32 United States The EconomistFebruary 22nd 2020
P
eople oftenslow down to bop as
they pass Donald Campbell’s mobile-
phone shop in Shaw, a neighbourhood in
Washington,dc. Until 7pm every day
speakers outside blast Go-Go, a drum-
based fusion of funk,r&band soul that is
indigenous to the city. In an area that was
once dotted with Go-Go clubs, several of
them owned by Mr Campbell, this is one
of the last public places the music is
played regularly. It is also the scene of a
row that has forced a reckoning on how
gentrification is eroding the culture of a
once black-majority city.
Last spring residents of a glossy new
apartment block, mostly inhabited by
young, white newcomers to the area,
complained about the racket. T-Mobile,
which owns the shop, asked Mr Campbell
to turn it off, which he did. That un-
leashed a torrent of anger from African-
Americans across Washington. There
were large street protests at which Go-Go
bands played, a #DontMuteDC social-
media campaign and an online petition.
After a few days of this John Legere,
T-Mobile’s boss, tweeted that “the music
shouldnotstop ind.c.” Mr Campbell
turned it back on.
DontMuteDC has since morphed into
a wider protest movement against gen-
trification, with Go-Go its symbol.
Created in the 1970s by Chuck Brown,
whose “Bustin’ Loose” was for years the
Washington Nationals’ home-run cele-
bration song, Go-Go was the last flourish
of a black-majority city’s vibrant musical
culture. Shaw was at its centre. By the
1980s, Go-Go bands played every night in
the neighbourhood and beyond.
Go-Go’s decline began the following
decade when, in an effort to curb vio-
lence, the city forced clubs to close earli-
er and to stop serving alcohol. Around
the same time blacks began moving out
to the Maryland suburbs. Gentrification
has accelerated that process. By 2015 the
proportion of black Washingtonians haddropped below 50% for the first time
since the 1950s.
These changes have particularly
harmed Go-Go because it was created to
be experienced live. Its characteristics
include call-and-response, which turns
the audience into part of the perfor-
mance, and the use of percussive solos
instead of pauses between songs—which
is how Go-Go got its name. That makes
the music unsuitable for radio or three-
minute hits. Without live venues, a new
generation had mostly given it a miss.
That, says Mr Campbell, has changed
since last year’s protests. He is devel-
oping an internet streaming service for
his huge collection of live recordings. A
Go-Go museum is in the works and this
weekdcCouncil declared Go-Go the
city’s “official music”. Though it is not
clear quite what that will entail, it seems
likely to involve tourists. The efforts to
preserve Go-Go may end up gentrifying a
form of music that was created to be
anything but.A no Go-Go area
Gentrification in Washington, DCThe capital’s declining black population fights to preserve its musical heritageMissing a beatI
n 1971, anunemployed salesman named
Shep Glazer upended the typically som-
nolent hearings of the House Ways and
Means Committee by giving a live demon-
stration of dialysis before aghast congress-
men. The shock seemed to pay off. Mr Glaz-
er’s goal—to ensure that all patients reliant
on blood-filtering dialysis machines, be-
cause of failing kidneys, would be covered
by a then-newfangled programme called
Medicare, the government health-insur-
ance scheme for the elderly, regardless of
age—soon became law. Through the new
end-stage renal disease (esrd) pro-
gramme, Medicare for All became a reality
for a certain portion of the sick, and has re-
mained so for nearly 50 years.
What seemed like a small exemption
then has morphed into something much
larger. Originally designed to cover 10,000
patients, the esrd programme now in-
cludes 512,000. Dialysis is expensive: a
machine must filter out toxins and excess
fluids from the blood, often for several
hours a day and several times per week. It is
a life-or-death treatment. Still, two-thirds
of patients with esrddie within five years.
A year of treatment in a specialised centre
costs $91,000. The small programme
created in the 1970s now costs over $35bn,
or roughly 6% of all Medicare spending.
Much of this is due simply to rising
need. Diabetes and high blood pressure,
which have been rising, are precursors of
chronic kidney disease. Because Medicare
sets prices, costs for dialysis have grown
more slowly than for other health-care pro-
cedures. The operation of dialysis centres
has nonetheless become brisk business (in
part because private-insurance companies
pay more). A near-duopoly controls 70% of
the market, earning net profits of 18%.
For many patients a kidney transplant is
a much better option than several years of
dialysis before death—life expectancy is
much longer, and that life is of higher qual-
ity. It also saves money for the taxpayer,
notes Mario Macis of Johns Hopkins Uni-
versity. “The math is such that every kidney
transplant generates savings for Medicare
of about $150,000,” says Mr Macis.
The problem is that there are almost
100,000 people on the waiting list, and the
typical waiting time is more than four
years, meaning thousands die before their
turn. Incentivising organ donations is
morally fraught. But at present, there are
strong disincentives to living organ dona-tions. Though there is no medical bill for
giving up a kidney, costs for transport,
lodging and lost wages during recovery are
not reimbursed. For three-quarters of pros-
pective donors, these can amount to one
month of income. Research from Mr Macis
and two colleagues shows that Americans
are much more keen on reimbursement if
it is offered by a public agency—as opposed
to direct purchase—and if it meaningfully
increases the supply of organs.The curious case of the kidney gives a
few insights into the larger workings of the
American health-care system. Small, fos-
silised provisions morph into huge pro-
grammes decades later. Government influ-
ence over prices may limit overall growth
in costs, but can coincide with abnormally
high profits for a few operators. And com-
paratively clear ideas for reducing billions
in costs while improving thousands of
lives can go ignored for years.^7NEW YORK
A quirk in the law means that a kidney
shortage costs taxpayers billionsMedicine and the lawKidney failure