Diatribes of Jay

This blog has essays on public policy. It shuns ideology and applies facts, logic and math to social problems. It has a subject-matter index, a list of recent posts, and permalinks at the ends of posts. Comments are moderated and may take time to appear.

27 September 2019

Facing the Bully


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

As anyone who’s ever done it knows, facing a bully can be terrifying. You never know whether he’ll back down, as many do, or whether you’ll have to fight. If you face him, you’ve got to go all in and be prepared for anything.

That takes guts. One of the most dismal lessons of Trump’s presidency is how few left in our country have them.

For make no mistake about it: Trump is the quintessential bully. He lives by an internal code of personal reward and punishment. Do what he wants—no matter whether it breaks the law, scrambles right and wrong, or makes no sense at all—and you get the reward. Cross him, and comes the punishment. We also know from long observation that Trump doesn’t back down; he doubles down. So the risk of standing up is clear.

That’s the sum total of Trump’s mode of governing. His apparent threat to withhold hundreds of millions of dollars of vital security aid from Ukraine unless its president did him a personal “favor” was just par for the course. So was his promise to pardon underlings who might perjure themselves in testifying before Congress, which he later insisted was a “joke.”

With a man like this, loyalty goes just one way, up, never down to those who work for him. You can work your tail off to protect him—to hide and justify his wrongdoing, carelessness and stupidity. But get on his bad side, whether for reason or on a whim, and you’re gone. You’re lucky if he gives you a casual “great!” as you’re pushed out the door.

More likely, you’ll find out you’ve been fired by Tweet or from the nightly news. That’s what happened to Rex Tillerson, a man who ran, for more than a decade, the world’s largest multinational in a business that powers our civilization.

As I pointed out early in the game, neither Trump nor any other member of his cabinet—then or later—ever did anything like that. In comparison, Trump’s business is a limping midget: a small family enterprise that “succeeded” only in the small world of New York real estate and mostly failed everywhere else.

But back to the main point: how can people take this kind of treatment, day after day, and not hate his guts? How can they not begin to hate themselves for knuckling under?

That’s what I can’t ken about Trump’s Republican followers. He’s humiliated and diminished virtually every one he’s touched. He’s insulted, belittled, scorned and nicknamed them.

The long list begins with Hillary, but it hardly ends there. It goes right down through Jeb Bush, Ted Cruz, and Marco Rubio. It continues with a whole phalanx of GOP members of Congress who suppressed their hate and misgivings, knuckled under, and forfeited their character and principles just to stay in the game. (Have they no pride or other talents?) It ends with another phalanx who couldn’t stand the humiliation and retired to avoid being “primaried,” or who dared to stand up to the bully and were beaten.

What drives all these once powerful and able people to suck up Trump’s sludge and smile? Is it the shine of the White House and its now-diminished but still global power? Is it fear? Or is it a subtle combination of the two, a moral and emotional witches’ brew that poisons their innards and twists their souls?

I don’t know myself. I’m only asking questions. But we’re about to find out, as a nation and a culture, what we’re made of.

The trigger is the whistleblower complaint. We should all light candles, every night, to whoever wrote it. For he or she is the first to stand up and firmly call Trump out.

Mueller didn’t do it. He didn’t even try. His title was “Special Prosecutor, but he didn’t act like one. A prosecutor’s primary, if not his only, job is to turn an investigation into a prosecution, or to end it. Mueller did neither, at least not in his Report. He never said whether he thought Trump ought to be prosecuted. When it came to the strongest claim against Trump, for obstructing justice, Mueller hid behind the DOJ memo and concluded, in effect, maybe, maybe not.

After 1,000 experienced prosecutors wrote a memo saying more-than-maybe yes, Mueller said maybe yes in his testimony before the House. But by then, it was too late. Mueller’s opinion and his shine as an exemplar of professionalism had sunk in over 400 dense pages, an ocean of lies and “spin,” and the Mariana Trench of our 24/7/365 news cycle.

The thing is, Trump’s not just a one-on-one bully. He’s bullied his whole party, the whole political establishment, his own government, and the media, not to mention the Dems. He has made more enemies than anyone can count.

So you might expect the whistleblower to have started an avalanche. Isn’t that what usually happens when a bully has multiple victims? The first brave soul steps up to face him, and others follow. Lots of others.

“Will they now?” is the question of our age. The answer will fix our nation’s fate.

In their joint appearance on PBS tonight, David Brooks and Mark Shields considered the question, but only Books answered it. A Republican himself, Brooks thinks his craven party is too far gone. He foresaw an impeachment going nowhere in the Republican Senate, and a strengthened Trump winning in 2020. Mark Shields didn’t even address the question because he views the charge as too grave to ignore, regardless of its political consequences.

Isn’t that what we Americans used to stand for, at least more than most: doing what’s right, not wrong? WaPo pundit Eugene Robinson used a famous meme from World War II to make the point: “Damn the torpedoes. Full speed ahead.”

As people who’ve faced down bullies know, the fear doesn’t go away by itself. It goes away when the bullied get fed up. Seeing others step up makes that magic fed-up moment come easier. That’s the whistleblower’s gift to our nation.

Polls suggest this may be happening. In a poll done just the last two days, support for impeachment jumped twelve points from three months ago. Movement may be afoot.

As Caesar said in crossing the Rubicon to start a Roman civil war, “alea jacta est” (the die is cast). For the next few weeks or months, we are fated to live the Chinese curse, “May you live in interesting times.”

We can hope that, when those interesting times end at last, we will still have our democracy and our rule of law. We can also hope that many more of us will have pride of courage and can look at themselves in the mirror without cringing. For what the House started today is nothing less than a test of our national character and our commitment to the Republic our Founders hoped to give us for the ages.

Endnote: The Political Becomes Personal. One of the many unique and terrible things about Trump’s presidency is that it has made the political personal. Trump famously makes everything personal. It’s all about him and his infinitely fragile ego.

Perhaps his followers in Congress are subconsciously trying to do the opposite, or at least to pretend they are. It’s too humiliating to see themselves as knuckling under to a crude and vile bully, so they convince themselves that it’s all about policy. “Unchecked immigration really is destroying the nation,” they think. Or, “Tax cuts really will boost our economy and make us great again.” But deep down, in places they try to hide even from themselves, they know why they are knuckling under, and they are ashamed.

If this is the case, the solution is not more debate, far less more pitched battles on social media. It’s reviving the old congressional barroom.

It’s taking the senators out, one by one, getting them liquored up, and letting them spill their souls. Then it’s suggesting, in the nicest and most sympathetic way possible:
“Wouldn’t you feel better if you stood up, acted like a woman or a man, and had your say? Wouldn’t your party be better off? Wouldn’t the nation? Do you really think Trump is a very stable genius, or do you think more like Rex Tillerson?”
Maybe the solution is honey, not bile, plus a little alcohol. It couldn’t hurt.

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22 September 2019

Giving Democracy One More Try


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

Who Should Impeach: Schiff or Nadler?

Today the Washington Post reported that Speaker Pelosi is, for the first time, beginning to plan an impeachment inquiry. Her discussions reportedly involve whether to set up a special committee, headed by Intelligence Committee Chair Adam Schiff (D. Ca.), or to let the Judiciary Committee run by Jerrold Nadler (D., N.Y.) continue its work.

There’s no way for outsiders to know which man does better work behind the scenes. They are both consummately skilled lawyers. But for the public face of the impeachment process there’s a clear choice: Schiff.

Adam Schiff is simply the most brilliant and effective House member I can remember at 74. I can’t recall him ever exaggerating, downplaying, or “spinning” the facts. He’s like a human oracle. He speaks truth with full force, using just the right words. His understatement is barely perceptible, just enough so listeners prone to disbelieve him can never accuse him credibly of exaggerating.

Schiff is also superbly articulate and polished in speaking. I can’t remember him ever using an incomplete sentence or making a grammatical error. That’s not always easy when you’re speaking about complex things without notes.

But Schiff’s best advantage is that he never, ever loses his cool. He describes the most egregious wrongdoing by this Administration with a sense of bemused wonder, as if to say softly, “How in the world did we ever sink so low? Isn’t it strange?”

This, I think, is Schiff’s key advantage over Nadler.

Nadler, too, has a brilliant legal mind, which I respected as such long before I knew Schiff’s name. But when confronted with a man for whom law and rules are just more underlings to push around, Nadler loses his cool. When his witnesses don’t answer questions, or (worse yet) stonewall legitimate, lawful subpoenas, Nadler simply doesn’t know what to do. He all but sputters in helpless indignation, a highly visible form of weakness.

I don’t think helpless indignation—or even the public perception of it—is going to help impeach Trump, win the next election, or get our democracy back. And it bears repeating—something Speaker Pelosi knows full well—that a futile impeachment with no conviction entails a risk of losing the coming election and suffering four more years of corrupt, incompetent, clueless, Mafia-like leadership.

Impeachment is such an existentially important process, and so delicate, as to render personalities irrelevant. Nadler and his supporters in his committee and the House must do whatever it takes to win, loyalties and feelings aside. Every House member is, or should be, a professional—the more so as those like Schiff and Nadler got their starts as lawyers. This is a time to show professionalism and self-sacrifice above all.

That said, it would be foolish to give up all the good work Nadler and his committee have done and start over. Perhaps Pelosi could avoid that disaster by appointing a special committee to investigate only the latest and biggest charge, concerning Trump’s asking Ukraine’s president to investigate Joe Biden and his son. The special committee might also be in charge of putting all the dots together and presenting them to the public.

No one who has seen both Schiff and Nadler presenting their respective committees’ results to the public could possibly believe that Nadler could do that job as well as Schiff. Nadler is simply no match for Trump and his scofflaw apparatchiks. Schiff, with his bemused approach, penetrating insight, absolute accuracy, and understated self-confidence, just might be. It‘s now time to put turf, loyalty, pride and feelings aside and let the best man run this process, at least insofar as the public can see.



[The principal post on trying democracy one more time follows:]

It’s official. The “Oracle” of Western liberal democracies, the British weekly The Economist, hath decreed it. Our species’ democracies are in intensive care, if not on their deathbeds.

This goes for not just the obvious ones, like Hungary, Poland, Russia, and Turkey, and not just for perennially shaky democracies like Italy’s. Today it also describes the biggies: Britain and the United States.

Our own country became an oligarchy at least five years ago. In 2014, a careful study of 1,779 public issues showed that the elite and business interests get what they want most of the time, while the general population seldom gets what it wants. What’s more, our nine most populous states together have over half our total population but only 18 out of 100 senators. And several other peculiarities of our “democratic” structure give us something quite different from majority rule.

If practical proof were needed, look at gun control. Vast majorities of us Americans want universal background checks and bans on assault weapons and large magazines. We have wanted these things for decades. But we have none of them, and we probably will get none, except perhaps for a tiny expansion of background checks that closes no loophole, or a red-flag law that works only when people are forewarned.

The irony is that the oligarchs don’t want weapons of war on our streets any more than the rest of us do. But they travel in bulletproof limousines. More important, they use the issue as a distraction, to divide and conquer us. They want guns to remain an issue in perpetuity, so we don’t see them stealing the fruits or our labor and the substance of this nation.

Here’s how the whole rotten charade works. The oligarchs tell us that government is inefficient, incompetent and corrupt. Their GOP lackeys join the chorus. They all insist that business can do everything better. Then they all support pols who make government fail, in order to “prove” these lies.

The pols get themselves elected with the aid of the oligarchs’ money. Then they downsize government. They deprive it of sustenance by lowering taxes and cutting budgets. They appoint inexperienced, corrupt and incompetent people to work in it. Then they prove their point about corruption by indulging in it themselves. They support laws and policies that are short on ethics and transparency and long on benefits for themselves and for the oligarchs who support them, not the nation.

The bought pols lower taxes and cut regulations so that their oligarchs can wax rich and do what they want. That way, both the pols and the oligarchs accumulate ever more power. This is also how they cause the public trust to die of cynicism.

There is, of course, a paradox in all this. No sane board of directors of any successful corporation, let alone a multinational, would hire as its CEO a man as inexperienced, incompetent and erratic as Donald Trump. Can you imagine a CEO of Apple, Boeing, Caterpillar, or Ford who didn’t read his briefing papers and made decisions by watching Fox? He wouldn’t last two weeks.

Yet the oligarchs support Trump as leader of the whole nation because he mostly lets them alone. He rolls back taxes and regulations so they can make yet more money and accumulate yet more economic power. They keep silent about Trump’s own corruption because it distracts attention from theirs. And Trump’s stupidity, incompetence and flagrant abuses of the law play right into the oligarchs’ story: that government is useless and only their businesses can serve us well.

There’s more. A careful, book-length academic study, summarized by its authors here, shows that the oligarchs don’t telegraph their punches. They do all this mostly in secret, without taking public political stands.

The few progressive billionaires, such as Bill Gates, Warren Buffett, and George Soros, try to do good with their cash. They often speak out. But nearly all the rest keep totally silent about politics. At the same time, they work in secret to kill Social Security, lower taxes, cut regulations, and abolish the estate tax, so they can pass their great wealth to their progeny.

Our Supreme Court, having “reasoned” that money is “speech,” lets the oligarchs do all this with secret “dark” money. It says our Constitution requires this, as if it had built an oligarchy in. This is democracy?

How do we end this downward spiral? As The Economist’s page-long epitaph for democracy recognized, the key threat is failing public trust, both in our government and in each other.

If we, the people, continue to think that all pols are corrupt and continue to turn against each other, the downward spiral will continue. The oligarchs will not just win, which they mostly have done already. They will literally take all.

The only possible way out is for voters to focus on what matters: who deeply kens the rigging of everything and asks for our trust in de-rigging it? Nothing else matters. Not guns and all the innocent people they kill. Not what other people do between the sheets and with whom. Not abortion; not religion. Not immigration, which will sweeten only as our more basic problems improve. Not even climate change; it won’t stop accelerating until the people in control now lose their rigged power.

The only thing that matters is whether a candidate sees what’s going on—what’s destroying our economy and our democracy—and knows what can be done to fix it. If we don’t solve the rigging of everything, everything will get worse, either in the oligarchs’ direct self-interest or (like guns and abortion) as a distraction from their taking all.

That’s why an aging, “go along to get along” guy like Joe Biden will either lose the election or lose our democracy. That’s why Booker, Buttigieg, and Harris won’t cut it, as attractive, vital and young as they all are. That’s why Klobuchar’s sweet moderation falls far short of the task.

How can you be “moderate” when a few hundred people are rigging everything and making the rest of us hate each other just to get their way? Anyway, what does “moderate” mean in this case? letting the oligarchs take just half? three-quarters? Will people who act as they do ever be satisfied with anything less than all?

There is only one issue in the coming presidential election: the rigging of our nation. Everything is rigged. Our politics are rigged, by our skewed political structure, by the dominance of dark money, and by deliberate vote suppression and gerrymandering. The economy is rigged: gross inequality is built in. Racism, bigotry and discrimination are rigged because getting us to hate our neighbor takes our eyes off the ball. Our insane reliance on fossil fuels is also rigged, for self-evident reasons: fossil fuels made many of our oligarchs and continue to be the source of their wealth.

All these things are rigged for a single overweening purpose: to keep the pols and the oligarchs who are on top now on top forever, or at least until the oil and gas run out and we begin having killer heat waves in “winter.”

We have to break this vicious cycle. To do that, we must keep our eyes on the ball. When all the dust settles, if we still live in a society rigged by the oligarchs and their political lackeys, nothing will change.

So we have to focus on de-rigging our energy, our taxes, our regulations, our markets, our civic life, our so-called “democracy,” and our perpetual, needless wars. When we’ve not been attacked directly since 9/11, what’s another needless war, but a big distraction that kills?

There are only two candidates in the entire presidential field who see the writing on the wall: Elizabeth Warren and Bernie Sanders. All the rest offer just more or less of the same, perhaps with a few better policies.

If Trump wins a second term, US democracy will be finished. If he loses, our democracy could limp on for a lap or two. Then it could succumb to another, less outrageous or more skillful rigger.

History warns us that democracy is like milk. Once it sours, it never gets sweet again. Rome lasted centuries after the Pompeian civil wars, but it was never the same. It stopped being a democracy. It decayed into empire, and a slowly dying one at that.

The only way to cure and save our democracy is to stop and reverse the rigging, and the hating that promotes it. And the only way to do that is to elect pols who see through both and will focus single mindedly on undoing them. Nothing else will fix what ails us.

So vote for the pols you think are best at doing that. Give our democracy one last chance to recover and survive.

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15 September 2019

There is No “Market” for Health Care


UPDATE: for more detail on how pricing would work under Medicare for All, scroll down: the internal links don’t seem to be working today.

For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

Sometimes human culture rests on fundamental misconceptions of reality. You can’t call them “lies” because they’re not the product of identifiable individuals telling falsehoods in their own self-interest—at least not entirely. They are fundamental misconceptions honestly and wholeheartedly believed by most, if not all, of society.

These misconceptions have much in common with myths or religion. People take them on faith and seldom examine them rigorously. They worm their way into a whole society’s thinking. There they confirm an insight attributed to Euripides: “Those whom the gods wish to destroy, they first make mad.”

So it is with the notion that there are “markets” in health care. In fact, there are none. There are none for three simple and powerful reasons.

First, the very notion of a “market” presupposes not just the bare legal right, but the ability, to bargain. Bargaining depends on the power to “take it or leave it.” But you can’t leave your life behind and still exist, and you can’t leave your health behind if you want to be free of pain and suffering. Who doesn’t?

So there’s no “market” in health care because life and health are not things you can take or leave. You will pay whatever it takes (up to whatever you can afford) to preserve them.

The second reason why there’s no market in health care invokes classical economics. If health care were a common service like trash pickup, it would have what economists call “price elasticity.” That is, health care’s “market” price would depend on things like the price and availability of substitutes. But there are no “substitutes” for life or health; there is only death or suffering.

The third and final reason why there’s no “market” in health care is even more basic. The “consumers” of health care don’t pay for it. Insurance companies do. Sure, our oligarchs, Saudi oil sheikhs, and a few other similarly rich people don’t need insurance. But the overwhelming majority of people here in the US and around the world need insurance (or government run health-services, as in Britain) in order to afford the expensive scientific “miracles” of modern medicine.

This is not just abstract theory. Careful studies have shown that patients really don’t “shop” for health care, even if given information online with which to make price and quality comparisons. They don’t shop in part because most don’t have the expertise or patience to compare quality, let alone to relate price to quality.

But there’s a more fundamental reason why patients don’t shop. They don’t care about price when their lives and wellbeing are at stake and someone else is picking up the tab. Summaries of careful studies proving these points in fact, not in theory, appeared in the New York Times mere days ago [search for “Fallacy No. 4”].

So why do pols, business executives, and sometimes even economists talk about “markets” in health care? The reason is clear: “free markets” are something of a national religion. We learned that after the Crash of 2008, when supposedly mathematical economist (and then Fed chief) Alan Greenspan publicly recanted his religious belief that free markets always self-correct their imperfections and pathologies. It took the Crash to get him to recant, but as an honest man and presumed scientist, he did.

In a world where nearly all patients require insurance or government assistance to afford modern health care, there is yet another reason why there is no relevant “market.” As I have explained at length in another post, insurance doesn’t work by normal market principles. It’s not competition among many firms that lowers premiums, but having the largest possible risk pool by which to spread the many possible losses around.

This fundamental feature of insurance as a business, including health insurance, makes it violate the normal principles that competition is better than monopoly. In the insurance business, monopoly beats competition by putting all people subject to a given risk in a single pool, thereby lowering premiums and giving the entire population equal benefits.

In one of my last academic papers as a professor of law, I proved a related point for a subset of the health-care industry—the sale of patented or otherwise monopolized pharmaceuticals. I proved that there are no practical or economic limits on the amount of profit, or “return on equity” that a pharmaceutical firm can “earn” when it has the only product on sale that actually works to save life or reduce suffering caused by a specific disease or condition.

I proved this point mathematically, with equations, charts and simple cause-and-effect reasoning. The only limits on the monopolist’s returns, I showed, were the ability and willingness of society to pay. In today’s America, “society” means mostly the insurance companies or government.

My conclusion was that the pricing of monopolized pharmaceuticals (including most, but not all, patented ones) is, was and has to be a matter of politics. That is, society collectively must set or limit the prices through a political process. Otherwise, there are no “market” limits on the price that greedy business people can charge when they have no competition.

I’m proud of this insight but ashamed of its consequences. I have no idea whether my paper was the cause. But mere years after my paper came out, business people, if not pols, had assimilated its insight. The result was an epidemic of price-gouging in the pharmaceutical industry.

So-called “entrepreneurs” bought up sleepy old-line pharmaceutical companies producing long-established products. Then they raised the prices unconscionably, without warning or any apparent reason but greed. The most infamous of these so-called “entrepreneurs” was a man named Martin Shkreli, who raised the price of a life-saving HIV med 5000%, i.e., 50 times.

Shkreli is now in jail, not for that crime against economics and humanity, but for the more technical offense of securities fraud. His story is not unlike that of Al Capone, the vicious Chicago mobster presumed responsible for the St. Valentine’s day massacre in Chicago. They put him in jail, famously in Alcatraz, but only for tax evasion.

The great economist John Maynard Keynes once called economics a “dismal science.” It’s made a lot of progress since his day, mostly due to computers and massive data analysis. But in the field of health care, it has yet to undergo its “Copernican revolution.”

Before Galileo, humanity believed that our Earth was the center of the solar system and the Universe. The sources of this belief were religion and human arrogance. Tycho Brahe and Nicolaus Copernicus shook that theory with careful, methodical observations of the stars and the planets. But it wasn’t until Galileo Galilei perfected the telescope and observed the moons of Jupiter that accumulated evidence for our Earth revolving around the Sun reached the tipping point. (The Church threatened to excommunicate and execute Galileo for his insight.)

We are at or near that tipping point in the economic science of health insurance today. The evidence is overwhelming that there is no market in health care, and that the only restraints on pricing are a political process or internal struggles between the consciences and greed of doctors, nurses and the business people who run health-related firms.

So who will be our modern Galileo? Who will push us over the edge into believing that, in our era of rampant greed, there is no effective restraint on prices in health care but politics?

Before becoming president, even Barack Obama declined the role. In a 2007 speech, he declared a “public option” for health insurance politically impossible. At that time, I lauded his “realism” in this blog. I recalled my favorite uncle, a skilled Navy surgeon now deceased, thundering against “socialized medicine.”

But times have changed, due in part to President Obama’s Herculean effort. Public understanding of the absence of markets in health care has grown. We are now in the era of Brahe and Copernicus, but we have not yet found our Galileo. Could Elizabeth Warren or Bernie Sanders be the one?

From the perspective of strict logic, their “Medicare for All” plans seem unnecessary. “Medicare for All who Want It,” i.e., a “public option,” eventually will morph into “Medicare for All” as citizens voluntarily choose that option. Lower premiums, more reliable coverage, efficiency, and honesty (with no monetary incentive to deny claims) will draw patients inevitably to that choice.

So why not just enact a public option and wait? “Medicare for All” would not take more than ten years, maybe even five, to arrive organically, through tens of millions of individual choices.

The trouble is, as President Obama recognized, there’s about as much opposition to a public option as there is to “Medicare for All.” Doctors, hospital executives and insurance people are smart enough to know that the one will inevitably morph into the other over time. For various structural reasons, private insurers simply couldn’t compete with a properly arranged public option, any more than they now compete with Medicare. (They don’t. For patients eligible for Medicare, they only supplement it.)

Under these circumstances, pushing for Medicare for All has two advantages. First, it focuses on the end game. When all the dust settles, a public option eventually will have become “Medicare for All,” after having given patients time to understand reality and switch to Medicare. (Patients will also switch after losing or quitting their jobs, and so losing their private health insurance.)

By focusing on the end result, Warren and Sanders can simplify their political arguments and their debates. They can show voters what a rational health-insurance system will look like in the absence of health-care markets.

Second, Medicare for All is a political bargaining tool. To all the health-care and pharmacuetical providers who want their incomes (in the absence of competitive markets) to depend only on their personal balance between conscience and greed, it says:
“The writing is on the wall. Your days of self-determined income are numbered. Some day soon, a government bureaucrat will decide how much you can charge for various services, if you want to serve patients backed by health insurance. But if you drop your opposition to a public option, you will have a few years to transition from the current regime of pricing by whim. You will have time to accept reality and adapt.”
As support for “Medicare for All” rises rapidly, especially among youth, that political bargaining tool may soon win the day.

The absurdities of our current system should by now be clear to the average patient. Just look at your local medical laboratory, as I did. I saw three out of eight employees working full time not doing tests, or anything related to medicine, but taking and verifying insurance information. Then look at your bills. See the astronomical charges asked for simple procedures and services and the much lower prices actually paid by insurers, and ultimately accepted by providers (mostly under duress).

In the absence of any real market, someone is actually fixing the prices paid for medical care. Right now, it’s the insurance companies, whether Medicare or private firms.

As a result, prices for the same service vary crazily, from one hospital to the next, and from one doctor to another. They vary widely even in the same city, let alone from city to city and from state to state. And the initial asking prices, which you see on your insurance company’s invoice, have as much relationship to the final paid prices as those for women’s shoes, or the prices you might ultimately pay after bargaining in an Arabian souk.

In the absence of any real market, wouldn’t it be better to have a single, nationwide authority, not driven by profit or greed, setting those prices? Such an authority need not decree nationwide uniformity. It could accommodate differences in the cost of living in different cities. It could also improve access to medical care by providing price premiums in underserved rural and remote areas.

Before you answer the question, recall that insurance, whether by government or a private firm, is a service entirely outside of health care. Nothing in US law, now or in the future, will prevent doctors or hospitals from serving uninsured rich people and charging whatever prices those patients can bear. This is not just theory: there is, in the San Francisco Bay Area, at least one medical group that refuses to handle any insurance, including Medicare, but insists that its patients pay cash.

The Cleveland Clinic’s main campus provides another example. The private hotel on its grounds contains two floors set up for Arabian sheiks and their entourages, complete with closed-circuit Arabic-language TV. The unique prices the sheiks pay help subsidize medical care, facilities and medical research for the rest of us.

So there is method in the “madness” of Warren’s and Sanders’ insistence on “Medicare for All.” It simplifies the discussion by going right to the end game: the system into which any public option eventually will evolve. It provides a powerful argument to forces opposing any public option: if you accept the inevitable now, you will have a few years to adjust to it. And it gives us a vision of what a rational, nationwide health-insurance system would look like, if only we accepted the facts that the Earth revolves around the Sun and that there is no “market” in health care.

Footnote: As is well known to patent practitioners, not every patent confers an economic monopoly. If there are practical substitutes for a patented product, for example, noninfringing drugs that work about as well as the patented one, then the patent confers no practical monopoly. My paper and its summary in this blog address patented or otherwise monopolized pharmaceuticals which have no practical substitute for curing or alleviating a particular disease or health condition. Producers may have such practical monopolies without patents if, for example, the number of patients is too small to support more than one producer, a dominant trademark provides a monopoly, or for historical reasons no other firms have produced competing products.

Pricing without a Market

In the post above, I used a curse word. To conservatives, the word “bureaucrat” connotes an irresponsible functionary driven by clueless ideology, patronage or worse. To progressives, the word is an insult to all the highly educated, hard-working experts in our government who protect our economic health (the Fed) and medical health (CDC and NIH), monitor and control pollution (EPA), study the weather and warn of violent storms (NOAA), regulate workplace safety (OSHA), do basic scientific research (NSF, NASA), and seek justice (DOJ).

So I apologize for using a curse word on this blog. To atone for my sin, I want to write a bit about how pricing would work in a “Medicare for All” system. In the absence of any “market” for health care, how would we determine what prices universal health insurance would pay providers?

It’s not as if there are no precedents. The Fed is an independent committee of experts that fixes the price for the most basic commodity of all: money. Almost all states, and many cities, have public utilities commissions that set prices for electricity, natural gas, water, and/or disposal of sewage or trash.

No one thinks twice about these “price-fixing” bodies. They are established parts of our economy, our government and our civic life. It’s only when people get up from prostrating themselves before the “market God” where no market exists that they get confused.

The key to understanding how pricing would work under “Medicare for All” is that it would have nothing to do with any political ideology, far less “socialism.” It would be based on data.

An independent committee of experts in medicine and health economics would constantly monitor the data and adjust prices accordingly. It would review the number of patients and the prevention, diagnosis, treatment, outcomes, and re-treatment for every known disease and condition. (We can do this with modern “Big Data.”)

The committee would keep track of things like how long patients have to wait for treatment and how often each CAT scanner and MRI machine is used. If wait times got too long in a particular community, it would raise prices to encourage doctors and hospitals to locate there. If a CAT scanner or MRI were little used, it would provide financial incentives to relocate it where more needed. If medical-school enrollments started to drop nationwide, with no decrease in national need, the committee would raise reimbursements paid doctors generally to encourage more students to enter the profession. If service lagged in a rural or remote area, it could raise prices to encourage providers to relocate there.

In every case, the experts would closely monitor the effect of any price changes on services and outcomes, community by community. They would do their best, using the best of Big Data, to mimic the outcomes that a market would produce if there were a market in health care.

Just as the Fed has two mandates—full employment and low inflation—the Medicare for All committee would strive to maximize both the accessibility of health care and its quality, community by community, nationwide. Prices would probably vary geographically, just as they do today, but they would vary for a purpose: to insure accessibility of high-quality health care for everyone everywhere.

There would be controversies, of course. The genius of American health care is its ability to innovate. With every innovation in medicine—such as a new diagnostic tool or a cure personalized to one’s DNA—the committee would have to decide whether, when and how to cover it. If the committee was slow, the private insurance market could cover the innovation in an insurance supplement.

In this way, as I have outlined earlier, there would always be a need and a place for private insurance. But the Medicare for All system would make sure that everyone nationwide had access to at least the last generation of “modern miracle medicine.” And in the absence of any market, it would do so through the very same mechanism that markets use generally: price signaling, in this case through levels of insurance reimbursement.

At the same time, rich people could purchase health care, without insurance, for whatever price they were willing to pay. But doesn’t it make sense, if the people fund insurance through their own taxes, for them to decide, through experts aided by Big Data, what to pay for the levels of quality and accessibility they demand?

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12 September 2019

Eighteen plus Seventeen equals Thirty-Five, and the Dems’ Third Debate in Houston


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

In their perennial prattle about “electability,” so-called “pundits” forget a vital fact. The leading triad of Biden, Sanders and Warren represent two different kinds of politics.

Biden is the “moderate,” rated highly for his long experience in politics, his presumed ability to compromise, and his likability as “Good Ol’ Joe.” In contrast, Sanders and Warren have an entirely different brand of politics. They both think, and say, that the system is “rigged” against ordinary workers, and that we need strong medicine to un-rig it.

So as not to fall into the right-wing’s trap of labeling anyone who wants real change an “extremist” or “socialist,” I’m just going to call this brand of politics “strong.” Among the top three, we have one moderate or weak candidate and two strong ones vying against each other.

According to the latest poll, among Dems and Dem-leaning independents, 24% prefer Biden, 18% Warren, and 17% Sanders. I’d say that’s far from a win for Biden, at 24%. A total of 35% prefer the strong remedy.

Eventually, the Dems will have to choose between Warren and Sanders. When they do, Sanders’ votes will go to Warren, or vice versa. Few, I think, will go to Biden, because he’s a different kind of candidate offering weaker remedies for what ails us.

Of Warren and Sanders, who will win? Ultimately, I think (and hope) Warren.

Warren has three big things going for her. First, she doesn’t fall into right-wing verbal traps by talking about “socialism.” She insists she’s a capitalist who just wants fair rules of the game.

Second, Warren really knows her stuff in much greater detail than Sanders. She created the Consumer Financial Protection Bureau, and she studied financial shenanigans as a Harvard Professor for nearly two decades. If you want to un-rig a rigged system, you’ve got to know exactly how it’s rigged, in depth and in detail. Warren does.

Third, Sanders is something of an anomaly among this crop of Democratic candidates. He’s the only one among the eight whose education I reviewed who has no law or other graduate degree. He graduated from college, but that’s it.

Now the guys on Wall Street (they are nearly all guys!) are far from stupid. They are smart, and they are well trained in math and finance. Whom do you want to protect you against them, a guy who merely graduated from college, or a woman who became a distinguished, tenured professor at Harvard studying precisely how Wall Streeters cheat and bring our economy down for nearly two decades?

I don’t mean for a moment to belittle Sanders. The Dems, progressives and the American people all owe him a huge debt of gratitude for bringing the fact of a rigged economy into the political mainstream. He should be president today, and he might have been, if Hillary hadn’t rigged the party process.

But it’s not his time. Warren is the smarter, tougher, and more strategic candidate, and I think Democratic voters will eventually figure that out. When they do, it’ll be Biden 24%, and Warren at least 35%.

There’s not much question that the mass of today’s Dems wants the smartest person with the strongest remedies, and that’s she. I’ll post my analysis of tonight’s debate tomorrow.

The Dems’ Third Debate in Houston

Practice makes perfect. After a promising first debate, a mediocre second debate, and a privatized seven-hour “town hall” on climate change, last night the Dems finally got it right. They served up a solid debate that advanced the Dems’ chances of taking the presidency next year. Whether it winnowed the candidates significantly at this early stage won’t be known until the next major poll.

The private network, ABC, got it right, too. It limited itself to two commercial breaks in 2-3/4 hours, so that the candidates and the audience could concentrate on substance. Its moderators asked no questions about “gotchas,” such as making illegal immigration a civil, not criminal, offense. They did press the leading candidates on the peculiarities of their major policies and relevant bits of past behavior.

In other words, the moderators acted as neutral “newspeople” ought, eliciting the candidates’ goals, records and character, rather than batting for “home runs” of sensationalism. For some strange reason, the full transcript of the debate even appeared online for free, but under NBC’s brand. At least this time there is one.

What caused these big changes for the better is unclear. I hope it was stricter rules by the Democratic Party, if not prior vetting of all questions. If the Dems trust in the integrity and professionalism of commercial newscasters, they might get burned again, at a time too close to the elections to permit recovery.

Part of the reason for the Dems’ productive performance was teamwork. Candidates with little chance of becoming president took potshots at Donald Trump, with good effect.

Some pulled no punches. Beto O’Rourke accused Trump of inspiring the Hispanophobic killer in the El Paso massacre. Bernie Sanders noted that Trump had spent his first year trying to kill Obamacare and his second trying to get the Justice Department to bring back exclusions for pre-existing conditions and keep kids 26 or under from riding on their parents’ health insurance.

Pete Buttigieg noted that Trump “has no strategy” in his trade wars and left an “empty chair” of American leadership on climate change. Regarding our tussle with China, he taunted Trump, saying
“You know, when I first got into this race, I remember President Trump scoffed and said he'd like to see me making a deal with Xi Jinping. I'd like to see him making a deal with Xi Jinping.”
But the prize for baiting Trump goes to Kamala Harris. After pointing out how we must have both a competitive and a cooperative relationship with China, especially on global warming and North Korea, she likened Trump to the Wizard of Oz. “[W]hen you pull back the curtain, it’s a really small dude.”

Earlier, purporting to speak directly to Trump, she had castigated him at length:
“So, President Trump, you've spent the last two-and-a-half years full-time trying to sow hate and division among us, and that is why we've gotten nothing done. You have used hate, intimidation, fear, and over 12,000 lies as a way to distract from your failed policies and your broken promises. The only reason you’ve not been indicted is because there was a memo in the Department of Justice that says a sitting president cannot be charged with a crime.”
After describing how she would do things quite differently, she dismissed the absent president airily: “And now, President Trump, you can go back to watching Fox News.”

If the Dems are lucky, Harris’ words may bait Trump into Tweeting and insulting her with such over-the-top vituperation as to keep most African-Americans and women from ever voting for him. Baiting so skillfully is likely something that Harris learned in her distinguished career as a prosecutor.

While Pete Buttigieg, Kamala Harris, and Cory Booker all showed both passion and eloquence, the prize for eloquence probably goes to Booker. His peroration on gun control (in part by gun licensing) included these words:
“Nobody has ascended to the White House that will bring more personal passion on this issue. I will fight this and bring a fight to the NRA and the corporate gun lobby like they have never seen before.” * * *

“We have had more people die due to gun violence in my lifetime than [in] every single war in this country combined, from the Revolutionary War until now.” * * *

“We must awaken a more courageous empathy in this country so that we stand together and fight together and overwhelm those Republicans who are not even representing their constituency. Because the majority of Americans, the majority of gun-owners agree with me, not the corporate gun lobby. It is time for a movement on this issue, and I will lead it.”
The leading candidates—Joe Biden, Bernie Sanders, and Elizabeth Warren—were in no position to bait Trump or to be eloquent. Their job was to explain and justify big, important differences in policy among themselves and between themselves and the other candidates. The rest of this essay focuses on two such differences, which I think were crucial to the debate’s importance and the push it gave the Dems.

The first big difference was between [mandatory] Medicare for All, which would wipe out private insurance, and Medicare for All Who Want It, which, as I and Pete Buttigieg explained, introduces expanded Medicare gradually, as consumers themselves discover its benefits. Sanders and Warren both chose Medicare for All, while Harris chose a modified version of it, while Buttigieg and others rejected it.

The second big difference concerned our “forever” war in Afghanistan. Biden, Sanders and Warren all said they would bring our troops home. They all implied, but didn’t say, that they would bring them home immediately, whether or not there is a deal with the Taliban.

The trouble with both these views is that, examined closely, they are impractical. Wiping out all existing private health-insurance at the stroke of a pen would eliminate some 150 million policies. (The candidates’ own estimates in the debate ranged from 149 million to 160 million.) To say that would destabilize the insurance market and cause anxiety, if not panic, among insureds would be an understatement.

Just so an abrupt troop withdrawal from Afghanistan. You can’t pull all our troops out in a single (or even a few) airlifts, let alone with the Taliban still trying to kill them. Even if all our troops survived, what about all the people—spies, translators, cooks, drivers, Afghani soldiers and police, among others—who helped us? Would we abandon them to be imprisoned, tortured and killed? Even in Vietnam, our biggest military debacle to date, we tried to avoid doing that. Do it too often, and no one will ever help you in any other foreign military adventure.

So why do Warren and Sanders (on health insurance) and all three leading candidates (on ending the war in Afghanistan) take such impractical positions? The reasons are all political, not logical. I see at least six, as follows:

1. On issues as important as health insurance and war, voters want certainty. Give them a bunch of ifs, ands and buts, and they won’t trust you. Some won’t even understand you. So you’ve got to take positions that seem definite, clear and clean, even if they won’t be so in practice.

2. You don’t have the time even to state, let alone explain, all relevant ifs, ands and buts in a one minute, ten second answer or a 45-second rebuttal during a debate.

3. Taking an extreme position gives you bargaining leverage over domestic political opponents, for example, in Congress. It also give you room to compromise. (Unfortunately, this doesn’t apply to foreign opponents: promising in advance to get out of Afghanistan kills all leverage in dealing with the Taliban.)

4. On vital, complex issues, most pols promise an extreme or simple outcome, for reasons 2 and 3. Until Trump made lying a profession, this wasn’t considered lying. It was just thought to be “politics.”

5. Health insurance and war have always been complex, messy issues. For over a century, presidents since Grover Cleveland had tried to get us some form of universal health insurance. The problem got even more complicated after President Obama chose an incremental approach, rather than cutting the Gordian knot. As for war, the war in Afghanistan, like the war in Iraq (which it resembles) is among the two longest and messiest in our history. If you want voters’ attention and allegiance, you don’t explain messes. You promise to cut that Gordian knot and make things simple.

6. As for forever wars, promising to pull out regardless of consequences helps convince voters of your anti-warmongering bonafides. At least that stance shows voters that you’re not likely to start any new forever wars, whatever the provocation and however strong the pressure from our military-industrial complex and warmongering apparatchiks like John Bolton (but with greater people skills).

All of these reasons point to a simple conclusion: after decades of uncertainty and vacillation on health insurance and war (and other things like guns and the economy), voters want to trust the pols they elect. They want to hear solutions they can understand with reasonable intelligence and attention spans, and that they can expect to see implemented in their lifetimes. They want results, not excuses or explanations.

This is why, for me, the Dems’ third debate reinforces the conclusions in the green-framed box above.

The notion that voters want to chose someone “moderate” by triangulating between extremes is absurd. What’s a “half racist”? What’s a “moderate” white supremacist? How do you kill the middle class only “halfway”? How do you let the oligarchs rule us only “halfway”? What’s “halfway” out of Afghanistan: moving our troops to Pakistan, which also has its share of homicidal Islamic extremists?

What’s “halfway” to universal health insurance? fifteen million uninsured, instead of a full thirty? Anyway, didn’t voters reject Hillary for her triangulation? Didn’t Bill let the GOP take us all the way to the right-wing goal post by his own triangulation? Didn’t Trump himself win by making wild promises that are nowhere near fruition?

No, American voters are sick and tired of halfsies. In a little over a decade, they’ve suffered: (1) the Crash of 2008; (2) the bailout of the bankers that caused it; (3) those bankers going scot free; (4) the extension of our two forever wars towards double decades; (5) the loss of millions of jobs; (6) the closing of tens of thousands of factories; (7) the opioid epidemic, which killed about 400,000; (8) the failure of our health insurance for tens of millions, even as health care gets more and more expensive; (9) a sharp decline in our national prestige and influence; (10) the near monthly recurrence of firearms massacres; (11) the incarceration of millions, lopsidedly skewed by race; (12) the presence of millions of undocumented immigrants among us; (13) an explosion of student debt, which is eating our young; and (14) being told that, in the midst of all this confusion, they have to give up fossil fuels to save our planet. Will it make them happy to solve all these problems halfway?

Even if they ever really did, voters just don’t want halfsies anymore. They want whole solutions. That’s why they elected Donald Trump: they simply didn’t trust Hillary’s “moderation” and “triangulation.”

Sanders and Warren understand this truth. That’s why they’re fighting over much the same “solutions” for three of the most important issues: health insurance, war and peace, and student debt. That’s why, when the race gets tough and one of them sees the writing on the wall, the winner among the two will have the other’s votes. If both Sanders and Warren are out for the people, and not for themselves, as I believe they are, the loser will wholeheartedly endorse the winner. Then Joe Biden will fade into history, along with Amy Klobuchar and all the others who don’t ken the extreme danger of the moment we live in.

It’s not about just getting along, although solving our problems for real should help reach that goal. It’s about throwing off rule by the oligarchy, fixing what ails us and getting our country right.

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06 September 2019

Lies the Oligarchs Tell Us


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

CNN’s Subversive Climate Marathon


[To skip to the principal post on oligarchs’ lies, click here.]

Erratum: An earlier version of this commentary erroneously reported CNN’s climate-crisis program as allotting seven hours per candidate, rather than seven hours in all. I regret the error, which has been corrected below.

Readers may be wondering why this blog has had no comment on CNN’s seven-hour marathon “town hall” on climate change. The short answer is that the spectacle was a travesty and perversion of both “news” and political reporting.

How bad was it? Let me count the ways, as briefly as I can.

First of all, few but paid political operatives are going to watch seven hours of political blather, let alone in a single continuous sitting. Voters have to work, eat, sleep or (if still students) study and attend classes. Instead of emphasizing the importance of fighting climate change, this spectacle trivialized it. It implied that climate change is just a show that you can tune into and out of from time to time, until the Earth heats beyond the range in which our species evolved.

Second, there really isn’t that much to be said—at least that much both true and important—about climate change as a political issue. It’s an existential threat to our civilization and even our species, as much or more than nuclear proliferation. It’s going to require an “all hands on deck” approach, i.e., far greater global cooperation than our species has ever attempted, let alone achieved. We should have started decades ago, so we have to start now with instantaneously Herculean effort. The US is well-positioned to lead the process in wealth, research, technology, and communication; but we’re stymied by a president and his rabid base who believe the whole thing is a hoax. Leading a global response to these challenges offers the leading nation(s) and people advancement, if not supremacy, in jobs, science, technology, business, infrastructure, and ultimately economic dominance. That’s about all you need to know to evaluate climate change as a political issue.

You probably took less than minute to read the previous paragraph. So what could seven hours of obsessive focus on the subject add? The answer is my third point. By forcing each candidate to devote excessive time to the subject, CNN increased the chances for gaffes, misstatements, exaggerations, and less thoughtful replies, which CNN then could use (and repeat endlessly) as “gotchas.” CNN swept these gotchas up and presented them as twisted “summaries” of the candidates’ views.

If you doubt this, just take a look at CNN’s “key takeaways” page. Ironically, for Elizabeth Warren the “key takeaway” itself contained implied criticism of the whole focus-on-trivia fiasco: “Warren said that conversations around regulating light bulbs, banning plastic straws and cutting down on red meat are exactly what the fossil fuel industry wants people focused on as a way to distract from their impact on climate change.” Other candidates the “takeaways” merely caricatured with such peripheral issues: e.g., Julián Castro (poor people taking the brunt of storms), Kamala Harris (prosecuting the oil and gas companies), Beto O’Rourke (helping people in flood zones move to higher ground), and Cory Booker (letting people eat meat despite the fact that meat agriculture produces a lot of methane and CO2). The depreciation of Booker was particularly egregious: his “key takeaway” should have been his support for nuclear power, which could be a major help in slowing global warming if made safer.

This is not “news” or “reporting.” It’s propaganda and manipulation of the public, pure and simple. While I’m happy that CNN appears to have anointed Elizabeth Warren, the candidate I prefer, as the most serious, I think that allowing a commercial enterprise and the oligarchs who run it to slant the playing field like this sucks.

The final irony: we the people had to pay to be propagandized. To watch this climate fiasco, whether on the air or on line, you had to subscribe to a cable service or an online service that pays CNN for access. If determined to watch for free, you could have chosen “Play Station Vue’s” free five-day trial. But then you would have had to remember to cancel before the end of the five days, in order to avoid paying a subscription fee in perpetuity.

In the end, CNN’s climate marathon shows how our media oligarchs make money while controlling and manipulating public opinion. It was a fulsome endurance trial for viewers, bearing no resemblance to any serious and focused discussion of vital issues.

It allowed CNN to select what it wanted from nearly seven hours of blather. Then CNN used those juicy tidbits to sensationalize and caricature each candidate, the Democratic Party, and the very importance of climate change.

And for this disservice to the public and our democracy, CNN raked in money from its share of subscription fees and from commercials during seven hours of TV and online transmission. (While I’m not privy to CNN’s accounting, I would be astounded if advertisers didn’t pay far more per minute for this highly touted special event than for a normal minute of CNN’s talking heads “treading water” making 24 hours worth of “news” seem important on a dull day.)

One last, dismal point. If anyone wants to see how much CNN distorted the public impression of this marathon “town hall,” she or he would have to review a recording of the whole seven hours. And guess who owns the copyright in that recording: CNN or one of its corporate affiliates. So just in order to have the information to second-guess CNN’s selective reporting, you would have to have CNN’s permission and probably pay a fee. If you set out to devise a way for a private, for-profit corporation to wax rich while controlling “news” and our democracy, you could hardly do a better job.

Footnote: From the very first commercial “exclusive” on an American political debate that this blog reviewed—the one owned by ABC on the January 2012 Republican primary debate—I have never been able to find a full, clean feed of the proceedings online, let alone for free. CNN’s climate extravaganza was no exception. Not only are we letting private commercial ventures tell us what to look at and thereby what to think. We are also letting them own history. It’s as if the legendary Library of Alexandria had been owned and run by an LLC formed by the Pharaoh and his cronies.



Workers don’t need unions
The US has the world’s best health care
More guns mean more safety
The majority rules
What to do about it

1. Workers don’t need unions. In the last half-century, skilled workers in the US have fallen from grace and prosperity. The heady postwar days of suburban homes with two cars and reliable, well-paid, lifetime work are gone.

Whole factories have closed. Small towns that built them have dried up. Skilled work is scarce and getting scarcer. Over 399,000 people died from opioid overdoses from 1999 to 2017. The doctors and drug dealers that oversold this poison bear lots of the blame. But people don’t take pain killers unless they’re in pain.

This fall from grace and prosperity for the middle class closely tracks the decline in union membership over the same years. A graph of US union membership [open full report and scroll down] shows fluctuations from its peak in 1945 through the early 1960s—the postwar boom years. Since then union membership has declined steadily, from its peak of 35.5% in 1945 to a private-sector rate of 6.6% in 2012. It’s even lower now.

Two things broke unions in the US. The first and most important was globalization. The oligarchs transferred skilled work to factories in places like China, Mexico and Bangladesh. Then they told their US workers, in effect, “take less pay and don’t bargain for better conditions, or we’ll transfer your factory overseas, too.”

The second factor was transferring US factories from the North and Midwest to the South. There, so-called “right to work” laws broke unions, making lower wages and helplessness of workers an attraction to investors from abroad. Foreign car makers like BMW and Toyota built auto factories in the South, drawn by local make-workers-helpless laws.

In essence, the oligarchs broke US unions by playing foreign workers and workers from less-developed US states against those who had enjoyed fine jobs and pay in the US North and Midwest. These ploys worked brilliantly. Today we have less than half the rate of private-sector unionization we had in 1935, the year the National Labor Relations Act permitted and regulated collective bargaining.

Think all this might have something to do with the desperate condition of skilled workers today, and their stagnant pay since the 1970s? The United Auto Workers, while still a force to be reckoned with, once made “outsourcing” of jobs a big issue in its bargaining with the “Big Three” auto makers, until the oligarchs broke it. The oligarchs argued that foreign car makers were undercutting the Big Three, while building new factories down South, in make-workers-helpless states. [For how unions could organize online now, click here.

2. The US has the world’s best health care. This claim is flatly untrue. Here’s are the facts for the most recent years with the most complete data [click on category under “Health Status,” “Communicable Diseases,” or “Cancer” at left and scroll to right]:

Recent Rankings for US on Selected OECD Health Measures
MeasureCountries RankedUS RankingSome Lower
Ranked Countries
Life expectancy
2017
3527Mexico, Turkey,
Slovak Republic
Maternal and infant mortality (deaths
per 1,000 live births, 2017)
3331Mexico, Turkey
Cancer incidence
per 100,000 population, 2012
3531Australia,
Denmark, Norway
Incidence of
Hepatitis B, 2017
3227Chile, Turkey,
tied w/ Spain
Incidence of pertussis
per 100,000 population, 2017
3316Australia, Netherlands
New Zealand, Norway


What is true is that the US has highly innovative and up-to-date health technology. For example, in 2017, the US ranked fourth out of 31, after Japan, Australia and Iceland, in the number of CAT scanners (42.64) per million population, and second after Japan in the number of magnetic resonance imagers (37.56) per million population.

The problem is that this “miracle” technology is available mostly in big cities, and not at all to the poor or poorly insured. So citizens of the United States pay approximately twice the average of OECD citizens for health care and suffer outcomes, on average, near the back of the pack, simply for lack of universal health insurance.

The bottom line is clear. Health care is great in the US if you’re rich or middle-class and well insured. Otherwise, for you US health care sucks, and it sucks on a global scale.

3. More guns mean more safety. This canard is so self-evidently wrong as to blow one’s mind. How in Hell does filling our streets with assault weapons that can kill 100 people in a minute or so make us all more safe? Wouldn’t we all be safer if no one except the police and military had that kind of killing power?

As more guns end up in more hands, don’t they eventually fall into hands ruled by unstable, diseased, and delusional minds? Isn’t that precisely what’s happening today, with alarming regularity?

The only reason I can see why any sane person would believe this lie is the way Hollywood treats gunplay. When an embattled Western sheriff or a soldier for the good guys shoots, he makes every shot count. Every time the bad guys shoot, they miss.

Real life isn’t like that. If you’ve got a revolver than can shoot one round a second max, and the bad guys have AK-47s that can shoot ten rounds a second, your chances of surviving a battle, on average, are approximately one in ten times the number of AK-47-armed bad guys. If there are three, you’ve got a one-in thirty chance of surviving. Thats 3.33%.

So one time out of thirty, you end up like the hero of the movie. Twenty-nine times out of thirty, you end up dead or maimed, maybe paralyzed for life. Would anyone in real life take those odds?

Since more guns on our streets makes us less not more safe, you’d think there might be an economic reason for spreading all these deadly weapons among people not trained to use them, criminals and homicidal maniacs. But you would be wrong.

According to the firearm industry’s own trade association, the total economic impact of the civilian firearms industry in the United States is less than $52.1 billion. That amount includes the industry’s direct impact, impacts on suppliers, and “induced” impact.

But the US GDP is $21.06 trillion, as of the first quarter of 2019. So the civilian firearms industries, whose products killed 38,600 people in 2016 (including 22,900 suicides), account for 0.247 % of the national economy.

Yes, you read that right: not even a quarter of one percent. If the entire industry went bankrupt overnight, no one but its suppliers, customers and all those who would otherwise be killed or maimed would notice the difference. The stock markets wouldn’t even twitch.

There are more than 390 million privately-owned guns in the United States, or 1.2 for every living man, woman and child. But surveys show that only about 40% of American own these weapons. About 60% of Americans own none. You would think that every strong supporter of gun rights owns one. If so, that 40% marks the limits of gun ownership (and coincidentally, probably Trump’s base).

Forty percent is not even close to a majority. So how does this base of gun enthusiasts rule us on these issues, when large majorities of the public favor universal background checks and banning assault weapons and large magazines?

The short answer is that the Republican party panders to gun owners. Why? Because many of them appear to be single-issue voters. If they vote solely or mostly against restricting “gun rights,” they don’t have to worry about (or understand) any other issue.

So why do the oligarchs, who reside in and control the Republican Party pander to gun enthusiasts? Do they share their fetish for guns?

Not hardly. As near as I can tell, the oligarchs are much like the rest of us. They feel and are safer because they travel in private limousines, which are often bullet proof, and private planes and yachts. Once in a while, they might go to a big public performance, a place of worship, or a car stop, or their children might visit a public school, where they might be sitting ducks for lunatics with automatic weapons, just like the rest of us.

Surely they’re smart enough to know this. So why do they persist in making gun enthusiasts’ agenda their own? The answer is simple. Gun issues distract from oligarchs’ creeping theft of the nation’s substance and creeping control over its government. Every gun massacre increases the distraction, while the public’s appalled reaction increases the gun enthusiasts’ intransigence and loyalty to the GOP. With 40% of the voters in their pockets, the oligarchs need to delude only 11% of the rest of us to own a majority.

It’s not even that the gun-factory owners belong to the oligarchs’ social class. Mostly they don’t, but that’s not the point.

The more the oligarchs support the firearms “base’s” enthusiasms, the more they have a loyal Trump-sized base of voters—a good start at a perpetual majority. And the more massacres there are, with more controversies over gun rights, the more the oligarchs can be sure they have a good working distraction to keep the people from watching while they steal the country’s substance right out from under our noses.

4. The majority rules. When you want the truth about long standing myths, read the Brits. They have no dog in our many fights, and our Revolutionary War against them came too long ago to leave lasting scars today.

In a 2014 news item, here’s what Britain’s BBC headlined: “Study: US is an oligarchy, not a democracy.” This wasn’t an editorial judgment or analysis. It was a report of an American academic study.

The study looked at 1,779 separate public policy issues from 1981 to 2002. It concluded that, “[w]hen a majority of citizens disagrees with economic elites and/or with organized interests, they generally lose. Moreover, because of the strong status quo bias built into the US political system, even when fairly large majorities of Americans favour policy change, they generally do not get it.”

As often happens, a careful academic study just confirms the obvious. Take two of the most burning issues of today: (1) unlimited gun “rights” leading to regular massacres, and (2) the wide loss of work for skilled workers.

For decades, universal background checks for gun sales and banning the sale of assault weapons have enjoyed majority support among citizens. The most recent figures are particularly striking: 86% of Americans support universal background checks, and 90% support a ban on assault weapons. Yet we have neither, and not much chance for getting either.

As for jobs, Trump won the presidency by promising to bring back closed factories that one employed millions of skilled workers in the Upper Midwest. Like most of Trump’s promises, that one proved a little harder to keep than he let on.

But there’s a much easier way to get good jobs for unemployed and underemployed skilled workers. Our own American Society of Civil Engineers says we need to invest $2 trillion in our crumbling, Grade D+ infrastructure. Doing that would create millions of good jobs for skilled labor, which can’t be outsourced. So what did Trump and the GOP do instead? They passed a bill to give tax cuts that mostly enriched the already rich and big corporations. And they ran up $1.5 trillion in debt to fund those cuts.

No true democracy in America would have failed the majority so badly on either of these points, let alone both together.

Our government produces absurd results like these not just because the oligarchs have bought and captured our pols. Our government has an absurd structure. In our Senate, the nine most populous states together have more than half our nation’s total population (166,644,015 out of 331,883,896) but only 18 votes out of 100. Under our constitution, this absurd condition can’t be changed without every state’s consent.

Add to this Senate filibusters, Senate “holds” called by individual Senators, the so-called “Hastert Rule” in the House, under which the GOP would not move any legislation without approval by a majority of its caucus (not a majority the whole House, which might include Democrats). With all these impediments to majority rule, you can see how far our government is from the kinds of simple parliamentary democracies that exist in Britain, India and many other foreign countries.

But that’s still not all. Pols in power by virtue of these structural perversions of majority rule are still not satisfied. They are trying to stack the deck further by gerrymandering and suppressing votes. By stealing a Supreme-Court appointment from President Obama, they managed to procure a ruling that no federal court will disapprove gerrymandering, no matter how extreme.

So if you really think a majority rules in America, you’ve got a whole lot of explaining to do. As Bernie told us in 2016, our system is “rigged” against ordinary people, even a majority. It’s been that way ever since our Founding, when the Great Compromise, which was designed to preserve slavery and its economic benefits for the South, gave us a Senate badly skewed by population even then.

5. What to do about it. Suppose you want to do something about all this. Suppose you want to do it peacefully, without starting a second civil war.

Then there is something you can do, and it has a good chance of working. But like every bit of magic, it requires you to give something up. You have to abandon all vestiges of racism. If you’re not among our African-Americans, you have to support their voting in the coming election cycle as if they were your family.

That’s not really much to ask. They are part of our American family, but the deck has been stacked against them far more than against any other group, and for far longer. Try 350 to 400 years.

What you get for your support is more of the most loyal and consistent Democratic and progressive voters. As one report noted: “[African-Americans] have voted 85% or more Democratic in every presidential election since 1964[.]”

Think about that. Can you name any other group—let alone one whose votes have been systematically suppressed—with an 85% level of support for Democrats?

Arithmetically, what that means is that, for every 10 new African-American voters you register and get to vote, on average you get better than eight votes for Democrats—a four-to-one-advantage. No wonder Southern GOP pols try so hard (and often illegally!) to keep them from voting.

There’s more. If those new votes help swing Florida, Georgia and North Carolina, they can give the Democrats a demographic lock on the presidency, with 273 electoral votes, regardless of what Trump’s bastion in the Upper Midwest does.

There’s now a good chance to make this dream reality. African-Americans comprise a far greater proportion of the population in the South than in the rest of the country. Together with Hispanics, they approach 40% in the three key states. Encourage them to register and let them vote, and add a fraction of progressive non-Hispanic whites who account for around 15% of voters, and you get a whole new South and a whole new nation. Then the Senate’s and Electoral College’s malapportionment won’t matter so much.

Supporting your favorite Democratic candidates is also a good idea. But they’re not the problem. Democrat Stacey Abrams would probably be governor of Georgia today if the very GOP guy who gained hadn’t worked to discourage African-Americans and stop them from voting.

So send some of your political donations to Black Voters Matter and/or Stacey Abrams’ own voter-liberation group, Fair Fight Action. If you’re worried about security, donate through Act Blue, the online donation site for Democrats and progressive causes, which has strong online security and keeps good records. That’s what I did.

I don’t see anything more important or more strategic that Democrats and progressives can do this election cycle than give the strongest, most loyal, steady and persevering group of Dems a better chance to vote. The democracy and the future you save might just be your own, or your kids’.

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01 September 2019

Is Anglo-American Democracy Done?


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

[NOTE TO READERS: For some time, links to the first two lists above have not worked properly. As a workaround, I’ve removed the lists from the text of my posts and made them separate posts, starting with this current post. This will be the new normal: the links seem to work properly now, and each non-list post will be shorter.]

    A pleading in a civil suit does not have to “exclude every misinterpretation [of the Philippine Bill of Rights] capable of occurring to intelligence fired with a desire to pervert.” — Oliver Wendell Holmes, Paraiso v. United States (1907).
Don’t look now. And try not to act surprised. But Anglo-American Democracy may be finished.

It’s had a good run—804 years since Magna Carta, give or take. But the current generation of adults may be the last to see it fully functioning as a democracy, at least in its country of origin and its powerhouse, the US. Maybe it’ll survive for a while in the “outback:” Australia, Canada and New Zealand.

It doesn’t seem to matter whether your ostensibly democratic constitution is written, like ours, or unwritten, like the Brits’. What matters is whether the men and women who put it into practice, who interpret and apply it on a day-to-day basis, have the desire—and the wisdom—to “exclude every misinterpretation capable of occurring to intelligence fired with a desire to pervert.”

When they do, your constitution guides your society down the mainstream of governance, with wisdom and common sense, as your most fundamental law. When they don’t, your fundamental law itself becomes a perversion. It drives your society to permit, if not foster, human error, societal excess, and empire.

Bit by bit, it lets the self-interest of the powerful turn your society away from simple majority rule and toward oligarchy. Then custom overcomes law, and culture overcomes custom. Both custom and culture favor the rich and powerful, including the Executive, who comes to resemble a king or emperor. This is what happened to ancient Rome.

In the end, our much vaunted written American Constitution is just a piece of parchment paper. It’s quite explicit on who has the power to spend the national government’s money. Article I, Section 9, Clause 7 says “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law[.]”

Yet President Trump is pushing money around, without appropriation, to build a wall on our Southern border. Not only has Congress never appropriated money for his complete border wall; it has considered the request more than once and explicitly rejected it. Now Trump is encouraging his underlings to violate the law and Constitution by promising to pardon them. When called on it he claims he was joking. And he has taken for his wall money from our emergency services, weakening our response to Hurricane Dorian, which has grown to a Category 4 and is now approaching Florida.

Our Constitution also says (in Article II, Section 2, Clause 2) that the president “shall nominate, and by and with the Advice and Consent of the Senate, shall appoint . . . Judges of the supreme Court[.]” (emphasis added). But a single senator, in blatant disregard of this clause, custom and precedent, stole a Supreme-Court appointment from President Obama, letting the next president—the one who so flagrantly disregards congressional appropriations—appoint two.

Our much-heralded Second Amendment is very short. It says, in full: “A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” The short preamble self-evidently qualifies the sense of this simple sentence. It limits arms-bearing to collective and state purposes. Yet our Supreme Court has perverted it into a supreme right of individuals and even hinted at a right to rebel against government.

So individuals now bear weapons of war capable of killing dozens in a minute or so, and they wreak regular massacres upon innocent populations. The latest massacre left five dead and 21 injured at a traffic stop in Texas yesterday.

Our First Amendment says: “Congress shall make no law . . . abridging the freedom of speech, or of the press . . .” It’s pellucidly a carte blanche for political dialogue, not bribery. Yet our high Court, in Citizens United, has made it a carte blanche for disguised bribery, in the form of campaign contributions made anonymously by the rich and by corporations.

I could go on. I could mention Congress’ explicitly exclusive power to declare war, in Article I, Section 8, Clause 11. Congress has abandoned this power like a paralyzed muscle, preferring to adopt ambiguous “authorizations for the use of military force.” Several presidents have used them to make major wars, like the ones still ongoing in Afghanistan and Iraq, now the longest in our history. Some presidents have twisted these “authorizations” like the proverbial nose of wax for that purpose.

The point here is obvious, now a matter of fact and history. Our Constitution means nothing but what people in high places let it mean. When Executives and judges can take such liberties as these, its actual words restrain little. Then what, pray tell, is the difference between the Brits’ unwritten constitution and our so-called “written social contract”?

Open today’s newspaper and you will find how small the difference. The Brits’ current Prime Minister, Boris Johnson, has used the obscure (but customary and constitutional) process of “prorogation” to suspend the operation of Parliament for almost all of the time remaining before Britain is pledged to leave the EU with no deal. He has done this although prorogation customarily lasts a week or so, not the two months remaining before the October 31 Brexit deadline.

Johnson says he prefers a no-deal Brexit. Yet many suspect (and some hope) that his ploy is a means of putting pressure on the EU to make a last-minute deal with the Brits’ Parliament in Britain’s favor. If this presumed brinksmanship doesn’t work, a no-deal Brexit will occur. According to many experts, it will produce at least temporary shortages of food and medicine in Britain.

The major sticking point in the Britain-EU talks is the status of the border between Northern Ireland (a part of Britain) and Ireland itself (a separate nation and a now and future part of the EU). Many fear renewed violence among the separately-governed Irish—mostly Protestant in British Northern Ireland and mostly Catholic in the rest—if that border becomes encumbered with customs duties and limits on passage and immigration.

But what if not, and what if Britain leaves the EU with that border open? Then that little border in Ireland will become the only point of contact between Britain and the rest of the world that is free of customs, duties and restrictions on migration.

Will Belfast then become the Panama Canal of what used to be the British Empire? Will free trade from and to Britain run through the Irish isle, leaving “hard” borders everywhere else? Will the Ireland that has exploited low taxes to make itself a center of high technology and commerce then seize all the benefits of the global trade that has been Britain’s for half a millennium?

A distant observer, like this Yank, would like to think that all Brits, whatever their ethnicity and descent, might want to discuss these weighty matters fully. Yet if PM Johnson’s ploy prevails, they will have only days to do so. Think of that: the Brits’ millennial predominance in international trade up for discussion in mere days, as if at stake were only the receipts from parking meters in a far suburb of London.

On both sides of the Atlantic, citizens rely on the judicial branch to restore and maintain constitutional traditions, and to keep them consistent with common sense. Yet the judicial branch is nearly always the slowest and weakest of the three. It cannot, by itself, enforce respect for a constitution, real democracy, or common sense. Instead, it must rely on the other two branches for coercive power. Judge by themselves have no police and no army; those forces belong to the executive branch.

Judges often make things worse by playing with abstractions like children’s games, sometimes heedless of consequences, sometimes with hidden ideological agendas. The crux of the matter is that words on paper—like customs, culture and tradition—mean nothing unless people interpret them truly and enforce them. If people with the power to stop transgressions don’t do so, no one else can or will. If executives, leaders in Congress or judges find clever (or even crude) ways to bend a “supreme law” to their or their supporters’ purposes, there is little that the helpless majority of mere citizens can do.

During the Cold War, many Yanks and Brits castigated the Soviet Union, “Red” China, and their leaders for governing with a view that “the end justifies the means.” In practice, those words denied any consistent “means” for taking state action. There was no required procedure, no due process. There was only what the leaders wanted to do and the most expeditious way to do it, often at the cost of injustice, suffering, and even death for large populations. Stalin became famous for saying, “A single death is a tragedy, a million deaths only a statistic.”

What now makes this kind of horror possible, in both the United States and Britain, is the division and polarization of their respective societies. In the United States it involves a host of issues, including mammoth economic inequality and the treatment of minorities and asylum-seeking migrants. In Britain it mostly involves a single issue: whether to remain part of the EU and so allow free migration from the rest of it.

Yet whatever the cause or causes, the fierceness of the respective conflicts threatens abandonment of what makes “America” American and what makes the Brits British. Sincere devotion to a fair and orderly process of respectful decision making by the majority will become a casualty of ideological war. So will a “constitution” that accords with custom, tradition, and common sense.

Once that abandonment occurs, judges cannot save democracy. The executive or dominant faction in the legislature will simply ignore the judicial orders, as Trump and his Executive have done so many congressional subpoenas. Or the powers that be will twist the meaning of laws and orders in a clever or even a crude way. (Is Trump ever anything but crude?)

Then the people of the United States and those of Britain will be in precisely the same position as the people of Venezuela today, waiting for a divided military to enforce judges’ orders and breathe new life into a moribund democracy. If Yanks and Brits aren’t in that sad position today, they are far too close for comfort.

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