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Inscriptions throughout the Empire honour women as benefactors in funding public works, an indication they could acquire and dispose of considerable fortunes; for instance, the Arch of the Sergii was funded by Salvia Postuma, a female member of the family honoured, and the largest building in the forum at Pompeii was funded by Eumachia , a priestess of Venus. Agriculture and industry, such as milling and mining, relied on the exploitation of slaves.

Expanding Roman ownership of arable land and industries would have affected preexisting practices of slavery in the provinces. Slavery ceased gradually in the 6th and 7th centuries along with the decline of urban centres in the West and the disintegration of the complex Imperial economy that had created the demand for it.

They could be subjected to forms of corporal punishment not normally exercised on citizens, sexual exploitation , torture, and summary execution. A slave could not as a matter of law be raped since rape could be committed only against people who were free; a slave's rapist had to be prosecuted by the owner for property damage under the Aquilian Law. The terms of this account varied depending on the degree of trust and co-operation between owner and slave: a slave with an aptitude for business could be given considerable leeway to generate profit and might be allowed to bequeath the peculium he managed to other slaves of his household.

A bill of sale might contain a clause stipulating that the slave could not be employed for prostitution, as prostitutes in ancient Rome were often slaves. Those from outside of Europe were predominantly of Greek descent, while the Jewish ones never fully assimilated into Roman society, remaining an identifiable minority. These slaves especially the foreigners had higher mortality rates and lower birth rates than natives, and were sometimes even subjected to mass expulsions.

The range of ethnicities among slaves to some extent reflected that of the armies Rome defeated in war, and the conquest of Greece brought a number of highly skilled and educated slaves into Rome. Slaves were also traded in markets and sometimes sold by pirates. Infant abandonment and self-enslavement among the poor were other sources. Although they had no special legal status, an owner who mistreated or failed to care for his vernae faced social disapproval, as they were considered part of his familia, the family household, and in some cases might actually be the children of free males in the family.

Manumission had become frequent enough that in 2 BC a law Lex Fufia Caninia limited the number of slaves an owner was allowed to free in his will. After manumission, a slave who had belonged to a Roman citizen enjoyed not only passive freedom from ownership, but active political freedom libertas , including the right to vote. As a social class generally, freed slaves were libertini, though later writers used the terms libertus and libertinus interchangeably.

He could not marry a woman from a family of senatorial rank, nor achieve legitimate senatorial rank himself, but during the early Empire, freedmen held key positions in the government bureaucracy, so much so that Hadrian limited their participation by law.

The rise of successful freedmen—through either political influence in imperial service or wealth—is a characteristic of early Imperial society. The prosperity of a high-achieving group of freedmen is attested by inscriptions throughout the Empire , and by their ownership of some of the most lavish houses at Pompeii , such as the House of the Vettii. The excesses of nouveau riche freedmen were satirized in the character of Trimalchio in the Satyricon by Petronius , who wrote in the time of Nero.

Such individuals, while exceptional, are indicative of the upward social mobility possible in the Empire. See also: Senate of the Roman Empire , Equestrian order , and Decurion administrative The Latin word ordo plural ordines refers to a social distinction that is translated variously into English as "class, order, rank," none of which is exact. One purpose of the Roman census was to determine the ordo to which an individual belonged.

The two highest ordines in Rome were the senatorial and equestrian. Outside Rome, the decurions , also known as curiales Greek bouleutai , were the top governing ordo of an individual city. Fragment of a sarcophagus depicting Gordian III and senators 3rd century "Senator" was not itself an elected office in ancient Rome; an individual gained admission to the Senate after he had been elected to and served at least one term as an executive magistrate.

A senator also had to meet a minimum property requirement of 1 million sestertii , as determined by the census. Not all men who qualified for the ordo senatorius chose to take a Senate seat, which required legal domicile at Rome. Emperors often filled vacancies in the member body by appointment.

A senator could be removed for violating moral standards: he was prohibited, for instance, from marrying a freedwoman or fighting in the arena. Membership in the equestrian order was based on property; in Rome's early days, equites or knights had been distinguished by their ability to serve as mounted warriors the "public horse" , but cavalry service was a separate function in the Empire.

Roman aristocracy was based on competition, and unlike later European nobility , a Roman family could not maintain its position merely through hereditary succession or having title to lands. In antiquity, a city depended on its leading citizens to fund public works, events, and services munera , rather than on tax revenues, which primarily supported the military. Maintaining one's rank required massive personal expenditures.

Those in Imperial service were ranked by pay grade sexagenarius, 60, sesterces per annum; centenarius, ,; ducenarius, , In general, honestiores were the members of the three higher "orders," along with certain military officers. Cooperation with local power elites was necessary to maintain order, collect information, and extract revenue. Which was, hey, continuum of care, integrated care is better. Which is something that the CEO of Geisinger argues in the book.

Because how is this going to… Is this better or worse for rural healthcare? The Funnel Wars. Well, in some ways, if this causes a shrinking of Legacy Health Systems, that might be worse. So, and then of course, all of the virtual things that have come online and hopefully will stay online, will help with that. Chris Bevolo : So, I think it can impact it in different ways. It really just depends on where it goes.

And your cousin keeps telling you to check out the new Liberty Land Clinic that just opened in town. The clinic, one of that have sprouted up across the country is part of Liberty Land Health, a new entree into healthcare backed by billionaire media moguls, adventure capitalists.

That includes 25 acute care hospitals, urgent cares, and more than 5, affiliated physicians. Even has its own medical university that produces research, supporting such alternative medical approaches as vaccine free living and ivermectin protocols. Chris Bevolo : Your neighbor is a primary care doctor at a nearby clinic. The largest growing group on Facebook is dedicated to contrarian healthcare, and has been the primary driver of hostile demonstrations at city council meetings, school board meetings, and hospital board meetings across the country.

Here in town, a group called Boycott Deep River Hospital, has been fairly success at convincing dozens of formally long term patients to switch to Liberty Land Health, which better reflects their political views. The organization has been running television ads throughout prime time, featuring spokespeople like Joe Rogan and Jenny McCarthy.

Some politicians such as former Minnesota representative Michele Bachmann have called for the creation of an entirely separate parallel health system in the US. You may recall her, she was kind of a fire brand when she was in Congress. That she gave it an interview in December. And she called for exactly what we potentially predict here in the book which is, not only just the rise of health sects, which are groups that are oriented around medical views that fit their worldviews, but also the potential rise of providers to meet that group, to serve that group.

So think clinics and hospitals, just like the fictional Liberty Land Health that might crop up, that are focused on that political worldview and serving those people in the community that believe the same thing. And the hypercharged political atmosphere we found ourselves in due to a very, very contentious election. Chris Bevolo : We learned last year that the number one way to tell if an individual has been vaccinated by COVID is their political affiliation, not where they live, not their prior vaccination status, not their health status, not their income.

Surveys show that the best way to know is to ask whether they voted for a Democrat or Republican. The same was proven true at the end of last year and this year with booster shots. So that politicalization of medical choice is still coming through. The book talks about all of the trends that are fueling this, from the drop in trust in healthcare experts, like the CDC, which has just gone through the floor since the start of the pandemic.

A lot of that is self-induced pain that CDC caused themselves. We sent the book to press, but right before everything came out about Facebook late in the fall from the whistleblower, they talked about how Facebook knew that their algorithms was driving misinformation in terms of COVID, but did nothing to stop, it because it was also driving engagement and ad revenue.

And so really we asked the question, how long until we were going to see politically oriented or motivated clinics in organizations come forward? This is really to say, this is the state of play, now in moving forward, if you are a provider of care, what do you do with this?

When a George Floyd type incident happens, we have to say something. You have to say things about the importance of vaccines and social distancing and all of the accepted medical advice when it comes to public health issues. Yet, if you have a portion, in some cases, a large portion of the population that disagrees with those things, what happens when they come into your clinic and they argue with you, as we have seen time and time again in the news about COVID treatments?

What happens when they have an alternative? They listen to me over there. I mean, like you can see where that takes an already existing bubble and then intensifies it, like not only within this bubble are there new sources that support you, but now healthcare organizations and systems that support you as well.

What is the response to that kind of growing infrastructure and like growing misinformation? Like what have you seen anything that kind of gives hope to well, these are some approaches that might be effective? Politicalization in this country has hit everything, not just healthcare.

What cars you drive, what music you listen to, how you watch sports, all of this stuff, right? We talked to that in the book. But I mean, this is the way to treat this disease. Because oftentimes when people are presented with facts, [though ] the opps of the worldview, it actually gets them to dig deeper into that worldview.

But we see legislation in states across this country. I mean, Texas right now, right? And he had been on an incubator, he was basically coma and he was being kept alive by the machines. Who is the family suing? So this is impacting folks right now.

Chris Hemphill : Now. So one thing, there is a couple that I wanted to address here. Which Sundeep Aurora pointed out the impact that technology can have on intensifying these health sects such as Google searches and things like that. Just curious about in your research, did you find anything in terms of how there might be attempts to limit, like where the algorithms take people down YouTube rabbit holes or search and things like that?

When you think about this, we get to the end of this prediction and we thought, well, [inaudible ] this, how far can this really go? And you go, well, who monitors that? Who polices that? And we talk about this in the book. Then you look at how medical boards are formed. In almost every case we found state county they are political appointments. So, the health boards may not also be there to save us.

How does that work? But that is the kind of thing that potentially is coming. Throughout the history of the country, a large portion of our population has faced devastating health inequities and disparities. Chris Bevolo : Communities of color, the poor, the elderly all have been marginalized in numerous ways.

Disease symptoms misunderstood downplay or ignored. Sparse access to quality care, discrimination, inhumane treatment, over-index health issues, a worse quality of life, bankruptcies, shorter lifespans. The events of the last two years stemming from both COVID pandemic and social justice issues have brought these issues under the microscope, and the case of COVID 19, exacerbated them. As we know these issues are systemic and not easily addressed, but worse as we look forward a decade, we see these issues deepening, thanks to other equally significant challenges.

For example, the growing healthcare affordability crisis. The aging of the population, by the year there will be more grandparents in the United States than grandchildren. Chris Bevolo : The growing digital and technology gap. Research shows that, Medicare and Medicaid patients shoulder a hugely disproportionate share of climate sensitive illness costs. All these issues are worrisome in their own right, but they also have one thing in common.

They have an outsized impact on those who already face health inequities and disparate. Without some unforeseen dramatic change of events, the road ahead is not a positive one in terms of the health gap in the United States. Welcome to prediction, five disparity dystopia.

He has studied health systems. And he had some amazing insights to share. But this quote, I think is why maybe we took a little bit of a skeptical view, not a little bit, a deeply skeptical view of where the health gap is going to go in this country.

And so the things that make us great as a country, to be honest, also are why we see some of the things we see with our health system. But, what was really sad and frightening to us was, those other dynamics I mentioned coming forward and really shaping the future of this health gap in a worse way, not a better way, right?

The have nots are going to have less access to all those amazing things that make the Copernican Consumer was great. And at the same time, so while the haves are going to have it better, the have nots are going to have it worse, so that gap is widening in both ways. Chris Bevolo : And so of course there are hundreds, if not thousands of entities that are trying to work to solve this. Some big, some small across the spectrum of healthcare and beyond. By us all the way down to that provider, physician, clinician level.

Clearly people of color face this and continue to face it systemically. So yeah, that is a big part of this that has to be solved for, for sure. Chris Hemphill : And yeah, to add onto that is, when providers, or when people in the healthcare system make decisions on what types of care people should receive. So it hurts on more angles than just one. Something that we see in Western European countries. Let alone single payer kind of thing. Bringing Medicare to all would be a moonshot, because it would clear up so much access partially, right?

And he is like, and is also my cousin Marco spoke to this. Who gets access to the second tier? The people who have money. So, even though we have now given access to everybody, we have created another inequity. You should build yourself up, get a job, get insurance. Chris Hemphill : Pierre asked about this growing interest in patients, owning and controlling their data. Do you see relationship ship there between patient ownership of data and the healthcare disparity dystopia?

But in some ways exacerbates the disparities we already see, like I mentioned, the digital divide, right? But I would think that the more we see that, the more might see more of that gap. It goes back to the haves and the have nots. Chris Hemphill : Thank you for that.

How do you see that impacting this healthcare disparity dystopia that you outlined? So, systems that have this built in inherently and how that will sometimes overtly, but a lot of times in an invisible way impact this kind of thing. It took how many years for us to finally be in a place where we could allow the CDC to study be the impact of guns on healthcare in this country.

Chris Bevolo : That just came about this year or last year. How is that even possible? Chris Hemphill : Erica Johansson had the idea on, do NFTs potentially provide a way for patients to monetize their healthcare data? There is an argument there on, the technical disparity, but curious on your thoughts on NFTs or other ways that patients can monetize their own data. I mean, we touched on this a little bit, in Copernican Consumer.

And it may not come out in the form on FT as we know it today, maybe it does. I should own it, I should benefit from it. I mean, geez, I have so much I could retire right now, Chris, if I could monetize my health data, I got so much of it. People would love to get their hands on my health data.

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