New Jersey Hospital Is the Costliest in the Nation

[ed. Follow-up to the recent article: Hospital Billing Varies Wildly, U.S. Data Shows. See also: Why Hospital Charges Vary So Much.]

The most expensive hospital in America is not set amid the swaying palm trees of Beverly Hills or the luxury townhouses of New York’s Upper East Side.

It is in a faded blue-collar town 11 miles from Midtown Manhattan.

Based on the bills it submits to Medicare, the Bayonne Medical Center charged the highest amounts in the country for nearly one-quarter of the most common hospital treatments, according to a New York Times analysis of 2011 data, the most recent available. No other hospital was at the top of the price list more often.

Bayonne Medical typically charged $99,689 for treating each case of chronic lung disease, five times as much as other hospitals and 17 times as much as Medicare paid in reimbursement. The hospital also charged on average of $120,040 to treat transient ischemia, a type of small stroke that has no lasting effect. That was six times the national average and 24 times what Medicare paid.

For those prices, the quality of care at Bayonne Medical is no better — or worse — than that at most other New Jersey hospitals. In a 2011 state hospital quality report, Bayonne Medical scored only in the top 50 percent. But profits at the hospital, which was bankrupt in 2007, have soared in recent years, in part because it has found a way to turn some of those high billings into payments.

The increasingly contentious issue of hospital charges drew renewed attention last week when the federal government released Medicare data showing that facilities nationwide submitted widely divergent bills for the same treatments. And while the unassuming, six-story brick hospital here holds a notable place in those rankings, others stand out as well.

The midsize Crozer-Chester Medical Center in Upland, Pa., was the top biller in the country for urinary tract infections, while one prestigious Manhattan hospital, NYU Langone Medical Center, charged twice as much as the equally high-end NewYork-Presbyterian to implant a cardiac pacemaker. But Medicare considers the two New York hospitals so similar it pays them both about $20,000 for the procedure. The hospital industry is quick to say that the charges are irrelevant because virtually no one — private insurers, Medicare or even the uninsured — pays anywhere near those amounts. Medicare sets standard rates for treatments and insurers negotiate with hospitals. But experts add that the charges reflect decades of maneuvering by hospitals to gain an edge over insurers and provide themselves with tax advantages.

Until a recent ruling by the Internal Revenue Service, for instance, a hospital could use the higher prices when calculating the amount of charity care it was providing, said Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins. “There is a method to the madness, though it is still madness,” Mr. Anderson said.

A close look at the finances of Bayonne Medical Center sheds light on how hospital pricing at the extremes may financially benefit an institution. The practices at Bayonne Medical also highlight a new financial strategy used by a small number of hospitals to increase their profits by “going out of network” — severing ties, and hence contractual agreements that limit reimbursement rates, with large private insurers.

by Julie Creswell, Barry Meier and Jo Craven McGinty, NY Times |  Read more:

Image: Nadav Neuhaus for The New York Times

The 'Other' IRS Scandal

The burgeoning “scandal” over how the IRS chose for review 75 applicants for tax-exempt status puts on full display an unfortunate tendency in journalism—to quote people accurately without explaining the underlying context. Yes, it is as wrong for IRS employees to select groups to scrutinize based on their names as it is for police to stop and frisk young people based on the color of their skin. Still, the facts here are not so black-and-white as with racial profiling.

There is a scandal in all of this—several, actually, and some are more significant than the one that is getting all the attention. As the story unfolds, here are some important points to keep in mind:

• Missing from much coverage is the relevant recent history—the role of the Supreme Court’s 2010 Citizens United decision and how it prompted a deluge of requests from new organizations seeking tax-exempt status under tax code Section 501(c)(4) as “social welfare” organizations—despite the fact that many of these are blatantly political operations.

• Congress requires the IRS to review every application for tax-exempt status to weed out organizations that are partisan, political, or that generate private gain. Congress has imposed this requirement on the IRS, and its predecessor agencies, since 1913.

• When it comes to 501(c)(4) organizations, what the IRS is supposed to do is draw a distinction between groups that are “primarily engaged” in politics and groups that really are primarily engaged in “social welfare”—somehow “promoting the common good and social welfare of the community.” It’s kind of mushy. Brad Plumer has a good explainerabout this on The Washington Post’s Wonkblog.

• The first scandal here, meanwhile, is that the social welfare tax exemption is being used by existing 501(c)(4) organizations, including some very large ones, to promote partisan political interests—the very activity Congress has explicitly prohibited for a century. The New York Times, after a weak political piece on Saturday, had a clear and useful explainer about this on Tuesday.

• Also worth pointing out: None of the organizations that the IRS scrutinized as a result of the ill-considered screening-by-name regime was denied tax exempt status.

• The second—and widely ignored—scandal in this unfolding story is that the IRS is drowning. Congress is demanding that the agency do more and more with less and less, as we have reported here and elsewhere. As David Levinthal reported Tuesday at the Center for Public Integrity:

The IRS’ Exempt Organizations Division, which finds itself at the scandal’s epicenter, processed significantly more tax exemption applications in fiscal year 2012 by so-called 501(c)(4) “social welfare” organizations — 2,774 — than it has since at least the late 1990s.

That compares to 1,777 applications in 2011 and 1,741 in 2010, he reported.

Meanwhile, in real terms the IRS budget has been cut 17 percent per capita since 2002, even as Congress has piled on other new duties, such as hunting for offshore accounts, dealing with the complexities of the Affordable Care Act, and other expanded obligations.

by David Kay Johnson, Columbia Journalism Review |  Read more:

Image via: Ameristar Tax Centers

One World Trade Center
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Ingo Maurer, Broken Egg.
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Brion Gysin, Untitled, 1961
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Billionaires Unchained

The Supreme Court's 2010 Citizens United decision is often blamed -- or hailed -- for creating super PACs. In fact, it was a lesser-known case, SpeechNow.org vs. Federal Election Commission, decided by the D.C. Circuit Court of Appeals two months later, that did the trick. At the heart of SpeechNow was the central tension in all campaign money fights: the balance between stopping corruption or the appearance of corruption, and protecting the right to free speech. In this instance, the D.C. appeals court, influenced by the Citizens United decision, landed on the side of free speech, ruling that limits to giving and spending when it came to any group -- and here's the kicker -- acting independently of candidates and campaigns violated the First Amendment.

Wonky as that may sound, SpeechNow reconfigured the political landscape and unchained big donors after decades of restrictions. The lawyers who argued the case, the academics and legal eagles whose expertise is campaign finance, and the beat reporters like Carney Newlin soon grasped what SpeechNow had wrought: a new, turbocharged political outfit that had no precedent in American politics.

Super PACs can raise unlimited amounts of money from pretty much anyone -- individuals, corporations, labor unions -- and there is no limit on how much they can spend. Every so often, they must reveal their donors and show how they spent their money. And they can't directly coordinate with candidates or their campaigns. For instance, Restore Our Future, the super PAC that spent $142 million to elect Mitt Romney, couldn't tell his campaign when or where it was running TV ads, couldn't share scripts, couldn't trade messaging ideas. Nor could Restore Our Future -- yes, even its founders wince at the name -- sit down with Romney and tape an interview for a TV ad.

It's far easier, in other words, for a super PAC to attack the other guy, which helps explain all the hostility on the airwaves in 2012. Sixty-four percent of all ads aired during the presidential race were negative, up from 51% in 2008, 44% in 2004, and 29% in 2000. Much of that negativity can be blamed on super PACs and their arsenal of attack ads, according to a recent analysis by Wesleyan University's Erika Franklin Fowler and Washington State University's Travis Ridout. They found that a staggering 85% of all ads aired by “outside groups” were negative, while only 5% were positive.

And it will only get worse. "It's going to be the case that the more super PACs invest in elections, the more negative those elections will be," Michael Franz, a co-director of the Wesleyan Media Project, told me. "They're the ones doing the dirty work." Think of them as the attack dogs of a candidate's campaign -- and the growling packs of super PACs are growing fast.

The savviest political operatives quickly realized how potentially powerful such outfits could be when it came to setting agendas and influencing the political system. In March 2010, Karl Rove, George W. Bush's erstwhile political guru, launched American Crossroads, a super PAC aimed at influencing the 2010 midterms. As consultants like Rove and the wealthy donors they courted saw the advantages of having their own super PACs -- no legal headaches, no giving or spending limits -- the groups grew in popularity.

By November 2010, 83 of them had spent $63 million on the midterm elections. Nearly $6 of every $10 they put out supported conservative candidates, and it showed: buoyed by the Tea Party, Republicans ran roughshod over the Democrats, retaking control of the House and winnowing their majority in the Senate. It was a "shellacking," as President Obama put it, powered by rich donors and the new organizations that went with them.

In 2012, no one, it seemed, could afford to sit on the sidelines. Having decried super PACs as "a threat to democracy," Obama and his advisers flip-flopped and blessed the creation of one devoted specifically to reelecting the president. Soon, they were everywhere, at the local, state, and federal levels. A mom started one to back her daughter's congressional campaign in Washington State. Aunts and uncles bankrolled their nephew's super PAC in North Carolina. Super PACs spent big on abortion, same-sex marriage, and other major issues.

In all, the number of super PACs shot up to 1,310 during the 2012 campaign, a 15-fold increase from two years earlier. Fundraising and spending similarly exploded: these outfits raised $828 million and spent $609 million.

But what's most striking about these groups is who funds them. An analysis by the liberal think tank Demos found that out of every $10 raised by super PACs in 2012, $9 came from just 3,318 people giving $10,000 or more. That small club of donors is equivalent to 0.0011% of the U.S. population.

by Andy Kroll, Tomdispatch.com |  Read more:

Image: Reinhard Hunger for The New York Times. Model by Katrin Rodegast

Pat Metheny: Secret Story

Above the Treetops and Finding and Believing.

[ed. Repost. This still blows me away. When I first heard the album I thought there might be a Chinese children's chorus involved, then I saw the videos.]

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Wilhelm Sasnal, Untitled 2009.
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How the Case for Austerity Has Crumbled

In normal times, an arithmetic mistake in an economics paper would be a complete nonevent as far as the wider world was concerned. But in April 2013, the discovery of such a mistake—actually, a coding error in a spreadsheet, coupled with several other flaws in the analysis—not only became the talk of the economics profession, but made headlines. Looking back, we might even conclude that it changed the course of policy.

Why? Because the paper in question, “Growth in a Time of Debt,” by the Harvard economists Carmen Reinhart and Kenneth Rogoff, had acquired touchstone status in the debate over economic policy. Ever since the paper was first circulated, austerians—advocates of fiscal austerity, of immediate sharp cuts in government spending—had cited its alleged findings to defend their position and attack their critics. Again and again, suggestions that, as John Maynard Keynes once argued, “the boom, not the slump, is the right time for austerity”—that cuts should wait until economies were stronger—were met with declarations that Reinhart and Rogoff had shown that waiting would be disastrous, that economies fall off a cliff once government debt exceeds 90 percent of GDP.

Indeed, Reinhart-Rogoff may have had more immediate influence on public debate than any previous paper in the history of economics. The 90 percent claim was cited as the decisive argument for austerity by figures ranging from Paul Ryan, the former vice-presidential candidate who chairs the House budget committee, to Olli Rehn, the top economic official at the European Commission, to the editorial board of The Washington Post. So the revelation that the supposed 90 percent threshold was an artifact of programming mistakes, data omissions, and peculiar statistical techniques suddenly made a remarkable number of prominent people look foolish.

The real mystery, however, was why Reinhart-Rogoff was ever taken seriously, let alone canonized, in the first place. Right from the beginning, critics raised strong concerns about the paper’s methodology and conclusions, concerns that should have been enough to give everyone pause. Moreover, Reinhart-Rogoff was actually the second example of a paper seized on as decisive evidence in favor of austerity economics, only to fall apart on careful scrutiny. Much the same thing happened, albeit less spectacularly, after austerians became infatuated with a paper by Alberto Alesina and Silvia Ardagna purporting to show that slashing government spending would have little adverse impact on economic growth and might even be expansionary. Surely that experience should have inspired some caution.

So why wasn’t there more caution? The answer, as documented by some of the books reviewed here and unintentionally illustrated by others, lies in both politics and psychology: the case for austerity was and is one that many powerful people want to believe, leading them to seize on anything that looks like a justification. I’ll talk about that will to believe later in this article. First, however, it’s useful to trace the recent history of austerity both as a doctrine and as a policy experiment.

by Paul Krugman, New York Review of Books |  Read more:

Image: Pete Souza/White House

François Perrier, The Sacrifice of Iphigenia,1632-33.
Oil on canvas, 213 x 154 cm
Musйe des Beaux-Arts, Dijon
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Welcome, Robot Overlords. Please Don't Fire Us?

Increasingly, then, robots will take over more and more jobs. And guess who will own all these robots? People with money, of course. As this happens, capital will become ever more powerful and labor will become ever more worthless. Those without money—most of us—will live on whatever crumbs the owners of capital allow us.

This is a grim prediction. But it's not nearly as far-fetched as it sounds. Economist Paul Krugman recently remarked that our long-standing belief in skills and education as the keys to financial success may well be outdated. In a blog post titled "Rise of the Robots," he reviewed some recent economic data and predicted that we're entering an era where the prime cause of income inequality will be something else entirely: capital vs. labor.

Until a decade ago, the share of total national income going to workers was pretty stable at around 70 percent, while the share going to capital—mainly corporate profits and returns on financial investments—made up the other 30 percent. More recently, though, those shares have started to change. Slowly but steadily, labor's share of total national income has gone down, while the share going to capital owners has gone up. The most obvious effect of this is the skyrocketing wealth of the top 1 percent, due mostly to huge increases in capital gains and investment income.

In the economics literature, the increase in the share of income going to capital owners is known as capital-biased technological change. Let's take a layman's look at what that means.

The question we want to answer is simple: If CBTC is already happening—not a lot, but just a little bit—what trends would we expect to see? What are the signs of a computer-driven economy? First and most obviously, if automation were displacing labor, we'd expect to see a steady decline in the share of the population that's employed.

Second, we'd expect to see fewer job openings than in the past. Third, as more people compete for fewer jobs, we'd expect to see middle-class incomes flatten in a race to the bottom. Fourth, with consumption stagnant, we'd expect to see corporations stockpile more cash and, fearing weaker sales, invest less in new products and new factories. Fifth, as a result of all this, we'd expect to see labor's share of national income decline and capital's share rise.

These trends are the five horsemen of the robotic apocalypse, and guess what? We're already seeing them, and not just because of the crash of 2008. They started showing up in the statistics more than a decade ago. For a while, though, they were masked by the dot-com and housing bubbles, so when the financial crisis hit, years' worth of decline was compressed into 24 months. The trend lines dropped off the cliff.

How alarmed should we be by this? In one sense, a bit of circumspection is in order. The modern economy is complex, and most of these trends have multiple causes. The decline in the share of workers who are employed, for example, is partly caused by the aging of the population. What's more, the financial crisis has magnified many of these trends. Labor's share of income will probably recover a bit once the economy finally turns up.

But in another sense, we should be very alarmed. It's one thing to suggest that robots are going to cause mass unemployment starting in 2030 or so. We'd have some time to come to grips with that. But the evidence suggests that—slowly, haltingly—it's happening already, and we're simply not prepared for it.

by Kevin Drum, Mother Jones |  Read more:
Illustration by Roberto Parada

Some of My Best Friends Are Germs

I can tell you the exact date that I began to think of myself in the first-person plural — as a superorganism, that is, rather than a plain old individual human being. It happened on March 7. That’s when I opened my e-mail to find a huge, processor-choking file of charts and raw data from a laboratory located at the BioFrontiers Institute at the University of Colorado, Boulder. As part of a new citizen-science initiative called the American Gut project, the lab sequenced my microbiome — that is, the genes not of “me,” exactly, but of the several hundred microbial species with whom I share this body. These bacteria, which number around 100 trillion, are living (and dying) right now on the surface of my skin, on my tongue and deep in the coils of my intestines, where the largest contingent of them will be found, a pound or two of microbes together forming a vast, largely uncharted interior wilderness that scientists are just beginning to map.

I clicked open a file called Taxa Tables, and a colorful bar chart popped up on my screen. Each bar represented a sample taken (with a swab) from my skin, mouth and feces. For purposes of comparison, these were juxtaposed with bars representing the microbiomes of about 100 “average” Americans previously sequenced.

Here were the names of the hundreds of bacterial species that call me home. In sheer numbers, these microbes and their genes dwarf us. It turns out that we are only 10 percent human: for every human cell that is intrinsic to our body, there are about 10 resident microbes — including commensals (generally harmless freeloaders) and mutualists (favor traders) and, in only a tiny number of cases, pathogens. To the extent that we are bearers of genetic information, more than 99 percent of it is microbial. And it appears increasingly likely that this “second genome,” as it is sometimes called, exerts an influence on our health as great and possibly even greater than the genes we inherit from our parents. But while your inherited genes are more or less fixed, it may be possible to reshape, even cultivate, your second genome.

Justin Sonnenburg, a microbiologist at Stanford, suggests that we would do well to begin regarding the human body as “an elaborate vessel optimized for the growth and spread of our microbial inhabitants.” This humbling new way of thinking about the self has large implications for human and microbial health, which turn out to be inextricably linked. Disorders in our internal ecosystem — a loss of diversity, say, or a proliferation of the “wrong” kind of microbes — may predispose us to obesity and a whole range of chronic diseases, as well as some infections. “Fecal transplants,” which involve installing a healthy person’s microbiota into a sick person’s gut, have been shown to effectively treat an antibiotic-resistant intestinal pathogen named C. difficile, which kills 14,000 Americans each year. (Researchers use the word “microbiota” to refer to all the microbes in a community and “microbiome” to refer to their collective genes.) We’ve known for a few years that obese mice transplanted with the intestinal community of lean mice lose weight and vice versa. (We don’t know why.) A similar experiment was performed recently on humans by researchers in the Netherlands: when the contents of a lean donor’s microbiota were transferred to the guts of male patients with metabolic syndrome, the researchers found striking improvements in the recipients’ sensitivity to insulin, an important marker for metabolic health. Somehow, the gut microbes were influencing the patients’ metabolisms.

Our resident microbes also appear to play a critical role in training and modulating our immune system, helping it to accurately distinguish between friend and foe and not go nuts on, well, nuts and all sorts of other potential allergens. Some researchers believe that the alarming increase in autoimmune diseases in the West may owe to a disruption in the ancient relationship between our bodies and their “old friends” — the microbial symbionts with whom we coevolved.

These claims sound extravagant, and in fact many microbiome researchers are careful not to make the mistake that scientists working on the human genome did a decade or so ago, when they promised they were on the trail of cures to many diseases. We’re still waiting. Yet whether any cures emerge from the exploration of the second genome, the implications of what has already been learned — for our sense of self, for our definition of health and for our attitude toward bacteria in general — are difficult to overstate. Human health should now “be thought of as a collective property of the human-associated microbiota,” as one group of researchers recently concluded in a landmark review article on microbial ecology — that is, as a function of the community, not the individual.

Such a paradigm shift comes not a moment too soon, because as a civilization, we’ve just spent the better part of a century doing our unwitting best to wreck the human-associated microbiota with a multifronted war on bacteria and a diet notably detrimental to its well-being. Researchers now speak of an impoverished “Westernized microbiome” and ask whether the time has come to embark on a project of “restoration ecology” — not in the rain forest or on the prairie but right here at home, in the human gut.

by Michael Pollan, NY Times |  Read more:

Image: Hannah Whitaker for The New York Times. Prop stylist: Emily Mullin

Photo Copyright Clarissa Bonet, 2012 ‘Student Work’ Winner (PDN Curator).
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The Opihi Ohana

Opihi, limpets with a cone-like shell, have been overharvested for more than a century. In 1900, roughly 150,000 pounds of opihi were harvested for commercial sale in Hawaii. By 1944, opihi sales were down to 13,000 pounds. “The fishery had crashed,” says Dr. Chris Bird, a marine ecologist with The Hawaii Institute of Marine Biology (HIMB). Bird explains that the value of opihi is increasing due to the fact they’re getting harder and harder to find. In 2009, opihi were the fifth most expensive seafood harvested in Hawaiian waters, at $6.80 per pound wholesale, according to NOAA and the Hawaii Division of Aquatic Resources. (...)

Opihi Facts

Hawaii has three endemic species of opihi and each live in different sections along the rocky intertidal zone. They’re also very specific about what they like—and what they don’t.

Opihi Makaiauli

(Cellana exarata) want to be splashed, and don’t mind being dry between tides. The low ribs of their shells are dark and their troughs light. They grow to about two inches across.



Opihi Alinalina

(Cellana sandwichensis) crave constant splash or surge and can’t tolerate drying out for long periods. Their shells grow to about 2 and a half inches across and have a scalloped edge that was used by Hawaiians for shredding coconut meat.



Opihi Koele

(Cellana talcosa) are sometimes submerged and can live in depths of up to 10 feet. Koele are the largest of Hawaiian opihi, growing up to four inches across. Their shells are smooth and thick with a low profile.


by Sheila Sarhangi, Honolulu Magazine |  Read more:
Images: uncredited

Phaedra Brody
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This is the Life

[ed. Stumbled on this lyrical essay by Annie Dillard today, written, I think, around 2011.]

Any culture tells you how to live your one and only life: to wit as everyone else does. Probably most cultures prize, as ours rightly does, making a contribution by working hard at work that you love; being in the know, and intelligent; gathering a surplus; and loving your family above all, and your dog, your boat, bird-watching. Beyond those things our culture might specialize in money, and celebrity, and natural beauty. These are not universal. You enjoy work and will love your grandchildren, and somewhere in there you die.

Another contemporary consensus might be: You wear the best shoes you can afford, you seek to know Rome's best restaurants and their staffs, drive the best car, and vacation on Tenerife. And what a cook you are!

Or you take the next tribe's pigs in thrilling raids; you grill yams; you trade for televisions and hunt white-plumed birds. Everyone you know agrees: this is the life. Perhaps you burn captives. You set fire to a drunk. Yours is the human struggle, or the elite one, to achieve... whatever your own culture tells you: to publish the paper that proves the point; to progress in the firm and gain high title and salary, stock options, benefits; to get the loan to store the beans till their price rises; to elude capture, to feed your children or educate them to a feather edge; or to count coup or perfect your calligraphy; to eat the king's deer or catch the poacher; to spear the seal, intimidate the enemy, and be a big man or beloved woman and die respected for the pigs or the title or the shoes. Not a funeral. Forget funeral. A big birthday party. Since everyone around you agrees.  (...)

So the illusion, like the visual field, is complete It has no holes except books you read and soon forget. And death takes us by storm. What was that, that life? What else offered? If for him it was contract bridge, if for her it was copyright law, if for everyone it was and is an optimal mix of family and friends, learning, contribution, and joy of making and ameliorating what else is there, or was there, or will there ever be?

What else is a vision or fact of time and the peoples it bears issuing from the mouth of the cosmos, from the round mouth of eternity, in a wide and parti-colored utterance. In the complex weave of this utterance like fabric, in its infinite domestic interstices, the centuries and continents and classes dwell. Each people knows only its own squares in the weave, its wars and instruments and arts, and also the starry sky.

Okay, and then what? Say you scale your own weft and see time's breadth and the length of space. You see the way the fabric both passes among the stars and encloses them. You see in the weave nearby, and aslant farther off, the peoples variously scandalized or exalted in their squares. They work on their projects they flake spear points, hoe, plant; they kill aurochs or one another; they prepare sacrifices as we here and now work on our projects. What, seeing this spread multiply infinitely in every direction, would you do differently? No one could love your children more; would you love them less? Would you change your project? To what?

by Annie Dillard, billemory.com |  Read more:

Image: Corn Dog via billemory.com

Stasia Burrington - Droop (2012)
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America's First Climate Refugees

[ed. First in a series of articles on the effects of coastal erosion in Alaska. Others include: One Family's Great Escape, An Undeniable Truth, and The At Risk List.]

Sabrina Warner keeps having the same nightmare: a huge wave rearing up out of the water and crashing over her home, forcing her to swim for her life with her toddler son.

"I dream about the water coming in," she said. The landscape in winter on the Bering Sea coast seems peaceful, the tidal wave of Warner's nightmare trapped by snow and several feet of ice. But the calm is deceptive. Spring break-up will soon restore the Ninglick River to its full violent force.

In the dream, Warner climbs on to the roof of her small house. As the waters rise, she swims for higher ground: the village school which sits on 20-foot pilings.

Even that isn't high enough. By the time Warner wakes, she is clinging to the roof of the school, desperate to be saved.

Warner's vision is not far removed from a reality written by climate change. The people of Newtok, on the west coast of Alaska and about 400 miles south of the Bering Strait that separates the state from Russia, are living a slow-motion disaster that will end, very possibly within the next five years, with the entire village being washed away.

The Ninglick River coils around Newtok on three sides before emptying into the Bering Sea. It has steadily been eating away at the land, carrying off 100ft or more some years, in a process moving at unusual speed because of climate change. Eventually all of the villagers will have to leave, becoming America's first climate change refugees.

It is not a label or a future embraced by people living in Newtok. Yup'ik Eskimo have been fishing and hunting by the shores of the Bering Sea for centuries and the villagers reject the notion they will now be forced to run in chaos from ancestral lands.

But exile is undeniable. A report by the US Army Corps of Engineers predicted that the highest point in the village – the school of Warner's nightmare – could be underwater by 2017. There was no possible way to protect the village in place, the report concluded.

If Newtok can not move its people to the new site in time, the village will disappear. A community of 350 people, nearly all related to some degree and all intimately connected to the land, will cease to exist, its inhabitants scattered to the villages and towns of western Alaska, Anchorage and beyond.

It's a choice confronting more than 180 native communities in Alaska, which are flooding and losing land because of the ice melt that is part of the changing climate. (...)

It became clear by the 1990s that Newtok – like dozens of other remote communities in Alaska – was losing land at a dangerous rate. Almost all native Alaskan villages are located along rivers and sea coasts, and almost all are facing similar peril.

A federal government report found more than 180 other native Alaskan villages – or 86% of all native communities – were at risk because of climate change. In the case of Newtok, those effects were potentially life threatening. (...)

And so after years of poring over reports, the entire community voted to relocate to higher ground across the river. The decision was endorsed by the state authorities. In December 2007, the village held the first public meeting to plan the move.

The proposed new site for Newtok, voted on by the villagers and approved by government planners, lies only nine miles away, atop a high ridge of dark volcanic rock across the river on Nelson Island. On a good day in winter, it's a half-hour bone-shaking journey across the frozen Ninglick river by snowmobile.

But the cost of the move could run as high as $130m, according to government estimates. For the villagers of Newtok, finding the cash, and finding their way through the government bureaucracy, is proving the challenge of their lives.

Five years on from that first public meeting, Newtok remains stuck where it was, the peeling tiles and the broken-down office furniture in the council office grown even shabbier, the dilapidated water treatment plant now shut down as a health hazard, an entire village tethered to a dangerous location by bureaucratic obstacles and lack of funds.

Village leaders hope that this coming summer, when conditions become warm enough for construction crews to get to work, could provide the big push Newtok needs by completing the first phase of basic infrastructure. And the effort needs a push. When the autumn storms blow in, the water rises fast.

by Suzanne Goldenberg, The Guardian |  Read more:

Photograph: Getty Creative/Nasa