The chart to keep in mind for 2018

Love this from Pew that compares people who vote consistently in presidential and midterm elections with those who just vote in the presidential years.  It makes it pretty damn clear we have had a recent pattern of Democrats performing well in presidential years (and, let not forget the 2016 popular vote) and getting various levels of creamed in the midterm years.

In large part, because Democrats rely so heavily on young voters and minority voters, they disproportionately suffer from the drop-off in midterm years.  For example, the youngest cohort is only 6% of consistent voters, but 20% of drop-off voters.  Even more dramatically, non-white voters are only 20% of consistent voters, but 38% of drop-off voters.  Now, the Democrats are almost surely more likely to drop off more, again, in 2018, but the key is to have dramatically less drop-off.  And, I actually think there’s a decent chance of that.  Regardless, this is the baseline to keep in mind.

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Photo of the day

Okay, this is a pretty amazing hurricane photo in Atlantic photos of the week:

The eye of Hurricane Jose, imaged by the European Space Agency’s Sentinel-2A satellite, on September 9, 2017. 

CC BY ESA / Processed by Antti Lipponen

Single payer cognitive dissonance

So, Ezra Klein says Bernie pushing for single payer is actually a good thing, despite it being largely fantasy:

Jonathan Chait, at New York magazine, says Bernie Sanders’s Medicare-for-all bill “gets America zero percent closer to single payer.”

Chait’s argument, which I largely agree with, is that “single payer has always been, and remains, a political dilemma that nobody has been able to resolve, and there is no evidence the resolution has grown any easier.” But his conclusion — that Sanders “has accomplished approximately zero percent of the necessary work” — misses what I think Sanders is trying to do, and what a reasonable definition of success looks like.

Sanders’s bill stands very little chance of ever being enacted, or of getting America to single-payer. As I’ll explain, it solves precisely none of the problems that have foiled every other single-payer plan in American history. But it stands an excellent chance of getting the country quite a lot closer to single-payer.

What Sanders has achieved here is remarkable. A policy that used to be tentatively embraced by elected officials on the party’s left is now being enthusiastically embraced by key leaders from its mainstream, including the party’s most promising 2020 contenders. Even Joe Manchin, the Senate’s most conservative Democrat, is proclaiming himself open to the idea. Sanders has thrown a rock through the Overton window.

At the same time, it’s important to recognize what Sanders hasn’t achieved, and in fact hasn’t even tried to achieve: He has not solved or even admitted any of the very real challenges to implementing single-payer health care in the United States.

Sanders’s bill has 16 co-sponsors, including most of the Senate Democrats most often mentioned as possible 2020 presidential contenders. In one fell swoop, he has taken single-payer from an ideal on the margins of the Democratic Party to a goal endorsed by its likeliest standard-bearers.

The Democratic Party could’ve oriented itself around a number of health care goals in the coming years. It could’ve simply sought to improve Obamacare. It could’ve focused on cutting costs, or lowering premiums, or getting closer to universal coverage. But Sanders, I think, has preempted all that: He’s made the goal single-payer.

Most of Ezra’s post, though, is about how the goal of single-payer is virtually infeasible policy-wise and politics-wise.  Hmmm.  I love the goal of universal coverage.  To insist on the means of single-payer in the United States that has  a unique history and politics working against single payer, strikes me as unwise.  If the single-payer goal actually gets us closer to a good system of universal coverage, then, hey, I’m for it.  I’m just not sure that it does.  I worry that it sets up entirely unrealistic expectations.

Chait:

The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writesSanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare…

That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it…

There is nothing in Sanders’s rhetoric that indicates he even recognizes the shape of the political problem. Instead he employs the classic populist technique of imagining the people as a whole standing united around an obvious solution, and only the machinations of an invidious elite can thwart them…

Evil corporations are the only impediment he acknowledges. At no point does he grant that the most important source of opposition will come from actual American voters concerned about losing their current plan or paying higher taxes…

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit. [emphases mine]

And Chait’s response to Ezra:

Among center-left health-care analysts, there is very little disagreement that Bernie Sanders says a lot of things on the subject that are misleading or wrong, and that his bill stands little chance of enactment even if Democrats win full control of government. His defenders instead make a different argument: By taking extreme positions, they say, Sanders creates more political room for rational reforms to take hold…

There is a virtual consensus among progressives that the United States would be much better off if it had implemented single-payer insurance, or some other national health-care plan used by industrialized democracies, many decades ago. Instead, the American health-care system grew up around the malformed incentives created by employer-sponsored insurance and fee-for-service medicine. The astronomical cost of medical care, the deep fear of change among the insured, and the entrenched interests of providers have all made the system nearly impervious to systemic reform.

Sanders has not cracked this problem. Nobody really claims he has, or even claims that he has grappled with it. His alleged contribution is to refuse to acknowledge the problem at all. He assumes implausibly large savings, and dismisses fiscal estimates of the cost of his plan as rigged by crooked drug companies. He tells a different, much simpler story than other Democratic politicians. In his words, the only important question is a conviction about the morality of universal insurance, and only obstacle to progress is the profits of the insurance and drug industry. (He omits doctors and hospitals, not to mention change-averse voters themselves.)…

The theory also dismisses the possibility that the candidates who endorse the Sanders plan open themselves up to the attack that they favor a large middle-class tax hike. The Sanders plan attempts to deflect this vulnerability by leavings its financing mechanism open-ended as a list of suggested revenue-raisers. It will work if candidates can get away with attaching themselves to the promised benefits of his plan without committing themselves to the pay-fors it requires. Republican politicians often get away with this kind of legerdemain — but only because they benefit from a partisan right-wing media ecosystem. Democrats need to run the gauntlet of an independent news media that is unlikely to let them run around promising trillions of dollars in new spending without trillions of dollars in new taxes.

Meanwhile, Catherine Rampell is having none of it:

Thanks to the Grand Old Party’s demagoguery, Democrats have for a little while enjoyed a virtual monopoly on facts, evidence and experts. Dems — or some of them, anyway — embraced serious, solutions-based, often technical policymaking and the hard choices that went along with it.

But the lesson the Democrats seem to have taken from the 2016 electoral trouncing is that they need to become more like Republicans. Meaning: Abandon thoughtful, detail-oriented bean-counting and attempts to come up with workable solutions grounded in (occasionally unpopular) reality, and instead chant virtue-signaling catchphrases.

Such as “single-payer.”…

But we’re not starting from scratch. We live in our patchwork world, which means if we want single-payer — an ill-defined catchall, by the way — we need to figure out how to get from here to there. This involves painful political choices, sharp tax hikes and some degree of buy-in from the many stakeholders who are going to get shafted in the transition.

The goal should be universal health care, however we get there. And we’re much likelier to get there if we start from a baseline of reality than if both parties hand-wave away inconvenient truths. There is no courage in saying everyone should have health care. The courage is in staking out a plan to pay for it.

Okay, maybe not so much dissonance.  I think this marks one of the times I just disagree with Ezra Klein.  I’m more persuaded by both Rampell and Chait.

And, to reiterate the key point– Democrats absolutely need to be for genuine universal coverage that reduces overall system costs.  If advocating for single payer gets us to that goal, well, alright, then.  But single payer is a pipe dream given where we are.  Yet, there are other approaches, e.g., gradual Medicaid buy-in, that are far more feasible as policy and politics that reach the same end.  Seems to me, that should be where we put our focus and not lose sight that the goal is the key, not the means.

——

Okay, you know what, I thought about this more after queuing it up to post and I’m even more frustrated by this.  It would be one thing if Sanders actually understood the realities and complexities of health care policy (the way in which he so readily elides the many complexities suggests he either doesn’t know or doesn’t care) and saw advocating for single payer as the most effective way to improve our health care system.  But, instead, it seems that Sanders really doesn’t understand or care about these complexities and has a doctrinaire commitment to single payer that ignores so much reality.  That’s frustrating and I don’t like seeing the Democratic party follow him down that path.

One chart (on teaching) to rule them all

This whole article in Quartz on what America does wrong on teaching is excellent.  Pretty sure this will make it into the Public Policy syllabus.  Now, of course, there’s so much more to school performance around the world than relative teacher pay, but this depressing chart really tells us a lot:

What this chart tells us in stark terms is that the United States simply doesn’t value teachers.  So many of our other problems flow from that.  If we valued teachers we’d invest more in them and get more of America’s best and brightest in in the profession and take more seriously what it takes for them to succeed.  Do all that, and America’s schools get noticeably better.  These two paragraphs capture a lot:

Money and prestige matter. The highest performing education systems always prioritize the quality of teachers says Andreas Schliecher, head of the education directorate at the OECD. “Wherever they have to make a choice between a smaller class and a better teacher, they go for the latter. Rather than putting money into small classes, they invest in competitive teacher salaries, ongoing professional development and a balance in working time.”

US teachers spend 38% more time in front of the classroom than their international peers: 981 hours compared to an OECD average of 712 per year. This is time that they are not collaborating with peers, honing their knowledge of their subject or the practice of teaching.

It’s somewhat of a chicken and egg problem in that we don’t pay teachers enough because we don’t value them enough.  And one reason we don’t value teaching is that we (accurately) see it as a low-paying profession.  I’d love it for some forward-thinking school system to find a way to blow this up and just start paying teachers a ton more and let all the benefits flow from that.

Quick hits (part II)

1) Right up my alley– gut bacteria may be a key to weight loss:

Using feces samples, Danish researchers analyzed the ratio of two gut bacteria, Prevotella and Bacteroides, in 62 overweight people. For 26 weeks, they randomly assigned them to a low-fat diet high in fiber, fruits, vegetables and whole grains or a diet comparable to that of the average Dane.

Those on the high-fiber diet with a high Prevotella to Bacteroides ratio lost an average of 10 pounds of body fat, three and a half pounds more that those on the diet with a low ratio.

Obviously, there’s a long way to go on this topic.  But I fully expect that people will be losing weight by modifying their microbiome within the next 10-20 years.

2) I loved this Science story about NC State paleontologist Mary Schweitzer.  Great story of paleontological controversy over dinosaurs, but I loved learning that Schweitzer started out as a young-earth creationist.

3) Is Apple charging too much for the Iphone X?  Maybe.

With the iPod—Apple’s first successful stab at market dominance—Apple had begun with a high price but quickly dropped it. Over the next few years, the iPod underwent amazing transformations, each one introducing vast improvements and—wait for it—much lower prices. It was a classic instance of Moore’s Law, which explained how tech devices can quickly get both cheaper and dramatically better.

But the iPhone was different. It was introduced with $499 at its top price—and 10 years later, its successor costs twice as much. Apple is treating Moore’s Law as if it were a jaywalking statute. Even the second-rung phone announced today, the iPhone 8—albeit a substantial upgrade to the current top-line model—starts at $699.

I love my Iphone.  But, yes, it is a rip-off (especially what Apple makes you pay for additional memory).

4) Haven’t followed it that closely, but the acquittal of police officer Jason Stockley does seem really, really wrong.

5) Of course Trump’s fraudulent voter fraud commission is using private emails.  Lock them up!

6) Nicely reported piece by Michelle Cottle on why cutting taxes will be harder than Trump thinks.  “Failure is always an option.”

7) A policy that will both punish the poor and increase the deficit?  GOP is all over that.

8) How the opioid epidemic made Vox’s German Lopez far more skeptical of full drug legalization:

Meanwhile, the government responded very slowly. The opioid epidemic began in the late 1990s, particularly with the birth of Purdue Pharma’s OxyContin in 1996. But it wasn’t until 2014 that the Drug Enforcement Administration rescheduled some opioid painkillers to put harsher restrictions on them. And it took until 2016 for Congress to pass a law that attempted to seriously address the epidemic.

In fact, the federal government pushed doctors to prescribe opioids through the “Pain as the Fifth Vital Sign” campaign in the 1990s and 2000s, as drug companies misleadingly marketed opioids to treat chronic pain. And in some cases, different levels of government loosened access to opioids after lobbying from drug companies — by passing laws that, for example, required insurers to cover the drugs.

And while Purdue Pharma was eventually fined for its horribly misleading marketing for OxyContin, the hundreds of millions it paid added up to peanuts compared to the tens of billions it’s reaped from the drug.

As a result, a lot of people have died: In terms of overdoses, the opioid epidemic is deadlier than any other drug crisis in US history — more than crack, meth, and any other heroin epidemic. In total, more than 560,000 people in the US died to drug overdoses between 1999 and 2015 (the latest year of full data available) — a death toll larger than the entire population of Atlanta. And while many of these deaths are now linked to illicit drugs like heroin and fentanyl, the source of the epidemic — what got people started on a chain to harder drugs — was opioid painkillers, and legal painkillers were still linked to most opioid overdose deaths as of 2015 (although there are signs that changed in 2016).

This was exactly what anti-legalization activists have warned about: Companies got a hold of a dangerous, addictive product, marketed it irresponsibly, and lobbied for lax rules. The government’s regulatory response floundered. The government even worked with the drug companies in some cases — under the influence of lobbying, campaign donations, and drugmaker-funded advocacy groups. And people got addicted and died.

Looking at this crisis, it slowly but surely dawned on me: Maybe full legalization isn’t the right answer to the war on drugs. Maybe the US just can’t handle regulating these potentially deadly substances in a legal environment. Maybe some form of prohibition — albeit a less stringent kind than what we have today — is the way to go.

9) The fact that Mark Joseph Stern thinks DeVos is taking the right steps on campus rape, make me feel all the more confident that indeed she is.

10) This Op-Ed in support of keeping Confederate statues struck me as laughably bad:

Already across the nation there are moves afoot to take down monuments to Christopher Columbus, George Washington, Thomas Jefferson, James Madison, Andrew Jackson, and Woodrow Wilson, and to rename countless institutions, schools, towns, and much more. These efforts are part of an immense national effort which has at its origin small, hard core Communist groups, like the Workers’ World Party in Durham – the same group that cheers on Kim Jong Un in North Korea – who wish to completely erase nearly all American history, to rewrite totally all our past, to purify it of all perceived “impurities.” Once begun, where do they – where will it – stop?

But like all violent forces that wish to purify the past, these efforts end in a kind of intellectual and spiritual madness that devours us all and knows no end. For it is not just Confederate monuments, it is monuments to Vietnam veterans, to the Founders of this nation, to doctors, to women, to children … anyone who did not share a strict Marxist vision of society a century ago … that are now targeted.

Riiiiiight.  The communist menace, coming for our monuments.  What is this?  1952?

11) Still need to read Coates‘ big piece on race and Trump, but I still found George Packer’s rejoined quite compelling:

At the heart of American politics there is racism. But it’s not alone—there’s also greed, and broken communities, and partisan hatred, and ignorance. Any writer who wants to understand American politics has to find a way into the minds of Trump voters. Any progressive politician who wants to gain power has to find common interests with some of them, without waiting for the day of reckoning first to scourge white Americans of their original sin. This effort is one of the essential tasks of politics.

12) Seth Masket on the foolish attempts to silence Hillary Clinton.

13) James Fallows‘ very positive take on her book.

14) And I thought Ezra’s interview with her was really, really good.

15) Greg Sargent: “Hillary Clinton’s new book blasts Republicans and Russia. She’s 100 percent right.”

16) Why, yes, the NC legislature does need to stop governing by whim and decree.

17) Jon Bernstein on how Democrats’ embrace of Sanders’ single payer is not actually the equivalent of “repeal and replace.”

18) I’m not sure if this is how to fix it (sounds good), but if you want to reform criminal justice in America, you probably want to start with prosecutors offices.

19) This Quora post is actually the best thing I’ve ever read on white privilege:

What people are saying is:

  1. Denying you are lucky is silly.
  2. Stop looking bewildered every time a short person can’t reach something. We’re sick of explaining this incredibly simple concept.
  3. We know there are things you do not have (i.e. even higher shelves).
  4. We know there may be other things preventing you reaching the high shelves. Maybe you have bad elbows or arthritis. Short people with arthritis are still below you. You are still lucky you are tall.
  5. It works out well for most people, for the grocery store to put most things on medium shelves.
  6. If you can help shorter people with things on higher shelves, do so. Why would you not do that? Short people can help you with stuff on lower shelves.
  7. We are annoyed that the people who run the grocery store put all the best stuff on the top shelves.
  8. There are a lot of people who are putting things on higher shelves because they hate short people. Don’t associate with those people. They want everything to be about this height:

Same with white. Advantages. It doesn’t mean you’re rich. It doesn’t mean you’re luckier than a lucky black guy. Nobody wants you to be crippled with guilt. Nobody has ever wanted that, or means those things.

It means you have an advantage, and all anyone is asking is that you *get* that. Once you get that, it’s pretty straightforward to all the further implications.

20) Thanks to Irma and decaying infrastructure, Florida is awash in human sewage.

21) John Judis— who once argued that demographics are inevitably on Democrats side, no longer believes that is the case.  He makes the case for an economics-based Democratic politics of the future:

The second fact about elections is that conservatives in both parties have repeatedly defeated left and center-left candidates by dividing their natural constituency—the bottom two-thirds of America’s economic pyramid—along racial or ethnic lines. The Democrats who have successfully countered this divide-and-conquer strategy didn’t turn their backs on the civil rights of African Americans or Mexican-Americans, or on a woman’s right to choose; rather, they emphasized the fundamental interest in prosperity and peace that unites the working and middle classes. Think of Bill Clinton’s “putting people first” campaign in 1992, or Obama’s reelection effort in 2012, when he spent the year contrasting his vision of a country in which “everybody gets a fair shot” with the GOP’s “same old you’re-on-your-own philosophy.” …

If Democrats try to win future elections by relying on narrow racial-ethnic targeting, they will not only enable the Republicans to play wedge politics, they will also miss the opportunity to make a broader economic argument. Not long ago, I spoke with Mustafa Tameez, a Houston political consultant who made his name helping to elect the first Vietnamese-American to the Texas House. The momentum in American politics, he believes, is with Democrats who stress “an economic message rather than ethnic-identity politics. We can’t buy into the conservative frame that the Democrats are a party of the minorities.”

This thinking runs contrary to the “race-conscious” strategy touted by Democrats who believe that a majority-minority nation is a guarantee of victory. Sorry to say, but it’s not going to happen. The best way for Democrats to build a lasting majority is to fight for an agenda of shared prosperity that has the power to unite, rather than divide, their natural constituencies. There is no need, in short, for Democrats to choose between appealing to white workers and courting people of color. By making a strong and effective case for economic justice, they can do both at the same time.

22) Your absolute must-read for today– the resegregation of Jefferson County

Photo of the day

Seems like I would be remiss not to include a photo from Cassini.  Nice gallery in Vox

Here’s Titan in orbit around Saturn.  NASA/ JPL

 

Why I never give up the internet

I was going to put this in quick hits, but I loved this New Yorker essay from Matthew J. X. Malady to make it share.  He “unplugged” for 72 hours and I totally love his response to it:

During the world’s longest weekend, it became clear to me that, when I’m using my phone or surfing the Internet, I am almost always learning something. I’m using Google to find out what types of plastic bottles are the worst for human health, or determining the home town of a certain actor, or looking up some N.B.A. player’s college stats. I’m trying to find out how many people work at Tesla, or getting the address for that brunch place, or checking out how in the world Sacramento came to be the capital of California.

What I’m learning may not always be of great social value, but I’m at least gaining some new knowledge—by using devices in ways that, sure, also distract me from maintaining a singular focus on any one thing. I still read deeply, and study things closely, and get lost for hours at a time in sprawling, complicated pieces of literature. Since moving to California from Manhattan a couple of years ago, I’m almost certain I’ve paid attention to more sunsets and cloud configurations and blooming flowers than I had in the previous decade. But I also enjoy being able to find out what year Chinua Achebe published “Things Fall Apart” in roughly three seconds. And, while it is true that, as Nicholas Carr, Jaron Lanier, and others have pointed out, my desire to learn in this manner means that I am opening myself up more completely to advertising saturation and affronts to personal privacy, I’ve made the choice to live with and combat such vexations rather than proceed through life overrun with stagnating curiosity.

Yes, yes, yes!  My favorite thing about the internet.  I am always, always learning.  No way would I voluntarily give that up.  A couple times a year when we visit my grandmother-in-law I am without any internet for most of a day.  And it’s usually a lovely day, but I feel absolutely no need to voluntarily untether.  There’s too damn much to learn.

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