Time Magazine - January 19, 2015

JANUARY 19, 2015
WHAT
I LEARNED
FROM MY
$190,000
OPEN-HEART
SURGERY
BY STEVEN BRILL
THE SURPRISING
SOLUTION FOR FIXING OUR
HEALTH CARE SYSTEM
time.com
vol. 185, no. 1 | 2015
6 Editors Desk
8 Conversation
THE CULTURE
60 Books
A survey of the
best young-adult
literature of all time,
including Top 10
lists of the best
books for preteens
and tweens and
recommendations
from Gillian Flynn,
Michael Lewis
and more
BRIEFING
13 Verbatim
14 LightBox
A capsizing cargo
ship is run aground
near the Isle of Wight
16 World
A deadly terrorist
attack targets a
satirical newspapers
ofce in Paris
Plus, novelist Meg

Wolitzer on taking
inspiration from
Sylvia Plaths
The Bell Jar
18 World
Foreign-affairs columnist Ian Bremmer

maps global conicts
brewing for 2015
68 The Awesome
Column
20 Nation
A new lawsuit revives

a high-prole sexcrime case
The U.S.s total health care bill for 2014 was $3 trillion, bolstered by fees for
MRIs, CT scans and X-rays. Photo-illustration by Ann Elliott Cutting
Joel Stein tries out

hosting Americas
Funniest Home Videos
22 Health
Is the prevention of
most cancers out of
our control?
25 Milestones
Bill Clinton
remembers Mario
Cuomo
COMMENTARY
30 Viewpoint
Walter Isaacson
on building a safer
Internet
OY E L O W O : PA R A M O U N T P I C T U R E S
on the cover:
Time photo-illustration.
Medical tray: Fuse/
Getty Images
FEATURES
Fixing Obamacare
How letting hospitals run their own
insurance companies can bring down
health care costs for everyone by Steven Brill
34
44 Strange Bedfellows
Instability across the Middle East has
prompted promising conversations among
Israeli and Arab ofcials by Joe Klein
52 Marching On
A timely lm brings Martin Luther
King Jr.s civil rights struggle in Alabama
to the screen by Daniel DAddario
Plus: A review of Selma by Richard Corliss
David Oyelowo
as Martin
Luther King Jr. in
Selma, page 52
TIME (ISSN 0040-781X) is published weekly, except for two issues combined for one week in January, May, July, August, September and December, by Time Inc. Principal Ofce: Time & Life Building, Rockefeller Center, New York, NY 10020-1393.
Periodicals postage paid at New York, NY, and at additional mailing ofces. Canada Post Publications Mail Agreement No. 40110178. Return undeliverable Canada addresses to: Postal Stn A, P.O. Box 4322, Toronto, Ont., M5W 3G9. GST
#888381621RT0001 2015 Time Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. TIME and the Red Border Design are protected through trademark registration in the United States and in the
foreign countries where TIME magazine circulates. U.S. subscriptions: $49 for one year. Subscribers: If the Postal Service alerts us that your magazine is undeliverable, we have no further obligation unless we receive a corrected address within
two years. Postmaster: Send address changes to P.O. Box 62120, Tampa, FL 33662-2120. CUSTOMER SERVICE AND SUBSCRIPTIONSFor 24/7 service, please use our website: time.com/customerservice. You can also call 1-800-843-TIME
or write to TIME, P.O. Box 62120, Tampa, FL 33662-2120. Mailing list: We make a portion of our mailing list available to reputable rms. If you would prefer that we not include your name, please call, or write us at P.O. Box 62120,
Tampa, FL 33662-2120, or send us an email at privacy@time.customersvc.com. Printed in the U.S.
time January 19, 2015
Editors Desk
Americas Bitter Pill
LIGHTBOX James Nachtwey was moved to become

a photojournalist by the searing images of Americas
civil rights movement, so his recent undertaking
photographing scenes on the set of Selma for
Paramount (see one above)was stirring. There
were moments when I felt I had traveled back in
time, he says, yet many of the emotions that fueled
the historical event were still very much alive. To see
Nachtweys images, as well as a video interview with
Selmas director and star (right), visit time.com/selma.
Selma director
Ava DuVernay, left,
and lead actor
David Oyelowo
LIFE
NOW ON
TIME.COM
In an exclusive
interview with
TIME.com, Ford CEO
Mark Fields says the
world is not yet ready
for self-driving
carsdespite
advances in
technology and a
proliferation of newly
announced options
from other
automakers. Read
more at time.com/
fordinterview.
The Consumer Electronics Show, which this

year featured Bluetooth-equipped baby paciers,
has come a long way from its earlier incarnation
as the International Gadget and Invention Show.
See images from LIFEs coverage of the 1958
exhibition, including this foot-propelled hammock,
at time.com/gadgets1958.
Nancy Gibbs, editor
Write to us
Send an email:
letters@time.com.
Please do not send
attachments
Send a letter: TIME Magazine Letters, Time &

Life Building, New York, NY 10020. Letters
should include the writers full name, address
and home telephone and may be edited for
purposes of clarity and space
Customer Service and Change of Address For 24/7 service, please use our website:
time.com/customerservice. You can also call 1-800-843-8463 or write to TIME at P.O.
Box 62120, Tampa, FL 33662-2120. Back Issues Contact us at help.single@customersvc
.com or call 1-800-274-6800. Reprints and Permissions Information is available at the
website time.com/time/reprints. To request custom reprints, email TimeIncReprints@
parsintl.com or call 1-212-221-9595, ext. 437; for all other uses, contact us by emailing
timereprints_us@timeinc.com. Advertising For advertising rates and our editorial
calendar, visit timemediakit.com. Syndication For international licensing and
syndication requests, email syndication@timeinc.com or call 1-212-522-5868
Please recycle
this magazine and
remove inserts or
samples before
recycling
L I G H T B O X : J A M E S N A C H T W E Y PA R A M O U N T P I C T U R E S; L I F E : T H E L I F E P I C T U R E C O L L E C T I O N/G E T T Y I M A G E S
this weeks cover story marks the

culmination of Steve Brills extraordinary journey through the landscape
of American health care. He rst
launched this expedition for the 2013
story that became one of our bestselling covers, Bitter Pill, a riveting and often
infuriating autopsy of hospital costs. In subsequent
stories, he explored the terrain as a reporterbut
took a harrowing detour as a patient, winding up in
New YorkPresbyterian Hospital for open-heart surgery to correct a potentially deadly aneurysm.
Steves discoveries now come together in his new
book, Americas Bitter Pill: Money, Politics, Backroom
Deals, and the Fight to Fix Our Broken Healthcare System,
from which this weeks story is adapted. The Affordable Care Act, he argues, is a case study of a dysfunctional government trying to take on a dysfunctional
health care system. The more I looked behind the
point I made at the tail end of the rst Time article
that Obamacare didnt seem to do much about all the
pricing abuses I had identiedthe more I realized
that this was the overarching story of how Washington really works, he says. We have become a country where money seems to govern almost everything
in Washington, and those interests that enjoy the
most power and money, often abusively, will be able
to protect their positions.
His experience as a patient brought the vast, submerged forces in this debate to the surface: namely the
power of fear and emotion when it comes to a health
crisis. You can have a deep belief in the efciency of
markets and still doubt whether your own health, or
the health of someone you love, is suited to negotiation or bargain hunting. Steve proposes a solution
that does not require a change in human nature or the
current state of U.S. democracy. Let that be the start
of the next national conversation: Now that coverage
has been expanded, what
would it really take to control the costs?
BECAUSE SOMEDAY
I want to drink beer brewed

by monks. With the monks.
Alert:
Attachment:
Reminder:
Fidelity Meeting
Retirement Plan
Today
SAVE
Every someday needs a plan .

Get a clear view of yours
when you move your old 401(k).
SM
s/NE ON ONEGUIDANCEFOCUSEDONYOURGOALSNOTOURS

s!CONSOLIDATEDVIEWOFHOWYOURINVESTMENTSAREREALLYDOING
s4HEEXPERTISETOHELPYOUCHOOSEFROMABROADRANGE
OFINVESTMENTOPTIONS
Move your old 401(k) to a Fidelity Rollover IRA,

and get control over your own personal someday.
Fidelity.com/rollover
800.FIDELITY
Be sure to consider all your available options and the applicable fees and features of each before moving your retirement assets.
Keep in mind that investing involves risk. The value of your investment will uctuate over time and you may gain or
lose money.
Fidelity Brokerage Services LLC, Member NYSE, SIPC. 2015 FMR LLC. All rights reserved. 709195.3.0
Conversation
What You Said About ...
A guys
gonna go up in space for a year
why? asked Joe Scarborough on
Morning Joe in a discussion of Times
Dec. 29Jan. 5 cover story on an upcoming NASA mission that will send
Scott Kelly into space for a yearthe
longest period ever for an Americanwhile his
identical twin Mark is monitored at home on Earth.
On Chicago radio, writer Jeffrey Kluger addressed the
experiments possible physical and mental strain,
including third-quarter effect, or the fatigue and
depression that can set in before the end of such an
arduous period of relative isolation. Readers were impressed. I salute both of these intrepid men, wrote
Mike Moore of Warsaw, Mo. But Thomas McGugan
of Jacksonville Beach, Fla., thought NASA could do
better by the astronaut: I was shocked and a bit saddened to see the condition of Scott Kellys suit, including rust on the helmet lock ring and connectors that
belong on a 63 Rambler.
TWIN SPACE PIONEERS
THE TOP 100 PHOTOS OF 2014 TIMEs picks reected a wide spectrum of
emotion, according to Today.com, including Derek Jeters jubilant leap after
his game-winning last at bat at Yankee Stadium against the Baltimore Orioles
(second row, right) and a haunting closeup of a young Afghan refugee (second
row, left). BBC News, in particular, was taken by Massimo Sestinis astonishing
aerial photo of migrants crossing the Mediterranean Sea in a jam-packed boat
(top left): From a distance it looks like a sh, with colorful scales. But look
closely and you see that it is a boatpacked so tightly with people looking up
that you cannot actually see the boat ... like when a child sprinkles a piece of
cardboard with glitter. Meanwhile, on MSNBC, panelist Ayman Mohyeldin called
out a lighter entrythe now famous Oscar seleand debated the merits of
seles with TIMEs Belinda Luscombe. Is it cheating to use a sele stick? he
asked. To see the full list, visit time.com/photos2014
The Kentucky Senators

Time.com essay celebrating the Obama Administrations recent moves toward engagement with Cuba
sparked heated debatenot least between Paul
and fellow GOP star Marco Rubio, who critiqued Paul as a cheerleader for Obamas
foreign policy. On Time.com, commenter
MatthewKilburn supported incremental
steps toward engagement but wrote that
the manner in which the Presidentand
apparently, Rand Paulis so willing to wash away
any restriction on that country, and in doing so
enrich the current authorities while emptying our
current tool kit of any future available carrots, is
foolish. RicardoRivera disagreed: We must move
RAND PAUL ON CUBA
B O AT: P O L A R I S; O B A M A , F E R G U S O N : R E U T E R S; J E T E R , E L L E N S E L F I E , R E F U G E E : A P ; PA U L , R O O S E V E LT, S W I M M E R S : G E T T Y I M A G E S
away from outdated policy that harms the Cuban

people more than it will harm those in charge of
Cuban politics.
THE TEDDY AWARDS Joe Kleins annual shout-outs
for the politicians who showed the most courage
included President Obama for his moderate,
sane and humane policies (despite some
considerable missteps). Critics pounced.
What an ugly 8 years this will have been!
wrote D. Wymard of Fort Lauderdale, Fla.
In his own words (needless unforced errors,
negligent foreign policy) Klein castigates Obama,
and yet turns around and awards the Teddy. Rather
hypocritical!
Baie-Comeau
Saguenay
Fjord Tadoussac
QUBEC
CITY
Gasp
Perc
les de la
Madeleine
Charlottetown
Eastport
Bar Harbor
PORTLAND
BOSTON
Pictou
Halifax
Prince
Edward
Island
Qubec
Lunenburg
Nova Scotia
Canadian
Maritimes
12 Days of Perfect Spring Cruising
Call for Special Pre-Cruise Offer in Qubec City
1-888-594-9673
www.pearlseascruises.com
PEARL SEAS
Cruises
Quantum Mechanics:
The Physics of the
Microscopic World
BY J
RY
OR
off
LECTURE TITLES
1.
The Quantum Enigma
2. The View from 1900
19
LIM
70%
ER
KENYON COLLEGE
R
FE
IT
Taught by Professor Benjamin Schumacher
TIME O
ED
F
A
ANU
3. Two RevolutionariesPlanck and Einstein

4. Particles of Light, Waves of Matter
5. Standing Waves and Stable Atoms
6. Uncertainty
7.
Complementarity and the Great Debate
8. Paradoxes of Interference
9. States, Amplitudes, and Probabilities
10. Particles That Spin
11. Quantum Twins
12. The Gregarious Particles
13. Antisymmetric and Antisocial
14. The Most Important Minus Sign in the World
15. Entanglement
16. Bell and Beyond
17. All the Myriad Ways
18. Much Ado about Nothing
19. Quantum Cloning
20. Quantum Cryptography
21. Bits, Qubits, and Ebits
22. Quantum Computers
23. Many Worlds or One?
24. The Great Smoky Dragon
Quantum Mechanics
Made Clear
In its relatively short history, quantum mechanics has radically
changed our perspective on reality and has come to play a critical role
in todays most important technologies. Now, discover astonishing
insights into this remarkable field with Quantum Mechanics: The
Physics of the Microscopic World.
Award-winning Professor Benjamin Schumachera founder of
quantum information theory and a fellow of the American Physical
Societyintroduces you to the complex phenomena of quantum
mechanics in a way that is both enlightening and easily accessible.
Generously illustrated with diagrams, demonstrations, and
experiments, these 24 fascinating lectures are a great way to master the
secrets of this extraordinary discipline.
Offer expires 01/19/15
THEGREATCOURSES.COM/5TME
1-800-832-2412
Quantum Mechanics: The Physics of the

Microscopic World
Course no. 1240 | 24 lectures (30 minutes/lecture)
SAVE $185
DVD $254.95
NOW $69.95
+$10 Shipping, Processing, and Lifetime Satisfaction Guarantee
Priority Code: 105659
For 24 years, The Great Courses has brought the

worlds foremost educators to millions who want to
go deeper into the subjects that matter most. No
exams. No homework. Just a world of knowledge
available anytime, anywhere. Download or stream
to your laptop or PC, or use our free mobile apps
for iPad, iPhone, or Android. Over 500 courses
available at www.TheGreatCourses.com.
THE WEEK
Briefing
We have just
been hit
at the heart of
our liberty.
TERROR CAME
TO PARIS
Brisket
Prices for the
barbecue meat have
surged amid rising
demand and a
cattle shortage
HE
SOMETIMES
CALLS
ME BRO.
DAVID CAMERON, British Prime
Minister, describing his close

relationship with U.S. President
Barack Obama
GOOD WEEK
BAD WEEK
C A M E R O N , D E B L A S I O : R E U T E R S; H I D A L G O, B R I S K E T, W I L L I A M S : G E T T Y I M A G E S; M C N U G G E T S : M C D O N A L D S ; I L L U S T R AT I O N B Y B R O W N B I R D D E S I G N F O R T I M E (2)
ANNE HIDALGO, mayor of Paris,
after gunmen killed at least

12 people at the ofces of the
satirical newspaper Charlie
Hebdo, in a terrorist attack on
Jan. 7 that shook France
2,400
McNuggets
46 million
The number of people Starbucks
says received gift cards for the
coffee chain during the holidays,
about 1 in 7 Americans
20
The number of new

Cardinals chosen by Pope
Francis, none from the
U.S., as he diversies
Catholic Church leadership
They were
disrespectful
to the
families who
lost their
loved ones.
Sales in Japan were

halted after vinyl
was found in one
of the McDonalds
chicken bites
BILL DE BLASIO,
New York City mayor,

on the police ofcers
who turned their backs
on him during funerals
for slain colleagues.
De Blasio has feuded
with cops who say he
failed to support them
during protests against
the use of force
The number of miles

(3,900 km) traveled
by a lost Seattle
puppy named Penny,
who ended up in
Pennsylvania before
her microchip was
scanned and
her owners located
SERENA WILLIAMS,
I just asked
them to get me
a shot of
espresso.
tennis player, on
the cup of miracle
coffee she requested
after losing, 6-0, the
rst set of a match
at the Hopman Cup
in Australia.
Williams went on to
win the next two sets
and the match
I am very proud of all the employees ... who stood up

against some of the extortionist efforts of the criminals.
K AZUO HIRAI, Sony CEO, speaking for the rst time about the devastating hack of Sony Pictures Entertainment that prompted
the studio to pull, but then eventually release, The Interview following threats of 9/11-style attacks on theaters that screened the movie
Sources: New York Times (2); Daily Mail; ESPN; Reuters; Wall Street Journal; AP
Brieng
LightBox
A Tactical Tilt
The cargo ship Hoegh Osaka, which was
carrying 1,400 cars, was deliberately
grounded on a submerged sandbank near
the Isle of Wight in England on Jan. 3 in
order to keep it from capsizing. All 25 crew
members were rescued overnight.
Photograph by
Peter MacdiarmidGetty Images
FOR PICTURES OF THE WEEK,
GO TO lightbox.time.com
Brieng
World
An Attack
Foretold French
RFLDOVZHUH
concerned even
EHIRUHWZR
JXQPHQVWRUPHG
D3DULVQHZVSDSHU
BY VIVIENNE WALT/PARIS
16
Deant Thousands of Parisians gathered in the Place de la Rpublique on the evening of the attack
else too: it was an act foretold.

For months, French ofcials have expressed concerns
that the country was becoming increasingly vulnerable to
a terrorist attack. Last month
their nervousness appeared
well justied, when two separate drivers rammed their cars
into Christmas crowds in the
provincial cities of Nantes
and Dijon, injuring dozens of
people, while a third attacker
wielded a knife, shouting, Allahu akbar, or God is great.
Those car rammings
now seem amateurish and
opportunisticmore the work
of lone-wolf terrorists acting
without support. In contrast,
the men who mounted the

Jan. 7 massacre worked like a
well-drilled cell primed to inict maximum damage.
Their target was clear: Hardline Islamists have threatened
Charlie Hebdo for years for
publishing countless caustic
)5(1&+32/,&(
%(/,(9($%287
&,7,=(16
+$9(-2,1('
,6/$0,67*52836
,16<5,$$1',5$4
6,1&(
commentaries and cartoons

directed at extremist Muslims
(as well as ultra-religious Jews
and conservative Catholics).
In 2011 Muslims rebombed
Charlie Hebdos previous ofce building in Paris amid
widespread protests after the
paper published an issue purportedly edited by the Prophet
Muhammad, with a cartoon
lampooning him. French
people quickly assumed that
the assault had been an act of
retaliation against the papers
antireligious stance.
The attacks ruthless efciency shocked Parisians as
much as the result. Arriving
at the very moment Charlie
T H I B A U LT C A M U S A P
the french, who have seen

two devastating world wars
and a revolution on their soil,
are known for keeping cool
heads in the face of tragedy
and violence. Yet little could
have prepared them for the
gruesome events of Jan. 7. It
seemed a gray, rainy Wednesday like any other, until
two gunmen wearing black
ski masks stormed into the
ofces of the satirical weekly
newspaper Charlie Hebdo
just before midday, in Paris
congested 11th district, and
let loose a fusillade of bullets.
Outside on the street they shot
dead a police ofcer and ed
in a black car driven by a third
mana horrifying sequence
of events lmed by a witness
and seen around the world.
The men killed 12 people
in the attack, among them
three of Frances best-known
cartoonists, the papers top
editor and two police ofcers.
Rushing to the scene, President Franois Hollande stood
ashen-faced on the chilly
sidewalk, some 3 miles (about
5 km) from his grand Elyse
Palace, and appealed for the
French to show we are a united country. This was an act
of exceptional barbarity, he
said, and declared the attack
a terrorist operation.
The massacreFrances
worst terrorist attack in
memorywas something
Brieng
Hebdos journalists were in

their weekly editorial meetingthe only time the entire
staff gathers in the buildingthe two assailants sprang
from their vehicle carrying
automatic ries and wasted no
time killing as many people
as they could. They were well
equipped, they had military
weapons, they had probably
bulletproof vests, French terrorism consultant Jean-Charles
Brisard told the BBC after
watching video footage from a
closed-circuit security camera
outside the building. These individuals were well trained.
The attackers are precisely
the sort of terrorists the French
government has most feared.

With more than 5 million
Muslims, France has the
largest Islamic population in
all of Europe. Many French
Muslims emigrated from
French-speaking North Africa
or were raised as children of
immigrants from those countries. Their communities have
been hard hit by years of recession as France struggles with
record-high unemployment
now nearing 11%.
Some young French Muslims, disillusioned by the
economic hardship and what
they see as a French population increasingly hostile to
outsiders, have looked abroad
for direction and meaning, to
the jihadist groups ghting in
Syria and Iraq. French police
believe about 1,200 French
citizens have joined Islamist
groups in Syria and Iraq since
2011by far the most ghters
to have joined the jihadists
from any Western country.
French ofcials now fear that
those ltering home might return with professional military
skills and a desireor even
instructionsto harm France.
In response to the attack,
Hollande quickly ordered
Frances security threat raised
to its highest level in years,
while Interior Minister Bernard Cazeneuve vowed to hunt
down the attackers so they
can be punished with the severity that their barbarous acts
are worthy of.
Those words sound
reassuringfor now. And
as darkness fell on Jan. 7
Parisians came together in
mass gatherings to show their
sympathy for the dead and to
insist on their right to express
themselves free of the threat
of violence. But citizens and
security ofcials alike know
that unity will not necessarily
deter future attacks.
Figures Who Were Literally

Irreplaceable HUH
VQRRQHLQ
)UDQFHZKRFDQoOOWKHLUUROH
BY CL AIRE BERLINSKI
Im a journalist but was only

by chance in the vicinity of
the massacre at the French
satirical newspaper Charlie
Hebdo. I was en route to visit
a friend. This took me past the
papers ofce and thus put me
at the heart of the bloodiest
attack France has seen in the
past 50 years.
On my approach, it was
immediately obvious that there
had been a massive terrorist
attack. Such attacks have
a characteristic signature.
Swarms of ambulances. Police
vehicles and mobile labs. Grimfaced cops. Crime-scene tape
stretching for blocks. A very
particular expression on the
faces of dazed and bewildered
onlookers.
I asked the rst cop I saw
what had happened. She was
in no mood to explain: Youll
see it on the news.
How bad is it?
Grave. Not quite
translatable, but as bad as it
gets will do.
France is in shock. The
attack killed 12 people
and injured several others
critically, as of press time. The
number of fatalities may rise.
Masked gunmen attacked the
papers ofce. But their object
was not merely to terrorize.
This is obvious, and let no one
tell you otherwise. This was
an attack on France. It was an
outright declaration of war.
It was an attack on press
freedom in particular
on journalists, writers,
cartoonists and intellectuals
who were as well known here
as Jon Stewart and Stephen
Colbert are to Americans. They
were known above all for their
willingness to say whatever
they damn well pleasedno
matter whom they offended
or how many death threats
resulted. While their
publication was best known
for its parodies of Muslim
extremists, they were more

than happy to say whatever
they pleased about Jews and
Catholics tooand never were
that respectful, either. But
only radical Islamists thought
the proper rejoinder was
simply to kill them all.
In December 2011,
the magazines ofce was
rebombed following an issue
it claimed was guest edited
by the Prophet Muhammad.
Shortly before the latest
attack, it tweeted a mildly
amusing cartoon of the leader
of the Islamic State of Iraq and
Greater Syria.
The cartoonists who
diedCharb, Cabu, Tignous,
Wolinskiwere household
names. Bernard Maris,
known as Uncle Bernie, was
an economist to whom the
French have listened every
Friday morning on the radio
since the 1990s.
Le Monde, Radio France
and France Tlvisions have
lent their staff to keep Charlie
Hebdo going, but France is
not a big enough country
to replace such gures
readily. They were literally
irreplaceable. This is true of
every human being, of course,
but they in particular lled
a role no one else in France
can ll.
In 2012, in an interview
with Le Monde, Stphane
Charbonnier, Charlie Hebdos
director, was asked if he
was tempted to tone down
the publications inclination
toward the inammatory.
It may sound pompous,
he replied, but Id rather
die standing than live on my
knees.
It hardly sounds pompous
at all. Especially given that
this is precisely what he did.
Berlinski, an American
journalist and biographer, lives
in Paris
17
Brieng
World
Sea of Troubles H1HZ<HDUKROGV

XQFRPPRQULVNV+HUHDUHRIWKH
PRVWZRUULVRPHRQHV
By Ian Bremmer
every january, eurasia group, the political-risk consultancy

I founded and oversee, publishes a roundup of the most crucial geopolitical trends of the coming year. The ranking reects our forecast
of which global story lines will rise to the forefront over the next 12
months, which will have the biggest impact on the markets and on
politicsand where we can expect surprises.
As 2015 dawns, political conict among the worlds great powers is at a higher
pitch than at any time since the end of the Cold War. U.S. relations with Russia are
now fully broken. Chinas powerful President Xi Jinping is creating a new economy,
and the effects will be felt across East Asia and around the rest of the world. Geopolitical uncertainty has Turkey, the Gulf Arab states, Brazil and India hedging their
bets. International nance will be weaponizedand that could backre on the U.S.
But the years top risk is found in once placid Europe, where an increasingly
fractious political environment is generating new sources of conict.
1. THE BROKEN
POLITICS OF EUROPE
European economics arent
as bad as they were at the
height of the euro-zone
crisis in 2012, but the politics of Europe are now far
worse. Within key countries
like Britain and Germany,
anti-E.U. political parties
continue to gain popularity,
undermining the ability of
governments to deliver on
painful but needed reforms.
Friction will grow among
European states as peripheral governments come to
increasingly resent the inuence of a strong Germany unchecked by a weak France or
an absent Britain. Finally, an
angry Russia and the aggressive Islamic State of Iraq and
Greater Syria (ISIS) will add
to Europes security worries.
2. RUSSIA
Sanctions and lower oil
prices have weakened Russia
enough to infuriate President
18
Vladimir Putinbut not

enough to restrain him.
Moscow will continue to put
pressure on Ukraine, and as
a result, U.S. and European
sanctions will tighten. As
Russias economy sags, Putins
approval ratings at home
will increasingly depend on
his willingness to confront
the West. Western companies and investors are likely
targetson the ground and
in cyberspace.
3. THE EFFECTS OF
CHINAS SLOWDOWN
Chinas economic growth
will slow in 2015, but its all
part of Xis plan. His historically ambitious economicreform efforts depend on
transitioning his country
to a consumer-driven economic model that will result
in levels of growth that are
lower but ultimately more
sustainable. The continuing
slowdown should have little
impact inside China. But
U.S. percentage
of global GDP
22%
Percentage of
global trade
finance
conducted in
U.S. dollars
81%
Graphic sources: Eurasia Group;

Swift via Bloomberg
countries like Brazil, Australia, Indonesia and Thailand,

whose economies have come
to depend on booming trade
with a commodity-hungry
China, will feel the pain.
4. THE WEAPONIZATION
OF FINANCE
For the moment, the U.S.
public has had enough of
wars and occupations, but
the Obama Administration
still wants to exert signicant
inuence around the globe.
Thats why Washington is
turning nance into a weapon. It is using carrots (access
to capital markets) and sticks
(various types of sanctions) as
tools of coercive diplomacy.
The advantages are considerable, but there is a risk that
this strategy will damage
U.S. companies caught in the
cross re between Washington and targeted states. Transatlantic relations could suffer
for the same reason.
Brieng
World
Fallen star Turkeys Erdogan

is one of a number of incumbent leaders who will face
strong rivals at home in 2015
Zuma, Nigerias Goodluck

Jonathan and Turkeys Recep
Tayyip Erdogan will each
face determined opposition
and formidable obstacles as
they struggle to enact their
political agendas.
E D O U G E T T Y I M A G E S R E P O R TA G E
5. ISIS, BEYOND IRAQ

AND SYRIA
ISIS faces military setbacks
in Iraq and Syria, but its
ideological reach will spread
throughout the Middle East
and North Africa. It will grow
organically by setting up
new units in Yemen, Jordan
and Saudi Arabia, and it will
inspire other jihadist organizations to join its ranks
Ansar Beit al-Maqdis in Egypt
and Islamists in Libya have
already pledged allegiance to
ISIS. As the militant groups
inuence grows, the risk to
Sunni states like Saudi Arabia, the United Arab Emirates
and Egypt will rise.
6. WEAK INCUMBENTS
Feeble political leaders,
many of whom barely won
re-election last year, will
become a major theme in
2015. Brazils Dilma Rousseff, Colombias Juan Manuel
Santos, South Africas Jacob
Past approval rating

Dilma
Shinzo
Rousseff,
Abe,
post-2010
2013
peak
Recep
Tayyip
Barack
Erdogan,
Obama,
2011
post-2012
peak
79%
71% 67%
57%
Brazil Turkey Japan U.S.
Current approval rating

Abe,
2014
Rousseff,
2014
Erdogan,
2014
56%
51%
Obama,
2014
44% 43%
Brazil Turkey Japan
U.S.
7. THE RISE OF
STRATEGIC SECTORS
Global businesses in 2015
will increasingly depend
on risk-averse governments
that are more focused on
political stability than economic growth, supporting
companies that operate in
harmony with their political
goalsand punishing those
that dont. Well see this
trend in emerging markets,
where the state already plays
a more signicant role in
the economy, as well as in
rogue states searching for
weapons to ght more powerful governments. But well
also see it in the U.S., where
national-security priorities
have inated the militaryindustrial complex, which
now encompasses technology, telecommunications and
nancial companies.
8. SAUDI ARABIA
VS. IRAN
The rivalry between Shiite
Iran and Sunni Saudi Arabia
is the engine of conict in
the Middle East. Washington
and other outside powers
are increasingly reluctant to
intervene in the region, while
both countries struggle with
complex domestic politics
and rising anxiety about
the ongoing negotiations
over Irans nuclear program.
Expect Tehran and Riyadh to

use proxies to fuel trouble in
more Middle Eastern countries than ever in 2015.
9. TAIWAN/CHINA
Relations between China and
Taiwan will deteriorate sharply in 2015 following the opposition Democratic Progressive
Partys landslide victory over
the ruling Nationalist Party
in Taiwanese local elections
this past November. If China
decides that its strategy of
economic engagement with
Taiwan has failed, it might
well backtrack on existing
trade and investment deals
and signicantly harden its
rhetoric. The move would
surely provoke public hostility in Taiwan and inject even
more anti-mainland sentiment into the islands politics.
Any U.S. comment on relations between China and Taiwan would quickly increase
tensions between Beijing and
Washington.
10. TURKEY
Lower oil prices helped,
but President Erdogan used
election victories in 2014 to
try to sideline his political
enemiesof whom there are
manywhile remaking the
countrys political system to
tighten his personal hold on
power. But hes unlikely to
win the authority he wants
this year, creating more
disputes with his Prime
Minister, weakening policy
coherence and worsening
political unpredictability.
Given the instability near
Turkeys borders, where the
war against ISIS rages, thats
bad news for everyone. Refugees from Syria and Iraq are
bringing more radicalism
into the country and adding
to economic hardship.
19
Brieng
Nation
Settling Old
Scores
A new lawsuit
could revive a
KLJKSURoOHVH[
case
BY MICHAEL SCHERER
20
From top: Prince Andrew,

Alan Dershowitz and
Jeffrey Epstein
lowed Epstein to plead guilty

in 2008 to two state felonies,
including soliciting a minor
for prostitution. He was
required to register as a sex
offender and sentenced to 18
months in prison, of which
he served 13. As part of the
deal, prosecutors agreed to
try to keep the settlement
details off the public record.
Several of the victims,
including those like Roberts
who later settled civil lawsuits against Epstein, were
bothered by the leniency of
the deal. This stinks to high
heaven, says Cassell. Two
victims sued the Justice Department for violating the
2004 Crime Victims Rights
Act, which was meant to ensure that victims are given
a voice in criminal proceedings. In the Dec. 30 ling,
Roberts and another victim
asked to join the case.
If Cassell is successful,
the lawsuit could eventually overturn the initial
settlement and change the
way the Justice Department
handles pretrial negotiations. Its a big case, says
Meg Garvin, director of the
National Crime Victim Law
Institute.
In lings, the Justice Department has argued that
Epsteins alleged victims
had no right to consultation,
since the case was settled
before criminal charges
were brought. After the lawsuit began, Attorney General Eric Holder issued new
guidelines, directing prosecutors to make reasonable
efforts to make such consultations anyway.
Cassell considers that a
small victory but says he
hopes his case will send the
message that federal prosecutors cant keep victims in
the dark.
The Rundown
GAY MARRIAGE
In the latest
sign of the nations growing
acceptance of same-sex
marriages, Florida became
the 36th state to allow them
on Jan. 6. The newly lifted
statewide ban was enacted
just six years ago with 62%
of the vote.
CORRUPTION Former
Virginia governor
Bob McDonnell was
sentenced Jan. 6
to two years in prison after
being convicted on federal
corruption charges. The
onetime GOP rising star had
been considered a potential
presidential candidate. His
wife Maureen, who was also
found guilty of corruption, will
be sentenced on Feb. 20.
DRUGS
300%
The approximate increase
in seizures of methamphetamine at the CaliforniaMexico border from 2009
to 2014. Authorities say the
rise is the result of tighter
U.S. laws that have restricted
domestic access to meths
key ingredients, leading more
people to manufacture the
drug south of the border.
HISTORY
The contents of
a package that Samuel
Adams and Paul Revere
buried in a cornerstone of
the Massachusetts State
House in 1795 were revealed
by the Boston Museum of
Fine Arts on Jan. 6. Thought
to make up what could
be one of the oldest time
capsules in the U.S., the box
included ve newspapers,
24 copper and silver coins,
a seal of the Commonwealth
and a silver plate possibly
made by Revere. The most
recent coins are from 1855,
when the items were rst
discovered, placed in a brass
box and reburied.
P R I N C E A N D R E W, D E R S H O W I T Z , M C D O N N E L L : G E T T Y I M A G E S; E P S T E I N : A P
the 13-page legal filing

landed at a Florida courthouse on Dec. 30 with a
bang. As part of a lawsuit accusing the Justice Department of botching a major
sex-crime prosecution, attorneys Bradley Edwards and
Paul Cassell, a former federal judge, laid out the shocking claims of their latest
client, Jane Doe #3, who has
been named elsewhere as
Virginia Roberts. She said
she had been kept as a teenage sex slave by the
wealthy American nancier
Jeffrey Epstein. Cassells suit
has the potential to both reopen the long-closed case
and force the Justice Department to change the way it
deals with crime victims
during plea negotiations.
In the recent ling, Roberts said Epstein arranged
for her to have sex with his
friend Prince Andrew, the
Queen of Englands second
son, and trafcked her to numerous prominent American
politicians, a well-known
Prime Minister and others,
including noted Harvard
professor Alan Dershowitz,
one of Epsteins attorneys.
Buckingham Palace strongly
denied the allegations, which
had rst been hinted at in a
civil lawsuit in 2009 and later
in press reports that included
a photograph of Prince Andrew with his arm around a
teenage Roberts. Dershowitz
declared the accusations false

and libelous and vowed to
seek the disbarment of Cassell and Edwards. Cassell and
Edwards, in turn, have sued
Dershowitz for defamation.
A representative for Epstein
dismissed the accusations as
old and discredited.
The truth of the claims
has never been litigated
before a court. That fact
still motivates Cassell, a
victim-rights advocate and
law professor. Beginning
in 2005, police and the FBI
uncovered evidence that Epstein recruited an expansive
network of underage girls,
allegedly including Roberts,
for paid sex. Prosecutors al-
:7,*0(3
INTRODUCTORY
PRICE
YLN
V\YILZ[ZLSSPUNKYLZZZOPY[
[OLWPUWVPU[V_MVYK
^OP[LJV[[VU
JVSSHYZ[`SLZ
I\[[VUVYMYLUJOJ\Z
YLN\SHYIPN [HSSVY[YPT
2_[V_
-9,,TVUVNYHTTPUN
YLN
(KK[OPZZPSR[PLMVY
Q\Z[
YLN
WH\SMYLKYPJRJVT[Y`

:WLJPM`WYVTV[PVUHSJVKLTWRSTX
FREE EXCHANGES.5L^J\Z[VTLYVLY3PTP[ZOPY[ZWLYJ\Z[VTLY:OPWWPUNJOHYNLZL_[YH
*HUUV[ILJVTIPULK^P[OV[OLYVLYZ,_WPYLZ
Brieng
Health
Most Cancer Is Out of Our
Control Random DNA changes
are usually to blame
BY ALICE PARK
Source: Science
GLIOBLASTOMA
The cells that cause this

cancer divide often,
making many errors
BASAL-CELL
CARCINOMA
The most common skin

cancer is triggered
by exposure to UV rays
LUNG
Smoking, and the

carcinogens in tobacco
smoke, are the main
drivers of lung cancer
MELANOMA
Because skin cells

divide so frequently,
this cancer is among
the deadliest
PANCREATIC
This cancer is strongly

affected by random
mutations as opposed to
lifestyle factors
LIVER
Risk of this cancer

increases with age and
heavy alcohol use
OVARIAN GERM CELL
A hard-to-treat cancer, its

mostly the result of stemcell DNA-copying errors
OSTEOSARCOMA
Bone cells are actively

dividing, leading to
many chances for tumorcausing mistakes
I L L U S T R AT I O N B Y T O D D D E T W I L E R F O R T I M E
we think we know what causes cancer:

smoking, the suns UV rays, tumor-causing genes
we inherit from Mom and Dad. But these factors
alone cant explain why cancer in its many forms
is poised to edge out heart disease as Americas
No. 1 killer within the next few years. That rise
has sparked a spate of research into how much of
cancer is within our control and how much of it is
simply a roll of the genetic dice.
Now, in an eye-opening study published in
Science, researchers report that the majority
of cancer types are the result of pure chance,
the product of random genetic mutations that
occur when stem cellswhich keep the body
chugging along, replacing older cells as
they die offmake mistakes copying
the cells DNA.
Cristian Tomasetti and Dr. Bert
Vogelstein at the Sidney Kimmel Comprehensive Cancer Center of Johns
Hopkins University School of Medicine
found that the more stem cells there are
in certain kinds of tissues and the more
often they divide, the more likely that
tissue is to develop cancer over a persons lifetime. About 65% of cancers are
the result of these DNA mistakes made
by stem cells.
Only a small proportion of a tissues
cells are stem cells, which are essentially
templates for making more tissue. The
catch is that this kind of DNA copying is
also the process behind cancer, which
is triggered by cells that pick up mutations in their genes when they divide.
The element of chance does not,
however, mean you should stop wearing sunscreen or take up smoking.
My biggest fear is that people will do
nothing. The opposite is true, says
Tomasetti, who stresses that while we
may not be able to prevent all tumors,
we can focus on early detection and taking advantage of lifesaving treatments
like chemotherapy and radiation,
among other things. We need to do
everything we did before, but we want
to do it even more than before.
LIFESTYLE OR BAD
LUCK? IT DEPENDS
ON THE CANCER
Reach thousands of top decision makers by using one or more

of the key Fortune lists: Fortune 500 Fortune 1000
Fortune Global 500
100 Best Companies to Work For
The Fortune Databases give you everything you need:

key nancial and company contact information in an easy-to-use
spreadsheet...the ability to download, sort and mine the data...a roundup of
the largest and most important companies to research, prospect and target.
To nd out more, go to
fortunedatastore.com
Copyright 2014 Time Inc. FORTUNE and the FORTUNE Database names are trademarks of Time Inc. All rights reserved.
Brieng
Milestones
Mario Cuomo, who died Jan. 1 at 82, at a New York hotel in 1986
DIED
Mario Cuomo New York governor,
presidential hopeful, liberal lion
ARTHUR GR ACEZUMA
By Bill Clinton
Mario Cuomos life storythe proud son

of immigrants who raised him to believe
in faith, family and work and to use his
own gifts to enter public service and
reach the pinnacle of New York politics
will always be inspiring.
But it is especially important to us
today because he believed that every
American, native-born or immigrant,
should have the same chance hed
had, and that that could only happen
in a strong community with a compassionate, effective government.
He deplored winner-take-all economics and winner-take-all politics. He believed to the end that our country could
give anyone the chance to rise without
pushing others out or down, and that at
its best, the essential role of government
is to give everyone a fair chance to rise.
He never believed government could
replace strong families and individual
initiative. The beautiful family he and
Matilda created and the lives their
children have lived are more than

enough proof of that.
He simply believed that without a
hand up government, too many people
would be left behind and our country
would be diminished. Once an avid and
able baseball player, Mario said in an
interview for Ken Burns Baseball series,
You nd your own good in the good
of the whole. You nd your own individual fulllment in the success of the
community.
Everything Mario Cuomo did was
part of his passionate determination to
strengthen the bonds of community,
from his early efforts to address AIDS,
to his support for mentoring and health
care programs for children who needed
them, to his initiatives to create more
economic opportunities in upstate New
York. For him the struggle to solve particular problems was not interest-group
politics but community building, making the weak links stronger.
He believed that he could do his part

to build the more perfect union of our
founders dreams. He did it with a politics
like Lincolnswhom he so admired
and wrote aboutbased on the better
angels of our nature. He had a ne mind,
competitive drive and unsurpassed eloquence. While he loved to debate, often
ercely, with reporters and opponents,
he wanted his adversaries to have a fair
chance to make their case.
That was never more clear than in
1993, when his thorny critic, the New
York Post, hit hard times. As the Post
graciously said on Jan. 1, Mario Cuomo
stepped in and heroically performed a
one-man rescue mission ... because he
was convinced it was in New Yorks best
interests, not necessarily his own.
As all the political world knows, I owe a
great debt to Mario Cuomofor declining
to run for President in 1992, then electrifying our convention with his nomination
speech for me. I later wanted to nominate
him for the Supreme Court, but he declined. I think he loved his life in New
York and was content to be our foremost
citizen advocate for governments essential role in building a strong American
community, living and growing together.
In all the years since, Mario Cuomo
never stopped believing that, in our
hearts, Americans dont want to be divided, driven by resentment and insecurity. He saw problems and setbacks as a
part of the human condition, mountains
to be climbed and opportunities to be
seizedtogether.
Mario Cuomos America of community, compassion and responsibility
will live as long as there are people who
believe in it as strongly as he did, who
dene our success by the chances we give
to others who have dreams and the determination to chase them.
In his keynote address to the 1984
Democratic Convention, Mario said, We
still believe in this nations future ... Its a
story ... I didnt read in a book, or learn in
a classroom. I saw it and lived it ... Please,
make this nation remember how futures
are built.
That memory is Mario Cuomos lasting
gift to us.
Clinton is the 42nd President of the United States
25
COMMENTARY
Walter Isaacson
Time to Build a More Secure Internet
Yes, anonymity is empowering. But escalating hacks

and scams show that we need a safer alternative
the internet was designed in a
way that would allow it to withstand
missile attacks. That was cool, but it
resulted in an unintended side effect:
it made it more vulnerable to cyberattacks. So now it may be time for a little renovation.
The roots of the Internets design come from
the network built by the Pentagons Advanced Research Projects Agency to enable research centers
to share computer resources. The ARPANET, as it
was called, was packet-switched and looked like a
shnet. Messages were broken into small chunks,
known as packets, that could scurry along different paths through the network and be reassembled
when they got to their destination. There were no
centralized hubs to control the switching and routing. Instead, each and every node had the power to
route packets. If a node were destroyed, then trafc
would be routed along other paths.
30
40 MILLION
Number of
Americans who have
had personal
information stolen by
cybercriminals
T
$100 BILLION
Loss to the
U.S. economy in
2013 as a result
of cybercrime
he vener able requests-for- comments

process is already plugging away at this. RFCs
5585 and 6376, for example, spell out what is
known as DomainKeys Identied Mail, a service
that, along with other authentication technologies,
aims to validate the origin of data and verify the
senders digital signature. Many of these techniques
are already in use, and they could become a foundation for a more robust system of tracking and authenticating Internet trafc.
Such a parallel Internet would not be foolproof.
Nor would it be completely benecial. Part of what
makes the Internet so empowering is that it permits anonymity, so it would be important to keep
the current system for those who dont want the
option of being authenticated.
Nevertheless, building a better system for verifying communications is both doable and, for most
users, desirable. It would not thwart all hackers,
perhaps not even the ones who crippled Sony. But it
could tip the balance in the daily struggle against the
hordes of spammers, phishers and ordinary hackers
who spread malware, scarf up credit-card data and attempt to lure people into sending their bank-account
information to obscure addresses in Nigeria.
Isaacson, a former managing editor of Time, is the

author of The Innovators
I L L U S T R AT I O N B Y B R O W N B I R D D E S I G N F O R T I M E
hese ideas were conceived in the early

1960s by a researcher at the Rand Corp. named
Paul Baran, whose motive was to create a network that could survive a nuclear attack. But the engineers who actually devised the trafc rules for the
ARPANET, many of whom were graduate students
avoiding the draft during the Vietnam War, were
not focused on the military uses of the Net. Nuclear
survivability was not one of their goals.
Antiauthoritarian to the core, they took a very
collaborative approach to determining how the
packets would be addressed, routed and switched.
Their coordinator was a UCLA student named Steve
Crocker. He had a feel for how to harmonize a group
without centralizing authority, a style that was mirrored in the distributed network architecture they
were inventing. To emphasize the collaborative nature of their endeavor, Crocker hit upon the idea
of calling their proposals Requests for Comments
(RFCs), so everyone would feel as if they were equal
nodes. It was a way to distribute control. The Internet is still being designed this way; by the end of
2014, there were 7,435 approved RFCs.
So was the Internet intentionally designed to survive a nuclear attack? When Time wrote this in the
1990s, one of the original designers, Bob Taylor, sent
a letter objecting. Times editors were a bit arrogant
back then (I know, because I was one) and refused
to print it because they said they had a better source.
That source was Stephen Lukasik, who was deputy
HACK
ATTACKS
director and then director of ARPA from 1967 to

1974. The designers may not have known it, Lukasik
said, but the way he got funding for the ARPANET
was by emphasizing its military utility. Packet
switching would be more survivable, more robust
under damage to a network, he said.
Perspective depends on vantage point. As Lukasik explained to Crocker, I was on top and you were
on the bottom, so you really had no idea of what was
going on. To which Crocker replied, with a dab of
humor masking a dollop of wisdom, I was on the
bottom and you were on the top, so you had no idea
of what was going on.
Either way, the Nets architecture makes it difcult to control or even trace the packets that dart
through its nodes. A decade of escalating hacks
raises the question of whether its now desirable
to create mechanisms that would permit users to
choose to be part of a parallel Internet that offers
less anonymity and greater verication of user identity and message origin.
SI.COM
BOOKMARK
IT TODAY!
BREAKING
NEWS
SPORTS NEWS,
VIEWS, VIDEO
AND INSIGHT
FROM THE BEST
STORYTELLERS
IN SPORTS
RAPIDLY
EXPANDING
VIDEO CONTENT:
DAILY LIVE
SHOWS
TIMELY REPORTS
AND IN-DEPTH
ANALYSIS
NEWS ILLUSTRATED VIEWS ILLUSTRATED SPORTS ILLUSTRATED
NATION
What I Lea
My $190,00
Photo-illustration by Ann Elliott Cutting
arned From
00 Surgery
By Steven Brill
NATION | HEALTH CARE
i usually keep myself out of the stories i write, but

the only way to tell this one is to start with the dream I had
on the night of April 3, 2014.
Actually, I should start with the three hours before the
dream, when I tried to fall asleep but couldnt because of
what I thought was my exploding heart.
Thump. Thump. Thump. If I lay on my stomach, my heart
seemed to push down through the mattress. If I turned over,
it seemed to want to burst out of my chest.
When I pushed the button for the nurse, she told me
there was nothing wrong. She even showed me how to read
the screen of the machine monitoring my heart so I could
see for myself that all was normal. But she said she understood. A lot of patients in my situation imagined something
was going haywire with their heart when it wasnt. Everything was ne, she promised, before giving me a sedative.
All might have looked normal on that monitor, but there
was nothing ne about my heart. It had a time bomb appended to it. It could explode at any momentthat night
or three years laterand kill me almost instantly. No heart
attack. No stroke. Id just be gone, having bled to death.
Thats what had brought me to the fourth-oor cardiacsurgery unit at New YorkPresbyterian Hospital. The next
morning I had open-heart surgery to x something called
an aortic aneurysm.
Editors note: In 2013, Steven Brill wrote Times trailblazing
special report on medical bills. His subsequent book, Americas
Bitter Pilla sweeping inside account of how Obamacare
happened and what it does, and does not do, to curb the abuses
Brill chronicled in Timewas published Jan. 5. This article is
adapted from that book.
Its a condition I had never heard of until a week before,

when a routine checkup by my extraordinarily careful doctor found it.
And thats when everything changed.
Until then, my family and I had enjoyed great health. I
hadnt missed a day of work for illness in years. Instead, my
view of the world of health care was pretty much centered
on a special cover story I had written for Time a year before about the astronomical cost of care in the U.S. and the
dysfunctions and abuses in our system that generated and
protected those high prices.
For me, an MRI had been a symbol of proigate American
health carea high-tech prot machine that had become a
bonanza for manufacturers such as General Electric and Siemens and for the hospitals and doctors who billed patients
billions of dollars for MRIs they might not have needed.
But now the MRI was the miraculous lifesaver that had
found and taken a crystal-clear picture of the bomb hiding
in my chest. Now a surgeon was going to use that MRI blueprint to save my life.
A week before, because of the reporting I had done for
the Time article, I had been like Dustin Hoffmans savant
character in Rain Manable and eager to recite all varieties
of statistics on how screwed up and avaricious the American
health care system was.
We spend $17 billion a year on articial knees and hips,
which is 55% more than Hollywood takes in at the box ofce.
Americas total health care bill for 2014 was $3 trillion.
Thats more than the next 10 biggest spenders combined:
Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. All that extra money produces no
better, and in many cases worse, results.
There are 31.5 MRI machines per 1 million people in the
U.S. but just 5.9 per 1 million in the U.K.
Another favorite: We spend $85.9 billion trying to treat
back pain, which is as much as we spend on all of the countrys state, city, county and town police forces. And experts
say that as much as half of that is unnecessary.
Weve created a system in which 1.5 million people work
in the health-insurance industry while barely half as many
doctors provide the actual care.
And all those high-tech advancespacemakers,
MRIs, 3-D mammogramshave produced an ironically
upside-down health care marketplace. It is the only industry in which technological advances have increased costs
instead of lowering them.
When it comes to medical care, cutting-edge products
are irresistible and are usedand pricedaccordingly. I
could recite from memory how the incomes of industry
Adapted from Americas Bitter Pill by Steven Brill. 2015 by Brill Journalism Enterprise LLC. Reprinted by arrangement with Random House, a division of Random House LLC. All rights reserved.
Photograph by Peter Larson for TIME
The Cleveland
Clinic Model
The vast network of
hospitals, clinics and
doctors practices in
Ohio draws patients
from all over the world
Delos Toby Cosgrove

The Cleveland Clinic CEO
was a celebrated heart
surgeon before becoming
one of the savviest hospital
executives in the world
executives continued to skyrocket even during the recession and how much more the president of the Yale
New Haven Health System made than the president of
Yale University.
I even knew the outsize salary of the guy who ran the
supposedly nonprot hospital where I was struggling to fall
asleep: $3.58 million.
Which brings me to the dream I had when I nally got
to sleep.
As I am wheeled toward the operating room, a man in
a nely tailored suit stands in front of the gurney, puts his
hand up and orders the nurses to stop. Its the hospitals CEO,
the $3.58 million-a-year Steven Corwin. He, too, had read the
much publicized Time article, only he hadnt liked it nearly
as much as Jon Stewart, who had had me on his Daily Show
to talk about it.
We know who you are, the New YorkPresbyterian
CEO says. And we are worried about whether this is some
kind of undercover stunt. Why dont you go to another
hospital? I dont try to argue with him about gluttonous
prots or salaries or the possibility that he was overusing
his MRI or CT-scan equipment. Instead, I swear to him that
my surgery is for real and that I would never say anything
bad about his hospital.
In real life, I could have given hospital bosses like him
the sweats, making them answer questions about the dysfunctional health care system they prospered from. Their
salaries. The operating prots enjoyed by their nonprot,
non-tax-paying institutions. And most of all, the outrageous
charges$77 for a box of gauze pads or hundreds of dollars
for a routine blood testthat could be found on something
they called the chargemaster, a massive menu of list prices
they used to soak patients who did not have Medicare or private insurance. How could they explain those prices, I loved
to ask, let alone explain charging them only to the poor and
others without insurance, who could least afford to pay?
But now, in my dream, I am the one sweating. I beg Corwin to let me into his operating room so I can get one of his
chargemasters. If one of the nurses peering over me as he
stopped us at the door had suggested it, Id have bought a
years supply of those $77 gauze pads.
1. Why U.S. Health Care Is So Hard to Fix

health care is americas largest industry by far,
employing a sixth of the countrys workforce. And it is average Americans largest single expense, whether paid out of
their pockets or through taxes and insurance premiums.
So the story of how our country spent years trying to
overhaul this vast portion of the economyand still left the
U.S. with a broken-down jalopy of a health care systemis
an irresistible tale.
The story of how what has come to be called Obamacare
happenedand what it will and will not dois about politics and ideology. In a country that treasures the marketplace, how much do we want to tame those market forces
when trying to cure the sick? And in the cradle of democracy, or swampland, known as Washington, how much taming can we do when the health care industry spends four
times as much on lobbying as the No. 2 Beltway spender, the
much feared military-industrial complex?
38
Its about the people who determine what comes out of

Washingtonfrom industry lobbyists to union activists,
from Senators tweaking a few paragraphs to save billions
for a home-state industry to Tea Party organizers ghting to
upend the Washington status quo, from turf-obsessed procurement bureaucrats who crashed the governments most
ambitious Internet project ever to the seless high-tech whiz
kids who rescued it, and from White House staffers ghting over which faction among them would shape and then
implement the law while their President oated above the
fray to a governors staff in Kentucky determined to launch
the signature program of a President reviled in their state.
But late in working on the book from which this article
is adapted, on the night of that dream and in the scary days
that followed, I learned that when it comes to health care,
all that political intrigue and special-interest jockeying play
out on a stage enveloped in something else: emotion, particularly fear.
Fear of illness. Or pain. Or death. And wanting to do something, anything, to avoid that for yourself or a loved one.
When thrown into the mix, fear became the element
that brought a chronically dysfunctional Washington to its
knees. Politicians know that they mess with peoples health
care at their peril.
Its the fear I felt on that gurney, not only in my dream but
during the morning after the dream, when I really was on
the gurney on the way into the operating room.
Its the fear that continued to consume me when I was
recovering from my operation. The recovery was routine.
Routinely horrible.
After all, my chest had just been split open with what,
according to the website of Stryker, the Michigan-based
company that makes it, was a Large Bone, Battery Powered,
Heavy Duty Sternum Saw, which has increased cutting
speed for a more aggressive cut. And then my heart had
been stopped and machines turned on to keep my lungs
and brain going.
Its about the fear of a simple cough. The worst, though
routine, thing that can happen in the days following surgery
like mine, I found out, was to cough. Coughing was torture
because of how it assaulted my chest wounds.
I developed a cough that was so painful, I blacked out.
Not for a long time; there was a two-two count on Derek
Jeter just before one of the episodes, and when I came to, Jeter
was about to take ball four. However, because I could feel it
coming but could do nothing about it, it was terrifying to me
and to my wife and kids, who watched me seize up and pass
out more than once.
In that moment of terror, I was anything but the wellinformed, tough customer with lots of options that a robust
free market counts on. I was a puddle.
There were occasions during those eight days in the hospital when the non-drug-addled part of my brain wondered,
when nurses came in for a blood test twice a day, whether
one test was enough and what the chargemaster cost for
both was going to look like.
But most of the time the other part of my brain took over,
the part that remembered my terror during those blackouts
and the overriding fear, reprised in dreams that persisted
for weeks, that lingered in someone whose chest had been
There are 31.5 MRI machines per 1 million people in the U.S.
There are 5.9 per 1 million in the U.K.
sawed open and whose heart had been stopped. As far as I

was concerned, they could have tested my blood 10 times
a day if they thought that was best. They could have paid
as much as they wanted to that nurses aide with the scale
or to the woman who awlessly, without even a sting, took
my blood. The doctor who had given me an angiogram the
afternoon before the surgery and then came in the following
week to check on me became just a nice guy who cared, not
someone who might be trying to add on an extra consult bill.
In the days that I was on my back, to have asked that
nurse how much this or that test was going to cost, let alone
to have grilled my surgeona guy I had researched and
found was the master of aortic aneurysmsabout what he
was going to charge, seemed beside the point. It was like asking Mrs. Lincoln what she had thought of the play.
When youre staring up at someone from the gurney,
you have no inclination to be a savvy consumer. You have
no power. Only hope. And relief and appreciation when
things turn out right. And you certainly dont want politicians messing around with some cost-cutting schemes that
might interfere with that result.
That is what makes health care and dealing with health
care costs so different, so hard. The Obamacare story is so
full of twists and turnsso dramaticbecause the politics are so treacherous. People care about their health a lot
more than they care about health care policies or economics. Thats what I learned the night I was terried by my
own heartbeat and in the days after when I would have paid
anything for a cough suppressant to avoid those blackouts.
Its not that this makes prices and policies allowing
indeed, encouragingrunaway costs unimportant. Hardly.
My time on the gurney notwithstanding, I believe everything I have written and will continue to write about the
toxicity of our proteer-dominated health care system.
But now I also understand, rsthand, the meaning of
what the caregivers who work in that system do every day.
They achieve amazing things, and when its your life or your
childs life or your mothers life on the receiving end of those
amazing things, there is no such thing as a runaway cost.
Youll pay anything, and if you dont have the money, youll
borrow at any mortgage rate or from any payday lender to
come up with the cash.
Most of the politicians, lobbyists, congressional staffers
and others who collectively wrote the story of Obamacare
had some kind of experience like that, either directly or vicariously through a friend or loved one. Who hasnt?
The staffer who was more personally responsible than
anyone else for the drafting of what became Obamacare had
a mother who, in the year before the staffer wrote that draft,
had to take an $8.50-an-hour job as a night-shift gate agent at
the Las Vegas airport. She worked every night, not because
she needed the $8.50her semiretired husband was himself
a doctorbut because a pre-existing condition precluded
her from buying health insurance on the individual market.
That meant she needed a job, any job, with a large employer.
Her daughters draft of the new law prohibited insurers from
stopping people with pre-existing conditions from buying
insurance on the individual market.
And then there was Senator Edward Kennedy, for 50 years
the champion of extending health care to all Americans. Be-
yond his brothers tragic visits to two hospital emergency

rooms, Ted Kennedys rsthand experience with health care
began with a sisters severe mental disabilities, was extended
by a three-month stay in a western Massachusetts hospital following a near fatal 1964 plane crash and continued
through his sons long battle with cancer.
Everyone involved in the writing of the Affordable Care
Act similarly saw and understood health care as an issue that
was more personal and more emotionally charged than any
other. Accordingly, they struggled with one core question:
How do you pay for giving millions of new customers the
means to participate in a marketplace with inated prices
customers with a damn-the-torpedoes attitude about those
prices when theyre looking up from the gurney? Is that
possible? Must the marketplace be tamed or tossed aside?
Or must costs be pushed aside, to be dealt with another day?
Even the seemingly coldest sh among politiciansthe
cerebral, no drama Barack Obamadrew on his encounters with people who desperately needed health care to
frame, and ultimately fuel, his push for a plan.
Everywhere I went on that rst campaign, I heard directly from Americans about what a broken health care
system meant to themthe bankruptcies, putting off care
until it was too late, not being able to get coverage because of
a pre-existing condition, Obama would later tell me.
should we be embarrassed and maybe even enraged
that, as my book chronicles, the only way Obama ended up
being able to reform health care was by making backroom
deals with the industry interests who wanted to make sure
that reform didnt interfere with their proteering?
Of course. Well be paying the bill for that forever.
But should we blame Obama for making those deals?
I dont think so.
Obamacare gave millions of Americans access to affordable health care, or at least protection against being unable
to pay for a catastrophic illness or being bankrupted by the
bills. Now everyone has access to insurance and subsidies
to help pay for it. That is a milestone toward erasing a national disgrace. But the new law hasnt come close to making health-insurance premiums and out-of-pocket costs low
enough so that health care is truly affordable to everyone,
let alone affordable to the degree that it is in every other
developed nation. Worse, it did little beyond some pilot projects and new regulations to make health care affordable
for the country. Instead, it provided massive government
subsidies so that more people could buy health care at the
same inated prices that so threaten the U.S. Treasury and
our global competitiveness.
The Obama Administration trumpeted Obamacare as
a modern innovation that would force another hidebound
industry to be more competitive. expedia for health
insurance was a winning political bumper sticker in an
age when even Democrats were wary of being accused of
anything that could be labeled as income redistribution.
But the real bumper sticker might have read money for
the poor and middle class so they can get insurance
to buy the same product everyone else does at the
same price that makes everyone in the health care
industry so rich.
39
2. How To Fix It: Let the Foxes

Run the Henhouse
is there something we can now do to fix that ? how
can we go beyond Obamacare?
Thats the puzzle I was struggling with before my
operation, so when I was able to move around afterward,
I went back to New YorkPresbyterian to talk to its top
executives. We discussed the aggressive chargemaster
bills I had gotten following my surgerytotaling more
than $190,000and the fact that the hospitals brand name
was so strong, it had to offer only a 12% discount off those
exorbitant prices ($451 for each of the eight times a portable
X-ray machine took a picture of my battered chest) to my
insurer, UnitedHealthcare. I then discovered that for massive hospital systems like New YorkPresbyteriana product of the merger of New York Citys two most prestigious
hospitalsthis kind of leverage over even the largest insurers, like United, was not unusual.
But we also talked about how the kind of care I received
wasnt an accident. For example, only a third of CEO Corwins annual bonus (which accounts for about half his annual pay) is based on the hospitals nancial results. The
rest is based on an elaborate patient-satisfaction survey and
an even more elaborate set of metrics related to patient care.
It was then that my idea for how to x Obamacare and
American health care gelled: Let these guys loose. Give the
most ambitious, expansion-minded foxes responsible for the
chargemaster but also responsible for providing stellar care
of the kind Corwin gave me even more free rein to run the
henhousebut with conditions that would cut costs and, in
fact, kill the chargemaster.
Several months before, I had begun toying with the same
thought after encountering other leaders of high-quality
hospital systems who were fast expanding their footprints
and in the process gaining leverage over insurers.
At one event, I had been intrigued by Delos Toby Cosgrove, CEO of the Cleveland Clinic, a vast network of hospitals, clinics and doctors practices that dominated northeast
Ohio and had such a good reputation that patients traveled
there from all over the world.
Cosgrove, a celebrated heart surgeon, had built the Cleveland Clinics heart program into one of the worlds best. He
was also regarded as one of the savviest hospital executives
in the world, widely admired for the way he ran what he had
propelled into a $6 billion, 75-facility enterprise.
I had watched Cosgrove blanch while participating in a
program about health care reform when another panelist
implied that he dominated his market. Not possible, he
said. If we expand too much, the FTC will be all over us.
Should the Federal Trade Commission really want to stop
a guy like Cosgrove from dominating health care in Cleveland? I wondered.
But then I remembered Jeffrey Romoff, CEO of the University of Pittsburgh Medical Center (UPMC), who had long
been enmeshed in litigation over whether he had conspired
to control his market. By buying up doctors practices, clinics and other hospitals, Romoff truly did dominate health
care in and around Pittsburgh. Furthermore, he once told me
that he saw any attempts to hold him back as impediments
he needed to overcome.
40
By now, UPMC had settled litigation with, and was about

to complete a divorce from, Highmark Insurancethe Blue
Cross Blue Shield company it had been accused of conspiring
with to control the provider and insurance markets, respectively, in western Pennsylvania.
Through 2014, UPMC was lling the Pittsburgh area airwaves and every billboard not already taken by Highmark
with touts for its own insurance company as the one that
patients could use to get full access to its facilitiesbecause,
beginning in 2015, UPMC would no longer recognize Highmark insurance.
At the same time, Romoff was fighting a lawsuit
from the city of Pittsburgh that might have embarrassed
other hospital executives. The city charged that UPMCs
prices and prots were so high and its salaries, including
Romoffswhich by then was more than $5 million
were so exorbitant that it did not deserve nonprot taxexempt status and should therefore be subject to the
citys payroll tax. That would mean a lot to Pittsburgh,
because UPMC was the biggest nongovernment employer
in Pennsylvania.
UPMCs rst defense was that it didnt have any employees; only its subsidiaries did. By the summer of 2014, a state
judge would agree. He dismissed the case, though the city
would be allowed to le the same action against the various subsidiary hospitals. Nonetheless, the suit highlighted
UPMCs status as perhaps the worlds most tough-minded,
prot-oriented nonprot.
So to put it charitably, Romoff, who is not a doctor, didnt
seem to be the kind of hospital leader that Corwin or Cosgrove was.
Yet it was when I went to see Romoff (once I was able to
travel) that the idea I had begun playing with after those
talks with Corwin and other hospital leaders became fully
formed.
Sitting in front of a window in his suite atop the U.S.
Steel Tower, overlooking his citys football and baseball stadiums, Romoff laid out a vision for health care that put it all
together for me.
We spent much of the time talking about his UPMC
insurance company and its competition with Highmark.
By then, Highmarks insurance market share in the
Pittsburgh region had shrunk from 65% to 45%. Romoff
calculated that with all the business he was taking away
with his own insurance company, plus the inroads made
by other insurers with whom he had signed network deals,
Highmarks share would be 25% by the end of 2014 and still
sinking. He expected that his insurance company would
end up the leader in the marketand he was going to do
everything he could to get to 100%.
Would he be worried about being so successful that he
would drive out all the other insurance companies? I asked.
Of the things that keep me up at night, that is not one of
them, Romoff answered with a smile.
He was unabashedly trying to become the dominant
insurer. And he was already by far the dominant provider
through his 20 hospitals and hundreds of clinics, labs and
doctors practices.
In other words, like the Geisinger Health System in
Pennsylvania, only on a much larger scale and with little
Photograph by Peter Larson for TIME
The UPMC
System
Romoffs UPMC is
now touting its own
insurance company,
creating a system of
health care without a
middleman
Jeffrey Romoff
The University of Pittsburgh
Medical Center CEO bought
practices, clinics and other
hospitals to dominate
health care in Pittsburgh
competition in the market, Romoff could sell me health

insurance, which would cover me when I used Romoffs
hospitals, clinics, doctors and labs.
there would be no middleman. no third-party insurance company.

To me this was a hugely appealing idea, despite UPMCs
record of high prices and its take-no-prisoners approach to
competition. Why? Because it was the structure that made
sense, not the particulars of Romoff and UPMC.
The insurance company would have not only every incentive to control the doctors and hospitals costs but also
the means to do so. It would be under the same roof, controlled by Romoff. Conversely, the hospitals and doctors
would have no incentive to inate costs or overtreat, because
their ultimate boss, Romoff, would get the bill when those
extra costs hit his insurance company.
As Romoff put it, All the incentives are aligned the right
way. Its the beauty of being the payer and provider at the
same time. The alignments of interest are just so pure.
When the incentives are not aligned, he added, supplying a quote that could easily be read the wrong way, its why
seniors dying of cancer get chemo when they should just get
hospice care.
Maybe, but how could we know that those cancer
patientswho would have no place to go in and around
Pittsburgh except to UPMC if Romoff had anything to say
about itwouldnt be denied chemotherapy that they actually needed if Romoff-employed doctors were the ones holding the prescription pads?
Wasnt Romoffs interest the one that was the most purely aligned of all?
Thats where doctor-leaders like Corwin and Cosgrove
come inalong with strong oversight and regulation.
Hospitals are already consolidating. It is happening all
over the country, including in Corwins New York City and
Cosgroves Cleveland.
Lets let them continue. More important, as they continue, lets encourage them to become their own insurance
companies, la Romoff, so they can cut out the middleman
and align those incentives.
Lets harness their ambition to expand, rather than try to
gure how and when to contain their ambition.
Why shouldnt I be able to buy Cosgroves Cleveland
Clinic health insurance? What a great brand! I would know
that I could use all his facilities and doctors, and he would
know that his incentivewhich, he says, has always been
the samewas to provide good care, not expensive care full
of unnecessary and overpriced CT scans and blood tests.
And I would know that doctors whom I could hold accountable would determine the nature of that care, not insurance
companies.
But lets ensure that accountability by insisting on tight
regulation, mostly through the smarter use of federal antitrust law and state regulatory authority, in return for giving
doctor-leaders the freedom to expand and also the freedom
to become their patients insurance companies.
The rst regulation would require that any market have
at least two of these big, fully integrated providerinsurance
42
Cutting out middleman insurance companies would cut administrative costs,

which now account for 15% to 20% of private health care costs
3. Cutting Out the Middleman
company players. There could be no monopolies, only oligopolies, as antitrust lawyers would call them. The larger markets,
such as New York City, Los Angeles and Chicago, might have
to have four, ve or even more players to make the competition real and to make sure that, with accompanying regulatory requirements, their footprints were big enough and their
marketing plans robust enough to serve patients throughout
their regions, not just in the wealthier areas.
That would mean the hospital and all the doctors it controlled would be subject to pricing and service-delivery
standards that liberal reformers have sought since the mid
20th century. Health care in the U.S. would nally be treated as a public good, not a free-market product. However, the
change would have come jujitsu-style, not by a government
takeover. It would have come because the private players
had driven it to that state.
These fully integrated brands could pursue recent innovations that offer less expensive, more consumer-friendly
health care, such as storefront urgent-care centers that are
smart alternatives to expensive, time-wasting hospital emergency rooms. These urgent-care centers are now being opened
piecemeal by for-prot and often lightly regulated companies. Why not put them under the banner and branded accountability of the big hospital systems? In fact, Cosgroves
Cleveland Clinic has already opened a dozen urgent-care
and express-care (for more routine needs) centers. Id rather
pay him to care for me than pay a walk-in center owned by a
private-equity fund.
The second regulation would cap the operating prots of
what would be these now-allowed dominant market players,
or oligopolies, at, say, 8% a year, compared with the current
average of about 12%. That would force prices down. Better
yet, an excess-prots pool would be created. Those making
higher prots would have to contribute the difference to
struggling hospitals in small markets.
A third regulationwhich, again, the hospital systems
would have to agree to in return for their being allowed to
achieve oligopoly or even monopoly statuswould prevent
hospital nance people from playing games with that prot
limit by raising salaries and bonuses for themselves and
their colleagues (thereby raising costs and lowering prots).
There would be a cap on the total salary and bonus paid
to any hospital employee who did not practice medicine
full time of 60 times the amount paid to the lowest salaried
full-time doctor, typically a rst-year resident. (Under that
formula, Corwins and Cosgroves salaries would stay about
the same but Romoff in Pittsburgh would take a big cut.)
A fourth regulation would require a streamlined appeals
process, staffed by advocates and ombudsmen, for patients
who believed they were denied adequate care or for doctors
who claimed they were being unduly pressured to skimp
on care.
A fth regulation would require that any governmentsanctioned, oligopoly-designated integrated system have as
its actual chief executive (not just in title) a licensed physician who had practiced medicine for a minimum number of
years. Sorry, Mr. Romoff. The culture of these organizations
needs to be ensured, even if that means choosing leaders
based on something in addition to their business acumen
and stated good intentions.
Sixth, any sanctioned integrated oligopoly provider

would be required to insure a certain percentage of Medicaid
patients at a stipulated discount.
Wait a minute, I can hear my readers thinking. These
guys generate thousands of those obscene chargemaster
bills a year. Now youre going to put them in charge?
Which brings me to my nal regulation: These regulated oligopolies would be required to charge uninsured
patients no more than what they would charge competing
insurance companies whose insurance they accepted, or
else a price based on their regulated prot margin if they
didnt accept other insurance. In other words, no more
chargemaster.
All of this may seem complicated, but the rules required
to set up this structure would be a drop in the bucket compared with the thousands of pages of laws and millions of
pages of rules and regulations that are now on the books.
And it is certainly more realistic than pining for a public
single-payer system that is never going to happen.
Combining the work that the Corwins and Cosgroves of
the world do with Romoffs plan boils down to this: Allow
doctor-leaders to create great brands that both insure consumers for their medical costs and provide medical care.
Let them act on their ambitions. Let them compete with
other legitimate players in their markets, or even with one
another if they want to expand.
That kind of competition is already happening. But as
things stand now, an employer who wants to get health care
for his workers, or an individual who is shopping on the
Obamacare exchanges, has to gure out which insurance
company has which hospitals and doctors in its network and
what discounts it has negotiated. This change would create
a new, clearer competitive process.
Instead of hoping for the best with UnitedHealthcare, I
could just go on the exchange and pay Corwin to use all of
his New YorkPresbyterian doctors and facilities to keep me
healthy. Period. Full stop. There would be total clarity about
which facilities and doctors are in my network.
Or my employer could pay him after negotiating the
price.
It would be insurance the way its supposed to work
the risk associated with the cost of my heart surgery would
be spread across a pool of premiums that Corwin collected
from tens or hundreds of thousands of New Yorkers, most of
whom wont have the kind of medical mishap I had.
If Corwin and his integrated system charged too much
or didnt do a good job, either my employer or I (if I were in
the individual market) could switch to another competitive New York City brand like Mount Sinai Hospital or NYU
Langone Medical Center. And all that competition would be
fortied by advances in data transparency that would make
each competitors quality ratings for various types of care
readily available.
Corwins high price for my open-heart surgery would
truly be tested in the market, because he would be competing with other high-quality health systems to capture all of
my business or my employers business. He and his network
of hospitals, clinics and doctors would insure me not only
against heart surgery but for routine treatment and X-rays
in case I twisted my ankle or got the u.
4. Hundreds of Billions in Savings

i bet that with this plan, we could cut 20% off the
two-thirds of our health care bill not paid by Medicare or
Medicaid. Heres a sketch of how the math could work:
First, administrative costs for insuranceincluding vetting claims, paying bills, paying managers and executives
and distributing prots to shareholdersaccount for 15%
to 20% of private health care costs. Couldnt half or more
be saved by cutting out middleman insurance companies?
Corwin or Cosgrove would still have to employ managers,
actuaries, accountants and salespeople on the insurance side
of their integrated operations, but surely not to the extent
that an insurance company responsible for paying bills from
multiple third-party hospitals and other providers would.
Nor would they have to deliver prots to shareholders.
Lets say we could save 10% by eliminating middlemen.
Second, on the provider side of the equation, the main
culprit in driving costs upthe incentive for overtreating
and overtesting that comes with billing for each patient
encounter and procedure instead of billing for overall
treatmentwould be eliminated. And the general incentive to maximize revenue would be tamped down by the
new regulation capping operating prot at 8%.
That could likely save another 10%.
The total, then, could be 20% of nongovernment health
care costs, or $400 billion a year, and maybe $100 billion
more saved by allowing Medicare and Medicaid to pay those
integrated providers this way.
That would go a long way toward bringing American
health care costs as a percent of our gross domestic product
closer to those of the countries we compete with.
One of Corwins competitors, the giant North ShoreLIJ
Health System, is now selling its own insurance. Corwin
told me that although he is more comfortable being on the
provider side of the street, he would consider doing the same
if he thought his hospital system were big enough to provide
that full spectrum of quality care and if he needed to do it in
order to be competitive.
The rst thing we can agree on about the health care
system in the United States, the Cleveland Clinics Cosgrove
said, is that it is not a system at all. Its just a collection of
disparate providers. So, yes, we are consolidating, he continued, noting that although the number of hospital beds in the
U.S. had declined in recent years from 1 million to 800,000,
there is still only 65% occupancy.
Doctors, said Cosgrove, have consolidated their practices,
often under the umbrella of hospital systems like his, because medical knowledge doubles every two years. So you
continually need to specialize still more to keep up. And
the more you consolidate, the more you can specialize. The
more you specialize and do a lot of just one or two things, the
better you are at them and the more cost-effective you are.
Thats why they call it practicing medicine.
Would integrating insurance into that system be the
next logical step beyond consolidation? That seems right,
Cosgrove said. In fact, he added, we recently applied for an
insurance license.
The momentum for the consolidation I have in mind is
clearly there. We just need to seize it rather than resist it, and
then control it and push it in the right direction.
43
WORLD
THE PATH TO PEACE

Chaos in the Middle East is sowing the seeds for an
unlikely alliance between Israel and the Arab states
BY JOE KLEIN
Out of ashes A Palestinian man
prays in a Gaza neighborhood

destroyed during the war last
year between Hamas and Israel
Photograph by Peter van Agtmael for TIME
WORLD | MIDDLE EAST
46
Armed and anonymous A Hizballah ghter,

left, in Beirut. An image of ISIS militants in
Syria, right, that was put on an extremist site
Brotherhood leaders in 2013. (Al-Sisi

won a largely uncontested presidential
election last year.) But these are not sentiments that have often been uttered publicly by Arab leaders before.
And then, the very next day, the Times
of Israel reported that Israeli Foreign Minister Avigdor Lieberman and exiled Palestinian leader Mohammed Dahlan had
met privately in Paris. Dahlan has made
no secret of his desire to replace Palestinian Authority President Mahmoud Abbas;
Lieberman is a conservative who has fallen out with Netanyahu and wants to be
part of a coalition to replace him. So what
on earth were Dahlan and Lieberman
talking about?
All of this may add up to nothing. But
there seems to be a growing impatience
with the perpetual status quo in the region.
There is a new generation of leaders pushing for power in Israel and Palestine. There
are dangerous new threats like ISIS. There
is concern about the U.S.the possibility
of a nuclear deal with Iran, the waning
need for Middle East oil. There is the memory of the Arab Spring, which ultimately
produced chaos instead of democracy.
The established powers in the region,

like Israel, Saudi Arabia and Egypt, have
found in recent years that they have increasingly aligned foreign policy interests.
The Israelis and Saudis have been sharing
intelligence for the past few years, according to regional sources. The Israelis and
Egyptians are cooperating on security efforts in Sinai and in Gaza, where Hamas
the Palestinian branch of the Muslim
Brotherhoodis a common enemy. There
are private talks going on between Israeli
and Saudi Arabian ofcials. It might be
called mushroom diplomacy, an Israeli
told me. It can only grow in the dark.
Most Israeli and Arab officials I
spoke with during a December tour
of the region acknowledge the mushrooms and hope that the burgeoning
relationshipsespecially the acceptance
of Israel as a de facto allycan be brought
to light in time. There are, of course, all the
usual roadblocks, including the eternal
one: nothing can happen publicly without
an Israeli-Palestinian peace settlement.
The Saudis and the Arab League promised
to recognize Israel in 2002 if such a deal
were made, but the Arab termsa return
to 1967 borders, with Palestinians right
of return to their former lands in Israel
were unacceptable to the Israelis. Now
those terms may be changing. Prince
P R E V I O U S PA G E S : M A G N U M P H O T O S; T H E S E PA G E S , F R O M L E F T: M O I S E S S A M A N M A G N U M P H O T O S; A P
n may 26, 2014, an unprecedented public conversation

took place in Brussels. Two
former high-ranking spymasters of Israel and Saudi
ArabiaAmos Yadlin and Prince Turki
al-Faisalsat together for more than an
hour, talking regional politics in a conversation moderated by the Washington
Posts David Ignatius. They disagreed on
some things, like the exact nature of an
Israel-Palestine peace settlement, and
agreed on others: the severity of the Iranian nuclear threat, the need to support
the new military government in Egypt,
the demand for concerted international action in Syria. The most striking statement
came from Prince Turki. He said the Arabs
had crossed the Rubicon and dont want
to ght Israel anymore.
The Turki-Yadlin dialogue was not ofcial, but it sent a clear message. Saudi
Arabias King Abdullah had personally approved the meeting, intending it as an olive branch to the Israelis. But Israeli Prime
Minister Benjamin Netanyahu decided
not to reciprocateat least not openly.
It was too dangerous politically. Crucial
components of Netanyahus coalition, especially his supporters among right-wing
Jewish settlers in the West Bank, oppose
any deal with Palestinians.
And yet, in the months after he decided
against a public gesture to the Saudis, Netanyahu was suggesting at private meals
with editors and inuential gures at the
U.N. General Assembly meetings last September that an alliance with the Arabs
was not only possible but perhaps the best
way to resolve the Palestinian problem.
Other odd things have been happening recently in the gridlocked Middle
East. On New Years Day, Egyptian
President Abdul Fattah al-Sisi made an
interesting speech, challenging Islamic
radicalism and calling for a Muslim reformation. Its inconceivable that the
thinking that we hold most sacred, he
said, should cause the entire umma [Islamic world] to be a source of anxiety,
danger, killing and destruction for the
rest of the world. Impossible! The sentiments were not unexpected, since al-Sisi
had come to power by overthrowing the
countrys democratically elected Muslim
Turki described the proposal as a framework, which implies room to maneuver.

Is it possible that the Middle East has
become so unstable that an Arab-Israeli
peace is no longer unthinkable?
The ISIS Effect
as 2015 begins, the middle east seems
to be a greater mess than it ever was
especially when it comes to the conict
between Israel and the Palestinians. The
deterioration began with Israels 50-day
war in Gaza last summer, which increased the popularity of Hamas in the
West Bank and has led Abbas to take a
series of steps toward the unilateral declaration of Palestinian statehood. In recent
weeks, the Palestinian Authority applied
for membership in the International
Criminal Courta red ag to the Israelis
because the Palestinians would presumably use membership to bring war-crimes
charges against Israel. In return, the Israelis have cut off the monthly payment
of taxes they collect for the PA, which represent almost 80% of the governments
$160 million monthly budget. It is possible that the Palestinians could retaliate
by suspending government operations in
the West Bankschools, health care and,
especially, security. Chaos would be the
likely result.
In the rest of the region, the sectarian split between Sunni and Shiite has
become more dangerous, even as it has
become more confusing. The Sunni Arab
nationswhich include Saudi Arabia,
Egypt, Jordan and the Gulf stateshave
worried for a decade that the U.S. demolition of Saddam Husseins ugly but stable
dictatorship in Iraq has created a power
vacuum in a broad swath of the region
that the Iranians are exploiting. They call
it the Shiite crescent, a sphere of inuence stretching from Hizballah-controlled
southern Lebanon and President Bashar
Assads Alawite regime in Syria, to Iraq
and Iran, right up to the border of the Eastern province of Saudi Arabia, a majorityShiite area where most of the countrys
oil is produced.
But the old Sunni-Shiite conict has
been complicated by a new threat in the
region: ISIS, a Sunni radical military force
vastly more competent and frightening
than al-Qaeda. ISIS began in Iraq but made
its mark in the rebellion against Assads
government in Syria. Assad isnt well
liked by his Sunni neighborsand some
of them, like Qatar and perhaps private
sources in Saudi Arabia, gave surreptitious
support to ISIS and other Sunni militias in
the early days of the rebellion.
The lightning march ISIS made
through Iraq last year changed the equation. An ISIS-controlled Iraq would be a
threat not only to Iran but also to some of
the Sunni royal families in the region, as
well as Egypt. The Jordaniansalready
overwhelmed by refugees from Iraq, Syria
and Palestineare vulnerable. The Saudis, governed by an increasingly feeble
gerontocracythe 90-year-old Abdullah was hospitalized with pneumonia at
the start of the new yearare worried
too. The Egyptians are ghting ISIS-style
terrorists in Sinai and are threatened by
Libyan militias, which may also be loosely
afliated with ISIS.
In response, a heterodox alliance has
gathered to make war with ISIS. Iranianbacked militias, like Hizballah, are the
most ardent ghters in this war, along
with the Kurds. But they are now joined by
U.S. airpoweras well as pilots from Sunni powers like Saudi Arabia and Jordan.
Another potentially major change in
the region: the Israelis, Iranians, Saudis
and Egyptians are increasingly concerned
about Turkey, which sees the ISIS threat
somewhat differently from its neighbors.
Turkey has allegedly allowed thousands
of militants to cross its border and join
ISIS because the group is ghting Assad
and militant Kurdish groups like the
Kurdistan Workers Party (PKK), which
the Turks see as a permanent threat in the
south and east of their country. (Turkey
has acknowledged that its border with
Syria is porous but has denied accusations
that it purposefully allows militants to
cross.) Why arent you Americans making more of a fuss about Turkeys support
for ISIS? a prominent Egyptian ofcial
asked me. I read a lot more about our humanitarian problems in the American
press than I do about the Turks who are allowing terrorists to cross their border and
behead Americans.
Of course, the humanitarian problems in Egypt are very real, as al-Sisis
forces have led a brutal suppression of the
Muslim Brotherhood. But the Egyptians
have become sensitive to the point of paranoia about the changing U.S. role in the region. I had dinner in Cairo with a group of
prominent leaders. One of them, a banker,
asked seriously, Is it true that there is a
secret alliance between Obama and the
47
WORLD | MIDDLE EAST
Muslim Brotherhood to destabilize the existing Sunni governments in the region?

I started to laugh, but none of the
Egyptians at the table were smiling. They
didnt buy the bankers conspiracy theory,
but they laid out an array of charges, ranging from the (pre-Obama) Iraq invasion to
the Presidents support for the overthrow
of former President Hosni Mubarak to the
Administrations recent slow walk of military supplies, especially spare parts, to
the al-Sisi government. Doesnt he want
us to be fighting ISIS in Sinai? asked
the banker.
The Obama Administration maintains
that all al-Sisi has to do is free some political prisonersespecially those who
are American and three jailed journalists from al-Jazeera who were accused,
implausibly, of joining a terrorist group
and broadcasting false newsand the
military support will flow again. The
Administration argues that its overall
policysteering clear of neocolonial adventurism like the 2003 invasion of Iraq
and working to bring Iran back into the
international communityhas been
more effective than George W. Bushs neoconservatism. Obama aides also point out
that there are two U.S. naval eets in the
region, plus U.S. bases in Qatar, Abu Dhabi
and Djibouti. Does that sound like disengagement? one of them asked me. Were
not going anywhere.
From Washington, the region seems a
jigsaw puzzle ruled by anarchic moving
piecesa disproportionate source of concern that leaches attention from growing
problems in Russia and East Asia. From
Cairo and Riyadh and Jerusalem, though,
the U.S. seems a ckle ally that cant decide
whether its policy is to support stability or
the naive hope for democracy in a region
that isnt ready for it.
The modern Middle East was stabilized, in a toxic but effective way, by the
Cold War, when partnership with superpowers provided security and economic
aid. In the 21st century, the USSR is gone
and the U.S. no longer has the incentive, or
the money, to lavish vast aid packages on
local clients. But the nations of the Middle
East have been unable to wean themselves
from their dependency on outside forces.
Whenever were in trouble we dial 911,
48
an Arab diplomat told me. But it is illogical to think the U.S. was created to protect
the Sunnis.
With few other options, the Arabs
have returned to an old idea, which was
mostly bluster in the pastthat they
must unite to protect themselves. And
any serious conversation about security
and economic development has to include
the one nation in the region that has succeeded at both: Israel. There is no love for
the Israelis, but there is respect. And so
there is a hopea conversation that is
occurring across the Arab statesthat
perhaps the only alternative is to bank on
the regional forces of stability to create a
security alliance against the extremist
threat of both Shiite and Sunni militias.
Even if that means partnering with Israel.
Strange Bedfellows
is such an alliance even vaguely possible? History says no, vehemently. But in
the days before Netanyahus government
collapsed in December, Israeli intelligence
sourcesusually the most skeptical people in the countrywere allowing tiny
shreds of hope to creep into their calculations. The common security interests
with the Arabs were compelling, several
of them told me, and might lead to new
arrangements in the region. It was not impossible that the Arabs could help broker
a peace deal with the Palestinians. The
Egyptians could help provide security; the
Saudis and Gulf states could provide funds
for Palestinian economic development.
For that to happen, though, Israel
would need to make changes of its own.
These governments cant be seen to be
cooperating with Israel as long as there
isnt a deal with the Palestinians, said
one intelligence expert, who spoke on the
condition of anonymity. ISIS can turn the
Arab street, especially their young people,
against them. Its bad enough that [the
U.S.] is dropping bombs on Sunnis in Iraq
and Syria. That strengthens [ISIS] on the
street as well.
At the heart of this conundrum stands
Benjamin Netanyahu. The Israeli Prime
Minister may have been selling an alliance with the Arabs in New York, but hes
been selling intransigence back home.
That includes a new law that would make
Israel a Jewish statewith the implication of second-class citizenship for its

1.7 million Arab citizens. His insistence on
pushing that law resulted in the collapse
of his government, as moderate parties led
by Tzipi Livni and Yair Lapid refused to
support the legislation.
Netanyahu is no longer very popular
in Israel, but no one is betting against him
in the March election. Given his political
skills, the absence of a charismatic mainstream challenger and the steady tattoo of
terrorist incidentsstabbings, shootings,
cars running over pedestriansmost
observers assume that Netanyahu will
prevail somehow, though he might even
struggle to maintain control of his Likud
Party. The rising tide seems to be with
the settler-movement leader Naftali Bennett, whose party might well outpoll Likud in March. It is also possible that the
moderate-liberal coalition of the Labor
Party and the splinter party of Livnis supporters will challenge Likud for rst place
in the March election and the right to attempt to form a government of its own.
The real negotiations begin after the
election. Netanyahu will try again to
cobble together a centrist coalition. The
big question is whether he will have to
include Bennett in a government; if so,
there will be no hope of Israels negotiating a deal with the Palestiniansand no
hope of closer public ties with its Sunni
Arab neighbors.
But there are other possibilities as
well. If Labor-Livni polls strongly and is
joined by Lapids centrist party, they may
nd a partner in Avigdor Lieberman. The
Foreign Minister and leader of the Israel
Beitenu party ran a crass, anti-Arab campaign last time. But Lieberman plays a
different game inside the government
than he does outside, says Shai Feldman,
director of Brandeis Universitys Crown
Center for Middle East Studies. As Foreign Minister, hes had to deal with the
leaders of other countries. Hes more of a
realist now. But hes also less of a political force, as recent polls show support for
his party waning dramatically because
of renewed corruption charges against
Lieberman. It is absolutely impossible to
predict how this election is going to turn
out, Feldman says.
Advertisement
Dont Run Out of Money During Retirement

What Investors Should Worry About
Its no secret that the vast majority of Americans entering their retirement years
are doing so with vastly underfunded retirement savings. However, even if you
have signicant nancial assets in your retirement savings, assets in excess of
$500,000, your hope for a comfortable retirement is hardly assured. In fact,
you could be headed for a nancial disaster just when you can least afford it.
And thats why you should request a free copy of Fisher Investments The
15-Minute Retirement Plan: How to Avoid Running Out of Money When You
Need It Most. Unlike most retirement advice, this guide is written for Time
readers with investible assets of $500,000 or more. Youll be surprised at what
you might learn and how much you might benet.
The 15-Minute Retirement Plan is loaded with practical information that
you can use to help meet your personal nancial goals in retirement.
Specically, youll learn:
The truth about how long your nest egg can last
How much you can safely take as income each year
How ination can wreak havoc with your plan and how to deal with it
Why so-called safe investments just might be the most risky approach
How reacting to short-term market movements can hurt your returns
And much, much more!
Benet From The FREE Retirement Guide

If you have investible assets of $500,000 or more, youre invited to take
advantage of this opportunity to benet from the research professionals at
Fisher Investments. These insights are unique, not available from anyone else
and absolutely free. We are making this guide available to you for two reasons.
First, we believe this information will be of great interest and usefulness to
investors with substantial assets. Second, while there is no obligation or
assumption that you will be interested in our money management services,
by sharing our intellectual capital we simultaneously provide a solid
introduction to Fisher Investments philosophy and approach.
About Fisher Investments

Fisher Investments is a money management rm serving successful individuals
as well as large institutional investors. With over $58 billion* in assets under
management and with a track record of over 25 years in bull and bear markets,
Fisher Investments uses its proprietary research to manage money for investors
who want their money to last.
I want to send you The

15-Minute Retirement Plan
because it contains valuable
information you can use to
help attain one of lifes most
important assets: nancial
peace of mind. After living
through the bear market
and the Great Recession,
its more important than
ever to request your free
report, even if you have an
investment plan in place.
Just one insight might
change your future.
The call to request your
copy only takes a minute,
but the rewards could last
a lifetime.
Ken Fisher
CEO and Co-Chief
Investment Ofcer,
Fisher Investments
Forbes Portfolio Strategy
columnist for 29 years
Author of 10 nancial
books, including four
New York Times
bestsellers
Please hurry! This offer contains time-sensitive information.
Call today for your FREE report!

1-800-695-5929 Ext. AC25
2014 Fisher Investments. 5525 NW Fisher Creek Drive, Camas, WA 98607.
Investments in securities involve the risk of loss. *As of 6/30/2014.
WORLD | MIDDLE EAST
50
The last stand Kurds in Turkey watch air
strikes in Kobani. The Syrian town is a symbol

of Kurdish resistance against ISIS
an alliance with a Palestinian leader currently sitting in an Israeli prison. Marwan

Barghouti, 55, is considered a folk hero by
both Hamas and Fatah. He was a prominent leader of the rst and second intifadehs before he was arrested by the Israelis
in 2002 and sentenced to ve continuous
life terms for murder. Barghoutis wife
has already announced her support for a
movement to draft him for President. Dahlans vision is that Barghouti would be the
titular head of the PA from inside prison
and Dahlan himself would be the handson guy, running the show from Ramallah,
while former Palestinian Prime Minister
Salam Fayyad, widely considered Palestines most effective bureaucrat, would
administer the West Bank.
Netanyahu has long lamented the fact
that he doesnt have a strong partner
on the Palestinian side. Abbas has never
had the support among his people to cut a
deal, and his predecessor Arafat had little
desire to do so. But a government led by
Barghouti or Dahlan could hardly be considered weak, and a Barghouti-Dahlan coalition would be formidable. The question
of what to do with Barghoutiwhether
P E T E R VA N A G T M A E L M A G N U M P H O T O S
The New Generation

netanyahu has been at the center of
Israeli politics for nearly 25 years. Abbas
has been a force in Palestinian politics
even longer. But a new generation of leaders is rising, which is why the LiebermanDahlan meeting in Paris was noteworthy,
at the very least. One thing the two men
have in common, despite their wildly divergent politics, is that both believe the
Netanyahu-Abbas era is coming to a close.
Dahlan is perhaps the most skilled of
the next generation of Palestinian leaders,
although he developed a well-deserved
reputation as a thug when he led the Palestinian security services in Gaza. He is
a young-looking 53, a protg of Yasser
Arafats and a native Gazan. Hes also the
sworn enemy of Abbas, who accused Dahlan of corruption and convicted him in
a show trial; Dahlan has been living in
Abu Dhabi since 2011. He has already announced that he will run for President of
the PA against Abbaswho is supremely
unpopularshould Abbas ever call the
Palestinian election that has been long
delayed. But Dahlans strategy is more
expansive than a one-on-one ght with
Abbas. His hope is to create a new coalition that would appeal to people across
the Palestinian political spectrum, from
Hamas to Fatah.
How could he manage that? By forming
to release him or nothas been discussed

by Netanyahus inner circle. At this point,
Barghoutis political views are a mystery;
he has been described as Mandela-esque
and utterly unrepentant.
Dahlan has been meeting with Arab
leaders across the region. He is close to
Sheikh Mohamed bin Zayed Al Nahyan,
the crown prince of Abu Dhabi, and also
to Egypts al-Sisi. His aspirations parallel
Netanyahus: that the Arab states could be
brought into the talks as intermediaries.
Dahlan hopes the Arabs will nudge the
Israelis to make concessions; Netanyahu
hopes that the Arabs will nudge the Palestinians to make concessions. But the
bottom line is the same: visions of commercial cooperation that transforms ports
in Gaza and Haifa into Middle Eastern
Singapores; visions of a security alliance
strong enough to fend off Islamic radicalism, both Shiite and Sunni.
The only thing preventing all this is
what usually gets in the way in the Middle Eastreality. Here is what might also
happen in 2015: Israel might elect a rightwing government that wants nothing to
do with the Arabs. The West Bank may
fall into chaos as the PA struggles without
the funds necessary to keep its security
forces in operation. The U.S. might make
a nuclear deal with Iran, with unforeseen
consequences for the region. The U.S.
might not make a nuclear deal with Iran,
with unforeseen consequences for the
region. King Abdullah might pass away
in Saudi Arabia. The moderate Jordanian
government might be overwhelmed by
the tide of Syrian, Iraqi and Palestinian
refugees. Bashar Assad might fall, or survive, with consequences for the Kurds,
the Turks and the Lebanese. Libyan militias might find common cause with
ISIS. The rickety new government in Iraq
might collapse.
Any of these events is more likely to occur than a peace deal between the Israelis
and Palestinians, brokered by the Arabs.
But the fact that the conversation is taking
placebetween Prince Turki and Amos
Yadlin, between Mohammed Dahlan and
Avigdor Lieberman, secretly at the U.N.
and in capitals across the regionmeans
that peace, the most unlikely Middle East
result, is no longer off the table.
100+ MAGAZINES | ALL-YOU-CAN-READ ACCESS | ONE LOW PRICE
Try it
FREE for
30 days
START YOUR FREE TRIAL TODAY AT NEXTISSUE.COM
On the march
Director Ava
DuVernay and actor
David Oyelowo,
photographed in
New York City
Photograph by Peter Hapak for TIME
CULTURE
A vivid new lm about

Martin Luther King Jr. couldnt
come at a better time
MAKING
SELMA
HISTORY
BY DA N IEL D A DDA R IO
the most surprising thing about the

history of Hollywood and Martin Luther
King Jr. is that there isnt one. There are
no good King movies. There are no bad
King movies. There are simply a handful of cameos in biopics about other
people, such as Ali and Lee Daniels The
Butler. Nearly 50 years after Kings death
in 1968, Selmawhich was released in
selected cities Dec. 25 and opens nationwide on Jan. 9is the rst full-length
lm to take a deep look at King or make
him the main character. Directed by Ava
DuVernay and starring David Oyelowo,
it examines a pivotal period in the last
four years of Kings life, the three votingrights marches he organized from Selma
to Montgomery, Ala., that ultimately led
to the passage of the landmark Voting
Rights Act in 1965.
Kings absence from theaters is a jaw
dropper, says DuVernay. Lets not even
list the biopics that weve had, she says,
53
CULTURE | FILM
King (Oyelowo) and his wife Coretta

(Carmen Ejogo) anked by marchers
54
A Long March
the cast and crew of selma began
breaking boundaries even before the lm
was released. DuVernay is the rst black
woman to be nominated for the Best Director prize at the Golden Globes; expectations are high that she will break the same
barrier when nominations are announced
on Jan. 15 for this years Academy Awards.
Oyelowo, who appeared last year in supporting roles in Interstellar and A Most Violent Year, was one of only two black actors
nominated for the 30 movie-acting slots at
this years Golden Globes. (The other was
Annies Quvenzhan Wallis.) The Screen
Actors Guilds 20 nominees were all white.
DuVernay and Oyelowo both toiled in
relative obscurity before Selma. The director spent many years as a publicist, marketing awards-ready moviesoften made by
white directorsto the black community,
including Invictus, The Help and Dreamgirls.
She directed the sensitive Middle of Nowhere
(2012), co-starring Oyelowo, about a young
woman dealing with her husbands incarceration, which won her a Best Director
prize at Sundance. But her lm was overshadowed that year by Beasts of the Southern
Wild, a fantastical tale about black life in
the South. It was only after Lee Daniels
dropped out of a long-gestating King biopic
that DuVernay came aboard, on Oyelowos
recommendation.
DuVernay, who reshaped screenwriter
Paul Webbs script before production began, says she was still rewriting in Decem-
ber 2013. Less than a year from script to

theaters is a little accelerated, she says.
That Selma came together at all after
years on hold is remarkable. But its all the
more impressive that the movie denies
easy gratication. It has more to say about
the messy business of political organization than it does about King. And its time
framethe early months of 1965means
theres no triumphant I Have a Dream
moment. King gave that speech at the
March on Washington 18 months earlier,
and though he would later reprise elements
of it, his tone in Selma is far less optimistic.
Oyelowo, a trained Shakespearean actor, found an advantage in skipping Kings
most famous refrain. Its like doing To be
WE WERE NOT
DOING A SAINTED
VERSION OF
HIM OR AN
OVERCORRECTED,
ANTIHERO
VERSION OF HIM.
ava duvernay
J A M E S N A C H T W E Y PA R A M O U N T P I C T U R E S (3)
but not one about one of the most famous

and inuential Americans who changed
the way we all behave and live. Films with
African-American protagonists are not
rst on the list of things to do.
Selma addresses Kings legacy not by
putting him on a pedestal but by showing him frustrated and beleaguered.
While his obvious opponents were whitesupremacist voters and politicians, he
also faced challenges from erstwhile allies, including the Student Nonviolent
Coordinating Committee, which had
grown impatient with his tactics, as well
as a complicated presidential partner in
Washington. The lms tight focus on the
Selma marcheswith their climax on
Bloody Sunday, when 600 marchers assembled on the Edmund Pettus Bridge and
were met with the nightsticks, tear gas
and charging horses of Sheriff Jim Clark
and his deputiesallows it to closely follow tactical debates among Kings uneasy
collaborators and between King and Lyndon Johnson (Tom Wilkinson), who urges the civil rights leader to proceed with
greater caution, insisting that change
would come incrementally.
We were not doing a sainted version
of him or an overcorrected, antihero version of himboth of which are scripts
that have floated around, DuVernay
says. We wanted to stay close to what
happeneda dynamic leader who was
at times depressed and let his ego get
in control.
Bloody Sunday, which turned public

opinion in favor of voting rights
Marchers cross the Alabama River on the

Edmund Pettus Bridge
or not to be, he says. Not to denigrate

the speech, but its a bit like doing a karaoke song. What you want, in playing a
character like Dr. King, is something revelatory. Otherwise, go watch a documentary. He had been hesitant to dig into the
project, he says, until the director put so
much meat on the bone, challenging him
to create an original character rather than
ventriloquize an icon. In one gripping
sequence, Kings marital tensions come
to the fore when the FBI sends his wife
Coretta (Carmen Ejogo) a tape of her husband, apparently with another woman. I
knew it was something we had to handle,
says DuVernay.
Oyelowos voice echoes Kings familiar
intonations but, directed at individuals
rather than projected to a crowd, lacks its
preacherly openness. Audiences will hear
a more intimate side of King. Most Americans dont know Dr. Kings conversational
voice, DuVernay says. They havent seen
interviews or heard him laugh. They know
the I Have a Dream speech and then that
he was killed. Theres a lot in between.
Reliving History
kings achievements were legion, but
theyre under threat. The Voting Rights
Actthe signature accomplishment won
in the Selma marcheswas weakened by
a 2013 Supreme Court ruling. The arguments over what sort of resistance is acceptable and what goes too far could as
easily have taken place a month ago, durtime January 19, 2015
ing nationwide protests against police brutality toward unarmed people of color. The
images of tear gas look all too familiar. If
theres one thing that Selma shows, says
Oyelowo, its that things havent changed
enough. Theres things in our lm that
show how far we need to go and means by
which we can get there.
The lms most stirring scene comes
early, when Annie Lee Cooper (played by
Oprah Winfrey, one of the lms producers) attempts to register to vote, having
brought ample documentation, and is
faced with an unpassable political-IQ test.
The challenges the Selma protesters faced,
the movie suggests, werent rooted in the
sort of racism that could be argued away
when rhetoric makes people see reason.
They were baked into the political system.
Selma has already ignited controversies
of its own. DuVernay has earned praise
for her nuanced portrayal of King, but in
showing Johnson as a President who was
opposed to the marches and had to be manipulated into proposing the Voting Rights
Act, she blurred the facts, according to some
historians and an aide who worked in the
White House at that time. While Johnson did want to advance his Great Society
agenda rst, they argue, he had already
prepared voting-rights legislation that he
could present to Congress. Furthermore,
the President was happy that Kings Selma
protests were making Southern bigots look
bad; he knew the news footage would build
support among sympathetic whites.
Critics also question a key plot point involving Johnson, the FBI and its director,
J. Edgar Hoover, who tells the President
hed be happy to smear King in retaliation.
At rst, Johnson rejects the idea and decries Hoovers methods, but later he asks
a secretary to connect him with Hoover.
We then see Kings wife opening a parcel that holds a recording of King in bed
with another woman, along with a threat
that he must stop his activity in Selma
or face further revelations. Its true that
King was a notorious womanizer, but it
was actually Robert F. Kennedy who had
approved Hoovers mud gathering, years
earlier. And though the FBI did send such
a recording of King, it was mailed the previous year. We knew we were bugged,
former King aide Andrew Young, who is
portrayed in the lm, told MSNBC. But
that was before LBJ.
Others, including writer Gay Talese,
who covered the marches for the New
York Times, have defended DuVernays
portrayal of events. And most historians
agree that the claim made by Johnsons
aide that the Selma marches were the
Presidents idea is overstated. DuVernay
responded to the criticism with a tweet:
Bottom line is folks should interrogate
history. Dont take my word for it or LBJ
reps word for it. Let it come alive for yourself. With King nally getting the kind
of big-screen treatment he has always deserved, it is appropriate that he once again
stirs deep argument.

55
CULTURE | FILM
F I L M OF T H E Y E A R : 1965 OR 2014?
Ava DuVernays Selma shows how much we still have to learn from Dr. Kings message
BY R IC H A R D C OR L IS S
56
Marching in Selma for the

human dignity of all races
Paul Webb, is all about realpolitik in the

service of social idealism. King must woo
Johnson (Tom Wilkinson), preoccupied
with the War on Poverty, even as he and
his Southern Christian Leadership Conference cohorts negotiate with the younger, more restless leaders of the Student
Non-Violent Coordinating Committee.
KING WAS A
REALIST. AND
SELMA IS ABOUT
REALPOLITIK
IN THE SERVICE
OF SOCIAL
IDEALISM
DuVernay, taking the reins of the

Selma project after Lee Daniels (Precious)
moved on to direct The Butler, worked on
Webbs script, sheared the budget to a
manageable $20 million and impressively
shepherded a huge cast with dozens of
speaking roles and hundreds of extras. No
less than King, she proved herself a wizardly community organizer.
Given that Kings children withheld permission to quote their fathers
speeches, Oyelowo wisely avoids mimicking the tremulous cadences of Kings oration. This is a lm set not on great lawns
but mostly in back rooms, where a forceful
whisper can have more effect than a pulpit
homily. Oyelowo gives a warm, acute performance and lends King a presence that
makes everyone from his wife Coretta
(Carmen Ejogo) to LBJ feel the power of his
argument, the singe of his soul.
Selma should be a time-capsule relic
a clue to how well we heeded the preachers words and how far we have advanced.
Instead it is a reminder that the American problem has yet to be solved.
J A M E S N A C H T W E Y PA R A M O U N T P I C T U R E S
there is no negro problem. there is

no Southern problem. There is no Northern problem. There is only an American
problem. President Lyndon Johnson
spoke these words in a nationally televised address to Congress on March 15,
1965, just eight days after the Bloody
Sunday confrontation in Selma, Ala. The
naked brutality of this assault spurred
LBJ to propose the Voting Rights Act,
which passed that August.
Today that act, which Johnson signed
with Martin Luther King Jr. and other
civil rights leaders at his side, has been
effectively gutted by the Supreme Court.
The past six months have seen demonstrations, violent and nonviolent, protesting
the death of unarmed black men at the
hands of police. So Ava DuVernays Selma,
a vivid restaging of Kings three historic
marches from Selma to Birmingham, carries a message of heroic, tragic relevance.
If not quite in quality, then certainly in
import and impact, this is the lm of the
yearof 1965 and perhaps of 2014.
If it can overcome critiques from Johnson historians who have challenged part
of its narrative, Selma could be a favorite
for the Academy Award. To cite it for Best
Picturealong with Best Actor for David
Oyelowo as King and Best Director for
DuVernaywould testify to the Oscar
voters political consciences as well as to
the lms undeniable power. The members would be voting yes for the hallowed
memory of Dr. King and no for the unjustied killings of unarmed blacks.
King would appreciate that conundrum: that violence can be a goad to good.
Civil rights had advanced with images
of decent black folks clubbed by angry
white cops. Alabama promised fertile
ground for telegenic confrontation, with
its segregationist Governor George Wallace, and Sheriff Jim Clarks police force
primed to be rough on pacists with dark
faces. King knew: If it bleeds, it leads.
He wasnt a cynic; he was a political
realist. And Selma, from a cogent script by
In our nations cities, 1 in 3 residents lack

access to a nearby park or natural area.
Join The Trust for Public Land as we work
to ensure that everyone has access to
nature within a 10-minute walk from home.
Since 1972, weve worked with communities to protect more than 3 million acres
and create more than 5,000 parks and
natural places to enjoy. Help keep this
land our land.
SHARE WHY NATURE MATTERS TO YOU:
tpl.org/ourland
#OurLand
SUMMARY NOTICE OF PENDENCY OF CLASS ACTION AND NOTICE IN

CONNECTION WITH SETTLEMENT
If You Purchased Certain ProductsCarpet Cushion, Bedding Products (for example,
mattresses or pillows), or Upholstered FurnitureContaining Polyurethane Foam, a
Class Action Lawsuit and Settlement May Affect Your Rights.
Si usted compr Cojn Alfombra, Ropa de cama (por ejemplo, colchones o
almohadas), o muebles tapizados que Contiene espuma de poliuretano, una demanda
colectiva y solucin puede afectar sus derechos. Para una notificacin en Espaol,
llamar o visitar nuestro website.
A lawsuit called In re Polyurethane Foam Antitrust Litigation, Index No.
10-MD-2196 (JZ) is pending in the United States District Court for the Northern District of
Ohio in Toledo. The case is about whether certain manufacturers of polyurethane foam (which
is used in carpet cushion, bedding products (such as, mattresses or pillows), and upholstered
furniture) conspired to raise the prices of polyurethane foam. On April 9, 2014, the Court
decided that this lawsuit could proceed as a class action on behalf of a Class or group of
people and entities that may include you. Defendants petitioned for leave to appeal that decision
and on September 29, 2014, the Sixth Circuit Court of Appeals denied Defendants request.
Additionally, a partial settlement has been reached with two of the Defendants: Valle Foam
Industries, Inc. and Domfoam International, Inc. (the Settling Defendants). The litigation is
continuing against all other defendants (the Non-Settling Defendants).
The Court has not decided who is right or wrong and nothing in this Notice or the
Courts order permitting this case to proceed as a class action expresses any opinion
by the Court as to whether the Class will ultimately be successful on their claims or
whether Defendants are in any way liable to the Class. Instead, the Court has ordered
this notice to provide information so you may make an informed decision regarding
your legal rights.
This notice summarizes your rights and options before an upcoming trial against the
Non-Settling Defendants and related to the proposed Partial Settlement. More
information is contained in a detailed notice available at the website below.
What Is This Case About? The lawsuit claims that the Defendants engaged in a
conspiracy to increase prices of polyurethane foam, which is used in carpet cushion,
bedding products (like mattresses and pillows), and upholstered furniture, and to allocate
customers. Plaintiffs contend that Defendants actions violated antitrust and consumer
protection laws in numerous states. The parties have vigorously litigated the suit for
several years, including many motions and an interlocutory appeal. The Non-Settling
Defendants deny that they did anything wrong and/or that they are liable to the Class. The
Court has not decided who is right. If this case goes to trial, the lawyers for the Class will
have to prove their claims with the Non-Settling Defendants at a trial.
Are You Affected? If you purchased, not for resale, carpet cushion, bedding products
(for example, mattresses or pillows), or upholstered furniture containing polyurethane
foam made by Carpenter Co., Domfoam International, Inc., FFP Holdings LLC (f/k/a/
Flexible Foam Products LLC and f/k/a Flexible Foam Products, Inc.), FXI-Foamex
Innovations, Inc., Future Foam, Inc., Hickory Springs Manufacturing Co., Mohawk
Industries, Inc., Leggett & Platt, Incorporated, Scottdel Inc., Valle Foam Industries, Inc.,
Vitafoam Products Canada Limited, Vitafoam, Inc., Woodbridge Foam Corporation,
Woodbridge Sales & Engineering, Inc., or Woodbridge Foam Fabricating, Inc., in AL,
AZ, CA, CO, DC, FL, HI, IL, IA, KS, ME, MA, MI, MN, MS, MO, NE, NV, NH, NM,
NY, NC, ND, OR, RI, SD, TN, VT, WV, WI during the period January 1, 1999 to the
present, then you are a member of the Class. You are included in the Class if you
purchased polyurethane foam indirectly, meaning that you did not purchase
polyurethane foam directly from any of the Defendants, but instead bought a product
from a company other than one of the Defendants that incorporated polyurethane foam
made by one of the Defendants.
What Does the Partial Settlement Provide? A Partial Settlement has been reached
with the Settling Defendants: Valle Foam Industries, Inc. and Domfoam International,
Inc. No money is being paid by Valle Foam Industries, Inc. and Domfoam
International, Inc., but they have agreed to provide substantial assistance to the Class
in the prosecution of their claims.
Who Represents You? The Court has appointed Marvin A. Miller of Miller Law LLC
to represent the Class. The lawyers for the Class will have to prove their claims with
the remaining Defendants at a trial. No date has been set for when the trial will begin.
What Are Your Options? If you are included in the Class, you will need to decide
whether to: (1) stay in the Class or (2) ask to be excluded from the Class.
To stay in the Class, you do not need to do anything at this time. You will be legally
bound by all orders and judgments of the Court, and you wont be able to sue, or
continue to sue, the Defendants as part of any other lawsuit for conspiring to fix prices
or allocate customers of polyurethane foam or polyurethane foam products which
contain polyurethane foam manufactured by Defendants.
If you do not want to participate in this lawsuit or the Partial Settlement, you may
request to exclude yourself from the Class. If you exclude yourself, you will not be
bound by or benefit from any court orders, jury verdicts, or settlements approved by the
Court, but you keep your right to sue or otherwise resolve your claims, if any, with
Defendants on your own. Requests to Exclude must be in writing and received by
March 13, 2015. You can obtain more information at www.PolyFoamClassAction.com.
The Court will hold a hearing on April 2, 2015, at 9:00 a.m. at the Carl B. Stokes U.S.
Court House, 801 W. Superior Avenue, Cleveland, Ohio 44113 to consider whether to
approve the proposed Partial Settlement with Valle and Domfoam. If you stay in the Class,
you may object or comment on the Partial Settlement by March 13, 2015. You or your
own lawyer may, but are not required to, ask to appear and speak at the hearing at your own
cost. The Court may change the date, time or location of the hearing. To obtain the most
up-to-date information regarding the hearing date and location, please visit
www.PolyFoamClassAction.com or call 866-302-7323.
If you have questions or want a detailed Notice or other documents about this
lawsuit and your rights, go to www.PolyFoamClassAction.com or call
866-302-7323. Para una notificacin en Espaol, llamar o visitar nuestro website.
AUTHOR
APPROVED!
The Culture
CURTIS SITTENFELD
Author of Sisterland
George and Martha

by James Marshall
These tales of two
hippo BFFs are
wonderfully irreverent
and full of both
misbehavior and
compassion.
Books
OUR
ALL-TIME
FAVORITE
BOOKS
FOR YOUNG
READERS
The best illustrated and chapter books;
Meg Wolitzer on a transformative teen novel;
grownup authors recall beloved classics
INSIDE:
Illustrations by Tomi Um for TIME
Were living in a golden age of young-adult literature,

when books ostensibly written for teens are equally
adored by readers of every generation. In the likes of
Harry Potter and Katniss Everdeen, theyve produced
characters and conceits that have become the
currency of our pop-culture discourseand inspired
some of our best writers to contribute to the genre. To
honor the best books for young adults and children,
Time compiled this survey in consultation with
respected peers such as U.S. Childrens Poet Laureate
Ken Nesbitt, childrens-book historian Leonard
Marcus, the National Center for Childrens Illustrated
Literature, the Young Readers Center at the Library
of Congress, the Every Child a Reader literacy
foundation and 10 independent booksellers. With
their help, weve created two all-Time lists of classics:
100 Best Young-Adult Books and 100 Best Childrens
Books. The top 25 in each category are presented here;
for the full lists, visit time.com/youngreaders.
MARTIN AMIS
Author of The Zone of Interest
Goodnight Moon by Margaret Wise Brown (author)

and Clement Hurd (illustrator)
I must have read Goodnight Moon to my children several
thousand times, and I was never bored by it. The book has
its own soporic poetryand it quite often worked.
GILLIAN FLYNN
Author of Gone Girl
The Westing Game

by Ellen Raskin
It completely
charmed me as a
kid: the clever
mystery, the
complex characters
(especially the
grownupswho
knew they had lives
too?) and the nasty,
fantastic TabithaRuth Wexler. I still
read it once a year.
The Culture
Books
TOP 10:
YOUNG ADULT
AGES 12 AND UP
1 The Absolutely True Diary of

a Part-Time Indian Sherman
Alexies coming-of-age
novel (illustrated by Ellen
Forney) illuminates family and heritage through
young Arnold Spirit,
torn between his life on
a reservation and his
largely white high school.
The specics are sharply
drawn, but this novel,
with its themes of selfdiscovery, speaks to young
readers everywhere.
2 Harry Potter (series) What
more can be said about
J.K. Rowlings iconic franchise? How about this:
seven years after the nal
volume was published,
readers young and old still
go crazy at the slightest rumor of a new Potter story.
3 The Book Thief For many
young readers, Markus Zusaks novel provides their

rst in-depth contemplation of the Holocaust. Although terror surrounds
Liesel, a young German
girl, so too does evidence
of friendship, love and
charityredeeming
lights in the darkness.
4 A Wrinkle in Time Mad-
eleine LEngles surrealist

adventure has provided
generations of children
with their rst-ever mindblowing experiences, as
Meg travels across the
fth dimension in search
of her father. But the sci-
also has a message: Meg
learns self-sufciency and
bravery in the process.
62
5 Charlottes Web Read-
ers are still drawn to the

simplicity and beauty of
arachnid Charlottes devotion to her pig pal Wilbur.
Though family farms may
be less common than they
were in 1952, E.B. Whites
novel remains timeless for
its enduring meditation
on the power of friendship
and of good writing.
6 Holes Louis Sachars sto-
ry of a family curse, fancy

sneakers and poisonous
lizards moves forward and
backward through time,
telling of how Stanley Yelnats IV ended up in a juvenile prison camp. Its an
introduction to complex
narrative, suffused with
fun, warmth and a truly
memorable villain.
7 Matilda With apologies
to the lovable Charlie and
the Chocolate Factory, this
may be Roald Dahls most
compelling read for young
MICHAEL LEWIS
author of Flash Boys
The Hardy Boys

by Franklin W. Dixon
As a kid I lived on a
steady diet of The Hardy
Boys and Archie comic
books, without the
slightest sense there was
anything better I might be
doing with my time.
people. Poor Matilda feels

thwarted and ignored by
her familya sense that
many preteens share.
They dont share her magical powers, but thats the
enduring appeal of this
escapist frolic.
8 The Outsiders Published
when author S.E. Hinton
was just 18, this comingof-age novel offers proof
that even the youngest
writer can provide valuable insight. Her striking look at Ponyboy and
gang life in the 1960s has
resonated for decades with
readers of all kinds, whether they identify more with
the Greasers or the Socs.
9 The Phantom Tollbooth In
a witty, sharp fairy tale
that illuminates language
and mathematics through
a picaresque story of adventure in the Kingdom
of Wisdom, Jules Feiffers
whimsical drawings do as
much as Norton Justers
plain-language interpolations of complex ideas
to carry readers through
Digitopolis and the Mountains of Ignorance.
10 The Giver Lois Lowrys
tale of self-discovery in a
dystopian society has a
memorable central character, Jonas, and an indelible
messagethat pain and
trauma have an important
place in individual lives
and in society, and to forget them is to lose what
makes us human.
daniel daddario
AND
15
MORE
Are You There God?

Its Me, Margaret
Judy Blume
To Kill a Mockingbird
Harper Lee
Roll of Thunder,
Hear My Cry
Mildred D. Taylor
Anne of Green Gables

(series)
L.M. Montgomery
The Chronicles
of Narnia (series)
C.S. Lewis
Monster
Walter Dean Myers
The Golden Compass

Philip Pullman
Looking for Alaska

John Green
The Diary of a Young Girl

Anne Frank
The Curious Incident

of the Dog in the
Night-Time
Mark Haddon
From the Mixed-Up Files

of Mrs. Basil E.
Frankweiler
E.L. Konigsburg
Little House on the

Prairie (series)
Laura Ingalls Wilder
The Miraculous Journey

of Edward Tulane
Kate DiCamillo
Wonder
R.J. Palacio
The Once and Future
King (series)
T.H. White
CONTRIBUTING BOOKSELLERS:
BOOK PEOPLE (AUSTIN); BOOKS
AND BOOKS (CORAL GABLES,
FL A.); ELLIOT T BAY BOOK
COMPANY (SE AT TLE); POLITICS
AND PROSE (WASHINGTON,
D.C.); POWELLS BOOKS
(PORTL AND, ORE.); PRAIRIE
LIGHTS (IOWA CIT Y ); SK YLIGHT
BOOKS (LOS ANGELES); SQUARE
BOOKS (OXFORD, MISS.); THE
TAT TERED COVER (DENVER); THE
STR AND (NE W YORK CIT Y )
FOR THE COMPLE TE

LIST, GO TO time.com/
youngreaders
Photograph by Andrew B. Myers for TIME
The Culture
Books
YOUNG ADULT
AT HEART
BY MEG WOLITZER
When novelist Meg Wolitzer began writing

Belzhar, her rst book for a YA audience, she
turned to Sylvia Plath and The Bell Jar
he first time i read
Sylvia Plaths autobiographical novel The
Bell Jar, it was an emotional,
chaotic experience. Her narrator has a nervous breakdown
while a college student and
attempts suicide, as Plath had.
The story is so viscerally real
and imaginable that I, then
a teenager, was immersed.
Plath, who recovered from her
breakdown but committed
suicide at age 30, left behind

one powerful novel, many
brilliant poems, a good deal of
short ction and voluminous
journals. But it was in The Bell
Jar that she used the detailed
landscape of a novel to look
bravely at her illness, and she
compelled readers to look
with her.
Flash-forward several decades. I had embarked upon
writing a young-adult novel
in which The Bell Jar plays a

part. Belzhar (pronounced
bel-jhar, a play on Plaths title)
is about a troubled girl, Jam
Gallahue, who tragically loses
her boyfriend and is sent to a
therapeutic boarding school
where shes placed in a class
that reads only one writer over
the whole semester. This year,
the teacher has decided they
will read Plath.
Plath told the truth in The
Bell JarI dont mean only
the autobiographical truth,
though that was part of it
but also a larger truth about
how emotional suffering can
Plath (left, circa 1957) and Wolitzer (pictured during her

college years) both studied at Smith College. Both have written
about womens struggles to dene themselves
P L AT H : B E T T M A N N/C O R B I S; W O L I T Z E R : C O U R T E S Y M EG W O L I T Z E R
64
make people feel isolated under their own airless glass jars.
Because of this truth, young
readers like me were deeply
affected and in some ways
transformed. Had Plath been
a famous suicide but not such
a ne writer, her reputation
would likely have zzled out
after her death. But she was uncommonly good, so she stuck.
Teenagers read her when I was
that age, and I sense that many
teenagers still read her now.
And so, for research purposes, I read Plath again. But
now, instead of responding
only to the young narrators
detachment and despair, as I
had long ago, I also found myself, to my surprise, responding to the woman Sylvia Plath
would never become. The
writer who would never continue to mature with age. The
mother who would never see
her children off into the world.
The person who wouldnt have
the chance to live a long life.
Younger me tended to take
the short view, feeling everything along with the narrator as it happened and never
thinking about that nebulous
thing called the future. But
now, as a middle-aged woman,
I denitely took the long view.
It occurs to me that not only
readers but also writers often
fall into the habit of taking either the short or the long view
when they work. Im a novelist
whose ction has mainly been
for adults; my most recent
adult book, The Interestings, lavishes a lot of time on its characters when theyre young.
Then it keeps going, following
them from age 15 all the way
into their 50san age I can
relate to well these days, as my

children have left home, and I
must remind myself to schedule my yearly mammogram.
But Belzhar, a novel about
adolescents written for adolescent readers (although these
days plenty of adults read
YA too), takes place over the
course of only one semester at
boarding school. And while
The Interestings is told from
multiple points of view, Belzhar hews close to its narrator,
letting her tell her story in
a particularly close-grained
way. Jam is someone who
needs to talk, who is breathless and single-minded; making her a rst-person narrator
JESMYN WARD
Author of Men We Reaped
The Hero and the Crown

by Robin McKinley
When I was around 8, I
discovered this book at my
local book fair. I charmed
one of my cousins into
buying it for me, and then I
devoured it. The heroine is
an illegitimate princess who
hunts dragons in an attempt
to nd a place for herself in
her fathers kingdom. The
heroine is tough, stubborn
and smart, taking on a world
bent on making her less than
she is. I empathized.
struck me as the best way to

convey her voice, her neediness, her absolutely certain
convictions about what had
happened to her.
I couldnt help but think,
when writing this novel, of the
two versions of me who had
read The Bell Jar. Maybe there
were two versions of me who
should be writing Belzhar: one
who was still close to the intensity of adolescence, for whom
everything felt fresh and raw.
That version, which still exists
inside of me, took care of the
parts in which I needed to drag
up feelings buried in the overstuffed dresser drawer that is
adolescence: What its like to
make rst-time emotional, romantic, even sexual decisions.
What its like to manage the
overwhelming new sensations
and thoughts that invade you.
What its like to feel rejected.
What its like to realize that
everyone is essentially on
their own.
But then the older version of me had to put the
whole thing into context, to
remember that circumstances
can change if you give them
enough time, even if my narrator cant know it. I wanted
the older me to be somewhere
in the mix of this YA book,
though not to give Jam a
goody-goody articial voice
of reason. Books arent morality plays; they dont all need
lessons. But given that Belzhar
takes place in a special class
at a special boarding school, it
seemed appropriate that there
would indeed be some kind of
essential lesson conveyed.
And thats the point at
which Mrs. Q stepped in: Jams
elderly teacher, a woman who

knows quite a bit about how
things can change. Without
realizing it at rst, I became
part Jam and part Mrs. Q, shuttling between someone who
takes the short view and someone who takes the long.
At book readings, audience
members often ask how writers create characters. People
want to know: Have writers
actually experienced what
their characters experienced?
And if not, where do their
ideas come from? My best,
though incredibly vague, answer is that ideas come about
through the long, slow process
of living. Even if a characters
experiences arent your own,
you are citizens of the same
world, and youve had your
experiences and witnessed
other peoples too. While all
thats been going on, empathy
has quietly been forming; its
almost a chemical process.
And if youre a writer,
youve also been reading. A lot.
And while Belzhar isnt a ripoff or a retelling of The Bell Jar,
it reects on Plaths novel and
owes a debt to it. Its not that
you want to imitate the book
you admire; you just want to
do your version of what that
writer did: you want to tell the
truth, ction-style.
There are quite a few of us
former teenagerswomen in
the middle of their lives (and
some men, for sure)who
have never forgotten what it
felt like to read The Bell Jar for
the rst time. So what are we
supposed to do with all that
leftover feeling?
Me, I decided to write a
book.
65
The Culture
Books
TOP 10:
CHILDREN
AGES 311
1 Where the Wild Things Are
Maurice Sendaks adventure has inspired generations of children to let out

their inner monsters,
showing how imagination
allows for an escape from
lifes doldrums. Its also a
moving testament to family love: when young Max
returns from his reverie,
his mother has saved him
a hot dinner.
instructive read for any

kid whos ever felt a bit
like a wild animal, or parents whove ever felt like
theyre raising one.
5 Little Bear (series) Else
Holmelund Minarik
wrote these stories, which
convey a young cubs
yearning for his absent
father, but its Sendaks illustrations that catch the
eye and allow for endless
imaginings of life among
woodland critters.
2 The Snowy Day The journey of Peter through a

snowbound New York
City made for a milestone:
as a successful childrens
story focused on a black
protagonist, it broke down
barriers many white editors may have never noticed. But Ezra Jack Keats
book is memorable too for
the sheer beauty of its collage illustrations.
6 Owl Moon Many young

bird watchers likely owe
their passion to Jane
Yolen, whose story of a
father-daughter trip to
nd the elusive great
horned owl takes ight
thanks to John Schoenherrs evocative woods-atnight illustrations.
3 Goodnight Moon Some-
7 The Giving Tree Its hard
where a child is being put

to sleep right now to Margaret Wise Browns soothing, repetitive cadences.
While the lines may be
etched in every parents
memory, Clement Hurds
illustrations, with their
quirky hidden jokes, provide amusement on the
thousandth reading.
to imagine a story more

poignant than Shel
4 Blueberries for Sal Robert
McCloskeys block-printed
illustrations show just
how similar families of
different species can be, as
child Sal and a baby bear
covet Maine blueberries
on a berry hunt with their
respective mothers. Its an
66
DAVE EGGERS
Author of The Circle
Adle & Simon and

Adle & Simon in
America by Barbara
McClintock
McClintocks artwork is
ridiculously beautiful,
and because readers
are asked to nd objects
that Simon has lost
during various trips
including turn-of-thecentury Paris and the
USAthe books reward
very close attention.
Silversteins tale of a tree

that gives its life for a
boy turned self-centered
young man. Its been interpreted along environmentalist and religious lines,
but all can agree on the
beauty of its underlying
theme of generosity.
8 The True Story of the Three
Little Pigs Jon Scieszka and
Lane Smiths ironic, witty

book, which revises the
story of the pigs as an exculpatory memoir by the
wolfwho claims hes
not so big and bad at all!
is a welcome corrective
to more saccharine tales.
It also introduces young
readers to the notion of
dueling perspectives.
9 Tuesday Who needs
text? Not illustrator

David Wiesner, who
also wrote the very few
words that make up his
tale. His stunning, propulsive watercolors show
ying frogs on a surreal
adventure. Reading may
be fundamental, but here
the pictures do almost all
the talking.
10 Where the Sidewalk Ends
Silverstein wasnt just

good at tales of leafy selfsacrice. His loopy poems
have been speaking to
kids concerns and sparking their imaginations for
decades. Any child whos
ever fantasized about
playing hug o war instead of tug-of-war will
nd a kindred spirit in
these pages. d.d.
AND
15
MORE
Harold and the

Purple Crayon
Crockett Johnson
(author and illustrator)
Make Way
for Ducklings
Robert McCloskey
Olivia (series)
Ian Falconer
Madeline (series)
Ludwig Bemelmans
Click, Clack, Moo

Doreen Cronin (author),
Betsy Lewin (illustrator)
Annos Journey
Mitsumasa Anno
The Story of Ferdinand

Munro Leaf (author),
Robert Lawson (illustrator)
Frog and Toad (series)

Arnold Lobel (author and
illustrator)
Dont Let the Pigeon

Drive the Bus!
Mo Willems
The Lorax
Dr. Seuss
Corduroy
Don Freeman
I Want My Hat Back

Jon Klassen
Miss Rumphius
Barbara Cooney
Alexander and the

Terrible, Horrible, No
Good, Very Bad Day
Judith Viorst (author),
Ray Cruz (illustrator)
FOR THE COMPLE TE
LIST, GO TO time.com/
youngreaders
Brave Irene
William Steig
Photograph by Andrew B. Myers for TIME
THE AWESOME COLUMN
JoelStein
Hey Baby, Can I Get You a Beer?
What I learned about making people laugh

on the set of Americas Funniest Home Videos
when i was in second
grade, I asked my parents
what the Vice President did.
They told me that the second most important person
in the country didnt have any responsibilities whatsoever. For the next ve
years, I told people that when I grew up, I
wanted to be the Vice President.
So when Tom Bergeron announced he
was stepping down as the host of ABCs
Americas Funniest Home Videos (AFV)
after 14 years, I applied. I could be on network TV every week, introducing a few
clip packages while making tons of money and getting invited to lots of parties
many of which, admittedly, would have
guest lists consisting of cats or men with
ice packs on their groins.
I walked onto the AFV stage feeling
surprisingly nervous, so I asked Bergeron
for advice on how to be funny when
hosting a family show. Relax, have fun
and remember your role is to service
the videos. Which sounds dirtier than I
intended, he said. In other words: make
jokes that sound edgy but are actually
safe because they dont make sense.
Vin Di Bona, the shows creator and

executive producer, told me hes leaning toward hiring someone famous and talented.
Still, he said, while I was unpolished, I had
some of that Bergeron magic, compared
with the blunter skills of previous host Bob
Saget. He had to have laughter to know it
was right, he said. You didnt need that.
You just presented and moved on. Yes.
That is exactly what I was trying to do. I
was not just being quiet because all the
jokes I could think of with a y, a penguin
and a leprechaun were racist.
To prepare, I watched Bergeron tape a
68
Di Bona, however, thought I might be

a better t as a writer. So a few weeks later
I spent an afternoon working for head
writer Todd Thicke, who has been with
the show since 1989. He has the same
good looks and deep voice as his brother
Alan Thicke and nephew Robin Thicke
and, Im guessing, other Thickes. I sat at a
table with three other writers, looking at
walls covered with index cards, on which
were written things like A boy comments on how to impress the ladies in the
car. Then suddenly screams in a panic
when he sees a spider and A dog shows
its teeth and growls while a woman rubs
its butt with her foot indoors. This was
going to be easy.
We stared at a screen and watched
the very best 10% of submitted videos,
as culled by screeners who Im assuming
The writers had an amazing ability to
predict, within just a few seconds, what

would happen in the clips we watched, all
of which provided me with valuable life
lessons: dont wear socks on kitchen tile;
dont run near the buttocks of an obese
woman; use extreme caution when weight
lifting at home alone; dont leave our in
an area accessible to toddlers. Since AFV is
a family show, the writers cant use a lot of
the best stuff, like a baby smiling widely
after tasting a beer. You can barely give a
monkey a cigarette, no less a baby a beer,
said Erik Lohla. The world has changed,
agreed Jordan Schatz.
So to make the clips seem more exciting, they combine them using clever
frames like Failed football entrances vs.
babies knocked over by sneezes. Thicke
also set us to work creating alternative
meanings for NSFW besides not safe for
work that he could print below clips. At
rst I tried to write for clips wed seen, such
as nice sprinkler fart, wanker for the guy
with the sprinkler stuck in his pants and
new style feline wevenge for the cat who
attacked a dog, but the other writers simply searched for new topics in their 25-year
database of clips. They found me lots of
guys falling off stripper poles for never
strip for women, but Thicke thought that
it wasnt in great taste. And they didnt
seem excited about my suggestion that we
take absolutely any clip anyone submitted
and just write no sense from within.
Its been several months, and I havent
heard back about either job. Luckily, I
have some pretty adorable footage of my
son that Im sure will win $10,000.
I L L U S T R AT I O N B Y T O M A S Z W A L E N TA F O R T I M E ; G E T T Y I M A G E S (3)
show, during which I noticed many surprising details, like the fact that the show
is an hour long. It turns out Id never actually seen Americas Funniest Home Videos,
which made me even more anxious.
When the show ended, I walked out to
great applause, whichalong with the
bright lights and my loud, distracting
heartbeatmade it hard to remember
which cameras to look at, though Im
pretty sure there wasnt one in my shoes.
Then I brought two audience members
up for a game called Pick the Real Video!
in which I asked them if I was about to
show a clip of a housey stuck to a frozen
hot dog, a penguin swimming in a hotel
fountain or a leprechaun falling down an
escalator. One of the contestants picked
the leprechaun. The show is not called
Americas Smartest Home Video Watchers.
work in Chinese prison camps. And they

were still insanely boringjust cute
pets, cute babies and uncute tweens dancing in their bedrooms. It took 90 minutes
before we saw the rst guy get hit in the
testicles, which was the rst time we
laughed. Its weird, I said. As soon as
someone gets hurt, people laugh. Writer
Mike Palleschi looked around the room
and said, I think thats our fault.
THE KEYS TO
A NEW HOME
OPEN A
NEW ERA.
Twenty years after the end of apartheid, the path to wealth through
property ownership is still closed to many South Africans. International
Housing Solutions, a global private equity rm, is determined to change
that. Their idea: a fund to build safe, affordable housing for rising middle
class families. Citis early support and expertise has helped the fund grow
to nance 27,000 housing units across South Africa. Its success is being
used as a model throughout the continent.
For over 200 years, Citis job has been to believe in people and help
make their ideas a reality.
citi.com/progress
2014 Citibank, N.A. Equal Opportunity Lender. Citi and Citi and Arc Design are registered service marks of Citigroup Inc. The Worlds Citi is a service mark of Citigroup Inc.

Time Magazine - January 19, 2015

Uploaded by

Document Information

Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Description:

Copyright:

Available Formats

Time Magazine - January 19, 2015

Uploaded by

Description:

Copyright:

Available Formats

JANUARY 19, 2015

vol. 185, no. 1 | 2015

Plus, novelist Meg

Foreign-affairs columnist Ian Bremmer

A new lawsuit revives

Joel Stein tries out

time January 19, 2015

LIGHTBOX James Nachtwey was moved to become

The Consumer Electronics Show, which this

Nancy Gibbs, editor

Send a letter: TIME Magazine Letters, Time &

time January 19, 2015

this weeks cover story marks the

I want to drink beer brewed

Every someday needs a plan .

s/NE ON ONEGUIDANCEFOCUSEDONYOURGOALS NOTOURS

Move your old 401(k) to a Fidelity Rollover IRA,

The Kentucky Senators

RAND PAUL ON CUBA

away from outdated policy that harms the Cuban

time January 19, 2015

Call for Special Pre-Cruise Offer in Qubec City

The Quantum Enigma

2. The View from 1900

Taught by Professor Benjamin Schumacher

3. Two RevolutionariesPlanck and Einstein

Complementarity and the Great Debate

Offer expires 01/19/15

Quantum Mechanics: The Physics of the

+$10 Shipping, Processing, and Lifetime Satisfaction Guarantee

Priority Code: 105659

For 24 years, The Great Courses has brought the

Minister, describing his close

ANNE HIDALGO, mayor of Paris,

after gunmen killed at least

The number of new

Sales in Japan were

New York City mayor,

The number of miles

I am very proud of all the employees ... who stood up

time January 19, 2015

else too: it was an act foretold.

the men who mounted the

commentaries and cartoons

the french, who have seen

Hebdos journalists were in

government has most feared.

Figures Who Were Literally

Im a journalist but was only

extremists, they were more

Sea of Troubles H1HZ<HDUKROGV

every january, eurasia group, the political-risk consultancy

Vladimir Putinbut not

Graphic sources: Eurasia Group;

countries like Brazil, Australia, Indonesia and Thailand,

Fallen star Turkeys Erdogan

Zuma, Nigerias Goodluck

5. ISIS, BEYOND IRAQ

Past approval rating

Brazil Turkey Japan U.S.

Current approval rating

s/NE ON ONEGUIDANCEFOCUSEDONYOURGOALSNOTOURS