Carriage of Musical Instruments

SUMMARY: The Department of Transportation is issuing a final rule to implement section 403 of the FAA Modernization and Reform Act of 2012 regarding the carriage of musical instruments as carry-on baggage or checked baggage on commercial passenger flights operated by air carriers. This rule responds to difficulties musicians have encountered when transporting their instruments during air travel.

DATES: Effective Date: This rule is effective March 6, 2015.  (...)

Background

On February 14, 2012, the FAA Modernization and Reform Act of 2012 (the Act) was signed into law. Section 403 of the Act requires U.S. air carriers to accept musical instruments on their passenger flights either as carry-on baggage or checked baggage, provided that certain conditions are met. The passage of Section 403 is Congress’ response to difficulties musicians have encountered when transporting their instruments during air travel. The statute directs the Department of Transportation (Department or DOT) to issue a final rule to implement the requirements set forth in section 403.

During the past year, the Department has been engaged in dialogue with musicians as well as representatives of airlines and industry associations to address the difficulties musicians face when traveling by air with musical instruments. In July 2014, DOT Secretary Anthony Foxx hosted a ‘‘Flying with Musical Instruments’’ meeting to provide airline representatives, musicians, and government officials an opportunity to exchange ideas on ways to prevent or resolve difficulties encountered by musicians when flying with their instruments while still ensuring the safety of passengers and crew. At the meeting, several members of various musician organizations described problems that musicians encounter when traveling by air with their musical instruments, particularly when bringing instruments as carry-on baggage. Airline representatives in attendance described their policies for transport of musical instruments as carry-on or checked baggage. Many airlines have already adopted policies concerning the air transportation of musical instruments that mirror the requirements in Section 403 of the Act. The stakeholders recognized that, while most airlines’ current policies regarding musical instruments are consistent with the statute, frontline customer service agents and flight crew may not always be well-versed in those policies and may not communicate those policies accurately and effectively to musicians. By the same token, the meeting attendees also agreed that many musicians were not very well informed about airline policies regarding transporting musical instruments or about the measures they can take to better prepare themselves to ensure that the transport goes smoothly.

Since then, the stakeholders have voluntarily taken certain steps to better understand the extent of the problem and prevent or minimize confusion over musical instruments as carry-on baggage. (...)

Section 403 of the Act and this final rule provide that carriers are required to allow passengers to stow their musical instruments in an approved stowage area in the cabin only if at the time the passenger boards the aircraft such stowage space is available. With the exception of certain disability assistance devices, overhead bins or under seat stowage space is available to all passengers and crew members for their carry-on baggage on a ‘‘first come, first served’’ basis. Accordingly, carriers are not required to remove other passengers’ or crew members’ carry-on baggage that is already stowed in order to make space for a musical instrument. However, this also means carriers are not allowed to require a passenger to remove his or her musical instrument that is already safely stowed (e.g., in the overhead bin) to make room for carry-on baggage of other passengers who boarded the aircraft later than the passenger with the musical instrument. This is true even if the space taken by the musical instrument could accommodate one or more other carry-on items. Because the rule does not require that musical instruments be given priority over other carry-on baggage, we encourage passengers traveling with musical instruments to take steps to board before as many other passengers as possible to ensure that space will be available for them to safely stow their instruments in the cabin. This includes utilizing preboarding opportunities that some carriers offer (usually for a fee). This rule also states that carriers are prohibited from charging passengers with a musical instrument as carry-on baggage an additional fee other than any standard fee carriers impose for carry-on baggage. By including such a requirement in the statute, Congress clearly meant to require carriers to treat musical instruments in the cabin as no different from other carry-on baggage. For example, many carriers’ FAA approved carry-on baggage programs permit one piece of carry-on baggage plus one personal item such as a purse or a briefcase. If the passenger with the musical instrument already has these two standard items and the musical instrument is the third carry-on item, that carrier may not permit the passenger to board the aircraft with a third carry-on item. (...)

§ 251.3 Small musical instruments as carry-on baggage. Each covered carrier shall permit a passenger to carry a violin, guitar, or other small musical instrument in the aircraft cabin, without charging the passenger a fee in addition to any standard fee that carrier may require for comparable carry-on baggage, if: (a) The instrument can be stowed safely in a suitable baggage compartment in the aircraft cabin or under a passenger seat, in accordance with the requirements for carriage of carry-on baggage or cargo established by the FAA; and (b) There is space for such stowage at the time the passenger boards the aircraft. § 251.4 Large musical instruments as carry-on baggage. Each covered carrier shall permit a passenger to carry a musical instrument that is too large to meet the requirements of § 251.3 in the aircraft cabin, without charging the passenger a fee in addition to the cost of an additional ticket described in paragraph (e) of this section, if: (a) The instrument is contained in a case or covered so as to avoid injury to other passengers; (b) The weight of the instrument, including the case or covering, does not exceed 165 pounds or the applicable weight restrictions for the aircraft; (c) The instrument can be stowed in accordance with the requirements for carriage of carry-on baggage or cargo established by the FAA; (d) Neither the instrument nor the case contains any object not otherwise permitted to be carried in an aircraft cabin because of a law or regulation of the United States; and (e) The passenger wishing to carry the instrument in the aircraft cabin has purchased an additional seat to accommodate the instrument.

by Federal Register, Vol. 80, No. 2 / Monday, January 5, 2015 / Rules and Regulations | Read more (pdf):

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Real vs. Fake: The Eames Lounge

I know this post is kind of a departure from my regular programming ’round these parts, but what can I say? It’s Monday, it’s almost the end of March, it’s snowing, possibly this is the rapture, my apartment building has no heat, and I woke up feeling like it was high time to nerd out over chairs.

So. Remember how I used to have a fake Eames lounge chair? Back when my living room looked like this:

Yeah. Well. When we received the very special things from my grandparents’ house, there was a brief hot second when I had two Eames lounge chairs—the real deal, straight out of Zeeland, Michigan circa 1972, and the fakey guy who I think was manufactured by Plycraft, probably a few years later.

“Reproductions” and “replicas” and “inspired-by” designs have been around for forever, but it seems like only in more recent years have these unauthorized replicas inched closer and closer to looking like the real thing. Now. There is a whooooollllleeee long debate to be had about “real” vs. “fake” and the legal standing of intellectual property surrounding furniture designs and who is getting ripped off and how and what this means for society and design and quality and whether the sky is blue. Frankly, I’d rather not get into that because everybody has their own opinions and I find that type of squabbling annoying. Personally, I can’t picture myself buying a newly-produced knock-off piece of furniture for a number of reasons, but I think the rules change a little when you’re talking vintage and secondhand. Nobody’s getting hurt, it isn’t perpetuating the lousy knock-off furniture industry—it’s just good clean old-fashioned thrifty fun times. I support that.

Point is, people often wonder what the differences are between authentic and knock-off furniture—Eames lounge chairs, specifically—and it’s hard to find a good guide explaining it. So being in the unique position of owning both concurrently, I thought it would be a good time to put together a little show and tell.

by Daniel Kanter, Manhattan Nest |  Read more:

Images: Daniel Kanter

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Max Ernst Visits Frida in a Dream
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Is Pharma Research Worse Than Chance?

The two most exciting developments in psychopharmacology in the 21st century so far have been ketamine for depression and MDMA for PTSD.

Unlike other antidepressants, which work intermittently over a space of weeks, ketamine can cause near-instant remission of depression with a single infusion – which lasts a week or two and can be repeated if needed. Ketamine use may be successful in 50-70% of patients who have failed treatment with conventional antidepressants. Ketamine treatment has some issues right now, but the race is on to create an oral non-hallucinogenic version which could be the next big blockbuster drug and revolutionize depression treatment.

MDMA (“Ecstasy”) is undergoing FDA Phase 3 clinical trials as a treatment for PTSD. Preliminary research has been small and underpowered, but suggests response rates up to 80% and effect sizes greater than 1 in this otherwise-hard-to-treat condition. None of this is on really firm footing – that’ll have to wait for the Phase 3. But signs are looking very good.

I say these are the two most exciting developments mostly because no other developments have been exciting. In terms of normal psychiatric drugs, the best that the 21st century has given us has probably been pimavanserin and aripiprazole, modest updates to the standard atypical antipsychotic model. These drugs are probably a bit better than existing ones for the people who need them (especially pimavenserin for psychosis in Parkinson’s) but they don’t revolutionize the treatment of any condition and nobody ever claimed that they did. And most drugs aren’t even at this level – they’re new members of well-worn classes with slightly different side effect profiles. The landscape was so quiet that ketamine came in like a bolt from the blue, and MDMA is set to do the same in a couple of years when the trial results come out.

(if I’m wrong, and history decides these two drugs weren’t the biggest developments, the most likely failure mode is that psilocybin turned out to be more important than MDMA)

There’s a morality tale to be told here about how the War on Drugs choked off vital research on some of the most powerful psychiatric compounds and cost us fifty years in exploring these effects and treating patients. I agree with this morality tale as far as it goes, but I also think there’s another, broader morality tale beneath it.

Suppose that neither ketamine nor MDMA were illegal drugs. Ketamine was just used as an anaesthetic. MDMA was just used as a chemical intermediate in producing haemostatic drugs, its original purpose. Now the story is that, fifty years later, we learn that this anaesthetic and this haemostatic turn out to have incredibly powerful psychiatric effects. What’s our narrative now?

For me it’s about the weird inability of intentional psychopharmaceutical research to discover anything as good as things random druggies use to get high.

For decades, pharmaceutical companies have been coming out with relatively lackluster mental health offerings – aripiprazole, pimavanserin, and all the rest. And when asked why, they answer that mental health is hard, the brain is the most complicated organ in the known universe, we shouldn’t expect there to be great cures with few side effects for psychiatric diseases, and if there were we certainly shouldn’t expect them to be easy to find.

And this would make sense except in the context of ketamine and MDMA. Here are some random chemicals that affect the brain in some random way, which people were using mostly because they felt good at raves, and huh, they seem to treat psychiatric diseases much better than anything produced by some of the smartest people in the world working for decades on ways to treat psychiatric diseases. Why should that be?

One could argue it’s all about numbers vs. base rates. There are way more chemicals synthesized each year by people who aren’t looking for psychiatric drugs than by people who are. Even if the people who are looking for drugs are a thousand times more likely to find them, the people-who-aren’t-looking can still overwhelm them with sheer numerical advantage. And maybe when a psychiatric drug is discovered by people who weren’t looking for it, what this looks like is a few random people trying it, noticing it feels good, and turning it into a drug of abuse.

And I’m sure this is part of the story. But that just passes the buck to the next question. Abusers take the vast flood of possible chemicals and select the ones they think will feel good at raves. Psychopharmacologists take the vast flood of possible chemicals and select the ones they think will treat mental illnesses. How come the abusers’ selection process is better at picking out promising mental health treatments?

Here’s one hypothesis: at the highest level, the brain doesn’t have that many variables to affect, or all the variables are connected. If you smack the brain really really hard in some direction or other, you will probably treat some psychiatric disease. Drugs of abuse are ones that smack the brain really hard in some direction or other. They do something. So find the psychiatric illness that’s treated by smacking the brain in that direction, and you’re good.

Actual carefully-researched psychiatric drugs are exquisitely selected for having few side effects. The goal is something like an SSRI – mild stomach discomfort, some problems having sex, but overall you can be on them forever and barely notice their existence. In the grand scheme of things their side effects are tiny – in most placebo-controlled studies, people have a really hard time telling whether they’re in the experimental or the placebo group.

Nobody has a hard time telling whether they’re in the experimental or placebo group of a trial of high-dose MDMA. I think this might be the difference. If you go for large effects – even if you don’t really care what direction the effect is in – you’ll get them. And if you go for small, barely perceptible effects, then you’ll get those too. The dream of the magic bullet – the drug that treats exactly what it’s supposed to treat but otherwise has no effect at all on you – is just a dream. The closest you can come is something with miniscule side effects but a barely-less-miniscule treatment effect.

by Scott Alexander, Slate Star Codex |  Read more:

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The Wine Shop Alternative: Gas Stations

It's the most incredible miracle in the Bible: Jesus turns water into wine during a wedding in Cana, a dusty and sunny place in Galilee where he performed his first "signs." And his very first sign would prove to be his best.

Its distinction has nothing to do with the miracle itself. Save for one thing, turning water into wine could not compete with, say, the resurrection of the dead, such as the daughter of Jairus (Jesus tells her father that she's not dead, but sleeping), or the curse of death, like the unfortunate fig tree mentioned in the gospels of Mark and Matthew (Jesus was hungry, he saw a fig tree, he walked to it, found it had no fruit, and cursed it, causing it to wither immediately).

What happens is this: Jesus is chilling at the wedding with his mother when it is announced that the party has run out of wine. The party wants to go on, but it can't do so without wine. It's a real crisis, because in these olden times, you can't just make a quick run to the supermarket or even a mini-mart and grab some bottles or cases of wine. There is nothing like that in Cana, or Galilee, or the whole Roman Empire. If you run out of wine, you have to hope a prophet is around, because these are the days of miracles and wonders.

Jesus's mother knows her son is also the son of God and asks him to do his thing. He reluctantly tells the servants to fill jars with water, which they do. Then he says: "Give it to the governor of the feast." When the governor tastes it, he discovers it's not water, it's wine. But that's not what makes this miracle more impressive than raising the dead or damning the living. The thing is, the wine is good.

Jesus could have turned the water into okay wine, or at least wine that was as good as the wine served at the start of the party. But that wasn't his style. His wine was unquestionably good. How do we know? It's in the Bible. King James version: "'Every man at the beginning [of a party] doth set forth good wine, and when men have well drunk, then that which is worse [is served,' said the governor]. 'But thou hast kept the good wine until now [when everyone is well drunk].'" Can you feel that? There's no bad resurrection or good damnation, but the miracle of transforming water into wine can be thus judged.

Let's keep all of this in mind as we turn to the Porter's at the gas station on Rainier Avenue. Though it has a view of Beacon Hill's verdant section, which is capped by the monument of modern architecture, the Pacific Tower (formerly the Pacific Medical Center), the location of the mini-mart is unrelentingly unlovely. Its little car wash looks like a car trap, its huge parking lot bakes when the sun is out, and it sits next to a stoplight that always fries the brains of impatient drivers. There are dying and dead signs here and there. You enter the mini-market with the goal of getting out as soon as you can. Gas stations are such miserable places.

But once inside this Porter's, a miracle occurs (gas stations are, after all, as American as Jesus). Just beyond the checkout is a stack of open wine boxes that are crowned by a sign: "Wine Specials." Avoid these. All the wine there is bad: Oak Leaf, Sancho, the Naked Grape—cheap crap. Behind this display on the left is where you find the good stuff. One shelf is lined with Château Roc De Segur (a surprisingly rich merlot blended with cabernet sauvignon and cabernet franc for $5.99), Château La Freynelle (a stiff Bordeaux for $10.99—and one that does not taste like the nimble feet of a pretty peasant is stiff), Château Haut-Roudier (a Bordeaux that does have a dash of the peasant's feet for $9.99), and Vieux Papes Blanc (a simple sauvignon blanc blended with crusty chardonnay and a bold ugni blanc for $6.99). All of these wines are more than drinkable. They are respectable.

The reason I often buy wine here is because I like to buy roasted chicken from San Fernando, the Peruvian restaurant that's across the street. I kill two birds with one stone and then jump on the 7 bus, which takes me home.

by Charles Mudede, The Stranger |  Read more:

Image: Getty

Be Careful Celebrating Google's New Ad Blocker

Google, a data mining and extraction company that sells personal information to advertisers, has hit upon a neat idea to consolidate its already-dominant business: block competitors from appearing on its platforms.

The company announced that it would establish an ad blocker for the Chrome web browser, which has become the most popular in America, employed by nearly half of the nation’s web users. The ad blocker — which Google is calling a “filter” — would roll out next year, and would be the default setting for Chrome when fully functional. In other words, the normal user sparking up their Chrome browser simply wouldn’t see the ads blocked by the system.

What ads would get blocked? The ones not sold by Google, for the most part.

The Chrome ad blocker would stop ads that provide a “frustrating experience,” according to Google’s blog post announcing the change. The ads blocked would match the standards produced by the Coalition for Better Ads, an ostensibly third-party group. For sure, the ads that would get blocked are intrusive: auto-players with sound, countdown ads that make you wait 10 seconds to get to the site, large “sticky” ads that remain constant even when you scroll down the page.

But who’s part of the Coalition for Better Ads? Google, for one, as well as Facebook. Those two companies accounted for 99 percent of all digital ad revenue growth in the United States last year, and 77 percent of gross ad spending. As Mark Patterson of Fordham University explained, the Coalition for Better Ads is “a cartel orchestrated by Google.”

So this is a way for Google to crush its few remaining competitors by pre-installing an ad zapper that it controls to the most common web browser. That’s a great way for a monopoly to remain a monopoly.

There’s more to the story, however. The real goal for Google appears to be not just blocking ads sold by other digital suppliers besides Google, but to undermine third-party ad blockers, which stop Google ads along with everyone else’s.

According to the Financial Times, Google will allow publishers what it’s calling “Funding Choices.” The publisher could charge the consumer a set price per page view to use third-party sites that block all advertising. Google would do the tracking of how many pages users view, and then charge them. Users could then “white list” particular sites, allowing ads to be shown on them and removing the charge. If users decided to pay to block ads, Google would receive a portion of that payment, sharing it with the publisher.

Web users will quickly recognize their only options: pay to use the internet, or uninstall the ad blockers and surf the web for free. At least 11 percent of all web users, and perhaps as many as 26 percent of all desktop users, have third-party ad blockers on their devices, a number that will likely grow in the next few years. But it’s easy to see how Google’s policy would depress ad blocker usage — except for the case of Google’s ad blocker, which creates preferences for Google’s own ads.

David Dayen, The Intercept |  Read more:

Image: Lluis Gene/AFP/Getty Images
[ed. Not related, but another Intercept essay worth reading: Jared Kushner Still Has a Job Because Washington Only Fears Republicans.] 

Baby Boomers Are Downsizing — and the Kids Won’t Take the Family Heirlooms

For 30 years, Pat Fryzel stored her children’s memorabilia, and her grandmother’s, too. But when she and her husband downsized, from a large Winchester home to a two-bedroom Boston townhouse, there was no room for the American Girl dolls or Nana’s cake plates. So Fryzel asked her grown kids to collect what they wanted.

She was not met with much enthusiasm. “They said, ‘Take a picture and text it to us,’” recalled Fryzel, 64, a retired nurse practitioner.

For generations, adult children have agreed to take their aging parents’ possessions — whether they wanted them or not. But now, the anti-clutter movement has met the anti-brown furniture movement, and the combination is sending dining room sets, sterling silver flatware, and knick-knacks straight to thrift stores or the curb.

And feelings are getting hurt, as adult children who are eager to minimize their own belongings — and who may live in small spaces, and entertain less formally than their parents did — are increasingly saying “no thanks” to the family heirlooms. (...)

The cold math of downsizing can be seen in a 2016 profile of buyers and sellers from the Massachusetts Association of Realtors. From the ages of 18 to 54, when a person sells a house, the next home he or she buys is larger. When sellers hit 55, the homes they buy next are smaller.

But the square-footage numbers don’t capture what space means in emotional terms, in memories: the mahogany hutch Grandma inherited as a young bride, too big for the dining nook in her retirement community apartment; the books that have been like friends, too voluminous to take along; the kids’ art projects and book reports from long ago. (...)

“I have a lot of mementos from my grandmother that my mother foisted on me,” said Fine, 59. She dutifully stored them for three decades, in boxes she never opened, and while she doesn’t expect her daughter to take them, she’s now facing a quandary.

“How can you take these things to a consignment shop?” she asked. “It’s almost like a burden that we carry with us through life. Sometimes I wish we had less connection to our possessions.”

The burden is only likely to grow. The number of Americans ages 65 and older is projected to more than double, from 46 million to over 98 million by 2060, according to a 2016 report by the nonprofit, Washington, D.C.-based Population Reference Bureau.

by Beth Teitell, Boston Review |  Read more:

Image: Shutterstock
[ed. No surprise here. I'm in the process of moving and the storage units in my town and the one I'm moving to are all booked (1200+ units).  Talk about a growth industry.]

How Online Shopping Makes Suckers of Us All

As Christmas approached in 2015, the price of pumpkin-pie spice went wild. It didn’t soar, as an economics textbook might suggest. Nor did it crash. It just started vibrating between two quantum states. Amazon’s price for a one-ounce jar was either $4.49 or $8.99, depending on when you looked. Nearly a year later, as Thanksgiving 2016 approached, the price again began whipsawing between two different points, this time $3.36 and $4.69.

We live in the age of the variable airfare, the surge-priced ride, the pay-what-you-want Radiohead album, and other novel price developments. But what was this? Some weird computer glitch? More like a deliberate glitch, it seems. “It’s most likely a strategy to get more data and test the right price,” Guru Hariharan explained, after I had sketched the pattern on a whiteboard.

The right price—the one that will extract the most profit from consumers’ wallets—has become the fixation of a large and growing number of quantitative types, many of them economists who have left academia for Silicon Valley. It’s also the preoccupation of Boomerang Commerce, a five-year-old start-up founded by Hariharan, an Amazon alum. He says these sorts of price experiments have become a routine part of finding that right price—and refinding it, because the right price can change by the day or even by the hour. (Amazon says its price changes are not attempts to gather data on customers’ spending habits, but rather to give shoppers the lowest price out there.)The price of a can of soda in a vending machine can now vary with the temperature outside.

It may come as a surprise that, in buying a seasonal pie ingredient, you might be participating in a carefully designed social-science experiment. But this is what online comparison shopping hath wrought. Simply put: Our ability to know the price of anything, anytime, anywhere, has given us, the consumers, so much power that retailers—in a desperate effort to regain the upper hand, or at least avoid extinction—are now staring back through the screen. They are comparison shopping us.

They have ample means to do so: the immense data trail you leave behind whenever you place something in your online shopping cart or swipe your rewards card at a store register, top economists and data scientists capable of turning this information into useful price strategies, and what one tech economist calls “the ability to experiment on a scale that’s unparalleled in the history of economics.” In mid-March, Amazon alone had 59 listings for economists on its job site, and a website dedicated to recruiting them.

Not coincidentally, quaint pricing practices—an advertised discount off the “list price,” two for the price of one, or simply “everyday low prices”—are yielding to far more exotic strategies.

“I don’t think anyone could have predicted how sophisticated these algorithms have become,” says Robert Dolan, a marketing professor at Harvard. “I certainly didn’t.” The price of a can of soda in a vending machine can now vary with the temperature outside. The price of the headphones Google recommends may depend on how budget-conscious your web history shows you to be, one study found. For shoppers, that means price—not the one offered to you right now, but the one offered to you 20 minutes from now, or the one offered to me, or to your neighbor—may become an increasingly unknowable thing. “Many moons ago, there used to be one price for something,” Dolan notes. Now the simplest of questions—what’s the true price of pumpkin-pie spice?—is subject to a Heisenberg level of uncertainty.

Which raises a bigger question: Could the internet, whose transparency was supposed to empower consumers, be doing the opposite?

by Jerry Useem, The Atlantic |  Read more:

Image: Justin Fantl

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The Doctor Is In. Co-Pay? $40,000.

When John Battelle’s teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.

“They’re taking him to a local hospital,” Mr. Battelle’s wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. “No, they’re not,” Dr. Shlain instructed them. “You don’t want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.”

Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco’s top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.

For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.

“I feel badly that I have the means to jump the line,” he said. “But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?”

Increasingly, it is a question being asked in hospitals and doctor’s offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.

Money has always made a big difference in the medical world: fancier rooms at hospitals, better food and access to the latest treatments and technology. Concierge practices, where patients pay several thousand dollars a year so they can quickly reach their primary care doctor, with guaranteed same-day appointments, have been around for decades.

But these aren’t the concierge doctors you’ve heard about — and that’s intentional.

Dr. Shlain’s Private Medical group does not advertise and has virtually no presence on the web, and new patients come strictly by word of mouth. But with annual fees that range from $40,000 to $80,000 (more than 10 times what conventional concierge practices charge), the suite of services goes far beyond 24-hour access or a Nespresso machine in the waiting room.

Indeed, as many Americans struggle to pay for health care — or even, with the future of the Affordable Care Act in question on Capitol Hill, face a loss of coverage — this corner of what some doctors call the medical-industrial complex is booming: boutique doctors and high-end hospital wards. (...)

For patients, a limit of no more than 50 families per doctor eliminates the rushed questions and assembly-line pace of even the best primary care practices. House calls are an option for busy patients, and doctors will meet clients at their workplace or the airport if they are pressed for time.

In the event of an uncommon diagnosis, Private Medical will locate the top specialists nationally, secure appointments with them immediately and accompany the patient on the visit, even if it is on the opposite coast.

Meanwhile, for virtually everyone else, the typical wait to see a doctor is getting longer.

by Nelson D. Schwartz, NY Times | Read more:
Image: Chris B. Murray

Retirees Flock to Latin America to Live an Upper-Class Lifestyle on $1,500 a Month

To casual visitors, this colonial town in southern Ecuador looks like it was torn from the pages of history. With its cobbled streets, soaring cathedrals and bustling markets, it exudes a lazy, old world charm.

But Cuenca is also on the cutting edge of a very modern trend: providing a safe haven for U.S. retirees who have found themselves unwilling — or unable — to live out their golden years at home.

The growing wave of ex-pat seniors is not only upending notions about retirement in the hemisphere but reshaping the face of communities throughout the Americas. And the trend is expected to grow as waves of baby boomers exit the workforce ill-prepared for retirement.

There’s no accurate way to measure the phenomenon, but the Social Security Administration was sending payments to 380,000 retired U.S. workers living abroad in 2014 — up 50 percent from a decade ago.

In the Americas, records show that seniors are flocking to Canada, Mexico, Colombia, the Dominican Republic and Ecuador.

Best known for the Galapagos and providing asylum in its London embassy to WikiLeaks founder Julian Assange, Ecuador is home to 2,850 retirees receiving benefits, according to the U.S. government. But that number doesn’t tell the full picture. The city of Cuenca recently conducted a census that found its municipality alone was home to almost 10,000 foreign retirees, most of them Americans from Texas and Florida. (...)

In Cuenca, a city of about 350,000 people, they’ve found robust public transportation, an extensive museum network, solid healthcare and markets bursting with fresh fruits and produce. It’s a place where their two-bedroom, two-and-a-half bath apartment costs less than $400 a month. They’ve found that for about $1,500 a month, they can live a solidly upper-class lifestyle, dining out frequently and traveling. (...)

If there is a real driving force for retirees, it’s healthcare. Although the Trump administration has said it will leave Medicare untouched, its desire to scrap the Affordable Care Act amid rising premiums has created anxiety among seniors, said Prescher with International Living.

“Look at what retirees [in the U.S.] are facing,” he said. “They have a fixed income, maybe their investments haven’t been doing that well and now nobody knows what public healthcare will look like in the United States.”

“In the face of that … if you can live in a place where you can cut your cost of living in half while getting access to high quality healthcare, you have to think seriously about it,” he added. (...)

Cuenca’s survey of retirees found that most were either paying for healthcare out-of-pocket or had private healthcare. But some are reliant on Ecuador’s public healthcare system. Foreigners only need to pay into the system for three months before they have access to full benefits.

Because Medicare doesn’t cover most costs abroad, the Herrons, for example, were paying $84 a month to belong to the public healthcare system. When Michael, a 76-year-old retired IT worker-turned-novelist, recently ended up in the emergency room for a cardiac issue, the total bill was $133. In the past, the same procedure in the United States had been billed to his insurance company at $186,000.

Crespo, the city official, said the retirees are pumping money into the economy, but there are growing concerns over how they might be affecting the healthcare system.

“We’ve heard about cases where someone night need brain or heart surgery that might cost $300,000 in the United States and they have the operation here for $300 because they had paid into the system for three months,” she said. “The price differences are abysmal.”

Congresswoman Soliz said the legislature is planning on doing a comprehensive study of how foreign retirees might be straining public resources.

by Jim Wyss, Charlotte Observer | Read more:
Image: Jim Wyss

Océanic Surcouf 1956 
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The Loneliness of Donald Trump

Once upon a time, a child was born into wealth and wanted for nothing, but he was possessed by bottomless, endless, grating, grasping wanting, and wanted more, and got it, and more after that, and always more. He was a pair of ragged orange claws upon the ocean floor, forever scuttling, pinching, reaching for more, a carrion crab, a lobster and a boiling lobster pot in one, a termite, a tyrant over his own little empires. He got a boost at the beginning from the wealth handed him and then moved among grifters and mobsters who cut him slack as long as he was useful, or maybe there’s slack in arenas where people live by personal loyalty until they betray, and not by rules, and certainly not by the law or the book. So for seven decades, he fed his appetites and exercised his license to lie, cheat, steal, and stiff working people of their wages, made messes, left them behind, grabbed more baubles, and left them in ruin.

He was supposed to be a great maker of things, but he was mostly a breaker. He acquired buildings and women and enterprises and treated them all alike, promoting and deserting them, running into bankruptcies and divorces, treading on lawsuits the way a lumberjack of old walked across the logs floating on their way to the mill, but as long as he moved in his underworld of dealmakers the rules were wobbly and the enforcement was wobblier and he could stay afloat. But his appetite was endless, and he wanted more, and he gambled to become the most powerful man in the world, and won, careless of what he wished for.

Thinking of him, I think of Pushkin’s telling of the old fairytale of The Fisherman and the Golden Fish. After being caught in the old fisherman’s net, the golden fish speaks up and offers wishes in return for being thrown back in the sea. The fisherman asks him for nothing, though later he tells his wife of his chance encounter with the magical creature. The fisherman’s wife sends him back to ask for a new washtub for her, and then a second time to ask for a cottage to replace their hovel, and the wishes are granted, and then as she grows prouder and greedier, she sends him to ask that she become a wealthy person in a mansion with servants she abuses, and then she sends her husband back. The old man comes and grovels before the fish, caught between the shame of the requests and the appetite of his wife, and she becomes tsarina and has her boyards and nobles drive the husband from her palace. You could call the husband consciousness—the awareness of others and of oneself in relation to others—and the wife craving.

Finally she wishes to be supreme over the seas and over the fish itself, endlessly uttering wishes, and the old man goes back to the sea to tell the fish—to complain to the fish—of this latest round of wishes. The fish this time doesn’t even speak, just flashes its tail, and the old man turns around to see on the shore his wife with her broken washtub at their old hovel. Overreach is perilous, says this Russian tale; enough is enough. And too much is nothing.

The child who became the most powerful man in the world, or at least occupied the real estate occupied by a series of those men, had run a family business and then starred in an unreality show based on the fiction that he was a stately emperor of enterprise, rather than a buffoon barging along anyhow, and each was a hall of mirrors made to flatter his sense of self, the self that was his one edifice he kept raising higher and higher and never abandoned.

I have often run across men (and rarely, but not never, women) who have become so powerful in their lives that there is no one to tell them when they are cruel, wrong, foolish, absurd, repugnant. In the end there is no one else in their world, because when you are not willing to hear how others feel, what others need, when you do not care, you are not willing to acknowledge others’ existence. That’s how it’s lonely at the top. It is as if these petty tyrants live in a world without honest mirrors, without others, without gravity, and they are buffered from the consequences of their failures.

“They were careless people,” F. Scott Fitzgerald wrote of the rich couple at the heart of The Great Gatsby. “They smashed up things and creatures and then retreated back into their money or their vast carelessness or whatever it was that kept them together, and let other people clean up the mess they had made.” Some of us are surrounded by destructive people who tell us we’re worthless when we’re endlessly valuable, that we’re stupid when we’re smart, that we’re failing even when we succeed. But the opposite of people who drag you down isn’t people who build you up and butter you up. It’s equals who are generous but keep you accountable, true mirrors who reflect back who you are and what you are doing. (...)

Some use their power to silence that and live in the void of their own increasingly deteriorating, off-course sense of self and meaning. It’s like going mad on a desert island, only with sycophants and room service. It’s like having a compliant compass that agrees north is whatever you want it to be. The tyrant of a family, the tyrant of a little business or a huge enterprise, the tyrant of a nation. Power corrupts, and absolute power often corrupts the awareness of those who possess it. Or reduces it: narcissists, sociopaths, and egomaniacs are people for whom others don’t exist.

We gain awareness of ourselves and others from setbacks and difficulties; we get used to a world that is not always about us; and those who do not have to cope with that are brittle, weak, unable to endure contradiction, convinced of the necessity of always having one’s own way. The rich kids I met in college were flailing as though they wanted to find walls around them, leapt as though they wanted there to be gravity and to hit ground, even bottom, but parents and privilege kept throwing out safety nets and buffers, kept padding the walls and picking up the pieces, so that all their acts were meaningless, literally inconsequential. They floated like astronauts in outer space.

Equality keeps us honest. Our peers tell us who we are and how we are doing, providing that service in personal life that a free press does in a functioning society. Inequality creates liars and delusion. The powerless need to dissemble—that’s how slaves, servants, and women got the reputation of being liars—and the powerful grow stupid on the lies they require from their subordinates and on the lack of need to know about others who are nobody, who don’t count, who’ve been silenced or trained to please. This is why I always pair privilege with obliviousness; obliviousness is privilege’s form of deprivation. When you don’t hear others, you don’t imagine them, they become unreal, and you are left in the wasteland of a world with only yourself in it, and that surely makes you starving, though you know not for what, if you have ceased to imagine others exist in any true deep way that matters. This is about a need for which we hardly have language or at least not a familiar conversation.

by Rebecca Solnit, LitHub |  Read more:

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Vincent van Gogh, The Plain near Auvers
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Administration Returns Copies of Report on C.I.A. Torture to Congress

Senators, spies and a president spent years in a pitched battle over how the history is told of one of the most controversial chapters of America’s campaign against terrorism, the detention and interrogation of prisoners in secret C.I.A. jails.

But recent moves by the Trump administration have increased the likelihood that much of what is known about the macabre humiliations that unfolded in those jails around the world will remain hidden from public view.

Congressional officials said on Friday that the administration has begun returning to Congress copies of a 6,700-page Senate report from 2014 about the C.I.A. program. The move raises the possibility that most of the copies could be locked in Senate vaults indefinitely or even destroyed — and increases the risk that future government officials, unable to read the report, will never learn its lessons.

The classified report is the result of a lengthy investigation into the program by Democrats on the Senate Intelligence Committee, telling the story of how — in the years after the Sept. 11, 2001, terrorist attacks — the C.I.A. began capturing terrorism suspects and interrogating them in secret prisons beyond the reach of the American judicial and military legal systems. The central conclusion of the report is that the spy agency’s interrogation methods — including waterboarding, sleep deprivation and other kinds of torture — were far more brutal and less effective than the C.I.A. described to policy makers, Congress and the public.

The Trump administration’s decision honors the request of the Republican chairman of the Senate Intelligence Committee, Richard M. Burr of North Carolina, who has decried the report for being shoddy and excessively critical of the C.I.A. and the George W. Bush administration. The F.B.I., the office of the Director of National Intelligence, the C.I.A. and the agency’s inspector general have returned their copies of the report, said American officials who asked not to be named to discuss the status of those classified copies.

The report is the most comprehensive accounting of the Bush-era program that exists. A declassified executive summary was made public in December 2014, and it laid bare some of the worst excesses of the war on terrorism, drawing broad condemnation both inside the United States and abroad.

Officials who played important roles in the C.I.A. detention program remain at the agency, including its newly appointed deputy director, Gina Haspel, and the former head of the agency’s counterterrorism center, Michael D’Andrea. Mr. D’Andrea recently assumed control of the agency’s Iran operations.

The Senate Intelligence Committee, which was run by Democrats when the executive summary was released, sent copies of the entire report to at least eight federal agencies, asking that they incorporate it into their records — a move that would have made the documents subject to requests under the Freedom of Information Act. That law, which allows citizens, the news media and other groups to request access to information held by the federal government, does not apply to congressional records.

The agencies all refused to add the report to their records, and instead kept their copies locked up, prompting the American Civil Liberties Union to sue the C.I.A. for access to the full report.

by Mark Mazzetti, Mathew Rosenberg and Charlie Savage, NY Times | Read more:

Image: Doug Mills/The New York Times
[ed. Shameful.]

Ryuichi Sakamoto

The U.S. Has Forgotten How to Do Infrastructure

As Vox’s Matthew Yglesias points out, the problem with high infrastructure costs is that they force us to debate the wrong things. If costs were reasonable, even skeptics would probably agree to fix roads and build better trains. But when the price of maintaining high-quality infrastructure is ridiculously high, the issue gets divided into two camps -- a pro-building contingent that advocates biting the bullet and overspending to maintain transportation networks, and an anti-building group that throws up its hands at the price tag. When this is the debate, the country loses either way, because it ends up either spending too much money or living with potholed roads and trains that never arrive.

The U.S. is in the grips of exactly this sort of dilemma. For some mysterious reason, the same mile of road or train track costs a lot more to build in the U.S. than in other rich countries like France or Japan. When it comes to trains, the disparity is particularly egregious. During the past few years, people who pay attention to this problem have catalogued a list of potential culprits. But none of these is really satisfying.

One popular villain is union labor. The Davis-Bacon Act, passed in 1931, mandates that infrastructure workers get paid locally prevailing wages, which usually means the wages that union members would receive. Some studies have claimed that this law and other union-friendly policies drive up costs in the U.S.

But unions probably don’t help explain the yawning gap between the U.S. and other rich countries. The reason is that places like France have some of the strongest unions in the world. Strikes by rail workers are commonplace. Yet France’s trains cost much less.

Japan is another counterexample. The median salary for a Japanese construction worker in 2014 was about 4 million yen a year, which at current exchange rates is roughly $36,000. Construction workers in the U.S. make about the same -- an average of $37,890 in 2016. Now, it’s possible that the average Japanese worker is capable of building much more in an hour than the average American worker, meaning U.S. laborers could still be overpaid in the relative sense. But it seems unlikely that the difference is that huge. The numbers are pretty clear -- high wages aren’t the big culprit in U.S. costs.

Another bogeyman is land-acquisition costs. People think of China’s authoritarian government forcing millions of people to move in order to build dams and highways, and assume this must be why it can get things done so much more cheaply than in the democratic U.S.

But this is also probably a red herring. As transit blogger Alon Levy notes, land-acquisition costs are much higher in Japan, where eminent domain laws are weaker. So much for the U.S. being the land of property rights! And yet, somehow, Japan still lays train track much more cheaply.

Explanations based on geography -- the U.S. is too spread out, or New York City is too dense -- also fail to stand up to scrutiny. Cumbersome environmental impact reviews are a possible culprit, but it’s hard to believe that countries such as France would be so willing to pave over their natural beauty and slaughter endangered species that their trains would cost only half as much as America’s as a result.

There is reason to suspect that high U.S. costs are part of a deeper problem. For example, construction seems to take a lot longer in the U.S. than in other countries. In China, a 30-story building can be completed in only 15 days. In Japan, giant sinkholes get fully repaired in one week. Even in the U.S. of a century ago, construction was pretty fast -- the Empire State Building went up in 410 days.

Yet today, it takes the U.S. many years to spend the money that Congress allocates for infrastructure. New buildings seem to linger half-built for months or years, with construction workers often nowhere to be found. Subways can take decades. Even in the private sector, there are problems -- productivity in the homebuilding sector has fallen in recent decades.

That suggests that U.S. costs are high due to general inefficiency -- inefficient project management, an inefficient government contracting process, and inefficient regulation. It suggests that construction, like health care or asset management or education, is an area where Americans have simply ponied up more and more cash over the years while ignoring the fact that they were getting less and less for their money.

by Noah Smith, Bloomberg |  Read more:

Image: Frank Polich/Bloomberg