, not a list of people who <em>would</em> for sure. You'd probably want better numbers than that unless you're sure you can get all of them. </p>
What does this mean for legislation?<iframe width="730" height="430" src="https://www.youtube.com/embed/KS7pnPlQLcY" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> It doesn't necessarily need to mean anything. Representatives of all faiths or lack thereof can govern in a secular manner that doesn't favor any particular worldview.</p><p>The Congressional Freethought Caucus, dedicated to fostering science and reason while defending the secular nature of <a href="https://secular.org/governmental-affairs/congressional-freethought-caucus/" target="_blank" rel="noopener noreferrer">government</a>, has 14 members. It is, obviously, impossible for all its members to be non-religious. Its members represent a variety of faiths and denominations of Christianity, including humanism, while supporting all people's rights.</p><p>A remaining concern is that the disproportionate representation could lead to specific points of view not being <a href="https://friendlyatheist.patheos.com/2021/01/04/the-religious-makeup-of-the-117th-congress-includes-a-few-surprises/" target="_blank" rel="noopener noreferrer">heard</a>. There are no atheists in Congress to articulate their viewpoints on legislation that concerns others like them. This lack of representation is <a href="https://www.teenvogue.com/story/why-representation-in-politics-matters" target="_blank" rel="noopener noreferrer">something</a> that <a href="https://thehill.com/blogs/pundits-blog/campaign/297143-why-our-representation-in-government-should-look-more-like-us" target="_blank" rel="noopener noreferrer">can</a> and <a href="https://genderwatch2018.org/scaling-womens-political-representation-matters/" target="_blank" rel="noopener noreferrer">has</a> been <a href="https://www.theguardian.com/us-news/commentisfree/2018/oct/04/few-us-politicians-working-class" target="_blank" rel="noopener noreferrer">said</a> for <a href="https://www.voanews.com/usa/why-arent-more-native-americans-members-us-congress" target="_blank" rel="noopener noreferrer">other</a> demographic groups both now and at different points in our history. </p><p>In any small body representing a larger one, there will be strange demographic mismatches by necessity. In the case of the United States Congress, these differences are rather pronounced. While they may have only a limited effect on legislation, there may be other, less tangible ways that this disconnect causes issues. </p><p>Or, it might be nothing more than a statistical curiosity. </p>
Research from MIT's School Effectiveness & Inequality Initiative found making college more affordable cut dropout rates and boosted degree attainment.
The study groups<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk1OTU2OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NzYyMjgyMH0.HoOUfA4eXLgFltk-M_Mu3E3qORUh2shzeYoVa3wk86E/img.jpg?width=1245&coordinates=0%2C237%2C0%2C237&height=700" id="861dd" class="rm-shortcode" data-rm-shortcode-id="cfef9e15abee21ae82c46b76199c4436" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
An aerial view of MIT and Harvard Bridge. The university's School Effectiveness & Inequality Initiative partnered with the Susan Thompson Buffett Foundation for the study.
Credit: Adobe Stock<p>The study comes from <a href="https://seii.mit.edu/" target="_blank">MIT's School Effectiveness & Inequality Initiative</a>. Its researchers wanted to determine the effect scholarships had on degree attainment. As they put it, </p><p style="margin-left: 20px;">"Financial aid is typically motivated by a desire to increase postsecondary attainment by making college more affordable. This raises the question of whether aid meets this test by boosting educational attainment. As with any sort of award or subsidy, it's worth considering the extent to which financial aid changes behavior. The fact that aid is motivated by the desire to increase schooling does not mean aid programs accomplish this."</p><p>To test this question, they partnered with <a href="https://buffettscholarships.org/" target="_blank">the Susan Thompson Buffett Foundation</a>, an organization that offers scholarships to first-time freshman attending public colleges in Nebraska. The researchers designed a partially randomized study around the Foundation's 2012–2016 scholarship applicants, a cohort of roughly 16,500 students seeking aid. </p><p>Because low-scoring applicants were unlikely to complete college, they were not provided a scholarship and were removed from the study. Similarly, while high-scoring applicants were awarded a scholarship, they too were removed from the study as their degree completion was likely with or without the financial abetment. This left a middle pool of applicants, each sporting a comparable level of need and college-readiness.</p><p>The Foundation awarded scholarships randomly to this middle group of applicants; those who did not receive scholarships served as the controls. Because the number of applicants far exceeded the available aid, no student was artificially denied a scholarship for the study's sake. All told, the study included 3,699 scholarship-awarded participants and 4,491 controls. Most sought degrees at four-year colleges though some matriculated into two-year schools.</p><p>As this group was comparable in areas such as GPA, colleges attended, and expected family contributions, any statistically significant difference between the recipients and the controls would provide some evidence of a causal connection between financial aid and degree attainment.</p>
Easing the six-year itch<p>The researchers followed the students' college careers, from freshman year to spring 2019, and found that the scholarships did change behavior. Enrollment was only slightly higher for the aid recipients than the controls—98.7 percent compared to 96.1—but as the two groups' college careers continued, a noticeable difference emerged in dropout rates. By the end of their fourth year, only 71.6 percent of the control group remained, a dropout rate of 24.5 percent; meanwhile, the scholarship group only declined by 18 percent.</p><p>The scholarships also bolstered degree completion. Though bachelor degree completion was roughly even by the end of the fourth year, the aid recipients began to pull ahead after that. By the end of their sixth year, 71 percent of the award recipients received their degree, 8.4 percentage points more than the control. This suggests that as degree completion began to drag on longer, the infusion of extra financial resources made the final push more manageable.</p><p>The researchers not only found that aid promotes full-time enrollment, but that it benefitted historically underrepresented groups most, including non-white and first-generation applicants. These findings support a <a href="https://vtechworks.lib.vt.edu/handle/10919/100548" target="_blank">growing</a> <a href="https://files.eric.ed.gov/fulltext/ED545465.pdf" target="_blank" rel="noopener noreferrer">body</a> of <a href="https://kuscholarworks.ku.edu/bitstream/handle/1808/12507/Shulenburger_University.pdf;sequence=1" target="_blank" rel="noopener noreferrer">research</a> that suggests college affordability directly impacts student decision-making and degree attainment.</p><p>The study, titled "<a href="https://seii.mit.edu/wp-content/uploads/2020/10/SEII-Discussion-Paper-2020.06-Angrist-Autor-Pallais.pdf" target="_blank" rel="noopener noreferrer">Marginal Effects of Merit Aid for Low-Income Students</a>," is part of an ongoing research study. Additional reports will be released as the study continues.</p>
What does college affordability mean?<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="2f032882b6038c7d6734ac69f95fbb69"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/qZTnmMxnU0A?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Scholarships are one way of making college more affordable, but they are part of a much larger conversation as to what affordability means.</p><p>The <a href="https://www.cnbc.com/2019/10/24/why-college-tuition-keeps-rising.html" target="_blank">ballooning cost of tuition</a> in recent decades is another concern. Factors for this surge include a massive increase in demand, cuts in state funding, new student services, and <a href="https://www.chronicle.com/article/executive-compensation-at-public-and-private-colleges/#id=table_public_2019" target="_blank" rel="noopener noreferrer">bloated administrative compensation</a>. While colleges could certainly rein in some of their more extravagant expenses, and legislators agree to fund more, <a href="https://www.luminafoundation.org/files/publications/ideas_summit/College_Affordability-What_Is_It_and_How_Can_We_Measure_It.pdf" target="_blank" rel="noopener noreferrer">the question of affordability</a> goes further still. </p><p>It concerns the quality of education, whether students are dependent or independent, their resources before matriculating, what they can expect from the investment after graduation, and how much of their future income they are willing (or able) to pay. The calculus must also consider <a href="https://bigthink.com/kenzie-academy/software-engineering-school" target="_self">available alternatives</a>, their costs, and their potential outcomes. It's a multifaceted balancing act between what's available, what students can afford, and what schools can offer with the resources they have available—which, of course, ties directly to the funds that schools have available. </p><p>In <a href="https://www.higheredtoday.org/2017/05/16/think-college-affordability/" target="_blank" rel="noopener noreferrer">an op-ed for Higher Education Today</a><em>, </em>Susan Baum, a senior fellow in the Education Policy Program at the Urban Institute, correctly points out that a "low-cost program designed purely to train people for an occupation that is unlikely to exist in 10 years, while appearing 'affordable,' is not affordable at all."</p><p>So then, how should we think about college affordability?</p><p>Baum recommends we start the conversation with need-based considerations at the forefront. "The financial resources available to a student at the time of enrollment are critical. Students have very different starting points for measuring outcomes and value depending on their circumstances," Baum writes. But it also requires us to think beyond funding; we need to consider the resources colleges need to provide a valuable education as well as the types of experiences that students want. </p><p>If we want more students to graduate, we need to discover the right balance between moderate spending, need-based aid, and program quality, a balance that will make college accessible to all who desire to attend.</p>
The federal government and private insurers greatly increased Americans' telehealth access during the pandemic. Will these changes be permanent?
- When telehealth visits began skyrocketing after the pandemic began, hospitals had to increase their number of virtual appointments by magnitudes. Most did it seamlessly.
- Big Think spoke to Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, about this transition and how it benefited patients.
- Telehealth has proven its value during the pandemic, but it might stop evolving unless the federal government redesigns the regulatory framework so that insurers cover it and patients can afford it.
What are the obstacles facing telehealth?<p>One of the biggest obstacles to widespread adoption of telehealth has been a lack of national legislation providing financial incentive for health centers to adopt it.</p><p>States laws vary on how practitioners are paid for telehealth visits. In some states, laws require insurance providers to cover telehealth visits at parity—at the same rate as in-person visits. But in states without parity laws, there's little incentive for health care organizations to invest in telehealth infrastructure and training.</p><p>Access is also a major obstacle. The Centers for Medicare and Medicaid Services (CMS) generally reimburse practitioners for telehealth visits only when patients live in "designated rural underserved areas."</p><p>But not all underserved areas are in small, remote places. After all, a single parent living in Brooklyn, New York, might also have trouble accessing quality health care.</p><p>"Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab," Doerfler said. "So access is almost certainly going to be improved by the greater availability of telehealth in that direct-to-patient, in-their-home-or-office, setting."</p><p>Lack of internet access is also a problem. A <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768771?appId=scweb" target="_blank" rel="noopener noreferrer">paper</a> published by the JAMA Network in August found that 41 percent of Medicare beneficiaries don't have a computer at home with access to high-speed internet, and roughly the same number don't have a smartphone with an unlimited data plan.</p>
What is the future of telehealth?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDU1NTU1Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NjA1MjkxMH0.1UuR6tky1k58rOeE9Vcgt8bUfhA2vut6yaCAXik1MEY/img.jpg?width=980" id="9f55b" class="rm-shortcode" data-rm-shortcode-id="4549f30a0347a85c7145690870cf742c" data-rm-shortcode-name="rebelmouse-image" alt="Caucasian female doctor delivering telemedicine consultation to a patient" data-width="5600" data-height="3150" />
Credit: Daniilvolkov via AdobeStock<p>Lawmakers in both parties and health care professionals have indicated a desire to make permanent some of the regulatory changes to telehealth enacted during the pandemic. That's key, because without the financial incentives to continue expanding telehealth, health care providers may revert to the pre-pandemic approach.</p><p>"One issue, which is important for health care and non-health-care folks to know, is that telehealth will continue to expand dramatically as long as there's funding and reimbursement for it," said Michael Dowling, Northwell's president and CEO. "If the insurance companies and government decide, 'We don't want to pay for telehealth going forward or virtual visits,' then it's going to slow down. If there is no delivery system, no health care system, hospital, or doctor is going to continue to expand telehealth if they don't get reimbursed for it."</p><p>Yet some of the nation's biggest insurers have already stopped waiving telehealth deductibles and copays for some customers, even though there's no clear end in sight for the pandemic.</p><p>The long-term solution, Doerfler said, is for CMS to start paying for telehealth services, a<a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a>t parity, up and down the chain, and passing federal legislation that requires <a href="https://www.siia.org/i4a/pages/Index.cfm?pageID=4546#:~:text=What%20is%20a%20self%2Dinsured%20health%20plan%3F&text=A%20self%2Dinsured%20group%20health,care%20benefits%20to%20its%20employees." target="_blank">self-insured health care plans</a> to pay for telehealth services as they would in-person visits.</p><p>Telehealth is proven to work for urgent care, primary care and some specialty care, and it clearly expands access to behavioral health care, according to Doerfler. "Some have said that costs of providing telehealth are lower than face-to-face care, but most of the costs are unchanged, and new ones are added with technology requirements. When the patient receives a very specific service there are billing codes used to define that service. If the service is less, the code represents that. If the service is the same, the code will represent that and needs to be paid at parity."</p><p>Doerfler added that, while telehealth can't replace all traditional health care services, it should be "<a href="https://www.northwell.edu/news/insights/how-to-have-an-effective-telehealth-visit" target="_blank">in the toolbox</a>" for patients and physicians.</p><p>"In the modern world, where this type of technology is being used for all sorts of personal and business uses, excluding something as personal as your care between you and your doctor from fitting into that modern paradigm makes no sense," Doerfler said.</p>