vox--2020-11-19--Why the new PlayStation and Xbox are such a big deal

A lot of people spent a lot of time refreshing their browsers the week of November 9 .
“ How I look after staying up all night just to get no PS5 from Best Buy or Target , ” reads one characteristic tweet from a browser-refresher Twitter user named RyanReallySucks .
Attached is a familiar meme pic of a dude dressed in a clown costume while sitting at his work computer .
RyanReallySucks was one of many disappointed customers that week who compared themselves online to sad , embarrassed , video-game-console-less clowns .
They were united in their brutal failures @ @ @ @ @ @ @ on the night of its release , thwarted by restricted stock and much quicker trigger fingers .
As of now , the only options for RyanReallySucks and his cohort of console-less video game enthusiasts is to put their name down on a long waitlist for whenever there ’ s more stock — or to head over to eBay , where they ’ ll be looking at a minimum $ 1,000 spend on average .
While it ’ s pretty easy to buy a new video game — you can usually do it without @ @ @ @ @ @ @ to your console or computer — it ’ s not quite as easy to buy a new video game console .
And the opportunity to do so right when it launches is one that comes only a handful of times a decade .
In that sense , a new video game console is sort of like a new iPhone : People sometimes wait in line for hours to be the first to get one when they come out , too .
But Apple , predictably , releases several versions of the iPhone every @ @ @ @ @ @ @ video game hardware is a once-in-half-a-decade event , one defined by sky-high demand and highly constrained stock .
Once they ’ re released — and you manage to get your hands on one — you ’ re set .
You ’ re not going to upgrade or replace it every year , as you might with your smartphone .
Instead , everyone who ’ s excited about the prospect of the newest , shiniest , best tech has been waiting a long , long time for these consoles .
This year ’ s @ @ @ @ @ @ @ 5 and Microsoft ’ s Xbox Series X , which launched just two days apart on November 12 and November 10 , respectively .
The consoles are available at almost identical price points , and each one comes with big technical advancements over their predecessors , the PlayStation 4 and Xbox One .
They ’ re also both incredibly hefty boys .
Look at them : That two hugely anticipated pieces of gaming hardware arrived in the same week — during a pandemic and right after an anxiety-inducing election — is almost overwhelming @ @ @ @ @ @ @ is going on in the world , though , the most loyal of gaming lovers will put everything else aside to get their hands on a new console .
In late October 2019 , Sony and Microsoft announced the PlayStation 5 and the Xbox Series X would be available by the end of 2020 .
The news came after months of speculation and a drip feed of teasers about what the hardware would look like .
It also came years after the November 2013 launch of the PlayStation 4 and the Xbox One @ @ @ @ @ @ @ .
Their successors , then , arrived almost seven years later .
Seven years might sound like 70,000 years to someone who ’ s accustomed to the constant refresh of new content to stream or glossy smartphones to inevitably drop on the sidewalk .
But a lengthy gap between new systems is par for the course in the gaming industry .
For some striking numbers , consider the PlayStation console timeline : Sony released the first PlayStation in Japan in December 1994 , followed by its US release in September 1995 .
The @ @ @ @ @ @ @ the spring ( in Japan ) and fall ( everywhere else ) of 2000 ; the PlayStation 3 followed in November 2006 .
That gives each PlayStation console an average life cycle of 6.5 years or so .
Console hardware takes a long time to design , test , and promote , and to sell someone on a big purchase of any kind , you need great incentives to push them over the edge .
For a console , that means you need marquee , day-one launch games ; surefire , eye-catching features @ @ @ @ @ @ @ to meet at least a high percentage of the demand .
This all helps to put the price in context .
Right , the price : The highest-end models of the PlayStation 5 and the Xbox Series X each retail at $ 499.99 , while less full-featured versions cost $ 399.99 ( PS5 ’ s digital-only edition ) and $ 299.99 ( the digital-only Xbox Series S , a smaller and less-powerful version of the Series X ) .
Those prices aren ’ t terrible compared to the cost of a phone or @ @ @ @ @ @ @ as long as a console .
But then you factor in the cost of games ( which can run $ 60 to $ 70 apiece ) , annual subscriptions to play those games online with friends , extra add-ons … and the endeavor can be costly .
A console buyer may see these costs as a fair trade-off , as the release of the PS5 and XSX is undoubtedly exciting : New console hardware marks the start of a new “ generation ” of video games .
A new generation means more power @ @ @ @ @ @ @ more diverse , and more interesting ideas .
There aren ’ t always many newfangled games to put the newness into practice at launch ; the PlayStation 5 has only a few console-exclusive games available right now , and the Xbox Series X has none ( ! )
.
But once new consoles are out , a new era in gaming immediately kicks off .
Over the next half-dozen years — until the next consoles are out there — the PlayStation 5 and Xbox Series X will continue to iterate on what gaming @ @ @ @ @ @ @ ways both surprising and necessary .
On a technical level , each one offers a lot over their predecessors : Both have much faster processors , which will greatly reduce load times for games and allow for vastly improved graphical features .
( The Verge has great reviews of each console that dive deeper into those aspects . )
Both have more stable solid-state drives that are less prone to getting hot and overworked , which should translate into longer-lasting hardware .
And both offer more storage to let you download more games @ @ @ @ @ @ @ or Xbox Series X buyer is ready for all of that , and they ’ re in it for the long haul .
What they ’ re also ready for are the iterative , bolder elements that aren ’ t as quantifiable as processing power : the new features of both consoles that will help reconceive gaming as a whole .
The most intriguing change is that both the PlayStation 5 and the Xbox Series X offer digital-only , disc-drive-less editions of their hardware , a move that dares to eliminate physical media @ @ @ @ @ @ @ particular is leaning hard into adopting a streaming service model for its gaming library with Xbox Game Pass , a subscription service that grants members easy access to a vast library of games from every Xbox generation to play .
Through Game Pass , and Sony ’ s more restrictive but similar on-demand gaming service PlayStation Now , console owners can cultivate a wider library of games they ’ re tinkering with instead of having to solely take bets on big-banner games that you pay for piecemeal .
Industry-redefining features like this kind @ @ @ @ @ @ @ in a much more visible way than new graphics or hardware alone .
It ’ s the combination of the two that often dazzles fans into wanting a new console , stat .
Testing out a new controller that adapts to your play style and offers rumbling feedback with every slight movement is a cool trick ; the hope that we ’ ll one day try so many more interesting games with less of an access barrier can be downright empowering .
So it ’ s not just a financial investment for many @ @ @ @ @ @ @ it ’ s an emotional one , where buying a console often comes with the intense anticipation of a novel future .
But the emotions also play into something that exists outside of playing games themselves : brand loyalty .
Two new consoles mean countless reviews and debates and breakdowns about which one is more worth your time and money .
They mean new , exclusive games meant to entice buyers over to one “ side ” or the other .
And they mean time to fiercely defend your console of choice .
@ @ @ @ @ @ @ mainstream as “ the console wars , ” a pithy framing device that dramatically portrays video games as opposing armies .
The concept is a longstanding , mostly economic one whose origins stem from way back when video games were young .
There ’ s a pretty interesting Netflix documentary series that gets into a lot of this called High Score , but the gist is the console industry was volatile in the 1980s and early ’ 90s .
New hardware companies would enter the fray , hoping to edge out the others @ @ @ @ @ @ @ s living rooms .
There were so many options to choose from , and the costs of production were so high , that companies were taking huge bets every time they put out a new console .
A lot of them didn ’ t make their money back and eventually exited the industry .
The console wars have always been more theoretical than real , though .
There are only three big console makers now : Microsoft , Nintendo , and Sony .
There are hundreds of big and small studios developing games @ @ @ @ @ @ @ for personal computers ) , so there ’ s still a ton of variety and options out there , more than there ’ s been at any other point in gaming history .
There should no longer be much concern , at this point , that your favorite console maker and its systems are going to go away .
Most people who play video games recognize that and operate as such , enjoying whatever it is they like to play .
There are Pokémon fans ( c ’ est moi ) , Call @ @ @ @ @ @ @ and countless others .
Most of these people are not oppressively insistent that their favorite games are the best games and that all other games are terrible , crying , “ How dare they push their favorite games out of the sales spotlight !
” But the minority that does feel this way — that anyone who plays such-and-such game or owns such-and-such console is an existential threat to their own platform of choice — is very , very vocal .
Between the high cost of entry attached to gaming and the amount @ @ @ @ @ @ @ big-deal video game purchase — all that waiting in line or refreshing of websites — people sometimes feel a strong attachment to their console purchase .
They want their console to come out on top sales-wise , so they prove they made the right call in buying it .
If Microsoft sells fewer Xbox units , for example , it can feel invalidating to the Xbox-exclusive owner , as though they wasted their money on an unsuccessful system .
PlayStation fans determined to see the Xbox “ fail ” might dunk on the @ @ @ @ @ @ @ saying the Xbox has no games , the PlayStation ’ s games will always be better , or owning an Xbox is disgraceful .
And Xbox owners could say the same things right back at them .
Fandom can breed resentment and ferocity .
The public fallout of Gamergate six years ago gave the mainstream a taste of just how bad things can get when self-righteous , easily angered people get their games mixed up with their politicking and biases .
Although the scale of Gamergate , which saw developers and journalists harassed @ @ @ @ @ @ @ progressive values and personal relationships under the guise of “ ethics , ” was anomalous , it did bring a legitimate issue to light .
There are people out there who love video games , just as they do any other thing , and there are people out there who take their love to an abusive level .
This can make the entire idea of getting into video games daunting ( or even a turnoff ) to some people .
It ’ s important to recognize that these hardcore fans are a niche @ @ @ @ @ @ @ adults who play video games .
The happiest video game player is the one who puts allegiances aside and buys whichever consoles and games interest them , if they can afford to do so .
I ’ ve got a Nintendo Switch and a PlayStation 4 sitting side by side near my TV , just like a pair of old friends .
It ’ s 100 percent possible for all video games , and video gamers , to get along .
The release of PlayStation 5 and the Xbox Series X — in @ @ @ @ @ @ @ — may also seem ill timed to the skeptics .
They may balk at the idea of charging people upward of $ 1,000 ( for the most fully featured version of each console , if you buy them both ) for anything during tough economic times .
And I don ’ t judge them for it ; consider me on the side of “ that is way too much money for me to spend on fancy gaming toys right now.
” I might not be able to convince you that celebrating a pricey @ @ @ @ @ @ @ good thing .
But what I do want to impart is how , regardless of whether you can or even want to buy a console right at launch , the kick-start to a new generation of video games is absolutely a cause for celebration .
For those of us who find so much joy and pleasure and art within video games , experiencing the dawn of a new era in gaming produces a rare euphoria .
Booting up a new device after years of using an old one feels so special and mesmerizing @ @ @ @ @ @ @ of getting a new phone is multiplied by the long wait for the hardware and a glimpse of years of possibilities ahead : the software improvements that create more immersive worlds , the potential to let everyone try out way more games , the quality-of-life changes that let us jump in and out of our games with more ease .
And to experience that magic , we ’ ll wait on a retail website with our fingers on the refresh key for as long as we have to .

A lot of people spent a lot of time refreshing their browsers the week of November 9.
“How I look after staying up all night just to get no PS5 from Best Buy or Target,” reads one characteristic tweet from a browser-refresher Twitter user named RyanReallySucks.
Attached is a familiar meme pic of a dude dressed in a clown costume while sitting at his work computer.
RyanReallySucks was one of many disappointed customers that week who compared themselves online to sad, embarrassed, video-game-console-less clowns. They were united in their brutal failures to buy the new Sony PlayStation 5 on the night of its release, thwarted by restricted stock and much quicker trigger fingers.
Me trying to get an Xbox Series X on Gamestop, Target, Best Buy, and Microsoft all in different tabs pic.twitter.com/xSrz2MPyHF — SoCalNoel ☀ (@SoCalNoel) November 10, 2020
Me taking a break from refreshing the Best Buy and Target sites#PS5pic.twitter.com/huf6DiBvGd — LSK (@kenny_817) November 12, 2020
Let us all put on our clown outfits for round 3 of #ps5 with @Walmart pic.twitter.com/6cKb30SD7T — Ri Lebrõn ♒ (@arikristina) November 12, 2020
As of now, the only options for RyanReallySucks and his cohort of console-less video game enthusiasts is to put their name down on a long waitlist for whenever there’s more stock — or to head over to eBay, where they’ll be looking at a minimum $1,000 spend on average.
While it’s pretty easy to buy a new video game — you can usually do it without ever going outside, by downloading it to your console or computer — it’s not quite as easy to buy a new video game console. And the opportunity to do so right when it launches is one that comes only a handful of times a decade.
In that sense, a new video game console is sort of like a new iPhone: People sometimes wait in line for hours to be the first to get one when they come out, too. But Apple, predictably, releases several versions of the iPhone every fall, whereas the debut of new video game hardware is a once-in-half-a-decade event, one defined by sky-high demand and highly constrained stock.
Once they’re released — and you manage to get your hands on one — you’re set. You’re not going to upgrade or replace it every year, as you might with your smartphone. Instead, everyone who’s excited about the prospect of the newest, shiniest, best tech has been waiting a long, long time for these consoles.
This year’s new consoles are Sony’s PlayStation 5 and Microsoft’s Xbox Series X, which launched just two days apart on November 12 and November 10, respectively. The consoles are available at almost identical price points, and each one comes with big technical advancements over their predecessors, the PlayStation 4 and Xbox One.
They’re also both incredibly hefty boys. Look at them:
let the games begin pic.twitter.com/qlnQrFdF4h — Tom Warren (@tomwarren) October 27, 2020
That two hugely anticipated pieces of gaming hardware arrived in the same week — during a pandemic and right after an anxiety-inducing election — is almost overwhelming to reconcile. No matter what else is going on in the world, though, the most loyal of gaming lovers will put everything else aside to get their hands on a new console.
New console launches are a rare event
In late October 2019, Sony and Microsoft announced the PlayStation 5 and the Xbox Series X would be available by the end of 2020. The news came after months of speculation and a drip feed of teasers about what the hardware would look like. It also came years after the November 2013 launch of the PlayStation 4 and the Xbox One, the new consoles’ immediate predecessors. Their successors, then, arrived almost seven years later.
Seven years might sound like 70,000 years to someone who’s accustomed to the constant refresh of new content to stream or glossy smartphones to inevitably drop on the sidewalk. But a lengthy gap between new systems is par for the course in the gaming industry.
For some striking numbers, consider the PlayStation console timeline: Sony released the first PlayStation in Japan in December 1994, followed by its US release in September 1995. The PlayStation 2 didn’t arrive until the spring (in Japan) and fall (everywhere else) of 2000; the PlayStation 3 followed in November 2006. That gives each PlayStation console an average life cycle of 6.5 years or so.
Console hardware takes a long time to design, test, and promote, and to sell someone on a big purchase of any kind, you need great incentives to push them over the edge. For a console, that means you need marquee, day-one launch games; surefire, eye-catching features; and, hopefully, enough supply to meet at least a high percentage of the demand. This all helps to put the price in context.
Right, the price: The highest-end models of the PlayStation 5 and the Xbox Series X each retail at $499.99, while less full-featured versions cost $399.99 (PS5’s digital-only edition) and $299.99 (the digital-only Xbox Series S, a smaller and less-powerful version of the Series X). Those prices aren’t terrible compared to the cost of a phone or computer, neither of which typically last as long as a console. But then you factor in the cost of games (which can run $60 to $70 apiece), annual subscriptions to play those games online with friends, extra add-ons … and the endeavor can be costly.
A console buyer may see these costs as a fair trade-off, as the release of the PS5 and XSX is undoubtedly exciting: New console hardware marks the start of a new “generation” of video games. A new generation means more power, which often allows for newer, more diverse, and more interesting ideas. There aren’t always many newfangled games to put the newness into practice at launch; the PlayStation 5 has only a few console-exclusive games available right now, and the Xbox Series X has none (!). But once new consoles are out, a new era in gaming immediately kicks off.
Over the next half-dozen years — until the next consoles are out there — the PlayStation 5 and Xbox Series X will continue to iterate on what gaming looks like and can be, in ways both surprising and necessary. On a technical level, each one offers a lot over their predecessors: Both have much faster processors, which will greatly reduce load times for games and allow for vastly improved graphical features. (The Verge has great reviews of each console that dive deeper into those aspects.) Both have more stable solid-state drives that are less prone to getting hot and overworked, which should translate into longer-lasting hardware. And both offer more storage to let you download more games with abandon.
The day-one PlayStation 5 or Xbox Series X buyer is ready for all of that, and they’re in it for the long haul. What they’re also ready for are the iterative, bolder elements that aren’t as quantifiable as processing power: the new features of both consoles that will help reconceive gaming as a whole.
The most intriguing change is that both the PlayStation 5 and the Xbox Series X offer digital-only, disc-drive-less editions of their hardware, a move that dares to eliminate physical media from our gaming experiences. Microsoft in particular is leaning hard into adopting a streaming service model for its gaming library with Xbox Game Pass, a subscription service that grants members easy access to a vast library of games from every Xbox generation to play. Through Game Pass, and Sony’s more restrictive but similar on-demand gaming service PlayStation Now, console owners can cultivate a wider library of games they’re tinkering with instead of having to solely take bets on big-banner games that you pay for piecemeal.
Industry-redefining features like this kind of streaming model can shake up gaming in a much more visible way than new graphics or hardware alone. It’s the combination of the two that often dazzles fans into wanting a new console, stat. Testing out a new controller that adapts to your play style and offers rumbling feedback with every slight movement is a cool trick; the hope that we’ll one day try so many more interesting games with less of an access barrier can be downright empowering.
So it’s not just a financial investment for many of these most excitable console buyers, it’s an emotional one, where buying a console often comes with the intense anticipation of a novel future. But the emotions also play into something that exists outside of playing games themselves: brand loyalty.
Console wars are fierce — even if they’re not real
Two new consoles mean countless reviews and debates and breakdowns about which one is more worth your time and money. They mean new, exclusive games meant to entice buyers over to one “side” or the other. And they mean time to fiercely defend your console of choice.
This has often been noted in the mainstream as “the console wars,” a pithy framing device that dramatically portrays video games as opposing armies. The concept is a longstanding, mostly economic one whose origins stem from way back when video games were young. There’s a pretty interesting Netflix documentary series that gets into a lot of this called High Score, but the gist is the console industry was volatile in the 1980s and early ’90s. New hardware companies would enter the fray, hoping to edge out the others to ensure their place in people’s living rooms. There were so many options to choose from, and the costs of production were so high, that companies were taking huge bets every time they put out a new console. A lot of them didn’t make their money back and eventually exited the industry.
The console wars have always been more theoretical than real, though. There are only three big console makers now: Microsoft, Nintendo, and Sony. There are hundreds of big and small studios developing games for these consoles (as well as for personal computers), so there’s still a ton of variety and options out there, more than there’s been at any other point in gaming history. There should no longer be much concern, at this point, that your favorite console maker and its systems are going to go away.
Most people who play video games recognize that and operate as such, enjoying whatever it is they like to play. There are Pokémon fans (c’est moi), Call of Duty fans, Halo fans, and countless others. Most of these people are not oppressively insistent that their favorite games are the best games and that all other games are terrible, crying, “How dare they push their favorite games out of the sales spotlight!” But the minority that does feel this way — that anyone who plays such-and-such game or owns such-and-such console is an existential threat to their own platform of choice — is very, very vocal.
FedEx driver writes on Xbox Series X shipping box "Playstation is Better"#PS5 #XboxSeriesX pic.twitter.com/K4ld8XAPCS — Marlon Gaming Nation (@GamesAndWario) November 11, 2020
Enough console war fanboy pic.twitter.com/ekM6prC2Kb — DivanteScrollsTweeter #BlackLivesMatter (@DivanteScrolls) November 16, 2020
Between the high cost of entry attached to gaming and the amount of effort that goes into making a big-deal video game purchase — all that waiting in line or refreshing of websites — people sometimes feel a strong attachment to their console purchase. They want their console to come out on top sales-wise, so they prove they made the right call in buying it. If Microsoft sells fewer Xbox units, for example, it can feel invalidating to the Xbox-exclusive owner, as though they wasted their money on an unsuccessful system. PlayStation fans determined to see the Xbox “fail” might dunk on the other console as much as possible, saying the Xbox has no games, the PlayStation’s games will always be better, or owning an Xbox is disgraceful. And Xbox owners could say the same things right back at them.
Fandom can breed resentment and ferocity. The public fallout of Gamergate six years ago gave the mainstream a taste of just how bad things can get when self-righteous, easily angered people get their games mixed up with their politicking and biases. Although the scale of Gamergate, which saw developers and journalists harassed, doxxed, and bullied for their progressive values and personal relationships under the guise of “ethics,” was anomalous, it did bring a legitimate issue to light. There are people out there who love video games, just as they do any other thing, and there are people out there who take their love to an abusive level.
This can make the entire idea of getting into video games daunting (or even a turnoff) to some people.
It’s important to recognize that these hardcore fans are a niche among the more than 160 million US adults who play video games. The happiest video game player is the one who puts allegiances aside and buys whichever consoles and games interest them, if they can afford to do so. I’ve got a Nintendo Switch and a PlayStation 4 sitting side by side near my TV, just like a pair of old friends. It’s 100 percent possible for all video games, and video gamers, to get along.
The release of PlayStation 5 and the Xbox Series X — in this, the Lost Year of 2020 — may also seem ill timed to the skeptics. They may balk at the idea of charging people upward of $1,000 (for the most fully featured version of each console, if you buy them both) for anything during tough economic times. And I don’t judge them for it; consider me on the side of “that is way too much money for me to spend on fancy gaming toys right now.”
i like video games, i think they are cool and fun. i hope i can afford to own one some day — tall allegra frank (@LegsFrank) September 16, 2020
I might not be able to convince you that celebrating a pricey product launch during a pandemic is a good thing. But what I do want to impart is how, regardless of whether you can or even want to buy a console right at launch, the kick-start to a new generation of video games is absolutely a cause for celebration. For those of us who find so much joy and pleasure and art within video games, experiencing the dawn of a new era in gaming produces a rare euphoria. Booting up a new device after years of using an old one feels so special and mesmerizing.
With video games, that feeling of getting a new phone is multiplied by the long wait for the hardware and a glimpse of years of possibilities ahead: the software improvements that create more immersive worlds, the potential to let everyone try out way more games, the quality-of-life changes that let us jump in and out of our games with more ease. And to experience that magic, we’ll wait on a retail website with our fingers on the refresh key for as long as we have to.


vox--2020-11-19--Urgent care centers are cementing their role in American health care during Covid-19

Demand for urgent care is spiking as the country continually breaks daily records for new Covid-19 cases .
This makes sense : Americans are seeking out coronavirus tests more than ever and urgent care centers are one of few places people can walk up and get one without an appointment .
In fact , urgent care is quickly becoming the go-to health care destination for a growing share of the population .
As the third wave of the pandemic began across the United States , visits to urgent care jumped nearly 10 percent in October compared to September according to @ @ @ @ @ @ @ and urgent care centers had already been busier than ever after starting to offer Covid-19 tests in earnest back in May .
Fifty percent more people are going to urgent care currently than is typical for this time of year , according to data from Solv , an app that handles online and in-person booking for urgent care centers .
Searches for urgent care on Google are at an all-time high , as are searches for Covid-19 testing .
A big reason for this growth is the unique role that urgent care centers @ @ @ @ @ @ @ system .
Urgent care centers are standalone medical practices where patients can drop in for immediate medical care for anything from fractures to the flu , no appointment necessary .
Their hours tend to be longer — some are 24 hours , 7 days a week — than primary care doctors , though their copays are usually higher .
While state testing sites , pharmacies , community clinics , and primary care doctors all offer Covid-19 tests , urgent care centers do so on demand .
In addition to the record number of @ @ @ @ @ @ @ seeing a rise in the number of people seeking testing because it ’ s the start of the season for colds and flu , which have similar symptoms to Covid-19 .
Many people are also getting tested as a way of trying to safely visit family for the holidays .
It ’ s not clear exactly what share of the 172 million coronavirus tests conducted so far in the US have been done through urgent care centers , but it ’ s certainly sizable and growing .
Urgent Care Association CEO Lou Ellen @ @ @ @ @ @ @ a “ tremendous ” number of Covid-19 tests , which accounts for the “ vast majority of visits.
” Urgent care centers were doing about 725,000 tests per week in late October , which roughly amounted to 10 percent of the total tests per week in the US at that time .
Since the number of tests urgent care centers conduct per week has grown so quickly — as has the total number of tests conducted in the US — we don ’ t have precise current numbers for urgent care ’ s @ @ @ @ @ @ @ grown rapidly and is estimated to be $ 28 billion in the US this year , and coronavirus care is likely to add to its growth .
That said , all this new business might not be that great for the financial viability of urgent care in the short term , since Covid-19 tests and precautions are so expensive .
Insurance companies commonly pay urgent cares a flat fee per visit , regardless of what services are provided .
The cost for Covid-19 tests and the added personal protective equipment needed is high @ @ @ @ @ @ @ insurance companies does not always cover the total cost of conducting these tests , according to Horwitz .
There is a provision in the federal CARES Act that should help cover these added costs , but Horwitz says that has been a “ struggle in reality , ” though she ’ s hopeful that insurance companies and urgent care will sort out fair payment .
Regardless , Covid-19 tests are continuing to be a large portion of urgent care ’ s new business .
And the extent to which these clinics remain popular @ @ @ @ @ @ @ on how health care is delivered in the United States .
The rise of urgent care and the decline of primary care businesses The first urgent care clinics launched in the early 1980s , and the concept grew slowly through the early aughts .
They began to grow more rapidly thanks to shortages — both real and perceived — of primary care doctors and a growing effort to avoid expensive emergency room visits .
Then , about a decade ago , investors started pouring money into the industry , whose retail model seemed @ @ @ @ @ @ @ systems started opening their own urgent care centers .
There are currently more than 10,000 urgent care centers in the US , up 44 percent from five years ago , according to the Urgent Care Association .
Urgent care had been gaining in popularity long before the pandemic due to a unique space it filled between primary care doctors and emergency room visits .
Research published in JAMA Internal Medicine found that Americans had increasingly been going to urgent care for “ low-acuity conditions ” — complaints like respiratory infections , muscle strains @ @ @ @ @ @ @ 2015 , urgent care centers saw a 120 percent increase in those types of visits .
These places are also equipped to treat more severe injuries like fractures or wounds that need stitches .
Indeed , Americans have been utilizing urgent care to avoid expensive emergency room bills .
Young people especially have been drawn to the convenience of urgent care , where longer hours and walk-in appointments seem to outweigh the cost of bigger copays .
At the same time , the number of Americans getting health care from primary care doctors @ @ @ @ @ @ @ detrimental to people ’ s health , according to a report in the Annals of Internal Medicine .
Estimates from the Urgent Care Association indicate that urgent care represented more than 23 percent of all primary care visits in the US before the pandemic , and that number is undeniably higher now .
“ Primary care is super important because it ’ s associated with better outcomes and lower health care costs , ” said one of the report ’ s authors , Ishani Ganguli , an assistant professor of medicine at Harvard @ @ @ @ @ @ @ at Brigham and Women ’ s Hospital .
She added that primary care is also important for coordinating all of a person ’ s medical care and for finding underlying problems that could be missed in one-off visits to urgent care .
While urgent care has certainly been taking some of that traffic , there are other reasons for that decline , according to Ganguli ’ s research .
The internet , accessible from the comfort and privacy of our homes , is the first stop for many Americans looking for answers about @ @ @ @ @ @ @ — what to do about pink eye , for example — obviate the need for medical care .
The rising cost of health care , meanwhile , means that some people can not afford to see a doctor .
Other reasons for the decline in visits to primary care doctors have to do with how their practices have changed .
Patients are getting more done in fewer visits and are supplementing those visits with calls and emails to their primary care doctors .
These are positive developments for patients , but they can @ @ @ @ @ @ @ lines of medical practices .
Doctors are often paid by the visit , which doesn ’ t always take into consideration this increased care .
Doctors are increasingly adding online portals for communication and telehealth visits , reducing the need for in-person visits , and online health care grew rapidly due to the necessities of the coronavirus pandemic .
The share of Americans who tried telemedicine had already doubled this spring .
Online visits , however , are not being covered by insurance companies or Medicare at the same rates as in-person appointments @ @ @ @ @ @ @ routine care during the pandemic has forced some primary care businesses across the country to close .
There ’ s been a lot of interest from policymakers , insurers , and doctors in moving from a per-service payment model to a per-person system , and the pandemic is making it more likely .
But by the time that happens , many of the primary care businesses operating in the US will have already gone under .
What this means for medical care The increased use of urgent care doesn ’ t have to @ @ @ @ @ @ @ .
It can be a complement to it .
While urgent care can be used to treat one-off issues like the flu or stitching a wound , primary care physicians can focus on managing more long-term and major health care needs .
“ If I were to redraw the medical system to decide where do I want primary care doctors spending time , it would be on the sicker population , ” Ateev Mehrotra , an associate professor at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center , said @ @ @ @ @ @ @ health conditions .
“ If that means that other providers are taking care of flu and sinusitis , so be it.
” As far as the pandemic is concerned , urgent care centers have become a critical part of a patchwork of health care providers who can meet the high demand for testing in lieu of a national strategy .
Their on-demand appointments , relatively straightforward test offerings , and ubiquity have made urgent care centers ideal places for the public to find Covid-19 tests , in addition to other medical care .
@ @ @ @ @ @ @ to get certain services at urgent care .
Covid testing is a good example of that , ” said Ganguli , who thinks urgent care and primary doctors can collaborate to create more informed , holistic treatment .
“ The ideal future state is that retail clinics and urgent care are an extension of what primary care is already doing , helping us do that job better.
” The fear , however , is that people will use urgent care centers in place of seeing a regular primary care physician .
When you @ @ @ @ @ @ @ a different nurse or doctor each time , whereas at primary care you ’ d see your regular doctor , who could follow your health over time and across different providers .
“ By skipping primary care , you risk delayed or missed diagnoses of major yet treatable conditions like high blood pressure , heart disease , cervical cancer , and depression , as well as higher medical bills , ” Ganguli said .
The consequences of going to urgent care rather than seeing a regular doctor also depend on the patient and @ @ @ @ @ @ @ ’ re talking about younger , healthier folks , it ’ s fine to have a more convenient care option , ” Mehrotra said .
“ My concern goes up if people using it have a lot of medical conditions or are on lots of medications.
” While urgent care centers serve all sorts of demographics , millennials and people with young children tend to be top customers , according to Horwitz , the head of the Urgent Care Association .
It ’ s less popular among elderly people , who are more @ @ @ @ @ @ @ who see a wider range of doctors whose care needs to be coordinated .
Horwitz added that there has been a low rate of urgent care patients who have needed to be transferred to the emergency room .
This suggests that people aren ’ t mistakenly using urgent care for more serious issues .
How urgent care could be at the center of Covid-19 care Urgent care was a bridge between primary care and the emergency room in normal times , and now , it ’ s filling a variety of needs around @ @ @ @ @ @ @ testing but advising people on treating the illness , quarantining properly , and , if necessary , when to go to the emergency room .
In order to stop the spread of the virus , it ’ s essential that people know whether they have it in the first place .
Some 193 million tests per month are necessary to safely operate schools and nursing homes , according to a report released in September by the Rockefeller Foundation .
Currently , the US is doing less than a quarter of that .
To @ @ @ @ @ @ @ Covid-19 test providers , including urgent cares , will have to accommodate more customers .
For many , Covid-19 testing will be their first experience using urgent care .
Horwitz says urgent cares “ fully intend to participate ” in distributing coronavirus vaccines , so those visits likely won ’ t be their last .
One of the major challenges with the coronavirus vaccines , once they are ultimately approved for use , will be distributing them to the population .
That task will largely fall to the states , which will in @ @ @ @ @ @ @ urgent care centers to make sure that those who need it can get it , beginning with priority populations like health care workers and the elderly .
Horwitz expects urgent care ’ s popularity , buoyed by coronavirus testing and — someday —vaccines , to increase the use of urgent care for other reasons after the pandemic .
“ Coronavirus gives urgent care the opportunity to show their communities as well as government entities what urgent care is capable of , ” Horwitz said .

Demand for urgent care is spiking as the country continually breaks daily records for new Covid-19 cases. This makes sense: Americans are seeking out coronavirus tests more than ever and urgent care centers are one of few places people can walk up and get one without an appointment. In fact, urgent care is quickly becoming the go-to health care destination for a growing share of the population.
As the third wave of the pandemic began across the United States, visits to urgent care jumped nearly 10 percent in October compared to September according to the industry group Urgent Care Association — and urgent care centers had already been busier than ever after starting to offer Covid-19 tests in earnest back in May. Fifty percent more people are going to urgent care currently than is typical for this time of year, according to data from Solv, an app that handles online and in-person booking for urgent care centers. Searches for urgent care on Google are at an all-time high, as are searches for Covid-19 testing.
A big reason for this growth is the unique role that urgent care centers have played in the American health care system. Urgent care centers are standalone medical practices where patients can drop in for immediate medical care for anything from fractures to the flu, no appointment necessary. Their hours tend to be longer — some are 24 hours, 7 days a week — than primary care doctors, though their copays are usually higher. While state testing sites, pharmacies, community clinics, and primary care doctors all offer Covid-19 tests, urgent care centers do so on demand.
In addition to the record number of Covid-19 cases, urgent care centers are seeing a rise in the number of people seeking testing because it’s the start of the season for colds and flu, which have similar symptoms to Covid-19. Many people are also getting tested as a way of trying to safely visit family for the holidays.
It’s not clear exactly what share of the 172 million coronavirus tests conducted so far in the US have been done through urgent care centers, but it’s certainly sizable and growing. Urgent Care Association CEO Lou Ellen Horwitz said urgent care centers are conducting a “tremendous” number of Covid-19 tests, which accounts for the “vast majority of visits.”
Urgent care centers were doing about 725,000 tests per week in late October, which roughly amounted to 10 percent of the total tests per week in the US at that time. Since the number of tests urgent care centers conduct per week has grown so quickly — as has the total number of tests conducted in the US — we don’t have precise current numbers for urgent care’s contribution. The urgent care market has grown rapidly and is estimated to be $28 billion in the US this year, and coronavirus care is likely to add to its growth.
That said, all this new business might not be that great for the financial viability of urgent care in the short term, since Covid-19 tests and precautions are so expensive. Insurance companies commonly pay urgent cares a flat fee per visit, regardless of what services are provided. The cost for Covid-19 tests and the added personal protective equipment needed is high — high enough that the reimbursement from insurance companies does not always cover the total cost of conducting these tests, according to Horwitz. There is a provision in the federal CARES Act that should help cover these added costs, but Horwitz says that has been a “struggle in reality,” though she’s hopeful that insurance companies and urgent care will sort out fair payment.
Regardless, Covid-19 tests are continuing to be a large portion of urgent care’s new business. And the extent to which these clinics remain popular after the pandemic could have lasting effects on how health care is delivered in the United States.
The rise of urgent care and the decline of primary care businesses
The first urgent care clinics launched in the early 1980s, and the concept grew slowly through the early aughts. They began to grow more rapidly thanks to shortages — both real and perceived — of primary care doctors and a growing effort to avoid expensive emergency room visits. Then, about a decade ago, investors started pouring money into the industry, whose retail model seemed to fit American consumerism, and health systems started opening their own urgent care centers.
There are currently more than 10,000 urgent care centers in the US, up 44 percent from five years ago, according to the Urgent Care Association.
Urgent care had been gaining in popularity long before the pandemic due to a unique space it filled between primary care doctors and emergency room visits. Research published in JAMA Internal Medicine found that Americans had increasingly been going to urgent care for “low-acuity conditions” — complaints like respiratory infections, muscle strains, and rashes. From 2008 to 2015, urgent care centers saw a 120 percent increase in those types of visits.
These places are also equipped to treat more severe injuries like fractures or wounds that need stitches. Indeed, Americans have been utilizing urgent care to avoid expensive emergency room bills. Young people especially have been drawn to the convenience of urgent care, where longer hours and walk-in appointments seem to outweigh the cost of bigger copays.
At the same time, the number of Americans getting health care from primary care doctors has been declining, which could be detrimental to people’s health, according to a report in the Annals of Internal Medicine. Estimates from the Urgent Care Association indicate that urgent care represented more than 23 percent of all primary care visits in the US before the pandemic, and that number is undeniably higher now.
“Primary care is super important because it’s associated with better outcomes and lower health care costs,” said one of the report’s authors, Ishani Ganguli, an assistant professor of medicine at Harvard Medical School and a primary care physician at Brigham and Women’s Hospital. She added that primary care is also important for coordinating all of a person’s medical care and for finding underlying problems that could be missed in one-off visits to urgent care.
While urgent care has certainly been taking some of that traffic, there are other reasons for that decline, according to Ganguli’s research. The internet, accessible from the comfort and privacy of our homes, is the first stop for many Americans looking for answers about their health. And sometimes those answers — what to do about pink eye, for example — obviate the need for medical care. The rising cost of health care, meanwhile, means that some people cannot afford to see a doctor.
Other reasons for the decline in visits to primary care doctors have to do with how their practices have changed. Patients are getting more done in fewer visits and are supplementing those visits with calls and emails to their primary care doctors. These are positive developments for patients, but they can have a negative effect on the bottom lines of medical practices. Doctors are often paid by the visit, which doesn’t always take into consideration this increased care.
Doctors are increasingly adding online portals for communication and telehealth visits, reducing the need for in-person visits, and online health care grew rapidly due to the necessities of the coronavirus pandemic. The share of Americans who tried telemedicine had already doubled this spring. Online visits, however, are not being covered by insurance companies or Medicare at the same rates as in-person appointments. That coupled with people putting off routine care during the pandemic has forced some primary care businesses across the country to close.
There’s been a lot of interest from policymakers, insurers, and doctors in moving from a per-service payment model to a per-person system, and the pandemic is making it more likely. But by the time that happens, many of the primary care businesses operating in the US will have already gone under.
What this means for medical care
The increased use of urgent care doesn’t have to be a bad thing for primary care. It can be a complement to it. While urgent care can be used to treat one-off issues like the flu or stitching a wound, primary care physicians can focus on managing more long-term and major health care needs.
“If I were to redraw the medical system to decide where do I want primary care doctors spending time, it would be on the sicker population,” Ateev Mehrotra, an associate professor at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center, said, referring to those with more severe health conditions. “If that means that other providers are taking care of flu and sinusitis, so be it.”
As far as the pandemic is concerned, urgent care centers have become a critical part of a patchwork of health care providers who can meet the high demand for testing in lieu of a national strategy. Their on-demand appointments, relatively straightforward test offerings, and ubiquity have made urgent care centers ideal places for the public to find Covid-19 tests, in addition to other medical care.
“It makes good sense to me to get certain services at urgent care. Covid testing is a good example of that,” said Ganguli, who thinks urgent care and primary doctors can collaborate to create more informed, holistic treatment. “The ideal future state is that retail clinics and urgent care are an extension of what primary care is already doing, helping us do that job better.”
The fear, however, is that people will use urgent care centers in place of seeing a regular primary care physician. When you go to urgent care, you see a different nurse or doctor each time, whereas at primary care you’d see your regular doctor, who could follow your health over time and across different providers.
“By skipping primary care, you risk delayed or missed diagnoses of major yet treatable conditions like high blood pressure, heart disease, cervical cancer, and depression, as well as higher medical bills,” Ganguli said.
The consequences of going to urgent care rather than seeing a regular doctor also depend on the patient and their particular situation.
“If we’re talking about younger, healthier folks, it’s fine to have a more convenient care option,” Mehrotra said. “My concern goes up if people using it have a lot of medical conditions or are on lots of medications.”
While urgent care centers serve all sorts of demographics, millennials and people with young children tend to be top customers, according to Horwitz, the head of the Urgent Care Association. It’s less popular among elderly people, who are more familiar with the primary care model and who see a wider range of doctors whose care needs to be coordinated. Horwitz added that there has been a low rate of urgent care patients who have needed to be transferred to the emergency room. This suggests that people aren’t mistakenly using urgent care for more serious issues.
How urgent care could be at the center of Covid-19 care
Urgent care was a bridge between primary care and the emergency room in normal times, and now, it’s filling a variety of needs around the coronavirus. That includes not only testing but advising people on treating the illness, quarantining properly, and, if necessary, when to go to the emergency room.
In order to stop the spread of the virus, it’s essential that people know whether they have it in the first place. Some 193 million tests per month are necessary to safely operate schools and nursing homes, according to a report released in September by the Rockefeller Foundation. Currently, the US is doing less than a quarter of that. To reach that level of testing, all Covid-19 test providers, including urgent cares, will have to accommodate more customers.
For many, Covid-19 testing will be their first experience using urgent care. Horwitz says urgent cares “fully intend to participate” in distributing coronavirus vaccines, so those visits likely won’t be their last.
One of the major challenges with the coronavirus vaccines, once they are ultimately approved for use, will be distributing them to the population. That task will largely fall to the states, which will in turn work with local medical providers like urgent care centers to make sure that those who need it can get it, beginning with priority populations like health care workers and the elderly.
Horwitz expects urgent care’s popularity, buoyed by coronavirus testing and — someday —vaccines, to increase the use of urgent care for other reasons after the pandemic.
“Coronavirus gives urgent care the opportunity to show their communities as well as government entities what urgent care is capable of,” Horwitz said.


vox--2020-11-19--How to fix the presidency after Trump

How to fix the presidency after Trump

The framers of the Constitution thought long and hard about the risks of imbuing the presidency with too much power .
But for all their concerns , most of them assumed that , in the words of Alexander Hamilton , future presidents would be constrained by a “ sense of responsibility ” and would exercise such awesome power with “ scrupulousness and caution.
” The “ dread of being accused of weakness or connivance , ” Hamilton wrote , would “ beget equal circumspection.
” After four years of Trump , I think we can say that Hamilton ’ s @ @ @ @ @ @ @ is not burdened by a “ sense of responsibility ” — something that ’ s become all too clear in this interregnum — and he ’ s arguably the least scrupulous human being ever to hold that office .
The failsafes built into our Constitution , moreover , have proven unreliable in the face of a president with no regard for the health of the republic .
So how can we fix the system to guard against future presidents who might overreach or ignore the laws and norms that make our democracy work @ @ @ @ @ @ @ Bob Bauer and Jack Goldsmith , called After Trump , is one of the first attempts to answer this question .
It ’ s a close look at the “ gaps and ambiguities ” in our constitutional process and how the Trump era has exposed them .
The book , in their words , is a blueprint for “ reconstructing the presidency ” after Trump vacates the office .
Both authors served at high levels in previous administrations — Bauer as Obama ’ s White House counsel , Goldsmith as George W. Bush @ @ @ @ @ @ @ Office of Legal Counsel — and their analysis is as even-handed as it is incisive .
I spoke to Bauer , who is now an adviser to the Biden campaign , about how destructive ( and revealing ) the Trump presidency has been , whether it ’ s accurate to call him the “ most dangerous president in American history , ” what urgent reforms we need moving forward , and why we ’ re headed for another crisis if Congress doesn ’ t find the political will to reform the presidency .
@ @ @ @ @ @ @ follows .
You make what may be a surprising point at the beginning of the book , which is that Trump ’ s “ law-breaking bark ” has been far worse than his bite .
Do you still feel that way now that he ’ s actively challenging the election results ?
Has the bite caught up with the bark ?
In the first three years of his term , he repeatedly went on and on about firing special counsel Robert Mueller or having Attorney General Bill Barr prosecute his opponents , to @ @ @ @ @ @ @ couldn ’ t do the first thing , and he ’ s been unable to do the second thing — and there ’ s no indication that he can .
So Trump has often made noises about what he wants to do or can do , but in reality , he hasn ’ t had the authority or ability to do it .
Clearly , as he rages over his losses , he is being more aggressive .
And he can , of course , fire officials who don ’ t do his @ @ @ @ @ @ @ want to minimize the dangers of his behavior or his norm-shattering or his indifference to legal restraints .
But I also think it ’ s important to separate out the bluster from what in fact he ’ s been able to accomplish , or the threats that he ’ s been able to execute on .
If Trump ’ s talent for bureaucracy and governance matched his talent for demagoguery , how different might the last four years look ?
Well , this is a point we make in the book .
It @ @ @ @ @ @ @ when you think about an institutional reform of the presidency .
We have these fissures , which have been exploited before , but never on this scale and never across the board in the way that Trump has .
But we certainly do posit that someone more experienced in government , someone who was more thoughtful in picking the people around him , who can execute on what he wants done , who can execute with more sophistication , who ’ s just as malicious as Trump and just as indifferent to legal @ @ @ @ @ @ @ could do phenomenally more damage .
And that ’ s taking into account how much damage Trump has already done .
Is the perception of Trump as the most dangerous or lawless president in American history wrong or overstated in your opinion ?
No , I don ’ t think it ’ s overstated .
I think that ’ s his inclination .
I don ’ t think he understands institutions .
I don ’ t think he has respect for the rule of law .
There ’ s a very telling moment @ @ @ @ @ @ @ which Trump is raging about Mueller and the threats that he sees from all sides and he says , “ Where ’ s my Roy Cohn ?
” [ Cohn was a high-powered New York lawyer and Trump ally who made a name for himself as Sen. Joe McCarthy ’ s legal attack dog in the 1950s . ]
And in the book , we talk about his model for the sort of lawyer he thinks the president needs , or someone in the business world needs .
It ’ s very telling @ @ @ @ @ @ @ of the law , and it ’ s an extension of his overall amoralism .
He doesn ’ t understand what lawyers actually are supposed to do , and he doesn ’ t understand the importance of listening carefully to lawyers and legal advice .
He views these as impediments that could be swept away if you put in place the right people who will enable you to do whatever you want , irrespective of norms and law .
A lot of focus in the book is on the role of “ nonlegal @ @ @ @ @ @ @ presidency over the years .
You just alluded to Trump ’ s indifference to those norms and his corruption — or attempted corruption — of institutions that relied on them .
Can this sort of damage be undone ?
It can be undone , but a reform program is critically important .
To take a leading example , the damage that Trump has done to the credibility of the Department of Justice and to the idea of apolitical law enforcement is truly extensive .
We ’ ve never , not since Watergate certainly @ @ @ @ @ @ @ I do think there has been a significant amount of damage done .
Now it is also true that the president has had various norms asserted against him over the course of his administration .
But he keeps on battering those norms and undercutting the institutions defending them .
And one of the ways he does that is by weeding out of the government people with experience and integrity , who are attentive to those norms , and replacing them with people who are enablers or who share his contempt for the norms @ @ @ @ @ @ @ ve seen steadily occurring over the course of his presidency .
Trump doesn ’ t want to hear from people who tell him things he doesn ’ t understand , and he doesn ’ t want to hear from people who get in his way .
So a huge problem begins to emerge when you have a president recruiting people into government who will serve his interests and undermine the institutions themselves .
What other problems has Trump exposed in our system ?
You see it across sort of a broad range of @ @ @ @ @ @ @ a straightforward example .
There ’ s the problem of being involved in a business and being the president at the same time .
This is a president who said , from the beginning , that he was not going to take the norms around financial conflicts of interest seriously the way previous presidents have done .
And of course he famously became involved in a dispute with the head of the Office of Government Ethics , who eventually resigned .
Presidents are not subject to the same conflict-of-interest regulations as other senior @ @ @ @ @ @ @ overwhelmingly complied with them .
Trump didn ’ t want to do that .
Not only did he not want to do that , he set up a structure that at the outset lacked credibility as a protection against conflicts of interest .
And then he didn ’ t comply with the fundamental commitments that he made .
He spoke at one point of separating himself totally from his business .
He clearly has not done that .
So it ’ s very clear that something needs to be done .
And we @ @ @ @ @ @ @ It certainly begins but it doesn ’ t end with mandatory disclosure of tax returns .
We also see a constitutional basis for regulations around financial conflicts of interest for presidents .
We even think there may be Republican support for these regulations after Trump is gone and this isn ’ t viewed as a direct attack on him .
You ’ ve mentioned AG Bill Barr and the Department of Justice .
I think most observers agree that the DOJ has been compromised under this administration .
What reforms do we need @ @ @ @ @ @ @ propose [ is ] additional requirements for the qualification of an attorney general to be confirmed to that post — to prevent , for example , someone who had a senior position in a president ’ s campaign organization from becoming the attorney general .
That would ’ ve applied to Jeff Sessions , but not Bill Barr .
But then there are a series of other steps that could be taken to constrain a Department of Justice from wandering into troubled territory under pressure from a president like Trump .
They include @ @ @ @ @ @ @ apply to the president and identifying the circumstances in which , constitutionally , they can be applied to the president .
There are also internal rules that govern how investigations are conducted at the DOJ that can be revised to ensure investigations aren ’ t politicized or launched with the intention of affecting the outcome of an election .
We just saw Trump commute GOP operative Roger Stone ’ s sentence in what appears to be a reward for his non-cooperation in the Muller probe .
So do we need to rethink the @ @ @ @ @ @ @ outdated institution or does it just need to be reformed ?
I think it could be heavily reformed .
We ’ ve made a couple of proposals and actually just consulted with the House Judiciary Committee about them .
Two of our proposals did end up in their presidential accountability bill .
I think it ’ s called the Protect Our Democracy Act .
It has a number of other provisions in it , but I think Congress has to be clear that a president can not self-pardon .
And the so-called bribery @ @ @ @ @ @ @ the president can not use a pardon corruptly — for example , to silence a witness in order to undermine a judicial proceeding .
These proposals are in the House Judiciary Committee bill , and they ’ re the sort of reforms we need to constitutionally prohibit corrupt uses of the pardon .
Apart from what you said earlier about financial conflicts of interest , how can we guard against foreign interventions in presidential campaigns ?
It was a big issue in 2016 .
It ’ s even more of an issue in @ @ @ @ @ @ @ we need to brace ourselves for more of this , both the sowing of misinformation on the internet and the possibility of direct attempts to disrupt voting processes in the US .
Lots of reforms are possible , and some are pretty basic — for example , the question of whether a foreign power providing useful research to a campaign is illegal .
Campaign laws could be clarified to make this obvious , and it would have removed an impediment that Mueller clearly encountered in his investigation into the infamous meeting at Trump @ @ @ @ @ @ @ reforms that we suggest are important .
One is that a campaign that is contacted by a foreign power with an offer of political support has to report it to the FBI .
And a second and critical reform is a prohibition on entering into that kind of a political alliance .
We don ’ t think that this problem is solved entirely by amending the campaign laws to prohibit contributions or expenditures from being made .
A fundamental understanding between a campaign and a foreign power for mutual support , meaning the @ @ @ @ @ @ @ elected and the candidate will owe that power afterward , whether it ’ s explicit or tacit , ought to be regulated .
We have an extensive discussion of how that could be done by amending some current laws that are frankly not used very often , but that provide a good platform for that kind of reform .
If none of these reforms are even considered , much less passed , where does that leave us ?
In a bad place .
Trump is leaving , but he is not taking the @ @ @ @ @ @ @ They remain there to flare up again in the future , and potentially at the hands of someone far more deft at exploiting these institutional weaknesses .

The framers of the Constitution thought long and hard about the risks of imbuing the presidency with too much power.
But for all their concerns, most of them assumed that, in the words of Alexander Hamilton, future presidents would be constrained by a “sense of responsibility” and would exercise such awesome power with “scrupulousness and caution.” The “dread of being accused of weakness or connivance,” Hamilton wrote, would “beget equal circumspection.”
After four years of Trump, I think we can say that Hamilton’s optimism was misplaced. The current president is not burdened by a “sense of responsibility” — something that’s become all too clear in this interregnum — and he’s arguably the least scrupulous human being ever to hold that office. The failsafes built into our Constitution, moreover, have proven unreliable in the face of a president with no regard for the health of the republic.
So how can we fix the system to guard against future presidents who might overreach or ignore the laws and norms that make our democracy work?
A new book by law professors Bob Bauer and Jack Goldsmith, called After Trump, is one of the first attempts to answer this question. It’s a close look at the “gaps and ambiguities” in our constitutional process and how the Trump era has exposed them. The book, in their words, is a blueprint for “reconstructing the presidency” after Trump vacates the office.
Both authors served at high levels in previous administrations — Bauer as Obama’s White House counsel, Goldsmith as George W. Bush’s assistant attorney general in the Office of Legal Counsel — and their analysis is as even-handed as it is incisive.
I spoke to Bauer, who is now an adviser to the Biden campaign, about how destructive (and revealing) the Trump presidency has been, whether it’s accurate to call him the “most dangerous president in American history,” what urgent reforms we need moving forward, and why we’re headed for another crisis if Congress doesn’t find the political will to reform the presidency.
A lightly edited transcript of our conversation follows.
Sean Illing
You make what may be a surprising point at the beginning of the book, which is that Trump’s “law-breaking bark” has been far worse than his bite. Do you still feel that way now that he’s actively challenging the election results? Has the bite caught up with the bark?
Bob Bauer
In the first three years of his term, he repeatedly went on and on about firing special counsel Robert Mueller or having Attorney General Bill Barr prosecute his opponents, to take a couple of examples. He couldn’t do the first thing, and he’s been unable to do the second thing — and there’s no indication that he can. So Trump has often made noises about what he wants to do or can do, but in reality, he hasn’t had the authority or ability to do it.
Clearly, as he rages over his losses, he is being more aggressive. And he can, of course, fire officials who don’t do his bidding. So I don’t want to minimize the dangers of his behavior or his norm-shattering or his indifference to legal restraints. But I also think it’s important to separate out the bluster from what in fact he’s been able to accomplish, or the threats that he’s been able to execute on.
Sean Illing
If Trump’s talent for bureaucracy and governance matched his talent for demagoguery, how different might the last four years look?
Bob Bauer
Well, this is a point we make in the book. It’s a source of real concern when you think about an institutional reform of the presidency.
We have these fissures, which have been exploited before, but never on this scale and never across the board in the way that Trump has. But we certainly do posit that someone more experienced in government, someone who was more thoughtful in picking the people around him, who can execute on what he wants done, who can execute with more sophistication, who’s just as malicious as Trump and just as indifferent to legal constraints but more competent — that person could do phenomenally more damage. And that’s taking into account how much damage Trump has already done.
Sean Illing
Is the perception of Trump as the most dangerous or lawless president in American history wrong or overstated in your opinion?
Bob Bauer
No, I don’t think it’s overstated. I think that’s his inclination. I don’t think he understands institutions. I don’t think he has respect for the rule of law. There’s a very telling moment in Bob Mueller’s report in which Trump is raging about Mueller and the threats that he sees from all sides and he says, “Where’s my Roy Cohn?” [Cohn was a high-powered New York lawyer and Trump ally who made a name for himself as Sen. Joe McCarthy’s legal attack dog in the 1950s.] And in the book, we talk about his model for the sort of lawyer he thinks the president needs, or someone in the business world needs. It’s very telling.
He has an entirely instrumental view of the law, and it’s an extension of his overall amoralism. He doesn’t understand what lawyers actually are supposed to do, and he doesn’t understand the importance of listening carefully to lawyers and legal advice. He views these as impediments that could be swept away if you put in place the right people who will enable you to do whatever you want, irrespective of norms and law.
Sean Illing
A lot of focus in the book is on the role of “nonlegal norms” in constraining and guiding the presidency over the years. You just alluded to Trump’s indifference to those norms and his corruption — or attempted corruption — of institutions that relied on them.
Can this sort of damage be undone?
Bob Bauer
It can be undone, but a reform program is critically important. To take a leading example, the damage that Trump has done to the credibility of the Department of Justice and to the idea of apolitical law enforcement is truly extensive. We’ve never, not since Watergate certainly, experienced anything like this. So I do think there has been a significant amount of damage done.
Now it is also true that the president has had various norms asserted against him over the course of his administration. But he keeps on battering those norms and undercutting the institutions defending them. And one of the ways he does that is by weeding out of the government people with experience and integrity, who are attentive to those norms, and replacing them with people who are enablers or who share his contempt for the norms. That’s something you’ve seen steadily occurring over the course of his presidency.
Trump doesn’t want to hear from people who tell him things he doesn’t understand, and he doesn’t want to hear from people who get in his way. So a huge problem begins to emerge when you have a president recruiting people into government who will serve his interests and undermine the institutions themselves.
Sean Illing
What other problems has Trump exposed in our system?
Bob Bauer
You see it across sort of a broad range of issues, but let’s take a straightforward example. There’s the problem of being involved in a business and being the president at the same time. This is a president who said, from the beginning, that he was not going to take the norms around financial conflicts of interest seriously the way previous presidents have done. And of course he famously became involved in a dispute with the head of the Office of Government Ethics, who eventually resigned.
Presidents are not subject to the same conflict-of-interest regulations as other senior executive branch officials, but they have overwhelmingly complied with them. Trump didn’t want to do that. Not only did he not want to do that, he set up a structure that at the outset lacked credibility as a protection against conflicts of interest. And then he didn’t comply with the fundamental commitments that he made. He spoke at one point of separating himself totally from his business. He clearly has not done that.
So it’s very clear that something needs to be done. And we lay out an extensive reform program. It certainly begins but it doesn’t end with mandatory disclosure of tax returns. We also see a constitutional basis for regulations around financial conflicts of interest for presidents. We even think there may be Republican support for these regulations after Trump is gone and this isn’t viewed as a direct attack on him.
Sean Illing
You’ve mentioned AG Bill Barr and the Department of Justice. I think most observers agree that the DOJ has been compromised under this administration. What reforms do we need on this front?
Bob Bauer
One thing we propose [is] additional requirements for the qualification of an attorney general to be confirmed to that post — to prevent, for example, someone who had a senior position in a president’s campaign organization from becoming the attorney general. That would’ve applied to Jeff Sessions, but not Bill Barr.
But then there are a series of other steps that could be taken to constrain a Department of Justice from wandering into troubled territory under pressure from a president like Trump. They include clarifying that the obstruction of justice statutes apply to the president and identifying the circumstances in which, constitutionally, they can be applied to the president. There are also internal rules that govern how investigations are conducted at the DOJ that can be revised to ensure investigations aren’t politicized or launched with the intention of affecting the outcome of an election.
Sean Illing
We just saw Trump commute GOP operative Roger Stone’s sentence in what appears to be a reward for his non-cooperation in the Muller probe. So do we need to rethink the power to pardon? Is this an outdated institution or does it just need to be reformed?
Bob Bauer
I think it could be heavily reformed. We’ve made a couple of proposals and actually just consulted with the House Judiciary Committee about them.
Two of our proposals did end up in their presidential accountability bill. I think it’s called the Protect Our Democracy Act. It has a number of other provisions in it, but I think Congress has to be clear that a president cannot self-pardon. And the so-called bribery statute has to be amended so that the president cannot use a pardon corruptly — for example, to silence a witness in order to undermine a judicial proceeding. These proposals are in the House Judiciary Committee bill, and they’re the sort of reforms we need to constitutionally prohibit corrupt uses of the pardon.
Sean Illing
Apart from what you said earlier about financial conflicts of interest, how can we guard against foreign interventions in presidential campaigns?
Bob Bauer
It was a big issue in 2016. It’s even more of an issue in 2020. The intelligence community tells us we need to brace ourselves for more of this, both the sowing of misinformation on the internet and the possibility of direct attempts to disrupt voting processes in the US. Lots of reforms are possible, and some are pretty basic — for example, the question of whether a foreign power providing useful research to a campaign is illegal. Campaign laws could be clarified to make this obvious, and it would have removed an impediment that Mueller clearly encountered in his investigation into the infamous meeting at Trump Tower.
But there are two other reforms that we suggest are important. One is that a campaign that is contacted by a foreign power with an offer of political support has to report it to the FBI. And a second and critical reform is a prohibition on entering into that kind of a political alliance. We don’t think that this problem is solved entirely by amending the campaign laws to prohibit contributions or expenditures from being made. A fundamental understanding between a campaign and a foreign power for mutual support, meaning the foreign power will help the candidate be elected and the candidate will owe that power afterward, whether it’s explicit or tacit, ought to be regulated.
We have an extensive discussion of how that could be done by amending some current laws that are frankly not used very often, but that provide a good platform for that kind of reform.
Sean Illing
If none of these reforms are even considered, much less passed, where does that leave us?
Bob Bauer
In a bad place. Trump is leaving, but he is not taking the problems with the presidency with him. They remain there to flare up again in the future, and potentially at the hands of someone far more deft at exploiting these institutional weaknesses.