Public Policy and Governance – Page 220

Anticipating Unanticipated Consequences

These are horrific political times. It’s hard not to be depressed–every day, it seems, we wake up to a new assault on what we thought were American values, new evidence of deplorable behaviors and attitudes we thought we’d left behind, new efforts to roll back hard-won progress.

But.

We need to remind ourselves that the turbulence and upheaval we see around us is not a new phenomenon. Times of social transition are typically unsettled and contentious. (Think of the Sixties, not to mention the Industrial Revolution, the Civil War…). The question is: what comes next? What are we transitioning to?

My own prediction–based on history and a lot of hope–is that the election of Trump will prove to be a turning point, that the resistance and increased activism we are already seeing will grow more pronounced, and the political pendulum will swing back toward sanity and concern for the common good. The problem is, in the meantime, Trump and the Congressional GOP are doing incalculable damage to the environment, to the rule of law, to the economy and to America’s place in the world.

Yesterday, McConnell finally unveiled the Senate’s Trumpcare bill, and it is even worse than the House version; it proposes to take health care from millions of struggling Americans in order to give a huge tax break to the rich.

Despicable as it is, I’m not the only person who sees potential for eventual progress lurking in short-term disaster. Take Ezra Klein’s recent article for Vox, “Republicans are about to make Medicare-for-All Much More Likely.”

On Friday, McConnell reportedly “delivered a private warning to his Senate Republicans: If they failed to pass legislation unwinding the Affordable Care Act, Democrats could regain power and establish a single-payer health-care system.”

History may record a certain irony if this is the argument McConnell uses to successfully destroy Obamacare. In recent conversations with Democrats and industry observers, I’ve become convinced that just the opposite is true: If Republicans unwind Obamacare and pass their bill, then Democrats are much likelier to establish a single-payer health care system — or at least the beginnings of one — when they regain power.

And if the GOP successfully unwinds Obamacare, the Democrats are far more likely to regain power in 2018. As Klein says,

The political fallout from passing the American Health Care Act — which even Donald Trump is reportedly calling “mean” — will also be immense. In passing a bill that polls at 20 percent even before taking insurance away from anyone, Republicans will give Democrats a driving issue in 2018 and beyond — and next time Democrats have power, they’ll have to deliver on their promises to voters. Much as repeal and replace powered the GOP since 2010 and dominated their agenda as soon as they won back the White House, if the American Health Care Act passes, “Medicare for all” will power the Democratic Party after 2017.

The bubble that Congressional Republicans occupy has become so divorced from the reality of American life and opinion–so in thrall to a (shrinking) base that is itself divorced from reality–that they no longer connect with most Americans. And presumably, the Democrats will have learned some important lessons from their experience with the ACA.

If Republicans wipe out the Affordable Care Act and de-insure tens of millions of people, they will prove a few things to Democrats. First, including private insurers and conservative ideas in a health reform plan doesn’t offer a scintilla of political protection, much less Republican support. Second, sweeping health reform can be passed quickly, with only 51 votes in the Senate, and with no support from major industry actors. Third, it’s easier to defend popular government programs that people already understand and appreciate, like Medicaid and Medicare, than to defend complex public-private partnerships, like Obamacare’s exchanges….

Obamacare was the test of the incrementalist theory, and, politically, at least, it’s failed. Democrats built a law to appeal to moderate Republicans that incorporated key ideas from Mitt Romney’s Massachusetts reforms, and it nevertheless became the single most polarizing initiative of Obama’s presidency. All the work Democrats did to build support from the health care industry has proven to be worth precious little as Republicans push their repeal plan forward. And the complex public-private design of the Affordable Care Act left the system dependent on the business decisions of private insurers and left Democrats trying to explain away premium increases they don’t control. The result is a Democratic Party moving left, and fast, on health care.

“I have been in contact with a lot of Democrats in Congress,” says Yale’s Jacob Hacker, who is influential in liberal health policy circles, “and I am confident that the modal policy approach has shifted pretty strongly toward a more direct, public-option strategy, if not ‘Medicare for all.’”

As bleak as our current political environment is, Klein and others see Ryan, McConnell and our clueless President unwittingly sowing the seeds of fairer and more cost-effective policies.

The accuracy of that prediction, of course, depends upon the strength, savvy and persistence of the Resistance.

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About That Echo Chamber…

As this blog frequently notes, one of the thorniest problems bedeviling our unravelling democracy is the distortion of reality–intentional and unintentional– provided via the Internet. That distortion is immensely aided by our tendency to live in echo chambers populated by friends who think like we do.

Most of us trust links from friends – a vulnerability exploited by phishing sites and other forms of online manipulation. An increasing number of us “unfriend” contacts who post uncongenial opinions or facts inconsistent with our political prejudices.

This is a real problem.

On the one hand, citizens who occupy different realities cannot have productive conversations or negotiate practical solutions to common problems; on the other hand, censorship of electronic media, in an effort to separate wheat from chaff, is neither wise nor possible.

Can technology save us?

Most of us, whatever our political orientation, recognize the problem. As an IU Professor of Computer Science and Informatics puts it,

If you get your news from social media, as most Americans do, you are exposed to a daily dose of hoaxes, rumors, conspiracy theories and misleading news. When it’s all mixed in with reliable information from honest sources, the truth can be very hard to discern.

In fact, my research team’s analysis of data from Columbia University’s Emergent rumor tracker suggests that this misinformation is just as likely to go viral as reliable information.

As he notes, the Internet has spawned an entire industry of fake news and digital misinformation.

Clickbait sites manufacture hoaxes to make money from ads, while so-called hyperpartisan sites publish and spread rumors and conspiracy theories to influence public opinion….

This industry is bolstered by how easy it is to create social bots, fake accounts controlled by software that look like real people and therefore can have real influence. Research in my lab uncovered many examples of fake grassroots campaigns, also called political astroturfing.

In response, we developed the BotOrNot tool to detect social bots. It’s not perfect, but accurate enough to uncover persuasion campaigns in the Brexit and antivax movements. Using BotOrNot, our colleagues found that a large portion of online chatter about the 2016 elections was generated by bots.

The real question–as the author readily concedes–is how to combat technology that spreads propaganda, or “fake news.” As he says, the first step is to analyze how these sites are operating. Then we can hope that smart people adept in use of these technologies can devise tools to combat the spread of false and misleading information.

Long-term, however, “fixing” the problem of fake news will require fixing the humans who have a need to believe whatever it is that such “news” is peddling. That fix will necessarily begin with better civic education and news literacy, but it can’t end there.

Ultimately, we have a problem of political psychology…It would seem that we humans have invented tools that have outstripped our ability to properly use them.

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Power to the People?

As Americans hold our collective breath watching an increasingly deranged Chief Executive (did you see that Cabinet meeting?), political scientists ponder the short- and long-term consequences of this unprecedented Presidency. How much damage will he do, and how long will it last?

Elaine Kamarck of the Brookings Institution has a recent article speculating on what happens next: she describes the possibilities as 1)Trump learning and his presidency becoming more normal or at least adapting to what she delicately terms his “impulsiveness;” 2) the chaos continuing and power moving away from the presidency as a result; or 3) Trump being forced to leave office.

I suppose the good news is that any of these scenarios spells doom for Dick Cheney’s wet dream of a “unitary executive.”

If I were a gambling woman, I’d put my money on #2. The chaos will continue, and the federal government–at least the Executive Branch– will no longer be the center of domestic or international policy. Power abhors a vacuum.

As Kamarck writes,

The second model involves little learning and no adaptation. This is a model for continuing chaos, with the likely result that power will begin to drain from the White House towards other centers. For instance, power can move from the White House to the states and to the private sector. In the area of climate change, California Governor Jerry Brown has already stepped into a leadership role. It is likely that governors and corporate leaders may begin to take action regardless of what the White House thinks. Power can also move to Congress where possibilities for a limited tax bill and some infrastructure spending can move more or less without White House leadership. And internationally, power can move to the heads of Germany and France in Europe and also to China, as the United States pulls back from the world or offers leadership that is too unstable to count on. It’s unclear whether turning the presidency into a sideshow would be permanent or not. But continuing chaos from a Trump presidency could do it at least temporarily.

During the turbulent Sixties, “Power to the People” was a popular slogan, but the scenario painted in Kamarck’s second model is hardly benign. Despite Americans’ longstanding distrust of central authority, numerous aspects of our national life require a measure of uniformity if we are to remain the United States.

In normal times, we would expect Congress to step in to fill the power vacuum. That would certainly be the best-case scenario–if we had a functioning legislative branch. But we don’t. One result of the Republicans’ exceedingly thorough 2011 gerrymander was the election of what has appropriately been dubbed the “lunatic caucus,” reactionary ideologues and culture warriors uninterested in the nitty-gritty details of governance and unacquainted with the concepts of pluralism or the common good. They are “led”–to the limited extent they are tractable–by men who have elevated party over country and power over the rule of law.

Devolving power to the states can help to ameliorate some of the immediate damage being done to American institutions, but the only real solution I see is a “wave” election in 2018 that gives us a Democratic Congress capable of containing Trumpism.

The 64 Thousand Dollar Question is whether the Democrats can get their act together, recruit responsible and attractive candidates, and forgo their usual intra-party fratricide.

The whole world is watching….

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Missing the Point

In the wake of Trump’s withdrawal from the Paris Accords, apologists have gone into overdrive. Even those who recognize that climate change is real have pooh poohed the significance of our withdrawal; after all, the goals were voluntary and weak, and anyway, America’s cities and states are stepping up to the plate, so we’ll probably make our goals even without participating in a formal agreement.

A recent article in Time is typical of the many arguments that what looks like a sow’s ear might really be a silk purse in disguise:

Trump knew his decision to withdraw the U.S. from the climate agreement would provoke global outrage, and it did. For Trump, the economy is the priority. But Trump’s promise to revive the coal industry isn’t going to happen; instead, the opposite will occur. And it’s safe to say that by 2020 — the earliest date that the U.S. can technically withdraw from the climate pact — Trump could point to his decision even as he points at all the shuttered coal plants, and say: “See, I told you we didn’t need the Paris deal. America’s emissions went down regardless, and our economy became stronger without it.”

Let’s parse that paragraph. If Trump knew the decision would provoke outrage, he should have recognized that such outrage would make it more difficult to achieve other goals, both domestic and international, so why do it? As even the apologists have conceded, the targets we had endorsed were entirely voluntary; the administration could simply have ignored any that they felt were bad for the American economy.

What we’ve seen of this deeply disturbed man suggests that he withdrew because it would provoke outrage. Trump likes to stir the pot, and he desperately needs to be the center of attention. Achieving his goals quietly (assuming he has goals unconnected to his ego), without fanfare, doesn’t feed his narcissism.

And what about that statement that the economy is his priority? Where’s the evidence that Trump has even the slightest understanding of economic policy? His insistence that he will bring back a coal industry that even coal company CEOs admit is no longer viable should have been a clue to his cluelessness.

And arguing that we will meet our emissions goals without being party to the Paris Accords misses the point. The point is: symbolism matters, and it matters a lot.

When President Obama led the negotiations that produced the Paris Accords, he was signaling that the United States remained the world’s leader. He was demonstrating this nation’s willingness to work with countries around the globe to address common challenges, and our willingness to do the hard work of analyzing relevant science and working through thorny political barriers in order to hammer out an agreement.

Obama’s commitment to the process sent a message to the rest of the world, and it was a message that enhanced American stature and our ability to exercise global “soft power.”

The message sent by Donald Trump’s exit from that hard-won agreement was exactly the opposite: America is no longer a steadfast global presence, no longer a source of reassuring leadership in a dangerous world.

Under a volatile, unpredictable, and profoundly ignorant President and his cabinet of intellectual and moral pygmies, America is withdrawing from global leadership. (As Angela Merkel put it, in her typically understated way, America is “no longer a reliable ally.”)

Whatever the practical effect of withdrawal on our ability to fight climate change, the symbolism was devastating. Far from making America “great,” it diminished us and significantly weakened our influence around the world.

It was yet another unforced error by a man who tweets them daily.

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The Deepening Divide

America is reaching historic levels of inequality. We are likely to surpass the divide between rich and poor that characterized the Gilded Age, and what is worse, lawmakers are doubling down on policies that eviscerate the middle class and further enrich the wealthy.

We are getting used to seeing articles that tell us how much someone has to make in order to afford basic housing. The bottom line: there is not a single place in the United States of America where someone working a full-time minimum wage job can afford to rent a two-bedroom apartment.

What about a one-bedroom unit?

You would have to earn $17.14 an hour, on average, to be able to afford a modest one-bedroom apartment without having to spend more than 30 percent of your income on housing, a common budgeting standard. Make that $21.21 for a two-bedroom home — nearly three times the federal minimum wage of $7.25.

Forget compassion (the GOP certainly has.) Lawmakers with even a cursory understanding of economics ought to look at that mismatch between the minimum wage and a worker’s ability to afford a roof over his head and realize that people making that wage–people who are spending every cent they have on life’s necessities– have no disposable income to spend in the marketplace.

It is demand that drives our economy and creates jobs; if fewer people can afford my consumer goods, I buy less from my suppliers, who then buy less raw material. I need fewer salespeople, and my suppliers need fewer people on the factory floor.

If we needed evidence that today’s Republicans dismiss both arguments– compassionate and economic–Karen Handel recently reminded us. Handel is running against Jon Ossoff in Georgia, in a special election to fill a Congressional seat recently vacated by Tom Price. During a debate, Ossoff was asked about the wage issue, and strongly endorsed raising the minimum wage. Handel responded to the same question by saying, “No, I don’t support a livable wage. I’m a Republican.”

While Handel didn’t have to take a hard line on a “livable wage,” her views are not out of the mainstream for Republicans in a place like Georgia, where opposition to any minimum wage is common. The Republican who held the district for a dozen years before becoming HHS secretary, Tom Price, voted against the increase that raised the minimum wage to where it is today.

If America had an adequate social safety net, the wage issue might be ameliorated somewhat, but very few of the working poor qualify for any sort of benefit. The most glaring omission from that safety net, of course, is healthcare. The Affordable Care Act (aka “Obamacare”) is imperfect, but it was a step in the right direction. Most other industrialized countries have some version of national healthcare, or single-payer; such systems not only improve health outcomes significantly, they make an enormous difference to low-wage workers.

When a broken leg can mean the difference between an uninsured person paying the rent or being evicted, the Republicans’ current mean-spirited effort to deprive twenty-three million people of health insurance is incomprehensible.

Equally incomprehensible is Congress’ steadfast refusal to allow government agencies to negotiate prices with Big Pharma, or to allow Americans to purchase drugs manufactured in America from countries that have negotiated for–and achieved–lower prices.

If you are poor in the United States, a broken leg or extended bout of influenza is bad enough, but treatment of a serious illness like cancer is simply unaffordable. Doctors are desperately trying to find ways to keep cancer patients alive without bankrupting even those with better-than modest resources.

A group of prominent cancer doctors is planning a novel assault on high drug costs, using clinical trials to show that many oncology medications could be taken at lower doses or for shorter periods without hurting their effectiveness….

The initiative is the latest response to rising concerns over “financial toxicity,” the economic devastation that can be wrought by the high cost of cancer care. With new oncology therapies routinely debuting at more than $100,000 a year, “lots of people are worried about developing drugs that people can’t get,” said Leonard Saltz of Memorial Sloan Kettering Cancer Center in New York, who helped organize the new group.

Our lawmakers are very good at protecting the profits of drug companies. They are also good at figuring out how to fund tax cuts for the wealthy–just decimate Medicaid and stop subsidizing health insurance for poor Americans.

What they aren’t so good at is recognizing the human, social and economic consequences of continuing to expand the abyss between the rich and the rest.

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