I Will Never Understand This

There are a lot of things I don’t understand. Bitcoin. How wireless internet works. Why anyone gives a rat’s patootie about Kardashian-type celebrities.  Lots more.

But on Thanksgiving–when I reflect on my good health and comfortable life and give thanks for my family– I am reminded that what I really, really don’t understand is why so many people oppose allowing government to insure other people’s health.

Don’t get me wrong: I certainly understand debating the how of healthcare, arguing for policy A rather than policy B or C. But I’m appalled by those who evidently consider health care an optional consumer good–and believe that people who can’t afford it shouldn’t have it.

What triggered this rant was a post from Dispatches from the Culture Wars. I’ve met Ed Brayton, who writes Dispatches. He is a delightful person, a steadfast proponent of reason, the rule of law, civil liberties and science.

He also has a pre-existing condition.

While Trump and virtually every Republican lies about not wanting to do away with the ACA’s protections for those who have preexisting medical conditions, the AARP has a new report out that says the result would be a massive increase in premiums for people like me, as high as $26,000 a year.

Brayton quotes from the AARP report:

The revised American Health Care Act (AHCA) threatens to do away with the Affordable Care Act’s (ACA) protections for people with preexisting health conditions. These protections prevent insurance companies from denying these individuals coverage or charging them higher rates based on their health.

Eliminating these protections could force millions of Americans to — once again — rely on state high-risk pools. State high-risk pools are supposed to provide access to health insurance for people who cannot get coverage in the individual health insurance market because of preexisting health conditions.

State high-risk pools may sound like a good idea but, in reality, they are fraught with problems. One of the biggest lessons learned from experience with state high-risk pools: They bring steep premiums that put coverage out of reach for millions. In the past, monthly premiums in state high-risk pools could be up to 200 percent higher than in the individual (nongroup) market. Consequently, only a small fraction of those with preexisting conditions could afford to buy a plan. Yet, these premiums — high as they were — only covered about half the amount needed to pay enrollee claims. Most states tried to close the financial gap through taxes on providers and government subsidies, but even those efforts proved insufficient. We project that if states return to pre-ACA high-risk pools in 2019, as proposed, high-risk pool premiums for people with preexisting conditions could be as high as $25,700 annually.

Brayton’s reaction paints the picture in very personal terms:

High-risk pools are a disaster. They make insurance completely unaffordable for the overwhelming majority of people. As I’ve said many times, if the Republicans succeed in repealing Obamacare, I’m dead. Probably within a year. There’s no way I could afford the premiums in a high-risk pool and my medication costs run into thousands of dollars a month, and that doesn’t count all the specialists and tests and stays in the hospitals.

The United States health industry (as a student once explained to me, we don’t have a ‘system’) costs twice as much per person as in the next most expensive country, and our outcomes are far worse. (We not only aren’t “number one,” the last time I looked, we were number 37.) Private health insurance companies have average overhead costs of 23-25% (costs that include bloated management salaries and corporate jets, along with marketing costs and personnel hired solely to decide that you don’t really need that medicine).

Medicare’s overhead is 3%.

Americans pay much more for much less, all because we don’t want to subsidize medical care for the Ed Braytons of the world–or for the children of poor families, or people who don’t look like us.

The day America joins the rest of the civilized world by guaranteeing universal access to basic medical care will really be Thanksgiving.

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Telling It Like It Is: Election Version

In a riff on the title of the book What’s the Matter with Kansas, Ron Klain’s recent column for the Washington Post was “What’s the Matter with Florida?”

The column could have more accurately headed “What’s Wrong With America’s Electoral ‘System’?” Note the quotation marks around the word system; they’re there because (much like the situation with health care), we don’t have anything that remotely deserves the word “system.”

As the New York Times reported just last Sunday in an article about voting glitches,

Though it wasn’t a 2000 redux, the 2018 midterms exposed persistent problems and the haphazard way the voting process was administered across the country. In Arkansas, three-member boards handle elections at the county level, while in Connecticut all 169 towns and cities use their own registrars.

The inherently political nature of running elections can call into question some officials’ decision-making.

Klain served as general counsel for Al Gore in that 2000 recount effort in Florida; he says he’s often asked why these problems keep happening in Florida.

Part of what we are seeing now in Florida, as we did in 2000, is the product of factors specific to the state: persistently weak election administration in key counties, perennially close and hard-fought elections, and a colorful group of political players that seems ripped from the pages of a Carl Hiaasen novel. But the most important thing to know about what’s happening in Florida is that it has little to do specifically with Florida at all.

Take a step back and look at the big issues playing out in Florida, and what you’ll see, instead of Florida’s foibles, are three critical challenges to American democracy as a whole.

It’s hard to argue with the negative effects of the three challenges Klain identified in his column: we allow “interested” officials to supervise elections;  we entrust the electoral process to amateurs and incompetents; and state election systems are poorly run and underfunded.

The recent midterms especially highlighted the first of these. As Klain notes,

Florida’s chief law enforcement officer, Gov. Rick Scott, who is also the Republican nominee in the Senate recount, is in a position to allege crimes by election officials, attempt to seize voting machines and dispatch state troopers to try to intervene in the post-election dispute. But a similar spectacle has been unfolding for months next door in Georgia.

As chief of election administration in Georgia, Secretary of State Brian Kemp— who is also the Republican nominee for governor, in a vote also being contested — stalled more than 50,000 new voter registrations, supported closing more than 200 polling places in predominantly minority areas and purged 1 in 10 Georgia voters from the rolls. In Kansas, Secretary of State Kris Kobach — again, also the Republican nominee for governor — employed many of the same tactics as Kemp, and fell just short of being elected.

These are egregious conflicts of interest, but such conflicts are only slightly less concerning when partisan officials not running for office oversee elections. Those officials have, as the saying goes, “a dog in the fight,” and significant incentives to game the process to favor their political party.

The clusterf**k in Florida also illustrates Klain’s other points: the machine recount  in Palm Beach County was hampered because old machines overheated from processing so many ballots; and 30,000 ballots in Broward County recorded votes for state agriculture commissioner but not the U.S. Senate. That weird result turned out to be the result of a poorly designed ballot.  More incompetence in the state of the hanging chad….

Klain’s most important point, in my view, is the following:

But again, that’s not just in Florida. While some election misadministration (such as inadequate numbers of voting machines in targeted areas) appears to be a deliberate effort to suppress the vote in minority communities, much Election Day mayhem is caused by systems that are poorly run and underfunded.

No matter how much we hail democracy on the Fourth of July, come November, elections are just another government service: In communities where thin budgets and lax leadership produce scant bus service, slow ambulance response times and unkempt parks, we should not be surprised to find confusing ballots, bad instructions at the polls and slow vote tabulation.

For the past 40 years, Americans have been beating up on the very idea of government. We have voted for people whose proudest “qualification” is that they know nothing about public service, and for people who insist that taxation is “theft” rather than the dues we pay for civilization. We lionize the small percentage of our population who have the means to retreat into gated enclaves and provide for their own comfort and safety.

We the People no longer support government’s most basic obligation: to provide an adequate physical and social infrastructure administered by competent public servants.

It shows. And not just during elections.

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Gains and (Huge) Losses

In age of internet, I worry that it is no longer possible to have a truly national conversation.

The ability of social media platforms to target recipients for advertising and other information based upon sophisticated analyses of individual preferences threatens the very existence of a genuinely public sphere in which a true First Amendment marketplace of ideas might operate. As one scholar of the media despairingly asked, “How can you cure the effects of ‘bad’ speech with more speech when you have no means to target the same audience that received the original message?”

We are clearly in uncharted waters.

As regular readers of this blog know, I teach a course in Media and Public Affairs. It used to be titled “Mass Media and Public Affairs;”  the name change reflects a change in the reality of our methods of communication: there’s no truly “mass” media anymore.

Subject-matter covered in the course has morphed along with the media it studies. When then-Dean of Journalism Jim Brown and I began team teaching it more than a decade ago, our goal was relatively simple–introduce Journalism students to policy formation (so they would better understand how coverage of government affects policy), and help public affairs students understand the difference between what journalists consider “news” and thus worthy of coverage, and garden-variety policy argumentation.

Over the years, the media environment has fragmented and dramatically changed, and so has the course. Today, it focuses on the role of media in a democratic society, beginning with the assumption that the ability of citizens to participate in the democratic process on the basis of informed decisions is heavily dependent upon the quality, factual accuracy, objectivity and completeness of the information available to them. We examine the responsibility of the “fourth estate” to the public it serves, and the role of media in the American political system.

We look at the legal and ethical constraints that should apply to a free press, the business pressures that affect reporting, the impact of technology and social media, the role of political pundits, the challenges of issue framing, the impact of American diversity on the profession of journalism and–with increasing urgency– how to assess the credibility of the innumerable “news” resources available to us.

We also consider the dramatic collapse of what has come to be called “legacy journalism,”  and the consequences of the current information environment for democratic and accountable governance.

Throughout the class, I keep coming back to that one core issue: how the incommensurate realities and filter bubbles we inhabit (thanks to both confirmation bias and the wildly different sources of information that are available to us) make it increasingly impossible to have a genuinely public discussion.

I think it was media historian Paul Starr who said that a public is different from an audience. An audience is fine for entertainment; a democratic polity, however, requires a public, and I’m not sure we have one anymore.

There is so much that is wonderful about the Internet; the technology has made unlimited information immediately available to us. It has allowed in-depth explorations, introduced dramatically diverse people to each other, made the arts accessible, allowed the human imagination to soar. (It has also made shopping infinitely more convenient…)

On the other hand, it has destroyed the business model that sustained most local newspapers–a grievous loss for multiple reasons, including the way that loss has influenced trust in media generally. As Michelle Goldberg recently wrote in the New York Times,

In general, people trust local papers more than the national media; when stories are about your immediate community, you can see they’re not fake news. Without a trusted news source, people are more vulnerable to the atmosphere of disinformation, cynicism and wild conspiracy theories in which fascism — and Trumpism — flourishes. Politico found that “Voters in so-called news deserts — places with minimal newspaper subscriptions, print or online,” voted for Trump in higher-than-expected numbers, even accounting for employment and education.

We live in a world of Kardashians and clickbait, Infowars and propagandists, cute kittens and adorable babies and weird cookie recipes–a world of inadequate coverage of local governments and overwhelmingly partisan coverages of national issues. In that world we inhabit, the American public has devolved into a variety of audiences–and lost most of the common ground necessary to exist as a public.

No wonder we’re polarized.

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The Wall And The Wave

No, not that wall. The wall that Republican partisan redistricting built to keep Democratic voters out.

A report from Politico in the wake of the midterm elections put it succinctly:the GOP had used partisan redistricting to build a “wall” around Congress; Trump tore it down.

For years, some Democrats said gerrymandering was an insurmountable roadblock to the House majority that couldn’t be cleared until after the 2020 census.

Then along came President Donald Trump.

House Democrats steamrolled Republicans in an array of districts last week, from those drawn by independent commissions or courts, to seats crafted specifically by Republicans with the intention of keeping them in the GOP column.

The overriding factor: a Republican president who political mapmakers could not have foreseen at the beginning of the decade. Trump altered the two parties’ coalitions in ways that specifically undermined conventional wisdom about the House map, bringing more rural voters into the GOP tent while driving away college-educated voters.

I’ve posted numerous times about the ways in which gerrymandering undercuts democratic decision-making, and discourages voter turnout. I’ve also referenced several  books and articles detailing 2011’s “RedMap”–the GOP’s most thorough, successful national effort at locking in a Republican House majority. (The book Ratfucked said it all…)

The were two important structural lessons from this year’s midterms.

First, the results confirmed a truism among political operatives and observers: In order to surmount the gerrymandered wall, Democrats would need at least a 7 point vote advantage. Nationally, they got that, and a bit more.

Second–gerrymandering really does matter more than the geography of “sorting” would suggest. In Bill Bishop’s book The Big Sort, he pointed out that Americans currently migrate to locations where they feel philosophically and politically comfortable. We can see the results in the rise of the Urban Archipelago–those blue dots representing cities with populations over 500,000.

One argument against nonpartisan redistricting rests on the theory that–since we have “sorted” ourselves into red and blue enclaves– gerrymandering really doesn’t make much difference. The Politico article undercuts that argument, bigly.

Despite Democrats’ massive House gains — the party’s biggest since 1974, after Richard Nixon’s resignation — redistricting clearly held them back in some places. Democrats netted at least 21 districts drawn by independent commissions or courts — getting a major boost from courts in Florida, Pennsylvania and Virginia that altered GOP-drawn maps in the past two years — along with 10 districts drawn by Republicans and the two in Illinois that were drawn by Democrats.

As the article makes clear, Democrats did appreciably better in non-gerrymandered districts.

The blue wave was high enough to overcome a large number of gerrymandered walls, thanks to revulsion against and very welcome rejection of Donald Trump. But in districts drawn fairly–without partisan bias–they did even better.

Gerrymandering, vote suppression (Georgia, anyone?) and the other tactics being used by the GOP to game the system need to be eliminated. A few states–Missouri and Michigan among them–voted this month for fair elections; the rest of us need to do the same.

We shouldn’t need a “wave” to install a government that reflects the values of  the majority  of America.

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Learning From My Students

We’ve reached my favorite point in the semester–the point where I stop lecturing/haranguing and listen while student teams present their research. They teach me.

Each team of students is given fifty minutes within which to present the major arguments involved in an issue currently facing policymakers, and to do so in a manner that is fair to all perspectives. Teams are allowed to approach their presentations in any fashion they choose, and they’re graded on clarity of communication, breadth of resources used, logic and organization. (Creativity is a plus.)

At the beginning of the semester, I assign teams (I use an “algorithm” called the alphabet) and give each team a general policy area (the economy, the environment, education, social policy, etc.) from which they then choose a specific issue to address.

In the past, teams have done skits (complete with costumes!), debates, power-point presentations, multi-media presentations, even movies. The only hard-and-fast requirement is that  all perspectives/sides of the debate be presented as fairly as possible. That said, students are permitted to “weigh in” on one side or the other after they’ve explored the arguments.

Last Monday, one of the teams presenting compared Obama’s Clean Power Plan (CCP) to Trump’s Affordable Clean Energy Act(ACE).

They began by discussing the Clean Air Act of 1970 and the underlying legal context (the role of government, the contending interests of state and federal governments, and the ongoing argument about the extent to which market forces should control policy).

They then launched into a comparative analysis of the two measures, focused on environmental impact, energy needs, the impact on jobs (no, Trump isn’t bringing those mining jobs back), and public health.

Let me share just a few of their (copious) findings:

  • The U.S. is the second-largest emitter of greenhouse gas on the globe. CPP was designed to reduce such emissions; ACE “makes no such commitment.”
  • By 2030, CPP would have reduced carbon emissions by 19%. ACE will cut them between 0.7% and 1.5%
  • Coal production will be higher under ACE, but will still decline.(That pesky market!)
  • There is only one “clean coal” plant in the entire country, and the cost of factories able to produce “clean coal” is in the billions, so no others are likely to be built.
  • One-third of the nation’s electricity is still generated from coal, and the percentage is declining.
  • That decline is a market phenomenon, not a result of regulation, although regulation has disadvantaged some types of coal over others.
  • Renewable energy technology is increasingly making alternative sources more cost-effective.

Perhaps the most interesting part of the analysis–at least to me– was the impact of the two plans on public health; the EPA’s mission, after all, focuses on giving citizens clean air to breathe and clean water to drink. The differences were striking.

The CPP passed by the EPA under Obama estimated the social damage done by carbon emissions at $50/ton. The ACE estimated the damage at somewhere between $1 and $7 per ton. Among the reasons for what the students labeled a “drastic” difference was that Trump’s EPA discounted the impact of climate change, and the Obama administration included the identified human health impacts of both climate change and the decline in ambient air quality.

There was much more.

Each semester, I am amazed and impressed at the amount of data these student teams collect, synthesize and analyze–and more significantly, the policy conclusions they draw from that data.

The real reward of teaching is what I learn.

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