20-year old Mississippi Delta-bred blues guitar prodigy Christone “Kingfish” Ingram is gearing up to release his debut studio album, Kingfish, this Friday, May 17th via Alligator Records. The young sensation has received huge praise from the blues community over the last several years for his live collaborations and online YouTube videos.Following the release of his first official single off of his debut record, “Fresh Out”, featuring mentor and blues hero Buddy Guy, Kingfish shared “Outside Of This Town”, his first-ever solo single. Recently, the rising star released a psychedelic new music video for “Outside Of This Town”, which was animated by Lyndon Barrois. The new music video was made entirely on iPhones using stop-motion animation and took over six months for Barrois to perfect.Watch Christone “Kingfish” Ingram’s creative new “Outside Of This Town” video below:Christone “Kingfish” Ingram – “Outside Of This Town”[Video: Alligator Records]Christone “Kingfish” Ingram continues touring through the summer with various solo performances and festival appearances. In August and September, Kingfish will target a completely different audience, offering support for indie rock act Vampire Weekend. See below for a full list of Kingfish’s 2019 tour dates.For ticketing and more information, head to Christone “Kingfish” Ingram’s website.Christone “Kingfish” Ingram 2019 Tour Dates:(headlining and festival dates)May 17 – Washington DC @ Pie ShopMay 27 – Asheville, NC @ The Grey EagleMay 31 – Atlanta, GA @ Eddie’s AtticJune 9 – Delaware City, DE @ St Georges Blues FestJuly 6–7 – Portland, OR @ Waterfront Blues FestJuly 13 – Nescopeck, PA @ Briggs Farm Blues FestJuly 21 – Winthrop, WA @ R&B FestJuly 27 – Sisters, OR @ R&B FestAug 3 – Mammoth Lakes @ BluesapaloozaAug 9 – Chattanooga, TN @ Songbirds South Stage(with Vampire Weekend)August 16 – Oklahoma City, OK @ The CriterionAugust 17 – Houston, TX @ White Oak Music HallAugust 18 – Irving, TX @ Toyota Music Factory – Texas Lottery PlazaAugust 20 – Austin, TX @ ACL Live at the Moody TheaterAugust 21 – Austin, TX @ ACL Live at the Moody TheaterAugust 24 – Miami, FL @ James L. Knight CenterAugust 25 – St. Augustine, FL @ St. Augustine AmphitheatreAugust 27 – Atlanta, GA @ Fox TheatreAugust 30 – Norfolk, VA @ Constant Convocation CenterSeptember 3 – Boston, MA @ Agganis ArenaSeptember 4 – Philadelphia, PA @ Mann Center for the Performing ArtsSeptember 8 – Montreal, QC, Canada @ MTELUSView Tour Dates
A video tour through five case studies of sustainability at Harvard, including:* Student Peer-to-Peer Programs Educate and Inspire* Innovative Solutions that Serve as Models for Other* Greener, Healthier, More Efficient Buildings* Rethinking Campus Operations* Building a Culture of Sustainability
The Harvard Gay & Lesbian Caucus is seeking current full-time Harvard student applicants for its 2011 Public Service Fellowship.The fellowship is a one-time grant of $5,000 made to an individual to educate, organize, or otherwise benefit the gay, lesbian, bisexual, and transgender community during the summer of 2011. Work can be independent or within an existing nonprofit organization. Thesis research projects will not be funded. Partisan campaign activity may not be eligible.
Howard Gardner has been bestowed with the 2011 Prince of Asturias Award for Social Sciences, an award that honors individuals whose research has significantly contributed to the progress of their field and to humankind. Gardner is the John H. and Elisabeth A. Hobbs Professor of Cognition and Education at the Harvard Graduate School of Education.Gardner’s field of research has focused on the analysis of the cognitive abilities of human beings, a field in which he has developed his theory of multiple intelligences, which has led to significant changes in the education system.“I am thrilled and humbled to receive this prestigious award,” said Gardner. “While my training is primarily in psychology, I have always considered myself a social scientist, and I feel that much of the best work about human nature and human society draws on a range of social scientific disciplines.”Gardner will receive the award at a ceremony in October.
In its first expansion in more than three centuries, the Harvard Corporation will add three new members this July: a distinguished university president soon stepping down from his post, a leading computer scientist and former president of the University’s Board of Overseers, and an admired business and civic leader widely active in Harvard alumni affairs.Tufts University President Lawrence S. Bacow, Susan L. Graham of the University of California, Berkeley, and Joseph J. O’Donnell, an influential Boston executive who is the chairman of Centerplate, will join the governing board formally known as the President and Fellows of Harvard College, after a five-month search that yielded more than 500 nominations.The appointments were announced today (May 25) in a message to the Harvard community from President Drew Faust and the Corporation’s senior fellow, Robert D. Reischauer.“We’re very fortunate to welcome such a capable and committed trio of alumni to the Corporation,” said Faust. “Each of them brings expertise and experience that the Corporation will greatly value, and each has an intensity of commitment to higher education, and to helping Harvard adapt and thrive in changing times, that promises to serve us well.”The appointments follow the Corporation’s announcement this past December of a set of changes intended to enhance its collective capacity, including an expansion from seven to 13 members over the course of two to three years. Reischauer and Faust have said the changes aim to enhance the governing board’s ability to focus on long-term strategy and University priorities and to meet the needs of an institution far larger and more complex than at the time of its founding.“These are three individuals with extensive governance experience who exemplify the remarkable accomplishment of our alumni across a range of professional domains,” said Reischauer, who chaired the search committee. “They are also three people strongly engaged with higher education and with Harvard, knowledgeable about its history and values and dedicated to its future excellence. We set out last December to amplify the Corporation’s capacity, and the addition of these three extraordinarily able new colleagues will do just that.” Bacow is regarded as one of the most thoughtful and effective university presidents in the nation, known for a strong commitment to civic engagement, to student access, and to promoting collaboration among Tufts’ different schools. He holds three degrees from Harvard, a J.D., an M.P.P., and a Ph.D. in public policy. He will step down as Tufts president this summer, after a decade of service.“This is a pivotal moment for universities, at a time of profound change in the world, and I hope I can help Harvard continue to lead in defining what a university can and should be in the years ahead,” Bacow said. “Harvard sets a high standard for all of higher education, and I’m pleased and excited at the opportunity to return to Harvard in this new role.”Before leading Tufts, Bacow was the chancellor of the Massachusetts Institute of Technology, his undergraduate alma mater, where he joined the faculty in 1977 and was chair of the MIT faculty and director of MIT’s Center for Real Estate. His scholarly interests lie at the intersection of environmental studies, law, economics, and policy. He has had many trusteeship roles, including chairing the Talloires Network, which aims to strengthen the civic roles of higher education institutions worldwide. He currently serves on the Harvard Kennedy School visiting committee and will be “president-in-residence” at the Harvard Graduate School of Education in 2011-12.Graham is the Pehong Chen Distinguished Professor Emerita of Electrical Engineering and Computer Science at Berkeley. She is a leading expert in programming language implementation, software development, and high-performance computing. A graduate of Radcliffe College who received her Ph.D. from Stanford University, she was a Harvard Overseer from 2001 to 2007 and chaired the Board of Overseers in 2006-07, when she also served on the presidential search committee.“I have relished my association with Harvard from my college days through my recent years as an Overseer, and I approach my time on the Corporation with a deep sense of the University’s power to transform the lives of students and to shape the world of ideas,” she said. “There’s a great sense of possibility, and there are great opportunities for creative integration, from the sciences to the arts and across the professions. I look forward to doing all I can to help Harvard thrive.”Past chair of the visiting committees to both the School of Engineering and Applied Sciences and the Radcliffe Institute for Advanced Study, she has also been an elected director of the Harvard Alumni Association and received the HAA’s Harvard Medal in 2008. Her board involvements include service as a vice chair of Cal Performances, Berkeley’s vibrant performing arts organization.O’Donnell, a native of Everett, Mass., is a graduate of both Harvard College and Harvard Business School. Early in his career, he served at HBS as associate dean of the M.B.A. program and then as director of the school’s Program for Management Development. Longtime CEO and chairman of the Boston Culinary Group, he is now the chairman of Centerplate, a nationwide leader in the food-service industry, and also owns Allied Advertising Agency.“Harvard has been a central part of my life,” said O’Donnell, a prominent figure in Boston business and civic affairs. “There’s no institution I know whose people are more capable of doing great things for the world, and no alumni community I know whose members are more devoted to their university’s progress. I’m proud to be able to extend my service to Harvard by joining the Corporation.”Widely active in philanthropic pursuits, O’Donnell, along with his wife, founded The Joey Fund in memory of their late son, and he has long been a leader in the National Cystic Fibrosis Foundation, among other board roles. He has for decades been one of Harvard’s most active alumni volunteers, serving as an Overseer, a visiting committee member, an elected director of the Harvard Alumni Association, a member of the Allston Work Team, an adviser to senior University officials, and a major force in Harvard campaign and development efforts. He received the HBS alumni achievement award in 2005.In accordance with Harvard’s charter, the appointment of the Corporation’s three newest members was voted today (May 25) by the President and Fellows with the consent of the Board of Overseers. It marks the first step in achieving the Corporation’s planned enlargement, as it grows from seven to 10 and eventually to 13 members. In 2011-12, the Corporation is also expected to launch several new committees, in areas including finance, facilities and capital planning, and governance, as well as a joint governing boards’ committee on alumni affairs and development.These and other changes grow out of an in-depth review in 2009-10 of the role, structure, and practices of the oldest corporation in the Western Hemisphere as it guides a university of Harvard’s scale, ambition, and complexity forward in the 21st century.
The Harvard Initiative for Learning and Teaching (HILT) will host its second annual conference on May 8. The theme for this year’s event is “Essentials,” drawing on the framing question, “In this time of disruption and innovation for universities, what are the essentials of good teaching and learning?”Ticket applications for this University-wide event are being accepted until May 2. Faculty, students, and staff from all Harvard schools are welcome to apply.Short keynote responses to the “Essentials” framing question will be offered by Harvard faculty and a outside scholars organized around the themes “The Science of Learning,” “The Art of Teaching,” “Innovation, Adaptation, Preservation.” The event will also highlight first-round Hauser Grant activities and January Academy Projects during an innovation fair.“Our goal is to create space for the Harvard community to actively discuss with one another what we know and believe about the essentials of excellent, transformative learning and teaching,” said HILT Director Erin Driver-Linn. “The boundaries and expectations of education are changing rapidly, and Harvard has added significantly in the past two years to experimental work in pedagogy with HILT and HarvardX — t is a perfect time to come together around the fundamentals, in light of this new work.”Launched last year with a generous gift from Rita E. and Gustave M. Hauser (read here and here), HILT’s mission is to catalyze innovation and excellence in learning and teaching at Harvard.Individuals interested in attending the conference can apply for tickets at http://hilt.harvard.edu/2013-conference.HILT trailer
A proposal issued today by the U.S. Food and Drug Administration, if finalized, would effectively make trans fat in the food supply a thing of the past. The Gazette asked Professor Walter Willett, chair of the Department of Nutrition at the School of Public Health, to discuss the potential impact of the ruling, in policy and health. GAZETTE: What exactly has the FDA done today? Is there a chance the ban could be derailed during public comment?WILLETT: The FDA announced a determination that partially hydrogenated fats are no longer “generally regarded as safe” (GRAS). This requires a comment period before implementation, but I don’t think any reasonable person could now claim that they are regarded as safe because every major organization that has looked at this issue has concluded that trans fats (produced by partial hydrogenation) are harmful. Implementation of this determination will effectively eliminate trans fats due to partial hydrogenation from our food supply.GAZETTE: Can you talk a little about why this is so important, in terms of public health and how many lives may be saved annually?WILLETT: Even though about 75 percent of trans fats have been removed from our food supply already, millions of Americans are still consuming amounts that are harmful. The CDC has estimated that about 7,000 premature deaths could be avoided by eliminating the remaining trans fats. Other benefits are likely, including reductions in rates of heart attacks, diabetes, and obesity.GAZETTE: Have most restaurants and food manufacturers already eliminated the use of trans fats? Do you expect any really meaningful resistance to the proposal?WILLETT: Yes, most but not all restaurants and food manufacturers have already eliminated trans fats. I don’t think there will be substantial resistance; it will probably become difficult to obtain trans fat because producers are likely to eliminate it.GAZETTE: So this seems like a pretty big advance for public health advocates. Is there a similar victory over the last 10 or 20 years to compare it with?WILLETT: The earlier steps in reducing trans fat were also important victories, including requiring trans fat on food labels and banning of trans fat from restaurants, which was done at city and state levels. We have had some important victories on smoking reduction, but again this has been mainly at city and state levels.GAZETTE: Any words of caution? Do you worry that after a major change like this there’s any risk of complacency in other areas of concern? For example, the person who says, “Well now that I don’t have to worry about trans fats, I can have the extra portion.”WILLETT: I don’t worry much about complacency due to trans fat elimination. By getting trans fat off the table entirely, we can redirect efforts to the many other aspects of our diet that need attention.For more: Spotlight on trans fats
8Carpenter Dennis Kotarac works in what will be a common room in McKinlock. As renewal continues at Leverett House’s McKinlock Hall, life in “Old Lev” still flourishes.A recent event called a “giant study break” brought together students from the various swing housing locations and Leverett towers. The gathering was a chance for them to sample a smorgasbord of tasty treats, gather with housemates, and visit venues they have yet to explore.With construction ongoing, some Leverett House students are living temporarily in Hampden, Ridgley, and Fairfax halls, and 20-62 DeWolfe St.McKinlock, the older neo-Georgian section of Leverett, is the latest project in the House renewal initiative, a system-wide effort involving the University’s 12 undergraduate Houses. Like the other river Houses, most of which were built in the 1920 and ’30s, McKinlock was designed to accommodate students whose needs were very different from those of today’s Harvard scholars, with their host of electronic devices and ways of socializing never envisioned by their pre-World War II predecessors.While much of the building’s historic façade will be familiar, though entirely restored, the interior will have been fundamentally reconfigured. In addition to better room configurations and circulation, McKinlock will have modern common spaces for meeting, studying, or just hanging out, as well as dedicated areas for music, art, and performances. Planned changes include the elimination of walk-through bedrooms, creation of additional single rooms, addition of elevators for accessibility, and horizontal internal corridors that will connect the traditional entryways.Quincy House’s Stone Hall was the first project in the renewal initiative. In just a few months, Stone Hall has shown how renewal will provide undergraduates with improved spaces that are designed to better support learning, exploration, relaxation, and fun. 3Leverett House “Giant Study Break”: Kathleen Hanley ’16 and Yuechen Zhao ’15 sample Thai food at Leverett G-Hutch. 9At Ridgely swing housing, House Master Howard Georgi sports the most recent Leverett logo on his sweatshirt. 4Leverett House “Giant Study Break”: Daily Guerrero (second from left) and Diana Acosta ’14 (center) join housemates for ice cream from J.P. Licks at Fairfax swing housing. 5Leverett’s McKinlock Hall under renewal, as seen from Memorial Drive. 2Leverett House “Not Just Sherry Hour”: Kelly Maeshiro ’14 (left) watches as Benjamin Antillon ’14 cuts a cake at swing housing at 20-62 DeWolfe. 6“Not Just Sherry Hour” at swing housing at 20-60 DeWolfe: Sherry bottles frame headshot photos of Leverett residents, placed so guests can connect a face with a name. 1McKinlock under renewal on DeWolfe Street. 7Worker Carlo Bonito applies plaster to the walls of a suite in McKinlock.
Drawing on the experience of four nations, experts described how crises and fundamental transitions often prove the catalysts behind universal health care systems during a panel event Tuesday at Harvard’s Longwood campus.In Turkey, it took an earthquake and thousands of deaths to galvanize reform of an unequal system. For Mexico and Thailand, it took a democratic transition, coupled with constitutional guarantees of citizens’ right to health care. In China, it took an outbreak of SARS — and the global attention that accompanied it — to call attention to the flaws in a market-based system.The common element, according to Dean Julio Frenk of the Harvard School of Public Health (HSPH), was that health care reform became aligned with wider national priorities.“In my opinion, the number one reason for success for reform is when it connects to the broader agenda in a country.”The result in each case been improved health-care access for millions, though panelists noted that improved access hasn’t always meant improved quality of care — a disparity bound to be a major challenge for years to come, they agreed.The occasion for the panel was the inaugural State of Global Health Symposium, “Transforming Health Systems for Universal Health Care.” Held at the Joseph B. Martin Conference Center, it was sponsored by the School’s Department of Global Health and Population and supported by the Harvard-Thai Ministry of Public Health Fellowship Fund.Samrit Srithamrongsawat, the deputy secretary general of Thailand’s National Health Security Office, delivered the keynote speech. Srithamrongsawat was also on the panel, along with Frenk, Professor of Health Policy and Management Ashish Jha, K.T. Li Professor of Economics William Hsiao, and Professor of Global Health Systems Rifat Atun.In his address, Srithamrongsawat presented Thailand’s experience with universal health care. The system was officially adopted in 2002, but its roots trace to the 1970s, when a program for the rural poor was established. Along with a continued focus on serving the poor, preventive and primary care are now areas of heavy emphasis, he said.The result is that a once hospital-heavy system has shifted toward clinics, and an estimated 60,000 households are protected from medical-cost related impoverishment each year.Though the country has achieved near-universal coverage, significant challenges remain, Srithamrongsawat said, challenges that the panel agreed are common among nations implementing universal health care. They include equalizing the quality of care among citizens who participate in different insurance schemes within the country, handling increased demand, managing a rise in chronic diseases, and ensuring long-term financial sustainability.Frenk pointed out that the increased cost of health care in nations that adopt universal systems means that the shift has to be accompanied with an emphasis on preventive and primary care.Jha focused on how care is sometimes associated with harm, despite providers’ mission to improve health. Some 43 million injuries annually are reported in hospitals around the world due to some kind of adverse event, a rate that puts hospital-related injuries among the top 10 to 15 causes of death and disability worldwide.The medical establishment needs a culture change, Jha said, with a strong emphasis on the health status of patients. Efforts could be bolstered by leadership buy-in, data collection, and sharper metrics for measuring progress, he said.“The fundamental principle of quality improvement is not, ‘Are you providing the right care?,’ it’s ‘Are you improving? Do you have a plan?’ Universal health care is important to improving the world’s health, but we have to make sure quality is also on the agenda.”
The U.S. Supreme Court is hearing oral arguments on Wednesday in the case of King v. Burwell, a suit challenging implementation of the Affordable Care Act (ACA), President Obama’s signature program to expand health insurance coverage to all Americans. The case revolves around federal subsidies that decrease insurance costs for low- and middle-income Americans who buy through federal health insurance exchanges in the 34 states that declined to set up state-run health insurance exchanges. Plaintiffs in the case argue that the law’s wording should limit the subsidies only to those getting insurance in the 16 states that did set up exchanges.The Gazette spoke about the case with John McDonough, professor of the practice of public health at the Harvard T.H. Chan School of Public Health and an authority on health care reform.GAZETTE: Can you tell us about the case and describe the issues involved?McDONOUGH: This lawsuit has been advanced by the Cato Institute, a libertarian think tank in Washington that wants to invalidate the provision of federal health insurance tax credits to consumers under the Affordable Care Act because of a narrow interpretation of the law. That [interpretation] suggests that the law was written in a way that does not permit tax credits/subsidies to flow to the consumers who obtain their insurance through the federal health insurance exchanges as opposed to state exchanges.GAZETTE: It seems like this split between federal and state exchanges is at the center of this case. Can you explain what the exchanges are and why there may be more federal exchanges than originally anticipated?McDONOUGH: An exchange is a creation of the Affordable Care Act that is now spreading across the country, in the ACA variety and in other forms as well. An exchange is a marketplace where consumers who can’t get health insurance anyplace else can go and buy individual insurance, sometimes referred to as non-group insurance.The exchange runs the website where people can go online and make their purchases. The exchange is responsible for making sure that the website only sells insurance policies that meet the requirements — the protection and the benefits — of the Affordable Care Act.The way the law was written, states were given the right of first refusal to set up their own exchanges. Then, if they either deliberately chose not to set up an exchange or didn’t make a decision, the establishment of “such exchange” is given to the U.S. Department of Health and Human Services.GAZETTE: What do those behind this lawsuit hope to accomplish?McDONOUGH: The folks behind this lawsuit, in particular the Cato Institute, have been vociferous opponents of health reform, [and have been] very much enemies of the Affordable Care Act since before the ACA was signed into law by President Obama in March of 2010. They have been parties to multiple lawsuits and have a strategy of doing anything and everything they can to repeal or undermine and bring down the Affordable Care Act. And I don’t think I’m saying anything they would disagree with at all.They are determined to see the law repealed, to see it fail, because their values, their ideology is completely opposed to any level of government providing this kind of protection to citizens.GAZETTE: What are possible ramifications if the Supreme Court agrees with them?McDONOUGH: There have been evaluations done by the Urban Institute, by the RAND [Corp.], by the Commonwealth Fund, and by others. The most credible estimates that I’ve seen suggest that if the decision were to go in the plaintiffs’ direction, between 9.3 and 9.6 million lower- and moderate-income working Americans who are obtaining subsidies right now would find their health insurance unaffordable, and most of them would drop coverage.The number of uninsured, with an adverse decision, would increase by about 8.2 million. We’ve seen the number of uninsured over the past year drop by more than 10 million. So this would erase a very large proportion of the progress that has been made over the last 18 months in expanding coverage.Importantly, we know from research that the lack of health insurance actually is a cause of death among Americans. One estimate suggests that — and this is pre-ACA — as many as 45,000 Americans every year have a premature death principally because they didn’t have health insurance.So one of the many amicus briefs that was filed in this case was filed by about 22 deans of U.S. schools of public health, and includes an estimate that if 8.2 million folks became uninsured, that would translate into approximately 9,800 premature deaths annually.There will also be significant disruption in the U.S. health sector. The people who would be most immediately and directly damaged would be people who currently have a subsidy. But there are also millions of folks who buy unsubsidized health insurance, both inside and outside exchanges, who would be adversely impacted by this as well.That’s because many of those people getting subsidized coverage are younger and healthier people. They would dive out of the market and there would be an adverse selection phenomenon in the markets in these 34 states. That would result in extraordinary health insurance premium increases to the non-subsidized folks as well. The estimate — again from Urban and Rand — suggests that premiums would increase anywhere between 35 and 47 percent. That would lead many, many, many of these unsubsidized, non-group enrollees also to drop coverage.GAZETTE: So it wouldn’t just be the hit from losing the subsidy. In addition, the rates would go up?McDONOUGH: It would be the market impact as well that would lead to another significant number of folks dropping coverage. Really what you would be seeing — and this is not an exaggeration — is the destruction of the non-group insurance markets in all of these states, these 34 states.The estimate of the loss in revenues to various parts of the health care sector annually is about $9.3 billion … and about $6.3 billion of that would be losses that would affect hospitals. And many of these hospitals provide disproportionate care to lower-income folks. So some of the safety-net hospitals would take some of the biggest hits and biggest pain as a result of an adverse rule.GAZETTE: If the government loses, is there a chance it will kill the law, or, if it just damages the law, is there any chance Congress might “fix” it?McDONOUGH: Those are all questions without answers. Massachusetts has its own state exchange, New York is another — there are about 16 states where it’s pretty clear things would continue.Massachusetts started in 2007 through its own reform law, and I don’t think there was any adverse impact in Massachusetts because other states did not have this structure. So I think that, in states that have their own state-based exchanges, things would continue without significant disruption.Would Congress find a way to come in and undo the damage? There’s a political game going on in Congress and in Washington, D.C., right now. Republicans are saying that they will come in and undo the damage. However, they have not put anything down concretely, and the pattern has been whenever the Republican-controlled chambers have attempted to do something, they can’t even agree among themselves what to do. For example, the House of Representatives voted more than 55 times now to repeal all or part of the ACA and has never advanced — even as a proposal — a significant replacement. So the notion that they would come together and advance an alternative framework is a speculative proposition.GAZETTE: What happens if the government prevails? Any changes at all, or just go back to business as usual?McDONOUGH: If the government prevails, which I suspect is going to be the case, then the last significant obstacle to full and secure and long-lasting implementation is discarded.Though Republicans came in promising to do significant damage to the ACA, they have not been able to agree on anything at this point other than minor changes around the 30-40 hour workweek rule. When the Supreme Court announced that it was going to consider this case, last December, it provided a reprieve for Republicans. It allowed them to kick any kind of replacement structure down the road. They used King v. Burwell to say: Whatever happens, we’re going to get to something in the fall after we see what the Supreme Court does.GAZETTE: Are there other legal challenges? You seemed to indicate this is the last big one.McDONOUGH: I stand to be corrected, but after this one there are just cats and dogs left.GAZETTE: What are the next big milestones for the law?McDONOUGH: We’re in the middle of the next big milestone right now. For the first time, people are filing their taxes and feeling the individual-mandate penalty.It is at a low rate this year: $95 or 1 percent of your household income, whichever is higher, if you didn’t have valid coverage in 2014. Next year, it will go higher, and the year after that, in 2016, it will go higher, and that’s where it will stay. So right now, people are facing the individual-mandate penalty, and there are also people who got subsidized coverage last year and didn’t correctly estimate what their household income would be.People who got subsidies larger than they were entitled to have to pay the excess back. People who got lower subsidies than entitled actually get an advantage. So all of this is swirling around right now as the Supreme Court is hearing the oral arguments.GAZETTE: Sounds like we’re at a phase in the implementation where the carrots are switching to sticks?McDONOUGH: Yes, but understand that the single most important day of implementation was Jan. 1, 2014. That was the day when the systemic insurance reform, elimination of medical underwriting and pre-existing condition exclusions, and putting in its place something called guaranteed issue, became law in all 50 states. That was the day that the individual mandate became real. That was the day the subsidies began to flow, the day that Medicaid expansion became activated under the provisions of the ACA in all of the states that have accepted the expansion.That is why, in the fall of 2013, there was a federal government shutdown. That really was the last major effort by Republicans to kill or undermine the law before it took full effect, because they understood how consequential that date was. On that date, the benefits of the law changed from being hypothetical to being real.GAZETTE: The kids are now covered, the pre-existing conditions are covered, and these are things people are not going to want to go back on. McDONOUGH: Right now, any changes that you make to any of those key elements affect real people who are getting benefits today. And that is a completely different dynamic. In terms of the implementation game, if you’re going to call it that, we’re way into the fourth quarter. GAZETTE: Once we get through the implementation and 2016, aren’t there still provisions for experimental programs and other ongoing changes, so it won’t be a situation where it’ll be done and that’s it?McDONOUGH: No, this is like Social Security, this is like Medicare, this is like Medicaid. The passage of the original law sets a new framework, and is the end of the initial legislative process. [But] it only opens a new era, of what I like to refer to as continuous policy improvement.Medicare and Medicaid were both established in 1965. That was the end of the initial journey by President Lyndon Johnson to pass a law. It was only the start of an endless change, evaluation, and improvement process. When Medicaid, for example, was established in 1965, the only people who could get any benefits from Medicaid were poor, low-income mothers and their children who were collecting public assistance.Shortly thereafter, states started experimenting, Congress started experimenting, expanding the scope of who could get benefits. It has grown and grown and grown and, obviously, took a major, historic leap forward with the Affordable Care Act as well.But many of these [new] programs will not succeed and will be repealed, gone and forgotten. Others will become an enduring part of our health system landscape for decades and longer. We won’t know for some time the durability of any of these, but it’s fairly certain that the essential, important ones will stay, although they will be — as has been the case with Medicare and Medicaid — changed, improved, cut back many, many times in the years and decades to come. That’s how it goes.It’s never over until you die, and then it goes on without you. That’s what I tell my students every year. It always gets a good laugh, but it’s true.