Perverse incentives to the left; greed to the right. Stuck in the middle with American health care

love Elisabeth Rosenthal’s  2013 NYT series on the high cost of American health care and have been assigning portions of it to my classes for years (including this semester).

So, when I learned she had written a new book about the American health care system, I was all over it and ordered it the day it was published and finished it in less than a week (that’s definitely fast for me– too much time with the internet, not enough with books).

The book is terrific.  I literally cannot recommend it highly enough.  Even if you think you are not interested in health care policy, chances are you’ve had plenty of interactions with our medical establishment and would be fascinated to learn just how perverse so many of the incentives are.   I’ve been a health care policy junkie for at least a decade and I still learned a lot that was new to me.  To some degree, what I learned was just how absurdly depraved and money-hungry the whole system has become.  In many ways, we are looking at a medical system of capitalism amok.  So many people are looking to monetize every last dollar off of human sickness and suffering.  There’s lots and lots of good people who just want to help, but they have been caught up into a perverse and greedy system where, often just practicing medicine, means partaking in a series of sleazy and ethically dubious practices and organizations that are looking to squeeze every last dollar out of patients and the government (i.e., all of us).  And it’s working.  And, as I’ve written time after time, this is largely a matter of policy choice.  Political Scientist Jacob Hacker sums it up quite nicely in his NYT review of the book:

The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. In every country where people have access to sophisticated medical care, they must rely heavily on the clinical expertise of providers and the financial protections of insurance, which, in turn, creates the opportunity for runaway costs. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge. [emphasis mine]

In the United States, such counterpressure has been headed off again and again. The industry and its elected allies have happily supported giveaways to the medical sector. But anything more, they insist, will kill the market. Although this claim is in conflict with the evidence, it is consistent with the goal of maximum rewards to (and donations from) the industry.

There’s literally dozens of examples from the book that left me open-mouthed that people were able to get away with such greed and perversity, supposedly in the service of human health.  One that really stuck out though, is that of Duexis.  It’s literally a pill that’s just ibuprofen and famotidine.  You can dose yourself with those two for literally pennies a day.  Yet somehow– only in America, of course– they manage to charge $1500 a month for it and get doctors to prescribe it and insurance companies to pay for it.  Ugh.  If I ever had a doctor prescribe something like this to me, I would find a new doctor the next day.

Now, imagine a book full of other such shocking and disturbing examples.  Not exactly fun to read, but totally engaging, and disturbing.  And, also designed to be useful for helping readers navigate this giant mess with their own health care needs.  Or, at least listen to the terrific Fresh Air interview.

Quick hits (part II)

1) Totally agree with Mark Joseph Stern that Democratic politicians need to get out in front on marijuana legalization:

The lack of mobilization from lawmakers is especially puzzling given how neatly marijuana legalization aligns with the goals of the self-styled resistance to Trump. Progressive Trump opponents not only tend to favor legalization on its own, they also broadly support the goals behind legalization. It’s true that the Trump era has reinvigorated liberals’ support for federalism, mostly out of necessity as blue states band together to protect sanctuary cities and fight Trump’s travel ban. But it has also intensified liberals’ opposition to mass incarceration and racial bias in the criminal justice system. Concerns about overpolicing and racism in law enforcement are what animate progressive support for legalization, along with a healthy respect for states’ rights and personal liberty.

And yet, on pot as on so many other issues, Democratic politicians are failing to respond to their base’s stated preferences.

2) Damn the militarization of the police and all the needless no-knock warrants.  And shame on our judicial system for making them way to easy to get.  People die and lives are ruined over these.  And, because, some police departments think it is a good idea to break into a house at 5am, basically unannounced, over a few ounces of marijuana.  Ugh.

3) Basically 75% of my twitter feed yesterday was about the NYT’s big Comey story. Many, many tweets mentioned the fact that the story completely ignores the role of the media in all this.  Relatedly, Drum lays out the clear case for why Comey’s letter was the decisive factor.  I agree.

4) Jacob Levy on Kushner and the problem of nepotism in a democracy.

5) I came across this latest example of classic interest group politics via a FB ad.  I’m 100% convinced that NC ophthalmologists are only interested in the welfare of their patients in attempting to stop optometrists from performing four types of simple surgery that they have been doing successfully in three other states.  I’m sure it has nothing at all to do with protecting their turf and their incomes.  My favorite is their “poll” stating, ” Almost nine out of 10 North Carolina voters oppose legislation that would allow eye-care providers who have not been to medical school to perform eye surgery, a new statewide public opinion poll found.”  As if 1 in 100 NC voters actually has any idea what this legislation is actually about.

6) Ben Mathis-Lilley, “There’s No News Right Now Because Trump Doesn’t Actually Do Anything.”

None of this is really surprising. As has been well-documented, Trump—though he claims to be a “builder”—actually made most of his hay in the private sector by licensing his name. He’s the guy who makes big promises at the ribbon-cutting and gets the name of the project in the newspaper, not the guy who gets the permits and arranges the funding and hires the subcontractors. He doesn’t make things; he talks. (When he does try to make things, they go bankrupt.)

7) While everybody was focused on Betsy DeVos and K-12 education, those in the know were aware that her real damage would be to higher education and college students.  When it comes to student loans, she’s already at it.

8) The saga of North Carolina’s contaminated water gets a nice feature in the Atlantic.  Thanks, NC Republicans!

9) Somehow I missed that prostate cancer screening is back in the news.  Good take on the latest from doctor/blogger Kenny Lin, whom I am now going to start following.  Short version: official take is now that you should at least discuss PSA test with your doctor.  Ongoing reality.  Getting a PSA test makes it about 10 times more likely you will end up incontinent or with sexual dysfunction than the likelihood it will save your life.  No thanks to that trade.

10) Great EJ Dionne column on Trump:

Two issues are paramount in American politics. The first is whether President Trump will get away with his arrogant dismissal of the public’s right to a transparent government free of corrupting conflicts of interest. The second is whether those who would hold him to account remain focused, mobilized and determined.

They are related. There are many reasons to stand against Trump, but the one that should take precedence — because it is foundational for decent governance — is his autocratic assumption that he is above the expectations that apply to us normal humans.

Should Trump separate himself completely from his business interests, as presidents had been doing for more than four decades? His implicit message is always: No, I can do what I want.

11) The political impact of helicopter parents.  Really.

Using a survey conducted at multiple universities in the U.S., we find that helicopter parenting has a significant impact on the policy attitudes of college students. Specifically, students with helicopter parents are more likely to express support for both government surveillance and social welfare policies than are students without helicopter parents. Given the growing trend of helicopter parenting, these findings will likely have substantial implications for both the political science classroom and public opinion in the near future.

12) Excellent Isaac Chotiner piece on how Bill O’Reilly was very much the proto-Trump:

But the aspect of The O’Reilly Factor that always shocked me was a different kind of resentment, which took the form of the anchor’s unrepentant solipsism. It’s simply impossible to overstate how much of each night’s show was consumed by O’Reilly’s own grievances. He skirmished with everyone from Matt Lauer to Rosie O’Donnell to Al Franken, and those fights would invariably become the topic of the day on his show. He spent countless hours talking about himself—usually as the victim of various conspiracies. (Frequently, George Soros was the conspiracy’s prime mover.) He would drone on about the New York Times and how it was out to make him look bad. It was endless, and it was exceptionally boring—to everyone except his legions of viewers and fans.

I never really had a theory for how this supposed man of the people got away with talking about nothing but himself. Then Donald Trump came along. Here was another rich guy who built a following speaking up for the working man. Like O’Reilly he seemed entirely driven by resentment: at President Obama, at the media, at the people who doubted him. And like O’Reilly, he spoke almost entirely of himself. His stump speeches were shocking, in part, because they were rarely about anything other than Donald Trump.

13) Interesting Rebecca Traister piece on the role of women’s reproductive rights within the Democratic party.  That said, I’m tired of throw-away lines like this:

For some time now, Sanders — who, it should be noted, has an extremely strong legislative record on reproductive rights — has spoken somewhat carelessly about a populist strategy that exchanges some core Democratic beliefs for the set of issues that are most important to him. “Once you get off the social issues — abortion, gay rights, guns — and into the economic issues, there is a lot more agreement than the pundits understand,” he said in 2015. In January of this year, at a CNN Town Hall, he reiterated, “Yes, of course, there are differences on issues like choice or on gay rights … But on many economic issues, you would be surprised at how many Americans hold the same views.”

Sanders is wrong that reproductive rights (or gay rights, for that matter) are separate from economic issues. The ability to control reproduction is central to women’s social, professional, and economic stability, and the women most likely to require abortion services and to be negatively affected by restrictions on access to reproductive health care are poor and low-income women, disproportionately women of color.

Really, I get it.  But still, let’s just not pretend people think about and conceptualize these issues the way they do matters like taxes, jobs, minimum wage, etc.  Oh, heck, as long as I’m letting Traister annoy me:

The deprioritization of reproductive rights was part of the strategy that helped Rahm Emanuel, chair of the DCCC, win the House for Democrats in 2006. But Ilyse Hogue, head of NARAL Pro-Choice America, argues that we should evaluate that strategy now with an understanding of its longer-term implications: “It did not result in more progressive legislation or in a durable governing coalition,” she says. “It depressed the base and predicated the rise of the Tea Party.”

Right.  That’s what led to the rise of the Tea Party.  Dumbest, most obviously self-serving political analysis ever?

14) The many forces pulling Trump in a more conventionally conservative direction.

15) Love Josh Marshall’s post on Trump’s “militant ignorance.”

What is endearing, terrifying and hilarious about Trump is not simply his ignorance, really his militant ignorance, but his complete lack of self-awareness about his ignorance. Trump told a reporter for The Wall Street Journal that his understanding of the problem of North Korea changed dramatically after hearing ten minutes of history from the President of China. Needless to say, Trump didn’t need to admit this. But neither was it candor.

So far the Trump Presidency has been a sort of Mr Magoo performance art in which the comically ignorant Trump learns elemental or basic things that virtually everyone in the world of politics or government already knew – things that the majority of adults probably know. Health Care: “Nobody knew health care could be so complicated.” North Korea: “I felt pretty strongly that they had tremendous power. But it’s not what you think.” There are perhaps half a dozen examples equally stark.

In other words, President Trump is open about his discoveries and even eager to share them but universally projects his previous state of comical ignorance onto the general public or whomever he is talking to. In other cases, this would make sense. If Trump discovered that humans could fly if they hold their nose, close one eye and say “Shazam!” I’d want to know. Because that’s awesome. And I wouldn’t think worse of Trump for not knowing it before. Because this is new and amazing information. But learning that health care policy is complicated is a different kind of discovery.

 

 

The Republican health care contradiction

Not quite sure what occasioned this from Ezra this week, as much has already said by him and others last month, but it’s a great succinct summary, so I’m going with it, too:

The most interesting policy argument in America right now is the debate between conservatives’ real position on health care and their fake position.

The fake, but popular, position goes something like this: Conservatives think everyone deserves affordable health insurance, but they disagree with Democrats about how to get everyone covered at the best price. This was the language that surrounded Paul Ryan and Donald Trump’s Obamacare alternative — an alternative that crashed and burned when it came clear that it would lead to more people with worse (or no) health insurance and higher medical bills.

Conservatives’ real, but unpopular, position on health care is quite different, and it explains their behavior much better. Their real position is that universal coverage is a philosophically unsound goal, and that blocking Democrats from creating a universal health care system is of overriding importance. To many conservatives, it is not the government’s role to make sure everyone who wants health insurance can get it, and it would be a massive step toward socialism if that changed…

There has not, in recent political memory, been a national Republican leader who actually argued that the American health care consensus was wrong and it was simply not the government’s job to ensure every American could get health insurance…

Republicans need to realize their problem isn’t poor legislative leadership or dissident House conservatives. It’s that they’ve been hiding their real health care position for decades, and so there’s no public support for the bills that actually achieve their goals. Either they need to change what they believe, and move toward the kinds of policies Roy proposes, or they need to begin the hard work of actually persuading the public that not everyone who wants health insurance should be able to get it.

Yep, yep, yep.  Also reminded me of a Chait post a few weeks ago I forgot to blog about:

But in the long run, these policy defects may be overshadowed by the ACA’s great political achievement: popularizing the idea that the government should guarantee health care to its citizens as a right.

This is not a radical idea. Every other advanced democracy arrived at it long ago, and many Americans already subscribed to the notion before Obamacare was ever introduced.

But as the Trumpcare debate illustrated, the ACA grew the constituency for government-provided health care while fostering the American public’s sense of entitlement to affordable insurance.

The GOP anticipated this development, which is why it fought so hard, on so many fronts, to kill the law. When those efforts failed, for short-term political gain, many Republicans chose not to attack Obamacare’s core premise — that the government should facilitate universal access to basic health care — but rather to attack the law for failing to realize that left-wing ideal…

The Republicans didn’t just lose the battle on health care — they lost the war.

Just eat it already

Damn, I love Aaron Carroll.  Here’s a great Upshot post on why he eats food off the floor.  I do to.  It occurred to me that I’ll think nothing of helping my daughter put her shoes on or picking something up off the floor before eating.  And, really, there’s not that much difference between either of those than just picking the frosted mini-wheat up off the floor.

Yes, regular hand-washing is important, but, at some level, you’ve got to just chill and accept that we’re totally surrounded by bacteria and just do what you can to keep your immune system healthy (personally, I’m a fan of fruits, vegetables, exercise, fortunate genetics, and enough sleep).

Anyway, Carroll makes the point that there’s way more bacteria to worry about in places other than the floor.  Like places you touch with your hands:

Our metric shouldn’t be whether there are more than zero bacteria on the floor. It should be how many bacteria are on the floor compared with other household surfaces. And in that respect, there are so many places in your house that pose more of a concern than the floor…

They found that the kitchen floor was likely to harbor, on average, about three colonies per square inch of coliform bacteria (2.75 to be exact). So there are some. But here’s the thing — that’s cleaner than both the refrigerator handle (5.37 colonies per square inch) and the kitchen counter (5.75 colonies per square inch).

We spend so much time worrying about what food might have picked up from the floor, but we don’t worry about touching the refrigerator. We also don’t seem as worried about food that touches the counter. But the counter is just as dirty, if not dirtier.

The same thing happens in the bathroom. I know a lot of people who are worried about the toilet seat, but it’s cleaner than all the things in the kitchen I just mentioned (0.68 colonies per square inch). What’s dirtier in the bathroom? Almost everything. The flush handle (34.65 colonies per square inch), the sink faucet (15.84 colonies per square inch) and the counter (1.32 colonies per square inch).

Things get dirty when lots of hands touch them and when we don’t think about it. We worry about the floor and the toilet seat, so we clean them more. We don’t think about the refrigerator handle or the faucet handle as much…

The alternative is to realize that for most of us, our immune systems are pretty hardy. We’ve all been touching this dirty stuff for a long time, without knowing it, and doing just fine.

I clearly fall into the latter group. If I drop food on the floor, I still eat it. I do that because the harm I might get from the floor is not worth my concern compared with many, many other things. You may feel differently. Either way, make an informed judgment based on relative risks, not on any arbitrary span of time that one thing has been touching another.

So, there you go, eat that food off the floor.  Oh, and maybe clean some of those much-handled surfaces more often.  I know I’m going to be looking at that refrigerator handle :-).

Quick hits (part I)

1) Here’s some cool political science from– air polluters like to position themselves just upwind from the border of a neighboring state.   Stick it to the other guy!

2) Just got Elizabeth Rosenthal’s new book on American health care.  I assign her fabulous NYT series on the matter to my Public Policy classes.  Can’t wait to read this.

3) On the resilience of failed fast food chains.  My wife and I still reminisce about Rax roast beef on our travels to and from Ohio State.

4) Both Derek Thompson and Father James Martin blame the law, as much as United for what happened.  I especially like Martin’s take:

Someone in authority—pilots, stewards, ground crew—might have realized that this was an assault on a person’s dignity. But no one stopped it. Why not? Not because they are bad people: They too probably looked on in horror. But because they have been conditioned to follow the rules.

Those rules said: First, we may sometimes overbook because we want to maximize our profits. Second, we can eject someone because we have overbooked, or if we decide that we want those seats back, no matter what a person can reasonably expect, and no matter how much of an inconvenience this is. And third, and most tragically, human dignity will not get in the way of the rules. A toxic cocktail of capitalism and corporate culture led to a man being dragged along the floor.

That is why bland “nothing to see here” defenses of the ills of corporate America and of the dictates of capitalism bother this capitalist and former corporate employee so much. They fail to see the victims of the system.

5) Tech products are specifically designed to be psychologically addictive.  I know I look at my phone too much, but I still think I’m pretty far from “addicted.”

6) When families use school vouchers for their children with disabilities, they often find they lose the legal protections for children with disabilities.  And they learn this the hard way.  Enough with vouchers, already.  Let’s just invest in high (or at least medium) quality schools for all.

7) Corwin Smidt’s work on the disappearance of swing voters just came out in the latest issue of AJPS and I couldn’t remember if I had ever quick-hitted this Vox piece on it.  It’s good stuff, even if Alvin Chang does not seem to realize that leaners = partisans is not exactly new.  Also, I can think of a view damn relevant piece’s on Party ID from a fellow Ohio State PhD that Smidt fails to cite.

8) In the face of the latest ANES data, Drum argues, “We Still Don’t Know How Much Trump’s Victory Was About Race.”  He’s got some good points:

Klinkner thinks race played a big role in the election. There’s no question this is true, but did it play a bigger than expected role? The two major parties have been splitting further apart by race for years, with Republicans becoming the party of whites and Democrats the party of non-whites. This means that to survive with an ever growing white base, Republicans have to cater to white resentment more and more. Likewise, Democrats have to cater to black and Hispanic interests more and more. This is a cycle with positive feedback, so it’s only likely to get worse.

Racial attitudes certainly played a bigger role in this election than in the past. But did Trump himself accelerate this partisan trend, or was he merely the beneficiary of it? That still seems like an open question to me.

Great points, from Drum.  That said, I think his headline is wrong (and as a blogger, I presume he writes his own).  We know race played a helluva role, like it does with almost everything in modern American party politics.  What we don’t know if this was more for Trump than it would’ve been for Rubio, etc.  I suspect that answer is yes, but for now, I do think that remains somewhat TBD.

9) I find it absolutely appalling that the 4th amendment seems to not apply at all upon entry into the country and that CBP can legally search the entire contents of your smartphone (i.e., the entire contents of your life) without a warrant.  Congress can and sure as hell should change this.

10) What color was that dress anyway, two years later.  Great stuff from a cognitive psychologist who studies color perception.

11) Uncovering the secrets of proto-dinosaurs (this one is for you, DHG).

12) Literally surprised by all these headlines about the “mystery” of why shoelaces untie.  Seriously?  You’ll be shocked to learn that it’s the ongoing low-level stresses caused by your foot hitting the ground and moving through the air.

13) Jay Geils just died.  I found this NPR story about the evolution of the band and the transition of pop music in the early 1980’s utterly fascinating.

14) In case you missed the story of the NC legislator (Republican, of course) who likened Lincoln to Hitler while he was defending his anti gay marriage bill.

15) I know most NYC apartments on TV are pretty unrealistic, but I really enjoyed this piece looking at the apartments on several popular shows.  I was also interested to learn where a lot of the characters lived.

16) Why social mobility is so bad in the South.  Short version: concentrated poverty and lack of social capital:

Concentrated poverty is related to another factor Chetty and his colleagues mention: social capital, which is essentially the mechanism that allows people to interact with others and become a part of broad networks that can lead to opportunity. It can help people get hooked up to first jobs, internships, and scholarships. Without these types of connections, children are more likely to take a similar path to their parents. For those who live in areas of concentrated poverty, this means they don’t learn about opportunities that might get them out of poverty, or about people in different income brackets.

17) Atlantic article summarizing some nice new PS research on how Trump may be changing the meaning of “conservative.”

18) Apparently, job interviews are pretty worthless.  Should we really just hire people based on resumes and application files?  Maybe?

19) I’m sure you’ll be shocked to learn that Susan Rice did absolutely nothing wrong in the silly “unmasking” episode.  I’m sure the cable news networks will devote plenty of time to this point.

20) Chait on Trump’s budget director accidentally telling the truth:

For more than a generation, the Republican Party has single-mindedly pursued the goal of maximizing economic inequality. They have been almost as single-minded about not describing this as their priority. Republicans say their goal is reducing out-of-control deficits, or reducing out-of-control surpluses, or promoting economic growth, or saving Social Security and Medicare. But Donald Trump’s budget director Mick Mulvaney, in a new interview with CNBC’s John Harwood, basically admits that what he cares about is reducing transfers from the rich to the poor…

The place to begin understanding Mulvaney’s ideas here is where he says “letting people keep more of their money … is the most efficient way to actually allocate resources.” The premise of this statement is that the market distribution of income is sacrosanct, and progressive taxation is thus both morally wrong (because it takes money that rightly belongs to high-income people who earned it on their own) and inefficient. Mulvaney concedes that cutting taxes for high-income earners can “contribute to the deficit,” but this fact is “less important.”

21) Seth Masket says goodbye and good riddance to the judicial filibuster.

22) Krugman on Trump’s mean and stupid health care negotiating tactic:

The nastiness should be obvious, but let’s spell it out. Mr. Trump is trying to bully Democrats by threatening to hurt millions of innocent bystanders — ordinary American families who have gained coverage thanks to health reform. True, Democrats care about these families — but Republicans at least pretend to care about them, too.

Why does Mr. Trump even imagine that this threat might work? Implicitly, he’s saying that hurting innocent people doesn’t bother him as much as it bothers his opponents. Actually, this is probably true — remember, we’re talking about a man who once cut off health benefits to his nephew’s seriously ill 18-month-old son to gain the upper hand in a family dispute. But it’s not the kind of thing one expects to hear from the occupant of the White House.

What makes Mr. Trump’s tactic stupid as well as nasty is the reality that Democrats have no incentive whatsoever to give in.

For one thing, what is he offering by way of a deal? Obamacare increased coverage two ways, via Medicaid expansion and subsidized private insurance. Mr. Trump might be able to undermine the private markets, but Medicaid wouldn’t be affected. Why would Democrats ever agree to Republican plans, which would basically kill both?

Then there’s the political reality that by sabotaging Obamacare, the Trump administration would be handing Democrats a huge electoral gift.

Americans love Opioids

Been meaning for a while to link to this Wonkblog post that puts American opioid use in international context.  Based on the title of this post, you can probably figure out the deal:

United Nations data provide one important benchmark against which to judge how much more or less opioid consumption might be appropriate for a given country. And what it finds about the United States is jaw-dropping: Even when the list is restricted to the top 25 heaviest consuming countries, the United States outpaces them all in opioid use.

For example, Americans are prescribed about six times as many opioids per capita as are citizens of Portugal and France, even though those countries offer far easier access to health care. The largest disparity noted in the U.N. report concerns hydrocodone: Americans consume more than 99 percent of the world’s supply of this opioid.

There’s a lot of factors as play, but I find the cultural explanation particularly intriguing:

Cultural factors may augment U.S. opioid consumption, as well. Relative to Europeans, Americans have more faith that life is perfectible (e.g., all pain can be avoided). Consider, for example, a 55-year-old who feels acute back and leg pain after doing the workout that was easy when he was 25. A European in this situation might reflect sadly that aging and physical decay must be accepted as part of life, but an achy American might demand that his doctor fix what he sees as an avoidable problem by prescribing him opioids.

And, while I’m at it.  Just how much do addicts want their opioids?  Enough that they will crush literally hundreds of pills of loperamide (presumably known to you as Immodium A-D), which is actually an opiate (don’t worry, it doesn’t usually affect the brain unless you take hundreds).

Amusingly to me, just last week I had a pretty good bout of what I prefer to refer to as lower gastro-intestinal distress, and the loperamide was amazingly effective, as it always has been for me.  Honestly, I can think of few medications I ever take that actually do a better job of treating the condition that they are supposed to.  Anyway, I’ll stick with 1-2 at a time.

Quick hits (part I)

1) The headline for this WP essay just kills me, “I gave up TV, then qualified for Olympic marathon trials and got my PhD.”  Oh, please, plenty of people manage to accomplish similar goals while enjoying TV.  I got a PhD, tenure, full professor and co-wrote a book while watching lots of TV!

2) Scott Pelley is pulling no punches on Trump.  I hadn’t realized– good for him.

3) Radley Balko on the foolhardiness of putting immigration enforcement above criminal law enforcement.

4) Fun take on how TV Opening Titles have gotten so good.  I totally agree, but, please, no reason to diss Magnum PI!

5) Vox interview with Pippa Norris on the entho-nationalist basis of Trump’s appeal.

I want to return to what you said earlier about the cultural roots of modern populism. In one of your recent papers, you tell a familiar but troubling story: Since at least the 1970s, Western societies have emphasized what you call “post-materialist” and “self-expression” values among the young educated strata of society. This has produced movements toward greater gender and racial equality, equal rights for LGBTQ people, more acceptance of diverse lifestyles and cultures, etc. It’s also resulted in less focus on redistributionist economics.

You argue that we’ve reached something of a tipping point culturally as less educated and older citizens, particularly white men, are now increasingly resentful of a society that no longer privileges them or their values.

Pippa Norris

The idea that values are being changed has long roots going back to the 1970s, but it has new traction, if you like. The argument is that you adopt the values at the time that you grew up and it’s part of your societal conditioning. Look, for example, at the actual groups who were growing up in Europe when there was a welfare state from cradle to grave. The arguments were about meeting basic material needs — full employment, free education, free health care, etc.

In many of these countries, values changed from a focus on material needs — jobs, economic growth, and the things people who lived through the Great Recession and the period of war cared about — to a different set of values, which was environmental, gender equality, participation, democracy and a whole range of other post-material values. This is a long-term change which my co-author, Ron Inglehart, has predicted for many decades.

What we think happened is that there’s been a tipping point in terms of where majority values have become the new minority. So it’s really about population change more than anything else. If a generation grows up with certain values, those values gradually take over that culture. We can see the manifestation in many policies.

Think, for example, of gay marriage and the way in which marriage rights were something that was not even discussed 20 years ago or even 10 years ago. They weren’t mainstream in the political agenda. And now many, many countries have equalized gay marriage, although affluent countries are still going through that process. Similarly, tolerance of homosexuality, ideas that women should have equal values, secular values as well, the idea that religion is no longer central to people’s lives. So those are values which are shifting.

Those people that are benefiting from these shifts take them for granted as they grow in their status and their power, but there’s been a tipping point when those groups and the values around them are no longer being reflected and, what’s more, they can’t even talk about them.

6) A scientifically-validated app that you can use to train your brain so that you won’t need reading glasses.  Cool!  One of the few benefits of my extreme nearsightedness (-10!) is that it delays onset of the need for reading glasses.  But once that small print starts becoming a problem, I am so doing this.  I’d like my wife to be the family guines pig as she’s definitely getting close.

7) No, we cannot blame fancy new dorms for the increasing cost of college.  And, yes, administrative costs are up.  But, mostly, its the cutbacks from state governments.

8) Nate Cohn concludes that poor Democratic turnout was not the driver of HRC’s defeat.  It’s that damn wwc:

If turnout played only a modest role in Mr. Trump’s victory, then the big driver of his gains was persuasion: He flipped millions of white working-class Obama supporters to his side.

The voter file data makes it impossible to avoid this conclusion. It’s not just that the electorate looks far too Democratic. In many cases, turnout cannot explain Mrs. Clinton’s losses.

9) Hobbyhorse riding is big in Finland ¯\_(ツ)_/¯.  Mika?

10) Oh man is the NFL evil and greedy.  And damn do they abuse the suckers who pay for their stadiums to support their greed.  The Las Vegas case is particularly egregious:

In the N.F.L.’s world, displays of principle and common economic sense are for chumps. Las Vegas and Nevada adopted the league’s preferred stance: They rolled belly up. Politicians raised taxes to provide a historic $750 million public subsidy.

This led to unremarked-upon cognitive dissonance in Las Vegas. Even as politicians increased taxes for stadiums, Clark County school officials voted last spring to increase public class sizes and to close a school for at-risk students. There was simply no money. “This is the last thing we ever want to do,” Linda Young, president of the school board, said at that time.

It’s a shame the school board did not build a football stadium, perhaps with a public school annex.

One team owner, Stephen M. Ross of the Miami Dolphins, voted against the relocation. “We as owners and as a league owe it to the fans to do everything we can to stay in communities that have supported us,” he said in a statement.

That was so sweet of him; I hope he has put a few food tasters on his staff.

The N.F.L. makes two demands of its owners: Build ever-grander stadiums with as many public dollars as you can find; and never, ever feel shame.

11) Cost of HB2 to the NC Economy? Just a measly $3.8 billion.

12) Good Conor Friedersdorf on how the egregious, scare-mongering lies of right-wing media set repeal and replace up for failure.

13) Damn, Texas is anxious to execute the mentally disabled.  Fortunately, five members of the Supreme Court believe otherwise.  Among other things, totally asinine to think that if an IQ test comes out 69 execution is off the table but at 74 it is okay.  This puts way too much faith in both the validity and reliability of IQ tests.  Love this key quote:

Texas cannot satisfactorily explain why it applies current medical standards for diagnosing intellectual disability in other contexts, yet clings to superseded standards when an individual’s life is at stake,” Justice Ginsburg wrote. She was joined by Justices Anthony M. Kennedy, Stephen G. Breyer, Sonia Sotomayor and Elena Kagan.

 14) Among the lessons of the AHCA failure– policy expertise and seriousness matter.  As I’ve often mentioned, there’s only one party in America that takes public policy seriously and we’re all the worse for it.

15) Alabama’s prisons are truly, horribly, shameful.  There is literally no excuse for this in a modern nation.  We really need judges to step in if the people of Alabama and their representatives are not going to.

16) I’m sure the law and order types hate the idea of college classes in maximum security prison.

17) There are bipartisan steps we can take to actually make the ACA work better.  Alas, there’s really little evidence many Republicans have any interest in ACA working better.

18) Terrific episode of Hidden Brain on Bandwidth Poverty.  If you are not familiar with the concept, you should be.  And this is a great listen.

19) Nice mini tweetstorm from Christopher Frederico on the just released 2016 ANES data.  Short version: confirming Brian Schaffner’s analysis from earlier data, it’s all about the racial resentment.

20) Why professors should not shame their students, even anonymously.

21) Good take from Vox’s Brian Resnick on the crazy/scary new poll showing that 74% of Republicans believe Trump Tower was wiretapped.

22) Ross Douthat wrote a column about how Obamacare doesn’t actually save lies.  Nice rebuttal from Drum:

folks has never been likely to have much effect on death rates.1 Below age 55, it’s even less likely: the death rate is so minuscule that it would take a miracle to invent any kind of health-related practice that had a measurable effect on life expectancy. If the crude death rate is already below 0.5 percent, there’s just no way to reduce it much more.

And yet, people like health care anyway. They like it so much that we’re collectively willing to spend vast amounts of money on it. As you’ve probably heard many dozens of times, health care is one-sixth of the economy. On average, that means we all pay about one-sixth of our income to provide health care for ourselves.

Why? At the risk of repeating the obvious, most medical care isn’t about lifespan. Before age 65, almost none of it is about lifespan. It’s about feeling better.

23) This is cool– evolution is slower and faster than you think.

24) This will be my last quick hits ever.

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