]]> http://thoughtbasket.com/2012/05/01/the-fakery-of-paul-ryan/feed/ 0 thoughtbasket paulryan120507_560 http://thoughtbasket.com/2011/08/06/democrats-need-to-lead-or-lose/ http://thoughtbasket.com/2011/08/06/democrats-need-to-lead-or-lose/#comments Sat, 06 Aug 2011 17:09:35 +0000 thoughtbasket http://thoughtbasket.com/?p=1013 Continue reading →]]> S&P downgraded US debt from AAA yesterday, knocking Treasuries from their perch as the safest debt on earth. We will see what happens to yields on Monday, but so far it’s not clear that the markets agree with S&P. After all, this is an agency that had AAA ratings on subprime mortgage-backed securities not that long ago.

But in the meantime, the GOP is using the downgrade to attack Obama, saying “look what happened on his watch.” The president doesn’t deserve all the blame, but I understand why the GOP has seized the downgrade as a bludgeon. And in the same way, democratic operatives are putting the blame on the tea party and its refusal to compromise on deficit cutting.

But you know who isn’t saying anything? Democratic leaders. The White House, Harry Reid, Nancy Pelosi — they are all keeping silent on this. They are trying to be the “adults” and not play the blame game. I appreciate that high-mindedness, but here’s the thing: the game is being played, with or without them. If they stay silent then they just let the GOP control the narrative. You know the Sunday talk shows will be full of Boehner and Cantor and Romney and the gang piling on Obama for the downgrade.

The Democrats have to realize that they are in the middle of a street fight and if they don’t fight back they will lose. And they’ll deserve to lose. If you are going to suck ass at politics, then you shouldn’t be a politician. Regular readers know that I mostly support Democratic policies (with some huge exceptions that I ought to detail one of these days), but I sure don’t support Democratic fecklessness. The Democrats got rolled on the debt ceiling negotiation, and now they are getting rolled on the downgrade. It’s pathetic. Or, to quote a senior democratic official: “if this White House showed a gram of leadership on the debt crisis we could have avoided this historic embarrassment.”

You might think, and certainly we would all like to think, that policies and results are more important than messaging. Oh, how sweetly naive! If you lose the messaging battle, you never get to implement the policy and see the results. Messaging is how you get the support of the public, and since most people have very little time and/or attention for politics, your message has to be short and sweet.

Since Democrats can’t seem to get it together to develop appropriate messaging, I thought that I would take a crack at some of the key issues of the day. I don’t claim genius for any of these efforts – I’m a blogger, not a fighter – but maybe they will spark a little conversation and get some more talented folks to chip in.

Judges respecting individual rights
GOP

• Judicial activism
• Non-elected officials creating laws

Thoughtbasket

• Understanding the meaning of the Constitution
• Following in the Founding Fathers’ footsteps
• Looking at the spirit of the law if the language is unclear

Estate taxes
GOP

• Death taxes

Thoughtbasket

• Monarchy prevention policy
• Asset transfer payment

Regulation
GOP

• Government control
• Business killer
• Job destroyer

Thoughtbasket

• Public safety measure
• Children’s health initiative

Aid to Poor
GOP

• Socialism
• Promoting dependency

Thoughtbasket

• Safety net
• Short-term help for the most vulnerable citizens

Economic Equality
GOP

• Threat to liberty

Thoughtbasket

• Promoting American capitalism

Questioning Security Policies
GOP

• Unpatriotic

Thoughtbasket

• Keeping America safe
• Developing the best security system in the world

Healthcare Reform
GOP

• Government takeover

Thoughtbasket

• Preventing the deaths of innocent citizens

Finance Reform
GOP

• Enabling taxpayer bailouts

Thoughtbasket

• Stopping taxpayer bailouts

Raising Tax Rates
GOP

• Destroying individual initiative

Thoughtbasket

• Fiscal responsibility

Reaching Out to Non-allied States
GOP

• Appeasement

Thoughtbasket

• Realpolitik

Cap & Trade
GOP

• Energy tax

Thoughtbasket

• Grandchild Safety Act

Immigration Reform
GOP

• Amnesty

Thoughtbasket

• Continuing the American melting pot tradition

Nuclear Arms Treaties
GOP

• Weakening America’s defense

Thoughtbasket

• Making America safer by reducing nuclear proliferation

Lithwick’s article draws heavily on this awesome NY Times op-ed by Geoffrey Stone, a law professor at University of Chicago. His money quote is here:

Although the framers thought democracy to be the best system of government, they recognized that it was imperfect. One flaw that troubled them was the risk that prejudice or intolerance on the part of the majority might threaten the liberties of a minority. As James Madison observed, in a democratic society “the real power lies in the majority of the community, and the invasion of private rights is chiefly to be apprehended … from acts in which the government is the mere instrument of the major number of the constituents.” It was therefore essential, Madison concluded, for judges, whose life tenure insulates them from the demands of the majority, to serve as the guardians of our liberties and as “an impenetrable bulwark” against every encroachment upon our most cherished freedoms.

Lithwick also refers to this Huffington Post piece discussing how the Democrats have greatly improved their messaging on this matter, linking economic populism with the role of the Court, as in this quote by Vermont senator and Judiciary Committee chairman Pat Leahy:

“Congress has passed laws to protect Americans in these areas, but in many cases, the Supreme Court has ignored the intent of Congress in passing these measures, oftentimes turning these laws on their heads, and making them protections for big business rather than for ordinary citizens.”

Then this weekend’s NY Times magazine had a long piece on the GOP’s moderate vs. Tea Party battle, as personified by the race in Florida between Charlie Crist and Marco Rubio. It turns out that Rubio has never done anything but hold elective office, serving as a West Miami city commissioner right out of law school.

Dorgan and Rubio might be great legislators — I don’t know enough about either of them to judge — but doesn’t it seem like we should want our politicians to have lived in the real world? Think of all the things we regular folks have to do: hunt for jobs, worry about insurance, cooperate with coworkers we hate, shop for cars, get things done at work, etc. Career politicians don’t have to do any of that stuff. They never need to execute and accomplish, and they get rewarded for being obstinate. They stop worrying about money, since they get to pay their family as “consultants” out of campaign funds. And they have staff to take care of life’s little details.

I’m not expecting our politicians to follow the lead of Cincinnatus, who left his farm to run Rome, and then returned to his farm. But maybe some experience in the real world, not the political world, would get our legislators to work — WORK — on policy, instead of spending all their time posturing and campaigning.

First there was this article in the NY Times, which discussed how the AMA has since 1929 (yes, 80 years ago) fought against systems (such as cooperatives) that would potentially limit doctor incomes by creating a salary structure rather than a fee for service structure. Although some cooperatives were formed, it was over the objections of the AMA. Not coincidentally, the two medical groups that are continually held up as paragons of cost-effective and world-class care, the Mayo Clinic and the Cleveland Clinic, are both cooperatives. At a recent conference on cost-effective care, most doctors and hospital executives agreed that the fee for service system is “archaic and fundamentally at odds” with good practice.

Next was this article by Dr. Atul Gawande in The New Yorker, in which he investigates why health care in McAllen, Texas is so much higher than the national average. In fact, he notes, McAllen’s health expenses are twice as high as El Paso, Texas, which has the exact same demographics. Gawande explores a number of reasons – service quality, technology, legal environment – but ultimately concludes that it comes down to massive overuse of medical care. Doctors in McAllen do far more tests and scans and procedures than average.

But Gawande goes even further. He blames this overuse not on a surfeit of caution, or desire to better treat patients, but on doctor greed. Doctors make more money when they do more procedures, and if they have ownership stake or revenue sharing agreements with imaging centers or labs or hospitals (and many of them do), then they have financial incentive to send patients to those facilities. Interviewing doctors in McAllen, Gawande uncovers a culture of greed, where doctors are in it for the money. Or, as a McAllen cardiac surgeon says, “Medicine has become a pig trough here.”

I sent Gawande’s article to a friend of mine, who is a doctor in a family practice, but who also has a Master’s in Public Health and did a fellowship in preventative medicine. My friend agreed with Gawande’s conclusions, noting that “nobody wants to give up that $500k+ salary, and the AMA is a huge lobby.”

Finally, The New Republic had a piece that sort of summed it all up, noting:

“Given how much of the game of reining in costs hinges on doctors–whether they see themselves as profit-maximizing small businessmen (or, for that matter, large businessmen), or as fundamentally involved in healing patients and receiving fair compensation for that service–I think we have to think about the kinds of people who go into the profession.”

And this is where I get to have my say. Because if someone is going into medicine because they want to make a million dollars, I say they should go to Wall Street instead. As this chart shows, it isn’t exactly like doctors are hurting for money. Practicing medicine isn’t a license to print money, and when a doctor orders an extra $1,000 procedure, while he gets to keep that $1,000, we all have to pay for it through higher insurance premiums. At which point he is no better than the greedy mortgage-backed security trader whose huge bonus ended up being subsidized by taxpayers.

This just in: right before posting, I read this article in the Wall Street Journal about how the AMA and the American College of Surgeons both came out against the idea of a commission setting Medicare payments to doctors. These groups continually lobby against reductions in Medicare payments.

Added bonus links:

• Slate article describing how a Supreme Court anti-trust decision gave rise to doctor-owned hospitals and other greedy doctor abominations.

• Denver Post article about a woman who died when a doctor-owned specialty hospital that didn’t have the resources necessary to handle her post-surgery complications.

• Book review by Harvard Medical School professor Arnold Relman, who attacks the “medical-industrial complex” and the whole concept of profit-driven medicine: “in no other country is medical care marketed and advertised so aggressively, as if it were just another commodity in trade.”

• New York Times article describing how the greediest hospital in Gawande’s article is one of the largest contributors to Democrats this year as it lobbies “to soften measures that could choke its rapid growth.” This lobbying has been successful, as language limiting physician ownership of hospitals has been stripped out of bills. According to Democrat Pete Stark, the physicians “just thought they could buy their way out of it, and it’s a sad commentary on the Congress.”

This tenuous coexistence, however, has now turned into open hostility, with each side blaming the other for McCain’s loss. And as the GOP tries to figure out what it really is, and how to avoid a third consecutive stomping in 2010, these two wings are fighting for dominance. Unfortunately for the future of the Republican Party, the two wings can’t reconcile, and neither wing can win an election on its own. After all, even with the wings combined, they just got smoked by Barack Obama’s politics of hope. On their own, they are doomed.

The intellectual wing itself has two components – the rabid neocons and tax cutters versus the more moderate Rockefeller Republicans – but they both share a commitment to lowering taxes and shrinking government. They also share a slavish devotion to President Reagan. McCain, despite his campaign rhetoric in 2008, is part of this wing. As Joe Klein from Time described him:

He believed in the unilateral exercise of American power overseas, with an emphasis on military might rather than diplomacy. He believed in trickle-down, supply-side, deregulatory economics: his tax plan benefited corporations and the wealthy, in the hopes that with fewer shackles, they would create more jobs.

But widening income disparity and the financial crisis of 2008 have fundamentally discredited that economic approach. Reaganism failed. And while the Rockefeller Republicans might be able to craft a workable economic theory, they are so marginalized in the party that they can’t ever win. Moreover, there simply aren’t enough Americans driven by desire for lower taxes to support this wing of the party. There are too many citizens who actually want their government to provide something.

The Main Street wing of the GOP is the part that believes there is a “real America,” as opposed to the liberal “fake America.” It’s anti-elite, anti-intellectual and anti-media. Which is its main problem: it’s against everything and for nothing. It is fueled purely by anger and self-pity. This is unsustainable; without new ideas, this wing will wither and die. It will be consumed by a black tumor of hate, like Lee Atwater‘s brain.

Also, much like the intellectual wing, the Main Street wing isn’t large enough to win on its own. There aren’t enough voters who buy into its false dichotomy. This wing, however, has a chance. If it were to embrace a truly populist economic strategy, it might be able to peel off enough blue collar Democrats to build a winning coalition. Even the Wall Street Journal notes that “new Republican voices are popping up to argue that the importance of working-class voters means the party needs to develop economic policies more obviously directed toward the working class than the capitalist class.” But that would require a complete reworking of Republican economics: supporting unions and trade protection at the expense of corporate interests and wealthy individuals. It would require an approach that sounds strikingly similar to….the Democrats.

This is the problem facing GOP strategists as they figure out what to do. They want to chase the voters, but that will require moving away from their core philosophy, because that’s what the voters are doing. As Politico put it, the GOP is “a party that is overwhelmingly white, rural and aged in a country that is rapidly becoming racially mixed, suburban and dominated by a post-Baby Boomer generation.” Some strategists want to pursue growing demographics, namely black and Hispanic voters. But how do you do that when your two wings cater to wealthy WASPS and white rednecks, respectively? Both wings of the GOP have painted themselves into electoral corners, and there is no obvious way out.

Perhaps the recent election marked the generational shift that we all knew was coming. For the past 20 years government has catered to, and been run by, people of our parents’ generation – those who grew up in the 1940′s and 1950′s – often leaving those of us from later decades mystified at the decisions being made. And we kept wondering, as old fogeys (Ted Stevens!) retired or died, and young folk grew old enough to vote, when our generation would start making decisions. Nobody WE knew hated blacks, or thought that poor people should be abandoned, so why was government pursuing such crappy policies? Why was the GOP so out of touch with our generation? After all, when you belong to a generation where a third of you have tattoos, it’s hard to see how branding a black candidate as “Muslim” is going to work. And it didn’t: Obama won, while conservative congressional candidates lost.

The GOP isn’t dead; its basic message of small government and individual liberty will always resonate. But it needs to do a lot of work to retool that message into a governing philosophy that will appeal to the new generation.

Tuesday’s post was about Lee Siegel’s theory that Republicans win by focusing on heartland culture while Democrats waste their time talking about policy. Today’s post addresses what Democrats can do about this problem.

Some of the easiest, fastest responses are tactical. For example, Democrats should divide and conquer: they can discuss policy with standard liberal audiences and talk culture to the heartland. In addition, they should be advancing their own cultural narratives, particularly those that tap into Siegel’s call for “vicariousness.” Show Obama and Biden being regular people: shopping, going to church, driving their kids to soccer practice. Distribute the message via the cultural milieu itself rather than through the media. Have the candidates talk about their personality and their dreams. And Obama, please, lighten up a little. The Democrats should take Spiegel’s trope of “ordeal and humiliation” and use it, playing up their own descent and rebirth narratives. Obama has the single mom/neglectful dad angle, and Biden has his car crash (yes, it’s utterly debased to use it, but his son already opened that door during the convention).

But these tactical moves don’t really turn Siegel’s thesis to our advantage. A larger solution is to emphasize the Democratic culture. Fortunately, that culture actually synchronizes with policy, unlike the Republican culture, which fundamentally conflicts with Republican policy. But what is this Democratic culture, and is it lived like the Republican one?

I posit that the Democratic culture is the culture of the founding fathers, which is so ingrained in the American psyche, so elemental to our identity, that we live it every minute of every day. The Democratic culture is one of equality and opportunity, where people who work hard deserve a better life for themselves, regardless of class, color, creed or gender. This is a culture that takes seriously the words “all men are created equal, that they are endowed by their Creator with certain unalienable Rights.” The Declaration of Independence is one of America’s totemic documents, and I think just as powerful as the Jungian archetype of descent.

For the Democrats, this culture is not a political strategy but the very essence of the party, the manifestation of their values, and thus is inseparable from policy. This is a culture, backed by policy, which favors hard work over family connections. It sides with student loans, not yacht owners; with sick children, not insurance companies; with producers, not paper pushers; with main street, not Wall Street. During a week when financial debacles are destroying value at unprecedented rates, it is worth remembering whose culture, and whose policies, support a market that is free but regulated. Democratic culture lives in churches that help the needy, in safety nets that help the disadvantaged, in methods of supporting families’ choices, and yes, in the ability of a mixed-race man with a single mother to become president.

If indeed people respond more powerfully, more viscerally, to culture than to policies, then let’s talk culture. In both red states and blue states people believe in the culture of forming “a more perfect union,” but only one party includes everyone in that union.  The Democratic culture is built on supporting the average American, on making real a “government of the people, by the people, for the people,” so don’t hide that culture – embrace it, spread it, and follow it to victory. Because what’s great here is that Democratic culture can speak to the heartland just as forcefully as the Republican culture can, and the Democrats can back their culture up with policies that reflect and actualize their culture of equality and opportunity.

Many thanks to Septa for her thoughts and edits.

Although Blinder has worked in Democratic administrations, he is a big deal economist. His textbook Economics: Principles and Policy, written with William Baumol, is a classic, which I used as an economics major in college.