Public Policy and Governance – Page 23

Words Have Meanings

Last week, a reader contacted me to ask that I address the GOP’s ever-more frequent portrayals of Democratic policy positions as “communist” and/or “fascist.” This particular variety of propaganda–the use of words to label and confuse rather than communicate–assumes (probably correctly) voters’ ignorance of the differences between socialism, communism and National Socialism, aka fascism.

Permit me to provide a “cheat sheet.”

Socialism is the collective provision of goods and services– a decision to pay for certain services collectively rather than leaving their production and consumption to the free market. There are some goods that free markets cannot or will not produce, making collective provision necessary. Economists call them public goods, and define them as both “non-excludable” –meaning that individuals who haven’t paid for them cannot be effectively kept from using them—and “non-rivalrous,” meaning that use by one person does not reduce the availability of that good to others. Examples of public goods include fresh air, knowledge, lighthouses, national defense, flood control systems and street lighting. If we are to have these goods, they must be supplied by government, and paid for with tax dollars.

Of course, policymakers also socialize non-public goods: we socialize police and fire protection because doing so is generally more efficient and cost-effective, and because most of us believe that limiting such services only to people who can afford to pay for them would be immoral. We socialize garbage collection in more densely populated urban areas in order to enhance the livability of our cities and to prevent disease transmission.

Getting the “mix” right between goods that we provide collectively and those we leave to the free market is important, because too much socialism hampers economic health. Just as unrestrained capitalism can become corporatism, socializing the provision of goods that the market can supply reduces innovation and incentives to produce. During the 20^th Century, many countries experimented with efforts to socialize major areas of their economies, and even implement socialism’s extreme, communism, with uniformly poor results. Not only did economic productivity suffer, so did political freedom. (When governments have too much control over the means of production and distribution, they can easily become authoritarian.)

Virtually all countries today have mixed economies. The challenge is getting the right balance between socialized and free market provision of goods and services.

In our highly polarized politics today, however, words like Socialism, Fascism and Communism are used more as insults than descriptions. Socialism may be the least precise of these terms. It is generally applied to mixed economies where the social safety net is much broader and the tax burden is somewhat higher than in the U.S.—Scandinavian countries are an example.

Communism begins with the belief that equality is defined by equal results; this is summed up in the well-known adage “From each according to his ability; to each according to his needs.” All property is owned communally, by everyone (hence the term “communism”). In practice, this meant that all property was owned by the government, ostensibly on behalf of the people. In theory, communism erases all class distinctions, and wealth is redistributed so that everyone gets the same share. In practice, the government controls the means of production and most individual decisions are made by the state. Since the quality and quantity of work is divorced from reward, there is less incentive to innovate or produce, and ultimately, countries that have tried to create a communist system have collapsed (the USSR) or moved toward a more mixed economy (China).

Fascism is sometimes called “national Socialism,” but it differs very significantly from socialism. The most striking aspect of fascist systems is the elevation of the nation—a fervent nationalism is central to fascist philosophy. There is a union between business and the state; although there is nominally private property, government controls business decisions. Fascist regimes tend to be focused upon a (glorious) past, and to uphold traditional class structures and gender roles as necessary to maintain the social order.

Three elements commonly identified with Fascism are 1) a national identity fused with racial/ethnic identity and concepts of racial superiority; 2) rejection of civil liberties and democracy in favor of authoritarian government; and 3) aggressive militarism. Fascists seek to unify the nation through the elevation of the state over the individual, and the mass mobilization of the national community through discipline, indoctrination, and physical training. (Think Nazi Germany.)

Politicians of both parties use these terms indiscriminately as epithets, secure in the knowledge that very few in their target audiences hear anything other than “bad!!”

Next time a MAGA person calls you a communist, you can share this little exercise in definition–but it probably won’t help. Communication isn’t the point.

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The Election And Sally Bowles

Last weekend, my husband and I joined a group of supporters and staff of Indianapolis’ Cabaret Theater on a weekend trip to New York. It was the first time we’d participated in these annual outings to Broadway to enjoy musical theater. This year, the entire group had tickets to the revival of “Cabaret at the Kit Kat Club.” Participants could choose from a wide variety of other shows as well, but the Cabaret revival was the common denominator.

Most Americans are familiar with previous iterations of Cabaret, but I will readily admit that this particular production had a new and concerning resonance for me.

It had been at least eight years since my husband and I had been in Manhattan, and several things seemed different on this particular trip. On a personal note, I was struck–and impressed–by how much cleaner Midtown was, and how kind and helpful people were. My husband has mobility issues that require the use of a mobility scooter, and doormen, restaurant personnel, theater ushers–even people on the streets– were unfailingly solicitous and helpful. These are not, I will note, adjectives I might have used to describe such folks on past visits.

As we braved the crowds on the streets in the theater district, it also occurred to me that the faces I encountered were the faces that upset and enrage the predominantly rural folks who make up the bulk of the MAGA movement. Native or tourist, the people we passed reflected a cosmopolitan universe: young people with purple hair on bikes or scooters, Black, brown and White men and women talking on their phones, women with hijabs, Hasidic men with fur hats… the wildly diverse America that MAGA does not want to recognize.

What really made an impression on me, however, was the performance of Cabaret. The music and staging of this particular revival were exceptional, but what really gave me chills were the similarities between Germany just before the Nazis assumed power and the United States poised on the brink of November’s election.

Let me be clear: I’m not referring to the cruelty of the Nazi assault on Jewish Germans, although it was heartbreaking to see the naiveté of the Jewish character, Herr Schultz, who insisted that “this will all blow over. After all, I am as German as they are.” Those of us who know what came later are aware of the prevalence of the sad belief of so many German Jews that it “couldn’t happen” in such a civilized, culturally-advanced country.

No, the character who summed up the nature of the real threat–then and now–was Sally Bowles, who insisted to her lover Cliff that “politics has nothing to do with us.”

Sally wasn’t the only character to dismiss so-called “political differences” as irrelevant to the lives people live. The young operative who had befriended Sally’s lover was astonished when the swastika on his armband made Cliff recoil (after all, that’s just politics, and we’re friends). But it was Sally’s utter incomprehension about why national politics should matter to her at all–why the events consuming Berlin should cause her to rethink a return to performing at the Kit Kat Club–that forced me to consider the millions of Americans who simply go about their daily lives without paying any attention to the national news or the daily revelations about the plans being made for a second Trump term.

It’s a political truth that most Americans pay little or no attention to national political campaigns until after Labor Day. (Until the expenditure of truly obscene amounts of money on electronic ads in the primaries, primary elections were low-key events interesting mostly to party insiders.)

That disengagement from politics may have been harmless when America’s two major political parties shared a basic understanding of their responsibilities–when their disputes were primarily about how to go about achieving broadly agreed-upon goals. But–just as in the Germany of Cabaret’s time–that is no longer the case. MAGA Republicans, aka Christian Nationalists, want to utterly transform what it means to be an American, just as Hitler’s Nazis wanted to redefine what it meant to be a German.

We’ve seen this play before. We know how it comes out–and how many innocent people were sacrificed to its madness.

I have repeatedly posted about the importance of turnout in the upcoming election. Unless the millions of Americans who are America’s version of Sally Bowles wake up to the fact that their lives and the lives of their children will be irreparably altered if Trump and his ilk win, America in 2024 will repeat the tragedy of 1929-30 Germany.

It could happen here.

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Drug Affordability

Most older Americans–make that “most Americans who are paying attention”–know that this country doesn’t have a healthcare system. As a former student put it, we have a healthcare industry. And we pay through the nose for it. A superficial google search will turn up mountains of data confirming the fact that healthcare costs in the United States vastly exceed those of other advanced countries, while giving us a “system” that ranks somewhere between 35th and 37th in the world.

I encountered the data that really made me aware of the insanity of market-driven healtcare several years ago, when I served on a committee organized by a medical-school friend. At the time, seventy percent of all healthcare costs were paid by governments at the local, state and federal levels. Not just Medicare and Medicaid, but through various other programs, and especially through the obligations of government-as-employer of teachers, police and fire personnel, etc. etc.

What really made an impression on me was data showing that those payments by government would be sufficient to pay for all medical care in a national system that eliminated health insurers’ marketing costs, claims processing, overhead and profit.

I’m a big fan of markets in areas where they work. Healthcare isn’t one of those areas. You don’t go “shopping” or comparing prices when you’re having a heart attack.

The Affordable Care Act was a good first step in delivering healthcare to Americans who’d been priced out of the market. It also gave added freedom to those whose medical issues had locked them into their jobs, thanks our insistence on tying coverage to employment. Drug costs, however, remained far higher than in other countries, thanks to the lobbying clout of “big Pharma,” despite the fact that the federal government is the major funder of research and development.

Reducing those costs is among the many under-appreciated accomplishments of the Biden Administration. As the Washington Post reported, “Monumental changes to prescription drug prices for seniors are coming.”

Thanks to the Inflation Reduction Act, one of President Biden’s signature achievements, prescription drugs are set to become substantially more affordable for seniors. Yet many Americans seem unaware of just how monumental these changes will be.

The article listed “six things to look for.” The first of those included eye-popping savings for both individual Americans and the government.

For the first time in history, Medicare can now negotiate directly with manufacturers. For the initial round of negotiations, the Centers for Medicare and Medicaid Services chose 10 drugs that treat common health conditions, including cardiovascular disease, cancer and rheumatoid arthritis.

Each of these medications costs consumers in the United States three to eight times what people pay in other countries. In 2022, Medicare paid an eye-popping $46.4 billion for them. The impact to consumers is equally staggering. As CMS Administrator Chiquita Brooks-LaSure told me, “Some of these drugs are thousands of dollars per year for people who depend on them to live.”

It will take some time for negotiated prices to take effect. Assuming the federal government prevails in the lawsuits filed by pharmaceutical companies, CMS expects lower prices to be in place in 2026.
But that’s only the beginning. Fifteen more drugs will be selected for 2027 and then 20 per year from 2029 and thereafter. The lower prices are projected to save the federal government $100 billion over the next several years. Crucially, this means that the negotiations won’t just benefit people who are on these specific medications; the savings are passed along, indirectly, to everyone on Medicare.

Other changes, thanks to the Biden Administration, will include a cap of $2000 per year on out-of-pocket Medicare spending, and significantly lower costs for insulin. Other changes include an income-based subsidy for the most vulnerable Medicare enrollees, making all adult vaccines recommended by the Centers for Disease Control and Prevention free for everyone with Medicare Part D, and requiring drug companies to pay a rebate to Medicare if they increase prices faster than inflation.

There has been very little media attention to these hard-won changes, presumably because skill at the actual business of governing is less sexy than wall-to-wall coverage of threats to desperate immigrants and hush-money payments to porn stars.

In her “Letters from an American,” Heather Cox Richardson often compares the autocratic and corrupt self-interest of Trump and the MAGA movement to the Biden Administration’s focus on making life better for average Americans.

Reducing the cost of lifesaving prescription drugs– rather than limiting women’s reproductive liberties and forbidding medical providers to assist trans children– is a perfect example of the wildly different priorities of today’s Democratic Party and the Republican MAGA cult.

In November, vote accordingly.

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It’s We, The People

Robert Kagan recently published a lengthy excerpt from his recent book “Rebellion: How Antiliberalism is Tearing America Apart — Again” in the Washington Post.

In it, he dismissed a variety of explanations for the MAGA embrace of Trump–discarding arguments that the movement is a result of rapidly changing technology, widening inequality, unsuccessful foreign policies or unrest on university campuses. Instead, he pinned it on failures of We the People.

It is what the Founders worried about and Abraham Lincoln warned about: a decline in what they called public virtue. They feared it would be hard to sustain popular support for the revolutionary liberal principles of the Declaration of Independence, and they worried that the virtuous love of liberty and equality would in time give way to narrow, selfish interest. Although James Madison and his colleagues hoped to establish a government on the solid foundation of self-interest, even Madison acknowledged that no government by the people could be sustained if the people themselves did not have sufficient dedication to the liberal ideals of the Declaration. The people had to love liberty, not just for themselves but as an abstract ideal for all humans.

Kagan worries that too many of us no longer care about preserving the system the Founders bequeathed us–a system based on the principles of universal equality and natural rights. Preserving that system, he says, “plain and simple, is what this election is about.”

“A republic if you can keep it,” Benjamin Franklin allegedly said of the government created by the Constitutional Convention in 1787. This is the year we may choose not to keep it.

Kagan follows that sentence with an extended recap of what most Americans know–about the intent of the January 6th insurrection, about Trump’s candid announcements of his goals, about the unconscionable failure of the Senate to use impeachment, the mechanism provided by the Founders, to negate the threat of further insurrection. Then he gets to the crux of his argument.

So, why will so many vote for him anyway? For a significant segment of the Republican electorate, the white-hot core of the Trump movement, it is because they want to see the system overthrown. This should not come as a shock, for it is not a new phenomenon. On the contrary, it is as old as the republic. Historians have written about the “liberal tradition” in America, but there has from the beginning also been an anti-liberal tradition: large numbers of Americans determined to preserve preliberal traditions, hierarchies and beliefs against the secular liberal principles of the Declaration of Independence and Bill of Rights. The Founders based the republic on a radical set of principles and assertions about government: that all human beings were created equal in their possession of certain “natural rights” that government was bound to respect and to safeguard. These rights did not derive from religious belief but were “self-evident.” They were not granted by the Christian God, by the crown or even by the Constitution. They were inherent in what it meant to be human.

That paragraph introduced a lengthy historical discussion in which Kagan reminded readers that MAGA is really nothing new. Throughout our history, significant numbers of Americans have rejected the classical liberal foundations of the nation’s constituent documents–and especially the notion of civic equality.

For two centuries, many White Americans have felt under siege by the Founders’ liberalism. They have been defeated in war and suppressed by threats of force, but more than that, they have been continually oppressed by a system designed by the Founders to preserve and strengthen liberalism against competing beliefs and hierarchies. Since World War II, the courts and the political system have pursued the Founders’ liberal goals with greater and greater fidelity, ending official segregation, driving religion from public schools, recognizing and defending the rights of women and minorities hitherto deprived of their “natural rights” because of religious, racial and ethnic discrimination. The hegemony of liberalism has expanded, just as Lincoln hoped it would, “constantly spreading and deepening its influence, and augmenting the happiness and value of life to all people of colors everywhere.” Anti-liberal political scientist Patrick Deneen calls it “liberal totalitarianism”….

Kagan reminds us that the fury on the Right against “wokeness” is nothing new. “Anti-liberal movements in America, whether in defense of the White race or Christianity, and more often both together, have always claimed to be suffering under the expanding hegemony of liberalism.”

There is much more, and it is definitely worth reading in its entirety.

Bottom line: MAGA’s Christian Nationalism is nothing new. In November, We the People will either defend our “natural rights” or we will lose them.

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Doonesbury Nails It

Stinging humor has been one of the more notable characteristics of what I devoutly hope will NOT be known as “the age of Trump.” Late-night comedians have gone where GOP politicians terrified of their MAGA base (and Democrats persuaded to “go high” when Republicans “go low”) have failed to go.

The result has been a situation in which the most biting–and frequently, most accurate–commentary has come from stand-up comedians and the Sunday funnies. Last Sunday, Doonesbury used a fictional psychiatrist to echo observations and conclusions that have been discussed for several months by real mental health professionals: Trump is rapidly slipping into dementia.

Elias–Doonesbury’s fictional “resident psychiatrist”– points to the symptoms: repeatedly mixing people up (not just forgetting names, which happens to all of us, but calling Biden Obama or Haley Pelosi); phonemic paraphasia (“freestyling” off the stem of a word); slurring; semantic aphasia; and tangental speech. The last panel of the cartoon is a warning, showing nonsense words coming out of the White House.

In all fairness, I didn’t find the Sunday strip funny. I did find it educational–and terrifying.

Trump’s “word salads” have been the subject of innumerable Facebook jokes and memes, but mental health professionals and pundits agree that his more recent speeches and outbursts have changed in nature. The Doonesbury labels appear to fit.

Phonemic paraphasia, for example, is defined as a disorder in which incorrect phonemes are substituted. For example, one may say “spot” instead of “pot.” Literal paraphasia could also be switching syllables or creating reverse compound words such as “markbook” instead of “bookmark.” There are differing types; according to Wikipedia,

Wernicke’s aphasia is characterized by fluent language with made up or unnecessary words with little or no meaning to speech. Those who suffer from this type of aphasia have difficulty understanding others speech and are unaware of their own mistakes. When corrected they will repeat their verbal paraphasias and have trouble finding the correct word….

Phonemic paraphasia, also referred to as phonological paraphasia or literal paraphasia, refers to the substitution of a word with a nonword that preserves at least half of the segments and/or number of syllables of the intended word. This can lead to a variety of errors, including formal ones, in which one word is replaced with another phonologically related to the intended word; phonemic ones, in which one word is replaced with a nonword phonologically related to the intended word; and approximations, an attempt to find the word without producing either a word or nonword. These types of errors are associated with Wernicke’s aphasia, among others. Phonemic paraphasias are often caused by lesions to the external capsule, extending to the posterior part of the temporal lobe or internal capsule.

Wikipedia defines “semantic aphasia”as a “progressive neurodegenerative disorder characterized by loss of semantic memory in both the verbal and non-verbal domains. However, the most common presenting symptoms are in the verbal domain (with loss of word meaning). Semantic dementia is a disorder of semantic memory that causes patients to lose the ability to match words or images to their meanings.”

Tangential speech is a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation. (Full disclosure: my kids will tell you I have this one…although usually I do– eventually– return to the initial topic.)

Quite obviously, I am not a doctor, nor do I play one on TV. Neither is Gary Trudeau, the Doonesbury cartoonist. That said, Trudeau hasn’t created this diagnosis out of thin air or political pique–increasing numbers of mental health professionals have raised alarms. It began during his first term, with “The Dangerous Case of Donald Trump” in which 27 psychiatrists evaluated concerning aspects of his personality; and has accelerated with psychologists warning of the dangers posed by more recent evidence of his mental decline. (One example: Harry Segal, a senior lecturer in psychology at Cornell University who has been critical of the former president’s mental health since he was first elected, said Trump was showing clear signs of onset dementia.)

It doesn’t correlate with age. Some people “lose it” at sixty; others are mentally sharp at 100.

And it isn’t simply the bone-chilling prospect of a single, truly demented head of state. The Trump presidency has illuminated a challenge going forward. It has become standard for candidates to share their medical evaluations with the voting public; is it time to require aspirants for high office to be screened for mental illnesses?

And given some of our past Chief Executives, where would we set the bar?

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