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Pluralistic: Critique and writing (23 Oct 2026) by Cory Doctorow
Sunday October 25th, 2026 at 12:26 PM

Pluralistic: Daily links from Cory Doctorow
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Today's links

  • Critique and writing: The most important part of a writing workshop is trying to fix other people's stories.
  • Hey look at this: Delights to delectate.
  • Object permanence: USPS nukes the mail; Enron Explorer; "Scored"; UAE's international hacker legion; NZ provides hacking tools to torturers; Truecrypt insecure; The Traitorous Eight.
  • Upcoming appearances: Vancouver, Ottawa, Vienna, Kilkenny, Courtenay, Vancouver, Oxford, Sheffield, Virtual, Oxford, Montreal.
  • Recent appearances: Where I've been.
  • Latest books: You keep readin' em, I'll keep writin' 'em.
  • Upcoming books: Like I said, I'll keep writin' 'em.
  • Colophon: All the rest.


A vast field of complicated machinery composed of many-times-overlaid 19th century printing presses. Caught in these gears are several figures who are all writing - a bearded Greek in a loincloth, a severe doge, a grande dame, a lady upon her settee, a recording angel, two drunken clerks at a table, a tormented poet in a wig. Invading the scene is a many-tentacled pulp robot.

Critique and writing (permalink)

Through my own writing life, nothing has done more to improve my writing than diligent participation in peer-based workshops; that's where a group of writers, all at about the same stage in their artistic development, gather to read one another's work and offer feedback specifically aimed at improving each other's stories.

This is a deceptively simple exercise, and the reasons it works so well are quite counter-intuitive. The most obvious benefit is the way that a workshop encourages you to write at all. When you're at the start of your writing career, you are almost totally reliant upon your own internal self-discipline to keep producing.

Acquiring that self-discipline is infinitely valuable, but it's also incredibly hard. Being part of a group of writers who expect you to regularly turn in new work adds a very useful bit of external motivation that augments your still nascent self-discipline. Knowing you have to turn in a story for the group by Friday can get you in gear when you feel discouraged or blocked.

Before you're getting published regularly (or at all), your critiquing circle might be the only source of validation you get for your work, so the knowledge that you're in for that validation if you get that story in on time is a great motivator. But this is where the counter-intuitive part comes in: as great as it feels to be the center of your peers' attention and to get close feedback on the work you sweated over, that's not the real value you get from a writing workshop, at least not at the start of your career.

Your peers' critiques can help you fix weaknesses in your story, and even teach you a little about how to avoid those weaknesses in future work. You might get feedback that turns an unpublishable story into a published one. But the point of a writing workshop isn't merely to make your stories better – it's to make you better at writing stories.

That's where critiquing other writers' stories comes in. The process of reading and re-reading someone else's imperfect work and devoting real mental energy to figuring out what's not working in it and how to fix it is how you develop the creative instincts that allow you to automatically and unconsciously avoid pitfalls and make breakthroughs in your own work.

Even if none of the feedback you offer is ever incorporated into the story you're critiquing, the act of preparing and delivering that critique is the most reliable fast-track to becoming a better writer yourself. There's something very valuable in the combination of thinking critically, being exposed to other workshop members' ideas about the story under discussion, and working with source material that you can look at with more objectivity because it didn't come out of your own head.

I bring all this up because I've now heard from a few beginning writers who tell me that they're finding LLMs to be good editorial feedback generators. They value the editorial suggestions they get from a chatbot after they finish their work, and use it to help them with a new draft. Without commenting on whether I think LLM feedback is editorially useful (I certainly wouldn't ever ask a chatbot for that kind of feedback), I want to point out that when it comes to improving your writing, getting editorial notes on your work is distinctly inferior to offering criticism of other writers' work.

The reality is that when you're starting out as a writer, the vast majority of work you produce will be artistically unsalvageable. The much-vaunted "million words of crap" you write on the way to becoming a publishable writer are about learning to marry technique to artistic vision and to sharpen both. Getting editorial feedback that helps you shore up the weakest spots in a story that is ultimately never published and constitutes a learning exercise has value, but it has far less value than applying the things you've learned from making and fixing those mistakes to your next story.

With vanishingly few exceptions, a commercially and artistically successful writer isn't someone who writes one great story or novel: a writing career is defined by a body of work, which means that you have to do more than rewrite. You have to write the next thing, and the next thing, and the next.

Having an editor-on-demand of highly variable (and often dubious) quality might help you improve your writing, but it's no substitute for participating in a peer workshop. The idea that an LLM might be able to stand in for a workshop is grounded in the fallacy that the point of a workshop is to have people tell you how to fix your story, rather than analyzing other people's writing in order to develop your own critical skills.

Look: it's a cliche to say "every writer is different," but I really believe that every writer is different, and that's down to the legibility of the writing process to other writers. If you're a painter or sculptor or other visual artist, you've likely spent many hours in a studio with many other practitioners while all of you work from the same life model or still life. If you're a musician, you've almost certainly played music with other musicians. If you're a dancer, you've definitely danced with other dancers.

But writers get precious little exposure to other writers' process. At best we might look at each other's drafts. A musician can listen to every note another musician produces while riffing or composing a new work or interpreting a work. Writers don't get to watch words emerge from each other's fingertips. Being observed that closely while you write would be ghastly and paralyzingly invasive.

I've taught a lot of writers over the years and I've had many discussions with my peers about their writing process, and I'm here to tell you that pretty much every writer finds every other writer's process baffling. We each of us invent an idiosyncratic process for ourselves that will never fully work for anyone else.

So if you value editorial feedback from a chatbot (ideally, a local one running on your computer and not one of the "foundation models" that are torching the planet and elevating the worst people on earth to positions of political, technical and commercial prominence), that's fine, you do you.

But even if that's the case, I still want you to know that whatever you're getting out of the chatbot is fundamentally different, and (I believe) much less useful than participating in a peer workshop.

That's what I wanted to say today, but I predict that an appreciable number of readers are about to email me to ask how these "peer workshops" work. There's a ton of variability in how these are conducted, but the basic shape of them is that in advance of each session, one or more writers submits a finished work to the other writers, who then read through the manuscript at least twice, making notes that include both minor copyedits and broader, thematic notes. They may write a brief editorial response as well, ranging from a paragraph to a couple of pages.

Then the workshop convenes. Each writer briefly expresses their views about the story under consideration, focusing on those thematic and structural notes on what worked and didn't work in the story, with suggestions for improving the latter. You don't need to point out every typo – they're noted on the manuscript. Critiquers don't need to repeat one another. If another workshop member says the thing you were planning to say, you can just say "Ditto what so-and-so said about whatever." If you have nothing to add when your turn comes about, it's fine to pass.

Those are pretty much universal characteristics of a peer workshop. Here are some variations that I am dogmatically committed to, but which other workshoppers might disagree with:

  • Every writer should submit regularly to the workshop. There is a serious risk that attending a workshop can become a substitute for actually writing. It is no kindness to your workshopmates to let them stay in the circle if it leads them to stop writing.

  • The subject of each session must not speak during the critiques, except to answer direct questions that are not related to the writing itself (e.g., "I couldn't figure out what word this was supposed to be – can you clarify?"). The subject can speak after all the other writers have spoken.

  • Each person in the critiquing circle speaks once, in turn, without being interrupted. No cross-talk allowed. It is useful to set a time-limit for critiques.

  • No partial manuscripts. It's not really possible to critique a story unless you have the complete tale. Novels can be workshopped as three chapters and an outline.

  • Stories should be distributed in advance and read in advance. Don't have writers read their work aloud for critique, as this can lead to critiquing the delivery rather than the material.

  • Critique the story, not the writer. It's fine to be offended by something in the story, but not OK to accuse your workshopmates of being bad people for having offended you.

  • Discourage resubmission of revised stories. Workshopping produces sharply diminishing returns. If you really want feedback on a rewrite, approach people individually and ask if they'll read the new draft.

Any group of three or more writers can start a workshop. You'll need to locate writers who are at about the same stage in their artistic and professional lives as you, and find a physical place (or a videoconference service) where you can meet. Library meeting rooms are a favorite, and so is rotating between workshop members' homes. Set a regular schedule – weekly, fortnightly, monthly, possibly quarterly – and stick to it.

If you write genre fiction and you are interested in attending a peer workshop that also has an instructor to guide the sessions, lecture, set exercises, etc, I can recommend the three workshops I've taught:

  • Clarion (UC San Diego, six weeks):

https://clarion.ucsd.edu/ (I'm also a 1992 Clarion grad)

  • Clarion West (Seattle, six weeks):

https://www.clarionwest.org/

  • Viable Paradise (Martha's Vineyard, one week):

https://viableparadise.com/

Hey look at this (permalink)


A shelf of leatherbound history books with a gilt-stamped series title, 'The World's Famous Events.'

Object permanence (permalink)

#25yrsago UK anti-terror laws could bankrupt ISPs https://web.archive.org/web/20011118143634/http://www.vnunet.com/News/1126338

#25yrsago What's an "iPod?" https://web.archive.org/web/20011024015856/http://www.apple.com/ipod/

#25yrsago Bible, Koran or Mein Kampf? https://web.archive.org/web/20011109123124/http://www.salon.com/people/feature/2001/10/24/book_quiz/index.html

#25yrsago Tongan court jester scam costs king millions https://web.archive.org/web/20011224034152/http://pidp.eastwestcenter.org/pireport/2001/October/10-23-01.htm

#25yrsago USPS irradiating the mail to fight anthrax attacks https://web.archive.org/web/20011109100316/http://www.newscientist.com/news/news.jsp?id=ns99991468

#20yrsago Enron Explorer mines Enron’s emails https://web.archive.org/web/20061106204850/http://enron.trampolinesystems.com/

#20yrsago Investigative journal: “Fair use is not applicable” https://archive.blogs.harvard.edu/shlep/2006/10/23/whaddayaknow-about-fair-use-and-copyright/

#20yrsago Warners stiffs African amputee film extras on prosthetics promise https://web.archive.org/web/20061105004400/http://www.nypost.com/seven/10232006/gossip/pagesix/pagesix.htm

#20yrsago Former FCC Chairman shills against Net Neutrality https://web.archive.org/web/20061028043416/http://www.lessig.org/blog/archives/003577.shtml

#15yrsago Plotting advice for fiction writers http://nielsenhayden.com/makinglight/archives/013243.html

#15yrsago DARPA wants vampire satellites to harvest parts from dead sats prior to decommissioning https://web.archive.org/web/20111022223128/http://www.darpa.mil/NewsEvents/Releases/2011/10/20.aspx

#15yrsago Understanding the hyperrich through the lens of tomorrow’s history http://www.antipope.org/charlie/blog-static/2011/10/a-cultural-experiment.html

#15yrsago Scored: pulse-pounding/thought-provoking YA novel about surveillance https://memex.craphound.com/2011/10/24/scored-pulse-pounding-thought-provoking-ya-novel-about-surveillance/

#10yrsago UAE surveillance contractor is recruiting an army of foreign hackers to break into its citizens’ devices https://web.archive.org/web/20161024141138/https://theintercept.com/2016/10/24/darkmatter-united-arab-emirates-spies-for-hire/

#10yrsago Publicly-funded NZ company sold mass surveillance tech to torturers and GCHQ https://web.archive.org/web/20161023101410/https://theintercept.com/2016/10/23/endace-mass-surveillance-gchq-governments/

#10yrsago RIP, Tom Hayden: Yippie, radical, politician, author https://www.bbc.co.uk/news/world-us-canada-37749127

#10yrsago Audit reveals significant vulnerabilities in Truecrypt and its successors https://www.helpnetsecurity.com/2016/10/18/veracrypt-security-audit/

#5yrsago Cyber-mercenaries helped Saudis hack an NYT reporter https://pluralistic.net/2021/10/24/breaking-the-news/#kingdom

#5yrsago The Traitorous Eight and the Battle of Germanium Valley https://pluralistic.net/2021/10/24/the-traitorous-eight-and-the-battle-of-germanium-valley/

#1yrago Checking in on the state of Amazon's chickenized reverse-centaurs https://pluralistic.net/2025/10/23/traveling-salesman-solution/#pee-bottles

Upcoming appearances (permalink)

A photo of me onstage, giving a speech, pounding the podium.


A screenshot of me at my desk, doing a livecast.

Recent appearances (permalink)


A grid of my books with Will Stahle covers..

Latest books (permalink)


A cardboard book box with the Macmillan logo.

Upcoming books (permalink)

  • "The Post-American Internet," a geopolitical sequel of sorts to Enshittification, Farrar, Straus and Giroux, 2027

  • "Unauthorized Bread": a middle-grades graphic novel adapted from my novella about refugees, toasters and DRM, FirstSecond, April 20, 2027

  • "Enshittification, Why Everything Suddenly Got Worse and What to Do About It" (the graphic novel), Firstsecond, 2027

  • "The Memex Method," Farrar, Straus, Giroux, 2027


Colophon (permalink)

Today's top sources:

Currently writing:

  • “Once Is Enemy Action,” a science fiction novel about the origins of modern technofascism. Today's words: 550 (28730 total).

  • "The Post-American Internet," a sequel to "Enshittification," about the better world the rest of us get to have now that Trump has torched America. Fourth draft completed. Submitted to editor.

  • A Little Brother short story about DIY insulin PLANNING

This work – excluding any serialized fiction – is licensed under a Creative Commons Attribution 4.0 license. That means you can use it any way you like, including commercially, provided that you attribute it to me, Cory Doctorow, and include a link to pluralistic.net.

https://creativecommons.org/licenses/by/4.0/

Quotations and images are not included in this license; they are included either under a limitation or exception to copyright, or on the basis of a separate license. Please exercise caution.

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"When life gives you SARS, you make sarsaparilla" -Joey "Accordion Guy" DeVilla

READ CAREFULLY: By reading this, you agree, on behalf of your employer, to release me from all obligations and waivers arising from any and all NON-NEGOTIATED agreements, licenses, terms-of-service, shrinkwrap, clickwrap, browsewrap, confidentiality, non-disclosure, non-compete and acceptable use policies ("BOGUS AGREEMENTS") that I have entered into with your employer, its partners, licensors, agents and assigns, in perpetuity, without prejudice to my ongoing rights and privileges. You further represent that you have the authority to release me from any BOGUS AGREEMENTS on behalf of your employer.

ISSN: 3066-764X

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KristenHG
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New Essay at the Pittsburgh Review of Books by Kristen
Saturday October 24th, 2026 at 10:41 AM

Kristen Hall-Geisler
1 Comment
Les Heures de Marguerite de Beaujeu: An Archival Adventure

This summer, I took up the call from the Pittsburgh Review of Books to comb through the digital stacks of the Posner Collection at Carnegie-Mellon University to see if there was something interesting to write about. I found what I thought was little medieval manuscript, which is one of my many areas of interest, so I thought I’d look into it. Well. Once I started, I could not stop. This little book was not exactly what it seemed, and neither was the book of hours it was discussing. Read on!

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KristenHG
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I don't just read essays, I also write them.
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Why Are So Many Contemporary Novelists Not Naming the Narrator? by Ilana Bean
Monday October 19th, 2026 at 10:56 AM

Literary Hub
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Often, I don’t notice it: the nameless narrator. Because I write nonfiction, I rarely include my own name. Why would I? It’s right there. It’s only when I finish a novel and try to Google a question that I realize I don’t know how to search it. I’ve spent hundreds of pages with this character. I might know what sex they have and what sex they wished they had. More often than I’d like, I know their defecation habits. I might know things about them that no one in their life knows, but I don’t know the one thing about them that everyone knows. I have no idea what to call them.

If you, like me, enjoy plot-light, vibe-heavy novels, you’ve probably spent a lot of time with unnamed narrators. In 2015, the phenomenon was widespread enough for Sam Sacks to label it an “epidemic” when he traced its history in the New Yorker. And it hasn’t slowed down in the years since. Nameless narrators show up in some of the most discussed literary fiction of the past few years: Audition by Katie Kitamura, Transcription by Ben Lerner, My Year in Paris with Gertrude Stein by Deborah Levy, and, most recently, Life of M by Rachel Cusk.

Of course, these only represent one species of nameless narrator. The convention is also popular in apocalypse novels, where social systems that make names useful have collapsed; in Christian allegory, where all of humanity is implicated; and in thrillers, where withholding a name can set up a plot twist. But I see these as separate lineages from the ones I keep running into: narrators wandering around a city, isolated not by the fall of society, but their own ruminations. To be clear, I enjoy these books, and I think brooding on the subway is cool and fun. I don’t mind the nameless narrator as a convention. I just don’t know what they want from me, or what they’re asking me to notice.

*

Names are often proxies for identity, and the same can be said for their absence. In Rebecca, one of the most famous examples, the second Mrs. de Winter is unnamed, and her lack of a fixed self is arguably the novel’s central wound. She imagines herself mostly as a replacement for the first Mrs. de Winter, Rebecca—a woman who, by contrast, has a name and agency so overwhelming that she titles the book. Audition, too, explores the instability of self, narrated by an unnamed actor who seems to experience two consciousnesses at once: “Not a splitting of personality or psyche, but the natural superimposition of one mind on top of another mind.”

I don’t mind the nameless narrator as a convention. I just don’t know what they want from me, or what they’re asking me to notice.

One common reading is that anonymity serves as a vessel the reader can step into—an idea sometimes linked to Everyman, the Christian allegory, and, more recently, to Everyman, the Philip Roth novel. But I’m not sure how effective that is. For me, at least, it isn’t the presence or absence of a name that keeps me from identifying with the narrator of Fight Club, so much as the fact that I don’t want to be punched in the face.

I think of a friend who once said he struggles writing fiction because he always gets stuck on the names. As soon as you choose one, he said, you implicitly lock in all this other information: age, ethnicity, gender. Our other friends teased him about this: surely he’d have to know something about his own characters. Did he expect to write a person outside of time, with no race, background, or relationship to gender, and expect that to resonate with anyone? This is, of course, the paradox: leaving out specificity creates a sense of vagueness, while universality is built in detail. If anything, a withheld name collapses the distance between narrator and author—not narrator and reader. When a text is plausibly autofiction, the name often serves as a dial the author sets for how autobiographically we’re meant to identify the character with the writer.

But then maybe I’m getting off track. Maybe I’ve been distracted by the question of how namelessness reshapes the narrator’s identity, and forgotten the other half of it.

*

Here’s something that matters: these nameless narrators actually do have names.

The narrator of Rebecca, for example, has one that we’re told is “lovely and unusual.” Maxim knows it. The staff at Manderley know it. It’s only the reader who is left in the dark, unable to see the narrator through the eyes of another person. A name is, after all, the simplest way someone exists for others.

The withheld name, then, marks a shift in narrative position as much as it does identity. It’s not that the character is “everyone” or “no one,” or even “the author,” but that their external form isn’t revealed to us. The story is shot from a camera mounted on the narrator’s chest.

It’s probably relevant that I started reading a run of contemporary nameless-narrator novels right after I finished Mrs Dalloway, and then listened to a bunch of podcasts about modernism.

Mrs Dalloway is in many ways the quintessential modernist text, using free indirect discourse to approximate the movement of thought. But before modernism emerged, the nineteenth-century realist novel dominated. These books were told by an omniscient narrator who observed characters from the vantage point of God. It was a stable intelligence surveying a world that could, at least in theory, be comprehensively known. But secularization, industrialization, and the horror of World War I interrupted old ways of thought. Freud was stoking enthusiasm about the subconscious and interior realities. An objective God’s-eye-view no longer seemed quite right, and so, modernism’s inward turn began, and the novel’s world was filtered through the individual. More and more, the camera moved inside the character.

All this—modernism, names, the visual scope of a novel—was already on my mind when I started reading Transcription, and so I saw it everywhere. The unnamed narrator’s 90-year-old mentor gestures toward the possibility that the self is created, at least in part, when it’s seen by someone else: “Did you know all melanin is brown,” the mentor asks, “It is how the light strikes the iris, how it is reflected to the eyes of the other, that gives them color.” If a name is the tool by which we conceptualize the other, removing it obstructs that external vantage point. Should the narrator’s eyes be blue, they will never be blue for us.

It seems like the question—are we looking or being looked at?—has a fraught cultural valence right now, at the same time as our narrators are losing their names.

If the modernist novel lets readers inside consciousness, the unnamed narrator continues this project by refusing to let the reader step back outside of it. Conveniently, my next book, My Year in Paris with Gertrude Stein, was a novel in which an unnamed narrator researches modernist pioneer Gertrude Stein. When the narrator writes about Stein, the desire to escape the vantage point of the others seemed core to Stein’s mission:  “If we create ourselves with and through language, it seems to me that Gertrude Stein’s project was to dismantle herself and a whole century through language, to uncreate herself as she had been created by her father, by her sneering professor at Johns Hopkins, by her brother, to undo the manner of the nineteenth century.” What faster way to shed the self someone else chose for you than by shedding a name?

But today’s authors aren’t twentieth century modernists. In My Year in Paris with Gertrude Stein, Levy writes about the limitations of trying to describe a new era with an older century’s vocabulary: “Every century needs an artist to dismantle coherence as we have been taught it and make a space for something new to happen.” As Stein’s work was shaped by her own changing century, the nameless “epidemic” is borne of this one.

What is it about our world that inspires novelists to write this way? Transcription is largely a book about the way that technology “structures experience even when quiet.” And there’s something to be said about that—the way that smartphones and social media make us conscious of the distance between the person we experience ourselves as being and the person others see. There’s also the fact that as work and daily life become less communal, the self becomes something we define privately. I’ve seen a million cat memes screaming “PLEASE DO NOT PERCEIVE ME!!!” It does seem like the question—are we looking or being looked at?—has a fraught cultural valence right now, at the same time as our narrators are losing their names.

The unnamed narrator is inherently mysterious, resistant to being fully known. But I know what happens when I read them, or rather, when I realize after the fact that I never learned their name: my eye is drawn off the page, and the narrative walls become visible. I become more aware of what was held back, that there is always something held back from me.

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Medicare for All: Separating the slogan from the substance by Katelyn Jetelina
Thursday September 24th, 2026 at 10:40 AM

Your Local Epidemiologist
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People are fed up with the U.S. health care system, and rightfully so. Medical premiums and debt are rising, clinicians are burned out, and patients have less access to care. As another election approaches, these conditions are building up, just waiting to ignite change like wildfire.

Is the solution Medicare for All? It remains a bumper-sticker topic in several local congressional races. This is somewhat unsurprising, given that many Democrats think it’s the answer and even some Republicans support it. But when it comes to politics, slogans tend to leave out nuances.

Medicare for All Is Popular — Even When Put Up Against Attacks

So I called Hayden Rooke-Ley, a professor of health policy and lawyer, to join me and weigh in on the practicalities of what could be the biggest change in health care since the passage of Medicare and Medicaid in 1965.

Can we actually afford Medicare for All?

This is the first question everyone asks. And the answer is yes.

The U.S. currently spends more on health care than any other country, with private insurance driving the highest costs. That’s why most experts think Medicare for All would lower overall healthcare spending.

But what society can afford differs from government financing. Fully funding this without going into debt requires significant new taxes. Convincing Americans to send more money to the IRS is a hard sell, even if the argument is that they’d stop sending money to insurance companies.

That said, when you tally it all up, roughly 70% of the U.S. health care system is already financed by taxpayer money. So the real question is less about whether we want taxpayers financing the health care system. We largely already do that. It’s more about how we want to do it.

Would it even look like “Medicare”?

Since the early 2000s, Medicare has been divided into the traditional government program (Original Medicare) and Medicare Advantage. Advantage plans offer the same benefits as Original Medicare plus extras like drug, dental, or vision coverage, but this privatization is known to cost taxpayers an additional $100 billion (!) a year. Meanwhile, seniors on Original Medicare need to buy a separate private plan for any extra coverage.

Medicare has other issues. It leads to overpaying specialists, subsidizing large corporate hospital systems, and leaving drug price negotiation to private plans and pharmacy benefit managers (PBMs).

Medicare for All advocates envision a single, all-inclusive plan with no extra fees or private insurance. This would replace all current programs and set new federal rules for taxes and coverage, making it a way bigger change than just expanding Medicare as it is now.

Would it fix the “broken” fee-for-service system?

U.S. health policy has long viewed high health care costs as the result of overutilization due to the fee-for-service model, where clinicians are paid per test or procedure. This has led to cost-containment measures that reduce use of services, like high deductibles, hospital and insurer consolidations, and prior authorization requirements.

But Americans don’t generally use more health care than people in other wealthy countries. In areas such as primary care, they may even use too little. The bigger reasons U.S. health care costs so much are higher prices for care, high billing and insurance overhead, and spending on costly drugs and treatments that offer little added benefit.

So rather than identifying the problem as fee-for-service and trying to manage utilization, Medicare for All would attack the core drivers of high costs head-on—mainly the prices and the administrative bloat. It’s a very different approach to cost containment.

Could it help small doctors’ offices?

It could.

This part doesn’t get talked about much. Big hospital chains and private equity rollups can charge insurers more than small medical practices can. That’s due to their negotiating power, not the delivery of better care, which forces small clinics to sell to larger chains.

If everyone had the same government insurance with the same set prices, that advantage would disappear. Small, independent clinics could survive without needing to merge into giant systems. Providers would compete instead on quality of care.

This doesn’t mean that corporate health care goes away overnight. Some Medicare for All proposals ban for-profit facilities like hospitals, but many nonprofits have become corporate. This means we need policies to regulate their governance and accountability, regardless of future reforms.

What about rationing and waiting in line for care?

People often say, “if we get government health care, we’ll have to wait forever for treatment, like in other countries.”

Is that true? Not really. U.S. wait times for primary care are longer than in peer countries, on average. While specialty care may take longer elsewhere, access also varies. U.S. access to specialists is quicker than in Canada, but Germany and France have shorter wait times for elective surgery and specialty care. Overall, Americans have the worst access to care among 10 peer nations.

Medicare for All could improve access to care, depending on its goals. Wait times are policy decisions.

But more so, Medicare for All tries to address rationing of access that already exists within the system. Medicaid pays providers much less than private insurance, so fewer doctors accept it, and 27 million Americans remain uninsured. In rural areas, sparse or spread-out populations can make hospitals and clinics financially difficult to sustain, leaving residents with fewer local care options.

High deductibles and copays can lead even insured people to skip unaffordable care. This gets worse every time employer health care costs go up: rising premiums are a flat, regressive tax, eating disproportionately into the wages of lower-income workers.

Medicare for All tries to address these access problems by covering everyone, making care free (or very cheap), and making everyone “worth” the same to providers.

It’s still only a piece of the puzzle.

Medicare for All would certainly be transformative, but changing insurance financing by itself won’t address many of the system’s issues, such as primary care shortages, medical school debt, financialization throughout the system, and much, much more.

And those are just the concerns in the medical system. We know that most of what affects health actually occurs outside of the exam room. That gets into the realm of public health and how our society tackles issues like poverty, education, and access to resources.

But here, Medicare for All plays an underappreciated role because it provides a mechanism for weighing priorities democratically. It allows us to decide whether to allocate more funds to health care versus social programs, for example, and creates a unified budget that we can titrate accordingly.

Bottom line

The U.S. needs solutions to its ridiculous health care costs. No solution will be easy, and no solution will fix it all. Whether the current health care landscape will reach a breaking point that makes Medicare for All a politically viable option at the federal level remains to be seen.

But it does feel like this country is at its tipping point. About time.

Love, YLE and HR-L

Hayden Rooke-Ley, JD, is Assistant Professor at the Brown University School of Public Health. His scholarship focuses on corporate consolidation in health care, Medicare and Medicaid financing, and labor and workforce issues in the health sector. He has published in leading journals, including the New England Journal of Medicine and Journal of the American Medical Association (JAMA), and he advises state and federal policymakers, enforcement agencies, and other health care stakeholders. He is a licensed attorney in Oregon and earned his JD from Stanford Law. His work can be found on X and LinkedIn.

Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. The YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:

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KristenHG
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In Portland, Violence Interrupters Struggle to Keep a Steady Foothold by Wesley Vaughan
Saturday September 19th, 2026 at 10:34 AM

Portland Mercury
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This story first appeared in Bolts, and is republished with permission.

In 2020, when Fernando was shot twice in the street outside the old Portland Meadows Racetrack, where he was working as a construction flagger, it was actually fortuitous that he tore a tendon in his knee while trying to run away. He says that’s the reason he crumpled to the ground, and probably why the rest of the gunshots missed him. Construction workers erecting an Amazon warehouse in the old racetrack’s place called 911 as he lay on the ground, and then he was rushed to Legacy Emanuel Medical Center in northeast Portland. 

Fernando’s wife Shauna, their two kids, and other relatives arrived at the emergency room in agony, frantically trying to learn of his condition. Amidst their anxiety, a familiar face came to visit them. 

Hiag Brown helps run a community violence intervention program called Healing Hurt People, which sends case workers like him to quickly respond to Portland hospitals when they receive gunshot victims. Before rushing to Legacy Emanuel the day Fernando was shot, Brown had already met Shauna and others in her family because of because of the group’s outreach work during other incidents of gang violence that have affected her family in the past. (The family asked that Bolts only use their first names to protect their privacy.)

After the shooting, Brown and other workers with Healing Hurt People became a near constant presence in the lives of Shauna, Fernando and their two boys. They checked in with the family daily, connected them to support services like counseling and job training, and also helped them cover essentials like utility bills.

Shauna says they became a stabilizing force for her family during that scary and chaotic time, and that the group has even continued to support them in the years since. She says they were especially good at supporting her boys as she was worrying how they might react to their father being a victim of gun violence. She says she had already been concerned about raising them in an area that had seen other shootings and gang violence, even before their dad was shot. 

“I’m sure you can just imagine how that could turn a good kid bad,” she told Bolts. 

Their youngest son, who was 15 when his father was shot, is now a young adult with a commercial driver’s license, which Shauna says he obtained because of help the family got though Brown and others with the program.

“A lot of time when you’re looking for help or services or anything you have to reach out and, in this instance, we never had to reach out,” Shauna told Bolts. “Hiag consistently checked on us.” 

Healing Hurt People is an example of the kind of violence intervention program that some communities have long tried to establish to provide more than just a police response to gun violence. The Portland program, which follows a model pioneered in Philadelphia nearly two decades ago, is one of at least 77 hospital-based violence intervention programs operating across the country. 

And like many other violence intervention programs, it has struggled over the years to keep its footing because funding is continually in jeopardy.

Proponents of these kinds of programs say they represent a more comprehensive response to shootings that better supports victims than simply tracking down and potentially prosecuting the perpetrator—an approach that they argue can help prevent retaliation and more violence. For Brown and other caseworkers, that often means helping shooting victims and their loved ones get counseling, housing assistance or job training after meeting them in the hospital and helping them get through those first frightening days. 

The research into this kind of community intervention has been limited but mostly promising. Violence interrupter programs like Cure Violence appear to be one of the most studied models and have been associated with reductions in violence in several cities. Hospital-based intervention programs have also been associated with reductions in violence.

Even so, studies have also concluded that the effectiveness of violence interrupter programs can vary depending on a number of factors like funding, buy-in from “credible messengers” who can reach people at the highest risk of violence, as well as the competence and integrity of people running the programs. Experts also typically caution that a number of other factors can also affect violent crime and make it difficult to know how much of a role any particular intervention may play. 

In Portland, Brown told Bolts that he’s witnessed how the approach can help defuse the potential for violence. “You now have somebody that can walk you through that process of helping you disengage from the gangs and walk away, and how you do that in a respectful way to where you don’t become a target because you’ve gotten out of the lifestyle,” he said.  

Healing Hurt People launched in the city in 2013 as part of a community mental health care group called Cascadia Behavioral Healthcare, a nonprofit providing services across the region like walk-in crisis centers and supportive housing. But five years later, Cascadia could no longer financially support their work as the service provider struggled to stay afloat. 

Brown says he was one of only two outreach workers meeting with shooting victims in the hospital around the time COVID hit, as Portland and other cities across the country saw an uptick in violence. And due to the lack of funding, Brown says he was mostly volunteering his time. 

Brown says the group—which has since gone under the wing of the Portland Opportunities Industrialization Center (POIC), the local chapter of a nationwide workforce training organization—has taken major steps in recent years to bolster their work, including by partnering with Portland State University to evaluate and standardize training for its community safety workers. 

Soon after launching, Healing Hurt People started sending on-call outreach workers to respond to Legacy Emanuel, a hospital in northeast Portland where shooting victims often end up. Then around 2022, the group also began sending people to the Oregon Health & Science University (OHSU) hospital in Portland, as part of a partnership with researchers at the school’s Gun Violence Prevention Center to study hospital-based responses to gun violence. 

That means the group is now integrated into the care teams at both of Oregon’s top-level trauma centers and quickly gets access to victims’ names and initial information about the shooting, including medical status or even what room they’re in, which often helps them act as an intermediary for loved ones in the community. The group says that hospital access also gives them the opportunity to rapidly connect shooting victims and their families with more support, and helps inform any further outreach in the community to try and prevent future violence.

Kathleen Carlson, director of the OHSU center that’s working with Healing Hurt People, told Bolts that having a program that meets shooting victims in the hospital and stays with them after discharge could help direct more attention to other issues that can have an impact on gun violence. People could get connected to counseling that helps them address other traumas, or they could receive help accessing services that allow them to move out of an unsafe living situation. 

“Really it is a humanistic approach,” she said. 

In 2022, supporters of these programs scored a major win when Oregon lawmakers earmarked $5 million in state grant funding to help expand their work and grow similar programs outside the Portland metro area. Legislation passed that year also allowed the group to start billing Medicaid for work with shooting victims who are enrolled. 

Roy Moore, who was integral in securing Medicaid funding for Healing Hurt People and is now co-director of POIC’s community care team that oversees its work, says the program currently has four hospital-based outreach workers who work full time and who are supported by a host of others on POIC’s community care team. 

“When you’re vulnerable like that, it’s easy to feel like there’s nobody looking out for you.”

Kolby Ross, gun violence survivor

While they would like to expand this work, funding still always seems precarious. For instance, the Trump administration last year terminated grants aimed at community safety and violence intervention programs nationwide, which Healing Hurt People and its university partners had intended to use to fund more research into their work and improve training for outreach workers. 

“Slashing of all the federal funding of programs that didn’t meet the new administration’s priorities really sets us back by years in terms of being able to grow our team and our capacity to do that kind of work,” Carlson told Bolts.  

The drying up of federal grant funding also coincided with a city proposal to reduce funding for violence prevention programs this year, as Portland grappled with a $172 million budget deficit.

The budget initially proposed by Mayor Keith Wilson this past spring would have cut future grants the city’s Office of Violence Prevention gives out by $1 million—grants that support POIC’s violence intervention work. It also proposed significant cuts for other police alternatives, including downsizing Portland’s behavioral and mental health crisis response team. 

Around the same time, city officials issued a press release praising the city’s Office of Violence Prevention for helping Portland lead the nation in reducing gun violence in recent years. The statement cited a report listing Portland among the cities that have seen the steepest declines in shootings since the height of the pandemic.

After advocacy from the affected groups and a show of support from the community, council members made budget amendments to restore nearly all of the funding the mayor had proposed to cut from the city’s Office of Violence Prevention. 

Council member Sameer Kanal, who voted for the budget amendments, said he thinks such programs are a necessary part of the public safety network. “There are types of calls that need an armed police response and types of calls that need a traditional firefight response, but then there are other calls that go to those two responders because we don’t have built out structures that are tailormade for those types of lower acuity calls,” he told Bolts. “We need the right responder available for each call.” 

As they support shooting victims, Healing Hurt People outreach workers do sometimes have to coordinate with police. But Brown stresses how they’ve tried to adopt policies that make it clear to both victims and the police bureau that they are not part of, or working for, law enforcement. 

This has meant drawing some bright-line rules with police; for example, if police are in the hospital room speaking with a victim, their community safety workers are not. “We are not part of the investigation, so we’ll step out so they can do their job,” Brown told Bolts. “They stay in their lane and we stay in ours,” Brown said. “We collaborate, but we’re not best friends.” 

Kolby Ross was 23 when he first met community workers with Healing Hurt People inside a Portland hospital in late July 2022, after a bouncer at a downtown club shot him three times. The bouncer, who was working with an expired gun license, said he was firing at someone else who had shot at him first. 

Ross says that the difference between how Healing Hurt People made him feel and how the police and prosecutors treated him after the shooting could not have been more stark. “The police kind of forced themselves into my room and made me give a statement while I was under pain medications,” he told Bolts. He also stressed that the way the Multnomah County DA’s office questioned him while he was in the hospital felt “overwhelming and it re-traumatized me.” 

“When you’re vulnerable like that, it’s easy to feel like there’s nobody looking out for you,” Ross told Bolts. “I feel like the DA kind of did a good job of trying to isolate me in that moment so that he could get what he wanted out of me.” After the DA’s office declined to indict the shooter on any charges, Ross says officials never explained to him why. 

Ross couldn’t get around on his own after he was shot, let alone work. After he was released from a hospital in a wheelchair, Ross relied on case workers like Isiah Bailey with Healing Hurt People for mobility. Bailey was part of the first cohort of community safety workers who graduated from the training and accreditation program that Portland State University worked with the organization to develop. Prior to his injuries, Ross also didn’t have secure housing that he could return to after leaving the hospital. So Bailey worked to get him set up in an apartment while the group paid for his first month’s rent. 

Just as importantly, Ross says that Bailey also helped him figure out how to navigate the intense feelings he was having after the shooting. “Once I started feeling really anxious going out to places, he was really the only person I could come to,” Ross says. 

Bailey told Bolts that providing “access to mental health services,” is a big part of the work they do, adding “there’s a lot of stigma, especially in the brown and Black communities, about mental health and how to address mental health,” but sees part of his role as normalizing that access and those conversations.

The post In Portland, Violence Interrupters Struggle to Keep a Steady Foothold appeared first on Portland Mercury.

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Art by Humans, For Humans: A Letter from Our Editorial Director by Grace Ebert
Saturday September 19th, 2026 at 10:20 AM

Colossal
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Art by Humans, For Humans: A Letter from Our Editorial Director

Dear Reader,

The New York Times recently asked dozens of 10-year-olds what the world will be like in 2050. Some are hopeful: a woman will finally be president of the U.S., people will be more kind, and everyone will have a pet fox. Others, though, feel as if they’ve been plucked straight from a dystopian hellscape: world wars, monarchic rule supplanting voting, embedded brain sensors that send your thoughts straight to an app, and the end of human civilization entirely. Whether optimistic or not, these children mention A.I. again and again. In their futures, it’s an inextricable fixture of life.

A.I.’s exponential growth has accelerated fears about its power, prompting numerous executives and technologists to warn that it’s time to slow such rapid expansions. Whatever your feelings, it’s clear that we’re collectively witnessing a moment that will shape our world for generations.

For artists, illustrators, designers, and writers like me, A.I. is not only a threat to our livelihoods but to the very substance of our humanity. The question is not whether a bot could create a technically proficient painting or describe a sculpture with more insight than I could, but rather about what we lose from outsourcing the singular technology that is ours. Art is uniquely human and one of the greatest drivers of empathy and connection with one another. As I’ve come to understand, it’s also a true act of faith in a world that can make hope feel impossible.

For the past seven years, I’ve spoken with thousands of curious and creative people striving each day to draw attention to the misunderstood, the overlooked, and the unimaginable. Artists are uniquely primed to envision alternative ways of being, and in their profound acts of generosity, they share their hopes for the great and small with us. Their faith, in turn, becomes something we can all take part in.

Colossal operates on generosity, too, propelled not by an algorithm or an A.I. model but by a devoted team of just four people. We strive to ensure that the widest array of readers, from students and educators to fellow creatives and art appreciators, have the opportunity to engage with artists’ work they might not otherwise encounter. We also prioritize a deeply human process. Every facet of the magazine, from selecting images to writing headlines to compiling our daily newsletter, is done with our hands. 

Although we certainly could be more efficient if we automated and outsourced our efforts, we know that would be the end of what makes Colossal what it is. We understand that in embracing friction, we’re supporting the artists, illustrators, designers, and more who have so generously shared themselves and their dreams with us. We’re also actively creating the world we want to live in.

But we can’t do this alone. An intentional and people-powered process like ours requires real resources, and less than 0.5% of our weekly readership financially contributes to Colossal. Increasing that support to 1% would mean cementing our long-term survival and ensuring we can continue to celebrate the unbridled human creativity that has come to characterize the magazine for the last 16 years.

Becoming a Colossal Member is both an act of generosity and a direct line to the work that matters. Colossal Members believe in the power of creativity and have faith that it can help usher in a better tomorrow. When there’s a rapid shift to sleek, frictionless life, they champion the nuanced, messy, and idiosyncratic, and the art that can only be made by humans, for humans.

Yours in hope,
Grace Ebert
Editorial director, Colossal

Do stories and artists like this matter to you? Become a Colossal Member today and support independent arts publishing for as little as $7 per month. The article Art by Humans, For Humans: A Letter from Our Editorial Director appeared first on Colossal.

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