Category Archives: Public Policy and Governance

I Will Never Understand This

There are a lot of things I don’t understand. Bitcoin. How wireless internet works. Why anyone gives a rat’s patootie about Kardashian-type celebrities.  Lots more.

But on Thanksgiving–when I reflect on my good health and comfortable life and give thanks for my family– I am reminded that what I really, really don’t understand is why so many people oppose allowing government to insure other people’s health.

Don’t get me wrong: I certainly understand debating the how of healthcare, arguing for policy A rather than policy B or C. But I’m appalled by those who evidently consider health care an optional consumer good–and believe that people who can’t afford it shouldn’t have it.

What triggered this rant was a post from Dispatches from the Culture Wars. I’ve met Ed Brayton, who writes Dispatches. He is a delightful person, a steadfast proponent of reason, the rule of law, civil liberties and science.

He also has a pre-existing condition.

While Trump and virtually every Republican lies about not wanting to do away with the ACA’s protections for those who have preexisting medical conditions, the AARP has a new report out that says the result would be a massive increase in premiums for people like me, as high as $26,000 a year.

Brayton quotes from the AARP report:

The revised American Health Care Act (AHCA) threatens to do away with the Affordable Care Act’s (ACA) protections for people with preexisting health conditions. These protections prevent insurance companies from denying these individuals coverage or charging them higher rates based on their health.

Eliminating these protections could force millions of Americans to — once again — rely on state high-risk pools. State high-risk pools are supposed to provide access to health insurance for people who cannot get coverage in the individual health insurance market because of preexisting health conditions.

State high-risk pools may sound like a good idea but, in reality, they are fraught with problems. One of the biggest lessons learned from experience with state high-risk pools: They bring steep premiums that put coverage out of reach for millions. In the past, monthly premiums in state high-risk pools could be up to 200 percent higher than in the individual (nongroup) market. Consequently, only a small fraction of those with preexisting conditions could afford to buy a plan. Yet, these premiums — high as they were — only covered about half the amount needed to pay enrollee claims. Most states tried to close the financial gap through taxes on providers and government subsidies, but even those efforts proved insufficient. We project that if states return to pre-ACA high-risk pools in 2019, as proposed, high-risk pool premiums for people with preexisting conditions could be as high as $25,700 annually.

Brayton’s reaction paints the picture in very personal terms:

High-risk pools are a disaster. They make insurance completely unaffordable for the overwhelming majority of people. As I’ve said many times, if the Republicans succeed in repealing Obamacare, I’m dead. Probably within a year. There’s no way I could afford the premiums in a high-risk pool and my medication costs run into thousands of dollars a month, and that doesn’t count all the specialists and tests and stays in the hospitals.

The United States health industry (as a student once explained to me, we don’t have a ‘system’) costs twice as much per person as in the next most expensive country, and our outcomes are far worse. (We not only aren’t “number one,” the last time I looked, we were number 37.) Private health insurance companies have average overhead costs of 23-25% (costs that include bloated management salaries and corporate jets, along with marketing costs and personnel hired solely to decide that you don’t really need that medicine).

Medicare’s overhead is 3%.

Americans pay much more for much less, all because we don’t want to subsidize medical care for the Ed Braytons of the world–or for the children of poor families, or people who don’t look like us.

The day America joins the rest of the civilized world by guaranteeing universal access to basic medical care will really be Thanksgiving.

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Telling It Like It Is: Election Version

In a riff on the title of the book What’s the Matter with Kansas, Ron Klain’s recent column for the Washington Post was “What’s the Matter with Florida?”

The column could have more accurately headed “What’s Wrong With America’s Electoral ‘System’?” Note the quotation marks around the word system; they’re there because (much like the situation with health care), we don’t have anything that remotely deserves the word “system.”

As the New York Times reported just last Sunday in an article about voting glitches,

Though it wasn’t a 2000 redux, the 2018 midterms exposed persistent problems and the haphazard way the voting process was administered across the country. In Arkansas, three-member boards handle elections at the county level, while in Connecticut all 169 towns and cities use their own registrars.

The inherently political nature of running elections can call into question some officials’ decision-making.

Klain served as general counsel for Al Gore in that 2000 recount effort in Florida; he says he’s often asked why these problems keep happening in Florida.

Part of what we are seeing now in Florida, as we did in 2000, is the product of factors specific to the state: persistently weak election administration in key counties, perennially close and hard-fought elections, and a colorful group of political players that seems ripped from the pages of a Carl Hiaasen novel. But the most important thing to know about what’s happening in Florida is that it has little to do specifically with Florida at all.

Take a step back and look at the big issues playing out in Florida, and what you’ll see, instead of Florida’s foibles, are three critical challenges to American democracy as a whole.

It’s hard to argue with the negative effects of the three challenges Klain identified in his column: we allow “interested” officials to supervise elections;  we entrust the electoral process to amateurs and incompetents; and state election systems are poorly run and underfunded.

The recent midterms especially highlighted the first of these. As Klain notes,

Florida’s chief law enforcement officer, Gov. Rick Scott, who is also the Republican nominee in the Senate recount, is in a position to allege crimes by election officials, attempt to seize voting machines and dispatch state troopers to try to intervene in the post-election dispute. But a similar spectacle has been unfolding for months next door in Georgia.

As chief of election administration in Georgia, Secretary of State Brian Kemp— who is also the Republican nominee for governor, in a vote also being contested — stalled more than 50,000 new voter registrations, supported closing more than 200 polling places in predominantly minority areas and purged 1 in 10 Georgia voters from the rolls. In Kansas, Secretary of State Kris Kobach — again, also the Republican nominee for governor — employed many of the same tactics as Kemp, and fell just short of being elected.

These are egregious conflicts of interest, but such conflicts are only slightly less concerning when partisan officials not running for office oversee elections. Those officials have, as the saying goes, “a dog in the fight,” and significant incentives to game the process to favor their political party.

The clusterf**k in Florida also illustrates Klain’s other points: the machine recount  in Palm Beach County was hampered because old machines overheated from processing so many ballots; and 30,000 ballots in Broward County recorded votes for state agriculture commissioner but not the U.S. Senate. That weird result turned out to be the result of a poorly designed ballot.  More incompetence in the state of the hanging chad….

Klain’s most important point, in my view, is the following:

But again, that’s not just in Florida. While some election misadministration (such as inadequate numbers of voting machines in targeted areas) appears to be a deliberate effort to suppress the vote in minority communities, much Election Day mayhem is caused by systems that are poorly run and underfunded.

No matter how much we hail democracy on the Fourth of July, come November, elections are just another government service: In communities where thin budgets and lax leadership produce scant bus service, slow ambulance response times and unkempt parks, we should not be surprised to find confusing ballots, bad instructions at the polls and slow vote tabulation.

For the past 40 years, Americans have been beating up on the very idea of government. We have voted for people whose proudest “qualification” is that they know nothing about public service, and for people who insist that taxation is “theft” rather than the dues we pay for civilization. We lionize the small percentage of our population who have the means to retreat into gated enclaves and provide for their own comfort and safety.

We the People no longer support government’s most basic obligation: to provide an adequate physical and social infrastructure administered by competent public servants.

It shows. And not just during elections.

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The Wall And The Wave

No, not that wall. The wall that Republican partisan redistricting built to keep Democratic voters out.

A report from Politico in the wake of the midterm elections put it succinctly:the GOP had used partisan redistricting to build a “wall” around Congress; Trump tore it down.

For years, some Democrats said gerrymandering was an insurmountable roadblock to the House majority that couldn’t be cleared until after the 2020 census.

Then along came President Donald Trump.

House Democrats steamrolled Republicans in an array of districts last week, from those drawn by independent commissions or courts, to seats crafted specifically by Republicans with the intention of keeping them in the GOP column.

The overriding factor: a Republican president who political mapmakers could not have foreseen at the beginning of the decade. Trump altered the two parties’ coalitions in ways that specifically undermined conventional wisdom about the House map, bringing more rural voters into the GOP tent while driving away college-educated voters.

I’ve posted numerous times about the ways in which gerrymandering undercuts democratic decision-making, and discourages voter turnout. I’ve also referenced several  books and articles detailing 2011’s “RedMap”–the GOP’s most thorough, successful national effort at locking in a Republican House majority. (The book Ratfucked said it all…)

The were two important structural lessons from this year’s midterms.

First, the results confirmed a truism among political operatives and observers: In order to surmount the gerrymandered wall, Democrats would need at least a 7 point vote advantage. Nationally, they got that, and a bit more.

Second–gerrymandering really does matter more than the geography of “sorting” would suggest. In Bill Bishop’s book The Big Sort, he pointed out that Americans currently migrate to locations where they feel philosophically and politically comfortable. We can see the results in the rise of the Urban Archipelago–those blue dots representing cities with populations over 500,000.

One argument against nonpartisan redistricting rests on the theory that–since we have “sorted” ourselves into red and blue enclaves– gerrymandering really doesn’t make much difference. The Politico article undercuts that argument, bigly.

Despite Democrats’ massive House gains — the party’s biggest since 1974, after Richard Nixon’s resignation — redistricting clearly held them back in some places. Democrats netted at least 21 districts drawn by independent commissions or courts — getting a major boost from courts in Florida, Pennsylvania and Virginia that altered GOP-drawn maps in the past two years — along with 10 districts drawn by Republicans and the two in Illinois that were drawn by Democrats.

As the article makes clear, Democrats did appreciably better in non-gerrymandered districts.

The blue wave was high enough to overcome a large number of gerrymandered walls, thanks to revulsion against and very welcome rejection of Donald Trump. But in districts drawn fairly–without partisan bias–they did even better.

Gerrymandering, vote suppression (Georgia, anyone?) and the other tactics being used by the GOP to game the system need to be eliminated. A few states–Missouri and Michigan among them–voted this month for fair elections; the rest of us need to do the same.

We shouldn’t need a “wave” to install a government that reflects the values of  the majority  of America.

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Learning From My Students

We’ve reached my favorite point in the semester–the point where I stop lecturing/haranguing and listen while student teams present their research. They teach me.

Each team of students is given fifty minutes within which to present the major arguments involved in an issue currently facing policymakers, and to do so in a manner that is fair to all perspectives. Teams are allowed to approach their presentations in any fashion they choose, and they’re graded on clarity of communication, breadth of resources used, logic and organization. (Creativity is a plus.)

At the beginning of the semester, I assign teams (I use an “algorithm” called the alphabet) and give each team a general policy area (the economy, the environment, education, social policy, etc.) from which they then choose a specific issue to address.

In the past, teams have done skits (complete with costumes!), debates, power-point presentations, multi-media presentations, even movies. The only hard-and-fast requirement is that  all perspectives/sides of the debate be presented as fairly as possible. That said, students are permitted to “weigh in” on one side or the other after they’ve explored the arguments.

Last Monday, one of the teams presenting compared Obama’s Clean Power Plan (CCP) to Trump’s Affordable Clean Energy Act(ACE).

They began by discussing the Clean Air Act of 1970 and the underlying legal context (the role of government, the contending interests of state and federal governments, and the ongoing argument about the extent to which market forces should control policy).

They then launched into a comparative analysis of the two measures, focused on environmental impact, energy needs, the impact on jobs (no, Trump isn’t bringing those mining jobs back), and public health.

Let me share just a few of their (copious) findings:

  • The U.S. is the second-largest emitter of greenhouse gas on the globe. CPP was designed to reduce such emissions; ACE “makes no such commitment.”
  • By 2030, CPP would have reduced carbon emissions by 19%. ACE will cut them between 0.7% and 1.5%
  • Coal production will be higher under ACE, but will still decline.(That pesky market!)
  • There is only one “clean coal” plant in the entire country, and the cost of factories able to produce “clean coal” is in the billions, so no others are likely to be built.
  • One-third of the nation’s electricity is still generated from coal, and the percentage is declining.
  • That decline is a market phenomenon, not a result of regulation, although regulation has disadvantaged some types of coal over others.
  • Renewable energy technology is increasingly making alternative sources more cost-effective.

Perhaps the most interesting part of the analysis–at least to me– was the impact of the two plans on public health; the EPA’s mission, after all, focuses on giving citizens clean air to breathe and clean water to drink. The differences were striking.

The CPP passed by the EPA under Obama estimated the social damage done by carbon emissions at $50/ton. The ACE estimated the damage at somewhere between $1 and $7 per ton. Among the reasons for what the students labeled a “drastic” difference was that Trump’s EPA discounted the impact of climate change, and the Obama administration included the identified human health impacts of both climate change and the decline in ambient air quality.

There was much more.

Each semester, I am amazed and impressed at the amount of data these student teams collect, synthesize and analyze–and more significantly, the policy conclusions they draw from that data.

The real reward of teaching is what I learn.

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Terrorism’s Tools

The hits keep coming.

Pipe bombs mailed, churches and synagogues targeted, young people once again mowed down by armed, unstable individuals…Last Sunday, the New York Times devoted several pages in its Sunday magazine to the phenomenon of homegrown, white rightwing terrorism (and the government’s failure to track it), and Time Magazine headlined a story “Why Terror is Rising in America.”

Both reports emphasize the relatively small number of perpetrators of these horrific assaults. For example, despite the Tree of Life massacre and the spike in anti-Jewish incidents, survey results suggest that anti-Semitism in the U.S. is at an all-time low.

Anti-Semitism has never been eradicated, and probably never could be. It dwells in the crevices and fissures. Largely extinguished in the uppermost reaches of society, it flourishes most among cranks and broken souls on the margins–those for whom the post-industrial world provides few satisfying occupational or real world communal niches. Jew hatred is a minority phenomenon, to be sure. In an age when AR-15s are easy to come by, even the smallest minority is profoundly dangerous.

Anti-Semitic incidents have increased dramatically, up 57 percent in just the last year according to the Anti-Defamation League, and, in fact, hate crimes are up across the board. Statistics show the number of people killed by far-right extremists since Sept. 11 are roughly equal to the number killed in the U.S. by jihadist terrorists–a fact that has received little public attention and gone unremarked upon by F.B.I. Director Christopher Wray in his annual testimony before Congress. Hate crimes against Muslims also rose almost 20 percent in 2016 over 2015.

When the Constitution was being crafted, James Madison and other Founders worried about “the tyranny of the majority.” Madison assumed that minorities–by which he meant people who held dissenting and/or anti-social beliefs–would be unlikely to find each other; they would easily be outnumbered (and silenced) by majorities of citizens who disagreed with them.

Madison couldn’t have envisioned the Internet, where all manner of advocates, kooks and haters can join each other in creating communities of the like-minded, and reinforce each others’ extremist beliefs.

As we’ve seen all too often, these online communities have become gigantic amplifiers, emboldening their participants and strengthening them in their most vile convictions. Just as the Internet turbocharged the jihadi universe and created a global support community for ISIS, it has networked and inspired the far-right.

Another thing Madison could never have predicted, of course, was the election of a President as dangerously anti-democratic, racist and dysfunctional as Donald Trump.

The second development that has lit up this increasingly linked and animated extremist world is the advent of Donald Trump. The statistics demonstrate clearly that the biggest bump in hate crimes in recent history coincides with the period since his presidential campaign began. This is not just a matter of correlation but causation. Trump’s incendiary rhetoric, from his accusation that Mexicans coming to the U.S. were rapists to his claims that the caravan of impoverished Central American migrants coming north included Middle Easterners–aka “terrorists”–has given license to those who peddle hatred to emerge from the shadows. Much as ISIS has done with its far-flung recruits, Trump’s conspiracy theories have weaponized mental disability.

A friend of mine, the chief executive of his firm, recently shared a rule he imposed at meetings: complaints and criticisms would be welcomed, but only when accompanied by proposed solutions.

Complaining about something without proposing a solution is just whining–and whining doesn’t get us anywhere.

This particular complaint is the growth of domestic terrorism. One part of the solution is obvious; we must replace Donald Trump with someone who understands the role and responsibility of the Presidency.

Madison’s question of faction–and the ease with which unstable individuals can now connect–is harder. But as the Times article suggested, a far more robust government response would be a good start.

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