It’s the Turnout, Stupid!

Do references to “President” Trump make you wonder how we ended up with a Congress and an Administration so wildly at odds with what survey research tells us the majority of Americans want?

This paragraph from a recent Vox article really says it all:

A general poll doesn’t reflect voters very much anymore. A general poll would have had Donald Trump losing substantially and the Democrats winning the House. About 45 percent of people in general polls don’t vote at all. What you saw in the election was that Republican voters came out at a very high rate. They got high turnout from non-minority people from small towns.

There are multiple reasons people fail to vote. There is, of course, deliberate suppression via “Voter ID” laws , restrictions of early voting periods and purposely inconvenient placement of polling places.

Gerrymandering, as I have pointed out numerous times before, is a major disincentive; why go to the polls when the overwhelming  number of contests aren’t really contested?

And of course, there are the holdover mechanisms from days when transportation and communication technologies were very different–state, rather than national control of everything from registration to the hours the polls are open, voting on a Tuesday, when most of us have to work, rather than on a weekend or a day designated as a national holiday, etc.

The Vox paragraph illustrates the repeated and frustrating phenomenon of widespread public antagonism to proposed legislation that nevertheless passes easily, or support for measures that repeatedly fail. If vote totals equaled poll results–that is, if everyone who responded to an opinion survey voted–our political environment would be dramatically different.

Americans being who we are, we are extremely unlikely to require voting, as they do in Australia. (Those who fail to cast a ballot pay a fine.) We can’t even pass measures to make voting easier. I personally favor “vote by mail” systems like the ones in Oregon and Washington State; thay save taxpayer dollars, deter (already minuscule) voter fraud, and increase turnout. They also give voters time to research ballot issues in order to cast informed votes. (Informed votes! What a thought….)

If the millions of Americans who have been energized (okay, enraged) by Trump’s election want to really turn things around, the single most important thing they can do is register people who have not previously voted, and follow up by doing whatever it takes to get them to cast ballots.

Voter ID laws a problem? Be sure everyone you register has ID. Polls and times inconvenient? Help them vote early or drive them to their polling place.

Gerrymandering a disincentive? First make sure that someone is opposing every incumbent, no matter how lopsided the district, and then help people who haven’t previously voted get to the polls. Those gerrymandered district lines are based upon prior turnout statistics; on how people who voted in that district previously cast their ballots. If even half of those who have been non-voters started going to the polls, a lot of so-called “safe” districts wouldn’t be so safe.

Not voting, it turns out, is a vote for the status quo. There are a lot of Americans who are cynical and dissatisfied with the status quo who don’t realize that the plutocrats and autocrats they criticize are enabled by–and counting on– their continued lack of involvement.

If everyone who has found his or her inner activist would pledge to find and register three to five people who haven’t previously voted, and do what it takes to get them to the polls, it would change America.

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Pastoral versus Ideological Church and State

Speaking of religion, as we did yesterday, I’ve been mulling over a column by E.J. Dionne that I read a couple of weeks ago, because I think it has application to what I will (somewhat grandiosely) call the human condition.

Dionne is a Catholic, and he was examining the differences between the approach to that religion of two other Catholics–the Pope, and Steve Bannon.

Bannon believes that “the Judeo-Christian West is in a crisis.” He calls for a return of “the church militant” who will “fight for our beliefs against this new barbarity,” which threatens to “completely eradicate everything that we’ve been bequeathed over the last 2,000, 2,500 years.”

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“Alternative” Realities

Bizarre as he is, Donald Trump does embody the GOP’s longstanding effort to substitute fantasy for evidence, and to act on the basis of the former.  

Forbes Magazine recently reported that Republican lawmakers have buried a report by the nonpartisan Congressional Budget Office, because the findings debunked their preferred  (fanciful) economic worldview.

The research study found absolutely no correlation between the the level of top tax rates and economic growth. The belief that taxing the rich slows economic growth is a key tenet of conservative economic theory, so rather than considering evidence contrary to that theory, Senate Republicans suppressed the report.

This has become the standard reaction of Republican lawmakers when inconvenient reality–facts, evidence, what your lying eyes tell you–conflicts with their preferred beliefs and/or the interests of their donors.

The question is: how long can a war on reality be maintained?

It isn’t just economics. An interesting article in a recent issue of the New York Times compared the anti-science assault of the new Trump Administration with a similar effort mounted by Stephen Harper, a previous Prime Minister of Canada.

I was surprised by the article, since Canadians seem so sane and reasonable in comparison to the United States. (I look rather longingly at Justin Trudeau…). Evidently, however, waging war on facts, evidence and empirical investigation are not solely an American phenomenon.

VANCOUVER, British Columbia — Less than a month into the Trump presidency, and the forecast for science seems ominous.

Scientists at federal agencies have been hit with gag orders preventing them from communicating their findings, or in some cases, attending scientific conferences. Social media accounts and websites have been censored, and at least one agency was asked to identify personnel who worked on climate policies. Now there are proposals for slashing research budgets and gutting funding that could affect the training of the next generation of scientists. To top it all off, President Trump’s cabinet nominees and senior advisers include many who are climate deniers or doubters.

Canadians experienced a similar assault on science a decade ago under Prime Minister Stephen Harper.

The author of the article, a Canadian scientist, shared the experience of that country’s scientific community in the hopes that it might prove helpful here. The parallels were striking:

Starting in 2007, shortly after Mr. Harper became prime minister, new rules were issued that prevented federal scientists from speaking freely with the media about their research without clearing it with public relations specialists or having an administrative “minder” accompany the scientists on interviews or to scientific conferences. More often, the government would simply deny permission for a scientist to speak with reporters if that person’s findings ran counter to Mr. Harper’s political agenda. Inquiries from journalists became mired in an obstinate bureaucracy, and media coverage of government climate research dropped 80 percent after the rules were imposed.

This censorship also had a chilling effect on scientific inquiry. A survey of federal Canadian scientists revealed that 90 percent felt they could not speak freely to the media about their work. If they were to speak up about science that affected public health or the environment, 86 percent felt that they would suffer retaliation. Nearly half of the scientists knew of specific cases of political interference hampering efforts to protect the public.

The article detailed the destruction of research libraries, and other “cost saving” measures. Research on pollution and environmental contaminants was de-funded;  monitoring stations were closed. Environmental protection laws were repealed.

Fearing the continued erosion of even the most basic protections for food inspection, water quality and human health, Canadian scientists filled Ottawa’s streets in the Death of Evidence march. That theatrical mock funeral procession became something of a cultural touchstone. It was a turning point that galvanized public opinion against Prime Minister Harper’s anti-science agenda. By the next election, Justin Trudeau’s center-left government swept in on a platform that put scientists’ right to speak and the promise of evidence-based decisions alongside job creation and economic growth.

In a very real sense, America’s political divisions are not between rational Republicans and Democrats, or conservatives and liberals. Our divisions are between people willing to examine evidence, value and trust expertise, and grapple with the complexities of modern life, and people who are unwilling or unable to do so–people frantic to avoid both ambiguity and evidence inconsistent with their religious or political fundamentalism.

A number of pundits have opined that the demonstrations and marches being held around the country will have little effect on political decision-making. The Canadian “Death of Evidence” march–and more recently, the “pussy hats” of the Women’s March–suggest otherwise.

Reason is an adaptive characteristic. It will prevail. Unfortunately, a lot of harm can be done in the interim.

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The Unarguable Benefits of Universal Healthcare

As political posturing over the Affordable Care Act (aka “Obamacare”) continues, the fiscal and social benefits of expanded access to healthcare become steadily more obvious.

The journal Health Affairs recently reported an 8 percent increase per year in the number of early-stage colorectal cancer diagnoses since passage of the ACA. Extrapolated across the country, the researchers estimate the ACA led to approximately 8,400 additional early-stage colorectal cancer diagnoses among seniors between 2011 and 2013.

A 2015 study published in JAMA found that the ACA had increased the number of early-stage cervical cancer diagnoses in women aged 21 to 25.

Early diagnosis doesn’t just increase the likelihood of successful medical intervention; it significantly reduces healthcare costs. When cancer is caught earlier, it is cheaper to treat.

America’s healthcare costs have long been far higher–and our outcomes considerably worse-– than in countries with universal systems. The lobbying clout of Big Pharma and Big Insurance continue to make a cost-effective “Medicare for All” politically impossible, but even with its problems, the ACA has vastly increased the number of Americans who are insured while significantly slowing the rise of healthcare spending; last June, Fortune Magazine reported

The United States will save about $2.6 trillion on health care expenses over a five-year period compared to initial projections made right after the passage of the Affordable Care Act.

While health spending spiked briefly in 2014, evidence shows that it has once again slowed down and will help save Americans trillions between 2014 and 2019, according to a new study by the Urban Institute and Robert Wood Johnson Foundation.

Spending declines will happen across both private health insurance as well as Medicare and Medicaid. Centers for Medicare and Medicaid Services actuaries predicted that total Medicare spending between 2014 and 2019 would be $455 billion lower than the ACA baseline forecast. Projected Medicaid spending over the same time period is expected to be $1.05 billion lower than previous ACA estimates, while private insurance spending projections declined by $664 billion.

I simply do not understand the Republicans’ hysterical opposition to the ACA. Both health outcomes and cost controls have improved, and problems with the program can be fixed with relatively minimal tweaking. The program’s popularity has also improved. (According to survey research, approximately half of those who do remain unhappy with Obamacare complain that it doesn’t go far enough–they would prefer a single-payer system.)

It isn’t just the ACA. Paul Ryan and the GOP are threatening to dismantle both Medicaid and Medicare–programs with low overhead and proven effectiveness– and they are intent on defunding Planned Parenthood, which delivers critical medical services to millions of poor women.

It isn’t as though a free market system could work for healthcare. Market transactions require a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction. Equal bargaining power doesn’t describe real-world doctor-patient relationships. In that real world, insurance companies have virtually total control over the options available to those fortunate enough to have coverage.

It seems inconceivable that Ryan, et al, simply do not see the multiple fiscal and social benefits of universal–or at least expanded–access to healthcare. So what accounts for their persistent hostility to programs that have proven their effectiveness? Why are they intent upon substituting block grants for Medicaid, turning Medicare into a “voucher” system, destroying Planned Parenthood and eviscerating the ACA?

If the answer to that question is what I think it is– slashing social programs that benefit millions of Americans will allow them to subsidize the insurance and pharmaceutical industries even more generously and deliver more tax cuts to their wealthy patrons–I wonder how they sleep at night.

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