Dishonesty And Healthcare

As the blizzard of political television ads becomes ever more annoying–and less informative–one thing about them has become very interesting. Even Republicans who have previously made it clear that they don’t want government involved in healthcare are airing advertisements touting support for Medicare and willingness to protect pre-existing conditions.

I’ve been particularly struck by the U Turn in Indiana’s Fifth District, where a radically-reactionary, pro-Trump Republican noted for opposing “socialism” (which she has defined to include pretty much anything done by government) has begun running commercials supportive of Medicare and coverage of pre-existing conditions. Evidently, her polling has overcome her previously expressed belief that government should have no role in health care.

She’s not alone.

When the Affordable Care Act (aka Obamacare) passed, several Republicans went on record with their concern that its trajectory would mirror that of Medicare and Medicaid: despite initial resistance, the public would come to expect/demand/approve of the program. Survey research has confirmed those fears, which is why GOP officeholders continue to pretend that they will protect access to healthcare at the same time as they are feverishly working to eviscerate it.

The Brookings Institution recently published a report detailing six ways Trump has sabotaged the ACA.The report began by stressing that its authors did not use the term “sabotage” lightly.

For analytic purposes, the term “sabotage,” should not be used lightly. Presidents upon taking office typically have priorities that trigger executive actions strengthening some programs while weakening others. The losing programs often face resource reductions, pressure to deemphasize certain goals, directives to alter their administrative approaches, and other measures that can undermine their effectiveness. In doing so, a president often pays lip service to the program, claiming it has been “modernized” or otherwise improved. In contrast, Webster’s defines “sabotage” as efforts to foster “destruction and obstruction” and to “cause the failure of something.” In the context of the administrative presidency, it reflects a commitment to program emasculation and termination through executive action. As such, it sharply departs from the constitutional requirement that the president “take care that the laws be faithfully executed.”

There were six actions detailed in the report.

1) The administration dramatically reduced outreach about, and opportunities for enrollment in, the ACA’s insurance exchanges. The administration sharply reduced support for advertising and exchange navigators and reduced the annual enrollment period to about half the number of days. 

2) Together with Congressional Republicans, it reneged on commitments to private insurance companies. Those insurers had been offered various subsidies that reduced the risks of participating in the exchanges. The GOP failed to honor those commitments.

3) The administration has constructed what the report calls “off-ramps to cheaper, lower-quality insurance.” One goal of the ACA was to improve the quality of health insurance by specifying essential benefits, guaranteeing coverage of those with preexisting conditions at reasonable rates, and prohibiting insurers from imposing certain spending caps. The Trump administration expanded access to coverage that was cheaper because it didn’t meet these standards and that siphoned off the healthier enrollees whose participation is needed to make the ACA work.

4) It allowed–indeed, promoted– a variety of state waivers that decreased ACA enrollments and undermined its regulatory structure.

5) It discouraged legal “aliens” from enrolling in Medicaid. In a particularly evil move, Homeland Security promulgated a “public charge” rule authorizing officials to treat Medicaid enrollment as a negative factor when reviewing the requests of legal non-citizens to extend their stays or change their status (e.g., from temporary to permanent resident).

6) And then there’s the existential threat. The Trump Administration brought the lawsuit that is now pending at the Supreme Court, attacking the constitutionality of the ACA. If that suit is successful–despite a legal argument that has been widely characterized as ridiculous, despite its endorsement by an appellate court composed of Trump-appointed judges– millions of Americans will lose access to health care.

As a student once reminded me, the United States doesn’t have a health-care system; we have a health-care industry. As a result, millions of Americans remain underinsured or completely uninsured, other millions are bankrupted each year by medical costs, and our health outcomes are among the absolute worst in the developed world. 

Deeply dishonest political rhetoric to the contrary, the current Republican Party wants to keep it that way.

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About that 40%…

The problem isn’t Trump. As numerous people have recognized, Trump–despicable and dangerous and deranged as he is– is the symptom, not the disease.

I’ve previously posted about the systemic and structural fault-lines that have been exploited by Trump’s GOP supporters and fellow-travelers–but the disease, the root problem, isn’t the systems. It’s those supporters. Polls suggest that some 40% of Americans fall into that category, and the recurring, haunting question is: why? How could any sane adult look at this man and say, yep, that’s the guy I want directing my government? That’s the role model I want my kids to emulate?

Actually, I think my manicurist answered that question during a recent appointment.

She’s an adorable young woman (and very “woke” as the current terminology would have it). We were discussing the election, and she shared her distress that several family members were Trump supporters. I asked the question I always ask: why? What was her impression/ best guess about the basis of that support? She thought for a moment, then said “I hate to say this, but I think they are sort of racist, and Trump gives them permission to feel that way.”

Her anecdotal suspicions continue to be confirmed by the research, some of which I’ve referenced in prior posts. As more studies emerge, the evidence continues to grow.

The Washington Post recently reported on research into the authoritarian proclivities of Trump supporters–research that  linked those tendencies to racial animus.

In “Authoritarian Nightmare,” Bob Altemeyer and John W. Dean marshal data from a previously unpublished nationwide survey showing a striking desire for strong authoritarian leadership among Republican voters.

They also find shockingly high levels of anti-democratic beliefs and prejudicial attitudes among Trump backers, especially those who support the president strongly. And regardless of what happens in 2020, the authors say, Trump supporters will be a potent pro-authoritarian voting bloc in the years to come.

The research paints a picture of  people who are “submissive, fearful, and longing for a mighty leader who will protect them from life’s threats.” They are particularly prone to divide the world into friends and foes, and to believe that the foes far outnumber the friends.

Other researchers have reached similar conclusions using very different methods. Vanderbilt political scientist Larry Bartels, for instance, recently used YouGov survey data to find that many Republican voters hold strong authoritarian and anti-democratic beliefs, with racism being a key driver of those attitudes.

In the most recent study, respondents were asked whether they agreed or disagreed with the statement: “Once our government leaders and the authorities condemn the dangerous elements in our society, it will be the duty of every patriotic citizen to help stomp out the rot that is poisoning our country from within.” Roughly half of Trump supporters agreed with that statement,  which–as Altemeyer and Dean point out– is “practically a Nazi cheer.”

If there has been one overarching lesson to be learned from the past few years, it is the (previously unappreciated) extent to which tribalism, racism and bigotry explain things that are otherwise inexplicable. A recent essay from New York Magazine analyzed the failure of Congress and the President to agree on a second, desperately needed stimulus package. The author’s conclusion was stunning: “bailing out” blue states would benefit ethnic minorities–something Republicans are loathe to do.

The most plausible explanation for this state of affairs is this: Most Senate Republicans face no great risk of losing their seats to a Democrat this year or any other. For them, the main threat to their power is a primary challenge. And right now, conservative media has turned opposition to fiscal aid into a cause célèbre, casting support for “blue-state bailouts” as treasonous.

How hateful do you have to be to withhold aid during a global pandemic to people you see as “Other”–even if by doing so, you and those you view as your own kind are harmed as well?

Even if there is a blue tsunami on November 3d, the people who hold these attitudes will still constitute a troubling percentage of the electorate. We can only hope that they fall far short of a majority.

And I have to wonder: What the hell is wrong with them?

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The Crux Of The Problem

The Senate–which has managed to do pretty much nothing during the pandemic (granted, it wasn’t exactly productive in the months before that, either)–is rushing through the process of confirming Amy Coney Barrett to the Supreme Court.

There are many aspects to this unseemly exhibition, but one that has been less remarked upon is the connection between the Senate’s growing problem of disproportionate representation and that body’s importance to the seating of Supreme Court Justices.

A recent post by Nate Silver at FiveThirtyEight.com connected those dots.

Silver says that the constitution of the Senate poses an “enormous problem for Democrats”–not simply because the parties as currently constituted map onto urban and rural representation. (Democrats dominate in cities; Republicans triumph in rural areas.) As he points out,

 because the Senate is responsible for confirming Supreme Court picks, that means the Supreme Court is a huge problem for Democrats too. Sure, Democrats might win back the Senate this year — indeed, they were slight favorites to do so before the Ginsburg news. But in the long run, they’re likely to lose it more often than not.

You can probably grasp intuitively that a legislative body which provides as much representation to Wyoming (population: 580,000) as California (population: 39.5 million) will tend to favor rural areas. But it’s a bigger effect than you might realize, so let’s run some numbers. At FiveThirtyEight, our favorite way to distinguish between urban and rural areas is based on using census tracts to estimate how many people live within a 5-mile radius of you.

Using this metric, Silver broke the country down into four categories: those with fewer than 25,000 people within 5 miles were classified as rural; those falling between 25,000 and 100,000 were exurban; between 100,000 and 250,000 were suburban or small city; and over 250,000 were urban. Using this (somewhat arbitrary) classification system, Silver found that these “buckets” were almost even: 25 percent rural, 23 percent exurban/small town, 27 percent suburban/small city, and 25 percent urban core/large city.

He then looked at the Senate, and– surprise! (no surprise; I’m kidding)– found a major skew to rural areas in that chamber’s representation. It turns out that the Senate has” two or three times as much rural representation as urban core representation … even though there are actually about an equal number of voters in each bucket nationwide.”

And of course, this has all sorts of other downstream consequences. Since rural areas tend to be whiter, it means the Senate represents a whiter population, too. In the U.S. as a whole, 60 percent of the population is non-Hispanic white and 40 percent of the population is nonwhite. But in the average state, 68 percent of people are white and 32 percent are nonwhite. It’s almost as if the Senate has turned the clock back by 20 years as far as the racial demographics of the country goes. (In 2000, around 69 percent of the U.S. population consisted of non-Hispanic whites.)

The post goes through a lot of mathematical calculations, which you can see if you click through, but the bottom line is stark:

the Senate is effectively 6 to 7 percentage points redder than the country as a whole, which means that Democrats are likely to win it only in the event of a near-landslide in their favor nationally. That’s likely to make the Republican majority on the Supreme Court pretty durable.

There is a lot to unpack in this article, beginning with my extreme discomfort with its underlying premise that the Supreme Court is merely another arena for American political partisanship. Granted, judicial philosophy has always been a significant cause of dissension, but it is only in the last few years that the judiciary has effectively been reduced to the status of partisan prize–as a tool for imposing political hegemony through the legal system, rather than a safeguard of fidelity to the Constitution and the rule of law.

What the article does make very clear, however, is the disturbing and undeniable fact of minority rule. White rural Republicans–who are advantaged by the current situation–like to recite that America is a republic, not a democracy, as if that somehow rebuts the fact that a true republic is a representative democracy. (Look it up.)

This situation is at the crux of our national problems. America is currently ruled by an unrepresentative minority–and the effect of that reality includes but is certainly not limited to the GOP’s intentional corruption of the nation’s judiciary.

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What’s Next?

In a recent New York Times op-ed, Thomas Edsall asks a question that is rapidly becoming more pressing: what happens after the election?

It’s a question we really can’t answer until we know not just who has won the Presidency, but how the transition has been handled and–far more important–who will control the Senate.

Although “what now?” depends upon currently unknown election returns, we can–actually, we should–consider a variation of that question. What ought to happen next?

My own concerns revolve around the inevitable splintering of the Democratic Party into its factions. One of the problems with single-party dominance (or in this case, single-party sanity) is that reasonable people holding very different views all end up in the non-crazy party. Democrats have never been ideologically monolithic; these days, thoughtful conservatives, liberals and leftist activists are all Democrats because their only other options are to join a cult (the contemporary GOP) or vote for a third-party candidate (essentially flushing their votes).

My most fervent hope–assuming Democratic control of the Senate as well as the House and the White House–is that leadership will immediately move to implement policies on which there is broad consensus: rolling back the roll-backs of environmental protections; passing H.B. One–the broad reform of electoral rules that passed the House by a massive margin and languished (along with everything else Mitch McConnell touched) in the Senate; ending tax policies that soak the middle class while allowing the rich to evade paying their share; re-instating DACA and instituting humane immigration policies.

There are others, and they should all be introduced and passed as expeditiously as possible.

Noted political scientist Theda Skocpol believes the Democrats will hang together; she tells Edsall that, in the event of a Democratic Senate majority, especially with a cushion of 2 or 3 votes, she

does not foresee any acute internal conflicts, because there will be so much to do in a pandemic and economic crisis,” adding, “I think joint approaches will not be hard to work out: voting reforms, expansion of Obamacare with a strong public option, college costs help for lower income and lower middle class, robust green jobs investments, etc., etc.

I hope she’s right.

Other measures that ought to be taken–preferably, within the first hundred days–include eliminating the filibuster and expanding the number of federal judges. If–as is likely–Judge Barrett has been confirmed in a departing f**k you by McConnell, the number of Justices on the Supreme Court should also be expanded. (Actually, according to the Judicial Conference, that should be done even if, by  some intervening miracle, her nomination fails). But what should be done and what will occur are two different things, and opinions on both the filibuster and the approach to the courts divide the party’s moderates and progressives.

“What’s next” is, of course, a broader question than “what policies should Democrats pursue?” Edsall’s column is concerned less with policy and more with politics. He quotes a political scientist for the rather obvious observation that it’s easier to unite against something than for something, a truism that doesn’t bode well for continued Democratic unity. He also tackles the less obvious–and far more important–question “what happens to Trumpism” if, as seems likely, Trump loses?

Rogers Smith–another noted political scientist–thinks that a loss for Trump won’t defeat Trumpism.

Trump has built a new right populist coalition that has more electoral appeal than the full-tilt neoliberal, moderately multicultural economic and social positions of the prior Republican establishment. It has plenty of reasonably charismatic youthful champions. Its leaders will avoid the crude bullying and rule-flouting that Trump displayed in the recent presidential debate, and they’ll certainly try to avoid Access Hollywood-type scandals. But otherwise they will carry the Trump right-populist movement forward.

The “Trump movement” is essentially racist, theocratic and misogynistic. So long as it remains a viable, non-fringe element of American political life, the “American experiment” is at risk.

Whatever is “next,” we probably aren’t yet out of the woods.

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Misunderstanding Religious Freedom

It was refreshing to read a New York Times column responding to the recent–and I must say, weird and troubling–ruminations on same-sex marriage issued by Clarence Thomas and Samuel Alito.

The reason I label these “opinions” weird is that they were not dissents, not even concurrences. They were peevish outbursts–not far removed from “get off my lawn” explosions by cranky old guys. I’m unaware of other instances in which Supreme Court Justices used a unanimous and otherwise predictable decision as an opportunity to simply gripe that the world wasn’t going their way.

As David Von Drehle wrote,

It was an odd document, not a dissent; just a four-page grumble about matters that may someday be a problem depending on the facts of unknown future cases. The justices might consider woodworking, because, from the looks of this, they don’t have enough to keep them busy. The statement, which carries no legal weight, is essentially a cry from the heart on behalf of Americans whose religious views condemn same-sex marriage. Fair enough: The freedom to hold beliefs different from those of the mainstream is a cherished aspect of American liberty. But the statement crosses into sophistry by suggesting that religious liberties are somehow infringed if they aren’t privileged above the civil law.

And that, dear readers, is the crux of the matter. The piteous complaints that meet any effort to ensure the civic equality–note the word civic–of Americans who do not conform to their religious beliefs are based upon their conviction that they (and only they) are in possession of Truth, that they (and only they) know God’s Will, and that other citizens should therefore be forced to comply with their beliefs and their bigotries.

Von Drehle notes that the Justices offer no new basis for their opposition: he references Thomas’ 2015 argument that same-sex marriage is not mentioned in the Constitution– and points our the obvious: opposite-sex marriage isn’t mentioned there, either.

Thomas and Alito engage in a profoundly damaging legal error: religious freedom is not the right to impose some people’s beliefs on other citizens.

Far too many Americans define “freedom” as “my right to do what I want, no matter how harmful that may be to my fellow Americans.” We see that distortion in the refusal of “freedom fighters” to wear masks to protect the health of their neighbors.

Our legal system was profoundly influenced by what is sometimes called the “libertarian construct.” That construct provides that we each have the right to “self government”–to live our lives as we see fit, to worship or not, to form and exchange opinions, to go about our business free of official constraint– so long as we do not thereby harm the person or property of a non-consenting other, and so long as we grant an equal right to others.

There are all kinds of good-faith differences of opinion about the nature of the harms that justify government interventions–second-hand smoke? Seat belts? There is no such “gray area” when it comes to our obligation to extend “an equal right to others.”

When the issue is religious liberty, Von Drehle gets it right, and the Justices get it wrong.

By prohibiting establishment of a state religion, the Constitution explicitly bars “courts and governments” from preferring one set of religious views over any other set — or over nonreligious views…

Nor does religious freedom confer immunity from criticism. Religious freedom by its nature implies robust disagreement over strongly held values. Imprecations will be hurled, alas. Names will be called. Devout Christians should appreciate this; indeed, we are called blessed when we’re reviled for the sake of our faith. Furthermore, we’re taught to distinguish between civil and religious authority, and to render due respect to both.

Churches and other religious establishments rightly have certain protections from laws that might compel them to violate their beliefs while conducting their own business. It’s dangerous to confuse that safe zone with a general power to flout the law.

I say AMEN.

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