Category Archives: Public Policy and Governance

Health And Safety

It’s hard to know whether to laugh or cry while you’re watching the Keystone Kops dismantle the federal government.

A recent article charting the decimation of HHS under RFK, Jr.–aka Mr. Brain Worm– contained the following tidbits: employees who were laid off and who wanted to pursue discrimination complaints were told to contact Anita Pinder, former director of the Office of Equal Opportunity and Civil Rights. Pinder died last year.  Then there was the report that a number of FDA staff members only discovered they were part of the sweeping reduction in force when they arrived for work one morning and their badges would no longer let them into the building.

Kennedy’s haphazard and unprecedented downsizing of the federal health workforce–the dismissal of twenty thousand workers–was evidently conducted with similar inattention to careful analysis, let alone standard procedures or pesky details. The dismissals removed what the article called “a broad swath of expertise: biomedical scientists, staff who respond to freedom of information requests and researchers who work to improve patient safety.”

Those dismissed from HHS included numerous senior leaders–individuals who represented often irreplaceable institutional memory.

At the National Institutes of Health, a nearly $48 billion biomedical research agency, at least five top leaders were put on leave. Among those offered reassignment were the infectious-disease institute director Jeanne Marrazzo, according to emails obtained by The Post and multiple people familiar with the matter, who spoke on the condition of anonymity because they were not authorized to speak publicly.

Marrazzo had succeeded Anthony S. Fauci as director of the National Institute of Allergy and Infectious Diseases, which helped lead the nation’s response to the coronavirus pandemic and later became a target of Republicans. An internal email showed that two other leaders there, H. Clifford Lane and Emily Erbelding, also lost their jobs, and the agency had no advance notice of who had been targeted for layoffs through the reduction in force, or RIF

The story was the same throughout the reckless purge of HHS. At the CDC, for example, senior leaders overseeing global health, infectious diseases, chronic disease, HIV, sexually transmitted disease, tuberculosis, outbreak forecasting and information technology were all among those notified that they would be reassigned to the Indian Health Service (a reassignment most refused). The article quoted one official for the probable effect: “The agency will not be able to function. Let’s be honest.”

The purge included some 3500 scientists working on bird flu and vaccine safety, as well as the safety of the U.S. food supply and tobacco products.

“The FDA as we’ve known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed,” Robert Califf, who served as FDA commissioner under Presidents Joe Biden and Barack Obama, wrote on LinkedIn on Tuesday morning.

Forbes was among the publications warning that the cuts could have profound effects on the health and well-being of Americans. A capacity to respond to emerging new diseases that has arguably already been inadequate will be even more vastly curtailed; food and drug safety are being imperiled; and research on diseases like cancer, Alzheimers and Parkinsons (among many others) will be dramatically set back. Other cuts significantly reduced the number of caseworkers who assist Affordable Care Act consumers and Medicare beneficiaries.

The list goes on.

And what about the “savings” being touted? Will the vast majority of Americans whose health and safety are being compromised by these ill-considered dismissals at least see a financial benefit? Hardly. The Trump administration is “saving” this money in order to fund further tax reductions for the wealthy–trading the health and well-being of the many for fatter pockets for the few.

America has long been the only Western democratic country without a program of national health care. Now we face the prospect of greatly diminished public health and safety protections, in order to exempt our plutocrats from paying their fair share of taxes.

Makes me want to ask those folks with the red hats: are we great yet?

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About Those Tariffs

All Americans have been getting an education about economics, and specifically tariffs. Some Americans–those who voted for Trump or who didn’t bother to vote–are also getting a rude awakening. (It turns out that it really does matter who holds political office…)

I have not encountered a single reputable economist who doesn’t agree that tariffs are really taxes on the American public, or who believes that their imposition will revive American manufacturing and provide Americans with good jobs. The jobs promise is particularly obtuse; even if the tariffs did result in more factories being built in the U.S.–which is highly unlikely for a number of reasons–anyone who has been watching the manufacturing sector will confirm that its workers are being steadily replaced by automation.

Perhaps the most concise and convincing case against the stupidity–the insanity– of Trump’s tanking of an economy that was the envy of the globe was this brief talk by Fareed Zakaria. 

Rather than indulge in my usual prolonged rant, I am urging you to click on the link and listen to a calm and convincing explanation of why the world of hurt we are all experiencing isn’t temporary and won’t–can’t–lead to Trump’s imaginary rosy future.

If one of our occasional MAGA trolls happens to be reading this, and discounts Zakaria, who is, after all, not just a member of the hated media, but eminently sane and reasonable (qualities anathema to MAGA), how about listening to Ronald Reagan on the subject?

So much winning…

My own rants will resume tomorrow…..

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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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