Category Archives: Public Policy and Governance

We Aren’t Number One…Not Even Close

Donald Trump is accelerating America’s retreat from the world stage, illuminating our national flaws and demonstrating the contradictions between our aspirations and our performance.

Let’s be honest: a nation that could elect this ignorant, unstable man is a nation seriously in decline. If we are really prepared to be honest, we will also concede that America’s social and racial divisions, extremes of inequality and lack of anything approaching an adequate social safety-net aren’t exactly attributes that confer bragging rights, either.

A prime example is our overpriced and underperforming health care system, which our Congressional overlords are eager to make even worse. How long can intellectually dishonest pundits and politicians keep a straight face while peddling the myth that American medical care is “the best in the world”–that “we’re number one”?

The truth is that, if you are very wealthy or have exceptionally good insurance, you can get extremely good care for serious illnesses in the United States. If you don’t fall into one of those categories, not so much. And if you are an average American with a treatable ailment–or an ailment that should be treatable– your prospects are even worse.

Over at Dispatches from the Culture Wars, Ed Brayton reports on yet another in a long line of studies ranking national healthcare systems.

A new study that looks at the effects of highly treatable diseases, ones for which greater access to continual medical care can mean the difference between life and death, finds that the American health care system lags behind much of the developed world.

There are a number of ways to evaluate healthcare systems, but if you are measuring outcomes over a country’s population, rather than touting cutting-edge therapies available only to the privileged few, the U.S. has long lagged other industrialized countries.

Christopher Murray, a researcher at the University of Washington, and his collaborators looked at 32 causes of death in 195 countries from 1990 to 2015 to create a health-care quality index they used for rankings. Murray described the findings as “disturbing.”

“Having a strong economy does not guarantee good health care,” he said. “Having great medical technology doesn’t, either. We know this because people are not getting the care that should be expected for diseases with established treatments.”…

As might be expected, many highly developed nations, such as Norway, Australia and Canada, scored well. Those in more-remote areas in sub-Saharan Africa, South Asia, Latin America and the Caribbean scored poorly…

The United States measures well for diseases preventable by vaccines, such as diphtheria and measles, but it gets almost failing grades for nine other conditions that can lead to death. These are lower respiratory infections, neonatal disorders, non-melanoma skin cancer, Hodgkin’s lymphoma, ischemic heart disease, hypertensive heart disease, diabetes, chronic kidney disease and the adverse effects of medical treatment itself.

The United States spends enormously more for medical care than any other country–twice as much per capita has the next most expensive system. We just spend our dollars in the least efficient ways possible: multiple non-standard insurance forms, laws that prohibit government agencies from negotiating drug prices, and private insurers whose high overhead costs include everything from marketing to sky-high management salaries and corporate jets. (Medicare’s overhead runs about 3% in contrast to 24-26% for private insurance companies.)

Obamacare is far from perfect (what we really need is “Medicare for All”), but its passage did represent a move in the right direction–and an acknowledgement that access to healthcare is a human right, not a consumer good to be made available only to those with sufficient disposable income. But rather than working to improve it with “fixes” that are fairly simple and obvious, the White House and  the Congressional GOP consistently sabotage it, most recently by threatening to end crucial Affordable Care Act payments to insurers. Politico has reported on the move, and the fact that it would guarantee huge premium increases, the withdrawal of insurers from the O-Care markets, and generally cause chaos across the individual health insurance marketplace.

It’s enough to make you think American policymakers put a higher priority on the bottom lines of Big Pharma and Big Insurance than they do on the health of average citizens.

But then, what do we expect when we elect people so corrupt and self-serving they don’t even care about the health of the planet their children and grandchildren will inherit?

I Guess We Won’t Always Have Paris….

When I read that Trump intends to exit the Paris accords, all I could think of was that famous line from Casablanca, “We’ll always have Paris.”

Well, evidently, we won’t.

Permit me to deconstruct Trump’s gift to China, a gift that comes on the heels of his large assist to Putin’s geopolitical ambitions, thanks to his conspicuously lukewarm show of support for NATO.

Stephanie Rule posed an interesting–and illuminating–question to her panel during yesterday’s news broadcast: Since the Paris Accords have no mechanism for enforcement, why exit? If the Administration is convinced that pursuit of a particular goal is inconsistent with American economic interests, why not simply refrain from pursuing that goal?

The answer can be found in Trump’s ego and his animus toward Barack Obama. Failing to enforce a particular element of the Paris agreement would accomplish what Trump says is his goal: protecting American interests (at least as he defines them). But it wouldn’t generate the attention he so obviously craves. And it wouldn’t be yet another public attack on Obama’s legacy.

I’m not a psychiatrist (and I don’t play one on TV), so I don’t know the genesis of Trump’s obvious hatred of Obama. Jealousy is clearly a big part, and I suspect it is magnified by racism: How dare this uppity you-know-what garner the obvious respect and admiration of world leaders who snicker at Trump? How dare he draw far larger crowds? It’s insupportable.

Whatever the psychiatric explanation, Trump’s animus toward Obama and his egomaniacal need to be the center of attention have done significant damage to America’s stature in the world, and that damage is not limited to our moral leadership. His disastrous first international trip convinced our longtime allies that America is currently headed by someone too erratic and ignorant to be trusted. (Think about that when you have to get a visa for your next trip to Europe–a document that was not previously required of U.S. citizens. At least when you return, getting through customs should be a snap: tourism to the United States has dropped dramatically since Trump’s election.)

Power vacuums don’t last; when one country’s global influence ebbs, other countries fill the void. Over the past several years, China has moved aggressively to increase its global reach from South Asia to Africa. Google “China’s growing global influence” and you get thousands of links to articles documenting the country’s strategies and global investments.

In contrast to the Trump Administration’s peevish anti-science posture, China is moving (with most other developed nations of the world)  to shift its economy to clean energy.

As 2017 begins, China is poised to leap ahead of the United States on clean energy to become the most important player in the global market. Last year, China increased its foreign investment in renewables by 60 percent to reach a record $32 billion, according to a new report from the Institute for Energy Economics and Financial Analysis. This includes 11 new overseas investment deals worth more than $1 billion each.

China’s new Going Global strategy for renewable energy was an important instigator of its huge increase in foreign investment in 2016. This is part of a broader picture of overseas investment. Last year, China showed its regional strength by establishing the Asia Infrastructure & Investment Bank and pouring money into the BRICS’ New Development Bank, which made its first loans, all for renewable energy.

And in contrast to Trump’s doomed effort to prop up a dying coal industry, China is generating economic growth through its commitment to renewable energy.

Looking at the entire economy, not just foreign investment, China regularly outspends the United States on renewable energy. It invested more than $100 billion in clean energy in 2015, more than double U.S. investment, which spurred robust job growth. Of the 8.1 million renewable energy jobs that exist globally, 3.5 million are in China, compared to less than one million in the United States. And China’s National Energy Administration projects that new investment from 2016 to 2020 will create 13 million jobs in the renewable energy sector.

People around the world used to study English in the belief that an ability to communicate with the dominant world power was important. I wonder how many people are studying Chinese these days….

Liar, Liar, Pants on Fire

There are lies, and then there are lies that make sentient humans do a double-take.

Anyone who follows the news knows that Donald Trump lies routinely. What makes his constant prevarications different from the spin (and worse) engaged in by more stable political figures is how pathetically inartful they are (you really have to want to believe them, in which case it helps to avoid reputable news sources).

But even those of us who have become inured to the constant tweets, the misspellings and weird syntax, and the widening chasm between Trumpism and reality had to be stunned by his transparent lie at the G7. As the Washington Post reported,

Cohn said that Trump did not want his G-7 partners to think he did not care about the environment, so the president told them, “The environment is very, very important to me, Donald Trump.”

Trump also told his counterparts that he has won environmental awards in the past, Cohn said. The Washington Post’s Fact Checker has found no evidence of any such awards — aside from one issued by a golf association for his New Jersey golf course — and environmentalists have strongly criticized many of his real estate projects over the years.

Yes–unreal as it seems, the man who has repeatedly called climate change a “Chinese hoax,” the man who wants savage cuts in the EPA budget, the man who put a climate change denier/fossil fuels apologist in charge of the nation’s environmental agency–that man pretended to be an award-winning protector of the environment in order to make himself look important to people he was trying to impress.

What is really terrifying about this episode isn’t the lie itself. It is Trump’s evident belief that it would be accepted at face value, that no one would question or fact-check it–that none of these knowledgable, sophisticated and informed heads of state would see his pathetic pose for what it so clearly was. (What’s even more terrifying is the distinct possibility that Trump actually believes whatever nonsense he’s spewing at any particular moment.)

As Ed Brayton points out, this particular lie has been trotted out previously, fact-checked, debunked, and awarded four Pinocchio’s. But in Trump’s universe, evidently, the fact that knowledgable people know he is lying, the fact that his obvious untruths are undermining whatever credibility he might have had with anyone but his most cult-like supporters, is irrelevant. It’s what makes him feel important in the moment.

Americans who followed Trump’s first trip abroad were repeatedly embarrassed by his clownish behaviors, his ignorance of history, policy and protocol, and his multiple gaffes. We cringed at the obvious disdain he elicited from the leaders of our longtime allies.

His constant compulsion to lie confirmed–and displayed– his emotional neediness.

This man isn’t just a lazy and intellectually-challenged buffoon. He’s mentally ill. And far from making America great, his self-important, fact-free posturing has made the United States a laughingstock and diminished any claim to global leadership.

On the other hand, it has certainly strengthened the European Union…

 

What Swamp Is Being Drained?

Reactions to Trump’s proposed budget from the country’s much-disparaged “elites” has been unremittingly negative, for obvious reasons–if such a budget actually passed, it would eviscerate support for science, the arts, medical research, children’s health, urban redevelopment and transportation, not to mention food for the poor.

As many policy analysts have pointed out, this budget would wreak havoc for huge numbers of Trump voters, which raises an obvious question: why would the administration  risk proposing massive cuts to the very programs that benefit his base?

A recent post to Washington Monthly  by Nancy LeTourneau offered a chilling answer to that question.

She begins by referencing an article about the budget by Damian Paletta and Robert Costa:

The budget, in its deeply conservative framework, risks alarming some of the president’s supporters…

But a White House official, who was not authorized to speak publicly, said Trump saw the shrinking of the “welfare state” as a necessary component of his nationalist, working-class appeal and part of his pledge to “drain the swamp.”

The unnamed official was almost certainly Bannon, who has been quoted as promising that Trump would bring “capitalism” to the inner cities. Bannon’s version of capitalism bears a striking resemblance to Social Darwinism’s “survival of the fittest.” (It certainly doesn’t include government action to level the playing field for people who would otherwise be excluded.) His is a savage, unregulated version of capitalism, and for Bannon, it applies primarily if not exclusively to inner cities.

“Inner city” is code, as LeTourneau notes, for people of color.

That kind of argument works once you have identified the recipients of government programs as the undeserving “them” who are separate from the deserving “us.” That is the divisive lie that Paul Waldman zeroed in on today.

The whole point here is to set “taxpayers” against the supposedly undeserving whose scams and schemes can be stopped with only indiscriminate cuts to social programs. Watching Mulvaney answer questions from the press this morning, that idea came through again and again. Every time he’d get a question about a specific cut the administration proposes — to Social Security disability, to food stamps, to Medicaid — Mulvaney would say that the only people who would suffer would be those who don’t deserve to get the benefit in the first place. “We are not kicking anybody off of any program who really needs it,” he said.

By now, most sentient beings should recognize that as the kind of code Lee Atwater explained when talking about the Southern Strategy.

As LeTourneau points out, this budget gives “draining the swamp” a whole new meaning. The phrase no longer applies to our maligned bureaucracy, or to the people (like the President himself) who have enriched themselves by taking advantage of government programs and tax loopholes; it applies instead to “those (dark) people” who are undeserving parasites living off hardworking taxpayers.

As Gabe Ortiz explains:

Sure, the new 2018 budget slashes billions from food assistance, cancer research, and disability benefits, but the Trump regime has still miraculously found plenty of taxpayer money for two of his favorite, racist pet projects. Office of Management and Budget Director Mick Mulvaney unveiled a budget proposal asking for billions to terrorize immigrant families, expand Trump’s mass deportation force that has been targeting moms and dads with no criminal record, and to build some of that f*cking wall that Mexico was supposed to pay for.

As LeTourneau  reminds us, none of this is new.

It is all Republican rhetoric from the past that is being warmed up and repackaged for the present. These are the tactics they have been using for decades now to win over the support of white working class voters and, for the most part, they’ve worked. Why change course now?

Support for “draining the swamp” all depends upon who you think inhabits the swamp.

They Run (for Office) and They Hide….

The unremitting chaos in Washington has triggered a number of Town Halls in which GOP members of Congress have faced rooms filled with angry constituents. As a result, a number of other Representatives have evidently decided against holding such events.

Not surprisingly, hiding from the people you represent hasn’t made those constituents very happy. Their reactions have varied.

I recently had an interesting conversation with a woman who lives in Indiana’s Fifth District, represented by Congresswoman Susan Brooks. She told me that she and several of her friends and neighbors had been frustrated by Brooks’ unwillingness to hold a Town Hall, so they decided that they would organize a meeting and invite her. If she wasn’t going to take the initiative, they would.

A meeting was organized via Facebook and word of mouth, and at 2:00 in the afternoon of May 13rth, approximately 120 5th District constituents gathered at the Sullivan Muncie Cultural Center in Zionsville.

Brooks declined to appear, nor did she send a representative, so the organizers set up an empty chair with her photo and proceeded to conduct a meeting without her.

According to her report, the voters who gathered at the Cultural Center were there primarily to voice their very serious concerns about the GOP Healthcare Plan, although  several other issues were raised as well.

Given the Congresswoman’s reluctance to attend either in person or through a surrogate, the organizers anticipated an effort to dismiss attendees as “agitators” or people from outside the district; in order to rebut any such claims, they prepared a “sign in” book in which those present provided their names, addresses and emails.  During the meeting, each voter was offered an opportunity to speak, to fill out a card with questions for Ms. Brooks, and to sign a large paper scroll expressing their views. The organizers plan to deliver these items to Brooks’ office.

The constituents who spoke at the nearly three-hour meeting shared stories of people with pre-existing conditions, children with ongoing medical needs, and people injured on the job who then saw those jobs eliminated. They  talked about the extent to which they and their families would be harmed by the repeal of Obamacare and its replacement by the current iteration of the GOP healthcare bill.  Some cried.

At the conclusion of the emotional meeting, those in attendance agreed to redouble efforts to meet face to face with Congresswoman Brooks. With or without the Congresswoman, however, they are determined to hold a series of Town Hall Meetings throughout the 5th District.

What is remarkable about this–at least to me–was the event’s genesis and spontaneity. I’ve complained bitterly over the years about Hoosiers’ civic apathy and lack of political engagement, our embarrassingly low voter turnout…Yet here in central Indiana, with no partisan sponsorship, no encouragement from activist organizations, no donations from any lobby or special interest group, ordinary voters got together and demanded to be heard.

It will be fascinating to watch this new democratic (small d) wave play out, not just in Indiana but in Congressional districts across the country. Will elected officials listen? If not, will they be voted out? How safe are those safe, gerrymandered districts?

What’s that old saying? They can run but they can’t hide….