In 2018, senior executives at one of the country’s largest nonprofit hospital chains, Providence, were frustrated. They were spending hundreds of millions of dollars providing free health care to patients. It was eating into their bottom line.
The executives, led by Providence’s chief financial officer at the time, devised a solution: a program called Rev-Up.
Rev-Up provided Providence’s employees with a detailed playbook for wringing money out of patients — even those who were supposed to receive free care because of their low incomes, a New York Times investigation found.
nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.
But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.
focused on investments in rich communities at the expense of poorer ones.
And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.
provide. That was below the average of 2 percent for nonprofit hospitals nationwide, according to an analysis of hospital financial records by Ge Bai, a professor at the Johns Hopkins Bloomberg School of Public Health.
Ten states, however, have adopted their own laws that specify which patients, based on their income and family size, qualify for free or discounted care. Among them is Washington, where Providence is based. All hospitals in the state must provide free care for anyone who makes under 300 percent of the federal poverty level. For a family of four, that threshold is $83,250 a year.
In February, Bob Ferguson, the state’s attorney general, accused Providence of violating state law, in part by using debt collectors to pursue more than 55,000 patient accounts. The suit alleged that Providence wrongly claimed those patients owed a total of more than $73 million.
Providence, which is fighting the lawsuit, has said it will stop using debt collectors to pursue money from low-income patients who should qualify for free care in Washington.
But The Times found that the problems extend beyond Washington. In interviews, patients in California and Oregon who qualified for free care said they had been charged thousands of dollars and then harassed by collection agents. Many saw their credit scores ruined. Others had to cut back on groceries to pay what Providence claimed they owed. In both states, nonprofit hospitals are required by law to provide low-income patients with free or discounted care.
“I felt a little betrayed,” said Bev Kolpin, 57, who had worked as a sonogram technician at a Providence hospital in Oregon. Then she went on unpaid leave to have surgery to remove a cyst. The hospital billed her $8,000 even though she was eligible for discounted care, she said. “I had worked for them and given them so much, and they didn’t give me anything.” (The hospital forgave her debt only after a lawyer contacted Providence on Ms. Kolpin’s behalf.)
was a single room with four beds. The hospital charged patients $1 a day, not including extras like whiskey.
Patients rarely paid in cash, sometimes offering chickens, ducks and blankets in exchange for care.
At the time, hospitals in the United States were set up to do what Providence did — provide inexpensive care to the poor. Wealthier people usually hired doctors to treat them at home.
wrote to the Senate in 2005.
Some hospital executives have embraced the comparison to for-profit companies. Dr. Rod Hochman, Providence’s chief executive, told an industry publication in 2021 that “‘nonprofit health care’ is a misnomer.”
“It is tax-exempt health care,” he said. “It still makes profits.”
Those profits, he added, support the hospital’s mission. “Every dollar we make is going to go right back into Seattle, Portland, Los Angeles, Alaska and Montana.”
Since Dr. Hochman took over in 2013, Providence has become a financial powerhouse. Last year, it earned $1.2 billion in profits through investments. (So far this year, Providence has lost money.)
Providence also owes some of its wealth to its nonprofit status. In 2019, the latest year available, Providence received roughly $1.2 billion in federal, state and local tax breaks, according to the Lown Institute, a think tank that studies health care.
a speech by the Rev. Dr. Martin Luther King Jr.: “If it falls your lot to be a street sweeper, sweep streets like Michelangelo painted pictures.”
Ms. Tizon, the spokeswoman for Providence, said the intent of Rev-Up was “not to target or pressure those in financial distress.” Instead, she said, “it aimed to provide patients with greater pricing transparency.”
“We recognize the tone of the training materials developed by McKinsey was not consistent with our values,” she said, adding that Providence modified the materials “to ensure we are communicating with each patient with compassion and respect.”
But employees who were responsible for collecting money from patients said the aggressive tactics went beyond the scripts provided by McKinsey. In some Providence collection departments, wall-mounted charts shaped like oversize thermometers tracked employees’ progress toward hitting their monthly collection goals, the current and former Providence employees said.
On Halloween at one of Providence’s hospitals, an employee dressed up as a wrestler named Rev-Up Ricky, according to the Washington lawsuit. Another costume featured a giant cardboard dollar sign with “How” printed on top of it, referring to the way the staff was supposed to ask patients how, not whether, they would pay. Ms. Tizon said such costumes were “not the culture we strive for.”
financial assistance policy, his low income qualified him for free care.
In early 2021, Mr. Aguirre said, he received a bill from Providence for $4,394.45. He told Providence that he could not afford to pay.
Providence sent his account to Harris & Harris, a debt collection company. Mr. Aguirre said that Harris & Harris employees had called him repeatedly for weeks and that the ordeal made him wary of going to Providence again.
“I try my best not to go to their emergency room even though my daughters have gotten sick, and I got sick,” Mr. Aguirre said, noting that one of his daughters needed a biopsy and that he had trouble breathing when he had Covid. “I have this big fear in me.”
That is the outcome that hospitals like Providence may be hoping for, said Dean A. Zerbe, who investigated nonprofit hospitals when he worked for the Senate Finance Committee under Senator Charles E. Grassley, Republican of Iowa.
“They just want to make sure that they never come back to that hospital and they tell all their friends never to go back to that hospital,” Mr. Zerbe said.
The Everett Daily Herald, Providence forgave her bill and refunded the payments she had made.
In June, she got another letter from Providence. This one asked her to donate money to the hospital: “No gift is too small to make a meaningful impact.”
Following a Script ‘Like Robots’
In 2019, Vanessa Weller, a single mother who is a manager at a Wendy’s restaurant in Anchorage, went to Providence Alaska Medical Center, the state’s largest hospital.
She was 24 weeks pregnant and experiencing severe abdominal pains. “Let this just be cramps,” she recalled telling herself.
Ms. Weller was in labor. She gave birth via cesarean section to a boy who weighed barely a pound. She named him Isaiah. As she was lying in bed, pain radiating across her abdomen, she said, a hospital employee asked how she would like to pay. She replied that she had applied for Medicaid, which she hoped would cover the bill.
After five days in the hospital, Isaiah died.
Then Ms. Weller got caught up in Providence’s new, revenue-boosting policies.
The phone calls began about a month after she left the hospital. Ms. Weller remembers panicking when Providence employees told her what she owed: $125,000, or about four times her annual salary.
She said she had repeatedly told Providence that she was already stretched thin as a single mother with a toddler. Providence’s representatives asked if she could pay half the amount. On later calls, she said, she was offered a payment plan.
“It was like they were following some script,” she said. “Like robots.”
Later that year, a Providence executive questioned why Ms. Weller had a balance, given her low income, according to emails disclosed in Washington’s litigation with Providence. A colleague replied that her debts previously would have been forgiven but that Providence’s new policy meant that “balances after Medicaid are being excluded from presumptive charity process.”
Ms. Weller said she had to change her phone number to make the calls stop. Her credit score plummeted from a decent 650 to a lousy 400. She has not paid any of her bill.
Susan C. Beachy and Beena Raghavendran contributed research.
The day thieves stole his truck and trailer, Alex Gonzalez nearly lost his entire business.
Inside was thousands of dollars’ worth of lawn care equipment that fueled Gonzalez’s livelihood.
“It’s a cutthroat business,” said Gonzalez, owner of Havana Gardens Lawn & Landscaping. “If you’re not there on a certain day that you tell your customers you’re gonna be there, they look for someone else.”
Thieves made off with machinery and truck parts worth $65,000.
The National Insurance Crime Bureau found car thefts rose 17% from 2019 to 2021. But certain regions saw massive spikes over those two years.
Like in Washington D.C., New York and Wisconsin — and up to a 79% spike in Colorado.
Some officials there worry punishments aren’t severe enough, which encourages car thieves to strike again.
In another staggering statistic, carjackings spiked triple digits in some parts of the country: 286% in New York and 238% in Philadelphia.
David Glawe, the head of the National Insurance Crime Bureau, says chop shops are turning mostly to juvenile carjackers to help feed the hungry, illicit market.
In New Jersey, authorities believe adults are paying minors as much as $1,000 per vehicle, knowing they won’t get in as much trouble when they’re caught.
Glawe told Congress they’re stealing more cars because the secondary market needs them.
Federal lawmakers are now calling for a national auto-theft task force — especially in port cities, which are often hubs for shipping stolen cars overseas.
In the first half of 2020, U.S. and Canadian law enforcement tracked down stolen cars bound for Europe, Africa and the Middle East totaling nearly $3 million.
Savvy crooks are also targeting the most precious parts of the cars.
Related StoryThere’s A Rise In Catalytic Converter Thefts Across The U.S.
Between 2020 and 2021 catalytic converter thefts more than quadrupled, with 65,000 stolen nationwide.
The converters are partly made with rhodium, one of the rarest metal on earth.
Every ounce of it can top $15,000 and is also valuable for jewelry, high-end mirrors and electrical devices.
In Tampa, police busted one recycler last year who advertised on social media he was paying cash for converters and seized his paperwork.
It showed that he had made well over $800,000 in about a year’s time just with the receipts.
One way people are trying to prevent theft is having their car’s VIN etched onto the converters.
Chicago is trying a pilot program that will spray paint the converters hot pink and mark them with a Chicago Police Department stencil.
But Joe Dipasquale, who works for Auto Zone, says criminals are targeting pretty much everything car-related right now.
“They’ll put their hands on anything they can turn around and flip,” Dipasquale said. “Tools are one of the things that go really quickly because they’re expensive.”
Officials have this advice: Keep your auto policy up to date, roll up your windows, lock your doors, park in well-lit areas and never leave behind your keys or any valuables.
Rhodium is used in car converters, but as the rarest metal in the world, it’s also valued for jewelry, high-end mirrors, and electrical devices.
It doesn’t take long; A quick slide under a car and moments later the thief emerges with a catalytic converter stolen for the precious metals inside.
“You just hear every day or every week somebody in my neighborhood is getting their catalytic converter stolen,” Tempe, Arizona motorist Scott Cook said.
Thieves cut the converters out of the car’s exhaust systems, then sell them to scrappers, who then sell them again to recycling companies.
The thieves get as little as $50, but the metals inside include rhodium, which is the rarest metal on earth.
There’s only a gram or two of rhodium inside, but an ounce of the silvery metal can top $15,000.
“Cars manufactured with a high amount of rhodium thefts, particularly in cars manufactured with a high amount of rhodium, like Prius and others,” Chicago Police Superintendent David O. Brown said. “Certain electric cars that have a high efficiency and high amount of rhodium because of the price of rhodium going up some 1,500% these past few years.”
Rhodium is used in converters with palladium and platinum to reduce exhaust gases, but as the rarest metal in the world, it’s also valued for jewelry, high-end mirrors and electrical devices.
In Tampa, police busted one recycler last year who advertised on social media he was paying cash for converters and seized his paper work.
“It showed that he had made well over $800,000 in about a year’s time just with the receipts we found in the home,” Tampa Police Department Officer Greg Noble said.
Bloomberg reports in 2021, State Farm Insurance paid $62 million in claims for around 32,000 converter thefts. That’s up over 1,100% from two years earlier.
“I started my car and it sounded like a race car,” West Palm Beach, Florida theft victim Pamela Beady said.
That was her first clue that something wasn’t right.
“There was metal pieces laying under the ground underneath,” she continued.
The catalytic converter on her new 2022 Mitsubishi Outlander was gone and cost $1,000 to replace.
“I’m like, ‘Man, if I would have just known that these were high-targeted,’ because there are things that you can do to your catalytic converters to prevent thieves from taking them,” Beady said.
In West Palm Beach, one way people are trying to prevent theft is by having their car’s VIN number etched onto the converters.
“If customers will call us, if it’s not one of our customers, ask them for the VIN number,” mechanic Ron Katz said. “We are more than happy to do that. There are other Midas’s around the country now that are also starting this initative.”
In Phoenix, Midas teamed up with the Maricopa County State’s Attorney to push for VIN number markings.
“For us on the County Attorney’s Office, this type of information that’s being etched today is crucial because it allows us to link a catalytic converter, once it’s recovered, back to its original car, its original owner,” Maricopa County Attorney’s Office spokeswoman Karla Navarrete said. “And it really aids in prosecution.”
Painting them different colors is also an attempt to cut thefts. In Chicago next month, a pilot program will include spray painting the converters hot pink and marking them with a Chicago Police Department stencil.
KOROPY, Ukraine — Four men tugged at long strips of fabric to lift a coffin out of the gaping hole in the backyard of a small house. They flung the lid open to reveal the moldy corpse of Oleksiy Ketler, who had been killed instantly by shrapnel when a mortar fell on the road in Koropy, a village outside Khavkiv in northeastern Ukraine, in March.
Mr. Ketler, a father of two young children, would have celebrated his 33rd birthday on June 25, if he had not been outside his house at the wrong time. Now, his body has become another exhibit in Ukraine’s wide-ranging effort to collect evidence to prosecute Russia and its military for war crimes in the brutal killings of Ukrainian civilians.
Experts say the process is proceeding with extraordinary speed and may become the biggest effort in history to hold war criminals to account. But it faces an array of formidable challenges.
rape, execution-style killings and the deportation of what Mr. Belousov said could be tens of thousands of Ukrainians to Russia — were being investigated.
Better Understand the Russia-Ukraine War
At the same time, hundreds of international experts, investigators and prosecutors have descended on Ukraine from an alphabet soup of international agencies.
Early in the war, the top prosecutor of the International Criminal Court, Karim Khan, arrived in Ukraine with several dozen investigators. But the court, which is based in the Netherlands, tries a limited number of cases, and usually seeks to prosecute only the upper echelon of political and military leaders.
It is also slow: Investigators working on the 2008 Russian-Georgian war did not apply for arrest warrants until this year.
There are a number of other initiatives, too. Amal Clooney, an international human rights lawyer, is part of a team advising the Ukrainian government on bringing international legal action against Russia. The United Nations has started a commission to investigate human rights violations in Ukraine — with three human rights experts — but cannot establish a formal tribunal because Russia wields veto power on the U.N. Security Council.
Investigators in Poland are collecting testimonies from refugees who fled there to feed to Ukrainian prosecutors. France has sent mobile DNA analysis teams to embed with the Ukrainian authorities to collect evidence. Nongovernmental organizations based in Kyiv, Ukraine’s capital, are going to territories recently occupied by Russian soldiers to collect witness statements.
The involvement of multiple countries and organizations does not necessarily lead to a more productive investigation, said Wayne Jordash, a British criminal lawyer who lives in Ukraine. Mr. Jordash, who is part of an international task force supporting Ukrainian prosecutors, was critical of some of the efforts to assist Ukraine judicially, describing it as “smoke and mirrors,” without results and clear priorities.
The International Criminal Court’s investigators were only just getting going, he noted, and experts from other countries have also been cycling in for stints of several weeks.
“You can’t just parachute into an investigation for two weeks and expect it to be meaningful,” Mr. Jordash said.
Iva Vukusic, a scholar of post-conflict justice at the University of Utrecht, said, “Resources are being poured in, but maybe down the line we will see that they were not being spent the right way,” for instance, duplicating investigation efforts rather than providing psychosocial support to victims.
Ms. Vukusic pointed out the large size of the endeavor. Across the country, she said, “there are thousands of potential suspects, and thousands of potential trials.” All of the material needs to be properly marshaled and analyzed, she said.
“If you have 100,000 items — videos, statements, documents — if you don’t know what you’re sitting on, it limits the use of material,” Ms. Vukusic said.
She also cautioned that the International Criminal Court’s leadership could face criticism by collaborating too closely with the Ukrainian authorities because, she said, Ukraine was also “an actor in this war.”
She feared Ukrainian officials were setting expectations for justice very high, and possibly wasting scarce resources on absentia trials.
“No big caseis going to be finished in two years or five years because of the scale of the violence and the fact it is going on for so long,” she said.
Mr. Belousov, the Ukrainian war crimes prosecutor, acknowledged as much. “We are playing a long game,” he said. Even if the perpetrator is tried and convicted in absentia, Mr. Belousov said, “We understand in a year, or two or three or five, these guys won’t be able to avoid punishment.”
Mr. Belousov said that he appreciated the international assistance but that coordinating it was the “biggest challenge” law enforcement authorities experienced.
For example, the Kharkiv prosecutors used a shiny new forensic investigation kit donated by the European Union for their exhumation in Koropy, the village in northeast Ukraine. But a police officer from a unit in Dmytrivka, a 45-minute drive west of Kyiv, said they had not seen or met with any international investigators or received any equipment from them.
Mr. Belousov said Ukraine wanted to take the lead in prosecuting the cases — a divergence from previous post-conflict situations in which the national authorities initially left the process to international tribunals.
But most Ukrainian investigators have little experience in these kinds of inquiries.
For example, Andriy Andriychuk, who joined the police force in the region west of Kyiv two years ago, said his work previously involved investigating local disputes or livestock theft. Now it involves “a lot more corpses,” he said.
On a recent sunny afternoon, he was called to a wooded area near the town of Dmytrivka. Several days before, police officers had received a call from foresters who had come upon a man’s grave. The dead man, Mykola Medvid, 56, had been buried with his passport; his hat was hung on top of a cross made out of sticks.
His daughter and his cousin identified his body. The local morgue officially established the cause of death: a fatal shot in the chest.
Since then, his daughter Mariia Tremalo has not heard from the investigators. No witnesses have come forward, and it was unclear who might have killed her father, or why. Still, she is hungry for justice.
“My father will never be returned,” she said. “But I would like the perpetrators to be punished.”
Right now that seems all but impossible.
In Koropy, the village near Kharkiv, Mr. Ketler’s mother, Nadezhda Ketler, was inconsolable as the gravediggers and inspectors worked. She wandered down the road to another part of her property. Six officials stood over her son’s body, photographing and documenting as his best friend, Mykhailo Mykhailenko, who looked petrified and smelled of stale alcohol, identified him.
The next day, Mr. Ketler’s body was taken to the city’s morgue, where the final cause of death was established.
Eventually, Ms. Ketler gathered the strength to show investigators the crater made by the bomb that killed him, leading the police to the exact spot where he died. Ms. Ketler stood looking at the trees as they rustled in the wind. She did not speak to anyone. She said she did not know if a guilty verdict in a war crimes trial, if it ever came, would ease the pain of losing her child.
“I had to bury my son twice,” Ms. Ketler said later. “You understand, this is hard enough to do once, and to have to do it a second time. The pain of a mother will not go anywhere.”
Evelina Riabenko, Diana Poladova and Oleksandr Chubko contributed reporting.
While being honored at the Banff Film Festival in Canada in early June, Bela Bajaria, Netflix’s head of global television, surprised some with what she didn’t say. Despite the recent turmoil at the streaming giant — including a loss of subscribers, hundreds of job cuts and a precipitous stock drop — she said Netflix was charging ahead, with no significant plans to change its programming efforts.
“For me, looking at it, the business works,” Ms. Bajaria said from the stage. “We are not doing some radical shift in our business. We’re not merging. We’re not having a big transitional phase.”
Two weeks later, after Netflix had laid off another 300 people, Reed Hastings, the company’s co-chief executive, doubled down on Ms. Bajaria’s message, reassuring the remaining employees that the future would, in fact, be bright and that in the next 18 months the company would hire 1,500 people.
“Spiderhead” and the series “God’s Favorite Idiot” have been critically derided.) A producer who works with Netflix said the word “quality” was being bandied about much more often in development meetings.
Emily Feingold, a Netflix spokeswoman, disputed the idea that focusing on a show’s quality was somehow a change in strategy, referring to such disparate content as “Squid Game,” the reality television show “Too Hot to Handle,” and movies like “Red Notice” and “The Adam Project.”
“Consumers have very different, diverse tastes,” Ms. Feingold said. “It’s why we invest in such a broad range of stories, always aspiring to make the best version of that title irrespective of the genre. Variety and quality are key to our ongoing success.”
The producer Todd Black said that the process for getting a project into development at Netflix had slowed down but that otherwise it was business as usual.
“They are looking at everything, which I get,” said Mr. Black, who last worked with Netflix when he produced “Ma Rainey’s Black Bottom” in 2020. “They are trying to course correct. We have to be patient and let them do that. But they are open for business. They are buying things.”
Indeed, the company still intends to spend some $17 billion on content this year. It paid $50 million last month for a thriller starring Emily Blunt and directed by David Yates (“Harry Potter and the Deathly Hallows”). And it plans to make “The Electric State,” a $200 million film directed by Joe and Anthony Russo (“Avengers: Endgame” and “The Gray Man”) and starring Millie Bobby Brown and Chris Pratt, after Universal Pictures balked at the price tag. The company also just announced a development deal for a television adaptation of “East of Eden” starring Florence Pugh.
On Tuesday, Whip Media, a research firm, said Netflix had fallen from second to fourth place in the firm’s annual streaming customer satisfaction survey, behind HBO Max, Disney+ and Hulu.
The most significant change coming for Netflix is its advertising tier, which, as it has told employees, it wants to roll out by the end of the year. Netflix’s foray into advertising stoked excitement among media buyers at the industry’s annual conference in Cannes last week.
“It was pretty intense,” said Dave Morgan, who is the chief executive of Simulmedia, a company that works with advertisers, and who attended the conference. “It was one of the top two or three issues everyone was talking about.”
Mr. Hastings said Netflix would work with an outside company to help get its nascent advertising business underway. The Wall Street Journal reported that Google and Comcast were the front-runners to be that partner. Still, advertising executives believe that building out the business at Netflix could take time, and that the company might be able to introduce the new tier only in a handful of international markets by the end of the year.
It could take even longer for advertising to become a significant revenue stream for the company.
“You have a lot of media companies duking it out, and it’ll take quite a while to compete with those companies,” Mr. Morgan said. “I could imagine it will take three or four years to even be a top 10 video ad company.”
In an analyst report this month, Wells Fargo threw cold water on the notion that subscriber growth for an ad-supported tier would be quick. Wells Fargo analysts cautioned that the ad model would offer “modest” financial gains in the next two years because of a natural cannibalization from the higher-paying subscriber base. They predicted that by the end of 2025 nearly a third of the subscriber base would pay for the cheaper ad-supported model, roughly 100 million users.
Bank of America went further last week. “Ad-tiering could serve as a way for consumers across all income brackets to extend their streaming budget by trading down to subscribe to an additional service, benefiting Netflix’s competitors much more than Netflix itself,” it said in an analyst letter.
Netflix has also reached out to the studios that it buys TV shows and movies from in recent weeks, seeking permission to show advertising on licensed content. In negotiations with Paramount Global, Netflix has mentioned paying money on top of its existing licensing fee rather than cutting the company in on revenue from future ad sales, said a person familiar with the matter who spoke on the condition of anonymity to discuss active talks.
This mirrors the approach Netflix took with studios when it introduced its “download for you” feature, which allowed users to save movies and TV shows to their devices to watch offline. When Netflix added that feature, executives at the streaming service agreed to pay studios a fee in addition to their licensing agreement.
In the end, though, Netflix’s success will most likely come down to how well it spends its $17 billion content budget.
“Netflix, dollar for dollar, needs to do better, and that falls on Ted Sarandos and his whole team,” Mr. Greenfield said, referring to the company’s co-chief executive. “They haven’t done a good enough job. Yet, they are still, by far, the leader.”
CAIRO — The song starts out like standard fare for Egyptian pop music: A secret infatuation between two young neighbors who, unable to marry, sneak flirtatious glances at each other and commit their hearts in a bittersweet dance of longing and waiting.
But then the lyrics take a radical turn.
“If you leave me,” blasts/explodes/shouts the singer, Hassan Shakosh, “I’ll be lost and gone, drinking alcohol and smoking hash.”
The song, “The Neighbors’ Daughter,” has become a giant hit, garnering more than a half- billion views of its video on YouTube alone and catapulting Mr. Shakosh to stardom. But the explicit reference to drugs and booze, culturally prohibited substances in Egypt, has made the song, released in 2019, a lightning rod in a culture war over what is an acceptable face and subject matter for popular music and who gets to decide.
The battle, which pits Egypt’s cultural establishment against a renegade musical genre embraced by millions of young Egyptians, has heated up recently after the organization that licenses musicians barred at least 19 young artists from singing and performing in Egypt.
arrested teenage girls who posted videos of themselves dancing, which is a crime there. And in 2020, Northwestern University in Qatar called off a concert by a Lebanese indie rock band whose lead singer is openly gay.
But online streaming and social media platforms have poked giant holes in that effort, allowing artists to bypass state-sanctioned media, like television and record companies, and reach a generation of new fans hungry for what they see as more authentic and relevant content.
Iran’s draconian restrictions on unacceptable music have produced a flourishing underground rock and hip-hop scene. The question facing Egypt is who now has the power to regulate matters of taste — the 12 men and one woman who run the syndicate, or the millions of fans who have been streaming and downloading mahraganat.
Mahraganat first rose out of the dense, rowdy working-class neighborhoods of Cairo more than a decade ago and is still generally made in low-tech home studios, often with no more equipment than a cheap microphone and pirated software.
DJ Saso, the 27-year-old producer of Mr. Shakosh’s blockbuster hit.
Many lawyers and experts say the syndicate has no legal right to ban artists, insisting that Egypt’s Constitution explicitly protects creative liberty. But these arguments seem academic in the authoritarian state of President Abdel Fattah el-Sisi, which has stifled freedom of speech, tightened control on the media and passed laws to help monitor and criminalize immoral behavior on the internet.
The syndicate’s executive members have adamantly defended their move, arguing that a key part of their job is to safeguard the profession against inferior work that they say is made by uncultured impostors who tarnish the image of the country.
He is one of the Arab world’s leading performers. Since he was barred, he has performed in Saudi Arabia, Qatar and Iraq, and “The Neighbors’ Daughter” has become one of the biggest Arabic hits to date.
“It’s not the same old love songs,” said Yasmine el-Assal, a 41-year-old bank executive, after attending one of Mr. Shakosh’s concerts before the ban. “His stage presence, the music, the vibe, it’s fresh and it’s all about having fun.”
Mr. Shakosh would not agree to be interviewed, preferring to keep a low profile, his manager said, rather than to appear to publicly challenge the authorities. The ban has been harder on other artists, many of whom do not have the wherewithal or the international profile to tour abroad.
They have mostly kept quiet, refusing to make statements that they fear could ruffle more feathers.
Despite the squeeze, however, many are confident that their music falls beyond the grip of any single authority or government.
Kareem Gaber, a 23-year-old experimental music producer known by the stage name El Waili, is still burning tracks, sitting in his bedroom with a twin mattress on the floor, bare walls and his instrument, a personal computer with $100 MIDI keyboard.
“Mahraganat taught us that you can do something new,” he said, “and it will be heard.”
SAN FRANCISCO — President Biden and many lawmakers in Washington are worried these days about computer chips and China’s ambitions with the foundational technology.
But a massive machine sold by a Dutch company has emerged as a key lever for policymakers — and illustrates how any country’s hopes of building a completely self-sufficient supply chain in semiconductor technology are unrealistic.
The machine is made by ASML Holding, based in Veldhoven. Its system uses a different kind of light to define ultrasmall circuitry on chips, packing more performance into the small slices of silicon. The tool, which took decades to develop and was introduced for high-volume manufacturing in 2017, costs more than $150 million. Shipping it to customers requires 40 shipping containers, 20 trucks and three Boeing 747s.
The complex machine is widely acknowledged as necessary for making the most advanced chips, an ability with geopolitical implications. The Trump administration successfully lobbied the Dutch government to block shipments of such a machine to China in 2019, and the Biden administration has shown no signs of reversing that stance.
Congress is debating plans to spend more than $50 billion to reduce reliance on foreign chip manufacturers. Many branches of the federal government, particularly the Pentagon, have been worried about the U.S. dependence on Taiwan’s leading chip manufacturer and the island’s proximity to China.
A study this spring by Boston Consulting Group and the Semiconductor Industry Association estimated that creating a self-sufficient chip supply chain would take at least $1 trillion and sharply increase prices for chips and products made with them.
Moore’s Law, named after Gordon Moore, a co-founder of the chip giant Intel.
In 1997, ASML began studying a shift to usingextreme ultraviolet, or EUV, light. Such light has ultrasmall wavelengths that can create much tinier circuitry than is possible with conventional lithography. The company later decided to make machines based on the technology, an effort that has cost $8 billion since the late 1990s.
The development process quickly went global. ASML now assembles the advanced machines using mirrors from Germany and hardware developed in San Diego that generates light by blasting tin droplets with a laser. Key chemicals and components come from Japan.
a final report to Congress and Mr. Biden in March, the National Security Commission on Artificial Intelligence proposed extending export controls to some other advanced ASMLmachines as well. The group, funded by Congress, seeks to limit artificial intelligence advances with military applications.
Mr. Hunt and other policy experts argued that since China was already using those machines, blocking additional sales would hurt ASML without much strategic benefit. So does the company.
“I hope common sense will prevail,” Mr. van den Brink said.