Public Policy and Governance – Page 25

Can You Stand A Re-Run?

I was looking through some old posts–trying to find one for a friend who’d asked me to dig it up–and came across a number of “golden oldies” that, unfortunately, remain relevant. I was particularly struck by a post from back in 2018 that married two persistent issues: national health care and vote suppression.

Here was what I wrote then.

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Thom Hartmann from Independent Media has written a column that is both provocative and persuasive.

If he’s right, it would also explain what I have thus far found inexplicable: why the GOP is so dead-set against a national system that would expand access to healthcare to all Americans.

Now we know why the GOP is truly terrified of Medicare for All; it will wipe out the Republican Party’s control of the House, Senate, White House, and most state governments. Because it could make it very easy for every citizen over 18 to vote.

Here’s how it works.

In Canada, every citizen has a Canadian government-issued “Health Insurance Card” … It’s largely only available to citizens, as all citizens are eligible for the Canadian Medicare system; everybody else has to work out other insurance options (yes, there are insurance companies in Canada). And in most provinces, the card has your photo and works as an ID card as well as a driver’s license or passport.

In Canada, that health insurance card is also a voter ID card.

As a Canadian explained to Hartmann, the health insurance card is unlike other government issued identifications, such as driver’s licenses, because virtually all Canadian citizens from all socioeconomic backgrounds have them. They can be used as photo IDs for flying domestically, buying alcohol and–most importantly– voting!

Among other voter suppression tactics, the GOP has spent the last decade fighting a war on (virtually non-existent) “voter fraud.” The party has used this largely fabricated concern to pass voter ID laws that make it hard for people who don’t drive –due to old age, lack of ability to afford a car, or in some cities (not mine), convenient public transportation–to cast a vote.

In 2016, Donald Trump won Pennsylvania, Michigan and Wisconsin by razor-thin margins far smaller than the number of voters purged and/or turned away at the polls.

The Brennan Center documents a 33 percent increase in voters purged during the 2014-1016 election cycle (16 million), compared with the 2006-2008 cycle (12 million purged), as the GOP has made ID and purges (along with fear mongering about brown-skinned people) their main electoral strategy. In just the past year, as many as an additional 14 million voters have been purged from rolls nationwide, while over the past two decades every Republican-controlled state has introduced rigid ID laws.

But with a national ID system in place that’s universally used because it’s the key to getting your health care and medications, there’s no need for “voter registration” and thus no ability for the GOP to purge voters. Voter registration, after all, is a practice we largely got after the Civil War because Southern white politicians warned of “voter fraud” being committed by recently freed black people, and some Northern states used it to prevent poor whites from voting.

In some places in the United States, voter registration just never caught on: North Dakota never bothered to put such a system into place; you just show up at the polls with ID to prove you’re both a citizen and resident, and vote. And with a national Medicare for All ID, every citizen could easily vote, everywhere.

Hartmann insists that the GOP’s adamant opposition to universal coverage is partly based upon the party’s realization that the universal ID such coverage would require would allow everyone to vote.

True or not, it’s hard to argue with Hartmann when he says that Medicare for All would allow America to join the rest of the developed world, by having both a national health care system and a functioning democracy.

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Given what appears to be the average IQ of today’s GOP establishment figures, Hartmann may have been giving the party pooh-bas far too much credit for strategic thinking. Republicans probably oppose a national health insurance program simply because “those people” would benefit. Still, such a program would, as he notes, provide Americans with a universal “Voter ID.”

Yet another reason to support joining the rest of the civilized world…..

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The Way We Never Were

One of my all-time favorite non-fiction books is Stephanie Coontz’ The Way We Never Were: American Families and the Nostalgia Trap. In it, Coontz debunks several of the persistent myths that continue to distort contemporary politics. (I think my favorite chapter is the one titled “We always stood on our own two feet,” in which she details several early important government programs that “small government conservatives” conveniently ignore.)

I thought about “The Way We Never Were” when I read a recent column by Jennifer Rubin, addressing the notion that today’s divisions are deeper than they’ve been–that the times we occupy are worse than those of the past. She titled her essay, “Get real and read some history. The past was worse.”

Nostalgia is a powerful political tool. Wielding nostalgia for a bygone era — one that is invariably mischaracterized — is a favorite weapon for fascist movements (Make America Great Again), harking back to a time before their nation was “polluted” by malign forces. In the United States, such nostalgia none-too-subtlety appeals to white Christian nationalism. Even in a more benign form (e.g., “Politics didn’t used to be so mean,” “Remember the days of bipartisanship?”) plays on faulty memories. If you really go back to study U.S. history, you would find two things: The past was worse, and conflict has always been the norm.

Economically, Americans were a lot poorer, even as late as 1960, when there were roughly 400 vehicles per 1,000 Americans, about half of today’s car ownership rate.

Tom Nichols has written extensively on the politics of false memory. “Times are always bad. Nothing gets better. And the past 50 years have not been a temporary economic purgatory but a permanent hell, if only the elites would be brave enough to peer through the gloom and see it all for what it is,” he wrote. “This obsession with decline is one of the myths surrounding postindustrial democracy that will not die.”

Given all the hand-wringing about crime and crime rates, for example, it is bracing to look at the actual data: It turns out that crime was considerably higher in the 1970s. Not only crime rates, but “poverty, child mortality, deaths from virtually any major disease, workplace injuries, high school dropout rates, etc., were all much worse in the 1950s. Also, kids got polio, Jim Crow was in full swing, gays had to be in the closet and no one had cellphones, home computers or microwave ovens. Very few people had air conditioning or could afford to fly.”

Troubling as the gap between the rich and the rest is and remains, income inequality has been on the decline since 2007. Rubin traces America’s history since the 1930s and The Great Depression–through World War, McCarthyism, the Cold War, the riots of the 1960s, the political assassinations, the Vietnam War….

You get the point. Though those who rail against modernity, urbanity, pluralism, tolerance and personal freedom in service of an authoritarian perch would like to turn back the clock, a perusal of history suggests now is the best time to be alive.

And what about the myth of America’s former bipartisanship? She reminds us that– “from the get-go”– politics in America was vicious. Hamilton, Madison, Jefferson, Adams, et al all assumed the worst of one another:

Jefferson, watching the government amass power and assume state debt, concluded that Hamilton’s Federalists were royalists and corrupt financiers who had been plotting ‘to betray the people’ since independence.” In turn, “Federalists, conversely, thought Republicans ideologically deranged to the point of near-treason. Blind infatuation with a hostile (and anarchic) France, faith in state sovereignty, Luddite opinions on public debt — all of these seemed like symptoms of a deeper mania among Jefferson’s followers.”

The founding era was followed by slavery, Civil War, Reconstruction, and racial segregation.

You can flip through the history of presidential insults, devastating feuds and congressional violence. None of this suggests we ever enjoyed a sustained halcyon period of unity. To be certain, we had brief interludes when World War II united the country and when the ideological gaps between the parties were not as vast. However, we “got things done” mostly when one party (in modern times, usually Republicans) got wiped out in elections, leaving Democrats to construct the New Deal and the Great Society. Republicans vilified Democrats every step of the way (even testing out a coup against Franklin D. Roosevelt).

What we have not had before is a president who rejected democracy, attempted to retain power by force and wound up indicted on 91 criminal counts. So yes, four-times-indicted Donald Trump was worse than every president who preceded him.

As both Coontz and Rubin remind us: Nostalgia– especially nostalgia for a time that never was–is the stuff of snake-oil salesmen.

That said, we need to protect that progress–and democracy–this November.

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Chasing Those ‘Elitists” Away

Even policies that are adopted after extensive research and thoughtful debate often generate unanticipated consequences, so it shouldn’t be a surprise that a policy based on rejection of relevant evidence and refusal to engage in debate is rapidly degrading access to medical care in Red states.

I’m referring, obviously, to the abortion bans that were enacted (or triggered) immediately after the Dobbs decision overturned Roe v. Wade.

In November, Timothy Noah reported that warnings of an eventual “brain drain” caused by those bans had the timing wrong: it wasn’t “eventual”–it was already occurring. Red state culture wars aren’t only creating medical care “deserts,” they’re driving other college-educated workers— teachers, professors, and more—out as well.

Noah began his article by telling the story of a married same-sex couple, both Ob-Gyns practicing in Oklahoma. They now live in Washington, D.C.–a move that doubled their housing costs and reduced their pay. (It turns out that Red states, which have fewer Ob-Gyns, pay doctors significantly higher wages than states where there are ample practitioners.)

Kate Arnold and Caroline Flint are two bright, energetic, professionally trained, and public-spirited women whom Washington is happy to welcome—they both quickly found jobs—even though it doesn’t particularly need them. The places that need Kate and Caroline are Oklahoma and Mississippi and Idaho and various other conservative states where similar stories are playing out daily. These two fortyish doctors have joined an out-migration of young professionals—accelerated by the culture wars of recent years and pushed to warp speed by Dobbs—that’s known as the Red State Brain Drain.

Abortion restrictions have turbocharged that brain drain, but state laws restricting “everything from academic tenure to transgender health care to the teaching of ‘divisive concepts’ about race” are making these states uncongenial to other knowledge workers.

The number of applications for OB-GYN residencies is down more than 10 percent in states that have banned abortion since Dobbs. Forty-eight teachers in Hernando County, Florida, fed up with “Don’t Say Gay” and other new laws restricting what they can teach, resigned or retired at the end of the last school year. A North Carolina law confining transgender people to bathrooms in accordance with what it said on their birth certificate was projected, before it was repealed, to cost that state $3.76 billion in business investment, including the loss of a planned global operations center for PayPal in Charlotte. A survey of college faculty in four red states (Texas, Florida, Georgia, and North Carolina) about political interference in higher education found a falloff in the number of job candidates for faculty positions, and 67 percent of the respondents said they would not recommend their state to colleagues as a place to work. Indeed, nearly one-third said they were actively considering employment elsewhere.

Here in Indiana, school corporations are experiencing dramatically higher teacher vacancies, and like other Red states, Hoosier rural residents struggle to find medical care–and not just prenatal care. It seems it isn’t just Ob-Gyn practitioners who are abandoning Red states.

Family doctors are also “reassessing” their options–and training availability.

Researchers from the Person-Centered Reproductive Health Program at the University of California San Francisco have found there is reason to be concerned about training for family physicians in ban states as well.

A study published in the November-December issue of the Annals of Family Medicine found that 29% or 201 of 693 accredited family medicine residency programs in the U.S., are in states with abortion bans or significant restrictions on abortion access. The study used publicly available data from the American Medical Association to conduct the analysis, and found 3,930 residents out of 13,541 were in states where abortion is banned or heavily restricted.

For practitioners who remain in those states, the training they are now able to receive deprives them of the skills they need to deal with miscarriages and various problems in pregnancy. Residents in those states no longer have access to comprehensive reproductive health training because they’re not experiencing it within their state context. As the lead researcher explains, “they cannot see abortions, cannot perform them, cannot learn how to care for patients after abortions in the same way they would be able to if they were working in a state where abortion was unrestricted.” As she points out, early pregnancy loss is very common, and the skill set for caring for that and first trimester abortion are very similar.

It bears repeating that the exodus of educated citizens isn’t limited to medical professionals. (MAGA Republicans are actually applauding the exit of the teachers and professors they distrust.) Ironically, the rural folks these MAGA lawmakers disproportionately represent are the ones first experiencing the “unintended consequences” of their misogyny–the absence of teachers and doctors.

It will only get worse…..

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A New Year

I’ve long since abandoned the practice of partying on New Year’s Eve. For the past several years, my husband and I haven’t even made it to midnight to welcome the turnover to a new, as-yet-unspoiled year.

But that lack of a proper welcome doesn’t mean that the turn of the calendar page goes unnoticed or that it lacks significance. Actually, for us older folks with grandchildren in their early adulthoods, the portents are especially significant. What will the coming year tell us about the world those grandchildren will have to navigate?

For what it’s worth, I think the year 2024 is likely to be pivotal for the United States–and thus for the world order.

I know that we tend to see whatever it is we look for, and I’ll admit up front that I’m looking for good omens. Those omens are out there–offsetting, to some extent, the dark clouds of hate and fear that dominate the news cycle. The bad omens remain “front and center”–wars in Ukraine and the Middle East, the growth of populism worldwide and Christian Nationalism at home, the ability of a handful of Congressional buffoons to paralyze the federal government, and over it all, the persistent warming of the planet and the multiple threats to human civilization posed by climate change.

Then there’s the inconceivable (to me) persistence of support for a moronic, narcissistic madman–coupled with an equally mystifying lack of appreciation for a President who will go down in history (assuming we have a history) as a leader as consequential as FDR.

I’m not ignoring the storm clouds.

But history develops in cycles, and the transition from one cycle to another is typically chaotic and difficult. Various academic studies peg those social cycles at anything between 40 and 80 years. In the US, the last truly monumental social upheaval occurred in the tumultuous Sixties, triggering a reaction that elected Ronald Reagan and devotion to trickle-down economics, and winked at racism and other forms of bigotry and tribalism.

The Internet came along and connected all the malcontents–both those who found modernity, with its multiple ambiguities, unbearable, but also those of us who welcomed it. The Internet destroyed local newspapers, and provided us with the ability to choose the news we wanted to believe, adding to the chaos of social change.

Among the positive omens is the fact that local news is rebounding across the country.

The international effort to combat climate change is moving more slowly than we might like, but more substantively than we had any right to expect in an ever-quarreling world. There are fewer and fewer people who dispute the reality of climate change, and encouraging scientific and technological breakthroughs aimed at ameliorating it.

Medical science continues to advance. People are alive today who would never have made it to their current ages but for those advances, and efforts to stamp out historically devastating diseases in poorer countries are succeeding. (The refusal of ideologically-motivated, scientifically-ignorant individuals to be vaccinated against a pandemic was unfortunate for those individuals and their families, but has likely improved the health–and perhaps the genome– of the overall population.)

And there are multiple signs that a majority of Americans reject the racism and antisemitism and misogyny that still garner headlines. It’s true that the minority of haters is a lot larger than I would have guessed a few years ago, and they are certainly more active. But they are a minority.

Think about it: the demonstrations after the murder of George Floyd were multi-racial. The “Karen” memes on social media and the sharing and shaming of racist incidents captured by those ubiquitous phone cameras are evidence of widespread disapproval of bigotry. Increases in inter-racial and inter-religious marriages (and I would add, the rise of the “nones”) are signs of weakened barriers between members of the human family. Add too, majority approval of same-sex marriage, and the overwhelmingly negative reaction to the (unbelievably paternalistic) Dobbs decision.

The fact that calling a proposal “socialist” is no longer sufficient to defeat it, and the rise of new economic theories challenging free-market absolutism are signs of a growing recognition that–as I used to tell my students–issues are complicated and finding correct answers depends on facts and context.

There’s more, but here’s the thing: the upcoming year will be pivotal. It will tell us whether a determined minority, empowered by gerrymandering and unencumbered by intellect or ethics, will strip women of autonomy, put gays back in the closet, and return Blacks and Jews to second-class status.

My New Year’s Resolution is simple: I intend to work my butt off to defeat the White Nationalist cult that has taken over what used to be my political party.

I hope you’ll join me.

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Economic Propaganda

I will be the first to admit that my knowledge of economics is incredibly superficial. (Perhaps I’m being defensive, but I suspect that “superficial”–or even “non-existent” also describes the technical economic expertise of most of my fellow Americans.)

As I previously explained, my recent reading about Modern Monetary Theory was prompted by the gift of a book on the subject; that book then triggered some additional research. (Calling my google searches “research” might be a misnomer…) At any rate, I found an essay from The American Prospect to be both interesting and “on point.”

The article was authored by Nick Hanauer, whose ability to explain matters in accessible and understandable terms has made him one of my favorite economic pundits.

If the basic foundation of Modern Monetary Theory (MMT) is that it is most closely based upon reality–upon the way that American monetary and fiscal systems actually work–the Prospect article provides additional evidence that far too many pundits and economists continue to assess policy using economic frameworks that are no longer accurate.

As the subhead says, “The alleged science doesn’t match up to the real world.”

The article focuses upon six myths that continue to muddy the waters of economic analysis.

Americans have been hammered for decades with an economic message that amounts to this: When wealthy people like me gain even more wealth through tax cuts, deregulation, and policies that keep wages low, that leads to economic growth and benefits for everyone else in the economy. And equally, that investing in you, raising your wages, forgiving your debt, or helping your family would be bad—for you! This is the trickle-down way of thinking about economic cause and effect, and there can be no doubt that it has substantially contributed to the greatest upward transfer of wealth in the history of the world.

You would think that trying to sell such a disastrous outcome for the broad mass of citizens would be incredibly unpopular. No politician would outright say they want to shrink the middle class, make it harder to get by, or reward hard work less. No politician would outright say that rich people should get richer, while everyone else struggles to make a decent life.

But this message has been hidden under the confusing, technical-sounding, and often impenetrable language of economics. Many academic economists do important work trying to understand and improve the world. But most citizens’ experience of economics comes from hearing a story—a narrative that rationalizes who gets what and why. The people who benefit from trickle-down policy the most have deployed economists to work their magic to tell this story, and explain why there is no alternative to its scientific certitude.

Hanauer points out that no economic model can fully reflect the “extraordinary complexity of human markets.” Models are intended to provide decision-makers with a sense–an overview– of the likely impacts of a particular policy proposal. But the assumptions upon which these models are based will determine their predictions. In other words, if the assumptions are wrong, the models will also be wrong.

And these models are deeply and consistently wrong…The problem is that few people take the time to explain what these faulty assumptions are, why they all promote the worldview of the rich and powerful, and why they shouldn’t be treated as science but as a trickle-down fantasyland.

Hanauer proceeds to explain–at length, and in language that non-experts can understand– what is wrong with six of those underlying assumptions:

public investments will “crowd out” private investment, and are by definition less productive than private investments.
workers’ wages are a direct reflection of their productivity.
higher taxes on corporations and high-income people reduce growth and investment.
investing in poor people reduces economic activity, and that immigrants are less productive than domestic American workers.
ten-year budget horizons are adequate for analysis.
performance is measured by looking at GDP and revenue– rather than overall well-being.

As Hanauer concludes:

Until we build models that reflect how the economy really grows, our leaders and the media should eye models from mainstream economists with skepticism. Models trying to convey the effects of policy should reflect the basic understanding that when more people have more money, that’s good for business. We need models that understand the basic principle that when the economy grows from the middle out, that’s good for everyone, and when more people participate in the economy, their consumer demand drives job creation and sparks innovation. In other words, our economic models must reflect the world as it really is—not as it was portrayed in the trickle-down Econ 101 classrooms of the 20th century.

All available evidence supports living in the world as it really is.

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