Category Archives: Public Policy and Governance

Who Will Die?

Among the travesties being committed by a lawless and determinedly stupid administration, its assault on science–and particularly medical science– is among the acts most likely to affect all Americans negatively. Ironically, the administration’s anti-science, anti-expertise tantrum has already proved to hit devoted MAGA Neanderthals the hardest.

While there have always been medical skeptics, this expanded retreat from sound medical advice began in earnest during the pandemic, when the “give me liberty” MAGA cult refused to wear masks, continued to sponsor and attend public gatherings, and–especially– refused to get vaccinated. They died of Covid in disproportionate numbers.

In the wake of the 2020 election, there was some speculation that–at least in some deep Red congressional districts–a fall-off in Republican votes was due to that disproportionate death rate. (I’ve been unable to find confirmatory data for that speculation, but the fact that unvaccinated folks were much more likely to suffer and die has been repeatedly documented.)

The designation of MAGA folks as a cult has become widespread, and the evidence for that continues to mount. During the pandemic, followers of their massively ignorant cult leader obediently ingested bleach and Ivermectin, a medication intended for horses; today, RNK, Jr.–he of the brain worm and an assortment of bizarre conspiracy theories–is busily substituting those theories for medical science. His cuts at HHS are already imperilling public health, and are likely to make it more difficult for sane Americans to receive the vaccines that protect us from a wide variety of diseases.

The dramatic politicization of health care is likely to affect us all, but–again, ironically–it is much more likely to affect the cult’s true believers. I recently came across an article describing how the choice of a doctor has become partisan. Research published in the British Journal of Political Science finds that Americans’ trust in their personal physicians—an area that the study notes “was once a rare nonpartisan sanctuary”—has become increasingly divided along political lines, with potentially serious implications for public health.

Here–in a nutshell–is what the study found.

Trust reversal: While Republicans were slightly more trusting of their doctors a decade ago, Democrats are now 12 percentage points more likely to express “a great deal” of trust in their physicians.

Political preferences matter: Both Republicans and Democrats strongly prefer doctors who share their political affiliation, sometimes placing as much importance on political alignment as on shared race or gender.

Health implications: With Trump voters over 50 being 11 percentage points less likely to closely follow their doctor’s advice, this partisan divide could affect health outcomes and potentially widen existing mortality gaps between Republican and Democratic counties.

It hasn’t always been this way.

In 2013, Republicans actually reported slightly higher trust in their personal doctors than Democrats. By 2022, the tables had turned dramatically, with Democrats approximately 12 percentage points more likely than Republicans to report “a great deal” of trust in their physicians.

The study noted that the General Social Survey–a research instrument that tracks American attitudes– found diminished “confidence in the scientific community, education, the press, and many other institutions had already polarized along partisan lines by 2010. Medicine, however, remained stubbornly nonpartisan until 2021.”

The COVID-19 pandemic thrust public health officials into the spotlight, where they quickly became lightning rods for partisan conflict. The study found strong evidence that as medical authorities like Dr. Anthony Fauci became political targets, the distrust spilled over into Americans’ relationships with their own personal doctors….

Between 2001 and 2019, researchers observed a growing gap in death rates between Republican and Democratic counties, with people in Democratic counties living longer. If partisan divides continue to influence healthcare decisions, this gap may widen further, creating a feedback loop where political identity affects health outcomes, which then reinforce political divisions.

As the linked article concludes, if this polarization continues or increases, and Americans increasingly make critical life choices based on political identity, those choices could mean the difference between early diagnosis and late-stage disease. That makes the stakes of this particular aspect of our deepening political divisions literally matters of life and death.

If the results of the stupidity were confined to those applauding it, that would be one thing. (Admittedly, still a bad thing, but–hey, I’m not a nice human–somewhat fitting.) But we’re all likely to inhabit a far less protective world. Cuts to the FDA alone will mean slower approval of new medications, fewer food safety inspections, and lapses in new medical products. Other cuts have decimated research into diseases like HIV, Parkinsons and Alzheimers.

The cult’s dominance threatens us all.

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The Perils Of Privatization

According to the Washington Post, Elon Musk and the Trump Administration are hauling out an “oldie but goodie” and promising that once they’ve hollowed out the federal government’s capacity to govern, they’ll turn any functions they deem necessary over to the private sector. They’ll privatize for “efficiency.”  What could possibly go wrong?

Let me count the ways.

I spent a fair amount of my academic career researching what folks on the Right misleadingly call “privatization.” The first thing you need to know is that calling what Trump and Musk want to do “privatizing” is a misnomer. When Margaret Thatcher sold off government-owned industries to the private sector–where they made or lost money, paid taxes, and were left to sink or swim–that was privatization. In the U.S., the term is used to mean contracts between a government agency and a business or nonprofit organization to provide a government benefit or service. Government continues to pay for that service or benefit with tax dollars, and government remains responsible for its proper delivery.

Sometimes, contracting out makes sense. Sometimes it doesn’t. (It also shouldn’t be confused with procurement— government’s purchase of goods and services from the private market.)

Contracts with units of government are qualitatively different from contracts between private actors, and those differences make it far more likely that the “privatization” contracts ultimately negotiated will be unfavorable to taxpayers. Contracting out first became a fad at the state and local level some twenty-plus years ago, and the results weren’t pretty.

As I wrote back in 2013, mayors and governors who are considering privatization are operating under a different set of incentives than the corporate CEO who is charged with long-term profitability of his business. Long term to a politician means “until the next election.” Typically, the elected official is looking for immediate cash to relieve fiscal stress (and improve his immediate political prospects) and is much less concerned with the extended consequences of the transaction.

Furthermore–although it really pains me as a former Corporation Counsel to admit this–the lawyers who reviewed these deals for local governments tended to be far less sophisticated than  lawyers acting on behalf of the contractors. That’s not because they aren’t good lawyers–most are. But the skills required to advise a municipality or state agency aren’t generally the same skills as those needed by practitioners of business transaction law.

In addition to the existence of unequal bargaining capacities, there is also—unfortunately—the very high potential for “crony capitalism,” the temptation to reward a campaign donor or political patron with a lucrative contract at taxpayer expense. Back in the bad old days, patronage meant that you volunteered for the party and if your party won, you–or maybe your brother-in-law–got a job with the city or state. With “privatization,” patronage meant that you made a meaningful contribution to the party and if it won, you got a cushy contract.

Ideally, the media would act as a watchdog in these negotiations, alerting the public when a proposed contract is lopsided or otherwise unfavorable. But media has never been very good at providing this sort of scrutiny, because news organizations rarely employ business reporters able to analyze complex transactions. (In today’s media environment, of course, we’re lucky if we even know a deal is in the works.)

In that 2013 post, I warned that we shouldn’t be surprised when these transactions turn out to be unfavorable to the taxpayer–and in the years that followed, a great many of them proved to be very unfavorable indeed. (For one thing, it turned out that too many government agencies lacked the capacity to effectively monitor contractors.)

Worse, from an accountability standpoint, when services are delivered by an intermediary, citizens often fail to realize that those services are really being provided by government. That failure has constitutional as well as political implications. Only government can violate an individual’s civil liberties–that’s what lawyers call “state action”–so it’s important that we be able to distinguish actions taken by private actors from those that can be attributed to government. Privatization has significantly muddied that distinction.

Also, when contracting is extensive, it masks the true size of government. Today, there are approximately 3.7 million contract employees in addition to 2.1 million civil servants. Only the latter are being targeted by Musk.

Will the public fall for this replay of an expensive and discredited “reform”? Hopefully, our earlier, extensive negative experience with privatization will prevent folks from falling for this again, but as we know, simple prescriptions sell.

The plutocrats are undoubtedly salivating….

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JD Vance Spills The Beans

Last Wednesday, I focused on two introductory paragraphs in one of Heather Cox Richardson’s daily Letters. Today, I want to revisit another paragraph from that same letter, in which Richardson quotes from a speech made by our creepy, faux “Hillbilly” Vice President.

Here’s that quote, from a 2021 interview.

“American conservatives…have lost every major powerful institution in the country, except for maybe churches and religious institutions, which of course are weaker now than they’ve ever been. We’ve lost big business. We’ve lost finance. We’ve lost the culture. We’ve lost the academy. And if we’re going to actually really effect real change in the country, it will require us completely replacing the existing ruling class with another ruling class…. I don’t think there’s sort of a compromise that we’re going to come with the people who currently actually control the country. Unless we overthrow them in some way, we’re going to keep losing.” “We really need to be really ruthless when it comes to the exercise of power,” he said.

That quote is the very essence of MAGA– the whine of White Christian males who are furious that American culture is depriving them of “ruling class” status, and who are determined to take the country back to the “good old days” when women, Black people and other “inferior” sorts knew our place.

I have previously noted that what Trump, Vance, Musk and the rest of MAGA are trying to do is inconsistent with today’s American culture–a point with which Vance rather obviously agrees. The question is: when politically powerful officials attempt to change the culture–when they embark on a project to reverse cultural changes–can they succeed?

Can this administration fulfill JD Vance’s fondest hope, and return us to the 1950s?

I doubt it, although they are certainly trying. (The recent attack on the Smithsonian Institution is a case on point, as are  efforts to erase the contributions of women and minorities from government websites, and restore Confederates names to national monuments.)

I found an excellent 2020 essay on this point, in a publication called The Minnesota Reformer. It’s worth reading in its entirety. The author suggested that in 2016, Republicans “decided to nominate the man who most loudly voiced their fears, who promised most explicitly to protect them from the cultural changes threatening them.”

Conservatives may argue that with laws such as the Civil Rights Act and Voting Rights Act, American liberals have indeed used the political system to drive cultural change, but that argument confuses cause with effect. Those laws, while historic, did not drive cultural change, they were the products of cultural changes that had already occurred. The civil rights movement of the ‘50s and early ‘60s, brought into American living rooms by the new technology of television, had made people see things differently, to think about things differently. Only after the civil rights movement changed hearts and minds, after it changed what was deemed culturally acceptable, were the laws changed to reflect that culture.

The essay argues that America’s government, with its constitutional limitations,

is not capable of producing cultural change on the scale that we are witnessing. It can slow such changes, for a while; it can adapt to them and regulate them and in the end it must reflect them, but it cannot create them. Only highly intrusive governments such as Soviet Russia, Communist China, Nazi Germany and revolutionary Iran can force such profound change.

As the writer notes later in the essay, “A government that is large enough, intrusive enough and brutal enough to tamp down cultural change in such an environment is not a government consistent with American traditions.”

JD Vance–a Yale Law “hillbilly”–clearly understands that. So do the (few) intellectuals in the MAGA movement–and so did the authors of Project 2025. Thus, the obvious conclusion: if only “highly intrusive” governments like Russia and Nazi Germany are able to force the changes they want, then America’s constitutional democracy must be replaced with such a government. Trump, Vance, Musk et al are proceeding at a furious pace with an effort to replace America’s admittedly messy and contentious liberal democracy with a fascist regime that will be capable of Vance’s desired “ruthless exercise of power.”

The author of the linked essay suggests that we may be witnessing the last stage of the culture wars, “the deciding battle of a decades-long effort by conservative Americans to enlist government as their champion against cultural changes that they have long fought against.”

Those of us who believe in the American Idea (and applaud the cultural changes consistent with it) simply cannot allow that to happen.

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RIP Pax America

It isn’t just the insane tariffs. They are just the coup de grace. As Lawrence Summers posted: the tariffs are to economics what creationism is to biology, astrology is to astronomy, or RFK thought is to vaccine science. In fact, it is likely that their effects will hasten the fall of our mad would-be king, as plutocrats join the millions of ordinary Americans appalled by the wholesale destruction of American governance and the world order. 

But the larger damage has been done, and it is not remediable.

Perhaps the most accurate–and damning–analysis was from The Bulwark.

We cannot overstate what has just happened. It took just 71 days for Donald Trump to wreck the American economy, mortally wound NATO, and destroy the American-led world order.

He did this with the enthusiastic support of the entire Republican party and conservative movement.

He did it with the support of a plurality of American voters.

He did not hide his intentions. He campaigned on them. He made them the central thrust of his election. He told Americans that he would betray our allies and give up our leadership position in the world.

And that is exactly what he’s done. The article quoted Canada’s Prime Minister’s sorrowful eulogy.

The global economy is fundamentally different today than it was yesterday. The system of global trade anchored on the United States, that Canada has relied on since the end of the Second World War—a system that, while not perfect, has helped to deliver prosperity for our country for decades—is over.

Our old relationship of steadily deepening integration with the United States is over.

The eighty-year period when the United States embraced the mantle of global economic leadership—when it forged alliances rooted in trust and mutual respect, and championed the free and open exchange of good and services—is over.

While this is a tragedy, it is also the new reality.

So–how did we get here?

Historians will undoubtedly spend decades looking for answers, and there are certainly lots of contributing factors: lack of civic education, an information environment that facilitates confirmation bias, the ballooning gap between the rich and the rest, the arrogance of the tech “bros”. But while all those elements contributed, my own research tells me that the single most consequential support for Trumpism is America’s entrenched racism.

When I use the word racism, I’m not simply referring to anti-Black animus, although that is indeed its most prominent characteristic. I am using that term to include the other persistent, notable bigotries that continue to be prominent elements of American society : anti-Semitism, raging misogyny…the simmering resentment that all too many Americans harbour for anyone they consider “Other.” 

As Trump and Musk have taken their hatchets to the federal government, they have made no effort to hide their major target: those Others. They have moved to expunge DEI, diversity and “woke-ism” from America’s society– “epithets” that are thinly veiled terms for civic equality and equal rights. 

A plurality of our fellow citizens cast their votes for a President and a political party devoted to White Christian supremacy. It’s doubtful that they intended to destroy Pax Americana, but placing America under a regime of know-nothings, bigots and buffoons could hardly have done otherwise. And as the linked article says, “There is no going back.”

If, tomorrow, Donald Trump revoked his entire regime of tariffs, it would not matter. It might temporarily delay some economic pain, but the rest of the world now understands that it must move forward without America.

If, tomorrow, Donald Trump abandoned his quest to annex Greenland and committed himself to the defense of Ukraine and the perpetuation of NATO, it would not matter. The free world now understands that its long-term security plans must be made with the understanding that America is a potential adversary, not an ally.

This realization may be painful for Americans. But we should know that the rest of the world understands us more clearly than we understand ourselves….

The article’s conclusion is depressing–but realistic.

We have a deeply stupid government—from our economically illiterate president to our craven and foolish secretary of state, from the freelancing billionaire dilettante who is gutting American soft power to the vaccine-denying health secretary who is firing as much talent as he can. From the senior economics advisor who thinks comic books are good investments, to the senators who voted to confirm this cabinet of hacks, to the representatives who stumble over themselves justifying each new inane MAGA pronouncement.

But also, we have the government we deserve.

The American age is over. And it ended because the American people were no longer worthy of it.

RIP.

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Left And Right

For several years, one of most annoying (and misleading) aspects of American political debate has been the insistence of participants on defining our differences as “left” and “right.” The MAGA cult, especially, has delighted in portraying all non-MAGA Americans as hated “libruls,” and–far from challenging their policy preferences–has displayed a child-like delight in “owning the libs,” seemingly unconcerned that their “successes” in that effort tend to hurt them more than their targets.

America’s liberals have historically been far more centrist and un-ideological than those in European countries, but today, the terminology simply fails to convey the reality of MAGA versus everyone else. So it may be useful to ask ourselves a question: In today’s political environment, what constitutes the “Left”?

Two paragraphs–an aside, really– from one of Heather Cox Richardson’s recent “Letters” provides an accurate answer to that question. While Richardson’s letter wasn’t focused on political language, the introduction to her discussion of the Trump administration’s devotion to Project 2025 aptly captured the essence of today’s political divide:

The craziness going on around us in the first two months of the second Trump administration makes a lot more sense if you remember that the goal of those currently in power was never simply to change the policies or the personnel of the U.S. government. Their goal is to dismantle the central pillars of the United States of America—government, law, business, education, culture, and so on—because they believe the very shape of those institutions serves what they call “the Left.”

Their definition of “the Left” includes all Americans, Republicans and Independents as well as Democrats, who believe the government has a role to play in regulating business, providing a basic social safety net, promoting infrastructure, and protecting civil rights and who support the institutional structures Americans have built since World War II.

Let me repeat that second paragraph, because it is an incredibly important description of our current reality:

Their definition of “the Left” includes all Americans, Republicans and Independents as well as Democrats, who believe the government has a role to play in regulating business, providing a basic social safety net, promoting infrastructure, and protecting civil rights and who support the institutional structures Americans have built since World War II.

The differences that existed between Left and Right when I was first involved in politics were far different than they are today. The Republican Party in which I worked for some 35 years (a party that no longer exists) had firm principles about the proper, limited uses of government power and authority. Admittedly, that party had its far-Right fringe, just as the Democrats had its collectivist-Left, but the GOP’s establishment was generally successful in isolating the Christian Nationalists and neo-Nazis that have always been in its midst.

Back then, establishment Republicans and Democrats argued about policy–about what constituted the proper and improper uses of government power, and/or the efficient/effective management of government programs.

What should government do about the struggle of poor families to feed their children? Should ameliorative efforts be left to the voluntary sector? To the states? If the federal government should be involved, how should its programs be fashioned?

When it came to foreign affairs, there was broad agreement that policy squabbles should not extend beyond the ocean’s edge–and a common commitment to a government that stood by America’s allies and promoted peace and democracy abroad. It’s true–and unfortunate– that America’s leaders too often misused the nation’s power and lost sight of the country’s fundamental philosophical commitments, but never in our history did either party heedlessly and overtly side with the country’s enemies over our allies.

Our internal fights to extend civil rights did tend to break down over party lines, but when I was an active Republican, the vast majority of Republicans I worked with rejected racism and agreed that the nation’s laws should be applied evenly and fairly. Today, MAGA Republicans’ devotion to Donald Trump rests largely on their wholehearted support of his efforts to take the country back to the days of Jim Crow.

Bottom line: The “libs” that MAGA delights in “owning” are the Americans who believe in retaining a government that operates under the Constitution and respects the rule of law. Full stop. We may disagree strongly about aspects of that operation, about the extent of federal authority, about the optimum contours of our social safety net, over what constitutes “merit”–but today, the “Left” that MAGA hates is composed of all conservatives and liberals who believe in retaining a government that answers to We the People.

According to MAGA, any American who wants to retain our democratic republic is a Leftist.

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