Learning From Portugal

Over the past few years, American politicians have been (grudgingly) coming to terms with the fact that the nation’s much-touted “War on Drugs”–a war almost as massively expensive as those fought by the Pentagon–has consistently proven to be a failure.

Years of research that documented that failure have pointed to the fundamental flaw in American drug policy: a failure to properly categorize.

That failure wasn’t just the lumping of relatively harmless recreational marijuana in the ranks of  truly dangerous substances, although that was bad enough. (As pro-pot activists liked to point out, alcohol and cigarettes, both legal, account for far worse health problems– there have been zero deaths attributed to pot.)

By far the worst “category” problem was the decision to attack drug abuse as a criminal justice issue rather than a health issue.

Portugal doesn’t make that mistake, and as years of research have demonstrated, properly characterizing drug abuse as a medical problem has allowed that country to achieve far more success in managing it.

Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action — in diametrically opposite directions. The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue.

After more than 15 years, it’s clear which approach worked better. The United States drug policy failed spectacularly, with about as many Americans dying last year of overdoses — around 64,000 — as were killed in the Vietnam, Afghanistan and Iraq Wars combined

In contrast, Portugal may be winning the war on drugs — by ending it. Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began.

The number of Portuguese dying from overdoses plunged more than 85 percent before rising a bit in the aftermath of the European economic crisis of recent years. Even so, Portugal’s drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S.

As the linked article notes, if the U.S. could meet Portugal’s death rate from drugs, that would equate to saving one life every 10 minutes. That’s almost as many lives as those that we lose now to guns and car accidents combined.

Many people are also coming to Portugal to explore what a smarter, health-driven approach might look like. Delegations from around the world are flying to Lisbon to study what is now referred to as the “Portuguese model.”

“This is the best thing to happen to this country,” Mario Oliveira, 53, a former typesetter who became hooked on heroin 30 years ago, told me as he sipped from a paper cup of methadone supplied by a mobile van. The vans, a crucial link in Portugal’s public health efforts, cruise Lisbon’s streets every day of the year and supply users with free methadone, an opioid substitute, to stabilize their lives and enable them to hold jobs.

Methadone and other drug treatment programs also exist in the U.S., but are often expensive or difficult to access. The result is that only 10 percent of Americans struggling with addiction get treatment; in Portugal, treatment is standard.

In the U.S., we don’t treat. We punish. And we aren’t deterred by the fact that punishment doesn’t work.

Many years ago, when I was Executive Director of Indiana’s ACLU, I made a speech to a large audience–I no longer recall what the event was–and included a critique of American drug policy. When an audience member suggested that we just weren’t being tough enough, I asked what seemed to me to be a very reasonable question: If there was a doctor who had performed 100 operations and every single one of his patients had died, would you agree that he just needed to do the same operation again? Would you go to that doctor?

What I call Americans’ “category problem” is influenced by our national inability to separate concepts of sin and crime. We saw that same confusion with prohibition–drunkenness is sinful, so we outlawed booze, making no distinction between social drinking and alcoholism. Drug addiction is sinful, so let’s not bother to distinguish between use and abuse, and let’s not look at evidence about cost-effective ways to address abuse…

The public health approach arises from an increasingly common view worldwide that addiction is a chronic disease, perhaps comparable to diabetes, and thus requires medical care rather than punishment. After all, we don’t just tell diabetics, Get over it

Portugal’s approach isn’t perfect. But it’s rational.

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An Accidental Insight

My husband and I were on a cruise ship for two weeks, on our way to Amsterdam where we  visited our son. Anyone who has taken one of these trips across the Atlantic can attest to the fact that Internet access–when available–is maddeningly slow and intermittent. It’s also expensive. On our cruise, connecting to more than one device at a time was costly, so I was unable to make planned use of my Kindle by accessing those of my books that reside on “the cloud.”

As a result, I inadvertently encountered some important research.

A couple of years ago, I had downloaded a book on the “Submerged State,” a title issued by Chicago Studies in American Politics. I’m embarrassed to admit that I’d read very little of it. (One of the enduring problems with academic research is academic language, which tends to be dense and inaccessible to all but the most determined readers…)

Since my vacation novels were unavailable, I decided to be determined, and to revisit it.

The authors make a basic–and very important–observation: thanks to America’s penchant for small government, conservatives have been able to give us governance that–despite being every bit as costly and ubiquitous as it it is elsewhere– is “uniquely invisible.”

They define the “submerged state” as policies and programs that function by providing incentives, subsidies or payments to private organizations or households to encourage or reimburse them for conducting activities deemed to serve a public purpose.

The result is that we have channelled a preponderance of the government programs that benefit citizens through private and nonprofit intermediaries, and that practice has had some very negative consequences: it has obscured the extent to which many of these policies enrich the already affluent; it has kept ordinary Americans from recognizing the role of government in their lives while allowing the programs to be “plainly evident” to the special interests that reap the rewards; and worst of all, by obscuring government activities and their positive consequences, it has reinforced anti-government attitudes.

In short, by “submerging” the operations of government, we have kept most citizens blissfully unaware of the ways in which government makes a positive difference in their lives.

The researchers considered a number of programs with varying degrees of visibility; they then surveyed recipients in order to evaluate their awareness of the benefits they receive, and recognition that those benefits originate from government.

Most of the citizens who had saved substantial dollars thanks to the home mortgage deduction, for example, claimed never to have been beneficiaries of a government program. Students whose federal loans are serviced by lending institutions are frequently unaware that those dollars come from (or are guaranteed by) government, and that eligibility and interest rates are considerably more favorable as a result.

Tax policies like Obama’s “Making Work Pay” are so obscure that the general public often  thinks rates have been increased when they have actually been lowered, leading to a pertinent question: can a reform be considered successful if it goes unnoticed?

Policy debates are also hijacked by widespread ignorance of the extent of government’s actual current role.For example, while many Americans know that the country spends more per capita on health care than any other nation, few of us are aware that government already foots most of the bill (estimates range from 56% to 70%), and that a program of national health care–with its vastly lower administrative costs– would be unlikely to cost much more.

The book has numerous other examples, but what I found most important was the researchers’ conclusion about the effects of non-visible governance on democracy. As they emphasize, an idea fundamental to democracy  is the premise that people are citizens, and citizens are active participants in governance. Participation requires that they be reasonably aware of what their elected representatives do on their behalf–that they should be in a position to form opinions about policies and be able to be involved in the political process. The submerged state, however, empowers interest groups and disempowers the public.

A couple of quotations that sum up the central point of the book:

The idea that public policies should reflect the will of the majority of citizens is a basic principle of representative democracy. Yet in the case of the submerged state, many citizens lack basic information, and public officials fail to provide it.

And

As long as public officials criticize government but persist in channelling public resources surreptitiously through private means, Americans will be deluded.

I guess I should thank the inadequacy of oceanic internet for a deeply instructive–if very depressing–read.

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The Rear-View Mirror

Like many who read this blog, I get the Letter from an American from Heather Cox Richardson. Richardson is a historian, and the great benefit of her Letters is that they provide what I like to think of as a look in humanity’s rear-view mirror.

Driving a car requires checking the traffic behind us in order to navigate the road ahead. History serves much the same purpose (which is one of the many, many reasons why the rightwing hysteria over teaching the country’s history of racism is so deranged…)

A few days ago, Richardson shared an “aha” moment.

It has been hard for me to see the historical outlines of the present-day attack on American democracy clearly. But this morning, as I was reading a piece in Vox by foreign affairs specialist Zack Beauchamp, describing Florida governor Ron DeSantis’s path in Florida as an attempt to follow in the footsteps of Hungary’s Viktor Orbán, the penny dropped.

She proceeded to outline the political currents prior to the election of Trump: the evolution of today’s GOP into the pro-oligarchy party, following what she described as the usual U.S. historical pattern to that point– “in the 1850s, 1890s, 1920s, and then again in the modern era, wealthy people had come around to the idea that society worked best if a few wealthy men ran everything.”

Each of those periods was a reaction to the expansion of civil equality. Richardson reports that wealthier Americans protected their privileged status by playing on the racism of  poorer white male voters– telling them that passage of laws protecting equal rights was really a plan to turn American governance over to immigrants or to Black or Brown Americans.

The idea that poor men of color voting meant socialism resonated with white voters, who turned against the government’s protecting equal rights and instead supported a government that favored men of property. As wealth moved upward, popular culture championed economic leaders as true heroes, and lawmakers suppressed voting in order to “redeem” American society from “socialists” who wanted to redistribute wealth. Capital moved upward until a very few people controlled most of it, and then, usually after an economic crash made ordinary Americans turn against the system that favored the wealthy, the cycle began again.

When Trump was elected, the U.S. was at the place where wealth had concentrated among the top 1%, Republican politicians denigrated their opponents as un-American “takers” and celebrated economic leaders as “makers,” and the process of skewing the vote through gerrymandering and voter suppression was well underway. But the Republican Party still valued the rule of law. It’s impossible to run a successful business without a level playing field, as businessmen realized after the 1929 Great Crash, when it became clear that insider trading had meant that winners and losers were determined not by the market but by cronyism.

Trump deviated from the usual cycle in one way–he didn’t care about enriching the oligarchy, only about enriching himself, his toadies and his family. Despite his  repellent personality and embarrassing ignorance of government and policy, he was especially dangerous because he turned the Republican base into a cult that no longer respected the rule of law.

Richardson warns that Trump’s deliberate destabilization of faith in our democratic norms is especially dangerous because it creates space for two right-wing, antidemocratic ideologies. Two current Republican governors model those ideologies: Abbott in Texas, who is pursuing the South’s Civil War insistence on “states’ rights,” and DeSantis in Florida, who is emulating Viktor Orbán’s “soft fascism.”

Orbán has taken control of Hungary’s media, ensuring that his party wins all elections; has manipulated election districts in his own favor; and has consolidated the economy into the hands of his cronies by threatening opponents with harassing investigations, regulations, and taxes unless they sell out.

DeSantis is following this model right down to the fact that observers believe that Florida’s “Don’t Say Gay” bill was modeled on a similar Hungarian law. DeSantis’s attack on Disney mirrors Orbán’s use of regulatory laws to punish political opponents (although the new law was so hasty and flawed it threatens to do DeSantis more harm than good).

Richardson counsels us to look in that rear-view mirror–to access the knowledge and tools that history provides to defend democracy from the ideology of states’ rights.” But she also warns that, because the rise of “illiberal democracy” or “soft fascism” is new to us, we need to understand how it differs both from Trump’s version of autocracy and from the old arguments for states’ rights.

At risk of over-extending my somewhat strained analogy, Orbanism represents a massive pothole on the road to democratic self-governance and civil liberty–a pothole requiring us to drive carefully and keep our eyes on the road– ahead and behind.

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Putting Us In Our Place…

The day the Alito draft opinion leaked, my youngest son sent me a reaction from The Onion, headlined “Vessel for Male Sexual Gratification Very Sad Today.”

Noting its slumping posture, slack expression, and overall downcast appearance, sources confirmed Wednesday that a vessel for male sexual gratification was very sad today. “It definitely appears to be upset,” said sources, adding that the object that exists solely for men’s physical pleasure was presently sitting unmoving with a distant, empty stare. “It doesn’t look happy. What’s wrong with it? I don’t like the way it’s ignoring me.” At press time, sources had decided to go over to the sexual apparatus and tell it to smile.

Despite the pious, “pro life” pronouncements of those who have worked assiduously to control women’s reproduction, the real issue has little or nothing to do with “saving babies.” (If it did–as innumerable people have pointed out–Americans wouldn’t continue to ignore the care and feeding of those babies once they are born.) It’s the “place”–the defined status– of women. 

We can see the desired end game of the “pro-life” movement in the declarations of the more rabid anti-choice warriors, who have made it quite clear that they oppose birth control as well.

I still remember a conversation with a partner at the law firm I joined after graduating from law school. It was 1977, and the firm had just hired its first two women lawyers (I was one). He mused that women’s ability to plan our childbearing had opened up employment opportunities that hadn’t previously been available. He was right.

Before the wide availability of birth control, the only real “choice” available to women who wanted to pursue professional careers was to abstain–from sex, marriage, and motherhood–or to delay for many years (or more commonly, to entirely forgo) careers.

The birth control pill changed women’s worlds. It also changed virtually all parts of American society. Remember that old cigarette ad, proclaiming “You’ve come a long way, baby?” We have.

Think about the trajectory.

Religion began–and mostly remains– highly patriarchal. Women were seen as either temptresses (Eve!), or nurturers and breeders. Gender norms were “God decreed,”  and religious texts were male-centered.

When the American colonies were first settled, they adopted English laws forbidding women from owning property or from keeping their own earnings. In 1877, all states had laws preventing women from voting. Women have had the vote for just over 100 years.

Most other advances toward civic equality for females came after 1960–the year the FDA approved the birth control pill. In 1963, we got the Equal Pay Act. In 1964, the Civil Rights Act was passed and the EEOC established. In 1965, the  Supreme Court ruled that state legislatures couldn’t forbid married people from using contraceptives–a ruling that Alito’s draft endangers. Other rulings allowed women to serve on juries, and forbid various types of gender discrimination. It was only recently that the Lily Ledbetter Act attacked the practice of paying women less than men doing the same job.

Thanks to those legal changes–and especially the ability to decide whether and when to procreate–women have entered much more fully into the life of this country. We have a woman Speaker of the House, a woman Vice-President. Turn on your TV, and women news anchors and sports reporters inform you. Today, your doctor and your dentist and your CPA are all as likely to be women as men.

The results have been salutary–and not just for women.

A friend whose company offers financial services recently posted an article from The Daily Shot, sharing research that compared companies with greater and lesser numbers of female executives in the ranks. Those with more female executives “have done far better over the last decade in return on equity than the rest of the S&P 500.”

The Christian Nationalist Party–formerly the GOP–finds the current state of affairs terrifying and “unGodly.” The old White guys who believe they should run the world have very accurately identified the foundation on which women’s progress rests: the ability to control our own reproduction. 

And that is what the fight over abortion is really about.

Assuming the extent of the backlash to the Alito leak doesn’t change the result–assuming the Court issues a version of Alito’s dishonest “history” and his astonishing decree that state legislators should have the right to require women to give birth–we will see whether America is willing to roll back the past fifty years of cultural change–whether even Red states are able to erase the civil status, empowerment and participation of half of the population.

Will this last gasp of patriarchy prevail? We’re about to find out.

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Briggs Gets It. Banks Doesn’t

James Briggs is currently an opinion columnist for the Indianapolis Star. (I say “currently” because for the past several years, the Star has employed one columnist at a time to opine about the news–usually national– arguably to distract readers from recognizing the extent to which the newspaper doesn’t cover state or local government. But I digress.)

I have tended to agree with Briggs’ take on the various matters he’s covered, and a recent column was no exception.The target was Florida Governor Ron DeSantis, and his retaliation against Disney for having the temerity to oppose his “Don’t say Gay” bill. Briggs wonders whether Florida’s break between business and the GOP will spread to other Red states.

Florida Gov. Ron DeSantis’ war on Disney feels like a potential breaking point for Republicans and big business.

The question is whether the rift will extend beyond certain regions (such as the Southeast) and personality-driven politics (DeSantis boosts his national profile by taking on that lib, Mickey Mouse) to alter the governing philosophy of Republicans in red states across the country.

As Briggs notes, the traditional alliance between the GOP and big business has become strained, as a number of corporations have responded to public opinion by taking political positions that have angered Republican culture warriors. He mentions Dick’s Sporting Goods, which led large retailers to stop selling semiautomatic rifles and ammunition in 2018, and decisions by Coca-Cola and Delta to oppose Georgia Republicans’ voting legislation last year.

The most famous Indiana example of government clashing with big business, of course, was the 2015 response of Hoosier business to the effort by then-Gov. Mike Pence and the Republican-controlled Indiana General Assembly to pass an altered version of the Religious Freedom and Restoration Act–a version that would have facilitated anti-LGBTQ discrimination. Business won that conflict.

This year in Florida, however, DeSantis’ obedient state legislature  passed a bill to eliminate a special district that enables Disney World to operate as its own municipality in the state. The effective date of the measure was delayed until after the midterm elections, undoubtedly because–if it goes into effect– it will raise taxes and shift enormous debt from Disney to Florida taxpayers. (Culture wars come at a cost…)

Some Indiana Republicans are agitating for that shift as well, most notably U.S. Rep. Jim Banks, who has called out Eli Lilly & Co. and bragged about being blacklisted by the Indianapolis drugmaker’s political action committee over objecting to Joe Biden’s election certification last year. Banks also is among 17 Republican members of Congress who wrote to Disney expressing opposition to extending copyright protection for Mickey Mouse beyond 2024.

The sentiment is simmering throughout Indiana. Rank-and-file Republicans in the Indiana General Assembly have been putting the state’s top companies on their heels in recent years, including the most recent session when they introduced legislation that would have all but banned employer vaccine mandates.

I find this 180 degree shift in Republican philosophy gobsmacking. The GOP used to be overly deferential, if anything, to corporate America’s freedom to manage its own business affairs.

Briggs is confident that Indiana will not follow DeSantis’ authoritarian lead. His reasoning is persuasive, but depressing. Essentially, he says Florida remains a state where people want to live and do business. It’s the eighth-fastest-growing state, and it has three of the 10 hottest housing markets. It’s “attracting the population and talent to drive a thriving business climate.”

Indiana is a tougher sell. Eli Lilly CEO David Ricks recently laid that out in brutal terms during a speech to the Economic Club of Indiana.

“Our education attainment in the state is not good,” Ricks said, as reported by WISH-TV. “The ability to reskill the workforce, I think, could improve. Health, life and inclusion, overall, I think, conditions rank poorly nationally in our state. And also workforce preparedness, also related to reskilling, is a liability for us.”

Ricks might have elaborated on that thesis, pointing out that Indiana’s infrastructure and overall quality of life don’t send welcoming messages to potential residents or businesses. “We’re cheap” isn’t exactly an enthusiastic endorsement. Add to our other visible deficits the voices of far too many of our elected officials; Banks isn’t the only embarrassment working overtime to appeal to the under-educated and overwrought GOP base.

Indiana’s Republicans have long since abandoned the statesmanship of Dick Lugar and Bill Hudnut. Instead, they are emulating the bigoted idiocies of Margery Taylor Green, Paul Gosar and their ilk.

As Briggs points out, Indiana needs big, high-paying employers–and those employers need workers who are unlikely to agree with Jim Banks, et al, on social issues. We aren’t Florida, “where oceans and warm weather in January have a way of making you forget about politics.”

These days, businesses will think twice about Florida–ocean or not–let alone Indiana.

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