System and Lifeworld

That's the subtitle of the second volume of The Theory of Communicative Action, by Jurgen Habermas. It's very heavy going so I don't necessarily recommend that you try to read it. But it seemed like a good title for this post.

Our modern, complex society is nothing like the kind of societies in which humans evolved. People lived in bands in which everybody knew everybody else, in fact they had varying degrees of kinship, and they communicated face-to-face. Many people are still part of communities like that, to some degree, although for most of us they are more diffuse. We're mobile, we don't see most of our kin regularly. Most of our daily interactions are in the form of narrow role relationships -- worker and boss, customer and server, teacher and student, colleague. And of course there is a vast system of mass communication that is our only window into a world far wider than the village or band, that affects us in ways that are often mysterious, in the face of which we feel largely helpless.

People's brains aren't really built for this. It's not hard to understand why people who are frustrated about the conditions of their lives would have mistaken ideas about what is causing their problems and what to do about it. It's perhaps a bit less obvious, but I hope it is now that I point it out, that messages may come through the system that people perceive as slights, or offend their sense of propriety. But in the old days any such message would come from a person you could have a conversation with. You could tell them how you felt, hopefully work out an understanding, or choose to avoid that person in the future. But people can't talk back to their televisions.

NPR has devoted about half of its news content of late to interviews with Donald Trump supporters. I can't even listen any more, I turn off the radio during my commute whenever they do this. It's just too disturbing to realize that we wound up with a malignant narcissist, authoritarian blithering idiot as president because these people are so deeply incapable of critical thinking. But as Chauncey DeVega explains, perhaps with a subtext less sympathetic than I would like, the shit will hit the lifeworld.

No, they won't get well-paying jobs bolting cars together or mining coal. If the Mexicans all get shipped back to Michoacan, their food will get more expensive. In fact, more of it will be imported and a lot of the local farms will go out of business. If we throw up high tariffs, everything in WalMart will cost more and our export industries will decline. If they repeal the affordable care act, a lot of them will lose their health care and it will get more expensive for the rest of them. And those are just the promises Trump made that they thought they liked. He's going to trash their public schools, make them breathe toxic fumes, cut their social security benefits, and oh yeah, their taxes will go up even as their wages go down.

The dirty secret is that federal taxpayer funds flow from states with liberal electorates to Republican states. As DeVega writes:

As philosopher Henry Girioux has repeatedly warned, the “dead zone of capitalism” will only be expanded by Donald Trump and the Republican Party’s obsessive advancement of predatory capitalism and austerity. “Red State” America is already economically unproductive and parasitic, largely dependent on the taxes and economic activity generated in “Blue State” America. As such, Trump’s policies will disproportionately punish his greatest supporters.

So what will happen when they look around in a couple of years and find themselves worse off? We'll find out.

The dog who caught the car

It's actually amusing watching the Republicans in congress flailing around trying to figure out how to repeal Obamacare. It turns out they didn't actually understand what it does and have no idea of what to do instead. Here's Sen. Schatz (D-HI) telling the amusing tale of Republicans begging him for help because they don't want to own what they are about to do.

"They want to be able to claim this is part of a good faith negotiation, but it's simply not.They have no idea what comes next so they want some bipartisan cover for their nonsense behavior," Schatz said.

He also said Republicans were looking for Democratic cooperation so that they can share the blame."They're really worried because anyone who pays any attention to health care knows exactly what is about to happen to the system, to the market and to individuals, and they don't want to be blamed for it so they're trying to see if they can take us off the cliff with them and we aren't going to abide by it," Schatz said.

They've been spending the last seven years telling people they're supposed to hate the Affordable Care Act, but they never got around to explaining why they are supposed to hate it. The fact is, the only way to extend affordable coverage to the population is to do what the ACA does: get everybody into the pool, require community rating (i.e. don't charge more to sick people), and provide subsidies for low income people and families. There's no other way. The ACA is something of a Rube Goldberg contraption, but that's because Congress is unwilling to pass the right solution, which is:

Universal, comprehensive, single payer national health care.

UPDATE: I commend to your attention Kevin Drum, who also asks why Republicans hate Obamacare. He notes that when polled, people like all the individual pieces of it; they also like it much better if it's called Kynect or the Affordable Care Act. Quoth Mr. Drum:

So why the continued rabid opposition to Obamacare? It's not because the government has taken over the health care market. On the contrary, Obamacare affects only a tiny part of the health insurance market and mostly relies on taking advantage of existing market forces. It's not because the benefits are too stingy. That's because Democrats kept funding at modest levels, something Republicans approve of. It's not because premiums are out of control. Republicans know perfectly well that premiums have simply caught up to CBO projections this year—and federal subsidies protect most people from increases anyway. It's not because everyone hates what Obamacare does. Even Republicans mostly like it. The GOP leadership in Congress could pass a virtually identical bill under a different name and it would be wildly popular. In the end, somehow, this really seems to be the answer:

Republicans hate the idea that we're spending money on the working class and the poor. They hate the idea that Barack Obama is responsible for a pretty successful program. They hate the idea that taxes on the wealthy went up a bit. They hate the idea that a social welfare program can do a lot of good for a lot of people at a fairly modest price.
What kind of person hates all these things?

Words of Wisdom

As I've been struggling to understand how so many voters -- not the majority,  we need to keep repeating -- but a lot, could have possibly thought it was in their interest or the world's to make a malignant narcissist, raging idiot and bigot president of the United States, along comes George Lakoff to remind us of how electoral politics really works.

I have noted that most voters have little understanding of public policy. I'm a particularly rational type of person. I try to collect information and work out the logic of problems. I study public policy the way academics do, because that's what I am. But few people have the time or inclination to do that. People live in constructed worlds, what Lakoff calls frames. Any information that doesn't fit in the frame will be ignored, disbelieved, or dismissed as anomalous.

What he is a bit less explicit about, but I believe he would agree with this formulation, is that the frames are built out of words. There are images in there as well but Lakoff focuses mostly on language. The words connect with each other in a web of presumptive causal and affinal relationships, and they have positive and negative connotations. Lakoff also says that frames contain value systems, and he sees a divide in U.S. (and possibly other countries') political culture between a system based on the view of the family as nurturant, and a contrasting view of the family as authoritarian. The family is our fundamental metaphor for the organization of society at higher levels, so these views of the family shape people's political allegiances.

Conservative political activists understand all this better than liberals because they study business and marketing in college, while we're off studying history and biology and useless stuff like that. Marketers know how to reach people, and they are totally amoral. Sell the sizzle, not the steak, the saying goes. Buy this car and you'll get a hot girlfriend. Drink this beer and you'll be a fascinating person. Vote Trump and win, win, win!

We need to learn these lessons. Elections are not machinery for turning people's self-interest into policy. If they were, the self-interest of 5% or less of the population would not continually prevail. We need to get a bit cynical, I think, and start talking to people in their own language.

Anyway, read Lakoff.

Tragedy or Farce?

It's getting to the point that I can't write anything because I don't know where to begin. The idea of Donald Trump as president was preposterous from the beginning, but nobody could quite imagine what the reality would be like. At this point it's an even bet, for me, whether the Trump presidency self-destructs in an explosion of idiocy, or whether it destroys us first.

The oppo research memo on the Russian connection is a lot of fun, but the absurd prospect of appointing RFK Jr. to head a presidential commission on vaccine safety is more telling. This will almost certainly not end up convincing people not to vaccinate their kids -- instead it will convince people that Donald Trump is a fool. If he wants funding for it he'll need legislation, which he won't get. If he tries to let Kennedy mess with the CDC in any way, the entire medical establishment will rise up in outrage. He is certain to make blunders of the same magnitude almost daily. For example, Ben Carson as secretary of HUD is similarly buffoonish, although HUD doesn't have such an influential constituency.

My thinking is that it's going to become increasingly damaging to the Republican party to continue owning him. They're going to start flailing for a way out. They are already flailing with the realization that they can't just repeal the ACA, but their president in waiting is trying to order them to do it next week. Their Chamber of Commerce constituency most definitely does not want tariffs and they don't want their low wage workers deported either. Their foreign policy establishment is going to howl like a pack of wolves with their tails on fire about buddying up with Vlad.

Public policy doesn't really matter to voters, who don't understand it anyway, but the man is a clown. The Republicans benefited enormously from Ronald Reagan's avuncular persona -- it's cast a glow over them ever since, despite Reagan's manifest incompetence. Trump, in contrast, will go down in a golden shower of ridicule. That gives me hope.

The historical moment

The historian Andrew Bacevich takes a step back from the present wailing and gnashing of teeth to look at the big picture. He should concede that there is a stochastic element to the outcome of the election, and that massive failure by the corporate media is a necessary condition for it as well. Nevertheless he has much of interest to say about the discontents that were also a necessary condition.

I am old enough to remember the existential dread of the Cold War and Mutual Assured Destruction. I saw the country torn apart by Vietnam, the Civil Rights movement and the countercultural movement(s) of what are usually called The Sixties, which actually lasted from about 1963 to 1974.  Then there were all the min-wars and interventions.

Bacevich's key point is that with the fall of the Berlin wall, followed by the collapse of the Soviet Union in 1991, U.S. elites  thought they bestrode the narrow world like a colossus.* "We" had won and now the U.S., the sole superpower, was going to lead the world into a new era of globalized  neo-liberal capitalism, and end all dispute. Instead we got one failure and disaster after another. The Clinton impeachment followed by the Supreme Court installing his witless successor. The terror attack in 2001, followed by a "mindless . . . and unsuccessful war launched on the basis of false claims and outright lies." The destruction of New Orleans. (He doesn't mention the poisoning of the Gulf of Mexico.) The crash of 2008. Meanwhile the neo-liberal revolution had made rich people richer, but left everybody else behind. And the cultural revolution that started in the 1960s was threatening and disturbing to many people.

The Obama presidency seemed to hold promise for real change, but hopes were dashed. The wars ground on, wages stayed stagnant, politics became more bitter than ever. The elites of the Democratic party, Hillary Clinton and her associates, were blind to the extent and nature of disaffection. Yes, fake news and conspiracy theories, and failure of the corporate media to talk about public policy certainly hurt her. But she was the exact symbol of everything that fueled discontent: however belatedly she tried to reinvent herself, she was a known to be a champion of free trade and failed wars. And of course the cultural upheavals.

Bacevich thinks Trump is transitional, not transformative. He doesn't have a coherent ideology or program and his rhetoric is empty. It seems very unlikely he will survive re-election - or perhaps even last until then. There isn't really any such thing as Trumpism, he is just a vessel for rejection. If we can survive the next four years the question is what happens next. That we can see only through a glass darkly.








* Allusion is to Shakespeare's Julius Caesar.

Mistakes were made

I believe the full article is off-limits to you common riffraff, but here at least is the abstract of a recent essay in JAMA about the consequences of the mass shuttering of psychiatric hospitals that happened in the 1990s. This happened for good and just reasons: mental hospitals were inhumane totalitarian institutions, it was generally believed that antipsychotic medications would enable people with serious mental illness to function more independently, and that people had a right to an environment that was the least restrictive and most integrated into the community that they could safely live in.

You may recall that this movement coincided more or less with the movement to liberalize the prescribing of opioid analgesics, also on humanitarian grounds, and you know where that got us.

This is not entirely parallel by any means. The problem with the desintitutionalization of the mentally ill is partly that the second half of the concept -- creating community based supportive living arrangements -- didn't happen. The states saved a lot of money by closing their mental hospitals, but they never got around to spending it on an adequate community based mental health system. The result is that seriously mentally ill people now wind up in jail when they aren't on the street.

What Bastiampillai and colleagues also note is that people do sometimes actually need hospitalization for acute psychiatric episodes. Maybe this is more true than it would be if they had adequate support in the community, but given the current situation, the availability of beds in psychiatric hospitals is simply inadequate. They think this may be associated with rising suicide rates. I don't know, I don't think that's been proven. But I will say that the Affordable Care Act mandated mental health parity and of course, extended coverage to a lot of people who really needed it. It's been a boon to the mental health system. It doesn't provide people with housing and other non-medical services that they also need, however.

Obviously rather than repeal the ACA we need to expand services for people with serious and persistent mental illness, including providing co-located and coordinated mental health and medical care. (They tend to have complex physical comorbidities as well.) The group homes that were supposed to follow deinstitutionalization also need to become real. Maybe if Donald Trump were to pay taxes we could afford it.

Fear and trembling

Probably the hardest thing about this historical moment, for me, is its profound uncertainty. We really do not understand what has happened, and have only the dimmest vision of what may happen after January 20.

Hunter extensively chronicles the president-elect's cognitive deficits. He knows nothing about public policy, either can't remember or doesn't care what he said yesterday, and his only coherent ideology is narcissism. We can get a fair idea of what a Trump administration is likely to do based on the people he has nominated to cabinet positions, and it's fair to assume that he'll sign any legislation the Republican congress puts on his desk. But on the other hand his incompetence raises the possibility that some of the worst may be avoided. The congressional Democrats have an agenda that is far more popular, and they won't face a coherent president who can articulate a Republican narrative.

At the same time, his business empire is extremely vulnerable, precariously balanced on a mountain of debt and quite possibly underwater.  We've all heard that he may be in hock up to his ears to Russian oligarchs close to Putin. But as James Wimberly points out, he is definitely in hock to Deutsche Bank, which is critically illiquid and could probably ruin him by calling in their loans. And, Angela Merkel can probably force them to do this. It is also unclear what Putin's actual agenda is re his orange-haired poodle. Having the U.S. president on a leash and his buddy from Exxon as secretary of state might enable him to develop some oil fields but it's not clear how much more Russia, in economic and social decline, can gain.

Trump also has a lot of legal problems including the possibility of a fraud indictment over the Trump Foundation. That would come from the Attorney General of New York so he can't prevent it. There are likely any number of revelations that could emerge at any time that would make it very difficult for the Republicans in congress to allow him to remain in office. Not that president Pence would be much of an improvement, but the spectacle of impeachment would wipe out most of the first year of the administration and leave the party badly weakened.

None of this is grounds for optimism, don't get me wrong. The disaster has already befallen us, we just aren't sure what exact form it will take. But if we can get through the next two years and the people come to their senses . . .

Now they tell us

NBC News has a good, readable summary correcting common misconceptions about the Affordable Care Act.

It isn't just about extending health insurance coverage, it has provisions reforming Medicare (and others the article doesn't mention such as the Patient Centered Outcomes Research Institute) intended to constrain the cost of health care while making it more effective and better meet people's needs.

It isn't government insurance. It's a mechanism for making private insurance more available and affordable to people who don't get insurance through employment, Medicare, the military or VA. Most people don't get their insurance through the ACA. Whatever is happening to your employer-provided insurance that you don't like, don't blame the ACA. Blame your employer.

It didn't make your premiums go up. (Contrary to a recent commenter.) Health care costs have been increasing forever. If anything the ACA has slowed this process down.

Yes, premiums for many plans on the exchanges will go up this year compared to last. That wasn't caused by the ACA, it happened because insurers underestimated how much new enrollees would cost.  People who have been without health care for a while often have expensive problems such as uncontrolled diabetes. But, government subsidies will take care of most of the increase for most people, and if the ACA were allowed to remain in place, this problem would ease over time.

Here's my complaint. Throughout the campaign, indeed the last seven years, through all the screaming and yelling about how the ACA was socialism with death panels and a government takeover and government coming between you and your doctor, they never bothered to sit down and carefully explain to people that none of that is true. They just channeled whatever lies the politicians were telling. Only after the disastrous election of 2016 do we suddenly start getting these simple, factual stories about public policy.

Since we seem to have different claims about the popularity of the ACA . . .

here is recent polling from the Kaiser Family Foundation. Highlights:

While health care was not a leading factor in voters’ presidential decisions, President-elect Trump and Republican lawmakers have made it clear that one of their top priorities is the repeal of the 2010 health care law. Americans are divided on what they want to see lawmakers do to the ACA with one-fourth of Americans (26 percent) wanting to see President-elect Donald Trump and the next Congress repeal the entire law while an additional 17 percent want them to scale back what the law does. This is compared to 30 percent of the public who want to see the law expanded and 19 percent who want to see lawmakers move forward with implementing the law as it is.

While President-elect Trump and Republican members of Congress work on a replacement to the ACA, this month’s survey finds that many of the law’s major provisions continue to be quite popular, even across party lines. The notable exception is the requirement that nearly all Americans have health insurance or else pay a fine.

The problem is that people do not understand that the only way to make health insurance available and affordable for everyone is to get everyone into the pool. You can't have the popular provisions without the mandate. It is unseverable. That doesn't fit on a bumper sticker, but it's how the world works. 

They don't know why, they just know they're supposed to hate it . . .

That would be Republicans and the Affordable Care Act. This just hit my in-box.

The rate and number of insured Americans reached historic highs in the years following passage of the Affordable Care Act (ACA). In a new report, researchers from the Urban Institute — with funding from the Robert Wood Johnson Foundation — provide a granular perspective on the 19 million people who gained coverage (2010-2015) and where they live.

Coverage rates increased broadly across age, gender, race/ethnicity, education, and state. The Urban researchers found that a large share of the nonelderly adult coverage gains occurred among those without a college degree – 87 percent. Fifty-seven percent of the children and adults gaining coverage were nonwhite or Hispanic.

"In recent years we have seen unprecedented gains in health insurance coverage,” said Kathy Hempstead of the Robert Wood Johnson Foundation. "What happens next is uncertain, and the ability to maintain these gains will undoubtedly be a central issue for policymakers to consider.”     

The report includes state-by-state breakdowns by key demographics to illustrate who gained coverage under the law. Highlights include: 

·         Among nonelderly adults gaining coverage, 14.1 million did not have a college degree; within this group, 44 percent were non-Hispanic white.

·         In California, 3.8 million people gained coverage and the uninsured rate dropped 53.4 percent after state policymakers expanded Medicaid eligibility.

·         In Florida and Texas, 3.2 million people gained coverage, even though these two Southern states chose not to expand Medicaid.

·         In Illinois, Michigan, Ohio, and Wisconsin, more than 2.3 million people gained coverage – accounting for a 38 to 49 percent drop in the percentage of people without health insurance across these Midwestern states.

Notice anything about bullets 1, 3 and 4? They're about to get what they voted for. I hope they enjoy it.

Another data point on the Fermi paradox

This Phys.org summary takes a while to get to the point, but it's an enlightening while. It doesn't quite explain everything it ought to explain, so I'll fill in the blanks for those of you who may need it.

Life on earth is something more than 3 billion years old. To be sure, Republicans don't believe this, but it is true. However, the metazoans -- a fancy name for the animals, that include us -- and plants haven't been around nearly as long, only (hah!) about 800 million years. We know that what made metazoan life possible was the rather abrupt enrichment of the earth's atmosphere with oxygen, which as I'm sure you have noticed animals need. This was brought about by an explosion in the population of photosynthetic organisms called cyanobacteria (often called by the misnomer "blue-green algae"). The cyanobacteria are still around, but they also made plants possible by getting themselves incorporated into plant cells as endosymbionts that today do the photosynthesizing work for your petunias.

The metazoans were made possible not only by the availability of oxygen, but also by another endosymbiotic event in which another line of bacteria became what are today the mitochondria, our cells' power plants. And plants also have those. Both kinds need a lot of phosphorous to thrive. The problem was, it wasn't around for the first 2 billion plus years, according to this new research -- or rather, it was sequestered deep in the ocean, where photosynthesis couldn't happen. Then TaDa! It showed up in substantial quantities in shallow coastal waters, cyanobacteria were in business, and 800 million years later, so were we.

This suggests that if whatever the key event was had not occurred, earth would still be inhabited by nothing but slime. It also suggests that many or most earth-like planets might never have hit the inside straight, which would help explain the Fermi paradox. It's also all the more reason not to do ourselves in. A) The environment that supports our kind of life is fragile and it can be screwed up and B) it may be quite rate in the universe so there' s nobody out there to carry on the cause of wondering about the universe and starting to understand it.  Let's take this historical moment very, very seriously.

Not that I want to bring you down . . .

but while the New York Times was obsessing over Hillary Clinton's e-mails this was happening. (Yes, there are still newspapers in Britain.)

The warming arctic and the disappearance of the arctic sea ice have caused the jet stream to weaken and meander. This has a few consequences including pulling down cold air to the south, and warm air to the north; increasing the intensity of storms; and causing weather patterns to become static over particular regions resulting in prolonged periods of storminess, or droughts.

That one of the two major parties in the U.S. is committed to denying this incontrovertible reality should scare the shit out of you.

Zdravstvuj tovarisch

There is a whole lot that is bizarre about the impending presidency, but surely the most perplexing but at the same time revealing weirdness is the apparent acceptance by the Republican party that our new BFF is Vladimir Putin. Nina Kruscheva, who ought to know, discusses the Russian takeover of the United States. I will put this in bullet points in case your attention span is flagging.

• Trump responded to reports that the CIA had concluded Russia was behind the hacking of the DNC and John Podesta by deriding the CIA as a tool of Hillary Clinton. Quoth NK, "The idea that a US president-elect would take the word of the Kremlin over that of CIA officials and even the most senior members of his own party is already bizarre and dangerous."

•  But then there is Secretary of State nominee Tillerson,  for whom "taking Russia’s side against the US is nothing new." 

• And National Security Adviser Michael Flynn, who, "like Tillerson, has also been feasting at the Kremlin trough. After being fired by Obama for his incompetent management of the Defense Intelligence Agency, Flynn immediately began to cultivate Russian business contacts. And Putin seems to have been more than happy to see that commercial doors were opened to Flynn. There is a now-infamous photograph of Flynn seated next to Putin at a banquet for RT (Russia Today), the Kremlin-backed cable news network that was a prime source of the slanted, and even fake, news that inundated the US during the recent election campaign. "

• "As for Trump, statements made by his sons suggest that, if the American public ever got a look at his tax returns and business loans, they would find that he has also been feathering his nest with Kremlin gold for some time."

•  And of course there is Paul Manafort

Kruscheva thinks that Trump is likely involved in criminal activity. Although she doesn't specify, violation of sanctions against Russia, tax evasion, or collusion in the hacking are all possible. She doesn't mention the likelihood that Putin has information with which to blackmail Trump. All of this is just fine with the Republicans in the House and Senate. And the news media, which are largely incurious about it. How deeply strange.

Thoughts on resistance

Randall Kennedy has some.

I actually think -- and I'm probably naive -- that many of the squishes, including even some Republican politicians, who initially decided to go with the flow and pretend everything was normal and they would try to figure out ways to use the famously unfocused and flighty orange orangutan for their own purposes are now starting to realize that he is even crazier than he seemed and touching him in any way is extremely dangerous.

In other words, it's possible that the Senate won't go along with handing the country over to Vladimir Putin, and once the Republicans contemplate the likely political cost of doing all the stuff they have been promising to do for the past 8 years they may go a bit soft. Where we are definitely screwed is on the environment including the fate of you know, the planet, but we'll still be around after 4 years to change that around. Voter suppression is definitely resistible, as is intimidation of dissent and of the press. Our political culture has a much stronger reserve of democratic norms than Germany or Italy did in 1939. Robert Kuttner checks off the parallels to fascism (see section 2 of this long essay) but noting how Trumpism is like fascism leaves out how the historical time and place is different. He concludes with more or less what I am saying:

An astute observation is ascribed to Mark Twain: It is easier to fool people than to convince them they’ve been fooled. True enough, but the contradictions are piling up. Even hardcore Trump voters are starting to experience buyer’s remorse.

We can place our hope in his incompetence. As long as we can avoid a ruinous war.

Philosophy after the Enlightenment

Metaphysics is essentially dead. Speculation about the ultimate nature of reality seems a waste of time when we can actually study the universe and learn about it. Whatever metaphysical speculation you come up with may one day be proved true or false, in which case why not wait for the answer? Alternatively, there may be no means of verifying or falsifying it, in which case why bother even to think about it, when we can spend our resources on questions that might have answers?

So here's Tim Urban discussing the Fermi paradox. Basically, even using the most conservative assumptions, if life develops on earth-like planets, even fairly infrequently; and it technological civilizations subsequently evolve, again even infrequently, there should be something like 100,000 technological civilizations in our galaxy, many of them presumably far more advanced and powerful than little old us.

So where are they? We have detected absolutely nothing that is suggestive of any technological civilization. Urban's discussion is very well organized and fascinating, so do read it. But I will say that the main possibilities include that life is actually exceedingly rare. That would be surprising because cosmologists have adopted the habit of thinking that our planet is nothing special. It would also be surprising because it seem evident from thinking about evolution on earth that if you get any sort of system that self-replicates with occasional mistakes, you are going to get evolution. But does evolution necessarily have to lead to multicellular organisms and nervous systems? Maybe the universe is full of pond scum, and nothing much more than that.

Another possibility is that technological civilizations arise,  but inevitably self-destruct because they can't handle the power they gain for themselves. That's certainly plausible, we almost did it during the Cold War and we might be about to do it now. On the other hand at least some of us are wise enough to avoid that. Why couldn't even 1% of civilized beings be more generally wise?

And there is the possibility that they're out there, but we can't detect them because they aren't emitting any signals that we would perceive as coming from a technological civilization. There is also the nasty possibility that a predatory species rules the galaxy and wipes out any competitors, in which case we may be on the menu.

These speculations are mostly fairly disturbing, but the point is, we may one day -- even soon! -- know the answer. Hegel, however, could never know anything.

Just to be clear about "Repeal Now, Replace Later"

The Republican proposal to repeal the Affordable Care Act but not actually abolish it until 2019 at which time they will purportedly have figured out what to replace it with comes with a bonus: it will immediately eliminate the taxes which finance the ACA, 100% of which fall on people making more than $200,000 a year. That would be $346 billion over ten years.

So where are they going to get the money from to "replace" the ACA? Are they going to reinstate those taxes? I really don't think so. Of course, that has always been the real reason Republicans don't like the ACA. What are the chances the people who vote for them will ever understand this?

Not Stayin' Alive So Much

You may have heard already that CDC is reporting that U.S. life expectancy declined by about 1/10 of a year from 2014 to 2015. (Link is to a PDF. If you prefer, you can go to the National Center for Health Statistics home page here.)

Now, this might not mean anything. Life expectancy in the U.S., while it lags behind other wealthy countries, has been steadily increasing. That's why it's a bit of a shock to see a decrease but one year does not a trend make. It's also hard to know what to make of the internals. The age adjusted death rate increased for Black men, and for white men and women, but not for Black women or Latinos. The age adjusted death rate for cancer went down: the main contributors to increased death rates included heart disease and stroke, lower respiratory disease (which is mostly due to tobacco), unintentional injuries, and suicide. While the prevalence of smoking has been going down substantially in the past couple of decades, it's possible that the earlier smoking epidemic is catching up with people now. Obesity may also be contributing to the heart disease and stroke increase.

Unintentional injuries aren't decomposed in this report, but I suspect they're a combination of motor vehicle crashes and drug overdoses. Infant mortality increased, in substantial part due to unintentional injuries, which I would guess points to motor vehicle fatalities.

An oddity is a sharp increase in the age adjusted death rate from Alzheimer's disease. Since it's age-adjusted, it wouldn't seem to be an artifact of the aging population but that could be wrong -- I'd have to see exactly how they did the age adjustment. If they capped out at 85+, that could explain it.

Apart from that, this is consistent with the story we've been hearing about our major public health problems: obesity, cars, opioids and suicide. All problems we can do something about.

Outsourcing . . .

To Maciej Cegłowski.

Just go there. Read. Understand. This is the hinge of history.

Here's a letter I wrote to my colleagues . . .

. . . along with one of them.

This is a critical time for the future of health care policy, and all policies affecting public health in the United States. The incoming president and congress have promised to take actions that will profoundly change our health care system, along with environmental regulation, immigration policy, labor policy, and much more that will affect the health and well-being of the population. Some of the rhetoric in the recent campaign has also affected the social and political culture of the nation with unpredictable but likely worrisome consequences.

            We were deeply concerned by the scarcity of informed and even accurate discussion of public policy in the recent campaign. It appears that voters have little understanding of what government does or how government policies and practices affect their lives. The news media largely failed to explain the facts and controversies underlying policy choices, and allowed empty rhetoric and personal questions about the candidates to dominate the communal discourse.

            We believe that we, as experts in policy issues that are of the greatest importance for our nation and its citizens, can and should do more to contribute to the public discourse beyond our traditional focus on publishing in journals that are read only by our peers. We believe that we need to define an expanded role for public health researchers that brings our science out into the world and engages with people from all communities and walks of life. Voters cannot make appropriate decisions if they cannot meaningfully evaluate what candidates say and promise.

            We hope to join with our colleagues, starting within the department but perhaps expanding to the entire school of public health and ultimately beyond to other institutions, in an effort to democratize our work. By this we mean listening and engaging communities in helping us to understand what matters to people, and how we can best serve the public interest through our scholarly work, but just as importantly o through effective dissemination of knowledge and empowering people to be informed civic actors.

            We have discussed a few ideas about what some components of this effort might be. We do know that it calls for re-examining the institutional expectation for how public health scholars will focus their time and how their accomplishments will be evaluated. But there is much we can do now, that we believe we should be doing as a matter of urgency. We hope that some of you will join us in discussion leading to action. Please let either or both of us know if you want to join us, and we will convene those interested.

I'm not the only one who feels this way -- for example there's the well-publicized open letter from MIT faculty -- but I'm not just talking about writing open letters or op-eds. I'm talking about working with community-based organizations to engage people directly in understanding the facts underlying policy choices and how government matters to their lives. We cannot survive in a post-factual world.

Not exactly news . . .

The Commonwealth Fund has done the latest in its series of surveys of 11 countries (western Europe, Canada and the U.S.) and, well, you already know:

• Adults in the U.S. are more likely than those in the 10 other countries to go without needed health care because of costs. One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill a prescription because of costs. This percentage is down from the 2013 survey (37%). [But it's about to go back up!] As few as 7 percent of respondents in the U.K. and Germany and 8 percent in the Netherlands and Sweden experienced these affordability problems.
• U.S. adults were also the most likely to report material hardship. Fifteen percent said they worried about having enough money for nutritious food and 16 percent struggled to afford their rent or mortgage.
• Half of U.S. adults struggled to get health care on the weekends and evenings without going to an emergency department. Between 40 percent and 64 percent of adults in the other countries reported the same. The Netherlands had the lowest rate on this measure, 25 percent.
• Adults in the U.S. (19%) and France (24%) were the most likely to say that their medical records or test results had not been available at the time of an appointment or that duplicate tests had been ordered in the past two years. These problems were reported less commonly in the other countries.
• Fourteen percent of chronically ill U.S. adults said they did not get the support they needed from health care providers to manage their conditions. This was twice the rate in Australia, Germany, the Netherlands, New Zealand, and Switzerland.

So the Republicans take over and vow to make all this worse -- much, much worse. My question is simple: what is the constituency for this? Why do we so passionately want to hurt ourselves?

We'll be in for a lot of this . . .

Sam Stein and Matt Fuller for the Puffington Host report on the 21st Century Cures Act, which appears likely to pass. Believe it or not, it does some things Democrats want to do, including providing some additional funding for NIH and money to the states to combat opioid addiction.

But of course, there's a high price to be paid. It also makes it easier to get medical treatments approved without demonstrating that they are safe and effective. Senator Warren has denounced this as a corrupt bargain. The Democrats in congress will be offered more of these corrupt bargains in the coming years, such as the phony infrastructure plan that really consists of giving away public goods to capitalists. The Republicans haven't been afraid to obstruct everything for the past 8 years -- how will the Democrats behave now?

Stay tuned.

Speaking of scams . . .

While the new president and his minions are busy selling out the country for personal enrichment, the pharmaceutical companies will not be left behind.

This is a slightly complicated scam, so you might want to read the essay in NEJM by Dafny, et al. For those with short attention spans, I will try to explain. There are lots of medications available to treat most conditions. The FDA has to approve them if they are safe and effective, but they don't have to be superior to existing treatments. Comparative effectiveness research doesn't always get done, but sometimes we know that a less expensive drug works as well as a more expensive one, at least for most people. Also, of course, once marketing exclusivity expires there are often cheaper generic alternatives to brand name drugs.

So, insurance companies put drugs in different "tiers" with consumers facing higher co-pays for medications the insurers want to steer people away from, because they are more expensive or less effective, or both. This helps them make money, sure, but it also helps keep premiums down for all of us. So what do the drug companies do when they want to keep selling their more expensive brand name drugs?

They pretend to be doing you a favor by giving out coupons that cover the co-pay. But they aren't doing you any favor, they're screwing you. Let's say a drug costs the insurance company eight times as much and they give you a coupon for a 20% copay? You use the brand name drug instead of the generic, which might have a much smaller copay but with the coupon the brand name drug is free. But the cost to your insurance company is much higher. The drug company gets their ill-gotten gains and ultimately, it comes out of your wallet anyway in the form of higher premiums.

I wouldn't count on your friends in congress to do anything about this.

The New Normal

Simon Maloy thinks Trump's corruption will sink the Republican party. To which I say, poppycock.

According to the New York Times and the rest of the corporate media, Hillary Clinton was the corrupt candidate. Can you imagine if Clinton had just settled a fraud lawsuit for $25 million, or the Clinton Foundation had admitted to self-dealing? My imagination can't even encompass what the news coverage would be like.

But they are doing their best to ignore Trump's blatant and proven corruption -- one brief story on each revelation, and we move on. What makes Maloy think that's going to change?

Theories of History

There are several approaches to understanding and writing about history. There is the Great Man (rarely Woman) school, which consists largely of biography. There are grand theories that explain history as a process shaped by large forces in which the choices of individuals have little weight, from Marxism to the inevitability of neoliberal dominance of the planet. The latter didn't exactly have a name but lots of people believed in it.

Then there are those who say, sure, there are grand forces -- technological change, climate, resource depletion, demographics -- but against that background, a lot of shit  just happens. Call this the "for want of a nail" theory of history. Well, it's true.

No-one can enumerate the links in the causal chain that led to our present disaster, but we can spot a few that are both necessary and basically stochastic. Hillary Clinton actually won the election by quite a substantial majority, but thanks to the historical anachronism of the electoral college, it doesn't count. There is no argument that I can see that makes this the right result. A few thousand votes in a key state tips the whole thing. In past elections that has been consequential but in this election it puts the country on a path completely opposite to what would otherwise have been.

Another necessary link was the Comey letter. There is plenty of evidence that it flipped the election, and probably the Senate. This of course would not have happened in the corporate media hadn't been obsessed with the completely bogus non-issue of Hillary Clinton's e-mails to begin with. But they were, and Comey  knew it.

Comey could not have played his dirty trick, however, if he didn't have Anthony Weiner's computer. Ergo, if the ridiculous and ridiculously named Anthony Weiner did not have an incorrigible habit of tweeting his junk, Hillary Clinton would be preparing to assume the presidency and appoint a young liberal justice to the Supreme Court.

In other words, this whole thing doesn't mean shit. It's a horrible accident. Jessica Williams (a Daily Show regular with John Stewart for those who aren't with it) said, "The first rule of politics is, Don't Tweet Your Junk," which presumably Weiner would have learned when it cost him his congressional seat. He did not, causing him to lose his chance to be mayor of New York and prompting Williams to say, "The second rule of politics is, Don't Tweet Your Junk."

Apparently we need a third rule. "Don't Tweet Your Junk."

Resistance

So, Paul Ryan says his first priority in 2017 is to phase out Medicare. He'll give people vouchers that will cover part of the cost of private insurance instead, but obviously the whole point is that they won't be sufficient. Medicare is much more cost-efficient than private insurance, because it doesn't have to pay for marketing, multi-million dollar executive salaries, or profits. And insurance companies have all kinds of ways of avoiding the most costly customers and screwing people out of benefits. Read the linked post if you want more details, but . . .

What is most strange about this is that it has almost no constituency, apart from a few extremist ideologues and plutocrats who don't want to pay taxes. Retired people and people who will retire depend on the program (as do people with disabilities). Doctors and hospitals get most of their revenue from it. The only way Republicans can advance their agenda is to lie to people, which is what Ryan is doing.

It seems to me that now that Republicans have total control over the federal government, and it actually comes time for them to do everything they have promised to do, it's suddenly going to get difficult. The first thing George W. Bush said after he was reelected was that he wanted to privatize Social Security. Funny thing about that, it didn't happen.

We need to resist everything, everywhere, with maximum energy. There is still plenty of life in the American republic and the progressive vision. We will win in the end.

How worried should we be?

I commend to your attention this essay by Ezra Klein. Before I try to very briefly summarize his argument (but do read this, although it's long form) I want to pull this:

He is a man who routinely praises dictators. Of Vladimir Putin, Trump said, "He's running his country, and at least he's a leader, unlike what we have in this country." Of Kim Jong Un, Trump said, "You've got to give him credit. He goes in, he takes over, and he's the boss. It's incredible." Of Saddam Hussein, Trump said, "He killed terrorists. He did that so good. They didn't read them the rights."

It’s not just that Trump admires authoritarians; it’s that the thing he admires about them is their authoritarianism — their ability to dispense with niceties like a free press, due process, and political opposition.

Trump has promised — in public, and repeatedly — to bring this hammer to American governance. He stood in a nationally televised debate and vowed to jail his opponent if elected. He has proposed strengthening libel laws to make it easier to cow the press and antitrust laws to punish Jeff Bezos and Amazon for the Washington Post’s coverage of his candidacy. In a recent speech at Gettysburg meant to preview his first 100 days in office, Trump said he would sue all of the women who accused him of sexual assault. 

During rallies, Trump has exhorted his followers to assault protestors, and has promised to pay their legal fees if their thuggery leads to arrest. He has warned that the only way he could lose the election would be if it is rigged, and has suggested he may refuse to concede.

And all this ignores his more basic flaws. He is cruel, lazy, and reckless. He knows nothing of policy and has not bothered to find anything out. He is easily baited, reliant on sycophants, and prone to conspiracy theories. He is a bigot who slimed an American-born judge for his Mexican heritage and a misogynist who boasted that his celebrity gave him license to commit sexual assault. He has cast doubt on America’s commitment to the NATO alliance and offhandedly encouraged Saudi Arabia and Japan to build nuclear weapons. His business is rife with conflicts of interest, and his campaign has been amateurish and poorly managed.

 Klein wrote this before the election, when he expected Trump to narrowly lose. (Actually, he did lose the popular vote, and it wasn't particularly close. But the problem of the electoral college is for another day. He got plenty of votes.)

Klein's basic claim is that the gatekeepers who once had control of the nominating process -- party elites, mostly, but corporate media as well -- have completely lost influence. But while the parties are institutionally weak, the public is more partisan than ever. The result is that once Trump got the nomination, Republican voters stuck with him despite whatever doubts some of them may have had. And party elites could not afford to abandon him lest their voters retaliate against them.

We can forget about checks and balances because soon, far right extremists will control all three branches of the federal government. They will do whatever they want, and believe me, New York Times editorials won't slow them down.

Gross Domestic Problem

Back when I was a 22 year old Nader's Raider I heard Hazel Henderson speak at one of our conferences and she was already saying what Edoardo Campanella apparently thinks is a radical new idea, which is that Gross Domestic Product is not a valid measure of well-being, and not even a valid measure of economic activity.

Hazel was not the only person to figure this out 40 years ago and plenty of people have kept hammering on the fairly obvious truth of it since, but it's just pissing into the wind. The corporate media and political leaders continue to treat GDP growth as the measure of a "healthy" economy.

The reasons why this is wrong are so many and so gross that nobody should be arguing about it, but apparently we have to do it anyway. Here are a few:

GDP does not account for externalities. You know, air pollution, stuff like that.

It treats resource extraction as production, even though the resource is gone.

It treats harms as goods. For example, a hurricane that destroys houses becomes economic growth because the cost of rebuilding them is counted as a positive while their destruction is ignored. Same with automobile crashes, disease (which leads to health care spending), basically anything that goes wrong and has to be fixed.

As a corollary, saving money is bad. Preventing disease, avoiding disasters, improving public safety - these are all negative for GDP.

It doesn't properly account for the value of technological advances. As the same goods and services get cheaper, we still have the value, or even greater value, but the contribution to GDP goes down.

It takes no account of inequality. If one person gets all the loot and the rest starve, it doesn't matter.

It takes no account of any activity that doesn't involve exchange of money -- from household work to volunteering. Take care of your elderly parent yourself, zero contribution. Hire somebody to do it, GDP. 

More money flowing around does not translate into human happiness. No account of community, friendship, the value of common space, free concerts on the green, mutual respect, you name it.

Do we really need to keep having this pointless discussion?

The grotesque corporate media

Jesse Berney and Matthew Yglesias have posted very similar essays, which means they are channeling a collective consciousness, not that one is stealing from the other. As Berney puts it:

You start with the assumption that Hillary Clinton is corrupt. After all, there have been whispers and accusations and investigations and allegations and scandals with ominous names like WHITEWATER and BENGHAZI for years. Even if you can't describe exactly what she's done wrong, there must be something to all these stories, right?

Or, in the words of Yglesias:

The latest Hillary Clinton email revelations arose out of an unrelated investigation into Anthony Weiner’s sexting. The best way to understand this odd hopscotch is through the Prime Directive of Clinton investigations: We know the Clintons are guilty; the only question is what are they guilty of and when will we find the evidence?

Berney:

When I fired up the New York Times app on my phone Saturday morning, I had to scroll through four full screens before I got to a headline that wasn't about FBI Director James Comey's letter to Congress that the bureau had discovered emails on Anthony Weiner's computer that possibly maybe perhaps might be related to its earlier investigation of Clinton’s private email server. With zero information about what is in those emails, zero information about any connection to Clinton, zero new allegations of wrongdoing, the Times and much of the media treated this story with the kind of wall-to-wall coverage usually reserved for the first moon landing.

Yglesias:

There are several rules that govern media coverage of the Clintons, but this year the Prime Directive has dominated them all. Network news has devoted more minutes of coverage to Clinton’s emails than to all policy issues combined, even as email investigations have not uncovered any wrongdoing. It’s inexplicable news judgment, unless you simply assume there’s a crime out there.

On their editorial and opinion pages, the corporate media from the New York Times to CNN all say that Trump is unqualified to be president and that his candidacy presents an unprecedented risk to the republic. But in their news pages all they ever talk about is phony Clinton scandals, while Donald Trump's innumerable very real scandals are completely ignored, even when they are reported by credible single sources such as  David Corn, David Farenthold and Kurt Eichenwald -- as are issues of public policy.

I am very puzzled by this.

Also, too, what Digby says.

All of this raises a question The Washington Post’s Paul Waldman raised two months ago: How is it possible that Clinton’s email brouhaha has marked her as thoroughly corrupt and dishonest, while Trump’s monumentally nefarious past, present and future are overlooked? Waldman’s assumption is probably the correct one: The narratives were set early in the campaign cycle, with Trump being the bigoted, crazy one and Clinton being the corrupt one. That’s just how the media frames the contest. They got it wrong. Yes, Trump is the crazy, bigoted one. He’s also a misogynist and worse. But he’s also the corrupt one, perhaps even more than most of us who had already understood that ever imagined.